Corneal / spectacle perforation in Reptiles | Vetlexicon
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Corneal / spectacle perforation

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Introduction

  • Cause: perforated corneal ulcer, trauma, foreign body.
  • Signs: unilateral blepharospasm, ocular discharge, change in corneal appearance, conjunctivitis, epiphora.
  • Diagnosis: history, clinical signs, ophthalmic examination.
  • Treatment: broad spectrum antibiotics, topical serum, pain relief, third eyelid flap, corneal graft, enucleation.
  • Prognosis: good if early treatment and no damage to deeper ocular structures.

Presenting signs

  • Usually unilateral.
  • Ocular pain: blepharospasm
  • Conjunctivitis.
  • Neovascularization.
  • Ocular discharge.
  • Self-trauma.
In snakes the eyelids are fused to form a spectacle. Perforation would be visible as a lesion or scab on the surface of the spectacle. The cornea is beneath the spectacle and is usually protected by it.

Acute presentation

  • Less common in snakes as the spectacle protects the cornea.

Cost considerations

  • If surgery is required cost can be moderate to high.

Special risks

  • Anesthetic risk if surgery required.

Pathogenesis

Etiology

  • Trauma.
  • Perforated ulcer.
  • Foreign body.
  • Inappropriate management of retained spectacle (snakes) Retained spectacle.
  • Retained shed with secondary infection (common in Leopard geckos Leopard gecko).

Predisposing factors

General

Specific

  • Dysecdysis Ecdysis / dysecdysis leading to retained spectacle Retained spectacle (snakes) or retained shed building up under eyelids (common in Leopard geckos Leopard gecko).
  • Inappropriate management of retained spectacle, eg forcibly removing it, leading to corneal desiccation and possible rupture.
  • Traumatic injury, eg grass seed perforation.
  • Progression of corneal ulcer Corneal ulceration.

Pathophysiology

  • If Descemet's membrane is breached, then loss of aqueous humor and iris prolapse occurs.
  • The anterior chamber may collapse.
  • Uveitis occurs.

Timecourse

  • Usually seen as an acute problem.
  • May be more chronic in snakes.
  • Healing tends to be slow.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Munevar C, Moore B A, Gleeson M D et al (2019) Acremonium and trichosporon fungal keratoconjunctivitis in a Leopard Gecko (Eublepharis macularius). Vet Ophthal 22 (6), 928- 932 PubMed.
  • Millichamp N J (1997) Management of ocular disease in exotic species. Semin Avian Exotic Pet Med (3), 152-159 SciDirect.

Other sources of information

  • Lawton M P C (2019) Ophthalmology. In: Mader’s Reptile and Amphibian Medicine and Surgery. 3r edn. Eds: Divers S J & Stahl S J. Elsevier, USA. pp 721-735.
  • Williams D (2012) The Reptile Eye. In: Ophthalmology of Exotic Pets. Wiley-Blackwell, UK. pp 181-182.