Enucleation - when it's absolutely necessary

[Jenna AK]

Just wanted to post an update on Jenna, my 12 yo baby. As of the 8th of July, her vet left our practice and moved out of state. She was supposed to enucleate Jenna on that day, but I couldn't gather the funds for the surgery in time. The opinion of her vet and her ophthalmologist is that at least he left eye should be enucleated because the pressure in it is up in the high 20's to 30 and that is painful. My vet wanted to remove both eyes to spare us extra expense and additional surgery, but the ophthalmologist wasn't on board that both needed to go. She may still have light reaction in the right eye, but the cornea is showing some vascular involvement and now has a 'shadow' in the same area that we're going to have another vet see her for on the 27th.


We're not sure how much Jenna hears, but in the hopes that her right eye may yet be saved I'm not fully behind removing both her eyes unless it's absolutely necessary, as in the case of unresolved infection or cancer. What do you think? Would you bilaterally enucleate a 12 yo Yorkie or would you just enjoy your time with her until the pain cannot be controlled and then let her go? Personally I can't see ending her life over this if eye removal could improve her QOL, but has anyone here ever dealt with an eyeless dog? She has terrible anxiety when I'm not around her and while she might be able to scent me out better without daily eyedrops (they really seem to impact her olfactory senses) would she be even more anxious without at least a little light getting through the remaining eye if I only have one removed?


Jenna has struggled with hypermature cataracts in both eyes for almost 2 years now and the prognosis is that this condition is starting to fail to respond to topical treatment.



My primary concern is that she not be in pain and that her health not be compromised, physical and mental. Any thoughts on this dilemma? It's had me horribly conflicted for a long time now and I'm still trying to raise enough money to at least pay for the sacrifice of the most painful eye.


Thanks to all in advance.

[ladyjane]

I'm so sorry...so upsetting. My Teddy Bear recently had glaucoma come on suddenly . Enucleation was discussed IF the eye drops didn't work. Thankfully he responded and the pressure started coming down .. his eye is now shrinking. They said the other eye might do the same...so far it has not. Teddy has multiple medical issues and is 14 years old .. I already had decided I would let him go before I would remove an eye.

It is a very personal decision and really depends on the pup. This has been very hard on Teddy as it is; and I am not so sure he would handle anesthesia well. He is high risk for anesthesia.

I wish you well in your decision. So sorry Jenna has to go through this.

[Bluebells]

I don’t have any close experience with this but, through rescue work, I know of many cases where dogs and cats have had eyes removed, either due to illness or injury. Other than the risks involved with the surgery, I don’t think there’s much difference between how an animal adjusts to eye removal vs how an animal adjusts to blindness without eye removal. Animals, in general, handle blindness quite well ... far better than they handle continuous pain. And — perhaps I’m wrong here, but — I don’t think an animal’s adjustment would be much different to being totally blind vs having a tiny amount of light & shadow in one eye. I don’t see why the tiny amount of light & shadow would be emotionally comforting in any way. So, if it were my decision, I would probably weigh the emotional cost and health risk of continuing discomfort and a possible second surgery as worse than losing that tiny bit of light & shadow.

It’s totally a personal decision, of course. No one is going to criticize you for taking whichever path you decide is best for your pup. I’m sorry your pup is going through this, but please don’t torture yourself over it. Make the best choice you can among the poor choices you’ve been given, and then remember you did your best.

[nanajoy]

Reading your post brought tears to my eyes. I am not able to give you any information, and I would not want to advise you on so personal a matter. You are doing the best that you can...pursuing both medical information and advice, and I hope that you will be able to reach an informed decision which will bring you peace. Unfortunately, as our beloved little ones come to their final years/days, we must often make difficult and painful decisions regarding their welfare. I will keep you and Jenna in my thoughts.

[ladyjane]

Hope all is well ...

[casey13]

Hope you are ok, I had the same decision with my nearly 17 year old silkie. He had Cushings and had lost his life partner 1 year before. He was deaf for a while before going blind and when he lost the last of his sight was so anxious not being able to sense me. It was unbearable for him and myself. We decided to let him go as he had no quality of life. Hugz to you.

[ladyjane]

Wondering how Jenna is doing.......

[Jenna AK]

Hello ladyjane,
Jenna is still soldiering on. She's had a very resistant ulcer in her right eye that's only now clearing up. We've been treating it for months. Sadly, the COVID situation has rendered it impossible for her ophthalmologist to see her, because it would mean travel from another county. Her regular vet left in July and so we have a new gentleman keeping up with her progress. We still don't have enough funds to enucleate but we seem to be keeping her pain as under control as possible.


Anyone here have experience of using gapabentin for their pups? I have to admit I'm wary of it. Used it years ago to help with my house rabbits' arthritis. It's supposed to work well for glaucoma discomfort but it does have some worrisome side effects.


We had to deal with lots of wildfire smoke from the Medford area of Oregon and also Northern California that irritated her eyes and breathing quite a bit for the last few weeks. Fortunately we've been blessed with rains so the air is much clearer, but it took a toll on her well being and we weren't able to conduct our usual long walks, which made her more agitated when awake.


She's normally very clingy but has become more so. I assume it's getting harder for her to even see patches of light. She bumps into a lot more walls and floor based objects like chairs. I'm just trying to keep her from injuring the eyes any farther, because that will be emergency surgery if they rupture or otherwise become untreatable.


Her favorite pastime is still time with me. She's always glad to realize when I've come home from work, and enjoys brief car rides around town. Everyone knows her here and loves to see her.


I was thinking of starting a GoFundMe page to see if I could raise some money that way, as things like selling on Ebay or garage sales seem to have gone by the wayside in the pandemic. I've never done anything like this before though and am dubious of success, but I suppose it would be worth a try. I hate the idea of publicly begging, which is all this is to me, but she is too important to me not to explore any avenue that could help.


Other than that we are just watching her pressures and hoping they remain stable. The left eye was last read a month ago at around 34 and the right at 13. She has an appointment in the next few days to check them again.


Thank you everyone for your kind words and concern for my baby.

[ladyjane]

Eye issues are awful. I have one right now who has been treated for three weeks now....he is on prednisone for lymphangectasia so that is not helping matters. We are using serum and antibiotics .... and yes, I have used and am using Gabopentin presently for him. I have used it many times with others and never had any issues with it. That is what the vets like to use these days for pain. Eye ulcers are painful as is the higher pressure...I would definitely use it.
As for Go Fund Me....doubtful it would do well unless you know a lot of people. I hate to be negative, but they don 't do well unless you just get lucky and it goes viral.
I have managed to sell some things lately on Ebay and Etsy...you might want to try that.
Thanks for updating! I hope t hings get better soon.

[Juliealfies mum]

We also have an eye issue at present. Lottie who is 15 years old has a tear in her cornea I have been to the vet twice and I have antibiotic drops and repair gel to put in her eye and the vet is monitoring it every week ,, he says he will give it 8 weeks to heal and if not he may as a last resort have to remove the eye!
I can sympathise with you both as it’s such a worry and I hate to think she is having pain.
Hope Jennas eye is improving,and LadyJane I hope your little one is also On the mend .

[ladyjane]

Originally Posted by Juliealfies mum

We also have an eye issue at present. Lottie who is 15 years old has a tear in her cornea I have been to the vet twice and I have antibiotic drops and repair gel to put in her eye and the vet is monitoring it every week ,, he says he will give it 8 weeks to heal and if not he may as a last resort have to remove the eye!
I can sympathise with you both as it’s such a worry and I hate to think she is having pain.
Hope Jennas eye is improving,and LadyJane I hope your little one is also On the mend .

Eye ulcers are awful. As to eye removal after eye drops fail....that should not be the last step. There are other things that can be done to help the eye heal. The next step for mine will be a grid keratotomy. I hate the thought of it and am hoping his eye heals with the new treatment of serum (something else your vet can add) and new antibiotic drops; but, I have had it done with others in the past and it did work.

Helpful link about ulcers that are difficult to heal:

https://www.northwestanimaleye.com/corneal-ulcers.pml

If your vet is not familiar with those other treatments, I suggest you consult with an ophthalmologist.

I hope Lottie's eye heals without a need for anything else.

[Juliealfies mum]

They did try some sort of debridement under local anaesthetic, and to keep going with the drops at present , I am worried due to her age .
I will check out the link thank you so much .

[ladyjane]

Originally Posted by Juliealfies mum

They did try some sort of debridement under local anaesthetic, and to keep going with the drops at present , I am worried due to her age .
I will check out the link thank you so much .

It is harder when they are older. I am so sorry....so worrisome.

[Juliealfies mum]

Thank you for the support I hope it won’t come to removing the eye, as I don’t know at her age if she would cope with the anaesthetic but on the other hand I can’t have her in pain.

[Jenna AK]

Wow, 15! That is an awesome age. I can understand your concern and also your determination that she not be in pain and how it may necessitate the risk. If needs be, I will probably allow Jenna's eye or eyes to be removed, as long as it can be done safely and her remaining time be kept comfortable. I just can't see losing her to this issue, she is still so full of life.


Well, to my surprise, at her recheck on this last Thursday, the vet found the pressure in her left eye to be down to 16-18 from the previous 34-35! Granted the pressure a month ago was just after her drops went in (within the hour) and while it doesn't seem like it should be an issue, apparently the longer you wait to take pressures after medication, the lower they will go. Her right eye was the same as last time, in the 13-16 range. He took the pressures on the left eye 3 times to be sure. At one point it looked like they would top out in the mid 20's but he was holding the instrument a bit sideways during that reading so position may have been a problem in getting a correct reading. With repeated attempts the pressure continued to read in the teens.


I'm gobsmacked, really. But she hasn't been going at her face as much and seems more comfortable. One thing I've been keeping up on better is timing of drops, keeping them properly spread out during the day when her in between dosing needs doing, and also using Systane Ultra for any dry eye she is experiencing which is doing wonders for that ulceration. I've googled a bit and noticed some topics about people asking if treating dry eye helps lower IOP but there's no conclusive evidence. More likely that we're sticking to our schedule and her pressures will likely be higher in the early mornings anyway since we don't wake her to dose drops overnight.


Personally, I'm over the moon! I know it's not a permanent fix but we seem to have been given a miraculous reprieve. It's so good to see her feeling more herself again. With the wildfire smoke pretty much gone now (we've had good rain for the last few days) we're all feeling a lot less uncomfortable.


Thanks to everyone thinking of my wee Jenna. Bless you. xx