ABSTRACT OF THE WEEK

Veterinary ophthalmology
Volume 21 | Issue 2 (March 2018)

Modified brow suspension technique for the treatment of pseudoptosis due to redundant frontal skin in the dog: a retrospective study of 25 cases.

Vet Ophthalmol. March 2018;21(2):112-118.

Martí Cairó¹, Marta Leiva², Daniel Costa³, Maria Teresa Peña⁴

¹ Fundació Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Bellaterra, Spain.; ² Fundació Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Bellaterra, Spain.; ³ Fundació Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Bellaterra, Spain.; ⁴ Fundació Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Bellaterra, Spain.

Abstract

PURPOSE:To describe the outcome of modified brow suspension technique for the treatment of upper eyelid pseudoptosis in canine patients with redundant frontal skin folds.

METHODS:Medical records from 1999 to 2015 were retrospectively reviewed. Only dogs that underwent modified brow suspension for treating bilateral pseudoptosis were included in the study. Recorded data included breed, age, gender, main ophthalmic complaint, ocular findings, suture material used for brow suspension, number of slings placed, postoperative treatment, complications, follow-up time, and outcome.

RESULTS:Twenty-five adult dogs of different gender and breed fulfilled the inclusion criteria, with the Shar-Pei being overrepresented (19/25;76%). The main complaint at first presentation was mucopurulent discharge (10/25;40%) and blepharospasm (10/25;40%). Concurrent corneal disease was diagnosed in 47 eyes (47/50;94%). Monofilament polyamide was the most frequently used suture material (46/50;92%). Number of slings placed varied, with one in two eyes (4%), two in 28 eyes (56%), three in 17 eyes (34%), and four in three eyes (6%). Complications were seen in three eyes (6%): suture rupture (one eye; 2%) and skin abscess (two eyes; 4%). Mean follow-up time was 17.6 months (1-84 months), with no cases of fold dermatitis or dermatologic disease observed within this period. Good esthetic and functional outcomes were obtained in 47 eyes at first intervention (97%) and in all patients after re-intervention.

CONCLUSIONS:The modified brow suspension technique described offers a surgical alternative for dogs with pseudoptosis secondary to redundant frontal skin folds that potentially reduces anesthetic time and facial changes.

Companion Notes

Retrospective report on a modified brow suspension technique for upper eyelid pseudoptosis due to redundant frontal skin in the 25 dogs

Introduction on redundant facial skin folds or excessive frontal skin

- common problem in certain breeds

- shar-pei

- English bulldog

- chow-chow

- mastiff

- basset hound

- Saint Bernard

- bloodhound

- great Dane

- excessive skin may place pressure on the lid margins resulting in the following:

- pseudoptosis [pseudoptosis = inability to elevate the eyelid]

- entropion

- vision impairment

- possible chronic irritation of cornea and conjunctiva which in turn can cause:

- chronic nonulcerative keratitis

- corneal ulceration, fibrosis, or pigmentation

- treatment is mainly surgical

- rhytidectomy (coronal, frontal, or stellate), most common technique

- with forced secondary granulation

- all previously described techniques require excision of facial skin

- some owners may not want to lose dog’s characteristic facial folds

- brow sling procedures may be recommended

- suspension technique

- uses synthetic material to suspend the eyelid margin from brow region

Study design

- study population: dogs seen at Autonomous University of Barcelona

- 25 dogs with upper eyelid pseudoptosis due to redundant frontal skin

- treated with a modified brow suspension technique

(Willis AM, Martin CL, Stiles J et al. Brow suspension for treatment

of ptosis and entropion in dogs with redundant facial skin folds.

Journal of the American Veterinary Medical Association

1999; 214: 660-662)

- both anchoring method and suture material used were modified

- procedure: records from 99-15 retrospectively reviewed

Results

- history & signalment

- sex:F, 15 cases

- 4 different breeds represented

- shar-pei overrepresented, 19 of the 25 (76%)

- English bulldog, 3

- Neapolitan mastiff, 1

- great Dane, 1

- sharpei/chow-chow cross, 1

- mean age at surgery: 2.1 years with a range of 0.4-7.5 years

- initial chief concerns

- mucopurulent ocular discharge, 26 of 50 eyes (52%)

- blepharospasm, 16 of 50 eyes (32%)

- corneal ulceration, 12 of 50 eyes (24%)

- cherry eye, 8 of 50 eyes (16%)

- initial palpebral findings

- pseudoptosis and entropion, all 50 eyes (100%)

- entropion of both upper and lower eyelids, 30 of 50 eyes (60%)

- of superior eyelid in 10 of 50 eyes (20%)

- of inferior eyelid in 10 of 50 eyes (20%)

- clinical signs

- concurrent corneal disease, 47 eyes (94%)

- nonulcerative keratitis in 27 of 50 eyes (54%)

- corneal ulceration in 12 of 50 eyes (24%)

- prolapse of the nictitans membrane accessory gland in 8 (16%)

- folliculitis in 8 of 50 eyes (16%)

- corneal fibrosis in 5 of 50 eyes (10%)

- modified brow suspension technique

- monofilament polyamide, 46 eyes (92%)

- number of slings placed varied

- 1 in 2 eyes (4%)

- 2 in 28 eyes (56%)

- 3 in 17 eyes (34%)

- 4 in 3 eyes (6%)

- complications, 3 eyes (6%)

- skin abscess, 2 eyes (4%)

- suture rupture, 1 eye (2%)

- outcome with a mean followup of 17.6 months with a range of 1-84

- no cases of fold dermatitis

- no cases of dermatologic disease

- good esthetic and functional outcomes at 1^st intervention, 47 eyes

- in all cases after re-intervention

“Based on the results of the present study, modified brow suspension is a surgical procedure to be considered when treating pseudoptosis associated to redundant frontal folds in dogs. The technique has the added advantage that it may preserve the presurgical facial appearance.”

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