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Drowning 275

• Repeated cryotherapy can lead to qualita- • Keratitis in a vertical pattern that follows signs of irritation caused by trichiasis due to
tive tear film abnormalities secondary to the path of upper eyelid movement should entropion, nasal folds, or eyelid coloboma.
VetBooks.ir Recommended Monitoring • Magnification is needed commonly to Client Education Diseases and Disorders
meibomian gland damage.
raise suspicion of an ectopic cilium in the
upper eyelid.
• Distichiasis or trichiasis does not necessarily
require treatment.
Owners should monitor postoperatively for
signs of recurrent ocular irritation, which may identify ectopic cilia. Without magnification, • Animals with distichiasis, ectopic cilia, or
the diagnosis should not be ruled out based
indicate regrowth of offending hair(s). on absence of visualization. trichiasis should be monitored for signs of
• Ectopic cilia and distichiae will regrow in 4-5 ocular irritation.
PROGNOSIS & OUTCOME weeks with mechanical epilation/plucking. • Recurrence is possible regardless of treatment.
• No single treatment guarantees permanent
Generally good prognosis; however, recurrence resolution of distichiasis, ectopic cilia, or SUGGESTED READING
is possible regardless of treatment. trichiasis. Maggs DJ: The eyelids. In Maggs DJ, editor: Slatter’s
Fundamentals of veterinary ophthalmology, ed 5,
PEARLS & CONSIDERATIONS Prevention St. Louis, 2013, Elsevier.
Avoid breeding affected or closely related dogs.
Comments RELATED CLIENT EDUCATION
• Distichiasis and trichiasis are among the most Technician Tips SHEETS
common eyelid abnormalities. Distichiasis, ectopic cilia, and/or trichiasis
• Goal is not simply to diagnose distichiasis should be considered as a possible cause for How to Assemble and Use an Elizabethan Collar
or trichiasis, but to determine whether every dog that presents with a corneal ulcer.
abnormal hairs are causing ocular irritation. Closely evaluate the eyelid margin (distichiasis), AUTHOR: Shannon D. Boveland, DVM, DACVO
This finding will help determine if treatment palpebral conjunctiva over the meibomian EDITOR: Diane V. H. Hendrix, DVM, DACVO
is necessary. glands (ectopic cilia), and corneal surface for

Drowning

BASIC INFORMATION
ASSOCIATED DISORDERS Etiology and Pathophysiology
Definition Acute respiratory distress syndrome (ARDS • Pulmonary, fresh water: affects the surface-
Potentially fatal disorder characterized by [p. 27]) tension properties of pulmonary surfactant
asphyxia and possible progression to dysfunction Water intoxication (surfactant washout), leading to alveolar
of multiple organ systems due to submersion Hypernatremia, if accompanied by salt water instability, the possibility of noncardiogenic
in a liquid medium (typically water) ingestion (p. 498) pulmonary edema, and altered ventilation/
perfusion ratio. Because of the hypotonicity
Epidemiology Clinical Presentation of fresh water, aspirated fluid is generally
SPECIES, AGE, SEX DISEASE FORMS/SUBTYPES quickly absorbed into the circulation. If
Dogs and cats of either sex and any age; cats Aspiration of fresh versus salt water enough fluid is absorbed, hyponatremia
rarely venture into water but could accidentally causes hemolysis and altered mentation
fall into water or could be drowned maliciously. HISTORY, CHIEF COMPLAINT (p. 518).
There is almost always a known submersion • Pulmonary, salt water: elicits fluid influx
GENETICS, BREED PREDISPOSITION incident. If possible, it is helpful to obtain into the pulmonary parenchyma (osmotic
Some dogs are innately better swimmers (e.g., information regarding factors with potential gradient) and alveolar flooding; fluid
retrievers compared to bulldogs), which may prognostic importance (extrapolated from volume shift may be great enough to cause
improve their ability to swim to safety but human medicine): hypovolemia.
may also increase the risk of venturing into • Circumstances surrounding submersion • Cardiovascular effects: elevated systemic
unsafe waters. (severe internal injuries worsen prognosis) and pulmonary vascular resistance, cardiac
• Duration of submersion (prognosis worsens arrhythmias, and cardiac arrest are primar-
RISK FACTORS with increased time) ily due to hypoxemia. In humans, they
• Pre-existing disorders (orthopedic injury, • Tonicity and temperature of the water are positively related to the length of
neurologic dysfunction, visual deficits, (prognosis better with fresh/ice water) anoxic insult and negatively related to the
respiratory abnormality) can predispose • Apnea after rescue (prognosis better with effects of hypothermia and effectiveness of
an animal to fall into water or become spontaneous breathing) resuscitation.
submerged. • Immediate neurologic condition after rescue • Hepatocellular: hepatic ischemia (hypoxemia,
• Lack of adequate supervision: similar to small (prognosis worse with poor condition) hypoperfusion) causes direct hepatic injury
children, dogs should be supervised when and lobar necrosis.
swimming or near access to water. PHYSICAL EXAM FINDINGS • Hematologic: hypoxemia, vascular stasis, and
Depends on severity but may include wet fur, acid-base disturbances predispose animals to
GEOGRAPHY AND SEASONALITY collapse, dyspnea, tachypnea, tachycardia, bra- development of disseminated intravascular
Late autumn and early spring, when ponds and dycardia, cyanosis, hypoperfusion, hypothermia, coagulation.
lakes begin to freeze: increased risk of falling increased bronchovesicular breath sounds, or • Acute kidney injury: renal hypoxia contrib-
through the ice cardiac or respiratory arrest. utes to tubular cell death.

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