Ophthalmic complications following ocular penetration during routine dentistry in 13 cats

Abstract

CASE HISTORY

Thirteen cats developed ophthalmic complications following dental procedures in Australia and New Zealand between December 2014 and February 2018. All cats had at least one maxillary tooth extracted and some received a transoral maxillary nerve block.

CLINICAL FINDINGS

Ocular signs were identified at a median of 1.5 (min 0, max 14) days following elective dental procedures and included fibrin in the anterior chamber, aqueous flare, vision loss and miosis. Response to medical management was poor overall, with 7/13 (54%) cats undergoing subsequent enucleation and one cat was subjected to euthanasia shortly after the dental procedure due to ocular disease. The remaining five cats were managed medically. Of these, four exhibited signs of persistent inflammation at the last ophthalmic assessment, and one was subsequently subjected to euthanasia due to reasons unrelated to ocular health. Active inflammation resolved in one cat, however the lesions caused by previous inflammation persisted.

PATHOLOGICAL FINDINGS

Assessment of six enucleated globes showed a variety of pathological changes, with marked fibrinous exudation and suppurative inflammation as predominant features. A scleral penetration site was identified in three globes. Four globes had lens capsule rupture and phacoclastic uveitis.

DIAGNOSIS

Endophthalmitis following iatrogenic globe penetration during routine dental procedures.

CLINICAL RELEVANCE

This case series demonstrates that globe penetration during dental procedures carries a poor prognosis for the eye. Clinicians should be aware of the risks of ocular trauma during dental procedures in cats and great care should be taken to avoid ocular penetration, particularly during tooth extractions. Transoral maxillary nerve blocks should be avoided or used with extreme caution in cats.

KEY WORDS:

• Feline
• dental
• ocular trauma
• uveitis
• maxillary nerve block
• tooth extraction

Acknowledgements

We would like to thank Dr Kate Hindley (Small Animal Specialist Hospital, Sydney, Australia) for the ophthalmic examination and submission of affected cases. We would also like to thank Drs Mark Krockenberger and Shannon Donahoe (University of Sydney) for the careful collation and provision of all histopathology results in this case series.

ORCID

HA Volk http://orcid.org/0000-0002-5887-9666