In emergency practice you may see traumatic proptosis, seen on the schedule as “dogs eye popped out, on the way immediately”.
Experiencing this diagnosis for the first time can be quite shocking, and even nerve wracking. How do I fix this? What do I do? Will the eye be okay?
Proptosis is caused by a traumatic event, often blunt force trauma, and is especially likely in brachycephalic breeds (the ones with the short faces and buggy eyes).
The eyelids become trapped behind the globe (eyeball) and prevent the globe from returning to its normal position. Swelling of the surrounding tissues further prevents the ability of the globe to return.
What to discuss with the owners.
Prognosis
~25% of dogs will regain vision, this number is much less in cats.
If PLR is intact, prognosis for return to vision is improved.
The globe may remain comfortable with or without vision though the following factors worsen prognosis: skull fracture, tearing of multiple extraocular muscles, and globe rupture.
Clinical Pearl - without globe rupture or obvious severe trauma, the only way to know if comfort or vision will be maintained is time. Advise clients that despite treatment, the eye may need to be removed later.
Brachycephalic
Being brachycephalic may improve the prognosis for the eye as less force is needed to displace the eye, as opposed to severe force that is likely to cause additional damage in a non-bracycephalic breed.
However, this animal is more prone to recurrence of proptosis, including the other eye, due to conformation.
Discuss possible referral options to help prevent recurrence - medial canthotomy can be performed to tighten the eyelids around the healthy eye.
Treatment
There are two treatment options, depending upon severity of presentation.
Tarsorrhaphy
If the globe appears to possibly be salvageable, this option may save the eye, and in a small percentage also save the vision.
When stable, the patient is anesthetized for the procedure.
Copious amounts of lubricant is applied and the globe is returned to position. Once in position, multiple horizontal mattress sutures with stenting material (sterile IV tubing, buttons) are placed. Sometimes a lateral canthotomy is performed to further open the eyelids and assist closure.
Multiple medications are to be sent home including oral antibiotics, pain medication, topical antibiotics and topical atropine.
Sutures remain for 2-3 weeks (with an e-collar) - at which time, they are removed and the fate of the globe is determined.
Possible complications include corneal ulceration, retinal degeneration, cataract formation, strabismus, keratoconjunctivitis sica, etc.
If the eye has any significant complications at suture removal, enucleation may be pursued.
Enucleation
If there are negative prognostic indicators as discussed above, enucleation may be elected at the time of presentation.
Otherwise, enucleation may be elected after tarsorrhaphy with unideal final results. For example, a globe with severe strabismus and cataract formation preventing vision.
Summary
This is an EMERGENCY and requires prompt attention with clear communication with the owner. They should be informed of prognosis and complicating factors to help guide their decision for tarsorrhaphy vs enucleation.
When electing tarsorrhaphy the owner must be adequately informed of possible complications, the low chance of return to vision, and the possibility of requiring enucleation after 2-3 weeks.
Hello friends, so my cat is currently having an operation to remove his eye, which is always gonna be rather costly. Luckily we’re not in a place where it’s unaffordable HOWEVER
I’m going to be opening cheap commissions to help foot the bill. Anything goes!
If you’ve ever wanted a pic from me, now is your chance!
Haven’t posted here for a while, to be honest i’m more active on Twitter than anywhere. I’ve spent most of my time recenltly making a game on Dreams (which is amazing by the way) called Proptosis Pete. It’s a nonsensical platform shooter where your main weapon is a constant stream of eyeballs.
I’ve had a lot of fun making it and am pretty proud of it! So far, there’s a hub world, one normal platformy level and one boss battle. I hope to add more levels eventually... got some ideas. So yeah, if you have Dreams and want to give it a try here’s the indreams link!
“Still a work in progress, but here's Proptosis Pete @mediamolecule #MadeInDreams #PS4share #DreamsPS4 https://t.co/hNw8dVFsw9”
So i’ve been addicted to Dreams since early access came out. It’s INCREDIBLE... like I have no idea how such a thing is even possible. Witchcraft?
Anyway, i’ve been working on a game for the past week or so called Proptosis Pete about a creature that shoots his eyeballs out of his face. Here’s what I have so far!
I looked like this. Miss the time. I had exophthalmos due to hyperthyroidism. I’ll find out some day how to cure this naturally. Don’t care how I look for now. Maybe one day, I will. #exophthalmos #proptosis #graveseyedisease https://www.instagram.com/p/CLEbtyaBo9W/?igshid=16u63f9q70uj3
Also known as proptosis, exophthalmos is the medical term to indicate protruding eyeballs or bulging eyes. Bulging eyes can be bilateral or...
One or both eyeballs protrude from the orbit due to space being occupied by either swelling of the extraocular muscles, fat, or tissues behind the eye. Bulging eyes can have impacts on eyes ranging from dryness to vision loss.
