Is surgical removal of the eye warranted?

Is surgical removal of the eye warranted?

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Sep 01, 2003

Signalment: Canine, Shih Tzu, 10 years old, male neutered, 20.7 lbs.

Clinical history: The dog presents today for a problem with the right eye and potential blindness.


Table 1: Results of laboratory tests
Physical examination: The findings include rectal temperature 102.2° F, heart rate 130/min, pink mucous membranes and normal capillary refill time. The dog is bright, alert and responsive. Normal heart and lung sounds are heard. Ocular examination shows corneal ulcer, buphthalmos and blindness in the right eye. A proliferative intraocular mass is extending through the globe of the right eye. Vision is normal in the left eye.

Laboratory results: A complete blood count, serum chemistry profile and urinalysis were performed and are detailed in Table 1.


Image 1.
Radiograph examination: The thoracic radiographs are normal -- no obvious evidence of metastatic disease noted. The abdominal radiographs show an air-filled stomach, slightly enlarged liver, cystic calculi, enlarged prostate gland and severe osteoarthritis of the coxofemoral joints.

Ultrasound examination: Thorough abdominal and right ocular ultrasonography was performed.

My comments: The liver shows an inhomogeneous to homogeneous texture in its parenchyma. No masses noted within the liver parenchyma.

The gall bladder is mildly distended, and its walls are not thickened or hyperechoic.


Image 2.
The gall bladder does contain some sludge material. The common bile duct is slightly dilated. The spleen shows an inhomogeneous texture in its parenchyma - no masses noted. The left and right kidneys are similar in size, shape and echotexture. Each kidney shows an inhomogeneous texture in the renal cortex. No masses or calculi were noted in either kidney.

The urinary bladder is distended with urine and contains a lot of urine sediment material - no masses noted. There are multiple calculi present in the lumen of the urinary bladder and proximal urethra.

The prostate gland is slightly enlarged, symmetrical in shape, and possible calculus or consolidated sludge material present within the prostatic urethra. The left and right adrenal glands are similar in size and shape. The stomach, small intestines, and colon are normal. The pancreas shows an inhomogeneous texture in its parenchyma.


Image 3.
The right eye shows a large mixed echogenic, irregular-shaped, mass-like structure that occupies the anterior chamber. The posterior lens is not seen. Multiple, irregular-shaped, small echogenic structures are seen in the posterior chamber.

One or two round-shaped echogenic areas are caudal to the optic disk in the extraocular area surrounding the optic nerve. The left eye is normal in the anterior chamber, posterior chamber, posterior lens, and optic disk.

Case management: In this case, right ocular mass and cystic calculi are the clinical diagnosis. The right ocular mass is most likely a melanogenic neoplasia. There was no obvious evidence of metastatic disease noted during this abdominal ultrasound study.


Image 4.
In addition, there is no obvious radiographic evidence of intrathoracic and intra-abdominal masses noted. At this point, surgical removal of the right eye and mass is warranted.

Therapy thereafter would depend on the findings from the histopathologic examination after right eye removal. Therapy for the cystic calculi could include feeding exclusively Waltham's S/O diet.

A bacterial urine culture is warranted and daily antibiotics administered according to the results of the urine culture. After about eight weeks of dietary management, cystic calculi may be resolved.

Ocular and orbital imaging technique Imaging of ocular and orbital structures has been improved by the development of ultrasonography, computed tomography and magnetic resonance imaging (MRI).