Ocular health is an important part of a pet’s overall health. Vision loss, squinting, and/or green-yellow discharge, are all common signs that a pet should seek veterinary care within 24 hours to identify the source of pain and prevent severe eye disease. Eye injuries can progress quickly, so when Charlie, a six-year-old Shih Tzu/Poodle mix, started squinting and it didn’t improve throughout the day, his Mom made the right call to bring him to our St. Paul ER!
Can you spy these clues that led to Charlie’s diagnosis and treatment?
I Spy With My Little Eye Something Squinting…
Of course, the first clue is the symptom that brought Charlie to our ER: squinting in his left eye. It’s also important to note that for the past few months, Charlie has had a mass on the lower eyelid of this eye that didn’t appear to irritate him. During the physical exam, our ER team spied something else about Charlie’s eye though…
I Spy With My Little Eye a Corneal Defect…
A corneal defect?! That’s right. Unfortunately, a corneal defect is a big concern for a corneal ulcer. Prompt treatment is important because without care, eye ulcers can quickly worsen.
Ulcers typically start as superficial corneal ulcers which means they penetrate through only one layer of the clear, outer part of the eye. But when a pet rubs at the eye, bacteria are introduced, which can lead to an ulcer that affects more than one layer of the cornea. Such ulcers require intensive care including repeated corneal debridement.
But one of the biggest risks is that an untreated ulcer can get so deep that it erodes completely through the cornea, causing a corneal rupture. Specialized surgery is then required to fix the cornea and save the eye, or an emergency removal of the eye is performed.
We’re sure glad Charlie’s Mom brought him to see us!
I Spy With My Little Eye Something Green…
Our team had to quickly determine if Charlie indeed had a corneal ulcer. The tricky part is that corneal ulcers are difficult to see! To confirm the diagnosis, our ER team had to apply a fluorescein dye that appears bright green under a black light.
Fluorescein stain is used in both humans and animals. It’s applied to the eye surface and binds to injured corneal tissue to highlight corneal ulcers, show a poor tear film quantity, and allow visualization of tear flow. In Charlie’s case, the fluorescein stain confirmed a corneal ulcer on his left cornea. Not surprisingly, this is the same area that the mass on his lower eyelid would rub when he blinked!
I Spy With My Little Eye Something To Make Charlie Feel Better…
With this diagnosis, Charlie was sent home on a topical antibiotic ointment to reduce the risk of infection and make him more comfortable while the ulcer healed. Typically, corneal ulcers heal within 7-10 days depending on the size and cause. Since corneal ulcers can be severely painful, Charlie also received pain a pain medication and of course, he couldn’t go home without a fashionable Elizabeth Collar (aka e-collar or cone) to ensure he wouldn’t scratch his eye and make the ulcer worse.
I Spy With My Little Eye an Ophthalmologist…
Since the left lower eyelid mass was an underlying cause for Charlie’s ulcer, our ER referred Charlie to our Ophthalmology Service to see our board-certified veterinary ophthalmologist, Dr. Rogen.
A week after his ER visit, Charlie met Dr. Rogen for a comprehensive eye exam. Fortunately, the ulcer had healed, but there was still that mass to take care of! Most eyelid masses are benign but locally aggressive – in other words, they typically aren’t cancerous and don’t spread BUT they can affect the tissues in that area.
If not removed, the mass would also likely continue to rub on the cornea and cause repeated ulcerations. Any repeated trauma or irritation to the eye can result in ulcers, so it’s important to address abnormalities early. For this reason, Charlie’s mom approved surgery to remove the mass.
I Spy With My Little Eye Something Getting Removed
After meeting Dr. Rogen, Charlie returned a few days later for an eyelid mass cryosurgery. To prepare for the surgery, Charlie was sedated and the skin around the left eyelid mass was locally anesthetized. The partial lid mass removal and cryosurgery was performed by Dr. Rogen. Charlie did great and was able to go home later that day!
I Spy With My Little Eye Someone Rocking Post-Op
A month later, Charlie returned to see Dr. Rogen for a follow-up appointment to monitor his eye’s post-surgical appearance. Dr. Rogen was pleased with Charlie’s progress!
Two months post-surgery, Charlie’s Mom shared with our team: “Charlie’s quality of life has greatly improved since his surgery! He is back to his normal, happy self, and I couldn’t be happier that his eye healed so well! [We’re thankful to] Dr. Sikes (Charlie’s emergency veterinarian) and Dr. Rogen for their thorough & quick evaluation and treatment for Charlie!”
One of the most valuable things about our team is the ability to collaborate, and we are happy to have been able to help Charlie not only with his emergency and urgent care, but also with an internal referral to one of our specialty services that could address the underlying issue that brought him to our ER in the first place.
We’re glad Charlie is feeling better and that he’ll be spying a lot more things with both of his little eyes!
You can follow Charlie’s adventures on Instagram @charlietheshihtzubear!
Our “Fur-tunately: Stories of Animal Survival” series features real pets treated by our team at Animal Emergency & Referral Center of Minnesota. All images and information have been shared with the owner’s permission.
Case content provided by Latasha Sikes, DVM.