eye enucleation

Re: eye enucleation

Gillian Mostyn — Sat, 20 Mar 2010 21:05:22 GMT

After reading this thread I did my last enucleation (cat) without attempting to clamp or ligate the vessel. Took me half as long as usual. Worked a treat - small ooze of blood, stopped within a minute. Many thanks for the excellent tip! Wish I'd learned that 10 years ago...

Re: eye enucleation

Jon Bray — Sat, 20 Mar 2010 20:51:07 GMT

A friendly local ophthalmology Specialist told me he doesn't bother to ligate and I've found that to be sage advice.

Personally, I to tend to put a clamp on whatever is behind the eye (blind, via curved mozzies) prior to cutting between that and the globe, just so I can be more confident that I'm minimizing traction on the nerve. Once the globe has gone though I remove the clamp without attempting to put a ligature behind it.

My own tip on top of that is to use intracuticular sutures when closing the skin which I believe gives a better seal - the orbit is going to fill with blood or serum at some point whatever you do; you just want to make sure nothing leaks through the skin.

Re: eye enucleation

Utlendigur — Wed, 27 Jan 2010 22:36:53 GMT

I'll second that Did a degu eye enucleation today and a small corner of Lyostypt worked perfectly - there was no way I was going to get a ligature or clamp on that one!

Re: eye enucleation

Vikki Halliday LLB — Wed, 27 Jan 2010 21:57:58 GMT

[quote user="Evelyn Barbour-Hill"] pack with one Lyostypt; close it up. [/quote]

Lysostypt; Bloody marvellous stuff!

Re: eye enucleation

Evelyn Barbour-Hill — Tue, 26 Jan 2010 02:15:18 GMT

[quote user="Clive Ansell"]Although it is sometimes tricky, I always try to get a decent ligature on the optic vessels. I know many say don't bother, but I just sleep easier knowing it is ligated. I don't pack the socket with anything, I don't like the idea of a buried foreign material left in - not had any problems - what do others do?[/quote]

Well, of course, a ligature is buried foreign material

[quote user="Clive Ansell"]Came across a vet once who clamped the vessels and just left the clamp in situ while he had his lunch -removed it 45 monutes later and closed the wound -did fine.[/quote]

As long as he didn't drop crumbs in the wound.

[quote user="Clive Ansell"]Another case, someone packed the socket with a coform bandage and pulled it out through a small hole bit by bit over 3 or 4 check up appointments.[/quote]

Ah, the seton. We did that 40 years ago. Then we realised that if you made an attempt to do the job aseptically it was completely unnecessary. I remember taking an eye out in 1977 and the boss was shocked and dismayed to find I had neglected to put a seton in.

It's personal preference, but my plan that works for me is: excise the eye; apply swab pressure one minute; try to grab and ligate anything still bleeding after that; don't worry if you can't ligate; pack with one Lyostypt; close it up. Big sockets might want two or three Lyostypt but it doesn't have to be packed tight. Ideally you find the outer surface of the Lyostypt is still only faintly bloody as you close the tissues over it.

I started Lyostypt not so much to prevent haemorrhage as to reduce the unpleasant "empty socket" appearance after healing. It helps a bit in that respect.

Re: eye enucleation

Rob Reid — Fri, 22 Jan 2010 17:52:50 GMT

[quote user="robloxley"][quote user="Utlendigur"]and have heard stories about excessive tension on the optic nerve causing problems at the optic chiasma[/quote][/quote]

This is theoretically more of a problem in cats where the optic nerve is shorter so excessive traction on the nerve bundle should be avoided - hence the case some people make for not ligating. I have not seen it occur, but Rob's post above proves that it can happen.

Re: eye enucleation

Rob Loxley — Fri, 22 Jan 2010 17:25:11 GMT

[quote user="Utlendigur"]and have heard stories about excessive tension on the optic nerve causing problems at the optic chiasma[/quote]

Have seen it happen, once, resulting in blindness in the remaining eye.

Re: eye enucleation

Charlotte Marshall — Thu, 21 Jan 2010 21:01:55 GMT

I usually try and get a ligature on before cutting if possible or after getting the globe out. My boss dissects down till just the vessel is left then twists it off. I do sometimes see them swell afterwards, it seems that once the swelling has come up as far as it can it provides the pressure to prevent any further bleeding anyway. I went off packing the sockets after we had one several years ago that got an infection.

Re: eye enucleation

Utlendigur — Thu, 21 Jan 2010 20:35:52 GMT

I try to get a ligature on by trying to slide it over the globe then down as far as possible but often give up (and have heard stories about excessive tension on the optic nerve causing problems at the optic chiasma), cut it, then try and clamp and ligate with the eye out of the way. Sometimes it works - if not I just put some pressure on with a swab while starting to stitch up, and it seems to stop. I don't pack the orbit. Sometimes there is a bit of swelling but it usually resorbs fairly quickly.

Re: eye enucleation

Rob Reid — Thu, 21 Jan 2010 17:45:41 GMT

I like to try and get some sort of a ligature on though I must confess I am not always sure if I get it !! I used to pack with some sort of haemostatic felt (lyostypt/emovet - take your pick) but I don't bother now. I did have one that swelled a bit post-op but nothing a cold pack, some NSAIDs and a bit of time didn't solve. To be fair to the dog it didn't really seem too bothered either.

I have seen Chloramphenicol soaked swabs put in and pulled out 2-3 days later and also people just leaving the vessels. All with good success rates. I guess like so many other things there are lots of ways to skin the cat.

Re: eye enucleation

Clive Ansell — Thu, 21 Jan 2010 17:14:29 GMT

Although it is sometimes tricky, I always try to get a decent ligature on the optic vessels. I know many say don't bother, but I just sleep easier knowing it is ligated. I don't pack the socket with anything, I don't like the idea of a buried foreign material left in - not had any problems - what do others do?

Came across a vet once who clamped the vessels and just left the clamp in situ while he had his lunch -removed it 45 monutes later and closed the wound -did fine.

Another case, someone packed the socket with a coform bandage and pulled it out through a small hole bit by bit over 3 or 4 check up appointments.

Re: eye enucleation

James Allsop — Thu, 21 Jan 2010 16:03:54 GMT

Also from opthal course I was told not to bother although i still try to get a clamp on if possible. I tend to just cut and apply pressure then a little gentle cautery if necessary.

Re: eye enucleation

scarlet — Thu, 21 Jan 2010 15:55:07 GMT

ooh goody a bit of kit specifically designed - does anyone use it and know if it works???!!

re ribbon guaze - used to use that yrs ago but now find the absorbable lyostypt (spelling?) heamostatic stuff less of a faff.

Re: eye enucleation

Don Rutherford — Thu, 21 Jan 2010 13:27:47 GMT

Ribbon gauze packed in to the orbit, concertina-wise, with a half inch protruding laterally - 24 hours later draw it out easily.

Re: eye enucleation

Rob Davis — Thu, 21 Jan 2010 13:21:58 GMT

Veterinary Instrumentation sell a clamp designed specifically for this purpose - it has a curved tip, but the handles are curved in the opposite direction so they are out of the way. I haven't tried them (only seen then in their catalogue), so can't comment on how useful they are.

Re: eye enucleation

scarlet — Thu, 21 Jan 2010 08:35:56 GMT

i just find they retract into the orbit and are impossible to grab!! tho even if that happens ,with some heamostatic packing i find they dont cause much problem. just wondered if there was a better way ,or little trick someone has found..........

thanks anyway

Re: eye enucleation

stuart mcmorrow — Wed, 20 Jan 2010 23:14:07 GMT

Just chop it out and tie off the optic vessels after the globe is out only if required. Quick, easy and have never had a problem with this way.

Hope that helps.

Cheers,

Stuart.

Re: eye enucleation

Hanna Bennett — Wed, 20 Jan 2010 22:59:12 GMT

having just come home from an opthalmology (still can't spell it!) course, the advice we were given was don't bother! not sure i'm that brave though...