Species: Canine | Classification: Diseases
Introduction Pathogenesis Diagnosis Treatment Outcomes Further Reading
Introduction
- Cause: macropalpebral fissure Macropalpebral fissure and a weak lateral canthal ligament.
- Signs: the middle of the lower lid is everted (ectropion) and, in severe examples, the lateral lower and upper lids are inverted (entropion) giving rise to a 'diamond eye' configuration.
- Diagnosis: breed, clinical signs.
- Treatment: surgical - a modified canthoplasty.
- Prognosis:good.
Presenting Signs
- A 'diamond eye' configuration with more severe examples having entropion of the lateral eyelids as well as ectropion of the lower middle eyelid.
- Those without entropion:
- Asymptomatic.
- Mucoid ocular discharge.
- Conjunctival exposure and hyperemia.
- Ocular pain (only if entropion is present).
Age Predisposition
- 6 months-2 years old.
Breed Predisposition
- St Bernard St Bernard.
- Clumber Spaniel Clumber Spaniel.
- Bloodhound Bloodhound.
Cost Considerations
- Surgical treatment.
- Can be difficult to manage.
Case referral advised.
Pathogenesis
Etiology
- Congenital.
- Macropalpebral fissure plus weak lateral canthal ligament.
Pathophysiology
- Macropalpebral fissure Macropalpebral fissure (overlarge eyelid opening) and a weak lateral canthal ligament → laxity of the eyelids → ectropion Ectropion of the middle lower lid and in some cases, lateral entropion Entropion
- Altered eyelid conformation → entropion → corneal irritation → corneal ulceration Ulcerative keratitis.
- Altered eyelid conformation → lagophthalmos → exposure keratitis Keratitis.
Diagnosis
Presenting Problems
- Ocular pain.
- Red eye.
- Mucoid ocular discharge.
Client History
- Red eye.
- Mucoid ocular discharge.
- Ocular pain.
Clinical Signs
- 'Diamond eye' appearance.
- Conjunctival hyperemia.
- Exposure keratitis Keratitis.
- Corneal ulceration Ulcerative keratitis.
Differential Diagnosis
- Macropalpebral fissure Macropalpebral fissure.
- Distichiasis Distichiasis.
Treatment
Standard Treatment
- A Wyman canthoplasty together with wedge resections of upper and lower eyelids Eyelid: wedge resection if required. This will create a tighter lateral canthal ligament and shorten the lids.
- A modified Khunt-Szymanowski technique in which the upper eyelid is also shortened.
- Surgery plus treatment for keratitis/conjunctivitis.
Monitoring
- Improved eyelid conformation.
- Reduction of conjunctival hyperemia.
- Reduction of ocular pain.
Outcomes
Prognosis
- Good.
Expected Response to Treatment
- Reduction of 'red eye' over 5-10 days.
- No ocular pain.
Reasons for Treatment Failure
- Standard Standard reasons for failure in a treatment.
- Inadequate correction.
Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Bedford P G C (1988) Conditions of the eyelids in the dog. JSAP 29 (7), 416-428 VetMedResource.
- Wyman M (1971) Lateral canthoplasty. JAAHA 7, 196.