"The solution is to stitch up the eyelids so that the ulcer can heal without the dog rubbing the eye as an ulcer is very painful. An exposed ulcer is irritated by the dust, breeze and light and will not heal well if the dog keeps rubbing his eye with his paw or against the wall or bed."

The surgery requires anaesthesia and there is always an anaesthetic risk of death on the operating table. Do you accept the risk and approve the surgery?

"How much is the cost?" the wife asked.

"Around $400 for the anaesthesia, surgery and hospitalisation."

"$400 just to stitch up the eyelids?" the wife asked.
"The cost involves more than just stitching up. There is the anaesthesia cost, the time needed to perform the surgery, the hospitalisation for at least 3 days and the nursing costs."
 

SOLUTION -
Tarsorrhaphy-Nictitans Membrane Flap

HOW THE EYE SURGERY IS PERFORMED
Elaborating on the surgery with script below.

EYE INJURIES ARE EMERGENCIES CONSULT YOUR VET WITHIN 24 HOURS OF INJURY TO SAVE YOUR DOG'S EYE-SIGHT

TIPS & ADVICES
1. Eye drops & e-collar as the treatment will not give good healing as the dog wants to rub his itchy and painful eye all the time. The Descemetocoele will rupture, leaking out liquid from inside the eye. Bleeding and infection will occur as in one case (image, left).



 

2.  Early treatment before the cornea ruptures gives good healing results but many owners are reluctant to pay for the anaesthestic and medical costs. So many vets prescribe eye drops and e-collars. This was what I did for the case study before the eye surgery option is accepted by the owners.



3.  If the owner insists on bringing the dog home instead of hospitalisation, the surgical outcome is usually poor (inflamed sclera and cornea) as the owner is unable to apply eye drops and clean the eye. Some dogs bite or shift their head during nursing or rub their eye and e-collar against the wall and bed when they are at home.




4. Some vets are against the 3rd eyelid flap, saying that the 3rd eyelid flap obstructs the application of eye ointment or drops as it covers the eyeball. I make sure that the eyeball and the inside of the 3rd eyelid are well irrigated and clear of debris before stitching.




5. Tarsorrhaphy (stitching of the upper and lower eyelids) may be another procedure without the 3rd eyelid flap.





6. A very high standard of veterinary nursing is required. Good outcomes are usually due to excellent and experienced nursing. The vet must examine the eye twice a day and not just leave the case to the nurses who may not be experienced in nursing such cases. Sedation is required to clean the eye area on Day 3.


7. Stitches loosen from Day 6-10 and are removed. Stitches can't stay for long due to the eyeball movements and tension.

8. Horizontal mattress sutures are advised. Practise placing horizontal mattress sutures to close the skin during the sterilisation of the dog and cats and the vet will have the necessary experience to perform tarsorrhaphy well. However, most vets will not use horizontal mattress sutures for skin sutures in sterilisation.

As in all professions, practice makes perfect. If a vet does hundreds of horizontal mattress sutures during sterilisations, he or she will have honed his skills which prepare him or her for tarsorrhaphy. Tarsorrhaphy is not a common surgery for most practices in Singapore and much success depends on good placing of the horizontal mattress sutures.     
    

P.S.       BE KIND TO PETS  
                        EYE INJURIES ARE EMERGENCIES
                     SEEK EARLY VETERINARY CARE
(show a before and after tarsorrhaphy treatment case in a Pekinese)

BEFORE SURGERY EXTENSIVE CORNEAL ULCER	AFTER EARLY SURGERY ULCER HAS HEALED CLEAR CORNEA WITH FAINT WHITE SCAR
EARLY EYE SURGERY (TARSORRHAPHY) HEALS THE DEEP CORNEAL ULCER PREVENTING RUPTURE & LOSS OF VISION IN THIS PEKINESE