Page 5 - Clinical Connections - Autumn 2022

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Page 5 - Clinical Connections - Autumn 2022
P. 5

Ophthalmology
         DEAF DOG HAS GRASS SEED BEHIND EYE

         REMOVED



               year-old  cocker  spaniel  presented   easily, the team was less concerned about a   CT identified a large swelling on the left side
               to  the  Emergency  and  Critical  Care   retrobulbar abscess at that point.  of  the  face,  extending  to  the  left  masseter,
         A service in July for acute onset redness   From  the  description  of  his  examination   consistent with an abscess. Although no clear
         and swelling of the left eye, which had started   findings  both  by  our  Emergency  Referrals   foreign  body  was  identified,  that  could  not
         two  days  before.  Marvin  had  been  running   service  and  the  referring  vet,  it  appeared   rule out a small unobserved object from being
         through tall grass and his local vet removed   that Marvin was responding to the antibiotic   present.
         several grass seeds from his mouth.   and  anti-inflammatory  injections  that  he
           Marvin  has  been  deaf  since  birth  and  is   received  prior  to  referral.  Therefore,  rather
         missing a toe pad but was always lively and   than proceed with 3D imaging of the head to
         playful with another dog in the household until   look for foreign material at that point, he was
         his eye deteriorated.                treated  symptomatically  with  antibiotics  and
           Clinical  signs  were  relatively  mild  on  his   anti-inflammatories.
         first  admission,  when  he  was  also  seen  by
         the  Ophthalmology  Service,  so  we  were   Deterioration and second admission
         not  able  to  justify  further  investigation  and   In  August  his  owner  noticed  reddening  in   Marvin, the day before the seed was removed
         symptomatic treatment was given. However,   Marvin's  eye,  along  with  protrusion  of  the
         clinical signs returned with a vengeance two   third eyelid. She administered some Celluvisc   Ocular   ultrasound   can   complement
         weeks after stopping medication and he was   but  over  the  next  few  days  the  protrusion   abnormalities  seen  on  CT  imaging.  The
         readmitted in August.                increased  and  the  eye  closed.  His  local   radiologists  identified  a  dorsal  lateral
           During  his  first  admission,  Marvin  was   vet  observed  that  the  left  side  of  Marvin's   subcutaneous  abscess  with  grass  seed,
         found  to  have  some  exophthalmos  ocular   head  was  swollen.  He  was  given  oral  anti-  which was removed with ultrasound guidance
         discharge. He was sedated to have his eye   inflammatories, and, during the night, Marvin   under  general  anaesthesia.The  area  was
         thoroughly checked for any foreign material.   developed mucopurulent ocular discharge. No   explored  and  lavaged  and  left  as  an  'open
         A small puncture wound on the soft palate at   obvious discomfort in the mouth or discharge   wound' to heal by second intention.
         the  back  of  the  mouth  (left  pterygopalatine   from the mouth was noticed but Marvin had
         fossa region) was found, which was draining   become withdrawn and had stopped playing
         bloody material.                     with the other family dog.
           When examined the next morning by the   Upon  return  to  the  QMHA,  the  left  eye
         Ophthalmology Service there was no longer   was  moderately  blepharospastic  with  a
         any protrusion of the eyeball. Marvin appeared   markedly  increased  blink  rate.  There  was
         comfortable and was holding the eye open,   mild mucopurulent discharge and the globe
         with only mild swelling of the conjunctiva. He   appeared  medially  displaced.  There  was
         could open his mouth fully, with no evidence   ventral  periocular  swelling,  which  was  hot
         of discomfort, so he was discharged from the   on palpation and painful. The palpebral and
         hospital.                            bulbar conjunctiva was markedly hyperaemic
                                              and congested with severe chemosis of the
                                              lateral  palpebral  conjunctiva.  There  were
                                              mild signs of uveitis. Given the deterioration
                                              in  clinical  signs,  further  investigation  was
                                              recommended.
                                                                                   Marvin in his shades after returning home

                                                                                    The  following  morning,  Marvin  showed  a
                                                                                   marked improvement in comfort and swelling
                                                                                   so  was  discharged  with  a  course  of  anti-
                                                                                   inflammatories  and  antibiotics.  Marvin  is
                                                                                   back to his normal self and has completely
          The offending grass seed                                                 recovered.  His  owners  are  now  trying  to
                                                                                   encourage him to wear goggles when out on
           Foreign  material  may  penetrate  the  soft                            walks to prevent a recurrence.
         part of the mouth but not become embedded
         or enter the tissue and remain there, where
         they then cause an abscess.
           Grass  seeds  can  move  in  one  direction                                    For small animal referrals, please call:
         but not the reverse, due to the presence of                                     01707 666399
         barbs. As Marvin's signs were subtle and he                                      Email:
                                                                                         qmhreception@rvc.ac.uk
         was comfortable and able to open his mouth   Post-contrast CT image
                                                                                                        Autumn 2022   5
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