Ophthalmology

Factors contributing to the eye pathology:

• These breeds of dogs have too long eyelids, which contributes to the formation of entropion. In order for the eyelids to perform their role of protecting the eye and evenly distributing the tear film, they must rest on the cornea along their entire length. If they are separated from the cornea or twisted inwards so that the hairs from the skin of the eyelids come into contact with the cornea, the eyelids will not preserve the health of the eye and will cause numerous eye diseases.
• In these breeds, there are exuberant skin folds that exert mechanical pressure on the eyelids, that is, the eyelids cannot sustain the skin folds. This is especially noticeable when we look at a dog with pronounced frontal folds when it bends its head (then its eyes are not visible).
• In English bulldogs, brachiocephalic syndrome with pronounced medial entropion contributes to eye pathology (see text “medial entropion in pug”)
• In these breeds, dry eye disease is a common finding.
• These dogs often develop serious allergies that their owners are not aware of, and are not in control of, and allergies are related to many eye pathological processes.
• These dogs have a long history of eyelid problems and that is why this problem is ignored by veterinarians, owners, and breeders. When a problem persists for a long time, it begins to be considered “normal.” Breeders tend to breed dogs with a larger number of folds because breed lovers consider it desirable, while entropion as an unwanted eye pathology is forgotten.
• In English Bulldogs, there are frequent pathological eyelashes that arise from the conjunctiva of the eyelid (ectopic cilia) or from the edge of the eyelid from the opening of the meibomian glands (dysthymia), which additionally irritate the cornea and contribute to spastic entropion.

Factors that contribute to the complexity of the surgical procedure

Choosing the right entropion correction procedure is more difficult in these breeds than in other breeds of dogs.

In order to successfully resolve the issue of entropion, other eye problems need to be solved first, and that is: to reduce the length of the lower eyelid, to remove most of the tissue from the medial (inner) and lateral (outer) part of the lower eyelid (because the lower eyelid has medial and lateral entropion, therefore, the entropion is not expressed equally along the entire length of the eyelid), the upper eyelid must also be shortened and the right procedure must be chosen to reduce the influence of the frontal folds on the position of the upper eyelid. All of the above represents a minimum of 4 surgeries per eye.

Surgical procedures used

There are several techniques that can resolve the problem, but most of them show certain complications in the listed dog breeds:

• The disadvantage of the “Brow-sling procedure” is recurrence because sometimes the sutures can come off the bone, and in addition, there is the possibility of a bacterial infection of the tissue around the sutures.
• The simple “Hotz-Celsus” technique for the upper and lower eyelids usually leads to the recurrence of the problem in a shorter period of time.
• If all wrinkles are removed, the problem will be solved, but the owner will not be satisfied with the “ironed” look of the dog because the appearance of the dog’s face changes significantly. It should be noted that this surgical technique is very aggressive and represents a great trauma for the dog.

The surgical technique that provides the best results

The best surgical procedure is a combination of 4 procedures per eye. “Stades” on the upper eyelid should be done precisely, to preserve all the meibomian glands that are important for the tear film production, and to remove all hair follicles to avoid irritation of the cornea with hair. The wound heals secondarily, which creates scar tissue that is strong enough to hold the frontal folds of the skin and prevents their further impact on the anatomy of the upper eyelids. Then the lower and upper eyelids are shortened by “V” resection and a customized “Hotz-Celsus” procedure is performed on the lower eyelids. This is a very successful surgical technique and the dog keeps its eyes open immediately after the surgery and no longer experiences discomfort.

When to opt for surgery?

Patients whose entropion has caused permanent damage to the cornea sometimes present to our clinic. In severe cases, entropion can cause corneal perforation. Then, we first do surgery on the cornea, in order to save the eye and sight, and two weeks later, surgery on the eyelids, in order not to cause a problem with the cornea again. In order for owners to recognize the problem in time and seek help in time, they should be familiar with breeds that are prone to entropion and pay attention to the early signs of entropion: tearing of the eye, discharge from the eye, blinking, closing the eye. At any sign of suspicion, they should take the dog to an ophthalmologist to determine if it has entropion and to take further steps to eliminate this eye pathology.