🔶 Transpalpebral Enucleation 🔶 Enucleation is probably the most common orbital surgical procedure performed in small animal practice. 🔸Rocky a 5 y old Shih tzu represented to our facility after fight with another dog with bite wounds and eye proptosis. 🔸Physical examination: With inspection eye proptosis was clear and there were deep 8 bite wounds in the face and neck bilaterally, they bled aggressively. 🔸Lab works: -CBC showed hypovolemia due to excessive blood lost -Serum chemistry: showed elevated ALT& AST due to the traumatic injuries After stabilization our patient with painkillers and resuscitation hypertonic fluids to correct the hypovolemia encountered, ophthalmic examination preformed. 🔸 Ophthalmic examination: There wasn’t response during testing the PLR, no menace response, vision was lost and the affected eye was completely blind. So surgeon decided to do transpalpebral enucleation. 🔸 Diagnostic imaging: Radiography, AFAST and TFAST preformed to exclude any other injuries. 🔸 Surgical approach: Under general anesthesia, In ventral recumbency, •Eyelids closed with simple continuous suture pattern using 3/0 nonabsorbable suture material, leaving the both ends of the suture long enough for eye traction. •Then applying circumferential incision around the traced eye 5mm from the eyelid. •Stepping forward for blunt and sharp dissection of s/c tissues after which canthotomy of medial and lateral canthus' tendons applied, clamping of ocular muscles near to it’s insertion before cutting them to reduce bleeding. •Till reaching free rotation of the globe. •Clamp the tissues at the posterior pole of the globe, remove the hemostat, and incise the stalk 5 to 10 mm posterior to the globe. •Remove the globe, lid margins, orbital lacrimal gland, conjunctiva, and nictitans, Flush the orbit and close the lids with 3/0 nonabsorbable suture material in simple continuous manner. 🔸Treatment plan: -Alpha chymotrypsin (for the traumatizing facial edema) -Amoxicillin-Clavulanic acid (for 2ndry bacterial infection) -Liver tonics (for the elevated ALT and AST) -Wounds cleaned and dressed with 0.9%saline, chlorhexidine and antibiotic spray. Procedure took 30 mins after which Rocky had smooth recovery Elhumdullah, continuing his fluids, receiving painkillers, antiedematous and antibiotic. Dr. Paws just wanted to take a moment to express heartfelt thanks to the entire team for the steadfast commitment to achieving our goals, your hard work and dedication truly keep the momentum going, thanks for rescuing these speechless creatures with your consistent effort and positive attitude.🙏 Surgeon: Dr. Ahmed Bahr #Surgery #Ophthalmology #Veterinary #Canine #Enculeation
Serum chemistry of the case showed elevated ALT and AST levels.