No More Tears for Tucker

Tucker is a bouncy, happy Springer Spaniel puppy that didn't actually look very happy before his surgery yesterday. ( I didn't get a picture before surgery, darn it. I'll try to remember when he comes in for his suture removal.) He was constantly tearing or crying in one eye-and certainly not because he had anything to be sad about. This puppy has great owners and when we pointed out the tears during his physical exam last month, they promised to watch the eye and note any changes. I showed them how Tucker's lower eyelid was rolling inward, a painful condition called entropion, which causes the eyelashes along the border of the lid to constantly rub on the sensitive cornea of the eye.

Entropion can have a genetic cause, and Springers are one of the breeds predisposed to the condition. Other breeds commonly affected are Boxer, Bull Mastiff, Cavalier King Charles Spaniel, Chesapeake Bay Retriever, Cocker Spaniel, English bulldog, Golden Retriever, Great Dane, Irish Setter, Labrador Retriever, Poodle, Pug, and St. Bernard. Chow Chows and Shar Peis have all those extra wrinkles in the skin, so they can have very severe forms of the condition, and left untreated, entropion can cause painful ulcers and erosions on the cornea that results in scarring and affects vision. Those pets with the heritable form of entropion should not be used for breeding. Entropion can also occur as a secondary condition resulting from scarring of the eyelid, infection, corneal spasms and pain, trauma, or nerve damage. Sometimes it happens after the eyelids lose their normal neurologic function.

Tucker was fortunate because only one lower lid was affected-entropion can often affect both eyes and both upper and lower lids. When we examined his eye, we applied a stain called fluorescein on his cornea. If there had been any defect on his cornea such as an ulceration from chronic eyelash rubbing, the stain would have glowed bright green when a black light was shown on the eye. Tucker's cornea was fine so far, so correction of the eyelid malformation should prevent that damage and subsequent pain.

Surgery is the only way entropion can be permanently corrected-essentially plastic surgery for dogs, although it is not an elective or cosmetic procedure. The hair is surgically clipped around the eye and the skin is scrubbed, protecting the delicate eye tissue. Then the excess skin is "pinched" between several hemostats, taking gradually bigger bites until the eyelid everts or rolls outward to a more normal position. We don't want to incorporate too much skin in the hemostats or we can cause ectropion, the opposite condition in which the eyelid is rolled outward. I really like the pinch technique because it allows me to see how the the anatomy of the lid will change after removing the incorporated tissue. After removing the hemostats, the pinched skin stays standing up; this is trimmed away (called a blepharoplasty) and the resulting skin incision is sutured closed with very tiny, silk sutures. Most dogs need to wear an e-collar or satellite dish on their heads to prevent rubbing the surgery site as it heals. Stitches are usually removed in 10 - 14 days and once the hair grows back, you usually can't see much of a scar at all.

There isn't much problem with recurrence of the entropion except for in the very wrinkled, extra-skinned dogs like Shar Peis. Some surgeons may take a conservative approach to the initial surgery, only taking a small amount of skin during the blepharoplasty. They believe they can always go back to take more skin at a later date if the lid needs to roll out more, but it wouldn't be possible to put it back if too much was removed the first time. Some dogs require systemic or topical antibiotics and all should have pain relief medications for at least a few days post op.

Tucker's surgery went very well. I believe the repair resulted in a more comfortable eye for him, and I know his owners will be watching him for any signs of problems. He also got neutered that day, so he definitely got some pain relief medications and a nice big e-collar. When he recovers he can go back to looking as happy as he actually is-no more crying by Tucker!

Peace,
DrReneigh