031001ASingapore veterinary keratitis, eye corneal ulcer, Silkie, 3 years old, Toa Payoh Vets surgery dog toa payoh veterinary surgery education stories published by asiahomes.com internet classifieds, apartme

Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Case written in a blog: 24 July 2008
Case updated: 06 June, 2009

"My dog's eye is still as bad as before you did your operation," the young lady with the big brown eyes matching her Silkie Terrier's phoned me on the 9th day after tarsorrhaphy - a surgical procedure to stitch up the upper and lower eyelids.

"The eyelids had opened up. Stitches hung from the lower eyelid. I can see that the eye has not improved at all. Does my dog need the eyelids stitched together again? "

"The stitches were used to protect the cornea from drying up so that the ulcer could heal. They hold the eyelids for 7-10 days. Due to the eyelid movement, the stitches will break but the dog's eye should be much better," I was surprised that the young lady with clear brown eyes had been disappointed. In my experience, tarsorrhaphy is very effective in healing the superficial and many deep corneal ulcers.

"You will need to bring the dog in for examination as it is hard to diagnose over the phone." Many owners expect one treatment cure all - otherwise the veterinarian is not competent. But this is not always the case especially in eye and skin diseases. In addition, this pet shop owner insisted on taking the dog home immediately after surgery to save on costs.

After self-treatment for 14 days, the owner brought her dog to the vet

Day 1 at the Vet. Two weeks of owner's self-treatment. Dog keeps rubbing eyes and feeling lots of pain. Other parts of the cornea gets infected and becomes cloudy. Poor post-operation nursing by the owner. Owner accused the vet of not doing a good job.	Dog rubbed the right eye. Blood vessels appear on cornea from 9 to 6 o'clock due to eye rubbing friction for past 2 weeks. Is it too late to save this eye?

Subconjunctival injection of antibiotic in very small doses before tarsorrhaphy.	Tarsorrhaphy (stitching eyelids) is meant to protect the cornea from drying and dirt so that the ulcer can heal fast. General anaesthesia is required.
Day 9 after tarsorrhaphy

Owner did not know how to take care of the eye post surgery as you can see eye discharges stuck to eyelids. Therefore the vet was accused of not doing a good job.	Two horizontal mattress stitches will be removed under general anaesthesia using a gas mask. Eye was cleaned thoroughly including flushing of debri from the 3rd eyelid before tarsorrhaphy.

After cleaning the eye, examine it in daylight.	Ulcers heal well. A red spot at 6 o'clock and 9 o'clock. The blood vessel ring from 9 to 6 o'clock has disappeared. Two corneal ulcers have healed satisfactorily and no further surgery is required. Still need eye care. Should be easier for the owner now.

Yet she did not know or had time to nurse the dog's eyes. Just putting some eye-drops would not be sufficient nursing. The eyes needed to be cleaned twice a day, checked and for some owners, this was difficult to do. At home, the dog just would not be so submissive. He will turn his head and move here and there. Some dog owners just could not do any nursing.

The owner brought the dog to the surgery today. My veterinary assistant took out the suture removal forceps all ready to take out the 2 sutures now hanging loose from the lower eyelid.

"This dog needs to be under general anaesthesia," I said to the dog owner and Mr Saw, my veterinary assistant. "If we take out the sutures without anaesthesia, the dog may move. The forceps may puncture the eye cornea. The eyeball collapses and we will have a blind dog!"

I asked the young lady to come back in the afternoon as she has her pet shop business to attend to. The dog's cornea was around 80% clear compared to 90% cloudy 9 days ago after cleaning the debris but the initial sight looked horrible to the fair pet shop owner, a lady in her twenties.

The dog should recover with 95% clear cornea and a 5% white scar. As the injury existed for around 2 weeks, you can see the ring of blood vessels on the cornea (corneal vascularisation) 9 days ago. At day 9 after tarsorrhaphy, the vascular ring had disappeared indicating that inflammation had subsided after veterinary treatment and tarsorrhaphy to protect the cornea from irritation, inflammation and drying up. This healing would not occur if the eyelids had not been stitched up. Although the stitches were said to break 3 days after stitching, there was still sufficient time for corneal healing in this case. There were no more complaints from the owner after this visit.

Tonsillitis in the dog due to poor dental hygiene

Day 1. Bad breath due to infected swollen tonsils overwhelmed the vet during intubation! Poor dental care is the usual cause!	Day 9. No bad breath after 9 days of antibiotics and infected tonsils are less enlarged and inflamed. Needs dental scaling but the owner was not aware of the need for good dental health or would not want to pay the veterinary expenses involved.

This dog had a horrible bad breath on the first day. His teeth were quite clean. The smell came for much enlarged tonsils which were around 1 cm x 0.5 cm in size. I saw the tonsils during intubation to put the dog under general anesthesia. As for today, he had no bad breath and must be feeling much better. As to why he had such big tonsils, it would be due to daily infections from the bacteria from the tartar and plaques inside the mouth.

This dog's bad breath will return after some time. As the lady owner's nose may be insensitive to the smell of bad breath due to daily exposure, it may be important for the veterinarian to at least, inform the lady owner that dental scaling of her 3-year-old Silkie Terrier needs to be done to get rid of the foul-breath forming bacteria. In this case, I have not informed the lady whose big brown eyes match exactly the colour of her constant companion.

I note that many Singapore dog owners of the baby boomer generation are not interested in the dental health of their dogs. They just accept teeth falling out with the years and live with the bad breath and let the dog suffer tooth ache. Maybe the internet generation can be educated and be more caring. Some owners may be ignorant but for this pet shop owner, it would be the dollars and cents that mattered.