Conjunctivoralostomy for the treatment of recurrent chronic epiphora in a dog.
Epiphora is an overflow of tears, usually caused by insufficient drainage of the tear film from the eye. The most common cause is blockage of the lacrimal (tear) ducts located next to the nose, but the condition may also result from the excessive production of tears. Epiphora is a symptom rather than a disease and may be caused by a variety of conditions. Conjunctivoralostomy is a surgical technique for treatment of chronic epiphora due to an obstructed lacrimal canaliculi. The present paper reports a chronic case of epiphora and its surgical management by conjunctivoralostomy.
History and Clinical Observations
A five year non descript female dog was presented with a history of chronic and excessive lacrimation with a prominent tear streak mark of rust to brown color staining of facial hairs since past 8 months (Fig.1). The animal was previously subjected to various ophthalmic preparations providing a short term relief but reoccurance was seen frequently.
Clinical examination revealed the excessive lacrimation in left eye. Schirmer tear test was conducted to measure the amount of tear production which was 26mm/min.
Jones dye test was performed to evaluate the patency of duct by passing the sodium fluroscein dye from both the nasolacrimal passages. For confirmation of the blockage and perceiving the location of the obstruction in the nasolacrimal passage, dacryocystorhinography was performed (Singh et al., 2004). A radiopaque contrast material (Diatrizoate meglumine) was passed into the nasolacrimal duct and its passage was recorded with a series of sequential radiographs. The obstruction was diagnosed in the left nasolacrimal passage.
Treatment and Discussion
As the lacrimation was excessive, it was decided to perform a surgical method to make an alternate route for the drainage of tears. With the congenital and acquired losses of different parts of nasolacrimal system, construction of an alternate route by surgical procedure has been advised to prevent recurrence of epiphora and to drain the tears directly into buccal cavity (Christine et al., 1997).
Conjuctivorhinostomy performed in many cases of recurrent epiphora with variable success. However, due to the involvement of facial bones, more manipulation was required. Therefore, an alternate surgical method i.e. conjunctivoralostomy was planned for establishing an artificial tear drainage channel. This method is comparatively easy and effective because there is no involvement of facial bones and causes less trauma (Covitz et al., 1977).
A subcutaneous tunnel was constructed from the middle part of lower eyelid to upper fornix of lip. After atropinization and sedation with Xylazine Hydrochloride @ 1mg/kg b.wt intramuscularly, followed by anesthetization with Ketamine Hydrochloride @ 6mg/kg b.wt i/v. Aseptic surgical preparation from the lower eyelid to upper lip was done and a small nick incision was made in the inferior conjunctival fornix and directly below the upper fornix of the lip (Fig. 2). A subcutaneous tunnel was created with a less diameter Steinman pin and small polythene tubing (2 to 4 mm outside diameter) was introduced through the newly created fistula. The Steinman pin of 3mm was found to be effective in creating the subcutaneous tunnel (Fig. 3). It created a passage without much damage to the surrounding tissues in short time and minimum hemorrhage, in contrast to mosquito forceps (Gelatt et al., 1981). Both ends were flanged by placing 2 sutures with 3-0 silk to stabilize the tubing at both the conjunctival and oral mucosal ends respectively (Fig. 4).
Post-operatively, Sulfacetamide and Prednisolone drops were instilled in the dog's eye four times a day for 1 week. Specific antibacterial medications were incorporated into the irrigating solution and they were instilled topically after the procedure. For this purpose, Tobra-D (a) eye drops containing (Tobramycin and Dexamethasone sodium Phosphate), local application of eye ointments like Neosporin-H (b) (containing Neomycin, Polymixin B sulfates, Bacitracin Zinc and Hydrocortisone) were used. Doxycycline 50 mg tablets were prescribed daily for 21 days for controlling the facial stain (Blogg, 1980).
This alternate method provided a complete check of excessive lacrimation at successive intervals and no reoccurrence was observed as per the owner in six months period. The observed post-operative complications included swelling on 3rd and 7th day post-operatively, which subsided with the parenteral administration of inj. Meloxicam. Also in the initial intervals animal was showing self mutilating injury including scratching at the area below lower eyelid. On 21st day the surgical wound was completely healed without any complication.
Blogg, J.R. (1980). Watery eye and lacrimal function. In: The Eye in Veterinary Practice Extraocular Disease. W.B. Saunders Co, Philadelphia, pp 272-294.
Christine, L.T., Bruce, H.G. and Fretz, P.B. (1997). Incomplete nasomaxillary dysplasia in a foal. Can. Vet. J. 38: 445-47.
Covitz, D., Hunziker, J. and Koch, S.A. (1977). Conjuctivorhinostomy- A surgical method for control of epiphora in the dog and cat. J. Am. Vet. Med. Assoc. 171: 251-55.
Gelatt, K.N. and Gwin, R.M. (1981). Canine lacrimal and nasolacrimal system. In : Gelatt K.N. (ed): Textbook of Veterinary Ophthalmology. Lea and Febiger, Philadelphia, pp. 309-316.
Singh, A., Cullen, C.L., Gelens, H. and Grahn, B.H. (2004). Left dacryocystitis with nasolacrimal duct obstruction. Can. Vet. J. 45: 953-95.
Ankush Maini (1), V.P. Chandrapuria (2) and Shobha Jaware (3)
Department of Veterinary Surgery and Radiology
College of Veterinary Science and Animal Husbandry
Nanaji Deshmukh Veterinary Science University
South Civil Lines
Jabalpur--482001 (Madhya Pradesh)
(1.) Post Graduate Scholar
(2.) Professor and Head and Corresponding Author
(3.) Assistant Professor
(a) - Brand of Laborate Pharma India Ltd., Panipat
(b) - Brand of GSK Pharma, Mumbai
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|Title Annotation:||Short Communication|
|Author:||Maini, Ankush; Chandrapuria, V.P.; Jaware, Shobha|
|Date:||Jan 1, 2013|
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