Contributors: David L Williams, James Oliver
Species: Canine | Classification: Diseases
Introduction Pathogenesis Diagnosis Treatment Outcomes Further Reading
Introduction
- Cause: most commonly epithelial in origin and benign.
- Signs: eyelid mass, ectropion/entropion, trichiasis, keratitis, ocular discharge.
- Diagnosis: histopathological examination of biopsy specimen.
- Treatment: surgical excision.
- Prognosis: usually good.
Presenting Signs
- Discreet eyelid mass.
- Eyelid thickening.
- Entropion Entropion /ectropion Ectropion.
- Chemosis.
- Ocular discharge Ocular discharge: overview.
- Trichiasis Trichiasis.
- Keratitis Keratitis.
Acute Presentation
- Ulcerative keratitis Ulcerative keratitis.
- Pain.
- Blepharospasm.
- Lacrimation.
- 'Red eye'.
Age Predisposition
- Older animals usually (>8 years old).
- Young animals for papillomas and histocytomas Skin: histiocytoma.
Cost Considerations
- If tumor is large then complicated blepharoplasty may be required needing specialist referral.
Special Risks
- General anesthetic Anesthesia: in ophthalmic surgery.
Pathogenesis
Etiology
- In order of decreasing frequency:
- Sebaceous adenoma Sebaceous gland: hyperplasia / neoplasia.
- Squamous papilloma Skin: cutaneous papilloma.
- Sebaceous adenocarcinoma.
- Benign melanoma Skin: melanoma.
- Histiocytoma Skin: histiocytoma.
- Mastocytoma Skin: mastocytoma
. - Basal cell carcinoma Skin: basal cell tumor.
- Squamous cell carcinoma Skin: squamous cell carcinoma.
- Fibroma.
Pathophysiology
- Meibomian gland adenomas and adenocarcinomas:
- Erupt through eyelid margin or palbebral conjunctiva.
- May ulcerate and hemorrhage.
- Can cause local irritation.
- Melanomas - two types recognized:
- Those arising from skin tend to be minimally invasive and are excised with low recurrence rates.
- Those arising from eyelid margin act more aggressive locally
.
- Fibromas and fibrosarcomas Fibrosarcoma can be locally invasive.
- Papillomas:
- May be viral in origin and may regress spontaneously
.
- May be viral in origin and may regress spontaneously
Timecourse
- Usually slowly growing over months/years.
Diagnosis
Presenting Problems
- Eyelid mass.
- Blepharospasm.
- Ocular pain.
- Lacrimation.
- Corneal ulceration.
Client History
- 'Sore eye'.
- 'Red eye'.
- 'Watery eye'.
- Eyelid mass.
Clinical Signs
- Discreet eyelid mass.
- Eyelid thickening.
- Entropion/ectropion.
- Chemosis.
- Ocular discharge.
- Trichiasis.
- Keratitis (ulcerative or non-ulcerative).
Diagnostic Investigation
- Clinical examination.
- Biopsy Biopsy: skin (incisional vs excisional) and histopathological examination.
- Thoracoabdominal imaging (conventional radiography or computed tomography) to check for metastases for malignant tumors.
Gross Autopsy Findings
- Mulitple sites of neoplasia in metastatic disease (rare).
Differential Diagnosis
- Blepharitis Blepharitis.
- Hordeolum Hordeolum (external stye).
- Chalazion Chalazion (internal stye).
- Dermoid Corneoconjunctival dermoid.
- Hamartoma.
- Eosinophilic granuloma.
- Nodular fasciitis.
- Parasitic granuloma.
Treatment
Initial Symptomatic Treatment
- Systemic anti-inflammatories and antibiotics Therapeutics: eye.
Standard Treatment
- Surgical excision
- usually curative:- Most tumors can be completely excised via wedge resection Eyelid: wedge resection and two layer closure.
- Removal of tumors >25% eyelid length require more complicated eyelid reconstruction.
- For malignant tumors, enucleation Eye: enucleation /exenteration may be required to achieve adequate surgical margins.
- Radiotherapy Radiotherapy for malignant tumors.
- Chemotherapy for lymphoma Lymphoma: chemotherapy protocols.
Monitoring
- Monitor tumor regression/recurrence.
- Evidence of metastasis.
Outcomes
Prognosis
- Depends on tumor type but usually very good and surgical excision curative in majority of cases.
Expected Response to Treatment
- Surgical resection usually curative.
Reasons for Treatment Failure
- Inadequate surgical margins.
- Metastasis.
Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Romkes G, Klopfleisch R, Eule J C (2014) Evaluation of one-vs two-layered closure after wedge exicsion of 43 eyelid tumors in dogs. Vet Ophthalmol 17 (1), 32-40 PubMed.
- Wiggans K T, Hoover C E, Ehrhart E J et al (2013) Malignant transformation of a putative eyelid papilloma to squamous cell carcinoma in a dog. Vet Ophthalmol 16 Suppl 1, 105-112 PubMed.
- Van Der Woerdt A (2004) Adnexal surgery in dogs and cats. Vet Ophthamol 7, 284-290 PubMed.
Other sources of information
- Gould D & McLellan G (2014)BSAVA Manual of Small Animal Ophthalmology.3rd edn.
- Gelatt K N (2013)Veterinary Ophthalmology.5th edn. Lippincott, Williams & Wilkins.