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Wednesday, June 12, 2013

Removing Both Eyes

Today's post is about a Siberian husky named Diesel.  He's a sweet six-year old boy that first began having problems in late 2012.  At first there was just some inflammation noted in his eyes, which we treated and it seemed like everything was okay.  Two months later, in December, he came in for more eye problems.  It didn't take long to determine that his eyes were painful and his eye pressure was very elevated.  A rather simple diagnosis:  glaucoma.  In his case there was still some inflammation within the eye (uveitis for the medically-minded) and I suspected that the glaucoma happened secondary to the first problem.  Whatever the cause, it needed to be treated and quickly.

I sent him to a local veterinary ophthalmologist the next day and she began treatment with multiple medications.  Over the next several months we slowly got his glaucoma under control with a few setbacks here and there.  The owners hated having do use 4-5 different eye drops every day, but they were willing to do so if it helped him.  Unfortunately he stopped responding as well, which brought us to May.

He made another visit to the specialist a couple of weeks ago and it was determined that his left eye had lost all vision and the right eye had only minimal vision along with a displaced lens.  The left eye was not salvageable, and the best thing to do was to remove it.  However, the right eye was mostly blind and the ophthalmologist gave it a guarded prognosis at best.  He could only see shadows to a certain degree and there was a high likelihood that the "good" eye would fail at some point in the future.

This situation led to a discussion between me and the client.  It was obvious that we needed to remove one eye.  But there was a strong justification for going ahead and removing the other one at the same time.  Both eyes were causing pain and discomfort.  He also did not like the multiple medications used to even somewhat control the glaucoma.  This was a lot of hassle, time, and expense for something that wasn't completely helping the problem.  We began to talk about doing a bilateral enucleation (fancy medical words for "removing both eyes") since there was a good chance that in six to twelve months we'd have to remove the other one anyway.

This was not an easy decision and I'm sure it sounds radical to many readers.  But in circumstances like Diesel the eyes are more of a problem than a benefit.  Neither of them was functioning well and he was effectively 80% or more blind already.  We think about it in our own terms and can't imagine not having our eyes.  Even if we were blind, removing such an important organ makes us cringe.  But with Diesel removing the eyes would be helping his comfort in the long run, and given that he is only six years old he still has a lot of life left in him.  The client thought long and hard and finally decided to go ahead with the surgery.

Here he is before the surgery.  You can tell that he is squinting his eyes more than a normal dog would, and that's due to the pain from glaucoma.


Here is a close-up of the left eye.  It's a little difficult to tell from this photo, but the eye is very cloudy and the pupil is dilated.


I've performed enucleations before, but this is the first time I've removed both eyes on the same pet.  As far as the technical aspects of the surgery, it went very well and without any complications.  In this kind of surgery we remove the eye, muscles, and tear gland (along with the associated third eyelid membrane).  We cut the edges of the eyelid and then sew them together so that there is no longer an opening.  Some specialists may place an artificial eye in the socket just to maintain a more normal, rounded appearance, but this is purely cosmetic and doesn't affect the surgical outcome.  It's also something I don't do.

Here he is immediately post-operatively.



The initial recovery period was a bit rough, despite extensive pain medications.  But he started coming around and relaxing.  My entire staff kept talking to him and when they were available would open his cage and pet him.

By the end of the day he was ready to go home.  He even wagged his tail as we walked him out to his owners!


I have known other dogs who have had double enucleations.  They actually do very well and learn to cope well with their new life and lack of vision.  They can still have a great quality of life and be very happy.  While I only recommend doing this radical of a procedure in extreme circumstances I also feel that this is not unfair to the pet and really is helping them.

Diesel and his people will have an adjustment period.  He will have to learn to get around without any sight or light at all.  The owners will have to learn to be patient and not move furniture around a lot.  But once he heals from the surgery he will be pain-free and will no longer have to deal with the hassles of eye drops.  We anticipate continuing to see him for many years to come.

22 comments:

  1. I remember the first time I did this. Well, removed a second eye when one had already been removed earlier. Glaucoma - same reasoning. He was in pain. Mine was a Pekinese and afterwards, the owner was thrilled to be free of the meds and pain for him.... his hair covered the sockets beautifully. Later, she said it made her laugh when people stroked him and smoothed back his fringe and realised he had no eyes - they knew he was blind, but were shocked at the nothingness.
    Strange really - but would recommend it to anyone who has a much loved dog with this condition.

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  2. Awww. As the proud parent of a born-blind dog, I know they cope a lot better than we do.

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  3. Wow, what an interesting case. We just finished with ophthalmology this semester, so it's nice to read this and understand the background. Hope Diesel is doing fine.

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  4. This was a pretty interesting story, it makes me cringe so bad thinking of cutting out something's eyes.

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  5. I just dropped my foster dog, Micah, off at the vet's this morning and she will be having both eyes removed. This article made me a little more comfortable in what to expect. This poor girl is also deaf but I know she's a fighter and will make it through this.

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  6. Day two. He is more bruised and swollen today. It looks worse than yesterday. He went outside and knew where to find the steps to come in. His cone keeps getting stuck on things. He doesn't feel good. He'll get through this. Today I was able to get him to eat chicken so I didn't have to squish the pill, add broth, then use the eye dropper to get it in him. I'm so glad to see him eat..

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  7. Our little lhasa tiggy had one eye removed last week after she got ulcers in both eyes. We are treating the other with drops, desperately trying to save it, but it's not looking good today. She's not opening it much at all. Very worried that the other will have to be removed next week.

    Steve.

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  8. awe...my dog Gigi is only 6yrs just went through surgery in December had an eye removal has adapted well full of energy. However, this past week i noticed her other eye a bit swollen took her to the vet and looks like she got glaucoma on this eye as well and will also need surgery. The news was very hard but she is so young reading this article is very comforting to know that she will be able to adapt. Thank you

    Joanna Avila

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  9. I have a 10 year old cocker spaniel who just had her remaining eye removed in February. She also suffered from glaucoma. she had the 1st eye removed in May. drops helped the Remaining eye but sadly they stopped working. We are now 3 months out and she really fascinated us how quickly she adapted. We joke we would still be in the fetal position feeling sorry for ourselves but this girl had no fear. She uses our doggy door, jumps on the couch, and still uses the doggy stairs to our bed. After shes been soundly sleeping and wakes up she has a tendency to bump into things but normally she runs out the dog door without an issue and uses the 2 stairs to the yard happily. We did put textured mats at the top of the 2 stairs outside. We also used runners to the doggy door ext. She also has a couple scents we use to let her know where she is. I must admit we were terrified and overwhelmed with the thought of having that 2cnd eye removed but truly she is finally pain free and has adapted very well already! Thank you for your article it is hard to find info on this subject.

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  10. That's really reassuring rescueme as my 12 year old Shar Pei bitch is having her remaining eye removed in two days. I feel really bad, but even with her eye meds, she sometimes awakens in the morning completely blind. It's only after her remaining eye is bombarded with drops for an hour or so that some degree of sight returns. Her cornea has become really cloudy, even when her eye pressure comes right down it stays that way. I'm sure she only has partial sight remaining, but it's gotten to the point that her appetite is suffering. She can't tell me that it hurts so the only way to be sure is to remove the eye. I'm sure she'll adapt in time as she's very headstrong. I just want her remaining years to be comfortable and pain free.

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    1. Phil, I still see this patient regularly, three years later. He is one of the happiest and most well-behaved pets that we see and has made the adjustment to having no eyes extremely well. Every time I see him he is still wagging his tail and eager to give kisses. If her eye is bothering her and is essentially mostly non-functional, you will see a big improvement in her energy and attitude once it is removed. Best of luck to you and her!

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  11. My 8 year aussie is having both eyes removed as I type this. He has been seeing an eye specialist for almost five years. Started with cataracts in both eyes and detached retinal in one which was probably due to abuse. Testing showed he was not a good candidate for cataract removal and was already blind in both eyes. Fast forward to today, after developing glaucoma in one eye and successfully getting pressure down with additional multiple drops we decided to have have both eyes removed. At least all his trips to specialist will come to an end as well as all of the drops. We will no longer have to worry about how the sun and snow affects his eyes. I will miss seeing his eyes but know he will be more comfortable.

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  12. Hi, glad I found this tonight. My foster failure wirehaired dachshund, about 10-12 years old, had both eyes removed today. He's been ours for 3 years and has been mostly blind for all of that time. About a year ago the glaucoma stopped responding to the various drops and he lost his vision. The eyes had to come out because of the pain. He hates the cone and I can't get him to take any food that I can sneak a pill into, but reading these stories gives me hope that we too will get to the other side of this journey. Blessings to all of you who love your pets enough to go through this with them .

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  13. I have a 15 year old rat terrier mix. In November of 2016, I had to have her eye removed due to retinal detachment...it was beyond saving at that point. She's been fine for the last 6 months, and then within the span of the last 3 days, she's lost her vision in her remaining eye. It's starting to swell, and show the same signs as what had happened to her first eye. The vet in my city recommended I go to an eye specialist, but the nearest one is over an hour's drive away, and the initial consultation is $234, which I don't just have laying around. I feel helpless right now. I feel helpless right now. I want to save what little vision she did have before this (I was told she has cataracts before all of this began)...but I know the longer I wait, the least likely that will happen. And if it was just her losing her vision, I know she would adjust... But because of the pressure building up in her eye, I know she's in pain...like I said, just feeling helpless right now. Looking for advice. She's old, she can't really hear very well anymore either, and now she's in pain and can't see...but I love her so much...and the fact that I don't have money to help her asap is killing me inside...

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  14. Hi Chris! I have a dog who was just diagnosed with glaucoma (and is likely already irreversibly blind in one eye; the other eye is predisposed but quite normal right now). I am so happy to have found your post. Thank you for this information; it is helping me cope with the inevitable.
    If I may, though, I was wondering if you might be able to speak to two things I've been wondering about since our diagnosis. Specifically, I'm wondering how having both eyes removed impacts: 1) sleep in dogs (I know the eyes aren't necessary per se, but I'm concerned about sleeping/waking troubles) and 2) emotional expression in dogs (e.g., is it still possible to get some visual cues of dogs' emotional states via eyebrow expressions, or do the eyebrows just not move much after enucleation?).
    By the way, we're not planning on removing her blind eye and her "good" eye at the same time; just preparing for the possibility of removing the blind one now and eventually having to remove the other one after it eventually succumbs to glaucoma attacks. Any insights or speculations are welcome. Thanks!

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    1. I've never seen it affect either sleep or expression. I still see this patient 4 years later, and he's as sweet and happy as ever!

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    2. Thank you, Chris! It's now been close to six months since my original comment. My dog's "good" eye is still going strong, and we ended up doing enucleation on her other eye in May.

      I am amazed by how much energy she had after recovering from surgery! Just goes to show how the pain must have really been wearing her down. I was so upset and worried for her prior to surgery, but it was totally the right move. Thanks for giving me peace of mind. If there's a silver lining to all this, it's that we've had time to start training her for total blindness when that day comes.

      Take care!

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  15. Hi my little guy had his eye removed two-years ago and we have been battling trying to save his other eye. He will now have his other eye removed next week. Its heart breaking he is almost 4 and weighs 5 pounds can you tell me what to expect the days following surgery? Also i have a cat do i need to worry about her trying to play. Also should i keep him in a kennel when im not home. Very scared and love this baby so much

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  16. It's nice to read all these comments, my Boston terrier 4 years old, Anji is in surgery right now for this and everyone at home is scared.This was very uplifting and reassuring.For Anji it started with uveitis that was caused by an infection in her uterus,then glaucoma, we tried really hard with meds, eye drops but her pressure would not drop just kept getting higher. So today it's getting done for her own good, we just want her to be pain free.

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  17. Praying your pup's surgery went well. It's a hard, drastic decision, but when you love them and they are in pain, it's the right choice. Hope you post back with a follow up. My little guy is doing fantastic two months post surgery!

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  18. All of these comments have helped tremendously. Perhaps our story might be able to help someone else that might face some of the issues and decisions we faced over the last 6 months. Our smallest family member, a 10 year old Brittany Spaniel was diagnosed with diabetes 6 months ago. Throughout his life,he was a very active hunter that maintained a diet most people would envy. However, diabetes was indiscriminate. We were told post diabetes cataracts were a common occurrence and not to be surprised. Sure enough it happened several months after his diagnosis, despite herculean efforts to maintain his glucose levels, his eyes went gray and he lost his vision. We took him to an opthamologist and were told he could have cataract surgery and lense replacement to restore his vision. They said there were some risks that the surgery may not work, but the odds were good, so we opted to go forward with the surgery as we wanted to restore his sight. The surgery was painful for him, lots of post operative maintenance with multiple drops numerous times a day and costly (around $6,000). Unfortunately, two months after the lense replacements, the pressures in one of the eyes became elevated and he was diagnosed with glaucoma. At that point the ophthalmologist recommended deadening the eye to stop the pain. We took his recommendation and deadened the eye and a month later the other eye started to have increased pressures and we were told he now had glaucoma in the other eye. To make matters worse, the eye that was deadened started to have calcium buildup that was causing irritation. At this point our final remaining decision was to have both eyes removed. Over the last six months our sweet dog has suffered so much pain chasing solutions that didn't work. We consequently decided to focus on his pain and move forward with eye removal. Yesterday, we picked him up from surgery with his eyes sewn shut, lots of swelling and the awful cone again. The comments here have helped to know after the healing process he'll be able to go on with no pain. At this point, knowing what he has endured over the last 6 months, its tough to say if we made the right decisions initially having the lense replacements. Clearly, with 100% hindsight, we would have had the eyes removed sooner, but he is a member of the family and we wanted to do everything we could to help him. Life with no eyes will be different for sure. I walked him out this morning to go to the bathroom and our neighbor came up and asked what was wrong. I explained that he had both of his eyes removed and the neighbor asked me if he was gong to be totally blind.
    Things will definitely be different, for sure.

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  19. I'm so sorry for all you and your sweet dog have gone thru. I am responding to offer encouragement. McKinney had been nearly blind for years due to glaucoma and we opted for eye removal when his presssures no longer responded to the drops. That was January 23, 2017 so we are 7 months out. He is a different dog. He used to stress at thunderstorms and not eat - he's missed maybe two meals since his surgery. Today he ate even after we had roofers replacing our roof for 13 hours! The sky was falling but his head was pain free.
    Your life and his will certainly be different, but I don't think you'll regret this decision. My only regret is not doing it sooner in our case. I'll keep you close in prayer. Never look back. Dogs don't, they live in the now.

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