Page 692 - Cote clinical veterinary advisor dogs and cats 4th

318 Eyelid Defects: Trauma, Masses

• A premium, highly digestible maintenance PEARLS & CONSIDERATIONS Technician Tips
diet is sufficient. Comments Serum TLI assays are species specific, and
VetBooks.ir Possible Complications • Some patients may not respond to enzyme species designation can lead to a false diagnosis
submitting a serum sample with the incorrect
replacement therapy and cobalamin supple-
of EPI.
Enzyme supplementation can lead to oral
bleeding in ≈10%-20% of patients:
○ Many of these patients have concurrent
• Oral bleeding will stop in most of these mentation alone. SUGGESTED READING
patients after a reduction of the dose. small-intestinal disease (i.e., small- Steiner JM: Exocrine pancreas. In Steiner JM, editor:
• Patients rarely develop bleeding diathesis intestinal dysbiosis and/or inflammatory Small animal gastroenterology, Hannover, Germany,
due to vitamin K deficiency, which must bowel disease). 2008, Schlütersche Verlagsgesellschaft, pp 283-306.
be treated with vitamin K supplementation. ○ If concurrent disease cannot be identi-
fied, gastric acid inhibition can be tried AUTHOR: Jörg M. Steiner, Dr. med. vet., PhD,
Recommended Monitoring (omeprazole 0.7-1.0 mg/kg PO q 12h has DACVIM, DECVIM, AGAF
EDITOR: Keith P. Richter, DVM, MSEL, DACVIM
Body weight and fecal quality been most useful).
• Fresh-frozen raw pancreas can also be used
PROGNOSIS & OUTCOME for enzyme replacement therapy (1-2 oz
[30-60 g] of ground raw pancreas equals
Most patients with EPI respond to therapy and about 1 tsp of powdered pancreatic extract).
have a normal life.

Eyelid Defects: Trauma, Masses Client Education
Sheet

BASIC INFORMATION Eyelid mass: the palpebral conjunctiva associated with
• Blepharitis (eyelid inflammation) the meibomian gland.
Definition • Conjunctivitis • Ocular discharge, blepharospasm, conjunc-
Eyelid trauma is associated with any injury • Corneal ulceration tivitis, keratitis if mass irritating the eye
to the eyelid predisposing to inflammation or Clinical Presentation • Eyelid hemorrhage
laceration. Eyelid masses are very common and • Lagophthalmos (incomplete closure of the
are associated with neoplastic or inflammatory HISTORY, CHIEF COMPLAINT eyelids)
conditions. Eyelid trauma:
• Witnessed traumatic event Etiology and Pathophysiology
Synonyms • Swollen eyelid(s) (blepharedema) • Eyelid trauma is generally associated with
• Chalazion: hordeolum, meibomian gland • ± Eyelid laceration blunt trauma, fight with other animal, pen-
cyst Eyelid mass: etration by sharp objects, or self-mutilation
• Meibomian glands: tarsal glands, palpebral • Growth on eyelid and/or eyelid margin (pawing at eye).
glands • Persistent or intermittent bleeding of eyelid • Eyelid mass (neoplastic)
• Signs of ocular pain if mass is large and ○ Common in dogs; most are benign.
Epidemiology causing conjunctival and/or corneal irritation ○ Rare in cats; most are SCC (malignant)
SPECIES, AGE, SEX • Ocular discharge or mast cell tumors.
• Dogs and cats ○ Similar to those of the skin; arise from
• Eyelid trauma may occur at any age. PHYSICAL EXAM FINDINGS epithelial, mesenchymal, and melanogenic
• Eyelid mass: average age 9-10 years (eyelid Eyelid trauma (some or all of the following): cells
neoplasia, dogs) but depends on type of mass • Blepharedema ○ In dogs, 82% of eyelid neoplasms are
• Eyelid laceration (partial or full thickness) sebaceous adenomas, papillomas, or
GENETICS, BREED PREDISPOSITION • Blepharospasm melanomas.
• Eyelid trauma: more common in young • Ocular discharge/hemorrhage ○ Sebaceous gland tumors (sebaceous
animals, outdoor animals, and sporting • Conjunctival hyperemia/edema (chemosis) adenoma, sebaceous epithelioma, and
breeds of dogs • Keratitis (ulcerative or nonulcerative) sebaceous adenocarcinoma) arise from
• Eyelid mass (dogs): more common in American Eyelid mass (some or all of the following): the meibomian glands.
cocker spaniel, boxer, poodle, golden retriever, • Mass located along eyelid margin or adjacent • Focal eyelid inflammation: a chalazion is
Labrador retriever, English springer spaniel, to margin of eyelid a pyogranuloma associated with retained
beagle, collie, Siberian Husky, and English setter • Size, location, and appearance vary with type meibomian gland secretions.
of mass
RISK FACTORS ○ Neoplasm associated with the meibomian DIAGNOSIS
Excessive sunlight and white hair in the gland appears as an irregular, raised,
periocular region predispose to squamous cell variably sized mass ± pigment on the Diagnostic Overview
carcinoma (SCC), the most common eyelid eyelid margin that may extend into the • The diagnosis of eyelid trauma is suspected
neoplasm in cats. eyelid. based on the presence of blepharedema and/
○ SCC appears as an erosive, ulcerated mass or acute blepharitis with or without ocular
ASSOCIATED DISORDERS along the eyelid, often near the medial discharge/hemorrhage.
Eyelid trauma: canthus. • The diagnosis of an eyelid mass is suspected
• Corneal/scleral trauma ○ Chalazion (meibomian gland cyst) is a based on the presentation of a mass-type
• Uveitis smooth, raised, yellow to white mass on lesion or swelling adjacent to or along the

www.ExpertConsult.com