Neoplasms of the orbit (Tumores retrobulbaris).

Agricultural animals can have benign and malignant neoplasms. Those and others develop slowly and at first do not have a noticeable effect on the eye. They note only a certain, gradually increasing exophthalmos. In the future, the eye and optic nerve atrophy, which leads to visual impairment. The location of the neoplasms can be different: they occur in the retrobulbar space or outside it, from the side of the eyeball in the third century. 

Etiology. The causes of neoplasms are not exactly established. 

Clinical signs. With significant exophthalmos, the eye gap is wide open, the eyelids do not close, the uniform moistening of the cornea with a tear fluid is broken, resulting in the cornea drying up, then inflamed. With the further development of the tumor of the orbit, the blood supply to the eye is disturbed, it atrophies. Vision is deteriorating or completely lost. Malignant neoplasms of the orbit in animals are more often observed carcinoma and sarcoma, horses also described chalk - nosarcoma and fibrosarcoma. Carcinoma of the orbit develops very intensively, rather quickly surrounds the eyeball and causes its protrusion. Sprouting conjunctiva and eyelids, is issued from the eye slit in the form of a tuberous soft tumor of irregular shape, easily maculate, covered in some areas of the surface with dead tissue, dried in the form of crusts. Sarcoma grows in the form of a soft, partially bumpy meat-like tumor, which gradually completely displaces the eyeball from the orbit. The clinical picture of exophthalmus in leukemia of cattle resembles the picture of sarcoma, however, in leukemia, not only one eye (more often the right eye) is affected, but often both eyes. Of benign oophorectic tumors, cysts are found in pigs and dogs; lipoma in horses and cattle.

Cysts are round or oval, soft, painless and moderately fluctuating tumors. If they lie on the side of the eyeball, then, increasing in volume, they protrude the eyelid forward and can be probed. With the cysts usually do not grow together. Lipoma - a soft, elastic, painless swelling, over which the skin is mobile; it is usually found in the retrobulbar space. As the lipoma grows, exophthalmos or strabismus develop. Slow growth, the absence of signs of acute inflammation give grounds to diagnose the neoplasm and differentiate it from inflammatory swelling. To accurately determine the type of neoplasm, a histological examination is necessary.

Treatment. Surgical intervention is indicated. Benign tumors located at the entrance to the orbit are removed by the orbit from the side of the eyeball.  If before (high-quality neoplasms are deep, in the retrobulbar space, and also in case of malignant tumors, they resort to ocular exenteration.)

 Orbitotomy: Preliminarily perform a deep infiltration anesthesia along the circumference of the tumor, cut the skin along the edge of the orbit, then dissect the orbital fascia and open the orbit. Having seized the tumor with tweezers, they take it out in an obtuse way, and at the end of the operation, knit stitches are applied to the skin, and the eye and its function are preserved. out by conjunctival incision in the transitional fold, but this method is less convenient than the first as it does not give good access and postoperative treatment difficult.

Exertion of the orbit. The essence of the operation is that the eyeball is removed together with the adjacent intraorbital fat, muscles, vessels, nerves, up to the periorbital. In the past, when examining the orbit, it was recommended not to remove the eyelids, especially if they are not affected. Observations of A.V. Makashova, V.N. Aurora show the advisability of removing the eyelids along with the conjunctiva: after removal of the eyelids, the wound of the orbit and its epithelialization will fully re-enter. Otherwise, there will be a hollow, partially lined with a conjunctiva, where inflammation will be constantly maintained, which will require systematic treatment of the festering cavity. Indications for surgery are malignant neoplasms of eyelid skin, conjunctiva, sclera, cornea, infiltrating retrobulbar fiber or captured eyeball, as well as fractures of orbital bones accompanied by eye damage. Anesthesia. Apply a combined anesthesia or retrobulbar blockade according to VN. Aurorov.

Operation technique.  The animal is laid on its side. After anesthetizing and preparing the operating field, a circular incision is made in the eye area within the tumor areas of the tumor, not trying to open the conjunctival cavity. To do this, large animals enter a finger into it, and in small animals - the end of a tweezers or spatula. Then, along the edge of the ossicle, the tharzorbital fascia is cut with a scalpel and proceed to exfoliate the eye along with the surrounding tissues (along the entire circumference of the eye and all over the periorbital cavity to the visual aperture). It is better to use a knife, as the scissors do not cut, but the intraorbital fat is squashed and the operation is delayed. The optic nerve intersects the optic opening with scissors and then the eye, together with the tumor surrounding the muscles and fat, is removed. When the tissues are cut, the following is done: the edges of the eyelids are grasped with Myso forceps, the eye, along with the eyelids, is displaced in one direction, while the tissues are dissected from the opposite side. During the operation, there is severe bleeding, which is somewhat reduced with tamponade of those wound sites, where at the moment the tissues are not excised. Apply tweezers or ligatures to bleeding vessels is a waste of time; it is better to speed up the operation itself than to try to stop the bleeding. After performing the surgical procedure, the whole cavity is swabbed and the condition of the periorbital walls is checked with a finger. The operation is completed by the removal of blood clots, powdering the walls of the cavity with antibiotics, tight tamponade (preferably Mikulich), and the application of interrupted nodular sutures to strengthen the tampon. As a sutural material in operative ophthalmology for the prevention of ligature fistulas, it is best to use the SVM thread (LP Troyanovskaya, 1998) and the string "Rusar-S" (PA Tarasenko, 2003). Thus, the final stop of bleeding is achieved by a tight tamponade. After 2 days, tight tampons must be removed, for which the joints are spread, tampons are moistened with a warm solution of ethacridine lactate, furacilin or peroxide (hydrogen peroxide), which facilitates their removal. Then treat the wounds with antiseptics (in cattle - preferably with powders or alcohol antiseptics), inject loose tampons and re-knot the knots.

 

Enucleation of the eye. The operation, which involves removing the eye along with the eyelids, is indicated for tumors of small size that do not affect the tissues of the retrobulbar space. In benign neoplasms, enucleation of the eye is sufficient. 

Anesthesia. Apply a combined anesthesia or a retrobulbar Novocain blockade according to VN. Aurorov. 

Operation technique. The technique of enucleation of the eye is similar to the technique of eye socket exenteration.  The difference is that in the first case, the eye and eyelids are removed, and in the second case, the eye, eyelids and periorbital contents, that is, the tissue of the retrobulbar space.

 Evisceration of the eye.  Indications for surgery are the penetrating wounds of the Roghvitsa with the loss of the lens and vitreous body, as well as panophthalmitis.

Evisceration in these cases is more desirable than eye socket examinations or enucleation of the eye because it does not open spaces connecting the eye with the cerebral spaces, and therefore there are less complications - meningitis and encephalitis. Removal of the eyelids, as in the previous cases, will lead to complete infection of the wound. Anesthesia. Apply a combined anesthesia or a retrobulbar Novocain blockade according to VN. Aurorov.

Operation technique. The animal is fixed in a lying position. Open the stove (use eyelid extensions). A linear or pointed scalpel over the limb is pierced with a cornea, and then completely removed with scissors. " Spoon all the contents of the eye to the sclera with a sharp spoon. Remove the eyelids. The operating cavity is powdered with antibiotics, plugging and impose temporary close joints. In the future, treatment and control of the wound process are the same as in the examination of the orbit. Thus, the common symptom of the orbital diseases considered is the forward displacement of the normal sizes of the eyeball. It should be noted that this position of the eyeball may be a consequence of many other causes, in particular bone changes in the orbit, hemorrhages into the orbit when blood vessels are ruptured as a result of mechanical damage. In severe injuries observe the dislocation of the eyeball you drop it from the orbit. In these cases, you need to anesthetize the eye and as early as possible to reposition it. Her pi in this way, the eyeball can not be fixed, then the outer corner of the optic cleft is dissected and, after the eye has been adjusted, sutures are placed on the wound. Some non-contagious animal diseases also occur with the symptom of exophthalmos, in particular hormonal disorders: hypothyroidism, functional pituitary insufficiency, hypothalamus. The authors observed mass exophthalmos in cows in the farm, where abundant concentrate feeding was used with a shortage of coarse fodder. It should be borne in mind that in the absence of pathology, the position of the eyeball in the orbit in different breeds of cattle is not the same. In particular, a significant "pop-eyed" observed in jersey animals.

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