Case of the Month – May 2012

Our Case of the Month for May involves Tom Palmar – a very smart ginger tom cat!  Over a few months the owners had noticed he had runny eyes, he was very well in himself, but they just did not seem to be clearing up. On examination Tom had a severe case of Entropion.  As he had started to age the fat pad behind his eyes had diminished. This resulted in his eye balls sinking into his sockets.  This is a natural part of aging for us all! Unfortunately with Tom the skin surrounding the eyes had then become baggy and the lower lids had begun to curl under.  The technical term for this is Entropion and simply means that the eyelids are turning in.Although the lids turning in, is not in itself painful, the hair on the skin then comes into contact with the eyeball surface. This causes irritation of the corneal surface – much like a speck of dirt on a contact lense.  To try and correct this the body naturally then produces lots of tears which spill over onto the cheeks.  Unfortunately this can be mistaken for conjunctivitis even though there is no infection present. You can see in the photo gallery below how many hairs were sticking to his eyeball surfaces and when conscious how this was causing him to squint. Tom was nearly 12 years old but was fit and well.  It is always aging cats that develop this condition so he underwent a full physical to ensure there were no other age related problems.  Blood samples revealed excellent liver and  kidney function.  Medical management with drops does not solve this condition as it is the physical in turning of the lids causing the problem.  Surgery is the only way to correct Entropion which can become painful over time if left untreated as eye ulcers can develop. Under general anaesthesia Tom had two large ellipses of skin removed from over his cheek bones.  You need to ensure that just enough skin is removed.  Too little and the eyelids will still curl, too much and you can actually pull the eyelid too far resulting in Entropion (an outward turning of the lids) which then become crusty and dry.  If you pinch the skin over your own cheek bones you can appreciate the difference it makes. Very fine surgical absorbable sutures were used to repair the holes.   These stitches were hidden under the skin to ensure comfort and avoid the dreaded lampshade collar!  Tom recovered very quickly from his anaesthetic thanks to a drip, maintaining his blood pressure throughout the procedure and essentially ‘flushing’ the anaesthetic out of his system more quickly. Photos of the operation are found below as well and actually are not very squeamish at all!  Considering the amount of skin removed there is very little blood loss with this operation.. On waking up he was so comfortable now his hair was not in his eyes he didn’t even try and rub his face or bother his sutures.  Being a predominantly outdoor cat he was kept indoors for the first 24 hours to ensure he was comfy and eating/drinking normally.  No eye drops were required but he did receive some anti-inflammatory pain killers for few days.  The sutures dissolve quickly once the skin has healed and do not need removing.  A blessing in such a delicate area! After the surgery, despite Tom’s age, he has not looked back.  Fit and active, he has been outside nearly all of the time enjoying the sunshine and has even started hunting again! If you have an aging cat that has often bouts of ‘conjunctivitis’ it is worthwhile having a very close look at his face to ensure the eyelids are not turning inwards as it is a more common problem than most would realise!  If you are worried and think your pet may have a case of Entropion then please contact the surgery for an appointment and we can advise you if any treatment is necessary.