Surgery of the Eyelids

Application of local anaesthesia and cryosurgery for eyelid masses in dogs

Background

Eyelid mass removal and cryotherapy application using only local anaesthesia and restraint may benefit patients with high anaesthesia risks.

Objective

To evaluate and validate cryosurgery application using the CryoPen XL^® on palpebral masses under local anaesthesia for patients not suitable for general anaesthesia.

Methods

Thirty patients underwent the procedure between November 2015 and April 2020. The procedure steps were as follows: skin preparation and local anaesthesia of the affected eyelid; debulking by resection and/or squeezing out the inspissated material; cryosurgery and post‐operative care using topical medication, antibiotics and anti‐inflammatory ointment. The medical records of the patients who underwent the operation were evaluated. Moreover, a telephonic survey with the pet owners was performed to determine recurrence, time to recurrence, survivability and side effects.

Results

Among the 30 owners, 29 responded to the survey. Ten (10/38, 26.3%) masses recurred with an average time to recurrence of 6.0 months. The estimated average depths for all, non‐recurred, and recurred masses were 1.89, 1.88 and 1.90 mm, respectively. The average recurrence rate and time to recurrence were higher and earlier, respectively, than previously reported values. However, no patient presented intra‐ or post‐operative complications.

Conclusion

These findings suggest that local anaesthesia and cryosurgery using the CryoPen XL^® can be used in patients with eyelid masses who are not suitable for general anaesthesia. Compared with the surgical eyelid mass removal and blepharoplasty procedure, the reported procedure is time‐ and cost‐effective, with the additional benefit of not requiring general anaesthesia.

Lip Commissure to Eyelid Transposition Flap to Correct Eyelid Agenesis in Cats in a Shelter Setting - a Case Series

Five cats were diagnosed with eyelid agenesis in a 6-month period at the Miami-Dade Animal Services, and a total of 9 blepharoplasties were performed using the lip commissure to eyelid transposition flap (LCET) technique. Eyelid agenesis affected 50%-80% of the superiolateral lid in all cats. Postoperatively, partial necrosis of the flap was observed in 4 and partial dehiscence was observed in 1 of the corrected eyelids, occurring where the buccal mucosa was sutured to the conjunctival mucosa. No cats with partial necrosis of the flap were known to have developed trichiasis due to scar tissue formed at the necrotic site. The single case in which dehiscence occurred developed slight trichiasis that may warrant further intervention to ensure permanent hair ablation. Eyelids were cosmetically acceptable and functional at final examination. Patients showed no evidence of initial discomfort at the surgical sites, nor discomfort or progression of corneal disease during the follow-up time. This case series documents a suitable technique to treat cat eyelid agenesis when referral to a specialist is not an option due to lack of resources, such as in shelters or low-cost veterinary clinics. The surgical technique, outcome and complications presented in this case series are evaluated, and discussed.

A description of blend electrolysis for treatment of canine distichiasis: 78 cases (2012-2017)

OBJECTIVE

To describe a population of dogs treated with blend electrolysis for distichiasis at The Royal Veterinary College and report the complications seen.

METHODS

In part 1, records were reviewed from 2012 to 2017 and a population of 78 dogs with distichiasis treated using blend electrolysis (Sterex SX-B blend epilator) analysed. In part 2, 18 dogs treated with blend electrolysis were re-examined prospectively by a diplomate of the European College of Veterinary Ophthalmologists (ECVO).

RESULTS

In part 1, brachycephalic breeds accounted for 62 per cent. English bulldog was the most common breed (42 per cent). In this population, 88 per cent of dogs were successfully treated with one treatment of electrolysis (successful treatment defined as resolution of clinical signs). Forty-five dogs had recurrent distichia on follow-up, mostly fine distichia without clinical discomfort. Twelve per cent required repeat electrolysis. Complications were infrequent: five dogs had scarring or hypopigmentation of the eyelid margin. In part 2, 18 dogs were re-examined. Ten had distichia recurrence, six had eyelid scarring and five had depigmentation associated with electrolysis. Two dogs had occasional clinical signs thought to be related to distichiasis. All owners perceived their dogs' ocular comfort to be improved following blend electrolysis.

CONCLUSIONS

Brachycephalic breeds, most notably English bulldogs, are over-represented in this population. Blend electrolysis appears an effective treatment for resolution of clinical signs.

Outcome of secondary intention healing of full thickness lower eyelid defects in dogs

OBJECTIVES

To assess healing of the canine lower eyelid without anatomical reconstruction.

MATERIALS AND METHODS

Retrospective case series of three client-owned dogs with lower eyelid defects. These dogs that underwent debridement of lower eyelid wounds that were left to heal by secondary intention were assessed for anatomical, functional and aesthetic outcomes.

RESULTS

Two of the cases had previously undergone tumour resection with a lip-to-lid reconstruction and, following flap failure, developed a full thickness defect. The third dog presented with a traumatic laceration. Each dog lost approximately 70 to 90% of the lower eyelid margin. Two received topical antimicrobial eye drops after debridement, while the third dog required no further treatment. Follow-up periods of 3 years, 15 months and 4 months were available. All owners were satisfied with the cosmetic outcome and provided pictures. One owner reported epiphora but no other ophthalmic complications occurred.

CLINICAL SIGNIFICANCE

The result of this small case series supports the notion that not all lower eyelid injuries or tumour resections require anatomical reconstruction. Selected cases can be left to heal by secondary intention with minimal post-operative complications.