Reconstruction of the lower eyelid by third eyelid lateral advancement and local transposition cutaneous flap after "en bloc" resection of squamous cell carcinoma in 5 cats

OBJECTIVE: To describe a novel technique for blepharoplasty to cover a tissue defect involving >/=50% of the lower eyelid. STUDY DESIGN: Prospective clinical study. ANIMALS: Five cats with lower eyelid squamous cell carcinoma (SCC). METHODS: En bloc resection of SCC by removing >/=50% of the lower lid with either the medial or lateral canthus was performed without other adjunctive treatment for SCC. The lid defect was reconstructed with a transposition skin flap derived from the frontal (medial defect) or temporal (lateral defect) region. The third eyelid was advanced laterally without dissection from its insertion; its outer conjunctival layer was removed, and the skin flap was sutured with single interrupted sutures dorsally over the nictitating membrane, ventrally to the cutaneous edge of the surgical wound and medially or laterally (depending on the canthus removed) to the skin of the remaining lower lid. RESULTS: Satisfactory cosmetic and functional results were achieved and the Schirmer tear tests were normal. In 2 cats, the skin flap needed monthly hair trimming to avoid corneal lesions. CONCLUSIONS: After en bloc resection of SCC involving >/=50% of the lower eyelid, reconstruction can be achieved by relocation of the third eyelid and use of a cutaneous transposition flap sutured to the scarified external surface of the third eyelid. Eyelid apposition and lacrimal function were preserved. CLINICAL RELEVANCE: Blepharoplasty using a cutaneous transposition flap sutured to the scarified surface of a relocated third eyelid should be considered for reconstruction of lower eyelid defects with >/=50% tissue loss of the lid margin.     

Investigations on the conjunctival goblet cells and on the characteristics of glands associated with the eye in the guinea pig

Objective To investigate the distribution and density of conjunctival goblet cells (GC) and to study the anatomy and microscopic characteristics of glands associated with the eye in the guinea pig. Procedures Twenty‐five guinea pigs were used. Meibomian gland openings were counted using biomicroscopy. Conjunctiva, eyelids and glands were embedded in glycol methacrylate and paraffin. Sections were stained with hematoxylin and eosin (H&E), periodic acid Schiff’s reaction (PAS) and Alcian blue (AB). Results Highest GC densities were found in the bulbar and palpebral region of the nasal conjunctiva (GC index: 13.7–16.4%). Lowest GC densities (GC index: 0.0–1.0%) were found in 3/4 limbal regions (nasal and temporal upper eyelid, temporal lower eyelid). Guinea pigs have 27.1 ± 3.0 (mean ± SD) meibomian gland openings in the upper lid and 25.7 ± 2.3 in the lower lid. Difference between upper and lower lid was significant (P = 0.037). Two subconjunctival sebaceous glands occur temporal to each eye. The Harderian gland is very large. In the lacrimal gland three different cell types were distinguished both according to the cell structure and histochemical staining. Conclusions Goblet cell densities are lower in guinea pigs than in dogs and horses. Positive staining with PAS and AB could be an indication that mucins are produced in the lacrimal gland. If so, they may contribute to the mucin layer of the tear film. Both the extraordinarily large Harderian gland and the subconjunctival sebaceous glands produce lipids and may contribute to the lipid layer of the tear film.     

Entropion correction in dogs and cats using a combination Hotz-Celsus and lateral eyelid wedge resection: results in 311 eyes

A novel surgical combination technique for the correction of lateral lower lid entropion in dogs and cats is described, involving a combination of Hotz-Celsus and lateral eyelid wedge resection procedures. The technique was used to treat 311 eyes with lower lid entropion: 269 canine (109 bilateral, 51 unilateral) and 42 feline (16 bilateral, 10 unilateral). The most common canine breeds were the Shar Pei, Rottweiler, Bull Mastiff and Labrador Retriever. Domestic cats made up the majority of feline cases. The overall success rate for a single surgical procedure to correct lower lid entropion with this technique was 94.2% per eye.     

Surgical management and outcome of lower eyelid entropion in 124 cats

Objectives To evaluate the success rate of various surgical techniques for the management of lower eyelid entropion in cats. Design Retrospective study. Animals studied One hundred and twenty‐four cats with surgical correction of lower eyelid entropion of 200 eyes over a 13 year period. Methods Records of 124 cats were reviewed for signalment, type of entropion, surgical procedure performed and post‐operative result. Results Combinations of the Hotz‐Celsus (HC), lateral canthal closure and full thickness wedge resection techniques were used to treat 64 bilateral and 60 unilateral cases of lower lid entropion. Twenty‐three cats were under a year of age, 52 cats were aged between 2 and 8 years and 49 were over 8 years old. The overall success rate for a single surgical procedure (which may consist of multiple techniques) to correct lower eyelid entropion was 96.0% per eye. The remaining 4.0% had the entropion resolved with a second surgery. A combined HC and lateral canthal closure had a 99.21% success rate of resolving lower lid entropion. Geriatric cats were the most likely age group to develop corneal sequestra; 37% of cats in this group presented with entropion and corneal sequestra concurrently. Seventeen percent of cats that presented with unilateral entropion and did not have prophylactic surgery on the fellow eye went on to develop entropion in the fellow eye. Conclusions A combined HC and lateral canthal closure was the most effective surgical technique in managing lower eyelid entropion of cats in our study. Prophylactic lateral canthal closure in the unaffected eye is recommended.     

Use of an axial pattern flap and nictitans to reconstruct medial eyelids and canthus in a dog

A 10-year-old male neutered Boxer presented with recurrence of a mast cell tumor at the right medial canthal area. Following excision including 2 cm margins, the medial one-half of the upper and lower eyelids and the medial canthus were reconstructed using an axial pattern flap based on the cutaneous branch of the superficial temporal artery. The bulbar conjunctiva of the nictitans was preserved and sutured to the medial flap edge, thus creating a conjunctival lining to the deep aspect of the flap, protecting corneal epithelium. This is a valuable surgical technique for closing a large skin defect and reconstructing the medial eyelids, thus preserving the globe.     

Eyelid reconstruction using a split eyelid flap after excision of a palpebral tumour in a Persian cat

This case report documents the use in a cat of a method of palpebral reconstruction previously only described in a series of dogs. A split eyelid flap was used to reconstruct a deficit created by the removal of an apocrine adenoma of the paratrichial sweat gland on the upper lid. This particular technique was chosen over other methods because of its ability to create a smooth hairless eyelid margin. The method previously described in dogs was modified in the present case to address both the fact that the resection was more extensive and the difference in periocular anatomy in the cat.     

Surgical repair of a complete endocardial cushion defect in a dog

Objective: To describe surgical repair of a complete endocardial cushion defect (ECD) in a dog. Study Design: Clinical report. Animal: A 5‐month‐old, 9.2 kg male Shetland sheepdog. Methods: Echocardiographic examination revealed an ostium primum atrial septal defect (ASD), an inlet ventricular septal defect (VSD), mitral regurgitation (MR) and tricuspid regurgitation (TR), and a complete ECD was diagnosed. Surgical correction was performed using cardiopulmonary bypass (CPB) via right atriotomy. A polytetrafluoroethylene (PTFE) patch was secured along the margin of the inlet VSD using simple continuous suture, then the cleft in the septal mitral leaflet was sutured. Similarly, the cleft in the septal tricuspid leaflets was sutured. To complete inlet VSD closure, the VSD patch was secured to these sutured leaflets by simple continuous suture. Another PTFE patch was used to close the ostium primum ASD. Result: After surgery, MR, TR, and interventricular shunting were decreased. The dog was alive 6 years and 5 months after the surgery with no evidence of an interventricular shunt, TR, or other clinical signs. Conclusions: Complete ECD in a dog was corrected using a 2‐patch technique under CPB.     

Prevalence of Ocular Disorders in an Indian Population of Horses

The objective of this clinical study was to report the prevalence of ocular disorders in a large population of horses from the Indian army. Both eyes of 500 horses were examined using a direct ophthalmoscope and by a transillumination procedure. Intraocular pressures were measured in several study horses. Fluorescein dye, Schirmer tear test, and menace testing were performed when indicated. Corneal culture swabs were collected from horses affected with corneal ulcers found on ophthalmoscopic examination. A total of 100 horses were found to be affected with some form of ocular disorder. The eye problems recorded were congenital eye lid disorders (2%) and included a subcutaneous cyst in the lower eye lid and slit in upper eye lid; conjunctivitis (12%); chronic interstitial keratitis (30%); a parasite in the anterior chamber (1%), which was however not removed for genus and species identification; phthisis bulbi (1%); uveitis (24%); glaucoma (13%); cataracts (3%); unilateral retinal hemorrhage (1%); luxation of cataractous lens (3%); posterior synechia (2%); and corneal ulceration (8%). Pseudomonas spp was the most common bacteria identified in horses affected with corneal ulceration. Vision-threatening ocular disorders are high in Indian army horses; this is a cause of major concern for the rider and the horse and, therefore, it is important to include ocular examination in horses as part of a routine and complete physical examination.     

Malignant melanoma of the eyelid in a red squirrel (Sciurus vulgaris orientis)

A 6-year-old male red squirrel (Sciurus vulgaris orientis) developed bilateral tumors of upper and lower eyelids. The tumors in the left lid recurred despite surgical removal. Necropsy revealed metastasis to the lung. The neoplastic cells were epithelioid and highly pleomorphic, and only a few cells contained melanin granules. Occasionally melanoma cells were immunoreactive for S100, neuron-specific enolase and vimentin, and a small number of cells for cytokeratin. Ultrastructurally, the presence of premelanosomes was confirmed in the cytoplasm. Possible presence of cytokeratin-positive neoplastic melanocytes should be taken into account when differentiating a nonpigmented epithelioid melanoma from other tumors such as anaplastic carcinomas.     

Microvascularization of the Third Eyelid in Dogs

The third eyelid protects the eye, contribute to the aqueous portion of the pre‐ocular film and its distribution over the corneal surface, as well as removal of foreign material from the anterior surface of the eye. It is rather vulnerable during fights and clinicians often have to perform surgery for third eyelid neoplasia. In dogs, this lid has a triangular shape, being widest at its free margin. It is vascularized by branches of the malar artery. Being of such importance as an adnexa of the eye, the authors concentrated their attention on its vascularization, which is not well defined. Methods: Scanning Electronic Microscopy of vascular corrosion casts and intact tissue. Observations: It was quite interesting to notice the presence of two patterns of vascularization inside the third eyelid. One can say that there are two segmental levels of vessels. In one of these there is a predominance of arteries and veins, while in the other a meshwork of third order arteries, capillaries and post‐capillary venules are present. In fact, the branch of the malar artery that reaches the base of the third eyelid divides into smaller branches that cross almost the complete length of the lid giving only a few collateral vessels, in a monopodical way, and only near the free margin of the lid is possible to observe dicothomical ramifications that became rather anastomotic (being anastomoses of type I and II are present) and contribute to the microvascular meshwork. This microvascular net is drained by post‐capillary venules and veins that empty as a brush into bigger veins that occupy the same segmental level as the third eyelid artery. Remarks: This uncommon angioarchitecture is probably an adaptation to the fact that in the medial canthus of the eye this lid has a smaller space and the way of obtaining an efficient vascularization is by going straight to the top of the lid.     

Chest wall reconstruction with latissimus dorsi and an autologous thoracolumbar fascia graft in a dog

A new technique for autogenous chest wall reconstruction using a latissimus dorsi muscle flap and a free graft of thoracolumbar fascia was utilised in a two‐year‐old Dobermann after resection of a high‐grade osteosarcoma from the left thoracic wall. En bloc excision of the chest wall mass, including six ribs, was performed. The resulting chest wall defect was too large to be reconstructed with only a pedicled muscle flap and was reconstructed with a latissimus dorsi muscle flap cranially and a free graft of thoracolumbar fascia caudally. The graft was harvested easily, and there was no donor site morbidity or postoperative complications. A free graft of thoracolumbar fascia can be considered as an option to supplement autogenous reconstruction of the chest wall.     

Multiple ocular colobomas in the snow leopard (Uncia uncia)

Two singleton female snow leopard cubs are reported with bilateral central upper lid colobomas. In addition, one cub had a coloboma of the fundus in one eye extending from the lower optic disc region. Surgical treatment by wedge resection was successful in both cases. Details of ocular colobomas in other snow leopards reported in the literature are described and it is suggested that the exact etiology of the condition in this species may be discovered by further study of similar colobomas in the domestic cat.     

COMPUTED TOMOGRAPHY OF NONANESTHETIZED CATS WITH UPPER AIRWAY OBSTRUCTION

Upper airway obstruction is a potentially life‐threatening problem in cats and for which a noninvasive, sensitive method rapid diagnosis is needed. The purposes of this prospective study were to describe a computed tomography (CT) technique for nonanesthetized cats with upper airway obstruction, CT characteristics of obstructive diseases, and comparisons between CT findings and findings from other diagnostic tests. Ten cats with clinical signs of upper airway obstruction were recruited for the study. Four cats with no clinical signs of upper airway obstruction were recruited as controls. All cats underwent computed tomography imaging without sedation or anesthesia, using a 16‐slice helical CT scanner and a previously described transparent positional device. Three‐dimensional (3D) internal volume rendering was performed on all CT image sets and 3D external volume rendering was also performed on cats with evidence of mass lesions. Confirmation of upper airway obstruction was based on visual laryngeal examination, endoscopy, fine‐needle aspirate, biopsy, or necropsy. Seven cats were diagnosed with intramural upper airway masses, two with laryngotracheitis, and one with laryngeal paralysis. The CT and 3D volume‐rendered images identified lesions consistent with upper airway disease in all cats. In cats with mass lesions, CT accurately identified the mass and location. Findings from this study supported the use of CT imaging as an effective technique for diagnosing upper airway obstruction in nonanesthetized cats.     

Patellar ligament‐bone autograft for reconstruction of a distal patellar ligament defect in a dog

A 3 · 5‐year‐old whippet was presented 4 weeks after sustaining a traumatic injury to the right stifle joint. A penetrating injury had resulted in patellar ligament (PL) rupture. Magnetic resonance imaging revealed a normal appearing proximal half of the PL and absence of normal fibres within the distal half of the ligament. Surgical repair involved reconstruction of the defect using an autogenous graft harvested from the medial third of the ipsilateral PL. This repair was augmented with a pedicle hamstring graft. A transarticular external skeletal fixator was used to protect the repair for 4 weeks. Seven months after surgery, the dog was able to exercise normally without lameness. To the author's knowledge, this is the first veterinary report of PL grafting of a PL defect, and the first report of surgical augmentation using a hamstring graft.     

Adnexal surgery in dogs and cats

Abnormalities in eyelid position and function can lead to chronic irritation of cornea and conjunctiva. Corneal ulceration, vascularization and pigmentation are common consequences. Loss of vision, or loss of the globe may be the end result. The combination of ptosis and entropion of the upper eyelid is commonly seen in breeds with abundant forehead skin folds. Treatment options include surgical reduction of skin folds, suspending the brows, enforced secondary granulation of the upper eyelid, or a combination of procedures. Lid-shortening procedures reduce corneal exposure, improve functional blinking and reduce likelihood of traumatic proptosis. Although a lateral canthoplasty is technically easier to perform, a medial canthoplasty is the preferred method of eyelid shortening. An involuted lateral canthus with entropion is seen in certain dog breeds with a broad skull base and redundant facial skin. Surgical correction is by either applying traction to the lateral canthus, or by resection of the lateral canthal ligament. A combination of entropion, ectropion and macroblepharon may result in the presence of diamond shaped eyelids. Surgical correction involves the combination of several procedures. Upper eyelid agenesis is a congenital absence of part of the upper eyelid in cats. Treatment options include a skin-orbicularis flap from the lower eyelid with a conjunctival pedical graft, the transposition of the lower eyelid to the upper eyelid, cross lid flap and subdermal plexus flap, and subdermal collagen injection. Several techniques for reconstruction of upper and lower eyelid defects are described.     

Reconstruction of the eyelids of a dog using grafts of oral mucosa.

A five-month-old English cocker spaniel with distichiasis had been treated four times surgically by a tarsomeibomian resection technique. As a result, three-quarters of the margins of its upper eyelids had been eliminated and the lower eyelids had become considerably thinner. The dog had developed upper entropion and upper eyelid trichiasis, and keratoconjunctivitis sicca. It was treated medically and grafts of oral mucosa were used to reconstruct its upper eyelids. A year after surgery, the new palpebral margin was completely functional and cosmetically acceptable. The dog's eyes appear normal and only require treatment with artificial tears.     

Use of the lip-to-lid flap for replacement of the lower eyelid in five cats

OBJECTIVE: To report outcomes after reconstruction of the lower eyelid following resection of squamous cell carcinoma (SCC). STUDY DESIGN: Retrospective study. ANIMALS: Five cats (6 eyelids). METHODS: Case records were reviewed for breed, sex, surgical findings, complications, and outcome. RESULTS: Six eyelids were reconstructed in 5 cats; functional outcome was excellent. Neither wound breakdown nor flap failure occurred. An area of superficial necrosis occurred in 1 cat; this spared the eyelid margin and healed by secondary intention without any cosmetic or functional effect. One cat was euthanatized 18 months later because of a nasal mass. The relationship between the nasal mass and the previously excised SCC was not established. CONCLUSIONS: Reconstruction of the lower eyelid using a lip-to-lid flap yields satisfactory functional and cosmetic results in cats. CLINICAL RELEVANCE: A lip to lid flap is a successful form of single-stage reconstruction after lower eyelid excision in cats.     

Procaine penicillin by subconjunctival injection in the treatment of infectious bovine keratoconjunctivitis

A profile off the penicillin concentration in bovine conjunctival sac fluid (CF) was determined after a single subconjunctival injection of procaine penicillin (6 x 10(5) iu in 2ml). When the injection was made through the skin of the upper eye lid, the duration of therapeutic concentration was significantly greater (P<0.01) than when the injection had been given by the perconjunctival route: approximately 68 hours or 40 hours respectively. These findings support the clinical use of subconjunctivally administered procaine penicillin in the treatment of infectious bovine keratoconjunctivitis. A single application of an equivalent dose of either procaine penicillin or benethamine penicillin, applied topically in a simple occulentum base, produced a therapeutic duration in CF of 37 +/- 4 hr and 56 +/- 4.5 hr respectively.     

Dacryops of the lacrimal gland in a dog

A case of congenital lacrimal cyst or dacryops of the lacrimal gland in an 8‐month‐old Neapolitan Mastiff dog is reported. The dog presented with a swelling dorsolateral to the left globe, which had been present since birth. In addition, hyperplasia and prolapse of the superficial gland of the left nictitating membrane, and bilateral macropalpebral fissure and ‘diamond eye’ conformation were apparent. On manual eversion of the upper eyelid, a subconjunctival mass was visible that was translucent and pink and affected the upper conjunctival fornix. B‐mode ultrasonography revealed the presence of an echolucent thin‐walled cystic structure measuring 15 by 12 mm and containing an echodense border and a distended tubular fluid‐filled structure that extended posteriorly. A viscous and transparent fluid was aspirated from the lesion. Surgery was performed to excise the lesion, reposition the nictitans gland, and correct the morphology of the palpebral fissure. Histopathology confirmed the mass to be a cyst and distended duct of the lacrimal gland. Although tear secretion was compromised, resection of the cyst was curative.     

Entropion correction by fornix-based suture placement: use of the Quickert-Rathbun technique in ten dogs

The objective of this study was to evaluate fornix-based suture placement as a method for entropion correction in the dog. Lower eyelid entropion with resultant trichiasis was corrected in 10 dogs using fornix-based suture placement similar to that employed in the Quickert-Rathbun technique used in man. A double-ended suture was placed originating at the deepest extent of the fornix and exiting the lid 1-2 mm from the eyelid margin. Degree of correction was assessed visually immediately after surgery and at re-examination with a follow-up period of up to 6 months. Fornix-based suture placement led to immediate eversion of the eyelid in each case and thus amelioration of the trichiasis in all dogs. In two cases eyelid eversion initially appeared over-corrected and in two cases exposure of conjunctival tissue was evident initially at the palpebral margin. In all cases, however, such complications were transient with long-term results giving an acceptable apposition between ocular surface and eyelid margin in all adult dogs. In three juvenile dogs on which the technique was used, further surgical treatment was required as the puppies grew. Fornix-based suture placement is a novel approach to entropion correction in the dog which yields acceptable results in the majority of suitable cases without recourse to incisional surgery.