COMMON EYELID PROBLEMS - PART 2 Oversized eyelid openings/exposure keratitis Pugs, Pekingese and Shih Tzu breeds commonly present with oversized eye

COMMON EYELID PROBLEMS - PART 2

Oversized eyelid openings/exposure keratitis
Pugs, Pekingese and Shih Tzu breeds commonly present with oversized eyelid openings and keratitis. Pugs as young as 6 months can have marked pigmentary scarring. Eyelid corner closure is required to reduce exposure and control corneal scarring to maintain vision. Depending on scleral show, medial canthal closure or a combination of medial and lateral eyelid closure (four-corner closure) is performed. The eyelids are closed down so that just the cornea is exposed and no sclera. Medial canthal closure involves specialised surgery to avoid damage to the nasolacrimal duct.

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Oversized eyelid openings

 
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Oversized eyelid openings post op

In milder cases, amount of pigment is measured with calipers and medical therapy is used. This involves the use of cortisone drops e.g. Maxidex® to control vascular component and Cyclosporin e.g. Optimmune® or Cyclosporin drops to control the pigment component of the keratitis. If pigment worsens, corner closure is performed. In severe cases medical therapy is used following surgery to reduce corneal scarring, with treatment courses usually extending 2-6 months duration. In some cases treatment is lifelong e.g. alternate day cortisone and Cyclosporin.

Dry eye is common in the Shih Tzu and eyelid corner closure can be useful to stabilise the tears.

Nasal Folds
Pekingese occasionally have nasal folds that result in trichiasis where the eyelid hairs are directed onto the cornea resulting in scarring. This can be corrected with quite simple surgery whereby the nasal fold is resected and closed with 5/0 Maxon® sutures. We will occasionally perform this surgery at the same time as four corner closure.

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Nasal folds

 
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Nasal folds - Post Op

Blepharitis
Blepharitis is most commonly due to allergy or immune mediated disease. Presenting signs include hyperaemia, alopecia, swelling, ulceration of the eyelid skin and often profuse mucopurulent discharge. Occasionally seen in puppies, it is best treated with Clavulox® and low doses of oral prednisolone, and Fusidic Acid (Conoptal®) topically. In adult dogs, we have very good success with oral Doxycycline @ 2mg/kg BID, oral prednisolone at anti-inflammatory doses and topical Panolog® TID after bathing. If the response is poor, our next line of treatment includes Cephalexin antibiotics.

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Various cases of blepharitis >>>>>

 
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