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What’s The Matter with Watt?- an article about entropion.

Mrs. Reed is one of my dearest clients. I have known her for quite a few years now and she remains one of the most colourful and interesting people I have met. She is a great lover of Pugs and has had them for many years. Her last pug Chaucer was a huge character but unfortunately we had to put him to sleep last year.

I was surprised to see Mrs. Reed’s name on the appointment book a couple of weeks ago and was looking forward to seeing her again. She duly arrived with a very bouncy, lively black pug called Watt. He had a friend with him in the shape of a three- legged terrier that spent the whole time they were at the surgery biting huge chunks of his neck. Watt took this in his stride and simply resolutely stood his ground with a resigned look on his face!

It turned out that Watt and his friend belonged to Mrs. Reed’s daughter and they were staying with her for a few weeks. Watt had developed a milky white patch on each of his eyes and Mrs. Reed was quite concerned.

Watt didn’t seem to be particularly bothered about the patches and wasn’t squinting from pain and had no discharge from his eyes. I put a special fluorescent dye in his eyes to see whether there was any ulceration. The cornea is built a bit like skin in that it has many layers on a base. Ulcers are like a graze in the surface. A break in the top few layers is like a dent in the cornea and is usually very painful. One of his eyes showed that there was an ulcer present. They usually arise form trauma like scratches or bacterial infections. There weren’t really any other signs of infection so trauma seemed to be the most likely reason. Pugs have quite bulging eyes and are more prone to superficial damage because of it.

Ulcers need to be dealt with fairly hastily because if left they can become deeper and deeper and, in the worst case scenario, can result in the eye rupturing. They can also be difficult to heal up because there is not a good blood supply to the surface of the eye. It relies on tear fluid for most of its nutrition and help.

We gave Watt a few days on antibiotic eye drops to see if we could get it to clear and protect it from infection. However, this made no difference and I admitted Watt for procedure called a grid keratotomy. This sounds like a barbaric procedure but works extremely well. Ulcers that don’t heal often have layers of dead tissue round them that prevent new, healthy tissue growing over. These are removed with a cotton swab and then the whole area of the ulcer is scratched with a needle in a grid pattern. This creates a huge inflammatory reaction and encourages small capillaries to grow into the area and healing gets under way immediately.

When we had Watt anaesthetised I found the cause of his problem. He was suffering form a condition called entropion. This is where the lower eyelids roll inwards and is present form birth. This in turn means that the eyelashes constantly rub the eyes and it can be a very distressing condition. The fact that Watt had been so uncomplaining about it was true testament to his staunch character. The milky patch on his other eye was an old ulcer that needed attention to remove the tissue from the top of it.

Having found the cause of his problem we set about the task of correcting his eyes. This is quite a simple procedure and is a little like having a face- lift! Watt’s problem was a little compounded by the large skin folds on his face. These were placing quite a lot of pressure on the eyelids and helping to push them in against his eyes.

Basically all we had to do was remove some skin from under the lids. The first incision has to be as close to the rim of the lid as possible and then a large oval flap of skin is cut away from underneath. Once this is done the two sides of the wound are stitched together. This has the effect of pulling the lid down away from the eye. You need to be quite careful to get the balance right. Too little removed and the operation will not be a success, too much and you end up with ectropion, the opposite problem that can be just as frustrating.

Once we’d done his ‘nip and tuck’ I gave both ulcers the keratotomy treatment and we woke him up. I have to say that these dogs usually look a lot worse afterwards and I always warn the owners. Watt had a rather unattractive row of sutures under each eye and a lot of gloopy ointment in his eyes and shaved patches that, combined with the stitches, gave him a rather patchwork- quilt appearance. He didn’t seem to mind to much though!

I always imagine that it must be such a relief for these dogs. We all know how uncomfortable it is to have an eyelash in your eye but to have half your eyelashes constantly scraping the surface of your eye must be unbearable. Hopefully he woke up feeling a lot better than before he went to sleep.

The aftercare is pretty straight forward. The surgery usually heals up normally and the only thing we need to watch is that the ulcers heal as intended. Providing all this happens hopefully the only thing Watt will have to put up with in the future is his little friend hanging off his neck!

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