Page 5 - Clinical Connections - Autumn 2022

Ophthalmology
DEAF DOG HAS GRASS SEED BEHIND EYE

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year-old cocker spaniel presented easily, the team was less concerned about a CT identified a large swelling on the left side
to the Emergency and Critical Care retrobulbar abscess at that point. of the face, extending to the left masseter,
A service in July for acute onset redness From the description of his examination consistent with an abscess. Although no clear
and swelling of the left eye, which had started findings both by our Emergency Referrals foreign body was identified, that could not
two days before. Marvin had been running service and the referring vet, it appeared rule out a small unobserved object from being
through tall grass and his local vet removed that Marvin was responding to the antibiotic present.
several grass seeds from his mouth. and anti-inflammatory injections that he
Marvin has been deaf since birth and is received prior to referral. Therefore, rather
missing a toe pad but was always lively and than proceed with 3D imaging of the head to
playful with another dog in the household until look for foreign material at that point, he was
his eye deteriorated. treated symptomatically with antibiotics and
Clinical signs were relatively mild on his anti-inflammatories.
first admission, when he was also seen by
the Ophthalmology Service, so we were Deterioration and second admission
not able to justify further investigation and In August his owner noticed reddening in Marvin, the day before the seed was removed
symptomatic treatment was given. However, Marvin's eye, along with protrusion of the
clinical signs returned with a vengeance two third eyelid. She administered some Celluvisc Ocular ultrasound can complement
weeks after stopping medication and he was but over the next few days the protrusion abnormalities seen on CT imaging. The
readmitted in August. increased and the eye closed. His local radiologists identified a dorsal lateral
During his first admission, Marvin was vet observed that the left side of Marvin's subcutaneous abscess with grass seed,
found to have some exophthalmos ocular head was swollen. He was given oral anti- which was removed with ultrasound guidance
discharge. He was sedated to have his eye inflammatories, and, during the night, Marvin under general anaesthesia.The area was
thoroughly checked for any foreign material. developed mucopurulent ocular discharge. No explored and lavaged and left as an 'open
A small puncture wound on the soft palate at obvious discomfort in the mouth or discharge wound' to heal by second intention.
the back of the mouth (left pterygopalatine from the mouth was noticed but Marvin had
fossa region) was found, which was draining become withdrawn and had stopped playing
bloody material. with the other family dog.
When examined the next morning by the Upon return to the QMHA, the left eye
Ophthalmology Service there was no longer was moderately blepharospastic with a
any protrusion of the eyeball. Marvin appeared markedly increased blink rate. There was
comfortable and was holding the eye open, mild mucopurulent discharge and the globe
with only mild swelling of the conjunctiva. He appeared medially displaced. There was
could open his mouth fully, with no evidence ventral periocular swelling, which was hot
of discomfort, so he was discharged from the on palpation and painful. The palpebral and
hospital. bulbar conjunctiva was markedly hyperaemic
and congested with severe chemosis of the
lateral palpebral conjunctiva. There were
mild signs of uveitis. Given the deterioration
in clinical signs, further investigation was
recommended.
Marvin in his shades after returning home

The following morning, Marvin showed a
marked improvement in comfort and swelling
so was discharged with a course of anti-
inflammatories and antibiotics. Marvin is
back to his normal self and has completely
The offending grass seed recovered. His owners are now trying to
encourage him to wear goggles when out on
Foreign material may penetrate the soft walks to prevent a recurrence.
part of the mouth but not become embedded
or enter the tissue and remain there, where
they then cause an abscess.
Grass seeds can move in one direction For small animal referrals, please call:
but not the reverse, due to the presence of 01707 666399
barbs. As Marvin's signs were subtle and he Email:
qmhreception@rvc.ac.uk
was comfortable and able to open his mouth Post-contrast CT image
Autumn 2022 5