Successful chemical ablation of an intraorbital cyst caused by an eyelid injury and iatrogenic ankyloblepharon formation in a duck

Shin Ae Park Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, MI 48824.

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Harriet Davidson Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, MI 48824.

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Kimberly A. Thompson Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, MI 48824.

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Rachel Policelli Smith Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, MI 48824.

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Erica Noland Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing, MI 48824.

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Dodd Sledge College of Veterinary Medicine, and the Veterinary Diagnostic Laboratory, Michigan State University, East Lansing, MI 48824.

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Jennifer S. Thomas Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing, MI 48824.

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András M. Komáromy Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, MI 48824.

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Abstract

CASE DESCRIPTION A client-owned 2-year-old 1.8-kg (4-lb) male pet Rouen duck (Anas platyrhynchos domesticus) was evaluated because of severe swelling around the left eye following traumatic injury to the upper and lower eyelids and 2 associated surgeries that resulted in the removal of the entire upper and lower eyelid margins.

CLINICAL FINDINGS At initial evaluation, ankyloblepharon of the left eye was observed, with no upper or lower eyelid margins and a large, round, fluctuant subcutaneous mass over the left orbit. Orbital exploration and histologic examination revealed a benign cyst consisting of fibrous tissue, conjunctiva, and skeletal muscle bundles. Bacterial culture of cystic fluid yielded few Staphylococcus delphini.

TREATMENT AND OUTCOME Excision of the cyst and evisceration of the left globe were performed, and once daily treatment with orally administered enrofloxacin suspension (12.6 mg/kg [5.7 mg/lb]) and meloxicam (1 mg/kg [0.45 mg/lb]) was initiated. Over the next 4 days, the cyst redeveloped and progressively enlarged. Accumulated fluid was aspirated from the cyst, and 20 mg of gentamicin was injected intraorbitally with ultrasound guidance. Over the subsequent 27-month period, no recurrence of clinical signs or adverse effects were reported by the owner.

CLINICAL RELEVANCE To the authors' knowledge, this is the first report of cyst formation after adnexal injury and evisceration in birds and its successful treatment with intralesional gentamicin injection. Findings emphasized the importance of preserving lacrimal puncta during adnexal or eye removal surgeries in birds. Intralesional injection of gentamicin with the goal of destroying fluid-producing cells may be a safe and effective way to treat intraorbital cysts in birds and other species, although additional research would be required to confirm this.

Abstract

CASE DESCRIPTION A client-owned 2-year-old 1.8-kg (4-lb) male pet Rouen duck (Anas platyrhynchos domesticus) was evaluated because of severe swelling around the left eye following traumatic injury to the upper and lower eyelids and 2 associated surgeries that resulted in the removal of the entire upper and lower eyelid margins.

CLINICAL FINDINGS At initial evaluation, ankyloblepharon of the left eye was observed, with no upper or lower eyelid margins and a large, round, fluctuant subcutaneous mass over the left orbit. Orbital exploration and histologic examination revealed a benign cyst consisting of fibrous tissue, conjunctiva, and skeletal muscle bundles. Bacterial culture of cystic fluid yielded few Staphylococcus delphini.

TREATMENT AND OUTCOME Excision of the cyst and evisceration of the left globe were performed, and once daily treatment with orally administered enrofloxacin suspension (12.6 mg/kg [5.7 mg/lb]) and meloxicam (1 mg/kg [0.45 mg/lb]) was initiated. Over the next 4 days, the cyst redeveloped and progressively enlarged. Accumulated fluid was aspirated from the cyst, and 20 mg of gentamicin was injected intraorbitally with ultrasound guidance. Over the subsequent 27-month period, no recurrence of clinical signs or adverse effects were reported by the owner.

CLINICAL RELEVANCE To the authors' knowledge, this is the first report of cyst formation after adnexal injury and evisceration in birds and its successful treatment with intralesional gentamicin injection. Findings emphasized the importance of preserving lacrimal puncta during adnexal or eye removal surgeries in birds. Intralesional injection of gentamicin with the goal of destroying fluid-producing cells may be a safe and effective way to treat intraorbital cysts in birds and other species, although additional research would be required to confirm this.

A client-owned 2-year-old 1.8-kg (4-lb) male pet Rouen duck (Anas platyrhynchos domesticus) was referred to the Michigan State University Comparative Ophthalmology Service for evaluation of severe swelling of the left orbit following treatment of multiple left upper and lower eyelid lacerations that had been sustained during an altercation with another duck. Complete excision of the left upper and lower eyelid margins had been performed by another veterinarian, and the eyelid skin without the margins was left open. The owner reported that 1 week after surgery the periorbital skin from the upper and lower eyelid area had begun to adhere together. Then, the same veterinarian performed a second surgery with a circumferential excision of the periorbital skin around the initial surgical area and no suture closure. However, the periorbital skin from the upper and lower eyelids completely adhered together even after the second surgery, followed by progressive swelling of the periorbital area.

Initial physical examination at Michigan State University revealed an absence of the left upper and lower eyelid margins and closure of the periorbital skin over the left eye, preventing evaluation of the eye. A large, round, fluctuant subcutaneous mass was palpable over the left orbital area, over which the skin appeared stretched and thin (Figure 1). On the basis of these findings and the clinical history, we suspected that the complete removal of the upper and lower eyelid margins likely had led to entrapment of tears with or without cyst formation caused by iatrogenic ankyloblepharon. Results of complete physical examination, including ophthalmic examination of the unaffected right eye and adnexa, were unremarkable.

Figure 1—
Figure 1—

Photographs of a client-owned 2-year-old 1.8-kg (4-lb) male pet Rouen duck (Anas platyrhynchos domesticus) with a cyst within the left orbit obtained before (A), during (B and C), and after (D) surgical exploration of the orbit, cyst removal, and a modified evisceration procedure. A—In the presurgical photograph, a large, round, fluctuant subcutaneous mass is visible. B—During surgery, a fibrous cyst wall was exposed and excised. C—Once the cyst has been removed, the grossly normal globe is visible. D—After surgery, the orbital area appears fat without swelling.

Citation: Journal of the American Veterinary Medical Association 253, 9; 10.2460/javma.253.9.1164

Because of the lack of functional eyelids without any eyelid margins, and thereby no feasible option of eyelid reconstruction, a surgical approach was planned to explore the left orbit, remove the cyst walls, if present, and perform evisceration of the globe by use of a modified procedure reported for avian species.1 Midazolama (2 mg/kg [0.9 mg/lb]) and butorphanol tartrateb (1 mg/kg [0.45 mg/lb]) were administered IM as premedications. Anesthesia was induced with propofolc (6 mg/kg [2.7 mg/lb], IV) and maintained with sevofluraned in 100% oxygen.

With the duck anesthetized, the feathers over the left orbital area were gently plucked and the skin was aseptically prepared. A linear scar was noticed, likely representing the area where the upper and lower eyelid skin had fused. A stab incision was made through the scar with a No. 15 scalpel blade, and clear fluid mixed with blood was drained through the incision. A fluid sample was collected for aerobic bacterial culture and antimicrobial susceptibility testing. The incision was extended, and subcutaneous tissue was bluntly dissected with Stevens tenotomy scissors. A fibrous cyst wall, adhered to the third eyelid and the residual eyelids, was identified (Figure 1). The entire cyst wall and the third eyelid were excised from the orbit. The excised tissue was fixed in neutral-buffered 10% formalin for histologic evaluation.

Removal of the cyst exposed the left eye, which had no noticeable abnormality (Figure 1). A modified evisceration procedure was performed as previously described.1 Briefly, the entire cornea was excised along the limbus. The iris, lens, vitreous body, retina, pecten, and choroid were removed with gentle blunt dissection. The incision was closed in 2 layers: the subcutaneous layer in a simple continuous pattern and the skin layer in a cruciate pattern with 5–0 polyglactin 910.e The duck was discharged from the hospital with meloxicam suspensionf (1 mg/kg, PO, q 24 h for 7 days) and enrofloxacing (12.6 mg/kg [5.7 mg/lb], PO, q 24 h for 7 days). Before the quinolone antimicrobial had been prescribed, we had the owner confirm that the duck served as a pet and was never intended to be used as food (per AMDUCA, such extralabel use would have been illegal if there had been a possibility that the duck would enter the food supply). Aerobic bacterial culture of the cystic fluid sample revealed a few Staphylococcus delphini, which were susceptible to enrofloxacin.

Histologic evaluation of excised tissue revealed a cyst wall lined by well-differentiated columnar conjunctival epithelium that was segmentally attenuated or ulcerated (Figure 2). Segmental loss and, in other regions, hyperplasia of goblet cells was visible within the epithelium, as highlighted by periodic acid–Schiff and Alcian blue stains. The cyst was surrounded by dense fibrosis. Such fibrosis occasionally extended into and disrupted underlying skeletal muscle bundles that were presumed to be part of residual eyelid muscles. Within the superficial subepithelial stroma surrounding the cyst epithelium, rare lymphonodular aggregates were identified as well as more diffuse moderate perivascular and scattered infiltrates of lymphocytes and plasma cells. These findings were consistent with a benign cyst caused by iatrogenic ankyloblepharon.

Figure 2—
Figure 2—

Photomicrographs of a section of cyst wall tissue from the duck in Figure 1. A—The H&E stain reveals that the cyst wall is lined by well-differentiated columnar epithelium with numerous goblet cells. The subepithelial stroma of the cyst is composed of dense fibrocollagenous tissue that contains moderate perivascular infiltrates of lymphocytes and fewer plasma cells. B and C—The periodic acid–Schiff and Alcian blue stains, respectively, highlight the presence of goblet cells. Bar = 50 μm in all panels.

Citation: Journal of the American Veterinary Medical Association 253, 9; 10.2460/javma.253.9.1164

Four days after surgery, a follow-up email conversation with the owner revealed that the left orbit started to appear swollen again. Starting 9 to 10 days after surgery, the duck had begun scratching the area with its foot. The swelling progressed daily until the duck was reexamined 11 days after the surgery. At this reexamination, the owner reported that the duck's appetite was as usual. Its body weight had increased to 2.2 kg (1 lb), and the duck was bright, alert, and responsive. On physical examination, the skin incision appeared completely healed but a left-sided periorbital swelling associated with a round, fluctuant subcutaneous mass was evident, and this swelling appeared similar to the previously removed cyst (Figure 3). Ultrasonographyh of the left orbit with a 12-MHz linear transducer revealed a 1.5-cm-diameter, superficial echogenic fluid pocket. Deep to this fluid pocket, there was a focus of ovoid soft tissue echogenic material with a large amount of internal vascularity apparent on Doppler ultrasonography. The soft tissue echogenic material was interpreted as reactive intraorbital tissue.

Figure 3—
Figure 3—

Images showing recurrence of the left orbital cyst in the duck in Figure 1 eleven days after surgical exploration of the orbit, cyst removal, and an evisceration procedure. A and B—Photographs (side and front views, respectively) of the round intraorbital mass on the duck's left side. C—Ultrasonographic image of the orbit, showing an echogenic fluid pocket (asterisk). D—Doppler ultrasonographic image showing ovoid soft tissue echogenic material deep to the fluid pocket, with a large amount of internal vascularity. E—Photograph of fluid aspirated from the cyst. F and G—Photomicrographs of a cystic fluid sample, revealing low cellularity, with cells consisting mostly of erythrocytes and fewer macrophages that contained phagocytized erythrocytes (F) and pigment consistent with hemosiderin or melanin (G). Modified Wright stain; bar = 10 μm.

Citation: Journal of the American Veterinary Medical Association 253, 9; 10.2460/javma.253.9.1164

With the duck manually restrained and unsedated, approximately 5 mL of brown fluid was aspirated from the fluid pocket by use of a syringe and 22-gauge needle, with ultrasound guidance (Figure 3). Then, 20 mg (0.2 mL) of gentamicin sulfatei (100 mg/mL) was injected into the orbit. Cytologic examination of the aspirated fluid revealed low cellularity, with cells consisting mostly of erythrocytes and fewer macrophages that often contained phagocytized erythrocytes or pigment granules consistent with hemosiderin or melanin. These findings were suggestive of a cystic lesion with chronic ongoing hemorrhage. The brown color of the fluid was believed to have been attributable to erythrocyte breakdown products and melanin. Neither atypical cells nor infectious agents were identified. Aerobic and anaerobic bacterial culture of the aspirated fluid yielded no bacteria. The duck was discharged from the hospital, and no medications were administered at home.

On the most recent physical examination, performed 2 months following fluid aspiration and intraorbital gentamicin injection, no swelling or palpable subcutaneous mass was evident over the left orbit (Figure 4). Feathers had grown back in the previously affected area, and body weight had increased by 0.6 kg (1.3 lb) since the previous visit. The owner reported that the duck was more active and its feather quality had improved. Twenty-seven months after the gentamicin injection, the owner reported by telephone that the cyst had not recurred and the periorbital area had remained flat.

Figure 4—
Figure 4—

Photographs showing lateral (A) and dorsal (B) views of the head of the duck in Figure 1 two months after aspiration of the cyst fluid and intraorbital injection of gentamicin. The left orbital area is fat and has no evidence of swelling.

Citation: Journal of the American Veterinary Medical Association 253, 9; 10.2460/javma.253.9.1164

Discussion

Intraorbital cyst formation has reportedly occurred in dogs as a result of residual adnexal structures following enucleation of the globe.2 Retention of the conjunctiva within the orbit following enucleation results in accumulation of secretory material that can eventually form a cyst in the orbit.2 Enucleation is the most commonly performed salvage procedure for the treatment of incurable, chronically painful eyes in birds as well as other species.1,3 However, the risk of surgical complications can be greater in birds than in other species owing to certain anatomic characteristics of avian eyes, including tight encasement of the globe within the orbit, presence of the scleral ossicles, a fragile and thin orbit, and a short optic nerve.1 One potential complication is hemorrhage, particularly in small birds, given that avian species can tolerate only low-volume blood loss.4 A large and heavy eye relative to the head size in some avian species can also result in severe disfigurement and balance issues following enucleation.4

To decrease the risks and disadvantages associated with enucleation, a modified evisceration method has been suggested as an alternative for globe removal in avian patients.1,5 This modified technique leaves in place the nictitating membrane, Harderian gland, lacrimal gland, and conjunctival tissue. The only difference between enucleation and evisceration in terms of the glandular tissue remaining in the orbit would be the conjunctiva. With enucleation, the globe, third eyelid, and conjunctiva are removed, compared with evisceration, in which only the cornea and inner contents of the globe are removed and the conjunctiva remains. Although the risk of complications associated with enucleation in ducks would not be as high as for smaller birds (risk of excessive hemorrhage) or birds of prey with large globes (risk of balance problems while flying), evisceration was chosen over enucleation for the duck of the present report because of the anticipated better cosmetic outcome and lower risk or complications.

Several types of tear-secreting glands have been described in birds, including the lacrimal and Harderian glands. Most tears are secreted by the Harderian gland, which is located near the base of the third eyelid.6,7 The lacrimal gland is situated inferotemporal to the globe. Although the contribution of the conjunctival tissue, which in poultry plays an important role in mucosal immunity,8 to tear secretion has not been reported for avian species, numerous goblet cells were identified in the conjunctival epithelium in the duck of the present report. We speculate that these goblet cells produce the mucin layer of tear film as in mammals.

Superior and inferior lacrimal puncta are located at the medial canthus in birds and drain tears to the nasal cavity via the nasolacrimal duct.1,8 To prevent intraorbital fluid accumulation following a globe evisceration procedure in birds, care must be taken not to remove or damage the lacrimal puncta.1 In the duck of the present report, neither the upper nor lower punctum was identified during the orbital exploration, and it was deemed likely that both puncta had been removed during one of the previous eyelid removal surgeries. Therefore, all the grossly visible conjunctival tissue was removed at the time of evisceration with the hope that this would prevent fluid accumulation. The third eyelid was also removed because it was involved in the cyst wall. Nonetheless, the swelling recurred after surgery, likely because of active tear secretion by the Harderian and lacrimal glands.

When the periocular swelling recurred, several treatment options had been discussed with the owner. First, we considered removal of all tear-secreting tissues, including the Harderian and lacrimal glands, by exenteration. However, such a procedure was considered to pose a risk of excessive hemorrhage. Also considered was intraorbital injection of polidocanol, a sclerosing agent that been used to treat cystic diseases such as bone, mucous, and renal cysts in humans.9–11 A report12 exists of successful treatment of an orbital mucocele in a dog with 1% polidocanol. However, what has yet to be reported is the safety or efficacy of polidocanol in birds. Lastly, we considered intraorbital gentamicin injection. Intravitreal injection of gentamicin, a drug with cytotoxic effects on the ciliary body epithelium and retina, has been used to control intraocular pressure in dogs with end-stage glaucoma.13 By destroying the ciliary body, intravitreal gentamicin injection causes a decrease aqueous humor production.13 Because systemic therapeutic dose ranges of gentamicin and related safety have been established for avian species, the owner elected to try intraorbital gentamicin injection over polidocanol injection or exenteration. The dose chosen (approx 10 mg/kg [20 mg in total]) was selected on the basis of systemic daily dose suggestions for avian species (5 to 40 mg/kg [2.3 to 18.2 mg/lb], q 8 to 24 h),14 and a single injection resulted in successful resolution of the cyst. The swollen area progressively flattened out without any systemic or local adverse effect or recurrence for at least 21 months.

Because the duck was a clinical patient, no attempt was made to evaluate the mechanism of gentamicin action by harvesting and histologically evaluating intraorbital tissue after injection. Considering the anatomic location of the Harderian gland, the body of which is mostly situated posterior to the globe equator, it remains unclear how the anteriorly injected gentamicin was distributed to the gland. We speculate that by removing the conjunctiva (including fornixes) at the time of evisceration, we created a physical passageway that allowed the drug to be distributed in the retrobulbar space. Distribution of the drug could also have been aided by the increase in vascular permeability caused by inflammation.

To our knowledge, the present report represents the first of intraorbital cyst formation after adnexal injury in birds. Cyst excision and evisceration failed to permanently resolve the cyst in the Rouen duck, likely owing to residual tear-secreting glandular tissue and previously damaged lacrimal puncta. We believe our findings highlight the importance of preserving lacrimal puncta during adnexal surgeries, enucleation, and evisceration procedures in birds. The present report also represents the first of resolution of an intraorbital cyst with a single intralesional gentamicin injection, and this approach may be useful for the treatment of cystic diseases in other species. Longitudinal studies with long-term follow-up and more birds are necessary to determine the long-term safety and effectiveness of local gentamicin injection for treating intraorbital cysts in avian species.

Acknowledgments

The authors thank Drs. Christopher Thibault and Martin Jamie Douglas for their anesthesia service and Drs. Martin Coster, Lorraine Karpinski, Annajane Marlar, Christopher Murphy, Maureen Murray, and Joanne Paul-Murphy for sharing their expertise on diagnostic and treatment plans for this patient with us.

Footnotes

a.

Akorn, Lake Forest, Ill.

b.

Butorphic injection (CIV), Akorn, Lake Forest, Ill.

c.

Actavis Pharma Inc, Philadelphia, Pa.

d.

Flurovess, VetOne, Boise, Idaho.

e.

Vicryl, Ethicon Inc, Piscataway, NJ.

f.

Metacam oral suspension, Boehringer Ingelheim, St Joseph, Mo.

g.

Enrofloxacin flavored 22.7-mg tablet, Putney Inc, Portland, Me.

h.

GE Logiq 9, GE Healthcare, Fairfield, Conn.

i.

MWI Animal Health, Boise, Idaho.

References

  • 1. Murray M, Pizzirani S, Tseng F. A technique for evisceration as an alternative to enucleation in birds of prey: 19 cases. J Avian Med Surg 2013;27:120127.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2. Ward AA, Neaderland MH. Complications from residual adnexal structures following enucleation in three dogs. J Am Vet Med Assoc 2011;239:15801583.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3. Murphy CJ, Brooks DE, Kern TJ, et al. Enucleation in birds of prey. J Am Vet Med Assoc 1983;183:12341237.

  • 4. Diehl KA, McKinnon JA. Eye removal surgeries in exotic pets. Vet Clin North Am Exot Anim Pract 2016;19:245267.

  • 5. Christen C, Richter M, Fischer I, et al. Unilateral evisceration of an eye following cornea and lens perforation in a sulfur-crested cockatoo (Cacatua galerita). Schweiz Arch Tierheilkd 2006;148:615619.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6. Bayon A, Almela R, Talavera J. Avian ophthalmology. Eur J Comp Anim Pract 2007;17:113.

  • 7. Burns RB, Maxwell MH. The structure of the Harderian and lacrimal gland ducts of the turkey, fowl and duck. A light microscope study. J Anat 1979;128:285292.

    • Search Google Scholar
    • Export Citation
  • 8. Kern TJ, Colitz CM. Exotic animal ophthalmology In: Gelatt KN, Gilger BC, Kern TJ, eds. Veterinary ophthalmology. 5th ed. Ames, Iowa: Wiley-Blackwell, 2013;17501819.

    • Search Google Scholar
    • Export Citation
  • 9. Dell'Atti L. Comparison between the use of 99% ethanol and 3% polidocanol in percutaneous echoguided sclerotherapy treatment of simple renal cysts. Urol Ann 2015;7:310314.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10. Rieger S, Dickschas J. Percutaneous sclerotherapy with polidocanol: successful relapse therapy of infantile aneurysmal bone cyst [in German]. Unfallchirurg 2016;119:781784.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11. Esson GA, Holme SA. Treatment of 63 subjects with digital mucous cysts with percutaneous sclerotherapy using polidocanol. Dermatol Surg 2016;42:5962.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12. Stuckey JA, Miller WW, Almond GT. Use of a sclerosing agent (1% polidocanol) to treat an orbital mucocele in a dog. Vet Ophthalmol 2012;15:188193.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13. Plummer CE, Regnier A, Gelatt KN. The canine glaucoma. In: Gelatt KN, Gilger BC, Kern TJ, eds. Veterinary ophthalmology. 5th ed. Ames, Iowa: Wiley Blackwell, 2013;10501145.

    • Search Google Scholar
    • Export Citation
  • 14. Plumb DC. Veterinary drug handbook. 8th ed. Ames, Iowa: Wiley Blackwell, 2015;485488.

  • Figure 1—

    Photographs of a client-owned 2-year-old 1.8-kg (4-lb) male pet Rouen duck (Anas platyrhynchos domesticus) with a cyst within the left orbit obtained before (A), during (B and C), and after (D) surgical exploration of the orbit, cyst removal, and a modified evisceration procedure. A—In the presurgical photograph, a large, round, fluctuant subcutaneous mass is visible. B—During surgery, a fibrous cyst wall was exposed and excised. C—Once the cyst has been removed, the grossly normal globe is visible. D—After surgery, the orbital area appears fat without swelling.

  • Figure 2—

    Photomicrographs of a section of cyst wall tissue from the duck in Figure 1. A—The H&E stain reveals that the cyst wall is lined by well-differentiated columnar epithelium with numerous goblet cells. The subepithelial stroma of the cyst is composed of dense fibrocollagenous tissue that contains moderate perivascular infiltrates of lymphocytes and fewer plasma cells. B and C—The periodic acid–Schiff and Alcian blue stains, respectively, highlight the presence of goblet cells. Bar = 50 μm in all panels.

  • Figure 3—

    Images showing recurrence of the left orbital cyst in the duck in Figure 1 eleven days after surgical exploration of the orbit, cyst removal, and an evisceration procedure. A and B—Photographs (side and front views, respectively) of the round intraorbital mass on the duck's left side. C—Ultrasonographic image of the orbit, showing an echogenic fluid pocket (asterisk). D—Doppler ultrasonographic image showing ovoid soft tissue echogenic material deep to the fluid pocket, with a large amount of internal vascularity. E—Photograph of fluid aspirated from the cyst. F and G—Photomicrographs of a cystic fluid sample, revealing low cellularity, with cells consisting mostly of erythrocytes and fewer macrophages that contained phagocytized erythrocytes (F) and pigment consistent with hemosiderin or melanin (G). Modified Wright stain; bar = 10 μm.

  • Figure 4—

    Photographs showing lateral (A) and dorsal (B) views of the head of the duck in Figure 1 two months after aspiration of the cyst fluid and intraorbital injection of gentamicin. The left orbital area is fat and has no evidence of swelling.

  • 1. Murray M, Pizzirani S, Tseng F. A technique for evisceration as an alternative to enucleation in birds of prey: 19 cases. J Avian Med Surg 2013;27:120127.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2. Ward AA, Neaderland MH. Complications from residual adnexal structures following enucleation in three dogs. J Am Vet Med Assoc 2011;239:15801583.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3. Murphy CJ, Brooks DE, Kern TJ, et al. Enucleation in birds of prey. J Am Vet Med Assoc 1983;183:12341237.

  • 4. Diehl KA, McKinnon JA. Eye removal surgeries in exotic pets. Vet Clin North Am Exot Anim Pract 2016;19:245267.

  • 5. Christen C, Richter M, Fischer I, et al. Unilateral evisceration of an eye following cornea and lens perforation in a sulfur-crested cockatoo (Cacatua galerita). Schweiz Arch Tierheilkd 2006;148:615619.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6. Bayon A, Almela R, Talavera J. Avian ophthalmology. Eur J Comp Anim Pract 2007;17:113.

  • 7. Burns RB, Maxwell MH. The structure of the Harderian and lacrimal gland ducts of the turkey, fowl and duck. A light microscope study. J Anat 1979;128:285292.

    • Search Google Scholar
    • Export Citation
  • 8. Kern TJ, Colitz CM. Exotic animal ophthalmology In: Gelatt KN, Gilger BC, Kern TJ, eds. Veterinary ophthalmology. 5th ed. Ames, Iowa: Wiley-Blackwell, 2013;17501819.

    • Search Google Scholar
    • Export Citation
  • 9. Dell'Atti L. Comparison between the use of 99% ethanol and 3% polidocanol in percutaneous echoguided sclerotherapy treatment of simple renal cysts. Urol Ann 2015;7:310314.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10. Rieger S, Dickschas J. Percutaneous sclerotherapy with polidocanol: successful relapse therapy of infantile aneurysmal bone cyst [in German]. Unfallchirurg 2016;119:781784.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11. Esson GA, Holme SA. Treatment of 63 subjects with digital mucous cysts with percutaneous sclerotherapy using polidocanol. Dermatol Surg 2016;42:5962.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12. Stuckey JA, Miller WW, Almond GT. Use of a sclerosing agent (1% polidocanol) to treat an orbital mucocele in a dog. Vet Ophthalmol 2012;15:188193.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13. Plummer CE, Regnier A, Gelatt KN. The canine glaucoma. In: Gelatt KN, Gilger BC, Kern TJ, eds. Veterinary ophthalmology. 5th ed. Ames, Iowa: Wiley Blackwell, 2013;10501145.

    • Search Google Scholar
    • Export Citation
  • 14. Plumb DC. Veterinary drug handbook. 8th ed. Ames, Iowa: Wiley Blackwell, 2015;485488.

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