Proptosis

Heads up, this is not a post for the squeamish.

Last night I was on call at our hospital. I was torn as to whether or not I wanted it to be a quiet evening, as I really have quite a lot to study these days, but it is refreshing to think about clinical medicine with a live patient!

We started off with the cutest golden retriever. She was apparently hanging out on the beach and found by some students. They dropped her off hoping that because she had an external fixator on her leg (for a fracture repair) that perhaps she was a clinic patient and they had owner contact information. Well, it turned out that the fixator was supposed to come out months ago, as it was an old break! We were going to anesthetize her and remove the device after taking confirmatory radiographs, but the clinician decided to grab a second opinion in the morning instead. So she got to hang out with us and cover us in dampness and sand :).

We received one emergency call about a kitty who's owner suspected had been hit by a car. The owner brought the cat in, and I had my first real ophthalmology case!

I think eyes are gross. They weird me out, and I really prefer to have nothing to do with their abnormalities, with the exception of an easy eye infection or simple corneal ulcer. Get much beyond that and all I can think is "yuck!" I had always heard stories of emergency veterinarians seeing cases where a dog got to excited and popped its eyeball out of the socket, and that makes me seriously cringe. This is usually in the little bug-eyed breeds such as shih zhus. Obviously trauma can cause this "proptosis," but it isn't necessarily uncommon for a smushed face breed to pop one out. Gross. Just talking about this makes me cringe. I hated our "pathology of the eye" section in pathology a few weeks ago. 50 minutes x 4 loaded with nasty eye disease pictures, and not usually on live animals mind you. Because pathology is all about the dead. Sometimes these nasty eyeballs were attached to heads, most were just set on a dissection board and photographed. Did I mention that quite a few of them were human?! EW. While I am not seriously grossed out by human stuff like some people, I REALLY prefer that pairs of nasty looking human eyeballs didn't stare back at me during class. All this is just leading to me stating that I figured that if I ever had to deal with something super nasty in the ophthalmology department, I'd be really rather freaked out and grossed out.

Turns out I was wrong. Or at least sort of. Our dear friend came in with his eyeball and all attached muscles just sticking straight out. not hanging there by a single attachment or anything you see in cartoons, but looking like a completely "normal" eye just sticking an inch out of the socket. (And don't say I didn't warn you, it was sentence number 1!!) So some answers to questions you might be thinking - yes I'm sure it hurt like heck, but kitty was in shock, had some head trauma, and was not quite mentally right. What did we do with the eye? Well, a proptosed eye is not life threatening. Head trauma and open wounds are. Being in shock is definitely life threatening. So assessing our friend and getting him started on fluid therapy, heat therapy, and pain meds were crucial. We determined that the poor cat had quite a few cranial nerve deficits and he really didn't seem to care about all our poking an prodding (which isn't a good thing, because if it was you are me and we were mentally appropriate, we'd be freaking out and very painful). We could have theoretically tried to replace the eyeball in the socket, but with the other head trauma, mental inapproriateness, and his blindness in that eye had us deciding to leave it and en-nucleate it when he was stable at a later date if that was in the cards for him. The plan was to support him over night, keep his eyeball well lubricated, and assess him the next day.

I believe the outcome of this case was euthanization. I am sad that we were unable to "fix" him and give him another shot at life, but I am very glad that he is now pain free and doesn't have to worry about everything he would have to overcome to get back to a "normal" life. I am so glad we have that option sometimes, because to watch a patient dismally suffer for a long time is heart wrenching. I know finances played a role in this case, but that is often the case in veterinary medicine. It is everyone's least favorite part.

So long story short, it really didn't bother me at all. I was surprised but pretty pleased! And if you're really brave, here is a link to a proptosed eye.