Page 15 - Eclipse - Autumn 2021

CLINICAL NEWS

CLINICAL NEWS Remarkable rhea’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 –
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 ‘quad’ 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 George’s eye

15