Page 1414 - Cote clinical veterinary advisor dogs and cats 4th

716 Orbital Diseases

melanomas may be amelanotic (unpig- Technician Tips periodic exam of the oral cavity as well as
mented). Malignant tumors other than • Technicians are on the front line of identify- • Animals adapt remarkably well after radical
routine dental care.
VetBooks.ir if the patient’s oral mucosa is normally cleanings. Do a complete oral exam on each resection of oral tumors (mandibulectomy
ing oral tumors during professional dental
melanoma may be partially pigmented
pigmented.
or maxillectomy), although one study noted
anesthetized patient, including the sublingual
• Removal of regional lymph nodes may be
beneficial at the time of oral surgery. A single area, palate, and tonsils. Bring all identified that 12% of cats did not regain the ability
to eat on their own.
oral masses to the attention of the clinician
surgical approach to parotid, mandibular, for possible biopsy under the same anesthetic • Altered cosmesis is usually well accepted
and medial retropharyngeal lymph nodes episode. by owners if masticatory function can be
has been described. • Provide as much information as possible restored. Clients should be shown before
• If the biological behavior of a tumor does on histopathologic forms. Include size (in and after pictures of similar surgical cases
not match histopathologic results, the biopsy three dimensions), surface characteristics to ensure their understanding of cosmetic
should be reread or retaken. A type of (ulcerated, smooth, verrucous), complete changes.
fibrosarcoma exists that appears histologically history, and specific location of tumors. • Lymph node aspirates and thoracic radio-
benign but is biologically (clinically) very When an excisional biopsy is performed, graphs are important for preoperative staging,
aggressive. ask the pathologist to evaluate the but microscopic metastasis cannot be totally
• Nonhealing dental extraction sites, particu- specimen for evidence of clean or dirty ruled out by these tests.
larly in cats, may be a clinical manifestation margins.
of SCC; biopsy any suspicious tissues at the SUGGESTED READING
time of extraction. Client Education Bertone ER, et al: Environmental and lifestyle risk
• Dehiscence and inappropriate healing often • Complete surgical removal of oral tumors factors for oral squamous cell carcinoma in domestic
occur when oral surgery is performed on provides the best long-term prognosis. cats. J Vet Intern Med 17:557, 2003.
irradiated sites. Tumors that are detected early are likely to be
• Oral tumors in cats are more often malignant operable. Advise new pet owners to acclimate AUTHOR: John R. Lewis, VMD, FAVD, DAVDC
EDITOR: Alexander M. Reiter, DVM, Dr.med.vet.,
than benign. puppies and kittens to feel comfortable with DAVDC, DEVDC

Orbital Diseases Client Education
Sheet

BASIC INFORMATION Labrador retrievers (masticatory myositis); PHYSICAL EXAM FINDINGS
extraocular polymyositis is more common Bilateral or unilateral:
Definition in golden retrievers. • Exophthalmos with any of the following:
Orbital diseases encompass several conditions • Craniomandibular osteopathy is more ○ Reduced ability or inability to retropulse
that frequently lead to an abnormal position of common in West Highland white terriers. the globe in the orbit
the eye in the orbit. These abnormal positions • Congenital strabismus may be seen in Akita ○ Lagophthalmos with or without corneal
include exophthalmos (rostral displacement of and Shar-pei dogs, as well as in Siamese and ulceration
the eye), enophthalmos (caudal displacement some shorthair cats. ○ Third eyelid protrusion
of the eye), and strabismus (deviation of ○ Conjunctival hyperemia, chemosis
the axis of the resting eye position). Orbital ASSOCIATED DISORDERS ○ Exposure keratitis (corneal neovasculariza-
diseases can be congenital or acquired and have Masticatory myositis (exophthalmos or tion, corneal edema, corneal ulceration)
vascular, inflammatory, traumatic or neoplastic enophthalmos) ○ Periocular swelling
causes. Exophthalmos: ○ Pain on opening the mouth (orbital
• Head trauma (proptosis) abscess/cellulitis; myositis)
Synonyms • Nasal or metastatic neoplasms (and/or ○ Blindness (especially with proptosis)
Exophthalmia, enophthalmia, retrobulbar strabismus) • Enophthalmos with any of the following:
disease, orbital or retrobulbar abscess and/ • Dental disease ○ Third eyelid protrusion
or cellulitis, orbital neoplasia, retrobulbar • Pharyngeal abscess (p. 6) ○ Ptosis (drooping upper eyelid)
neoplasia • Systemic mycoses ○ Miosis
Enophthalmos: ○ Corneal ulceration
Epidemiology • Facial fractures ○ Corneal edema, aqueous flare, hypopyon,
SPECIES, AGE, SEX • Primary ocular diseases (i.e., corneal ulcer- fibrin clot, hyphema (uveitis)
• Orbital abscess and cellulitis are more ation, uveitis) ○ Extraocular and/or masticatory muscle
common in younger animals. • Horner’s syndrome atrophy
• Orbital neoplasia is more common in older • Emaciation ○ Entropion
animals. • Dehydration (severe) ○ Emaciation (loss of orbital fat results in
• Tetanus enophthalmos)
GENETICS, BREED PREDISPOSITION • Strabismus
• Ocular proptosis is more common in Clinical Presentation ○ Deviation of the eye(s): dorsal, ventral,
brachycephalic breeds. HISTORY, CHIEF COMPLAINT medial, lateral, or a combination of these
• Myositis is more common in German shep- Sudden or progressive change in position of the eye positions
herds, Weimaraners, golden retrievers, and eye; abnormal eye position from birth ○ ± Exophthalmos or enophthalmos

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