OCULAR TRAUMA AND ER PROCEDURES SHELBY REINSTEIN, DVM, MS, DACVO
In this 1.5 hour webinar, Dr. Shelby Reinstein reviews the approach to the most commonly seen ocular trauma in the small animal patient – blunt trauma, proptosis, eyelid lacerations and corneal lacerations.
KEY HIGHLIGHTS
1 BLUNT TRAUMA In addition to stabilizing a patient and assessing the neurologic status with suspected blunt trauma patients, one of the most important parts of the initial assessment should include checking for a palpebral reflex to prevent corneal ulcerations and infections and if none is present, use topical lubricant gel/ointment. The most common presentations of blunt orbital trauma include traumatic uveitis (leakage of cells and protein leading to aqueous flare, hyphema and fibrin “spider webs”), lens luxation (most commonly into the vitreous), vitreal bleeding and possibly a detached retina. Treatment involves topical therapy, systemic therapy and possibly a temporary tarsorrhaphy. Topical therapy is usually directed at treating uveitis with broad spectrum antibiotics, steroid drops (if no ulcers), atropine to prevent synechia BUT use caution with severe hyphema since blood needs to drain from the irideocorneal angle, and lubrication of the eye. Systemic therapy involves using doxycycline for the anti-inflammatory e ff ect on the eye, NSAIDs or tapering steroids (use with caution in head trauma cases) and pain control. A temporary tarsorrhaphy may be needed if blinking is inhibited with massive hemorrhage in conjunctiva or under the third eyelid.
2 PROPTOSIS It is important to di ff erentiate proptosis from exophthalmos by eyelid position; globe will be in front of the eyelids with proptosis and the globe is behind the eyelids with exophthalmos. Brachycephalic dogs only need mild trauma for proptosis to occur whereas dolichocephalic dogs and cats require significant force in order for this to occur. Besides assessing the degree of extraocular muscle involvement (more muscles avulsed = more severe proptosis), the integrity of the globe by observing shape and turgor (the weakest point of the sclera is in the
back of the globe near the optic nerve so perforation may not be obvious), for any concurrent corneal ulceration, a consensual PLR is the best prognostic indicator of vision. Perform this by shining a light in the proptosed eye and assess PLR in normal contralateral eye; if consensual PLR is seen, this signifies an intact retina and optic nerve in the proptosed eye. Treatment for proptosis typically involves replacement and temporary tarsorrhaphy unless enucleation is indicated. It is important to inform an owner that approximately 20% of proptosed eyes will regain vision, and
06
vetgirlontherun.com
Made with FlippingBook - Online Brochure Maker