One of my favourite surgeries to do is enucleation. This is probably one of the many indications that I am (a) in the right profession and/or (b) one sick puppy.
For those of you unfamiliar with the term, enucleation means removing the eyeball. Which is just as much fun as it sounds. Also, for most people, just as gross as it sounds. It’s one of the bloodiest surgeries I do, and I loves it.
There are a few reasons an eyeball needs to come out. My first ever enucleation was in a dog with glaucoma. It was secondary glaucoma (secondary to what, we weren’t sure…) and we couldn’t get it under control, so out came the eye. The dog was blind in that eye by this point, and in constant pain from the high pressure… without the eye, still blind but no more pain!
Another I did was a puppy who had suffered some kind of penetrating injury to the eye that wasn’t looked after so the eye was rotted and all kinds of gross and just better off coming out. Puppy was happy and hyper with a rotting mess in his socket… and he was happy and hyper with a cleaned up, eyebal-less, properly sewed up socket!
My preferred approach is to sew the eyelid shut and cut through the skin and dissect around the globe that way. Right at the inside corner you have to be concerned about a big vessel, but otherwise it’s just a poke, poke, tear, cut until you’ve freed the eyeball from all the muscles around it. You need to be careful not to tug at the eyeball too much – we’re told if you pull too hard on the optic nerve on one side, you’ll cause blindness in the other eye. Never seen it happen, but I’ll just take their word for it and not pull hard. At the very back of the eye is the optic nerve stalk, with the optic nerve and a fairly large blood supply. Pre-emptively tying this off is a challenge. I tried once, it was a pain in the arse and didn’t work. So now I just cut and pull out the eyeball right quick and apply pressure. You can just hold gauze firmly in the socket for about 5 minutes, and the bleeding will stop. It’s like magic.
Of course, not everything is always textbook. I have had a dog whose eye literally came out of the socket. You know in Beetlejuice when buddy pops his eyes out and they’re just seriously bulging out his face? That’s what this dog’s eye was like. Only the sclera (white part) was all red and angry, and there was pus and hair stuck all over. Super disgusting. Thrill of my week. Needless to say, my usual “sew eyelids shut” approach was not going to be happening. Could not get that eye back in its socket, certainly couldn’t pull the eyelids over it. And all the muscles were already stretched out. So it was a snip, snip, snip situation involving a bit of w.t.f. is that supposed to be (all the tissues were swollen and edematous, looking nothing like they should..) and then once the eyeball was completely removed, I marvelled at how small the eye was “supposed” to seem (the bit of the eye you see when the eye is open is just a small small portion of the whole globe… always impresses me..). Anyway, trimmed away the eyelids (you don’t want to leave behind any tear ducts and eyelid glands to be filling the socket up with fluids later), stopped the copious bleeding, and bob’s your uncle.
Some clients balk at the idea of removing a problem eye… but, honestly? Your pet does not look in the mirror and think “Golly, I look different!” Your pet does, however, experience pain and irritation. So if the eye is already irreversibly blind, but still causing chronic issues with high pressures, infections, and inflammation… let’s just heave ‘er out!
And if the eye has already tried to remove itself from the body… well, just give the poor thing a hand and help it along.