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.     

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.     

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.     

Prevalence of bacteria in the conjunctival sac and on the eyelid margin of clinically normal cats

Samples from the palpebral conjunctiva, third eyelid and eyelid margin from 50 asymptomatic cats were analysed. Sixty-seven per cent of the samples showed bacterial growth with a high predominance of the genus Staphylococcus (97-8 per cent) predominantly coagulase-negative (93-5 per cent). The most frequent species was S epi-dermidis (45-7 per cent), followed by S simulans (23-9 per cent), S auricularis [17A per cent) and S saprophyticus (6-5 per cent). Three samples of S aureus (6-5 per cent) and one of Pseudomonas aeruginosa (2-1 per cent) were also identified. The role of these microorganisms in the eyes of cats is discussed and the importance of the new species Staphylococcus felis is stressed.     

Multiple eyelid cysts resembling apocrine hidrocystomas in three Persian cats and one Himalayan cat.

Multiple eyelid cysts were evaluated and treated in four cats. Surgical removal of the cysts was performed in two cats. Histopathologic examination revealed multilocular cystic structures of various size. The cysts were lined by cuboidal to columnar cells with papillary or cystic projections into the cyst lumen. Periodic acid-Schiff-positive, diastase-resistant granules were seen within the apical cytoplasm of many of the cells. The eyelid masses in these cats resembled apocrine hidrocystomas in human beings, both clinically and on histopathologic examination.     

Surgical management of bilateral,upper and lower eyelid entropion in 27 Shar Pei dogs,using the Stades forced granulation procedure of the upper eyelid only

ABSTRACT

Aims: To evaluate the outcome of surgical management of entropion of the upper and lower eyelids in Shar Pei dogs which had previously undergone temporary palpebral tacking, using the Stades forced granulation procedure of the upper eyelid only.

Methods: Medical records were retrospectively searched to identify Shar Pei dogs referred for bilateral entropion of both the lower and upper eyelids, and that were treated with the forced granulation procedure of the upper eyelid only. Dogs were included if they had previously undergone unsuccessful temporary palpebral tacking and had at least three follow-up examinations in the 30 days following surgery.

Results: Twenty-seven Shar Pei dogs with a median age of 7.9 (min 4, max 24) months were included in the study. Before surgery, all dogs showed signs of severe ocular discomfort with bilateral keratitis and visual deficit due to blepharospasm, enophthalmos and protrusion of the third eyelid. In 13/54 eyes, keratitis was associated with a corneal ulcer. When re-examined 4 weeks after surgery, correction of the upper eyelid entropion and associated trichiasis resolved ocular signs in 50/54 eyes. Mild bilateral lower entropion remained in two dogs postoperatively, which underwent revision surgery with the Hotz-Celsus technique. There were no cases of long-term recurrence of entropion or ocular irritation in the 38 eyes (19 dogs) which were re-examined 1 year after surgery.

Conclusion and clinical relevance: The forced granulation procedure performed on the upper eyelid only was effective for correction of entropion in the Shar Pei dogs included in this study. In our experience, it is preferable to operate on the upper eyelid alone, rather than attempting to correct upper and lower entropion during the same surgical operation. The dog can then be reassessed a few weeks later to determine whether the lower entropion is anatomical or secondary to the severe blepharospasm resulting from the painful ocular irritation.     

Pocket technique or pocket technique combined with modified orbital rim anchorage for the replacement of a prolapsed gland of the third eyelid in dogs: 353 dogs

The aim of this retrospective study was to evaluate the results obtained in 353 dogs (420 eyes) using two different surgical techniques for correction of a prolapsed gland of the third eyelid: the Morgan's pocket technique and a technique combining Morgan's approach with a slightly modified periosteal anchoring technique of Stanley and Kaswan. The pocket technique was used in 234 eyes and the combined technique in 186 eyes. Successful repositioning was obtained in 95% of all cases, with recurrence occurring in 5%. The recurrence rate in large breed dogs such as the English Bulldog and Boxer was lower with the combined technique than with the pocket technique.     

The conjunctival crypt of the equine third eyelid

The purpose of this study is to characterise the gross anatomy of a relatively large, cryptic structure within the bulbar conjunctival surface of the equine third eyelid that has commonly been observed by the authors during equine ophthalmic examinations. In this study, cadaveric eyes and adnexa were obtained from 13 Quarter Horses without history of ocular disease. The gross anatomy of the bulbar surface of the third eyelid was characterised by digital macrophotography and with an image capture system using an operating microscope. A well-defined cryptic structure was readily identified in the majority of eyes (17/26). The location of the crypt varied but was most commonly observed within the central aspect of the bulbar surface of the third eyelid, often in close proximity to prominent blood vessels oriented perpendicular to the leading edge of the third eyelid. A patch of lymphoid follicles was often observed surrounding the crypt. The rectangular shape and upward facing orientation of the crypt was akin to a shirt's breast pocket. Width and depth were variable but ranged between 1 and 8 mm in either dimension. Some crypts were complex, with multiple channels observed within the primary opening. In conclusion, this study confirms the presence of a well-organised mucosal crypt within the bulbar surface of the equine third eyelid capable of harbouring foreign material and ocular irritants. Additional anatomical characterisation of the macro-crypt by light microscopy, immunohistochemistry and electron microscopy is underway. Evaluation of this structure by equine practitioners and veterinary ophthalmologists should be performed during the routine ophthalmic examination to better understand its role in ocular disease.     

Use of conjunctival pedicle grafts in the management of feline keratitis nigrum

Feline keratitis nigrum (necrosis, sequestrum or sequestration) usually presents as a black plaque in the axial or paraxial cornea. Most cats can be treated by excision of the lesion and covering the defect with a third eyelid flap. This technique did not provide satisfactory results in some cases. This paper describes microsurgery using conjunctival pedicle grafting following keratectomy to provide a one step technique to manage recurrent feline keratitis nigrum, feline keratitis nigrum with full thickness lesions of corneal stroma and eyes also affected with keratoconjunctivitis sicca.     

Eyelid reconstruction in seven dogs using a split eyelid flap

The use of a split eyelid flap to reconstruct both a normal palpebral aperture and a smooth, hairless eyelid margin following the excision of eyelid neoplasia, in a series of seven dogs, is described. The patterns of reconstruction used in the procedure are discussed, and previously reported methods of eyelid reconstruction are reviewed.     

Intranictitans tacking for replacement of prolapsed gland of the third eyelid in dogs

Objective  To evaluate a new procedure for fixation of prolapsed nictitans glands to the cartilage of the nictitans that will not interfere with the mobility of the nictitating membrane.
Methods  A prospective clinical trial utilizing a nonabsorbable suture to anchor the prolapsed gland to the cartilage of the third eyelid was undertaken. Fifteen eyes of 10 dogs were included in the study. A 4-0 nylon suture was passed from the anterior surface of the third eyelid through the base of the cartilage to the posterior aspect and then tunneled circumferentially beneath the conjunctiva over and around the prolapsed gland. The suture was then passed through the cartilage again to the anterior face of the third eyelid. The gland was replaced into its normal position as the suture was slowly tightened and then tied on the anterior aspect of the nictitans.
Results  Over a period of several weeks, the glands reduced in size and took on a normal appearance. All glands but one remained in place for the length of follow-up, which ranged from 2 weeks to 33 months.
Conclusions  This procedure results in acceptable cosmetic effects with the return of the gland to its normal position posterior to the nictitating membrane. The advantage of this technique over traditional tacking to the orbital rim is that the third eyelid retains its normal mobility and, thus, its protective functions. The procedure once mastered is very quick and can be performed in less time than many of the traditional replacement techniques.     

Effect of removal of lacrimal and third eyelid glands on Schirmer tear test results in cats

Schirmer tear tests I and II values for 10 healthy cats were 16.2 +/- 3.8 mm/min and 13.2 +/- 3.4 mm/min, respectively. Surgical removal of the lacrimal gland or the third eyelid gland from the left eye resulted in decreased Schirmer tear test-I values. Clinical signs of keratoconjunctivitis sicca were not seen until the lacrimal and third eyelid glands were removed, at which time the Schirmer tear test-I value was close to 0 mm/min. Conjunctival glands (accessory lacrimal glands of Krause and Wolfring) appeared to contribute little to tear production in these cats.     

Feline periocular peripheral nerve sheath tumor: a case series

The objective of this retrospective study was to describe signalment, clinical presentation, surgical treatment, outcome, histopathologic, and immunohistochemical characteristics of periocular peripheral nerve sheath tumor in a series of cats. Six cats with a histologic diagnosis of peripheral nerve sheath tumor of the eyelid and/or conjunctiva were identified from 3997 feline ocular histopathologic submissions to the Comparative Ocular Pathology Laboratory of Wisconsin between 1976 and 2002. Medical records were reviewed and data were collected for signalment, eye affected, location, duration, and history of tumor recurrence. Ancillary diagnostic tests, surgical approach, and histopathology were also described. Special stains and immunohistochemistry panels were performed on the tissue. Follow-up information was obtained through telecommunications with the owner and local veterinarian. The mean age of the cats was 8 years (range: 5-15 years). There was an equal distribution of males and females. Breeds represented were two Domestic Long-haired (DLH) cats, three Domestic Short-haired (DSH) cats, and one Manx. The right eye was affected in four cats and the left eye in two cats. The superior eyelid was affected in four cats, the superior conjunctiva in two cats, and the inferior eyelid in one cat. All of the cats that underwent surgical excision, cryoablation, or laser ablation had an average of three recurrences of the tumor. Four of six cats undergoing wide excision with enucleation, exenteration or rhomboid flap had no recurrence of the tumor. Histomorphologically, all of the tumors were of spindle cell type with five of six tumors showing histologic features of Antoni type B tissue. All six tumors stained positive for vimentin. Five of six tumors stained positive for S-100 and laminin. All six tumors were negative for smooth muscle actin. Definitive histologic diagnoses of spindle cell tumors can be difficult. The presence of Antoni A and B histologic patterns as well as immunohistochemical reactivity for vimentin, S-100, and laminin suggest a diagnosis of peripheral nerve sheath tumor. Our findings suggest that local aggressive recurrence is common and that wide surgical excision combined with enucleation or exenteration may be indicated.     

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.     

IgA and secretory component (SC) in the third eyelid of domestic animals: a comparative study

Objective The third eyelid of domestic animals is important for the production and distribution of tears, in removing ocular debris and in protection of the globe, and has significant immunologic functions. Although it is known that tears contain antibodies of the immunoglobulin A (IgA) isotype which are produced mainly by plasma cells of the lacrimal gland, very little is known about the antibody repertoires in the third eyelid of domestic animals. To assess whether IgA is derived from local synthesis, we analyzed the location of IgA‐producing cells and the cellular distribution of secretory component (SC) in the third eyelid of domestic animals in a comparative study. Animal studied A total of 83 third eyelids of dogs, cats, pigs, cows, sheep, goats and horses were investigated in the course of this study. Procedures Third eyelids were obtained immediately after death, cut length‐wise, fixed overnight and processed for immunohistochemical detection of IgA and SC by the ABC technique. Results The results show that IgA‐producing plasma cells are densely populated in subepithelial spaces of the surface epithelium as well as in the nictitating gland in a species‐specific manner. In contrast, the SC could be demonstrated exclusively in glandular acinar and ductal epithelial cells and in different cell types of the surface epithelium, preferentially located on the bulbar side of the nictitating membrane. Conclusion It is suggested that most of the SC is locally produced by resident plasma cells and subsequently transferred through the surface epithelium and glandular duct cells by transcytosis. This indicates that the third eyelid is an important member of the secretory immune system in domestic animals.     

Mucosa-associated lymphoid tissue lymphoma of the third eyelid conjunctiva in a dog

A 4-year-old, neutered female Cocker Spaniel was presented to the veterinary clinic for protrusion of the left third eyelid. When the third eyelids from both eyes were everted, lobulated masses were present on the bulbar surface. The left third eyelid had a larger protrusion. There was no apparent associated ocular or systemic involvement. The tumor of left third eyelid was removed and referred for histological examination. Histologically, there were proliferations of lymphoid follicles surrounded by lymphoid cells forming a marginal zone. Those lymphoid cells occasionally infiltrated into conjunctival epithelium. A few apoptotic bodies with karyopyknotic and karyorrhexic nuclei were observed in the germinal center of lymphoid follicles. Mitotic figures were rare. On immunohistochemistry, tumor cells expressed CD79a but not CD3. A diagnosis of extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) of the third eyelid was established based on the histological and immunophenotypical features. At the 1-year follow-up, there was no evidence of recurrence of the mass at the area of excision of the left third eyelid and the remaining tumor of the right third eyelid was still a similar size. The dog still showed no significant findings, except those of the tumor, and no evidence of systemic involvement. To the authors' knowledge, this is the first reported case of MALT lymphoma of the third eyelid in a dog.     

Ulcerative keratitis associated with qualitative tear film abnormalities in cats

Three cats with indolent corneal ulcers and one cat with bilateral corneal sequestration and normal aqueous tear production were found to have rapid tear break-up times (BUTs). Tear BUTs in clinically affected cats averaged 2.5 ± 1.29 s and 2.33 ± 0.58 s for the right and left eyes, respectively. Palpebral conjunctival biopsies were harvested from consistent sites from each eye of affected cats ( n  = 7 affected eyes), and age-and breed-matched controls ( n  = 2 unaffected eyes). Light microscopy revealed a marked decrease to complete absence of conjunctival goblet cells (average goblet cell (GC):epithelial cell (EC) density = 18:50), conjunctival epithelial dysplasia, squamous metaplasia, and neutrophilic and mononuclear cell submucosal infiltration in affected cats. Specimens from the control cats had an average GC:EC density of 34:50, and minimal submucosal inflammatory infiltrate. The corneas ( n  = 7 eyes) healed following surgical keratectomy with ( n  = 2 eyes) or without ( n  = 1 eye) conjunctival pedicle flaps, superficial keratectomy and striate keratotomy with ( n  = 2 eyes) or without ( n  = 2 eyes) third eyelid flaps, and mucinomimetic tear supplementation ( n  = 5 eyes). Goblet cell regeneration was confirmed after 5 months of mucinomimetic supplementation ( n  = 2 eyes). The etiology for these mucin deficiencies remains unknown.     

A modification of the Mustardé technique for the surgical repair of a large feline eyelid coloboma

A one‐year‐old male domestic short haired cat was referred because of an area of keratitis that had developed adjacent to a particularly large unilateral eyelid coloboma. The defect was repaired using an undescribed three‐stage surgical technique, which is essentially a combination of existing techniques and consists of using the lower lid to re‐construct the upper lid and replacing the resultant lower lid defect with a full thickness graft from the upper lip. This technique is described and the results illustrated by photographs. A good functional and cosmetic result was achieved.     

Canine mesenchymal hamartoma of the eyelid

Objective Characterization of a benign disease syndrome involving the eyelids of dogs, describing the signalment, clinical appearance, anatomic location, and pathologic features. Animal studied The records and submitted tissue of 10 dogs with mesenchymal hamartomatous lesions of the periocular connective tissues were retrieved from the Comparative Ocular Pathology Laboratory of Wisconsin (COPLOW) database. Procedure The submitted tissue in each case was stained with hematoxilyn & eosin and Masson’s Trichrome stain and examined histopathologically. Clinical information was collected from the submission requests. The clinical history, treatment, and follow‐up are described in more detail for one of the 10 dogs. Results Seven different breeds, including four Golden Retrievers, were represented. The ages of affected dogs ranged from 6 to 11 years. Eight of 10 lesions were located at the temporal canthus, ranging in diameter from 0.6 to 3 cm. Clinically, the masses were subcutaneous, firm, lobular soft‐tissue growths, which were in some cases adherent to the underlying orbital rim, and in others, freely palpable between the skin and conjunctiva of the eyelid. Histologically, all had distinct margins but were not encapsulated and contained normal appearing collagen‐rich connective tissue with some adipose tissue. Five also contained fully differentiated skeletal muscle tissue arranged in poorly formed aggregates or as individual muscle fibers. Conclusion Mesenchymal hamartoma of the eyelid has not been previously described. The mass has a predisposition to occur at the temporal canthus and should be included in the list of differential diagnoses of benign eyelid masses in dogs.