Michelle Fiordaliso“Look, that dog has one eye,” a little girl said to her brother at the coffee shop. “What happened?” she asked me.
“The doctor had to take it out.” I said.
“But can he ever get it back?”
There are some words you go through most of your life without ever needing to know. Enucleation was one of them. Technically it means the surgical procedure that removes the whole globe of the eye and any intraocular contents like the inner lids. While I knew some humans with glass eyes, I had never heard the term enucleation before Percy, my 12-year-old mixed breed rescue dog, needed to have one.
Enucleations can be necessary for dogs when illness or injury occurs.
Symptoms Suggesting the Need for Enucleation
One winter day, Percy suddenly yelped and closed his left eye. It happened without warning, and there didn’t seem to have been any clues that something was wrong beforehand. However, looking back, Percy had exhibited some bizarre behaviors the previous month, including hiding in the closet and trying to climb behind the toilet.
I later learned that in addition to being signs of cognitive decline like dog dementia, these behaviors can also be symptoms of eye issues. Eye pressure can cause headaches for dogs, and Percy may have been seeking a quiet, dark place the way we do when we have a migraine.
Common symptoms which suggest a condition requiring enucleation include an eye that bulges out of the socket, a red or swollen eye, severe cloudiness of the eye, excessive blinking, squinting, an eye that is much larger or smaller than the other eye, discharge from the eye, and a dog’s aversion to bright light.
Some dogs won’t even have visible eye symptoms, but will show generalized signs of pain or discomfort as a result of an underlying condition. That condition can be glaucoma, an infection of the eye, severe inflammation around the eye, cancer, or severe trauma to the eye.
After Percy yelped, his eye was red, and he was keeping it closed. I took him to the vet, who reassured me that Percy still had vision in that eye but misdiagnosed his condition as an allergy, prescribing Benadryl and a topical ointment.
Two days later, with the eye still red and getting cloudier, I took him back to the clinic where another vet saw him. She came out and said, “I have bad news.”
Why Does My Dog Need to Have His Eye Removed?
The pressure in Percy’s eye was 75 mm Hg (normal eye pressure in dogs is 15-20 mm Hg), his eye was swollen to 3x its normal size and was full of blood and fluid. I was given an emergency appointment that day at a Veterinary Eye Center.
“What does the high pressure mean?” I asked.
“His optic nerve is dead, and he’s blind.”
“How did this happen?”
“There’s no way to know for sure, but either the lens moved out of place or something burst. He’ll need either a lens removal or an enucleation.”
There was that word. The vet said the term as though I would have it in my vocabulary. But despite being a writer, I did not know what an enucleation was before that day.
Are There Any Alternative Options to Enucleation?
At the Veterinary Eye Center, they confirmed that Percy was irreparably blind in his left eye. Something acute (perhaps a lens luxation – a dislocated lens) caused a secondary glaucoma (pressure in the eye) which, in turn, was causing the eye to swell. An enucleation would be the best treatment.
I asked about alternatives. In older dogs, who can’t undergo surgery due to heart or kidney issues, sometimes an intravitreal injection is given. An antibiotic, Gentamicin, is injected into the eye. In high concentrations, this causes the ciliary body (the origin of normal eye fluid) to die, permanently reducing eye fluid and pressure, and alleviating pain. This causes blindness in the treated eye, although in Percy’s case, this was irrelevant –- he was already blind in that eye.
An enucleation makes your dog look like he’s in a perpetual wink, while an intravitreal injection creates a shrunken and strange-looking eye. But the aesthetics are not the real issue. Despite the injection being a fast procedure done under local anesthesia, the eye remains at risk of infection. Therefore, it must continue to be cared for, and the need for an enucleation could still come later.
For Percy, there was only one clear path forward.
What Does a Dog Enucleation Involve?
The doctor said many pet owners have a hard time wrapping their minds around the idea of their dog losing an eye, but that the sooner we did it, the sooner Percy would have relief. So I scheduled his surgery for the next available appointment — ten days away.
During that time, I continued to treat the pressure in his eye with medicated drops, and the two of us took it easy. I grappled with many feelings about what Percy had gone through, what he was currently going through, and the challenges that lie ahead for him.
How Long Does Canine Eye Removal Surgery Take?
The Veterinary Ophthalmologist explained that on the day of the surgery, he’d fast from food and water beginning at midnight. I’d drop him off around 8 a.m., the enucleation would take 45-90 minutes, including preparation, and I could pick him up around 4 p.m. after he had recovered.
I did a hashtag search for #enucleation on Instagram and found a few dogs and owners who had gone through this procedure. I sent them DMs, and they all wrote kind messages about what to expect and tips about aftercare. Percy and I were being inducted into the world of one-eyed dogs – we were not alone, and that support was a relief.
How Much Does Dog Eye Removal Surgery Cost?
An enucleation can range in price from $450-$3500. Given that we live in New York City, you can guess which side of that range we were on. I asked the vet what people do who can’t afford it and was told that pet insurance can help and that sometimes an ASPCA will do it for free.
“What would happen if I did nothing?” I asked. She explained that that option was inhumane; the eye was likely causing Percy a great deal of pain and could potentially burst from the pressure. This would result in an eye infection and the need for an emergency enucleation. Luckily, we had a generous friend who offered to help.
What is the Aftercare?
The staff at the eye clinic explained that Percy would have no bandages when I picked him up. The stitches would be internal and dissolvable. And he’d have to wear a cone or e-collar for 2-3 weeks, which I just realized stands for Elizabethan Collar. Duh!
Other than the cone, he could sleep, eat and go out for short walks to relieve himself as he normally would. They created a clear cone that perfectly fit his size, which helped.
Will There Be Any Pain After the Operation? What Drugs are Prescribed to Manage Ophthalmic Pain?
There is pain after the enucleation, which is managed by pain medication. He was sent home with Carprofen for inflammation and Gabapentin for pain.
Once the anesthesia wore off, which had made Percy pretty loopy, he seemed like a mellow version of himself. He slept the whole night through and followed his regular routine the next day.
How Long is the Recovery Time after Dog Enucleation?
I was told I could expect the inflammation to go down in 4-5 days, and in two weeks, we’d return for a follow-up visit.
Something to keep in mind is if you have steps in your home, be aware that the e-collar can catch on a step and cause your dog to fall backward. And the last thing they need when healing from an enucleation is a fall.
The wound did take longer than expected to heal. About 5-6 weeks after the surgery, Percy was still having scabbing on either side of the wound. I sent photos to the surgeon who said that was uncommon, but it was around the time that the stitches should be dissolving and to bring him in to make sure there wasn’t an infection.
A tiny blue thread was sticking out of one side of the wound, the way a dandelion finds its way through a crack in the sidewalk, but it fell off the day before our appointment. The surgeon confirmed it was a stitch that Percy’s body pushed out. Once that was gone, the rest seemed to keep healing.
What Will My Dog Look Like?
As you can see from the photos, Percy is particularly cute. I have no genetic role in this, so I don’t say it with personal pride. Many times a day, people will stop to comment on how adorable he is. One reason might be that his mix of breeds gives him oversized eyes like a Disney character, floppy ears, and a smooth coat.
But I wasn’t so concerned about him being less cute as I was about the emotional effects of seeing the gruesome nature of the enucleation wound for the first time, as well as knowing he was suffering. So I asked my best friend to be with me when I picked him up.
Around 12:30, the office called to say he was doing well. Percy has always had severe separation anxiety, so I thought being away from me might add to his confusion. The office said I didn’t have to wait till 4 or 5 and could get him as early as 2:30.
Because of Covid, my friend had to wait in the reception area while I went inside to retrieve Percy. I braced myself while I waited and tried to be stoic and normal for his sake – to greet him with the same enthusiasm that I always do.
I’m not going to lie, he was wobbly on his feet, and the wound was red and swollen with lots of dry black blood on his face. I have worked in hospitals, and as a birth doula, so I’m better with blood and guts than the average person. If you have a tender stomach or are squeamish—seeing your pet for the first time after an enucleation might be hard.
Within a few days, the swelling went down. The redness lessened. And the dried blood fell away. And once the hair started to grow back, Percy looked like Percy.
Many still comment on how cute he is, maybe even more so now.
What Does an Eye Prosthetic Do?
The doctor I chose used a silicone prosthetic in the eye socket. This is for aesthetic purposes. Rather than the wound caving in and looking like a sunken hole – the prosthetic makes it look like he has a closed eye – not too different from how he always looked when he was sleeping.
I fielded ridiculous questions, and comments from friends who wondered why Percy couldn’t get a glass eye like humans do (too much risk of infection), why he couldn’t wear an eye patch (too uncomfortable) and whether he should now go by Percy-the-Pirate (ugh)?
What Happens to the Dog’s Eye After It is Removed?
Despite requests from my college-aged son to keep the eye, the eye got sent to pathology to determine if there were any conditions (like cancer) that might inform how to keep the other eye safe. Since it was Christmas, and my son and I have a tradition of wrapping up goofy gifts, I did get a life-sized gummy eyeball and wrapped it in a giant box, saying it was Percy’s left eye.
Not everyone in the family appreciated the humor the way the two of us did, but Percy didn’t seem to mind. The histology (microscopic investigation) of Percy’s eye appeared to be fine, but this doesn’t mean his right eye is entirely safe.
Double Enucleation in a Dog
The only things that were determined to possibly have contributed to Percy’s eye issue were slightly elevated kidney levels and high blood pressure. Therefore, monitoring his kidneys and bringing his blood pressure down with medication is our current course of action.
Since Percy is a senior dog and has lenticular sclerosis (clouding) in his right eye, the vet continues to monitor the pressure. And if swelling or closing his eye on the right side happens, I know that I should seek immediate medical attention.
Double enucleations, sadly, are not out of the question.
Prevention
If something acute happens in your dog’s eye, like a yelp and eye-closing, seek immediate medical attention.
If you have a dog presenting with eye issues, ask the vet to check the eye pressure, particularly if the dog is older or has clouded eyes.
If your dog is presenting with odd behaviors like hiding in the closet or other dark places, consider having their eyes checked. Dogs seeking darkness or hiding places are often in discomfort and/or distress, so trying to find the cause of this behavior is a good idea regardless of whether an eye issue is the cause.
Post-Surgery Behavior
Percy doesn’t seem to be in pain, but he’s confused from time to time. His spatial reasoning is altered. He occasionally falls when jumping up on the bed. If he comes up against something on his blindside, like the legs of the dining room table or one of his familiar places to pee, he might bump into it and get startled. I have had to become more mindful of where he is and how he perceives things –- and so has he.
Just yesterday, we were walking in Central Park during off-leash hours when he got on the scent of a fluffy dog. When he lost interest, he couldn’t find me again the way he normally would.
“Is that your dog?” a woman asked. “He looks lost.”
“He’s recently blind on one side. It takes him a full 360 degree-turn now to locate me.”
But just like always, I’m here waiting for him, and then we continue our path together.
