Cosmetic Preservation of a Blind Eye

Although it may not always be possible to preserve vision, it should be within our power to make our patients comfortable. The necessity of further treatment for an eye which is blind depends, of course, on the cause of the blindness. Many conditions which ultimately result in blindness are also painful. In particular, glaucoma may cause chronic discomfort long after the vision is lost. Although many animals with elevated intraocular pressure will not squint or rub at the affected eye, some will become progressively lethargic which owners may attribute simply to "old age". People affected with glaucoma describe an intense "headache" type of pain. Surgical removal of a blind, painful eye is always an option to relieve the pain and, for some owners, this offers the simplest choice with the least possibility of complications and no aftercare required. However, for many owners, removal of an eye carries a psychological significance beyond the loss of visual function. The importance that owners attach to their pet's physical appearance should not be underestimated.

There are alternatives for cosmetic preservation of an eye which is otherwise blind and painful. First and foremost, it is essential to establish that vision has indeed been irreversibly lost. Secondly, the underlying cause (i.e. intraocular tumor, systemic disease leading to retinal detachment or uveitis) must be identified. Thirdly, an assessment of discomfort should be made. Usually this requires measurement of intraocular pressure and an evaluation of ocular inflammation.

 

Laser Cyclophotocoagulation (CPC) involves selective destruction of a portion of the ciliary body to decrease aqueous humor production. This procedure utilizes a diode laser applied transclerally. This is the procedure of choice in cases of acute glaucoma where there is the potential to restore vision.
 

An Intraocular Prosthesis is a black, silicone sphere implanted into the corneoscleral shell after surgical removal of the uveal tract, lens and retina.

Pharmacologic Ciliary Body Ablation involves aspiration of vitreous followed by injection of a combination of gentamicin and dexamethasone. Gentamicin has been shown to be highly toxic to the ciliary body (as well as the retina) and thus results in reduced production of aqueous humor. Although this procedure is relatively inexpensive, the results are quite variable, with cataract formation and increased corneal opacity seen as well as excessive destruction of the ciliary body resulting in globe atrophy (phthisis). This procedure is generally reserved for those animals where it is necessary to avoid the depth and duration of general anesthesia required for the other surgical procedures.
 

Options for Treatment of Blind Eyes
	Laser CPC	Intraocular Prosthesis	Pharmacologic Ablation	Enucleation	No Treatment
Glaucoma	+	+	+	+	-
Intraocular tumor	-	-	-	+	-
Uveitis	-	possible	-	+	-
Retinal detachment	-	-	-	-	+/- laser retinopexy
Retinal degeneration	-	-	-	-	+
Irreparable perforating trauma	-	possible	-	+	-
Cost	+++	++	+	++
Specialized Equipment	Yes	Yes	Yes	No
Aftercare	3-4 weeks	3-4 weeks	2 weeks	none
Success rate	60%	90%	75%	99%
Final appearance	excellent	good	variable (phthisis, cataract may occur)	a matter of opinion

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