Page 1322 - Problem-Based Feline Medicine

1314 PART 15 CAT WITH EYE PROBLEMS

Clinical signs Clinical signs

Proptosis of the eye, with eyelid margins located Peri-orbital edema, hemorrhage and/or emphysema
behind the globe. associated with blunt trauma or surgery may result in
exophthalmos and increased globe prominence.
Subconjunctival hemorrhage.
Severe peri-ocular swelling, abnormalities in outline
Extra-ocular muscle tearing.
of the skull and/or proptosis of varying degrees may
Intra-ocular signs are variable. The pupil can be dilated occur as a sequel to trauma. Palpable zygomatic arch,
or constricted, but is more commonly dilated after vertical ramus of the mandible and/or frontal bone frac-
severe trauma, because of damage to the optic nerve and tures often evident.
or the long ciliary nerves. Hyphema may be present.
Orbital emphysema may be present associated with
trauma from a fall or motor car accident or following sur-
Diagnosis gery. Emphysema is most commonly caused by a fracture
of a bone lining one of the paranasal sinuses, in particu-
Diagnosis is obvious based on clinical signs.
lar the frontal sinus. Swelling is evident and there is
a fluctuant, “puffy” or crepitant feel on palpation of
Treatment peri-ocular tissues.
Irrigate the globe with a balanced electrolyte solution
to remove debris.
Diagnosis
Lubricate the cornea and bulbar conjunctiva with solu-
Diagnosis is usually based on the characteristic clini-
tions containing hypromellose, polyvinyl alcohol or
cal signs, and a history of possible frontal bone fracture.
carboxymethyl cellulose.
Plain skull radiography may show soft tissues dissected
Surgically attempt to replace the globe by manipula-
by air-containing compartments.
tion of the eyelid margins. Often orbital soft tissue
swelling makes this difficult. A technique using pre-
placed tarsorrhaphy sutures has been described: THE CAT WITH REDUCED GLOBE SIZE
● 4/0 or 5/0 polypropylene or nylon sutures are inserted
OR PROMINENCE
by passing through the dorsal and ventral eyelid.
● A flat object (e.g. scalpel handle) is placed on the
corneal surface under the row of pre-placed sutures ENOPHTHALMOS SECONDARY TO
with sufficient lubricant to protect the cornea. ORBITAL FAT LOSS OR MUSCLE
● The sutures are tightened over the scalpel handle to WASTAGE**
force the globe back into the orbit, at the same time,
the eyelids are brought together and the sutures are Classical signs
tied to effect a temporary tarsorrhaphy, which can
● Globe is caudally displaced into the orbit.
be left in place for 1–2 weeks, until peri-ocular and
● ± Entropion especially of the lower lid.
orbital swelling is resolved.
● Generalized atrophy of facial muscles and
prominence of zygomatic arch.
FRACTURES OF THE BONES AROUND THE ● Associated generalized poor body
ORBIT OR ORBITAL EMPHYSEMA* condition.

Classical signs
Pathogenesis
● Orbital swelling.
● Fluctuant, puffy or crepitant feel on Loss of orbital fat caudal to the globe secondary to
palpation. weight loss, or generalized muscle wastage causes
caudal movement of a normal-sized globe.