1. Examine the dog's eyes in detail including
ophthalmoscopy.
2. Fluorescein eye stain test on both eyes is mandatory
for all eye cornea injuries. Record extent and depth of
the ulcer and surrounding areas and take digital images
(side view and front view) of both eyes showing the
results of the fluorescein eye test.
3. If the eye ulcer is not infected, is recent (less
than 2 days), >3mm in diameter and is a deep
ulcer, advise tarsorrhaphy or 3rd eyelid flap.
4. If there is infection, wait for 3 days before
attempting tarsorrhaphy.
5. AMA - Against Medical Advice. Write in the case file
your advice for tarsorrhaphy if the owner does not
accept your advice and just want some eye drops and the
e-collar.
6. Superficial and small ulcers <3mm can be treated with
eye drops and e-collar.
7. Conjunctival flap may be necessary if the ulcers are
large.
8. A 3rd eyelid flap and tarsorrhapy may be useful in
cases of extensive and deep ulcers but there is the
problem of not being able to apply the eye drops.
Tarsorrhaphy.
1. Clip hair off face esp. around the eyelids and facial
area.
2. Clip off all hairs from the eye lids.
3. Sedation and general anaesthesia.
4. Forceps to lift up 3rd eyelid. Use a 10 ml syringe to
flush debris and dirt from inside the 3rd eyelid.
5. Thoroughly irrigate the eye with clean water a few
times.
6. Subconjunctival injection of antibiotics and minimal
anti-inflammatory at two spots on lower and upper
eyelid.
7. Apply antibiotic eye ointment liberally before sewing
the eyelids
8. Sew up the eyelids with 3/0 absorbable sutures or 3/0
nylon. Two horizontal mattress sutures to evert the
eyelids.
9. Leave a 3-mm gap at the medial canthus for
eye-drops.
10. Three eye drops 3 times/day and clean off discharge
for the next 14 days.
11. Stitch removal 14 days later.
Post-op
1. Ward the dog for at least 3 days. I prefer 10-14 days
as most Singapore dog owners are unable to crate the dog
and provide proper eye care.
2. Prescribe 2 bottles of eye drops (not one bottle) if
the dog goes home on Day 3.
3. Prescribe pain killers for 4 days.
4. Follow-up 3 days post-op. Record in your case file
your follow-up with the owner 3 days after the op to
check if the eye-care has been done properly. If the
owner complains of eye discharge and dry exudate, advise
the owner to bring the down back as the owner is not
able to provide good nursing care. Record this advice
given in your case file and also not being able to
contact the owner by phone. You can send an text message
instead.
Repeat tarsorrhapy
Wait for 3 days before attempting repeat tarsorrhaphy as
the eye is usually severely inflamed and infected due to
poor eye care and nursing by the owner. Ward the dog for
the next 10 days.
Poor post-op nursing care at home.
One case is at:
tarsorrhaphy - Against Medical Advice.
Tarsorrhaphy - Against
Medical Advice. The
owner is unable to provide
proper post-op nursing care
at home and the right eye
ulcer did not heal
uneventfully as the left eye
ulcer.
9. As at July 6, 2012, Singapore does not have resident
approved veterinary eye specialists. It may be wise to
refer the case to other vets if you don't wish to
perform tarsorrhaphy, 3rd eyelid flap or conjunctival
flap and deal with its post-op complications.
TOA
PAYOH VETS
