Dermoid in a 7-year-old Pug Miriam Smith-Drelich Advisors: Dr. Eric Ledbetter, Dr. Nita Irby Cornell University College of Veterinary Medicine, 02/21/18 The Patient 7-year-old MC Pug Hx mass OD Progressively irritating Pt Image Source: http://ak0.picdn.net/shutterstock/videos/4639820/thumb/1.jpg Physical Examination BAR, TPR WNL, systemically healthy 8 mm X 8 mm mass with hairs OD Corneal neovascularization Corneal melanosis Mild blepharospasm OD Menace, palpebral, PLR intact OU Preliminary Diagnostics Complete Blood Count-WNL Chemistry Panel-WNL Fluorescein Stain-Negative OU Schirmer Tear Test -24 mm/min OD, 17 mm/30 seconds OS Intraocular Pressures-12 mmHg OD, 17 mmHg OS Dermoids Dermoids: Congenital abnormal growth of epidermal and dermal structures in the ocular region Image Source: http://cal.vet.upenn.edu/projects/ophthalmology/ophthalmo_files/Corneal_Opacities/Dermoid/images/Corneal_Dermoid_hair.jpg In other words, they are the growth of skin tissue on the surface of the eye. 5 Pathophysiology Exposure of developing eye to intrauterine environment Mesenchymal metaplasia Abnormal ectoderm differentiation Image Source: https://www.researchgate.net/profile/Robin_Ali/publication/51034406/figure/fig1/AS:280298647506956@1443839813580/Figure-1-Eye-development-a-At-early-stages-of-eye-development-the-surface-ectoderm.png The pathophysiology of what causes dermoids is still largely unknown. However, one theory is that they are caused when a fetus’s eyelids fail to properly close as it is developing in the womb. This leads to exposure of the developing eye to the intrauterine environment, and results in congenital defects. The mesenchyme of the eye, which normally forms the connective tissue of the eye, undergoes metaplasia, and forms the connective tissue of the dermoid. The overlying ectoderm, which normally forms the cornea, abnormally differentiates into skin and associated structures, such as hair follicles. 6 Breed Predisposition: Image Source: http://dogsaholic.com/breeds/profiles/saint-bernard.html Image Source: http://dogtime.com/dog-breeds/german-shepherd-dog#/slide/1 Image Source: http://www.petguide.com/breeds/dog/french-bulldog/attachment/french-bulldog-2-2/ Image Source: http://dogtime.com/dog-breeds/pembroke-welsh-corgi#/slide/1 Image Source: http://www.allsmalldogbreeds.com/dachshund-smooth.html Species Image Source: https://www.ucdavis.edu/news/sustainability-be-focus-dairy-technology-day Image Source: https://www.youtube.com/watch?v=iXHEa-v15BQ Image Source: http://www.thirdlooks.com/2013/12/human-made-ss14-lookbook/ Image Source: https://www.freeimages.com/search/peacock Image Source: http://susansspace08.blogspot.com/2010/11/amazing-camel-its-creator.html Gross Appearance Temporal limbus Round Well circumscribed Normal skin Hairs Image Source: http://www.eyecareforanimals.com/wp-content/uploads/2016/05/dermoids.jpg Clinical Signs Image Source: https://i.ytimg.com/vi/AoXe0v76uAM/maxresdefault.jpg Image Source: http://www.vision4pets.com/images/stories/surgeries/corneal/dermoid.jpg Image Source: http://i.imgur.com/NmSGI3Z.png?3?1495 Treatment Image Source: http://www.bestinshowdaily.com/uc-davis-helps-rescued-dog-see-again/ Image Source: Small Animal Ophthalmic Surgery, Gelatt KN & Gelatt JP Healing Corneal re-epithelialization begins in 48 hours 7-10 days to complete Opacity for several weeks Image Source: http://todaysveterinarypractice.navc.com/observations-ophthalmology-answers-corneal-opacities-dogs-cats/ Postoperative Complications Rare Infections Delayed healing Image Source: https://southdownanimalclinic.com/category/case-of-the-month/ Normal Skin Histology Image Source: https://histologydrawings.blogspot.com/2014/01/skin.html Dermoid Histology Stratified epithelium (normal skin) Hairs Hair follicles Sebaceous glands Sweat glands Image Source: http://www.fmv.ulisboa.pt/atlas/olho/pages_us/olho003_ing.htm Our Patient’s Histology Report Mucosa is focally expanded and epithelium elevated by pilosebaceous units within the submucosa. Follicles contain normal hair shafts.  Sebaceous glands are mildly haphazardly arranged.  Pilosebaceous units are present in some surgical margins. Histology confirms the mass to be a benign dermoid.  Excision appears incomplete as pilosebaceous units extend to two surgical margins. Prognosis Good for vision and comfort Often curative Possibility of regrowth (rare!) Plan Neopolygram ophthalmic solution Cyclosporine ophthalmic solution Atropine ophthalmic solution Meloxicam Tramadol E Collar Recheck in 2 weeks Image Source: http://www.toybreeds.com/images/eye%20drops.jpg Cost Summary Hospitalization Fees: $570 Diagnostic Testing: $200 Anesthesia: $430 Surgery: $400 Medications TGH: $140 TOTAL COST: Approximately $1,750 Follow-Up: Pt doing well Red bump on eye Plan to follow-up at rdvm Image Source: http://pugalug.com/images2012/billy-cone.jpg Thank You! Dr. Ledbetter Dr. Irby Dr. Smith CUHA Ophthalmology Service Image Source: https://rlv.zcache.com/thank_you_pug_puppy_dog_greetings_sticker-rf115e46f1fb540f5b3a4c9f3ea6f0774_v9wf3_8byvr_540.jpg References 1. Brudenall DK, Bernays ME, Peiffer Jr. RL. Central corneal dermoid in a Labrador retriever puppy. Journal of Small Animal Practice 2007;48:588-590 2. Choudhury M, Kalita D. Surgical Management of Sclero-Corneal Dermoid in a Dog. Intas Polivet 2016;17(II):478-479 3. Gelatt KN, Gelatt JP. Surgical Procedures for Superficial Corneal Diseases. In: Small Animal Ophthalmic Surgery-Practical Techniques for the Veterinarian. Woburn: Butterworth-Heinemann; 2001:185-188 4. Jaiswal S, Singh NK, Singh HN. Ocular Dermoid in Animals-A Review of Ten Years. Intas Polivet 2016;17(II):470-472 5. Lee JI, Kim MJ, Kim YB, Kim MC. Surgical correction of corneal dermoid in a dog. Journal of Veterinary Science 2005;6(4):369-370   Questions? 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