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Proptosis Reduction

Caryn E. Plummer, DVM, DACVO, University of Florida

Ophthalmology|September 2013|Peer Reviewed

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Proptosis Reduction

Figure 1 (above). Proptosis in an Australian shepherd puppy.

Proptosis of the globe (Figure 1) is a true ocular emergency. The eyelids become trapped behind the equator of the globe, usually from trauma. The eyelid margins are seldom visible, and the patient is unable to blink and protect the cornea. Treatment delay and resultant elongated globe exposure can increase the likelihood of corneal ulceration, retrobulbar edema, and hemorrhage, raising the risk for blindness from globe perforation or optic nerve damage.

Related Article: The Concept of Corneal Protection

The force necessary to proptose a globe varies with orbital anatomy. Proptosis occurs more easily in brachycephalic breeds (both canine and feline) than in mesocephalic or dolichocephalic breeds, improving the odds for sight and globe retention in the former. The prognosis for vision is generally guarded to poor, but prompt treatment may save the globe. Enucleation may be best if the globe is ruptured or ≥2 extraocular muscles or the optic nerve is avulsed. If the status of the eye and muscles cannot be determined, proptosis should be reduced and a temporary tarsorrhaphy placed. The globe can be removed later if necessary, but it cannot be replaced.

Following surgery, the eye should be monitored for signs of keratoconjunctivitis sicca, a common sequela that requires frequent, diligent, and long-term medical therapy even if the globe has been rendered nonvisual. If owners are unwilling or unable to provide long-term care following resolution of proptosis, enucleation at initial presentation may be warranted.

Related Article: Exophthalmos in a Dog

What You Will Need:

  • Small scissors (Stevens tenotomy, strabismus, Mayo, or Metzenbaum)
  • Needle drivers
  • Small forceps (Bishop-Harmon, toothed)
  • Nonabsorbable suture (4-0, nylon or silk; 3-0 to 4-0 for dogs with thick eyelid margins [eg, English bulldogs])
  • Stents (pieces of wide rubber band material or IV tubing or buttons)
  • Topical ophthalmic antibiotic or lubricating ointment

Related Article: Corneal Cytology & Culture Collection

CARYN E. PLUMMER, DVM, DACVO, is on the faculty at University of Florida, where she completed her DVM and a residency in comparative ophthalmology. She completed her internship at Michigan State University. Her research interests include corneal disease and glaucoma. Dr. Plummer coordinates ophthalmic surgery laboratories at the NAVC Conference and has participated in the NAVC equine ophthalmology in-depth seminar and laboratories.

References

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