Eye ulcer post-dental

Re: Eye ulcer post-dental

Gerry Henry — Sun, 01 Dec 2013 17:45:31 GMT

[quote user="Martin Atkinson"]

[quote user="Gerry Henry"]

Lubrithal always, corneal eye shields if we think necessary.

[/quote]At what point would you consider shields 'necessary'? I confess I've not heard of corneal shields let alone use or know where to get them. Even the dentist in here appears not to use them. The majority do nothing or maybe put in some lubrigel. I generally do nothing special and never get any problems. My nurses use lubrithal for long operations where the cornea may dry out, dentals are normally quick and the lubrithal will not prevent a secondary infection, I don't recall any corneal complications ever in any procedure whether I've used lubrithal or not.. I think this is more important to the OP's case than the exception of using shields

[/quote]

Sorry Martin, been busy; Ellman make lovely eye shields; reusable, would put one in if working close to the eye, avoids inadvertent trauma.

Re: Eye ulcer post-dental

Mark Hedberg — Thu, 14 Nov 2013 19:40:00 GMT

[quote user="Anthony Dennison"]

[quote user="Robert Lowe"]It shouldn't be applied as a drop unless you think that using a hand grenade is a successful method of going fishing.[/quote]

I actually love this sentence! Will need to find somewhere in life I can use it

[/quote]

Hands up if anyone thought of Crocodile Dundee II!

Re: Eye ulcer post-dental

Kate Richardson — Thu, 14 Nov 2013 16:48:07 GMT

[quote user="Anthony Dennison"]

[quote user="Robert Lowe"]It shouldn't be applied as a drop unless you think that using a hand grenade is a successful method of going fishing.[/quote]

I actually love this sentence! Will need to find somewhere in life I can use it

[/quote]

Me too! I laughed out loud when I read it (is that LOL'd in text speak??)

Re: Eye ulcer post-dental

Anthony Dennison — Thu, 14 Nov 2013 14:56:53 GMT

[quote user="Robert Lowe"]It shouldn't be applied as a drop unless you think that using a hand grenade is a successful method of going fishing.[/quote]

I actually love this sentence! Will need to find somewhere in life I can use it

Re: Eye ulcer post-dental

Robert Lowe — Thu, 14 Nov 2013 14:16:53 GMT

My approach is to think what will improve the corneal health so that the eye can heal (there are no drops that we can give that will speed up re-epithelialisation of an ulcer)

Proxymetacaine - delays re-epithelialisation, therefore I don't use unless the eye is painful enough that trauma is more of a concern e.g. an entropion with a secondary ulcer that can't have surgery for a few days.

If an animal rubs the eye and the epithelium comes away it probably wasn't healthy epithelium in the first place so I don't concern myself about self trauma delaying healing that much

Equally if the animal is painful then I use systemic NSAIDs. I haven't appreciated a noticeable delay in healing.

As a reply to AT:

Phenol - superficial erosion only! I still use it quite happily for the typical Boxer ulcer. Applied with a cotton tip id does not need flushing afterwards. It shouldn't be applied as a drop unless you think that using a hand grenade is a successful method of going fishing.

We routinely use steroid post cataract surgery - they are excellent at controlling uveitis and the incisions are peripheral enough to not be a concern when it comes to healing. We don't as a rule use them in ulceration.

Re: Eye ulcer post-dental

Rob Loxley — Wed, 13 Nov 2013 14:07:16 GMT

[quote user="Anthony Todd"]Now the steroidophobes will leap in[/quote]

Sounds sensible to pre-empt any uveitis from poking around inside the globe. Not sure I'd be using steroids in our usual ulcers though.

[quote user="Anthony Todd"]Has the local phenol application to chronic corneal ulcers died out?[/quote]

For 'indolent'/'boxer' ulcers then remains an option, just be careful and flush out well. For the OP who describes a deep ulccer close to rupture I'm not sure it's appropriate...

Re: Eye ulcer post-dental

Anthony Todd — Wed, 13 Nov 2013 11:14:34 GMT

[quote user="Yantha Smyth"] I also understood local anaesthetic drops to slow healing,[/quote]

Not as much as one abrasive single misplaced rub....

And you'd make sure the local was applied as and when necessary only [or one minute before the devastating rub].

Do systemic NSAIDs really diminish the pain of a corneal ulcer significantly?

After my wife's cataract lens replacements she was put on dexamethasone drops....

Now the steroidophobes will leap in.

Has the local phenol application to chronic corneal ulcers died out?

Re: Eye ulcer post-dental

Yantha Smyth — Tue, 12 Nov 2013 21:36:25 GMT

[quote user="Thomas Johnson"]

[quote user="Kate Richardson"]

I thought this slowed healing? And I would also be concerned that reduced sensation could cause the ulcer could get much worse if they rubbed at it.

[/quote]

I haven't found that it slows healing, and it greatly reduces any pruritis so they attempt to rub the eye much less.

[/quote] I also understood local anaesthetic drops to slow healing, and also topical NSAIDs, but that systemic NSAIDs ok.

Re: Eye ulcer post-dental

Gillian Mostyn — Tue, 12 Nov 2013 21:08:10 GMT

my grandma had a perforated melting ulcer this year.....extremely painful and she was dispensed local anaesthetic drops alongside the myriad other meds..........

Re: Eye ulcer post-dental

James Laidlaw — Tue, 12 Nov 2013 20:17:48 GMT

I think proxymetacaine can cause problems with ulcers with regular use. Quick check on vin shows no major problems with single use but daily use can cause problems so probably not ideal. Don't think there's an ideal situation, I tend to use NSAIDs when required personally.

Re: Eye ulcer post-dental

Gillian Mostyn — Tue, 12 Nov 2013 20:07:17 GMT

[quote user="Kate Richardson"]I thought this slowed healing? And I would also be concerned that reduced sensation could cause the ulcer could get much worse if they rubbed at it.[/quote]

I also dispense proxymetacaine sometimes for the first couple of days. I expect dogs are far more likely to rub the eye if it hurts - which will delay healing far more.

Re: Eye ulcer post-dental

Thomas Johnson — Tue, 12 Nov 2013 18:48:16 GMT

[quote user="Kate Richardson"]

I thought this slowed healing? And I would also be concerned that reduced sensation could cause the ulcer could get much worse if they rubbed at it.

[/quote]

I haven't found that it slows healing, and it greatly reduces any pruritis so they attempt to rub the eye much less.

Re: Eye ulcer post-dental

Kate Richardson — Tue, 12 Nov 2013 18:28:07 GMT

[quote user="Anthony Dennison"]

[quote user="Thomas Johnson"]I will use oral NSAIDs for a few days if eyes are painful, but also sometimes send owners home with Minims Proxymetacaine drops to put in the eye.[/quote]

Ooh, I like this idea!

[/quote]

I thought this slowed healing? And I would also be concerned that reduced sensation could cause the ulcer could get much worse if they rubbed at it.

Re: Eye ulcer post-dental

Anthony Dennison — Tue, 12 Nov 2013 18:00:40 GMT

[quote user="Thomas Johnson"]I will use oral NSAIDs for a few days if eyes are painful, but also sometimes send owners home with Minims Proxymetacaine drops to put in the eye.[/quote]

Ooh, I like this idea!

Re: Eye ulcer post-dental

Thomas Johnson — Tue, 12 Nov 2013 17:20:18 GMT

[quote user="Lucy Fleming"]What are you using for analgesia if staying away from systemic nsaids? I had (anthropomorphism alert!) a small corneal ulcer a while back and it was incredibly painful (though shallow enough to have healed within 48 hours), so I now insist on patients with ulcers having oral metacam to go home...

[/quote]

I will use oral NSAIDs for a few days if eyes are painful, but also sometimes send owners home with Minims Proxymetacaine drops to put in the eye.

Re: Eye ulcer post-dental

Anthony Dennison — Tue, 12 Nov 2013 17:01:11 GMT

They will get meloxicam for the first few days when it is acutely painful (shown by blepharospasm), then at the first recheck, stop. Never seem to be painful after this. But, if I am wrong and NSAIDs don't affect ulcer healing, I will keep them on it

Re: Eye ulcer post-dental

Lucy Fleming — Tue, 12 Nov 2013 16:48:56 GMT

What are you using for analgesia if staying away from systemic nsaids? I had (anthropomorphism alert!) a small corneal ulcer a while back and it was incredibly painful (though shallow enough to have healed within 48 hours), so I now insist on patients with ulcers having oral metacam to go home...

Re: Eye ulcer post-dental

Gillian Mostyn — Tue, 12 Nov 2013 15:15:49 GMT

[quote user="Martin Atkinson"]dentals are normally quick[/quote]

really?

Re: Eye ulcer post-dental

Anthony Dennison — Tue, 12 Nov 2013 14:18:58 GMT

As we're discussing eye ulcers...

What is the general consensus of using systemic NSAIDs when treating eye ulcers? I remember being told when seeing practice that using NSAIDs whilst treating corneal ulcers can slow healing, so if using them only use for the first 3 or 4 days. Anecdotally I have found that ulcers do seem to heal a little quicker when the NSAID has stopped/not been used at all.

Re: Eye ulcer post-dental

Martin Atkinson — Tue, 12 Nov 2013 10:36:43 GMT

[quote user="Gerry Henry"]

Lubrithal always, corneal eye shields if we think necessary.

Re: Eye ulcer post-dental

Glenn Hodgson — Mon, 11 Nov 2013 18:03:32 GMT

we have a if x% over est. will endevour to contact you etc etc. i likeyour complications information. i think we may rejig the form.

thanks

Re: Eye ulcer post-dental

Anthony Dennison — Mon, 11 Nov 2013 16:44:54 GMT

[quote user="Glenn Hodgson"]I recently had an owner hugely upset about their £7 trimacare fee that cam with their extra 100% discounted post op consultation. to clear lick pyoderma post crtpt cast. they were of the opinion that ops should be all inclusive and wouldnt acknowledge that things could be any other way. even if all clear in detailed Estimate stating this.[/quote]

I've been stung with this before. On our consent forms there are two points where complications may require further costs, I always read them out and explain, even for routine ops.

Re: Eye ulcer post-dental

Glenn Hodgson — Sun, 10 Nov 2013 20:34:38 GMT

lubithral every ga and sed with us.

often repeated through procedure depending on length of procedure and head shape. alsolike head resring on towel/vetbed..

I recently had an owner hugely upset about their £7 trimacare fee that cam with their extra 100% discounted post op consultation. to clear lick pyoderma post crtpt cast. they were of the opinion that ops should be all inclusive and wouldnt acknowledge that things could be any other way. even if all clear in detailed Estimate stating this.

thankfully mild ailment but even mild things can be a frustration.

Am going to talk to her in hinddite now she is not woreying about her dog and see hiw goes/if she can maintain her registration woth us.

Re: Eye ulcer post-dental

Gerry Henry — Sun, 10 Nov 2013 16:53:12 GMT

Lubrithal always, corneal eye shields if we think necessary.

Re: Eye ulcer post-dental

Dave Cumber — Sat, 09 Nov 2013 11:39:29 GMT

Thanks for all the replies. I have not cultured from the ulcer as the antibiotic drops have been put in so frequently that I did not think it would be worthwhile. The consensus seems to be that it is probably a wise precaution to be applying lubrication to eyes during all ops but that it probably would not have made any difference in this case. Thanks again.