Enjoy ophthalmology knowledge
This is the story of Josi. She is a female Pomeranian dog. She has a long history of epiphora, blepharospasm and ocular discomfort.
She has gone several treatments before including surgery of the eyelids with mixed success.
Josi is a well monitored patient with all his dewormings and vaccinations on time.
Josi was presented for second opinion for ocular exam and consultation.
With the direct ophtalmoscope I saw some hair in the right eye. Near the limbus there was a dermoid mass with very small size and 3 hairs growing on the cornea.
Then I did Jones test of the both eyes with some fluorescin stain and it was negative for more than 60 seconds. The STT time of the left eye was normal 20 mm / min.
Both eyes were negative for ulcers.
Meanwhile I did nasolacrimal flush of the ducts in the both eyes.
So the second dermoid was resected and removed with scalpel blade.
Than I did nasolacrimal flush with IV catheter.
So Josi was sent for home management with some local Tobramycin drops and some hyaluronic gel for the cornea to heal fast.
Recheck will be done after 5 days.
Indolent corneal ulcer
Faculty of Veterinary Medicine Bucharest
The fluorescein test is very important in diagnosis of corneal diseases. Is our best friend that accurately describes the size and the depth of the corneal lesions. If the fluorescein test is positive exclude primarily a foreign body (from the conjunctival fornix or from the internal surface of the third eyelid) and then examine using the loupe, the edges of corneal lesion. If is an area of loose of the epithelium at the periphery of the lesion, looking like an “opened book (Figure 1, Figure 2 and Figure 5) your patient has indolent corneal ulcer.
The first step in the treatment of indolent corneal ulcer is the debridement of the denude epithelium using a cotton-tipped applicators (Figure 2), scalpel blade or Alger Brush® (Figure 3). Local anesthesia of the cornea using Benoxi® will allow you to perform debridement.
Using cotton-tipped applicators, the loose epithelium is removed using gentle lateral and circular movements. Debridement using a surgical blade is easily performed doing lateral movements, holding the blade’s sharpen edge perpendicular on the corneal surface.
The burr of the Alger Brush® device is faced towards the edges of the corneal ulcer and debridement is performed in a circular movement, following the limit between the ulcer and the healthy cornea. The small burr of the device quickly removes the epithelium so that the surgeon’s hand is laid on the periorbital area for support, to avoid accidents. Throughout debridement the corneal surface is flushed continuously using saline.
After performing the debridement of the indolent ulcer, the lesion is significantly bigger than the initial one (Figure 6), and in some cases, the anterior epithelium is completely removed.
The fluorescein test is used to reveal the size of the lesion after debridement in order to choose a therapeutic approach:
- medical treatment – corneal healer eye drops and gels
- therapeutic contact lens and eye drops (Figure 7)
- VetShield® colagen contact lens and tarsorrhaphy
- only tarsorrhaphy
Indolent corneal ulcer after debridement can be healed ad integrum (Figure 8) in 5-10 days or, in some cases, we need to perform many debridements. That’s why rechecks should be performed each 5 days after debridement and fluorescein test and reexamination with the loupe is mandatory.
Surgical removal of the luxated lens including the capsule (intracapsular lens extraction) in a bear
Veterinary Clinic NOVA
Violeta is a 37y.old brown bear form Belitsa Dancing bears park, Bulgaria.
She was suddenly blinded and had an urgent eye check.The ophthalmological examination revealed increased pressure (40mmHg) and displaced lens in the left eye.The cornea was mildly opaque and the lens was with senile cataract. No PLR. The retina was also degenerated resulting in marked tapetal hyper reflexivity.
Lens subluxation (posterior) is partial detachment of the lens form the ciliary body, due to breakdown or weakness of the zonules.
We preformed surgical removal of the luxated lens including the capsule (intracapsular lens extraction).
Hydrodissection was employed for the removal of lens. We left the eye without artificial lens (aphakic).
During the removal of the lens, prolapsed vitreous was determined and we removed it with scissors in the anterior chamber.
Following the irrigation of the anterior chamber, corneal incisions were closed by separate sutures using 8/0 polyglactine.
7 days after surgery, the eye is calm; there is no secretion or swelling.
Now the bear is in preparation for hibernation and her eye will be examined in the spring.