A Clinical Case from the Archives : 17/09/2004

This 12 year old Cocker Spaniel has for some time had mucoid discharge from both eyes and some mild ocular discomfort. What is the problem (or problems) and how may it (or they) be ameliorated?

The obvious problem here is upper eyelid entropion with trichiasis (eyelash hairs contacting the cornea) with mucoid discharge and corneal vascularisation, commonly seen in ageing Cocker spaniels. The problem can be rectified using the Stades procedure shown in these line drawings (Stades FC: A new method for surgical correction of upper eyelid trichiasis-entropion: operative method. J Am Anim Hosp Assoc 1987 23: 603-606, Stades FC: A new method for surgical correction of upper eyelid trichiasis-entropion: results and follow-up in 55 eyes. J Am Anim Hosp Assoc 1987 23: 607-610), these days also called a forced granulation technique since it removes the eyelashes and leaves a margin of granulation tissue preventing eyelid hairs contacting the cornea. A Schirmer tear test should also be undertaken in any dog with this sort of mucoid discharge – in this dog tear production was only 2mm of test strip wetting in a minute (normal around 15-20mm/min), showing that ocular surface drying was also a factor in the corneal pathology and ocular discharge. Topical cyclosporine increased tear wetting to 8mm in three weeks, giving a better lubricated ocular surface. Combining these medical and surgical treatment routes improved this dog’s ocular health immeasurably. The Stades Procedure: an ellipse of skin is excised including the eyelashes and then the supraincisional skin is mobilised and sutured to leave a 5mm margin of granulation tissue next to the lid margin.


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