The ultimate botox!

 

 This poor labrador was afflicted with botulism and spent a week on a ventilator before recovering well as seen here.

While paralysed a carbomer gel was assiduously applied to both eyes, but treatment ceased when she was able to breathe again. A few days later I was called to see her and closer inspection showed these changes to her ocular surface.

What is happening and what should we do?

 There is a grey hazy corneal oedema in a linear streak in both eyes and a break-up of the reflection from the camera flash, showing a defect in the tear film or the corneal epithelium or both. There was indeed ulceration and an evaporative dry eye even though her Schirmer tear test was over 20mm/min in each eye. These changes were associated with a failure to blink adequately. We used a cross-lnked hyaluronan gel (Sentrx Remend) with excellent results as can be seen below. There is still some oedema but the epithelium is perfectly healed, as seen by the crisp clear flash reflection.

The case shows the importance of protecting the ocular surface whenever blinking is defective, for instance during long surgical operations or during coma in the ICU.

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