Eye Displacement in Dogs

Trauma to the head can cause a dog’s eye to become displaced. When this happens, the eyeball will bulge in front of the eyelid and there may be tearing and inflammation in the muscles around the eye. Eye displacement, called proptosis, is more common in brachycephalic breeds or any dog that has some degree of exophthalmos (bulging of the eyes outward). In these breeds, proptosis can happen with only a small degree of trauma and no other injuries may be noted. In dolichocephalic breeds with longer noses, it takes a good deal of force to displace the eyeball, and proptosis usually only happens when dogs are hit by a car or sustain another severe traumatic injury. There is only a 20-40% chance that a dog will retain vision in the eye after suffering proptosis, especially if there are other life threatening injuries that the veterinarian needs to attend to first. With the eyeball displaced forward, the dog is unable to blink, so the cornea will dry out quickly. The pupil will be extremely constricted, and the dog may be in a good deal of pain. If there is some chance of retaining vision in the eye, the veterinarian may replace the eyeball and force the eyelid closed for several weeks to allow time for the trauma and inflammation to heal. Even if this is successful, it can result in complications like corneal ulceration, keratoconjunctivitis sicca (a serious eye disease caused by decreased tear production), and sometimes glaucoma. If the optic nerve is severed, or if there is a delay in treatment (as often happens in dogs with life-threatening injuries), removing the eye may be the only option.

In dogs, the eyeball can become displaced as the result of severe trauma to the head. The globe will be pushed forward in front of the eyelid, and the dog will be unable to close the eye. This is called proptosis.

These are some of the symptoms you might see in a dog with proptosis.

• Extreme protrusion of the eyeball forward
• Inability to blink (lagophthalmos)
• Constricted pupil (miosis)
• Redness and inflammation around the eye
• Bleeding inside the eye
• Inability to move the eye
• Damage and tearing to the tissue around the eye
• Shock
• Other injuries

Types

• Simple proptosis – the protrusion of the eyeball is the only injury; this happens most commonly in predisposed breeds
• Part of a complex traumatic injury – the dog suffers a serious accident and proptosis is combined with other internal injuries, especially skull fractures and trauma to the head

Proptosis is almost always the result of some type of trauma to the head, but causes can vary depending on the breed.

Brachycephalic breeds with short noses and naturally protruding eyeballs

• Bulldogs, Pugs, Pekingese, Boston Terriers, Boxers, Chihuahuas, and others
• Dogfights (common)
• Hitting the head unusually hard during routine household activities
• Unknown incident – owner comes home to find the dog with proptosis

Dogs with long or average sized skulls (dolichocephalic or mesocephalic breeds)

• Hit by car
• Hit by ride-on lawn mower
• Hit in the head with a large heavy object
• Owner finds dog unconscious or severely injured

Diagnosis is relatively easy with proptosis. In the majority of cases, the owner will be able to easily identify that something is amiss; severely displaced eyeballs can appear grotesque and frightening. Getting veterinary treatment as soon as possible is very important; however, you will need to proceed cautiously if your dog is unconscious, unable to move, or appears to be in shock. You should attempt to control severe bleeding, but avoid moving the dog as much as possible during transport since there may be internal injuries. 

If you saw the incident, a clear description of what happened will be very helpful. The veterinarian will need to physically examine your dog for signs of other injuries and x rays may be necessary if internal damage is suspected. The veterinarian will evaluate the damage to the eye by testing for signs of vision retention. A stain may be added to the eye to determine the degree of corneal ulceration. If the globe is ruptured, or the retina is detached, there will be less likelihood of retaining the eye.

The veterinarian will first need to stabilize any life threatening injuries before treating proptosis. Otherwise, lubricating and moistening the eye to avoid further corneal ulceration will be the first line of treatment. Dogs will be given pain medication to make them more comfortable. 

There are two treatments for proptosis: temporary tarsorrhaphy (replacement of the globe and closure of the eye during healing) or enucleation (complete removal of the globe). Tarsorrhaphy is usually only attempted if treatment happens immediately and there is some chance of retaining vision. The dog will be placed under anesthetic and the eye will be closed and secured with sutures. The sutures should remain for 7-21 days, or until the blink reflex returns. Loosening sutures can cause corneal ulceration, so you will need to return to the vet often for checkups. There is a high risk of complications with this procedure, including later eye problems, enophthalmia (misplacement of the eye inward), and lagophthalmos (inability to blink).

Removal of the eyeball is recommended in some cases. Owners also sometimes prefer this treatment because less follow-up is required and there is less risk of recurrence. The eyeball will be removed surgically under anesthetic. Complications are less likely with this treatment, but it can appear less cosmetically pleasing and vision will be reduced. An Elizabethan collar is recommended for 10-14 days after both treatments to avoid injury while the eye is healing. Antibiotics or anti-inflammation medication may be prescribed to aid with the healing process.

A complete recovery after proptosis is rare. If tarsorrhaphy is performed, complications may need to be managed with medication and further treatment. Frequent check-ups will be necessary so the veterinarian can monitor your dog’s eye. With complete removal, long-term management will be easier, but your dog will only have vision in one eye. You may need to alter feeding or play habits and help your dog adjust to a reduced range of vision.