Traumatic proptosis is a forward displacement of the globe from the orbit by a traumatic episode
resulting in entrapment of the eyelids behind the eye. Tarsorrhaphy is closure of the eyelids.
Clinically Relevant Pathophysiology
Blunt head trauma, combined with retrobulbar hemorrhage and/ or swelling and orbital fractures, can
cause acute forward displacement of the globe beyond the bony orbit and eyelids. Excessive restraint of
animals with large palpebral fissures and shallow orbits can also cause globe proptosis. Once displaced,contraction and inward rolling of the eyelids and spasms of the orbicularis oculi muscle prevent return of
the prolapsed globe to its normal position. Ocular muscle damage, hemostasis, conjunctival swelling,
and corneal exposure leading to corneal ulcers may occur. Traumatic proptosis is an emergency.
In brachycephalic dog breeds, proptosis occurs easily because they have shallow orbits and large
palpebral fissures that allow their globes to move forward more easily. With these dogs, less severe
trauma (e.g., restraint) can cause proptosis and usually results in less tissue damage than
nonbrachycephalic dogs. In dolichocephalic dog breeds and in cats, the naturally deeper orbits mean that
severe trauma (e.g., vehicular accident or animal fight) is needed to cause a traumatic proptosis, and the
orbital tissue damage is usually more severe. Head trauma can also cause skull, mandibular, and brain
injuries. Longer eye exposure times result in more extensive corneal damage and more severe
retrobulbar hemorrhage and edema. Pressure and stretching may damage the optic nerve, extraocular
muscles, and orbital tissues (e.g., the lacrimal gland).
The globe will be severely protruded, and the eyelid margins will not be visible because they are
entrapped behind the eye. Subconjunctival hemorrhage, chemosis, corneal exposure, periocular bruising,
and other signs of trauma are usually present.
While stabilizing the patient, immediately and frequently apply topical ointments or gels to the exposed
cornea to keep it moist and minimize damage. In many cases, the animal will not allow topical
treatments to be applied, but an attempt should be made. The animal should be kept without food and
water, and self trauma should be prevented with a rigid E-collar.
If possible, make a lateral canthus incision using a Mayo or iris scissor to enlarge the palpebral fissure
enough to move the eyelids in front of the globe. Lubricate the cornea with sterile ophthalmic antibiotic
ointment. Reduce entrapment of the lid margins using atraumatic forceps. Place two to four partial-
thickness temporary tarsorrhaphy sutures of 4-0 nylon or silk, but do not tie them, leaving the area of the
medial canthus open. Take care to allow the sutures to exit the lid margins so that sutures will not touch
the cornea when tightened. Grasp the ends of the preplaced sutures with a hemostat and pull them
anteriorly while applying gentle posterior pressure to the well-lubricated globe with a Jaeger lid place,
smooth Bard-Parker scalpel blade handle, or the cut finger of a surgical glove. Tie the sutures with the
ends left long; place stents if the sutures are excessively tight. Close the canthotomy incision with a
figure-eight suture at the lateral canthus and simple interrupted sutures of 4-0 to 5-0 absorbable
polyglactin 910. Place the sutures partial thickness in the eyelid to prevent corneal contact