Clinical Exposures: Palpebral reconstruction after entropion surgery in a dog
Mar 01, 2010
A 9-year-old 46.2-lb (21-kg) spayed female mixed-breed dog was presented to the ophthalmology service at Colorado State University (CSU) for evaluation of incisional infection and delayed healing after bilateral entropion surgery.
The dog received a dental prophylaxis at its regular veterinarian's clinic nine days before presentation. While the dog was anesthetized, the veterinarian also performed bilateral blepharoplasties on the upper and lower eyelids. The dog recovered uneventfully, but a day after the surgery, it exhibited epiphora and blepharospasm and frequently vocalized.The dog had been taken to an emergency clinic, and the emergency veterinarian prescribed a five-day course of tramadol for pain. The dog failed to improve and was re-presented to its regular veterinarian two days later. The veterinarian told the owner that the dog was progressing normally; however, the owner disagreed because the dog still had severe blepharospasm and had developed a greenish-yellow ocular discharge.
The owner had then taken the dog to a veterinary ophthalmologist for a second opinion. The ophthalmologist diagnosed septic blepharitis and removed the sutures to allow for better infection resolution and for second intention healing. In addition, the dog had received cephalexin (500 mg every eight hours) and triple antibiotic ophthalmic ointment (every eight hours in both eyes). The dog did not improve rapidly, so three days later it was presented to CSU.
PHYSICAL AND OPHTHALMIC EXAMINATION FINDINGS
A complete physical examination revealed that the abnormalities were confined to the dog's eyelids and eyes. Partially healed incisions extended the entire length of the upper and lower eyelids bilaterally.
The problem list included delayed healing of the eyelid incision sites due to infection and premature suture removal, excessive granulation tissue formation at the palpebral margins, misdirected cilia (iatrogenic distichiasis), conjunctivitis, and infectious blepharitis. The mechanical nature of these problems precluded resolution by medical therapy, so surgical intervention was necessary to remove the scar tissue and abnormal cilia and to reconstruct the eyelid margins to be as functionally normal and cosmetically acceptable as possible.