Why would this be indicated?

In almost all cases the eye is removed because it has reached a point where the patient cannot see and/or it is very painful due to:

• Trauma – scratches, injury (penetrating, foreign body, proptosis, hyphema), infections of the cornea and deeper eye structures non-responsive to topical and/or systemic therapy
• Glaucoma (increase pressure within the eye that cannot be managed medically leading to intense pain and blindness)
• Ocular Tumors
• Congenital diseases

Complications

• Infection can occur especially if post-operative swelling persists for longer than a week
• If the eye was enucleated due to a severe tear or rupture, there may be difficulty removing the eye in one piece and some pieces may be left behind leading to a secretion of fluids. If this occurs, additional surgery may be needed
• Manipulation of the eye being removed pulls on the optic nerve shared with the other eye, potentially risking contralateral (opposite side) blindness.
• Manipulation of the eye is linked to the parasympathetic nervous system (i.e. the “rest and digest” system of the body) and as such may cause a profound vagal response (low blood pressure, heart and respiratory rate) during surgery that can sometimes be life threatening, especially with pre-existing conditions.

Aftercare

• Stitches will be present and need to be removed in 10 to 14 days
• Eyelids will be swollen and there may be some bruising
• Mild red-tinged fluid may seep from the incision
• An Elizabethan collar is provided to be worn for 10-14 days to discourage rubbing or scratching of the eye area
• Peripheral vision of the enucleated eye will be gone (if the patient was still visual), so gradual adjustment and caution while approaching that side of face is recommended. Pets however adjust quickly and should not experience any serious changes.
• It is important to monitor the remaining eye with increased frequency to ensure vitality, particularly if the primary problem was not traumatic. Preventative measure are sometimes needed in the remaining eye (e.g. eye lubrication, topical medications

Prognosis

• As many ocular diseases are self-limiting (i.e. they do not often have systemic spread to other body systems), removal of the affected eye is curative.
• Certain disease processes may be progressive and affect the remaining eye (e.g. glaucoma, cataracts, neoplasia, certain uncontrolled systemic infections) over time so frequent close monitoring is essential.

Why would this be indicated?

There can be a variety of cases where amputations may be indicated for a patient and these could be due to:

• Tumors
• Severe trauma – wound and/or fracture that cannot be fixed, neurological disease causing a chronic painful limb
• Congenital defects rendering the limb useless

Complications

• Incision bruising – this will usually self improve after several days
• Seroma (fluid under the skin) can develop at the site in the initial two-weeks if the patient has been too active at the surgical site – small seromas usually self-resolve, bigger seromas may need to be drained.
• Infection can occur
• Hemorrhage
• Hernia
• Neuroma (nerves at the amputation site can form masses of nerve tissue leading to be pain and additional surgery and pain relief may be needed for management)
• Phantom limb pain

Aftercare

Most patients are discharged between 2-7 days post-operation depending on their level of comfort and ability to walk after surgery.

• Stitches will be present and need to be removed in 10 to 14 days
• An Elizabethan collar is provided to be worn for 10-14 days to discourage licking and biting at the wound.
• Exercise restrictions are recommended while the patient gains strength and co-ordination after the amputation. The patient should be kept strictly indoors initially for at least two days until they are stable enough on the remaining limbs. Do not allow access to stairs or slippery floors. Avoid rigorous activity for the initial 4-weeks and stick to short leashed walks only.
• Sling support can be provided to assist with pet rise and balance initially but ultimately the patient should be able to rise and balance without support.

Prognosis

Prognosis depends on the reason for amputation. Most patients return to a high level of activity following the four-week recovery phase. Ideally, these patients should be kept on the thinner side of normal for the remainder of their life to limit the amount of stress that will be exerted on the remaining limbs.