Saturday, June 15, 2013

How Do You Blink With Cauliflower In Your Eye? Eyelid Tumors

One of the most common eye problems that we see are eyelid tumors. I see a lot of these. Most commonly they are seen in older dogs.

Luckily, in most cases the masses (I prefer the term 'mass' to 'tumor' although in veterinary medicine they are used synonymously), are benign cosmetic eyelid defects. In almost all cases we choose to monitor these masses very closely after they first are noticed. 

There are a few exceptions to this;
  1. Any pet that is having problems blinking.
  2. Having discharge from the eye. Of greatest concern is any yellow or green discharge, excessive blinking, or squinting.
  3. Any mass that is growing rapidly or taking up more than 1/4 of the eyelid margin.
  4. Having multiple masses on the eye.
All eyelid tumors should be seen by the veterinarian as soon as they are noticed. 

This is Cody's story of his eyelid mass.

His dad noticed a small mass on his lower eyelid many months ago. At that time we just decided to monitor it. That was until a few weeks ago when his dad thought that it began to cause Cody some discomfort. 

Pre-operatively Cody had a very thorough physical examination, pre-operative blood work, and we discussed post-operative concerns and recovery needs.

Cody is a very active but anxious boy. He is young, healthy, and the joy of his fathers' life.

In the exam room he is a flash of brown and white. He shakes, jumps, shivers, quivers and is completely unable to relax even a teensy-weensy bit. When you can finally grab him and try to hold him still his constant erratic motion transfers to his vocal chords where a squealing high pitched ear shattering bellow makes the ability to hold him impossible. Cody is a quark of an English Springer Spaniel flavor. (For an interesting read see any veterinary neurology text book and all of the, (shall I say) "unique" neurologic disorders Springers have).

I have seen him four times in the last 4 weeks to examine the mass on his lower right eyelid. Each trip has been met with the same unfortunate outcome. He cannot sit still, and I cannot adequately examine him. It is a fate that befalls some. We work around it, and we provide drugs to coerce compliance. Sometimes it is necessary, but always it is the last option. We scheduled surgery for this week.

The eyelid mass was visible grossly, but truth be told I was not able to identify how invasive it was while he was awake.

Clipping the eye for surgery.
Being patient and extra careful to  not tear the very fragile tissue.
When Cody was placed under general anesthesia I saw for the first time how large the mass was.

The mass finally completely visible.
It is a glandular sebum engorged cystic mass.
In essence it is much like a large pimple on the inside of the lower eyelid.
The preliminary surgery plan was to safely and easily visualize the eyelid mass, resect it completely, and then rebuild the eyelid so that it remained functional and was as cosmetically pleasing (fancy-pants way of saying "looked good after").

Laser removal of the eyelid mass.
I elected to remove the mass with our laser. The laser allow for a very precise cut with little to no bleeding. This causes less tissue trauma a very precise incision and a quicker procedure.

The mass was removed in its entirety. This was essentially a full eyelid thickness "v" shaped cut to remove the entire cyst completely. A "v" shaped hole in the bottom lid. 

This was essentially a full eyelid thickness "v" shaped cut to remove the entire cyst completely. A "v" shaped hole in the bottom lid what left behind.

To close the defect an incision in the outside (lateral) of the eyelid had to be made. If we did not do this the bottom lid would be shorter than the upper lid.

An excerpt from Slatter's Fundamentals of Veterinary Ophthalmology displays the surgery well.

To close the "v" we have to be very careful to use suture that will not irritate the eye. Take special care to not leave any knots that could rub against the eye.

The second page of the excerpt from Slatter's,
showing the three layer closure technique.

Suturing the inner layer of the eyelid.

To close the defect we do a three layer closure. Closing the skin that touches the eye, then the middle muscular layer, and finally the skin. We also have to make sure the eyelid margin is together and on the same level.

Closing the outer layer of the eyelid.

Making the lateral incision to allow enough tissue to make the lower lid the same length as the upper lid.

Closing the lateral incision after the lower lid has been advanced as much as is needed.

Suturing the lateral aspect of the reconstructed lower eyelid.

Surgery is finished.

The incisions are closed and the eye reconstruction is complete. A bit of pos-op swelling and bleeding is normal.

Cody awake after surgery. His surgery looks great! (if I do say so myself).

Post-operatively the eyes look very similar. There is no pulling on the eyelids, no asymmetry, no drooping of the lids, and little to no swelling.

Here is a cost break-down of Cody's eye mass;

Pre-op exam $50
Pre-op blood work for anesthesia $50-150
Anesthesia $100
Laser to remove $100
Eye ointment for post op $20
E-collar $20
I don't charge for my post-op rechecks. but everyone else in the world does (I think)
I hope this helps. Use it as a checklist at your vets.

Cody went home with an e-collar so that he will not rub his eye, and an antibiotic ointment to keep the eye comfortable lubricated and free from infection.

If you have a pet related question please find me, and the amazing group of pet loving experts, at Pawbly is free to use and open to all who need help, or want to help others.

If you have a pet in need of eyelid surgery and you are in the Maryland area stop by for a visit. Jarrettsville Vet is open 7 days a week. I am also on Twitter @FreePetAdvice.


  1. I've had two cockers that needed this. Is it a spaniel thing? (My elderly cockers especially the buff ones have had lots of cysts and bumps on their skin, generally)

  2. I think that lots of dogs get lots of growths or masses..certainly Cockers are no exception. If we are lucky enough to live a long life we see these little growths appear..having a vet to help you distinguish the benign from the bad is very important. Thankfully the majority are just cosmetically unpleasing. But not a health danger.

    Thanks for reading!


  3. Hi Y'all!

    I had a growth on my upper lid that I had removed. The surgeon did that after the dentist removed my bad tooth.

    Y'all come by now,
    Hawk aka BrownDog

  4. Replies
    1. Hello,
      I dont have the invoice in front of me,, so I am going to estimate a little.
      Pre-op exam $50
      Pre-op blood work for anesthesia $50-150
      anesthesia $100
      Laser to remove $100
      eye ointment for post op $20
      e-collar $20
      I dont charge for my post-op rechecks. but everyone else in the world does (I think)
      I hope this helps. Use it as a checklist at your vets.