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Created page with "'''Exophthalmos''' occurs when the equator of the '''globe''' advances beyond the margin of the '''palpebral fissure'''. It is also known as '''ocular proptosis'''. ==Causes=..."
'''Exophthalmos''' occurs when the equator of the '''globe''' advances beyond the margin of the '''palpebral fissure'''. It is also known as '''ocular proptosis'''.
==Causes==
'''Blunt trauma''' (eg road traffic accidents, dog fights) are the most common cause of exophthalmos.
==Traumatic Exopthalmos==
===Treatment===
====Initial Management====
*The globe should be kept '''moist''' - owners should be advised to keep the eye lubricated whilst transporting to the veterinary clinic
*The patient must be assessed for other injuries from the trauma that caused the exophthalmos. This is especially important in '''dolichocephalic''' breeds where considerable force is required to protrude the globe.
====Decision Making====
*40-50% of dogs regain vision with surgical treatment.
*'''Negative''' prognostic indicators include:
**Rupture of three or more extraocular muscles.
**Lack of consensual pupillary light reflex to the contralateral eye.
**Corneal laceration extending past the limbus.
**Extensive hyphaema.
====Surgical Treatment====
The globe should be replaced under a [[http://en.wikivet.net/Anaesthesia|general anaesthetic]], followed by a '''temporary tarsorrhaphy''' to allow the tissues to heal:
*Clean the eye and periocular tissues with dilute povidone-iodine solution and sterile saline.
*Replace the globe. '''Lateral canthotomy''' is often required to allow this.
*Use three or four horizontal mattress sutures for the temporary tarsorrhaphy.
**Use 1 or 1.5 metric suture material, some authors advocate using silk.
**Use stents in the sutures to prevent eyelid necrosis.
**Care must be taken with the placement of the sutures to avoid '''corneal ulceration''' or '''entropian'''.
**Leave a small area open at the '''medial canthus''' to allow topical medication adminstration
*Close the canthotomy incision in two layers.
*Sutures should be removed after 10-14 days
If the globe is not salvageable, '''enucleation''' should be performed.
====Medication====
Broad spectrum '''antibiotics''' and systemic anti-inflammatory '''corticosteroids''' should be given at the time of surgery. Antibiotics and a tapering dose of steroids should be continued for 7-10 days after surgery.
Topical antibiotics and '''atropine''' should be used whilst the sutures are in place.
==References==
<references/>
#Giuliano, Elizabeth (2011) "Opthalmic Emergencies" ''Proceedings of the 2011 British Small Animal Veterinary Association Congress''
#[http://www.merckmanuals.com/vet/emergency_medicine_and_critical_care/ophthalmic_emergencies/traumatic_proptosis.html|Traumatic Proptosis], The Merck Veterinary Manual 2013
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[[Category:Neurological Diseases - Dog]]
==Causes==
'''Blunt trauma''' (eg road traffic accidents, dog fights) are the most common cause of exophthalmos.
==Traumatic Exopthalmos==
===Treatment===
====Initial Management====
*The globe should be kept '''moist''' - owners should be advised to keep the eye lubricated whilst transporting to the veterinary clinic
*The patient must be assessed for other injuries from the trauma that caused the exophthalmos. This is especially important in '''dolichocephalic''' breeds where considerable force is required to protrude the globe.
====Decision Making====
*40-50% of dogs regain vision with surgical treatment.
*'''Negative''' prognostic indicators include:
**Rupture of three or more extraocular muscles.
**Lack of consensual pupillary light reflex to the contralateral eye.
**Corneal laceration extending past the limbus.
**Extensive hyphaema.
====Surgical Treatment====
The globe should be replaced under a [[http://en.wikivet.net/Anaesthesia|general anaesthetic]], followed by a '''temporary tarsorrhaphy''' to allow the tissues to heal:
*Clean the eye and periocular tissues with dilute povidone-iodine solution and sterile saline.
*Replace the globe. '''Lateral canthotomy''' is often required to allow this.
*Use three or four horizontal mattress sutures for the temporary tarsorrhaphy.
**Use 1 or 1.5 metric suture material, some authors advocate using silk.
**Use stents in the sutures to prevent eyelid necrosis.
**Care must be taken with the placement of the sutures to avoid '''corneal ulceration''' or '''entropian'''.
**Leave a small area open at the '''medial canthus''' to allow topical medication adminstration
*Close the canthotomy incision in two layers.
*Sutures should be removed after 10-14 days
If the globe is not salvageable, '''enucleation''' should be performed.
====Medication====
Broad spectrum '''antibiotics''' and systemic anti-inflammatory '''corticosteroids''' should be given at the time of surgery. Antibiotics and a tapering dose of steroids should be continued for 7-10 days after surgery.
Topical antibiotics and '''atropine''' should be used whilst the sutures are in place.
==References==
<references/>
#Giuliano, Elizabeth (2011) "Opthalmic Emergencies" ''Proceedings of the 2011 British Small Animal Veterinary Association Congress''
#[http://www.merckmanuals.com/vet/emergency_medicine_and_critical_care/ophthalmic_emergencies/traumatic_proptosis.html|Traumatic Proptosis], The Merck Veterinary Manual 2013
{{unfinished}}
[[Category:Neurological Diseases - Dog]]