Thorn in the eye - help!

Re: Thorn in the eye - help!

ruths — Thu, 21 May 2015 13:45:16 GMT

That makes sense, I usually get owners to out the heel of their hand laterla to the eye when they are putting drops in for the same reason.

I hadn't thought of that.

i had retractors to hold my lids open, but I knew what was coming -))

Re: Thorn in the eye - help!

Robert Lowe — Thu, 21 May 2015 13:37:32 GMT

[quote user="ruths"]

I can testify to the fantastic properties of local on the cornea. I've had a number of treatments and never felt a thing after a shedload of local. I resume you have a nurse holding the eyelids open too, Robert.

[/quote] No nurse unless a really wriggly. I find it easier to hold the eyelids apart and control the movement of the head with my other hand than rely on someone else as I can pick minor head movements and work with them.

Re: Thorn in the eye - help!

ruths — Thu, 21 May 2015 12:43:38 GMT

Re: Thorn in the eye - help!

Vikki Halliday LLB — Thu, 21 May 2015 12:33:08 GMT

I may just be brave enough to try this with the next one that comes along...

Re: Thorn in the eye - help!

Martin Atkinson — Wed, 12 Feb 2014 18:07:44 GMT

[quote user="Robert Lowe"]However, its not something that I would recommend doing without extensive experience.[/quote]A well known orthopaedic vet from Essex whose opinion of himself was possibly greater than that of his peers and whose name rhymed with Liz Hurley, once pronounced in a CPD lecture on ophthalmology that he always removed corneal foreign body's like thorns by positioning the nozzle of a syringe over it and applying suction. Works every time apparently, The rest of us cringed and reflected that perhaps his ophthamological skills were not as great as his sxelf proclaimed orthopaedic ones. But is there any genuine mileage in that method?

Re: Thorn in the eye - help!

Michael Woodhouse — Tue, 11 Feb 2014 23:56:35 GMT

(I can sedate with dom and torb and remove the thorn for a chunk less than our nearest eye referral place's first consult )

Re: Thorn in the eye - help!

Evelyn Barbour-Hill — Tue, 11 Feb 2014 23:44:47 GMT

[quote user="Robert Lowe"]

[quote user="Evelyn Barbour-Hill"]Quite so, and I'm not doubting your skill, but........ why not just do a quick GA?[/quote]

It might make it more difficult due to eye position and I really don't see it as necessary in my hands. It is after all just a splinter removal and I was using it as an example of how referral might be cheaper for the client as the OP had said that cost was an issue.

[/quote]

OK, I see. I take your point about eye position.

In general, though, I'm not sure I see that a GA has to add an awful lot to costs.

Re: Thorn in the eye - help!

Robert Lowe — Tue, 11 Feb 2014 23:22:42 GMT

[quote user="Evelyn Barbour-Hill"]Quite so, and I'm not doubting your skill, but........ why not just do a quick GA?[/quote]

Re: Thorn in the eye - help!

Evelyn Barbour-Hill — Tue, 11 Feb 2014 23:08:25 GMT

[quote user="Robert Lowe"]

[quote user="ChrisBVSc"]How do you manage this? I'd be far too worried about even a well-held dog jerking its head just as I've put the needle up against the eye![/quote]

Time, peace and quiet, excellent nursing staff,close apposition of my hand to the dog's head and an understanding of how a dog moves it head when it jerks away.

Dogs usually move up and laterally so if you approach from ventromedially then the eye will "always" move away from the needle.

However, its not something that I would recommend doing without extensive experience.

[/quote]

Quite so, and I'm not doubting your skill, but........ why not just do a quick GA?

Re: Thorn in the eye - help!

Robert Lowe — Tue, 11 Feb 2014 22:58:43 GMT

[quote user="ChrisBVSc"]How do you manage this? I'd be far too worried about even a well-held dog jerking its head just as I've put the needle up against the eye![/quote]

Time, peace and quiet, excellent nursing staff,close apposition of my hand to the dog's head and an understanding of how a dog moves it head when it jerks away.

Dogs usually move up and laterally so if you approach from ventromedially then the eye will "always" move away from the needle.

However, its not something that I would recommend doing without extensive experience.

Re: Thorn in the eye - help!

Nicola Lawlor — Tue, 11 Feb 2014 22:34:33 GMT

Thank you all for the advice :-)

Re: Thorn in the eye - help!

ChrisBVSc — Tue, 11 Feb 2014 21:39:15 GMT

[quote user="Robert Lowe"]

As per Michael, removal with a needle is the way forward. I do 99% under local anaesthesia and loupes magnification during the initial consultation if I am happy that the foreign body is not full thickness. Chris J is absolutely right to be aware of lens damage if there is any sign of penetration.

[/quote]

How do you manage this? I'd be far too worried about even a well-held dog jerking its head just as I've put the needle up against the eye!

Re: Thorn in the eye - help!

Robert Lowe — Tue, 11 Feb 2014 20:04:59 GMT

I would also like to point out that sometimes it appears that there is a foreigin body in there with the naked eye but this is just the change in corneal refraction at the site of a previous foreign body injury. If you are not sure and the eye is comfortable and fluorescein negative then I would leave it alone.

As an aside - As I do most under local and during the consult referral is often cheaper than sedation/GA removal for the client ;)

Re: Thorn in the eye - help!

ChrisBVSc — Tue, 11 Feb 2014 18:16:20 GMT

Another +1 for the orange needle approach. I've only done a few but they've all been fine and fluor -ve within a couple of days. Magnification really helps, last one I did wasn't really possible without - tiny FB, we have some basic goggles rather than proper loupes but they work quite well. I did go on an eye course a while ago and was told if there's a small hole with aqueous leakage you can just place a corneal suture to close it - haven't had to do it yet though. Apparently you can also plug small corneal defects with tissue glue but as far as I know you need a special glue, NOT the standard tissue glue used for skin. Happy to be corrected if I'm wrong.

Chris.

Re: Thorn in the eye - help!

Alet Engelbrecht — Tue, 11 Feb 2014 17:35:02 GMT

Had a similar situation a while back. It did leak a little bit, put mild pressure on it with a cotton bud and tried to phone a friend (Kim). By the time I got hold of her, the leakage stopped and all was well. Apparently a small hole like that is rarely anything to worry about!

Good luck!

Re: Thorn in the eye - help!

Anonymous — Tue, 11 Feb 2014 16:51:37 GMT

check how deep its going, is there uveitis (likely) is there any blood in the anterior chamber, be careful of lens capsule damage . Blackthorns cause huge amounts of corneal necrosis and may end up dealing with the hole as you would a melt.

They are as has already been said generally easy enough to remove, sedate or ga but make sure its v asleep. local anaesth may help. ideally magnification but isnt always essential if you have good vision (good lighting also). use a needle (orange) bevel as you would be doing an iv injection 90degrees to fb (sometimes they are below the surface and you may have to 'dig' a trench to get to it). spike the fb from the side and lift it free. DONT try to grab it with even the finest forceps you run the risk of pushing it deeper. lift it free, at this point if its full thickness you may get a release of aqueous but dont panic. it will stop if its a small hole and fill with a fibrin clot. You may also get some iris bleeding unfortunately, I often premed with topical acular which may help but I think the bleeding is inevitable due to the inflmn and the pressure change. I'm not sure if there is anything else that you could do to reduce this , open to other opinions. The blood as long as its a small amount will reabsorb in time.

The hole will close (as long as its small ) and you could apply a bandage lens (dont like nm flaps as you cant monitor it) to protect it and help the seal but may not be needed. topical antibiotic (fuci) possibly acular +/- atropine if uveitis but care, may need more aggressive treatment if it is a melt possibly needing a conj graft. If its full thickness but not melting I would tend to use 5 days fuci, topical acular, oral; abs and nsaids just as a cover and reassess after a couple days and it should be fine. if its melting treat as a melt more aggressively.

dont panic take it slow and steady and it'll be fine just watch for lens damage and pushing it deeper and into the anterior chamber because then it becomes a bit of a pain to deal with. if its pround of the surface and you spike and lift from 90degrees it will come out, sometimes they can be well embedded though.

good luck

chris

Re: Thorn in the eye - help!

mariette asselbergs — Tue, 11 Feb 2014 16:04:00 GMT

+1 Often seen and done in my first job on an island in the North of Holland. Tourist dogs racing through the dunes used to come in with thorns in their cornea's and my very practical colleague taught me to do it as described by Michael. Not scraping so much at popping it out with the tip of the needle underneath the thorn.

Mariette

Re: Thorn in the eye - help!

Kirsten Simpson — Tue, 11 Feb 2014 15:10:50 GMT

Ditto. I've done a few (cats and dogs) and they have all done well. I get a bit freaked out trying to "ping" it out and panic that I'm going to go through the cornea, but I haven't yet. I#' only refer if it was obv full thickness penetration (unless they wanted eye out)

Re: Thorn in the eye - help!

Andrew Mellor — Tue, 11 Feb 2014 13:49:39 GMT

absolutely agree with Michael , i would do as he does and leakage is generally surprisingly little.

Re: Thorn in the eye - help!

Michael Woodhouse — Tue, 11 Feb 2014 12:44:34 GMT

Just a bog standard mixed vet here, but we see these quite often in shooting dogs. I sedate dom/torb and anaesthatise surface of the eye with local drops and then use a 25G (orange) needle to scrape out of the eye. If stubborn (don't tell people this) I will push the needle against a hard surface to create a barb at 90° and that helps.

Week of fucithalmic, jab of Carprofen and back to check in 7 days that fl-ve.

I've done loads and never had the slightest bit of bother. I wouldn't have even thought of referring them......