Veterinary Quarterly

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Transpalbebral exenteration in cattle

J. Vermunt

To cite this article: J. Vermunt (1984) Transpalbebral exenteration in cattle, Veterinary

Quarterly, 6:1, 46-48, DOI: 10.1080/01652176.1984.9693908
To link to this article: https://doi.org/10.1080/01652176.1984.9693908

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 Transpalbebral exenteration in cattle
J. Vermunt'

SUMMARY Description of a simple and fast surgical method and the necessary regional anes-
thesia for treatment of extensive global and orbital affections is given. The results of this transpalpe-
bral exenteration procedure were highly satisfactory.

INTRODUCTION
O p h t h a l m i c surgery in large animals is
nearly always related to the e c o n o m i c
value of the animal, the a m o u n t of post
operative t r e a t m e n t and the type of lesion.
Especially in cattle the majority of o p h t h a l -
mic surgery is of the peri-ocular type and
includes p r o c e d u r e s involving the orbit,
eyelids, nictitating m e m b r a n e , nasola-
crimal system a n d c o n j u n c t i v a . In this
article we give special a t t e n t i o n to surgery
of the orbit. O r b i t a l surgery in large ani-
mals is divided into the following:
Evisceration: R e m o v a l of the contents of
the eyeball, with the sclera being left intact.
This p r o c e d u r e has only been used occa-
sionally in very valuable horses with the
insertion of ocular protheses.
Enucleation: R e m o v a l of the eyeball a f t e r
the eyemuscles a n d optic nerve have been
severed, (subconjunctival- a n d t r a n s p a l p e -
bral ablation).
Exenteration: R e m o v a l of the entire con-
tents of the orbit (1, 9).
Enucleation is the most frequently used
orbital surgical p r o c e d u r e and is reserved
for: (1) massive t r a u m a and loss of the
entire globe o r contents of the eyeball; (2)
septic p a n o p h t h a l m i t i s ; (3) extensive cor-
neal ocular neoplasms; (4) phthisis bulbi
with associated conjunctivitis and (5) en-
larged p a i n f u l g l a u c o m a t o u s eyes which
rarely occur in cattle. T h e t r a n s p a l p e b r a l
a b l a t i o n p r o c e d u r e is used almost exclusiv-
ely in cattle, especially in cases of extensive
neoplastic involvement of the conjunctiva,
nictitating m e m b r a n e and globe. T h e exen-
teration p r o c e d u r e can be chosen in case of
extensive neoplastic a n d septic conditions
of the entire globe and orbit (2).
Both the t r a n s p a l p e b r a l a b l a t i o n a n d the
exenteration give m o r e h e m o r r h a g e a n d
tissue loss, but the procedures may be ac-
complished in a short period of time. T h e
relatively small globe a n d larger orbit in
cattle provide greater r o o m for surgical
procedures (3). W h e n little time is available
and speed required a c o m b i n a t i o n of the
t r a n s p a l p e b r a l ablation and exenteration
p r o c e d u r e may be used, ( t r a n s p a l p e b r a l
exenteration).
O p h t h a l m i c surgery in large animals is per-
f o r m e d u n d e r topical, regional or general
anesthesia. In cattle, regional and general
anesthesia are the most frequently used.
Both m e t h o d s need sedation prior to in-
duction of anesthesia.
General anesthesia can be obtained by
using chloral hydrate or b a r b i t u r a t e s (4).
F o r regional anesthesia we can use the
combined r e t r o b u l b a r and auriculopalpe-
bral nerve block (5). M o s t c o m m o n l y used
modifications are the P e t e r s o n m e t h o d (6)
a n d Slatter m e t h o d (7).
According to Slatter the Peterson block
does not give reproducible results on a con-
sistent basis (8). W h a t e v e r m e t h o d is
chosen, one has to be sure of accurate place-
ment of the local anesthetic solution.
In this article we describe the surgical pro-
cedure of t r a n s p a l p e b r a l a b l a t i o n / e x e n t e -
ration and the obtained results.

Veterinary Clinic, 45 M o o r h o u s e Street, Morrinsville, New Zealand.

46 THE VETERINARY QUARTERLY, VOL. 5 , N o . 1, J A N U A R Y 1984

MATERIALS AND METHODS million units penicillin plus 5-8 grams dihydrostrepto-
mycin (Depomycine®) for 5 days. T h e non a b s o r b a b l e
D u r i n g the period O c t o b e r 1981 - July 1983 transpal-
external stitches are removed after 10-14 days.
pebral exenteration procedures have been performed
on 20 cattle (12 Friesians, 6 Herefords. 2 Jerseys),
RESULTS
Indications for this type of surgery were:
— severe septic conditions of the globe and orbit; 5 When extensive neoplasm was the indica-
cases; tion for transpalpebral exenteration, sur-
— extensive neoplasms of the globe; 5 cases;
gery was only done on animals with no
— extensive neoplasms of the conjunctiva; 8 cases;
— massive ocular t r a u m a ; 2 cases. regional lymph node involvement.
When there was marked lymph node en-
We prefer surgery with light sedation and regional largement present we advised culling the
anesthesia, because most f a r m s have p r o p e r restrain-
animal. From the neoplasm cases, suitable
ing facilities: F o r sedation we used 0,5-2 ml of Xyla-
zine 2% ( R o m p u n ® ) intravenously. T h e eye and its for surgery, a sample was taken for histo-
immediate surroundings are vigorously cleaned with pathology. In all cases the clinical diagno-
water and surgical soap (Betadine scrub®). sis 'cancer eye' was confirmed by the labor-
The external eye is flushed with sterile normal saline
atory results. Both the Peterson block and
and all debris and discharge is removed as good as
possible. Regional anesthesia was accomplished by the Slatter block, if placed correctly, are
either the Peterson block or the Slatter block. In the fairly easy and reliable methods of regional
Peterson block a 10 cm slightly curved 18 gauge orbital anesthesia. Recovery from the orbit-
needle is inserted in a space b o u n d e d by the s u p r a o r -
al surgery was in all cases uneventful.
bital process, Z y g o m a t i c arch and the coronoid pro-
cess to reach the pterygopalatine fossa. After aspira- None of the animals showed septic wound
tion to prevent injection Into the internal maxillary conditions and no fistula formation oc-
artery, 30 ml of plain lignocaine 3%(Xylotox®) is in- cured in the gauze packed orbita cases.
fused retrobulbar. T h e needle is then partially retract-
Normally we advise the owners to cull the
ed and directed to a point 4-6 caudal of the s u p r a o r -
bital process along the dorsal aspect of the zygomatic operated on animals at the end of their lac-
arch to administer a palpebral nerve block with a n - tation period. 16 Animals started their fol-
other 10 ml of lignocaine. F o r the Slatter block retro- lowing lactation and are producing well.
bulbar injections are placed at f o u r separate places Missing the one eye seems to give no prob-
through the conjunctiva. 10 Ml of lignocaine is inject-
ed through the dorsal, ventral, medial and lateral lem. The other 3 cases, all Herefords, kept
canthi plus an infiltration of the eyelid margins. for beef production were slaughtered in
The r e t r o b u l b a r infusion of a relatively large a m o u n t excellent condition. One Friesian cow
of anesthetic solution causes a certain degree of ex- showed marked new t u m o r o u s infiltration
o p h t a l m u s and makes orientation easier.
The whole area is now sprayed with a 5% tincture of
of the orbita 2 months following the initial
iodine solution. T h e eyelids are apposed with a hori- operation. She was condemned at the
zontal mattress suture or closed with towel clamps to freezing works because of metastases.
be used as a hold or lead while removing the orbit
contents. T h e lids are incised by scalpel 2-3 cm f r o m DISCUSSION
the eyelid margins for 360°. Dissection is continued
through the orbicularis oculi muscle and a r o u n d the Transpalpebral ablation and exenteration
conjunctival fornices. F o r m now on the dissection are both almost exclusively used in cattle.
follows t h e ' b o n y part of the orbit up to its apex. Both procedures are relatively simple and
H e m o r r h a g e is minimized by blunt separation and
direct pressure. Once the apex is reached a heavy
need little time to perform. When there is
curved hemostat is applied on the optic nerve and no need or possibility to preserve the globe
hemostasis obtained by vessel ligation using No. 2 or maintain vision these surgical methods
chromic catgut. should be first choice.
T h e orbit is packed with a b s o r b a b l e gelatin sponges A combination of both methods, the trans-
(Gelfoam®), or stepwise folded sterile gauze. T e r r a - palpebral exenteration provides a surgical
"lycin powder or penicillin — dihydrostreptomycin is procedure which may be accomplished in a
mstalled into the orbit. T h e remaining eyelids are
stitched with n o n a b s o r b a b l e interrupted horizontal
very short period of time. When the diag-
mattress sutures using No. 3 Synthafil®. nosis and decision to operate are made, the
In case of packing the orbit with gauze we leave a b o u t whole transpalpebral exenteration pro-
5 cm hanging out in the medial c a n t h u s and ask the cedure can be done in less than thirty minu-
owner t o remove this after 48 h o u r s by very careful
pulling out the gauze f r o m between the sutures.
tes.
Only the 5 cases with septic conditions of the globe No post operative treatment is required.
and orbit were injected parenteral with 6-10 grams Antibiotics, placed in the orbit during sur-
oxytetracycline (Terramycine L.A. ®) once or 6-10 gery, are administered once. Administra-

47 T H E V E T E R I N A R Y Q U A R T E R L Y , V O L . 6 , N o . 1, J A N U A R Y 1984
tion of systemic antibiotics is only indi-
cated if deemed necessary, e.g. in presence
of marked sepsis.
Considerable post operative swelling and
deformity of the orbit are likely to occur
with this transpalpebral exenteration
method, but this can hardly be of any signi-
ficance in production and food animals.
'Cancer eye' susceptibility in cattle is
thought to be of moderate heritability, so
perhaps such animals should not be used
for breeding replacement stock.
REFERENCES
1. Gelatt, K. N., Titus, R. S.: O e h m e - P r i e r T e x t -
b o o k of Large Animal Surgery. T h e Williams and
Wilkins Cy, Baltimore 1974; 546-74.
2. Berge, E., Westhues, M.: Tierarztliche O p e r a t i o n s
Lehre. Paul Parey Verlag, Berlin, 29e Auflage
1969: 164-5.
NOTICE FOR AUTHORS
In general a u t h o r s should prepare their papers
according to the ' U n i f o r m requirements for m a n u -
scripts submitted to biomedical journals', also
k n o w n as the ' V a n c o u v e r style'.
Manuscripts should be written in English and
submitted in triplicate (One copy should be label-
led as master copy and should contain the original
illustrations, graphs, diagrams, tables etc., suit-
able for reproduction). They should be presented
in a f o r m that can readily be set by the printer, i.e.
they should be typewritten, double-spaced, on
one side of the paper only. Illustrations and tables
should be supplied on separate sheets in a clear
d r a w n (e.g. Indian ink) or typewritten f o r m , so
that p h o t o g r a p h i c plates can be made. P h o t o -
graphs should be submitted on glazed white
paper. X-ray pictures on film or paper. T h e a p -
48
3. Dyce, K. M., Wensing, C. J. G.; Essentials of
Bovine A n a t o m y . A. O o s t h o e k ' s Uitgevers Mi
N.V., Utrecht 1971: 20-4.
4. Wright's Veterinary Anaesthesia and Analgesia
Bailliere Tindall, L o n d o n , 7th edition 1971: 184
210.
5. Hare, W. C. D.: A regional method for the c o m
plete anaesthetization and immobilization of the
bovine eye and its associated structures. Can. J.
Comp. Med. vet. Sci. 1957; 21: 228.
6. Peterson, D. R.: Nerve block of the eye and asso
ciated structures. J. Am. Vet. Med. Assoc. 1951
118: 145.
7. Slatter, D.: F u n d a m e n t a l s of Veterinary O p h t h a l
mology. W. B. S a u n d e r s and Cy, Philadelphia
1981: 693.
8. Slatter, D.: C o n t r o l and T h e r a p y no. 1413, Univ.
Sydney. P o s t - G r a d . C o m m . on Vet. Sc., Oct.
1982.
9. Gelatt, K. N.: T e x t b o o k of Veterinary O p h t h a l -
mology, Lea and Febiger, Philadelphia, 1981.
p r o x i m a t e position of Tables and Figures should
be indicated on the manuscript. T h e paper should
c o m m e n c e with an abstract of u p to 150 words.
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torial office on request.
THE VETERINARY QUARTERLY, VOL. 6 , N o . 1, J A N U A R Y 1984