Eye to eye: Navigating ophthalmology emergencies

Although they are bound to enter the veterinary clinic at some point, not all veterinarians are as excited about the eyes as this week’s guest, Alex Sigmund, DVM, DACVO. To help general practitioners feel more comfortable when a ocular emergency comes into their clinic, Adam Christman, DVM, MBA, and Sigmund chat about the common ocular emergencies general practitioners could see, and how to go about diagnosing and treating them.

Below is a partial transcript

Adam Christman, DVM,MBA: et's start with the basic one, because these are the ones that people tend to scream at when they have, like, proptosis eye coming down. So you know, What? What? How do we stabilize that kind of a patient?

Alex Sigmund, DVM, DACVO: Yeah, when a proptosis comes in, it is usually a trauma, unless you are a pug, [or] brachycephalic dog, where their eyes can just kind of pop out sometimes if they fall off the couch, but usually it's going to be a traumatic injury. And so you do want to assess this patient with a physical exam, make sure you don't see any other signs of trauma. Because a lot of times we get a little excited Well, I do about the eye, and there is the rest of the body you got to worry about, so you want to make sure that there's no puncture wounds, other things that you need to worry about, if this was like a dog fight or hit by car or something like that. These are emergencies that need to be addressed sooner rather than later, because when that eye is proptosis, it has a lot of tension on the optic nerve, which is only going to lessen their visual prognosis.

So there are a few things to look at when you're trying to assess whether this eye should go back or not. And I think kind of the biggest one to remember is how much blood is there. If there is a lot of blood around this eye, then it probably does not need to go back and it should just be a nucleated now, if this is a relatively clean proptosis where there's just a little bit of subconjunctible hemorrhage, and those are ones, I'm going to be more willing to put back and, you know, replace them. If there's a ton of blood inside of the eye, then I'm also a little bit worried about trauma inside of the eye that we just can't see because you can't have these compressive injuries that actually that sounds really bad, crack the inside of the eye without rupturing it and those dogs do not do well either.