C09990498 / invoice 10000

Reason: red eyes + discharge, usual CS client
Referral Vet: Melville Animal Hospital
Verified: Y

HISTORY
Presenting for: Sammy presented for bilateral red eyes that developed over the last 10 days, with the LEFT-eye more affected than the RIGHT initially, though both eyes are now appearing a bit red/inflamed.
Historical Conditions: Previous cherry eye surgery on the RIGHT eye, with left eye having cyst formation that was surgically managed with a repeat revision sugery .
Current Meds: Predneferin Forte Q12h to both eyes since last visit with Dr Colin.
Diet: Big Dog frozen raw food approximately 200g daily plus biscuits.
Other: Owner reports eyes appear worse after walks/exercise but possibly improve after exertion. Cherry eye becomes more prominent during walks. Clear discharge from eyes, previously was green but that was before last surgery. No hard or sticky discharge across eyelids currently.

EXAM
Behavioural: Cooperative during examination, accepts treats readily.
Wt: 25.10kg                         BCS: 5/9
EENO: Eyes (see below); otherwise unremarkable
PLN: <8mm globally
MM/CRT: PM/1-2s
Dentition: Adult Dentition; V. Mild plaque on bilateral lower premolars & molars, otherwise unremarkable
HR/CVS: 72bpm / NIL obvious murmur or arrhythmias; HR=PR; PQ=Gd
RR/RE: 30brpm (Occ. Panting); Globally normal BVS
Abdo: Relaxed; NIL obvious palpable masses
Integumentary: Skin appears normal.
MSK/Gait: Ambulatory; 0/5 Lame, NIL resentment on manipulation
U/G: 2 x descended testicles; NIL obvious abnormalities of prepucwe on external assessment

Eyes: 
Left eye shows surgical scarring in the third eyelid pocket with some swelling, likely from previous surgery. 
Right eye shows cherry eye that becomes more prominent with exertion. Conjunctiva pink bilaterally. Clear discharge present, minimal amount. No signs of irritation or excessive rubbing.

PLR:
Pupils equal and responsive to light with normal consensual light reflex bilaterally. 

Dazzle/Menace:
Positive dazzle reflex and menace response bilaterally. 


DIAGNOSTICS:
1. Schirmer tear test -
A: L-Eye: 22mm/60 seconds; R-Eye: 21mm/60 seconds

ASSESSMENT (Dr Colin Sherry) 
Problem List:
1. Bilateral inflammation of the third eyelid & very mild clear ocular discharge from the L-Eye
A: Post-surgical changes following bilateral cherry eye repair 
Left eye showing expected scarring and mild swelling in third eyelid pocket from previous surgical intervention. 
Right eye TEL unremarkable 
Both eyes showing mild conjunctival redness likely related to exposure due to surgical conformational changes rather than active inflammation.

PLAN
Changes to Existing Meds/Tx:
- Reduce predneferin drops to once daily in both eyes for one week, then discontinue if no deterioration noted

Additional Discussion:
- Owner advised to take daily photos before applying drops to monitor for changes
- Left eye expected to remain slightly larger due to surgical scarring
- Mild redness anticipated due to increased exposure from eyelid changes
- If eyes become more red or irritated after stopping drops, reassess for underlying inflammation

Client Comms:
- Email close-up photos of eyes (75% of screen) in a weeks' time before discontinuing drops in one week for progress evaluation
- Monitor for any significant changes in redness or irritation during medication withdrawal

Reason - Revisit for suture removal if needed and assess NMP Sx
EMLD 2/2/26 [Dr KLM]

HISTORY
Presented for a 2-week post-operative recheck following Right eye Gland of Third eyelid prolapse pocketing and the re-opening of the LEFT  conjunctival cyst.
Historical Conditions: 
- Developed cyst/tear balloon inside conjunctival pocket of the left side following initial surgery, unable to be corrected at Reg Vet.
- CS first attempt to open the cyst for drainage failed, the latest surgery to create tear flow path appears to have been successful as no swelling has occurred since the surgery (during the time Owners were away). 
Current Meds:
- Antibiotic eye drops recently completed 2 days ago
Other:
- E-Collar was removed on Saturday
- No scratching at surgical sites
- Surgical area started to look red 2-3 days ago

EXAM
Mentation: BAR
Behavioural: Cooperative for examination with collar
Eyes: 
- Mild redness at surgical sites
- Mild inflammation of suture lines
- Sutures in the right conjunctival sac causing minor inflammation and mucus collection so was excised

- "Normal" tear production, no mucus overflow or mucus contamination of tear film.

Diagnostics: Fluorescein stain - negative

Ears: Clean, no odour
Integumentary: Mild irritation around E-collar contact area


ASSESSMENT
Post-operative bilateral eyelid gland re-pocketing - Both eyes now healing appropriately with mild inflammation
LEFT eye - Previous tear flow obstruction from NM Gland successfully resolved with no recurrence of tear balloon/cyst since surgery, (Previous surgeries had swelling with in the 7d days post op. 

PLAN
New Meds/Tx:
- Prednefrin Forte - Anti-inflammatory eye drops BID to both eyes for 1 month

Additional Discussion:
- Discussed original issue caused due to weakness of ligaments holding gland in place and pocketing surgery likely now to keep the gland in place. 
- The conjunctival tissue that is visible behind the leading edge of the NM is due to suture line and scarring and will reduce over time, though may never disappear completely
- Previous attempts to create tear flow after pocketing the prolapsed gland (LEFT eye) resulted in scarring and a "tear" balloon formation
- This latest surgical approach (LEFT eye) appears successful as no recurrence of tear balloon within expected timeframe
Client Comms:
- Recheck in 1 month
- Return sooner if any concerns develop
- Continue using E-collar properly positioned at top of neck to prevent scratching

Reason: LEFT eye revisit and repeat salvage Sx as NM cyst refilling.
Getting dropped off earlier -
 O aware Sx will likely be required and is happy to go forward with Sx,  fasted 8 hours, bring meds in and e-collar,
EMLD 19/1/26 [Dr KLM]
 
CS to examine - called O with findings before surgery to suggest that another surgery to be attempted to suture conjunctiva from within to to conj sac.
 
Assessment
Refilling NM gland Cyst Left eye - 

Mucopurulent discharge - mild collecting at the medial canthus - likely due to reduced tears with not having flow from gland of NM.

Medication:
Cefalexin i/v 4.66ml - intra-op

Premed - Methadone 1ml and Mede 0.1ml i/v - good sedation 
Induction - Propofol ~ 7ml 

Procedure
GA and lanced cyst ventral bulbar side of the scar tissue, drained 5ml clear lacrimal fluid and sutured conjunctiva lining from within the lacrimal cyst to the conjunctival sac with 5/0 Vilet to secure to create a continuous healed conjunctival tunnel for permanent drainage

Meloxicam Maintenance dose - 0.4r2ml - post op 

Recovery Smooth

Take home medications: 

Eye Drops:

Ocuflox Eye Drop - Antibiotic Drop
Instil 1 drop to BOTH eyes 4x daily, 
LEFT eye 3 weeks and RIGHT eye stopping treatment in 7 days 
2 doses due Wednesday evening. 

Chlorsig Eye Ointment -  Antibiotic ( at home or more from any  Pharmacy
Instill 1cm into his LEFT eye THREE times daily
1 more dose Wednesday evening

Acular Eye Drops - NSAID - STOP this for 2 weeks in LEFT eye 
Instill ONE drop into his RIGHT eye TWICE daily 

Oral Medication:

Amoxy-Clav 500mg x 12 Tablets - Antibiotic - new course
Give 3/4 (THREE QUARTERS) of a tablet by mouth TWICE DAILY until finished. 
Can be given with food. 
Next dose due Wednesday evening 
 
Gabapentin 300mg capsules - Pain Relief 
Give 1 capsule by mouth TWICE (or 3x) DAILY, as required for pain relief. May cause mild sedation.
Next dose due  Wednesday evening (14/1/26). 

Meloxicam Dog Oral 42ml - Anti-inflammatory Liquid
Give to the 20kg mark on the syringe provided, by mouth ONCE DAILY, ALWAYS with or after a meal. 
Stop if any vomiting occurs. 
Next dose due Thursday evening with main meal (15/1/26). 

Ear Medication:  -  Ears inflamed due to the long-term e-collar wearing
Dex/Enro Drops
Instil 0.5mL into BOTH ears TWICE daily for 2 more days (10 days in total)
Next Dose Due: WEDNESDAY evening 


Home care:
Please keep e-collar on for a minimum of 7 more days, to ensure no rubbing at the eye surgical site. 
Please not the he was seen to curve into a crescent and poke his eye with his hind foot! 
He may require an inflatable collar to keep his E-collar further forward on his neck!

Plan: 
Some mild blood in the tear field is normal over the next 1 - 2 days. 
A follow up eye revisit is recommended in 3 weeks' time. Please call if you have any concerns.