Saturday, May 28, 2016

50. A 16-year-old Shih Tzu had a badly infected swollen left eye. Enucleation or exenteration?

May 29, 2016

Yesterday, the young lady brought her 16-year-old Shih Tzu for a review of the left eye operated by me as she said that the stitches were still there.

"These are absorbable stitches," I had told her that they will dissolve in around 30 days from the date of stitching and it was now 27 days on this sunny blue-sky May 28, 2016 morning. She would be free on Saturday and spared the time to take the dog in for me to review. The knots were still there but when I touched them, they fell off with the granulation tissues. The eyelid wound had healed very well.

This 16-year-old Shih Tzu had a left swollen badly infected eyeball and the owner took the dog to Vet 1 who advised enucleation as the only option.  Enucleation was my 2nd opinion. However, the dog was very old and the owner had to give informed consent. The surgery would need to be short so that anaesthetic death risk would be lower.

An old vet has the benefit of years of experience to operate speedily without compromising on accuracy and completeness of surgery.  All vets will reach this stage when they age. As this dog was so old, I decided to operate myself as speed is of the essence.

Now, this oldie may also have eye cancer but it would be very expensive to do all the necessary tests. He may not have eye cancer for the swollen left eye. The swollen eyeball could be due to the high intra-ocular pressure of glaucoma and infections inside the eyeball.

A judgment call is needed. To enucleate, that is to remove just the eyeball. To exenterate, that is to remove the eyeball and eye socket contents which is a more involved and bloody operation. Most vets would just do enucleation and be done with it.

What is this old companion had eye cancer cells inside the eye socket? Enucleation will not remove the cancer. So, I decided on exenteration which is deemed harder to do. I used electro-surgery. I ligated the optic stalk.  I electro-excised the eye socket contents. Surprisingly, there was not a drop of blood after taking out all the eye socket content electrically. I got the 3rd eyelid out too. Then I excised a 3 mm wide strip from the upper and lower eyelid margins, creating two incised wounds which are then stitched up. At the last stitch, I filled the eye socket with eye ointment.

Post op nursing by the owners were excellent as we kept in touch by WhatsApp images. There was some bleeding at home. There were lots of care by the owners, cleaning and feeding the dog patiently - the mother and daughter.

Now, 27 days later, the dog's left eye wound has healed very well and so there is a happy ending as post-op death and infections could have occurred, leading to unhappiness. I am grateful for the happy ending as I prefer not to operate on high risk cases.


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