OPHTHALMOLOGY
A Guide to When Can (or Can’t )
The Eye be Saved?
Dr Ramona Allen
BSc (Med) Hons BVSc (Oph-
thalmology Resident)
Johannesburg Animal Eye
Hospital
To enucleate or not to enucleate? This might just
be one of the most common questions we, as vets,
are faced with on a daily basis. Questions that need
to be addressed are “Can the eye be saved?” and if
the answer is yes, the one needs to ask “Is this eye
visual?”.
Retaining a non-visual, blind eye for aesthetic purpos-
es provided the patient is comfortable and non-painful
is perfectly acceptable. Our clients are often reluctant
for an enucleation procedure as the visual appearance
can be fairly astounding, especially in horses which
have a particularly prominent, bony socket.
On the contrary, to retain a non-visual eye that is
chronically painful due to lack of or poor response
to treatment should be considered nothing short of
animal abuse! A good comparison would be in hu-
man patients with chronic glaucoma who say the pain
feels like they have a permanent migraine. I think I can
safely say that neither Bella, Garfield or Fido would ap-
preciate that.
We are all familiar with the phone calls that regularly
come through to our practices asking “My dog has
……, do I need to bring him or her in?”. I am sure we all
agree some things can wait and others simply can’t!
When it comes to ocular cases, I certainly tend to
push clients for a consult sooner than other cases, as
I genuinely feel many eyes could have been salvaged
had they been seen earlier.
So what I’m trying to is that, sometimes (just some-
times) clients are to be believed when they say that
this just happened overnight. Conditions such as
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melting ulcers and anterior lens luxations really can
go from bad to worse in the space of few a few hours.
The ocular emergencies that GP vets see are actually so
much more common than one would have thought.
Some cases are chronic conditions, which have now
gotten worse overnight such as a KCS patient which
has now developed a desmetocoele, whereas others
are truly acute onset emergencies such as acute on-
set blindness. Either way here we shall discuss and,
hopefully, give some practical advice to interpreting
such cases.
In short, common reasons for enucleation include:
1. Perforated or ruptured globe
2. Glaucoma which cannot be medically controlled
3. Ocular or retrobulbar neoplasia
4. Unrelenting infection or inflammation of the eye [eg:
chronic ulcers related to severe dry eye where there
is no patient or client compliance]
5. Severe proptosis
6. Phthisis bulbi [shrivelled up, end stage eye]
7. Certain ocular birth defects
The following is a brief guideline to salvage, sacrifice
and enucleation in a few commonly encountered
ophthalmic conditions:
PROPTOSIS (Fig 1)
Salvage if:
• Proptosis is mild
• One or no extraocular muscles are damaged
• Pupil miotic or good direct pupillary reflex [DPR] and
consensual reflex [CPR] from the other eye