Page 15 - Eclipse - Autumn 2021

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Page 15 - Eclipse - Autumn 2021
P. 15

CLINICAL NEWS



 CLINICAL NEWS  Remarkable rheaÐÂÔÂÖ±²¥™s RVC referral






        A                                   the left globe. Ultrasound-guided   Samples from the sinus were submitted
                pet rhea called George
                                            fine needle aspiration was performed
                was presented to the RVC
                                                                                to the RVC laboratory for culture and
                Exotics Service at the Queen
                                            but yielded a limited amount of fluid.
                                                                                sensitivity, cytology and histology.
                Mother Hospital for Animals
                                                                                pyogranulomatous inflammation and
        (QMHA) for assessment and treatment   Following surgical preparation and   Cytology and histology revealed
                                            instillation of 2mg/kg lidocaine, an
        of left-sided periocular swelling. The   incision was made over the swelling,   thankfully no evidence of neoplasia.
        Exotics Service runs weekly clinics at   into the dorsal aspect of the periorbital   Culture grew two species of E. coli and
        QMHA and often collaborates with the   sinus and a large amount of caseous/  an unidentified anaerobe. George was
        Ophthalmology and Imaging services   mineralised material curetted out. The   treated with oral marbofloxacin and
        on cases.                           pocket was then copiously lavaged with   metronidazole based on the bacterial
                                            sterile saline.                     sensitivity results.
        George was brought by trailer to the
        QMHA and was examined in a padded   Further pain relief was administered with   After discharge George continued to
        equine knock-down box. Her owner    IM meloxicam. At the end of the procedure,   improve. Antibiotics were continued for
        reported reduced vision and swelling   the medetomidine was antagonised   six weeks and she was very compliant
        around her left eye. A brief conscious   with an equal volume of atipamezole IM.   in taking these in her favourite food ÐÂÔÂÖ±²¥“
        ophthalmic examination revealed the   George made a smooth, rapid recovery   egg sandwiches.
        menace response was present in the   and was standing within 15 minutes.
        right eye and intermittent in the left eye.
        Dazzle reflexes were intact bilaterally.
        Further examination was limited by her
        temperament, so the team proceeded
        to anaesthesia for a full ophthalmic
        examination and further investigation.
        This allowed minimal stress to George,
        which is important, as rhea can suffer
        from capture myopathy with prolonged
        manual restraint.
        After an initial ÐÂÔÂÖ±²¥˜quadÐÂÔÂÖ±²¥™ protocol comprising
        intramuscular butorphanol, medetomidine,
        ketamine and midazolam, George was
        anaesthetised with IV propofol via her
        basilic vein and then intubated and
        maintained on sevoflurane in oxygen.

        Ophthalmic examination of the left
        eye revealed marked conjunctival
        hyperaemia. There was a soft mass
        in the medial aspect of the orbit,
        compressing the globe. The corneal
        examination was unremarkable. The
        anterior chamber was formed without
        aqueous humour flare. The pupil was
        round and mobile, and the lens was
        transparent. The fundic examination
        was unremarkable and the ophthalmic
        examination of the right eye was
        unremarkable. The intraocular pressure
        readings were 12 mmHg and 22 mmHg
        in the right and left eye, respectively.
        A CT with IV contrast revealed multiple
        pockets of fluid in the left periorbital
        sinus, with concretions of solid material
        with areas of mineralisation compressing   Exotics' specialist Jo Hedley examining GeorgeÐÂÔÂÖ±²¥™s eye

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