November 2023 41 Regulars I Ophthalmology Column After performing many of these procedures over the years the following are my top tips: 1. Outspoken entropion with severe corneal disease needs to be managed immediately or else globe perforation could occur. 2. This is probably one of the most common surgeries resulting in owner dissatisfaction as a result of poor choice of surgical technique or outcome. If you feel you are not competent in achieving a good surgical result then this should be a referral case. 3. Always ensure the client understands the post-surgical expectations [functionality and cosmetic outcome]. 4. Hopefully, the surgical procedure will be a “once-off” surgery but it is not uncommon that further surgeries may be required if the facial confirmation of the patient is really bad. [usually large breed dogs with very loose facial skin]. Explain this before the first surgery! 5. Make sure the owner is prepared for some cosmetic changes to the face/expression in some cases. 6. Having some visible fornix conjunctiva or bulbar conjunctiva visible after surgery may not necessarily be a bad thing and, in fact, probably will be beneficial a few weeks later when the surgical site has settled. 7. Be prepared to use an Elizabethian protective collar to prevent rubbing and further damage or even construct custom-made firmer collars from plastic pot plant holders. 8. Be prepared to clean some discharge and crustiness from around the eyelids. Husbandry is important in many of these cases. 9. May require the use of Trazodone or Gabapentin to reduce the dogs’ activity post-operatively. We are using this more commonly in very active and boisterous large-breed dogs. 10. Make the skin incisions with a scalpel blade and then remove the excess skin with scissors. This seems to ensure a better smooth and uniform base versus multiple hacking with the blade to remove the skin fragment. 11. Eversion of the eyelid will only occur when the skin incision is made just a few millimetres caudal to the tarsal margin. Making the skin incision far from the tarsal margin does not create the eversion that is required. 12. Suture material can be Vicryl or Nylon. Ensure no suture tips are going to make contact with the cornea. v
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