Eyelid surgeries – Eyelid abnormalities are frequently responsible for the ocular discomfort, pain and damage to the transparent part of the eye (cornea).

The most frequent eyelid abnormalities are:
- entropion (inward rolling of eyelids resulting in the hair rubbing to the surface of the eye)
- ectropion (outward rolling of eyelids, resulting in the excessive exposure and drying)
- distichiasis (growth of hairs from the eyelid margin resulting in the ocular irritation and sometimes corneal ulcers)
- ectopic cilia (growth of the hair from the conjunctival surface close to the eye resulting in ocular irritation)  
- trichiasis (excesive folds of skin or hair around the nose resulting in the eye rubbing and irritation)
- heavy eyelid folds (heavy eyelid folds are frequently present in Shar Pei, Chow-Chow and Hound breeds)
- lagophthalmus - large eyelid openings resulting in the incomplete eyelid closure, especially during the sleep may be present in many breeds of dogs with short faces (brachyocephalic breeds) resulting in the excessive corneal drying, corneal scarring and pigmentation, and ultimately predisposition for developing corneal ulcers,
- eyelid tumors - benign and malignant eyelid tumors can develop on eyelids, resulting in the irritation, pain and discomfort.

Our team performs numerous surgical procedures, which can effectively restore the normal eyelid function and structure, regardless of the problem complexity.
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Third eyelid surgeries – Prolapsed gland of the third eyelid ("cherry eye") is a problem sporadically encountered in predominantly young dogs. Repositioning of the prolapsed third eyelid gland is a must in order to secure normal tear production and eliminate any ocular irritation associated with this condition. Sometimes, gland can re-prolapse even after several surgeries. However, we use a more complex and effective surgical procedure, which do not result in the recurrence of the condition, and eliminate the need for additional surgeries.

Third eyelid can also be injured as a result of the traumatic event or tumor growth, and we perform different surgical procedures for the repair of the third eyelid and tumor removal.
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Nasolacrimal duct surgeries – We routinely perform surgeries for the reconstruction of the nasolacrimal duct after traumatic or inflammatory events. We also perform widening of nasolacrimal duct openings in cases where these openings are small or completely absent, which allows for the normal flow of tears from the eye surface to the nose and mouth.
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Corneal surgeries – Corneal injuries and degenerative conditions (corneal epithelial and endothelial degeneration, corneal sequestrum) are frequent causes of decreased vision, ocular discomfort and blindness in our pets. We perform different types of corneal surgeries (conjunctival pedicle graft, free island graft, corneo-scleral transposition, superficial keratectomy, corneal transplants, artificial corneal transplants, corneal freezing surgeries for tumor and pigment destruction), with a goal of eliminating ocular discomfort and preserving vision. Since corneal tissue is less than 0.5 mm thick, all surgeries are done with specialized instruments and with the help of the high-power operating microscope. Many corneal surgeries are extremely delicate procedures and are usually performed only by highly trained specialists. In our facilities, we do perform all routine and more complex corneal surgeries. We are one of the rare worldwide institutions equipped and trained to perform artificial corneal transplants in pets. The artificial corneal transplant is usually scheduled 2-3 months in advance, so all needed preparations can be done to secure the best possible outcome of the surgery.
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Glaucoma surgeries – Glaucoma is a disease characterized by elevation of the pressure inside the eye. In our facilities, we perform different glaucoma surgeries (regular subconjunctival shunt placement, frontal sinus shunt placement, diode laser treatment of ciliary body). Glaucoma is a very difficult disease to treat. However, our extensive experience with this disease allowed us to significantly improve diagnostic modalities, and medical and surgical treatment outcomes. We are on of rare national facilities, which is performing preoperative glaucoma screening using high frequency ultrasound and chromatic pupil light reflex testing, which allows for more precise timing of different surgical procedures and better long term outcomes.
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Lens/cataract surgeries

The luxated lens is an emergency condition, which can result in the secondary glaucoma and blindness within 12-24 hours. It is frequently encountered in terrier breeds. We perform routine and emergency lens removals in cases of lens luxation.

Cataracts are among the most frequent causes of blindness among pets. Non-operated cataracts may lead to numerous complications (uncontrolled intraocular inflammation, lens luxation, retinal detachment, glaucoma) resulting in ocular pain, discomfort and blindness.

Cataract surgeries are performed in the similar manner as done in human patients (phacoemulsification). A small probe is introduced in the eye, which has a pulsating ultrasonic tip - this tip moves inside the eye with the very high speed and energy, resulting in the cataract destruction. Once when the cataract is destroyed and removed, the artificial (plastic) lens is usually placed in the eye. Cataracts do not grow back, however some opacities may develop around the artificial lens. These opacities rarely have a significant impact on the vision after cataract surgery.

Emergency cataract surgeries are most frequently performed in patients with traumatic injury to the lens and in diabetic patients. Diabetic patients may develop the acute swelling of the cataract resulting in the secondary glaucoma and uncontrolled inflammation. In these cases, cataract surgeries must be done immediately to prevent the loss of vision or even worse - the loss of the eye.
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Retinal surgeries – Retinal detachments can be devastating complications associated with different hereditary and acquired conditions. Some breeds of dogs can be predisposed to retinal detachments, and preventative laser or cryo (freezing) surgeries can be performed to prevent retinal detachments from developing. We do perform a full range of transpupillary and transscleral laser retinal procedures, trans-scleral cryoprocedures, and intraoperative vitrectomy with a goal of preventing retinal detachments.
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Orbital surgeries – We routinely perform orbital surgeries for damaged eye globes: enucleations (removal of the eye globe with prosthesis placement) and eviscerations (intraocular prosthesis placement with the preservation of the eye globe). We also perform orbital exploratory surgeries with a goal of removing tumors and foreign bodies.
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General Anesthesia in Your Pet

Overview – General anesthesia is a procedure where a combination of medications are used to put your pet in a sleep–like state before and during surgery. Under general anesthesia, your pet should not feel pain. General anesthesia is usually induced using a combination of injectable drugs and inhaled gasses (anesthetics). While your pet is under anesthesia, we monitor your pet’s vital functions while managing your pet’s breathing.

When it is needed – Our team will recommend the best anesthesia option for your pet based on the overall health of your pet and type of surgery/diagnostic procedure that your pet may need. For certain short procedures our team may recommend brief intravenous anesthesia, or light sedation combined with topical/regional anesthesia. Some of these procedures are:

• Intraocular injections
• Corneal diamond burring for non-healing corneal ulcers
• Removal of corneal foreign bodies

Risks – Overall, general anesthesia in veterinary patients is very safe. The incidence of death because of general anesthesia in pets is between 0.05% to 0.17% (approximately 0.5–1.7 pets die per 1000 general anesthesia episodes). Most pets, even those with significant health conditions and of advanced age, can safely undergo general anesthesia. However, the risk of death during the general anesthesia is higher for older pets and pets with the presence of serious systemic diseases.

Specific conditions that can increase your pet’s risk of anesthetic complications during surgery include:

• Very young animals
• Very old animals
• Animals with the severe preoperative laboratory abnormalities
• Obesity/excessive body weight
• Severe underweight/inadequate body weight
• Brachiocephalic animals – dog and cat breeds with very short noses and respiratory structures frequently have anatomical abnormalities of esophagus, stomach, and intestines which can be complicating factors during the anesthesia)
• Other medical conditions involving your pet’s heart, lungs or kidneys
• History of adverse reactions to anesthesia

Preparing your pet for the general anesthesia – Fasting (no food) is usually necessary for about 6 hours before your pet’s surgery. Your pet maybe able to drink water until 3 hours before the general anesthesia.
For large breed dogs and brachiocephalic breeds (particularly English Bulldogs) it is our general recommendation that no food or water is given after midnight before surgery (or 8 hours before surgery).

For small toy breeds, puppies, diabetic dogs and cats, no food should be given for 4 hours prior to general anesthesia (usually we recommend no food and water after 5 am on the day of surgery).

Your pet’s medications before general anesthesia – You may need to stop any blood clotting/blood thinner medications (aspirin or similar) 3–4 days before the surgery. Blood pressure medications and diuretics (furosemide) should not be given on the morning of the surgery. Eye drops and all other systemic medications should be given on the morning of surgery unless directed otherwise by members of our team.

Vitamins, supplements, and herbal remedies should be stopped one day before planned surgery and general anesthesia.

If your pet has diabetes, please talk to our team members about any changes to insulin administration and dosing during the fasting period. Usually, we may recommend a reduced dose of insulin on the morning of surgery (half of the regular dose is given if no food was provided). However, if your pet was fed on the morning of the surgery, a full insulin dose should be given.

Answers that we will need about your pet before the general anesthesia – Before your pet undergoes general anesthesia, our staff will talk with you about:

• Your pet’s health history
• Your pet’s current medications and supplements
• Allergies
• Your pet’s past experiences with general anesthesia (we will be particularly interested about the history of the possible complications with the general anesthesia/sedation in the past.)

This will help our anesthesia staff choose the medications that will be the safest for your pet.

During general anesthesia – Our anesthesiology team typically delivers the anesthesia medications through an intravenous catheter in the front or back leg of your pet. At the site where the intravenous catheter will be placed, the hair will be shaved. It could take a couple of months before the hair will grow back.

Sometimes your pet may be given an anesthetic gas or pure oxygen from a mask to avoid the excessive stress and problems with breathing.

Once your pet is asleep, our anesthesiology staff will insert a tube into the mouth and run it through your pet’s windpipe (trachea). The tube ensures that your pet gets enough oxygen and protects your pet’s lungs from aspirating blood or other fluids, such as stomach fluids.

The members of our anesthesia team will monitor your pet continuously before, during and after surgical procedure is done. Our team will monitor your pets’ breathing, temperature, blood pressure, heart and lung function, and will adjust intraoperative fluids as needed. Any issues that occur during the surgery are corrected with additional medications and fluids.

After the surgery and general anesthesia – When surgery is complete, the member of our anesthesia team will monitor your pet, until they are completely awake. Your pet will slowly wake either in the operating room or in the recovery room.

The pets usually feel groggy and confused when they first wake, and some of the pets may excessively vocalize. Postoperative pain medications will be given. Pain medications will help reduce overall stress and discomfort.

Once when your pet is completely recovered from general anesthesia, a member of our team will give you a call to provide the update on the outcome of the surgical procedure and estimated time for the pick–up of your pet from our hospital. Please note that we do not allow for visitation during pre–surgical preparation, surgery and postoperative recovery of the pets.

It is not unusual for pets to be disoriented and restless for the first night after coming home, but this usually subsides by the next day. Some pets may be very sleepy for a good 12–24 hours after their general anesthesia. In some pets the urge to pee and potty may be decreased for 1–2 days after general anesthesia due to anesthetic drugs and postoperative pain medications. We usually recommend that a soft food is given for 2–3 days after general anesthesia (canned food or regular dry food moistened with a little bit of water).

It is important that diabetic patients are fed that evening after surgery. If they eat near normal or normal size of the meal, a full dose of insulin should be given after the meal. If they eat just a small amount of the food or do not eat at all, half of the regular insulin dose should be given. Sometimes it helps to prepare a small amount of liquid food, which can be given via syringe in the case patient is not showing interest in their regular food during the evening after surgery.

Questions – Please do not hesitate to contact us via phone or email if you have any questions pertinent to your pets’ general anesthesia and surgery. We sincerely hope that this document will help address most questions that you may find pertinent to the general anesthesia that your pet may need.

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