Prolapsed 3rd Eyelid

[Scooter_in_Kindergarten]

If any of you have read my first post on the general discussion forum this is an update but it seems to have become something more unique of a situation than I first had suspected.
Basically Scooter closed his nictitating membrane over his eye and hasn't been able to open it again for almost 3 weeks. After about 6 days of it being shut I took him to the vet and he was placed on antibiotics because the vet said it could just be a bacteria causing the hematoma. The antibiotics did nothing. I had him back in the vet today and. . . .
Scooter has been diagnosed with a prolapsed 3rd Eyelid. Basically there is a increase of blood flow and fluid near the front of the eye making it impossible for him to pull the nictitating membrane back and his eye out.
My vet wants to do a surgical procedure to release some of the pressure where there is increased blood flow.
The vet first suggested removing the nictitating membrane all together and said that I would then have to put drops or a gel on his eye daily to keep it from drying out.
Then the vet went back and said he preferred to go a less extreme rout and just make a small incision to release the pressure and hopefully correct the problem.
The technician said he would look/research through fellow vets and vet techs nationally & internationally to see if there are any other options.
What is your opinion?
I've scheduled the surgery for one week from today. . .

[El Lobo]

I'm really sorry Scooter has this condition.

I don't think anyone on this forum would be able to offer a substantial opinion regarding treatment, it is best left to the veterinarians. I'm more a rabbit person and as so can link to information for treatment of nictitating membrane prolapses in them. Be aware, this link has graphic pictorial content.

http://www.medirabbit.com/EN/Eye_diseas ... _gland.pdf

Mammals eyes are much larger than our bluey's and vets I know are cautious about treating eyes in larger mammals, often preferring a referral to an opthamologist when surgery is required.

I wish you and Scooter all the best for a good outcome.

[Coomassie]

I don't have any advice to give but I hope Scooter comes out of it ok. I'm really glad you were willing to seek out a vet and please keep us updated on his condition and treatment.

[Jeff]

I have no medical training of any kind, and want to be clear that I don't know anything about this condition or which treatment would have a better chance for success, but in general, I would prefer the least invasive procedure that I felt had a good chance of correcting the problem.

Making an incision to relieve the pressure SOUNDS like a better option to me, but again, that is not based on medical experience, just my general way of approaching things.

I am not trying to convince you to choose this procedure, just basically saying that if my vet recommended it to me I would be inclined to go that way.

[Alioop]

I would do your own research. See if you can find some extremely knowledgeable herp vets (maybe at a University?) and see if they will give you their opinion over the phone. Contact some opthamologists and see if you can find one who has treated this condition in reptiles before.

[Karen]

I really hope Scooter pulls through with the minimally invasive procedure. Does the vet have any idea what might have caused this?

[Scooter_in_Kindergarten]

Thank you all for your support. Truly you guys, and I know this is said ALL the time, are awesome for responding and sending well wishes. It feels nice to know that there are people who care. It's really unfortunate that there isn't any other personal experiences with this problem in BTS. Sadly Scooter and I can now have info for others that may experience this.

The vet said he has seen this before in Monitors and it is usually linked to some type of trauma or injury to the eye. He says he is perplexed as to how this happened to Scooter with no prior signs of trauma. Especially because this has happened before and Scooter was fine after a day.

He also said that he has done this procedure and even mentioned the difference between a rabbit's prolapsed eye and a reptile's because he treats many small animals, birds, and exotics. Thank you El Lobo for the link. It's the same thing, but with scooter his eye is back in his head and the nictitating membrane is pulled over the abscess.

I really believe that Scooter is in good hands. I will post an update after the surgery on Tuesday. If you would like, I can request some copies of the vet's photos during the procedure. It will probably be graphic though. let me know.

Thank you again for your suggestions and support. I will be emailing some other professionals with questions, but I feel pretty confident my vet is making the right call after reading your responses.

[El Lobo]

I'm getting a little confused with what the actual problem is now. I thought the nictitating membrane could not be withdrawn due to the presence of a haematoma, but I note reference to an abscess in the last post. If there is an abscess, is it a corneal abscess i.e. on the front of the eye, or retrobulbar i.e. behind the eyeball? Corneal abscesses from what I know are extremely rare in any species. Reptilian abscesses are difficult to treat as they are encapsulated and the pus which needs to be excised lacks an enzyme to make it free-flowing. Leaving a trace of the capsule can allow the abscess to regrow.

Below are some veterinary notes I have extracted from a reference which may be helpful:

Prolapse of the Glands of the Third Eyelid
General Description

Mass of tissue protruding from the medial canthus of the eye.
May present as swelling and protrusion of the third eyelid.
May be inflamed and therefore enlarged.
May be unilateral or bilateral.
Usually marked congestion of the underlying venous plexus
Conjunctival discharge may be present.

Treatment

Replacement of the gland using the mucosal pocket technique, as in dogs.
If the gland is extremely enlarged, careful partial excision may be required first.
Note: There is a risk of serious haemorrhage if the gland is removed; excision of the gland should be avoided.

[Scooter_in_Kindergarten]

Sorry, El Lobo You are right. I used the wrong terminology. Scooter doesn't have an abscess.
The Vet said it was a hematoma which I understand is an collection of blood outside of the blood vessels, (to me, who has NO medical knowladge, the word abscess was a synonym) Sorry for the confusion.
The vet explained that it was a localized collection of blood and fluid in the front of his eye socket that it was preventing the nictitating membrane to go back to the front of his eye and allow his eye to come back to the front.
Does that make sense?

[Scooter_in_Kindergarten]

I'm getting a little confused with what the actual problem is now. I thought the nictitating membrane could not be withdrawn due to the presence of a haematoma, but I note reference to an abscess in the last post. If there is an abscess, is it a corneal abscess i.e. on the front of the eye, or retrobulbar i.e. behind the eyeball? Corneal abscesses from what I know are extremely rare in any species. Reptilian abscesses are difficult to treat as they are encapsulated and the pus which needs to be excised lacks an enzyme to make it free-flowing. Leaving a trace of the capsule can allow the abscess to regrow.

Below are some veterinary notes I have extracted from a reference which may be helpful:

Prolapse of the Glands of the Third Eyelid
General Description

Mass of tissue protruding from the medial canthus of the eye.
May present as swelling and protrusion of the third eyelid.
May be inflamed and therefore enlarged.
May be unilateral or bilateral.
Usually marked congestion of the underlying venous plexus
Conjunctival discharge may be present.

Treatment

Replacement of the gland using the mucosal pocket technique, as in dogs.
If the gland is extremely enlarged, careful partial excision may be required first.
Note: There is a risk of serious haemorrhage if the gland is removed; excision of the gland should be avoided.

Thank you for the research you did. I'm glad my vet decided NOT to remove the gland or nictitating membrane. He explained that if he did, I would have to put drops/a gel on my Skinks eye every day to prevent Dry Eye.
I did enquire about excessive bleeding during the surgery, it seemed to me that if you are 'draining' and area of excess blood that there could be a high risk of hemorrhaging. The Vet then explained to me that they have this 'foam' that kinda freezes on the spot and stops bleeding. ?? Do you know what they could be talking about?

[El Lobo]

Sorry for not getting back to you.

I don't know what the foam may be. I tend to leave these things to the vets and ask a hundred questions after it is over.

I wish both you and Scooter all the best for a positive outcome to the surgery.