Ocular emergencies

Dr. Kimberly Brokaw, DVM

(6/2015) Determining how urgent an emergency is can be difficult for many owners. I always tell clients that if it pertains to an eye, it is an emergency that should be treated that day. While treating it within the first hour isn't essential, waiting a couple days to see if it gets better is a bad idea. Eyes can heal remarkably quickly, but they can also degrade rapidly as well. Small corneal scratches have led to permanent blindness and removal of the eye. At the same time, penetrating wounds such as removing a stick from the eyeball, have been successfully treated. Promptness of care and diligent treatment can make all the difference in whether your pet is able to see following ocular trauma.

Two of my clients had eye related emergencies over the weekend. Both of these clients knew that the vet should be called out to provide treatment. My first client has a pretty palomino quarter horse. Goldie had been brought in for breakfast when she noticed his eye. I was immediately called with the owner frantically telling me that Goldie had gouged out his eye and it was bleeding everywhere and swollen. She said she hadn't searched the field for his eyeball but asked if she found it could I put it back in. I told her most likely no. She didn't ask me any further questions and I drove straight to her barn.

When I arrived at the barn, I walked into the stall to discover Goldie quietly eating hay in the corner with his left eye swollen shut and a small scrape on the lower eyelid and a little bit of blood on his knee from where he had been wiping his eye. Since his eye was sore, he needed to be sedated in order to examine it thoroughly. His eye had not been gouged out. It was in the socket where it belonged. I reassured the worried owner and showed her that his eye was in fact there. It was just the swollen eyelids making it difficult for her to see the eye. There was a small scrape (just a little bigger than a paper cut) on the lower lid. I dyed the eye with fluorescein and could see two faint linear scratches on the cornea. I gave Goldie an injection for the swelling, put some antibiotic ointment in the eye and proceeded to tell the owner how to care for Goldie's eye. Since the scratches on Goldie's eye were small, not deep and received prompt care, they could be treated with an antibacterial ointment given every 4 hours for a day or two. With proper treatment, Goldie made a full recovery.

My second eye injury of the weekend was very different. A local dairy farmer called to say that her cow had cut her eye. She said it needed stitches but wasn't bad. She told me that if I was in the middle of dinner or doing something that it could easily wait until I was finished. I told her I was not and would head right over.

I'm very glad I went straight to her farm. The cow was standing in the milking parlor with puddles of blood in front of her face. She had cut through a small artery and blood was still squirting. You could see multiple bloody bandages where the dairy farmer had tried to hold pressure to get the bleeding to stop but had failed. I was thinking to myself that if this is the sort of thing she says can wait, I can't imagine what she thinks is urgent.

I numbed the eyelid with local anesthetic block, found the bleeding artery and tied it off and then sutured the eyelid back in place. Although the eyelid was cut, the eye itself was remarkably undamaged. As soon as I finished, the cow was back to eating. She seemed to be no more traumatized by the incident than her owner was.

Treating an eye is difficult without a good eye exam, a proper diagnosis, and an owner or other knowledgable person who will provide the prescribed treatment at the proper intervals. A minor scratch will usually heal rapidly with antibiotic ointment given every 4 hours for a day, as long as the owner does not inadvertently use a leftover eye medicine that contains steroid or is otherwise inappropriate treatment.

An eye that is swollen shut due to uveitis instead of a simple scratch, needs steroid or other immune suppressant to save the vision of the eye. An eye that has a deep ulcer, sometimes from a neglected scratch, may need antibacterial and antifungal eye medication every 2 hours around the clock. While some owners are able to administer eye medicine around the clock, other owners have work schedules that prevent them from doing the regular treatments. Sometimes, horses refuse to cooperate and let their owners administer eye medicines. It is important for the owner and the vet to have an honest discussion about what the owner can and cannot do. If the horse needs regular medication to save the eye, and the owner can't give the medicine, the horse can be sent to the Equine Medical Center in Leesburg or another hospital for treatments.

While both of these animals made a full recovery, the owner's interpretation of how significant the injuries were were quite different. One of the nice things about developing a working relationship with a client is that you get to learn how they interpret injuries to their pets. I have one client that I know if she calls hysterically saying that her dog is bleeding everywhere, I ask how much blood. Her answer will start with lots of blood and slowly as I ask her questions I realize that "lots of blood" is in fact just a few drops. I also have clients where the opposite is true. When they call to say their horse seems a little sick, you better get out there quickly as the horse is actually at death's door. So while all eye injuries are emergencies that need prompt treatment, even eyes have a variance of urgency.

Read other articles by Dr. Kim Brokaw