Surgical Approaches to the Eye and Orbit

By Dr. Zubair Khalid, DVM, MS, PhD · 2026-08-11

Key Takeaways

• The transpalpebral approach is the preferred enucleation technique in both dogs and cats due to superior exposure and reduced risk of conjunctival contamination, particularly for blind, painful eyes, intraocular neoplasia, or severe trauma.
• Orbital exploration requires precise anatomical knowledge, with lateral orbitotomy indicated for dorsal/caudal masses and ventral approaches for ventral orbital disease, necessitating careful identification of critical structures like the facial nerve branches and optic nerve.
• Eyelid reconstruction for defects utilizes full-thickness wedge resections for smaller defects and sliding or rotational flaps for larger ones, emphasizing precise apposition of the mucocutaneous junction for optimal healing and function.
• Diagnostic imaging, primarily CT, is crucial for orbital exploration to assess mass location, extent, and involvement of orbital structures like extraocular muscles and the optic nerve, guiding surgical approach selection and prognosis.
• Postoperative complications such as retrobulbar hemorrhage, orbital emphysema, implant migration, and wound dehiscence necessitate vigilant monitoring for swelling, hemorrhage, and signs of infection, with prompt intervention for conditions like expanding hematomas.
• While growth factors and platelet-rich plasma are explored for wound healing, their routine application in veterinary ophthalmic surgery remains experimental and does not substitute for sound surgical technique and meticulous tissue handling.

This article provides a procedural reference for the practicing veterinarian performing surgery on the canine and feline eye and orbit. It covers surgical approaches for enucleation, orbital exploration, and eyelid procedures, with emphasis on exposure, instrumentation, tissue handling, and postoperative care. Intraocular surgery is excluded. The content serves the clinician preparing for common ophthalmic procedures and addresses the decision-making required to select an approach that preserves function or achieves safe and complete removal of diseased tissue.

The reader is assumed to be comfortable with basic surgical principles and familiar with ocular anatomy. The focus here is on the technical choices that determine surgical success: incision placement, plane of dissection, retraction, and closure. These decisions differ substantially between the dog and cat, and between the superficial eyelid and the deep orbit. The procedures described are within the scope of a general small animal surgical practice, though orbital exploration may require referral-level case selection.

At a Glance

Surgical Anatomy and Exposure Principles

The orbit is a bony cone lined by periorbita, a dense fibrous membrane that separates orbital fat from the extraocular muscles. The globe occupies the rostral two-thirds of the orbit, and the retrobulbar space contains the optic nerve, ophthalmic vasculature, extraocular muscles, and the zygomatic salivary gland ventrolaterally. The orbital fissure transmits the oculomotor, trochlear, abducens, and ophthalmic branches of the trigeminal nerve, along with the ophthalmic artery. The optic canal lies medial and slightly dorsal to the orbital fissure and transmits the optic nerve and internal ophthalmic artery.

Exposure is governed by the relationship between the globe, the orbital rim, and the target tissue. For eyelid surgery, the surgeon requires only local anesthesia and magnification. For enucleation, the entire globe and as much of the optic nerve as possible must be visualized. For orbital exploration, the surgeon must work within a confined space where retraction of the globe and dissection of the periorbita determine access. The transpalpebral approach to enucleation provides the widest exposure and is the standard technique in both dogs and cats. The lateral orbitotomy provides access to the caudal and dorsal orbit but requires careful identification of the facial nerve and the zygomatic arch.

Tissue handling principles apply uniformly. The conjunctiva and eyelid margins are thin and tear easily, they should be grasped with fine forceps and incised with a scalpel blade instead of scissors where precision matters. The periorbita is tough and should be incised sharply. The extraocular muscles are avulsed or transected close to the sclera during enucleation, and the optic nerve is clamped or ligated before transection to prevent hemorrhage from the ciliary arteries. The surgeon must maintain a clear distinction between the dissection planes for eyelid surgery, which are subcutaneous, and those for orbital surgery, which are subperiosteal or within the periorbita.

Wound Healing and Biologic Considerations

The orbit and eyelids have a robust blood supply, and wounds in this region heal rapidly when tissue is handled gently and tension is avoided. The eyelid margin is a specialised structure with a mucocutaneous junction that must be apposed precisely to prevent corneal irritation from trichiasis or exposure. The conjunctiva has a high capacity for epithelial regeneration, but full-thickness defects require surgical closure to prevent scarring and symblepharon.

Growth factors play a central role in soft tissue healing and have been investigated as adjuncts to surgical wound management. Platelet-rich plasma, which concentrates autologous platelets and their alpha granule contents including transforming growth factor-beta and platelet-derived growth factor, has been used to enhance healing in various surgical fields platelet-rich plasma and its application in trauma and orthopedic surgery. Recombinant growth factor therapies have also been developed for wound management, though evidence for their efficacy in routine ophthalmic surgery remains limited advances in surgical applications of growth factors for wound healing. The clinical relevance for the ophthalmic surgeon is indirect: these biologic agents do not replace sound surgical technique, and their use in eyelid or orbital surgery is not standard practice.

Reperfusion injury is a theoretical concern when the orbital blood supply is compromised during surgery, particularly during prolonged orbital exploration or when the ophthalmic artery is inadvertently damaged. The pathophysiology involves oxygen readmission to ischemic tissues, generating reactive oxygen species that cause further cellular damage reperfusion injury, pathophysiology, clinical manifestations and therapeutic options. In practice, the orbit's collateral circulation makes clinically significant reperfusion injury uncommon, but the surgeon should minimize ischemia time by avoiding prolonged retraction of the globe and by controlling hemorrhage promptly.

Instrumentation

The minimum instrument set for eyelid surgery includes a scalpel handle with a number 15 blade, fine thumb forceps, small scissors, a needle holder, and absorbable suture material. Magnification loupes are strongly recommended for eyelid margin apposition. For enucleation, the surgeon additionally needs a large curved hemostat or an enucleation snare for the optic nerve, a periosteal elevator, and a malleable retractor. For orbital exploration, a self-retaining retractor, a suction tip, and a headlight are valuable additions.

Suture selection follows standard principles. The eyelid margin is closed with fine monofilament or braided absorbable suture, with the marginal suture placed first to align the mucocutaneous junction. The conjunctiva is closed with a simple continuous pattern using absorbable suture. The subcutaneous layer is closed with absorbable suture, and the skin with nonabsorbable or absorbable monofilament. The choice of suture size and needle type depends on the thickness of the tissue, eyelid skin is thin and requires a reverse cutting needle.

Enucleation

Enucleation is indicated for a blind, painful eye that cannot be managed medically, for intraocular neoplasia, for severe trauma with rupture, and for end-stage glaucoma. The transpalpebral approach is preferred because it avoids contamination of the surgical field by the conjunctival sac and provides the widest exposure. The technique begins with a full-thickness incision through the eyelids, 2 to 3 mm from the eyelid margins, and continues around the palpebral fissure. The skin incision is deepened through the orbicularis oculi muscle to the conjunctiva, which is then incised. The conjunctiva is dissected from the globe, and the extraocular muscles are identified and transected at their scleral insertions.

The optic nerve is the final attachment. It is clamped with a large curved hemostat, and the nerve is transected distal to the clamp. The clamp is left in place for 30 to 60 seconds before removal to allow thrombosis of the ciliary arteries. The orbit is then inspected for hemorrhage, and the surgeon decides whether to place an orbital implant. Silicone or porous polyethylene implants are used for cosmesis, particularly in cats. The implant is placed within the periorbita, and the subcutaneous tissues and skin are closed in layers.

The subconjunctival approach to enucleation is an alternative when the conjunctiva is healthy and the surgeon wishes to preserve it. This approach is less commonly used because it provides narrower exposure and risks leaving conjunctival tissue that can form a discharging sinus. The transpalpebral approach is therefore recommended as the default technique.

Orbital Exploration

Orbital exploration is indicated for retrobulbar masses, orbital cellulitis or abscessation that does not respond to medical therapy, and foreign body removal. The lateral orbitotomy provides access to the dorsal and caudal orbit. The skin incision follows the dorsal border of the zygomatic arch, and the underlying temporalis muscle is reflected. The orbital ligament is transected, and the periorbita is incised to expose the orbital contents. The zygomatic salivary gland lies ventrolateral and may be partially resected for additional exposure.

The ventral approach to the orbit is used for masses or abscesses located ventrally. The incision is made over the ventral orbital rim, and the dissection proceeds through the subcutaneous tissues and masseter muscle. The periorbita is incised, and the orbital contents are explored. This approach provides limited exposure and is best reserved for well-localized disease.

Orbital exploration carries a higher risk of complications than enucleation. Hemorrhage from the ophthalmic plexus can obscure the field, and the optic nerve and extraocular muscles are at risk of iatrogenic damage. The facial nerve branches that cross the zygomatic arch are vulnerable during lateral orbitotomy, and their injury results in temporary or permanent facial paralysis. The surgeon should have a clear preoperative plan based on diagnostic imaging, and should be prepared to convert to a more extensive approach if the exposure is inadequate.

Preoperative Assessment and Case Selection

The decision to proceed with a specific surgical approach begins with a complete ophthalmic examination, including Schirmer tear testing, fluorescein staining, tonometry, and fundic evaluation when the media are clear. Orbital disease requires additional diagnostic imaging before surgical intervention. Computed tomography is the preferred modality for evaluating the orbit, as it provides superior bony detail and allows assessment of extraocular muscle involvement, optic nerve diameter, and the extent of any mass lesion. Ultrasonography is a reasonable alternative when CT is unavailable, particularly for guiding fine-needle aspiration of cystic or fluid-filled lesions.

Systemic health assessment should follow standard preanaesthetic protocols. Coagulation testing is indicated when orbital neoplasia, trauma, or previous bleeding episodes raise concern. Patients with suspected retrobulbar abscess should be evaluated for sepsis, and those with exophthalmos should have fundic examination to assess for optic nerve compromise. The presence of blindness, absent pupillary light reflexes, or severe panophthalmitis shifts the surgical plan toward enucleation instead of orbit-sparing procedures.

The owner should be counselled about expected cosmetic outcomes, the need for histopathology, and the possibility of incomplete excision when orbital disease is extensive. For suspected neoplasia, thoracic radiography or CT is recommended before surgery to screen for metastatic disease. The ACVS animal health resources provide owner-focused summaries of common ophthalmic surgical conditions that can support preoperative discussions.

Approach Selection by Procedure

The transpalpebral enucleation is the most commonly performed approach and is appropriate for most clinical scenarios. The transconjunctival approach preserves the eyelid margin and provides superior cosmetic results, but it risks seeding neoplastic cells into the subconjunctival space when intraocular neoplasia is present. Exenteration is reserved for cases where tumor extension beyond the globe is confirmed or strongly suspected.

Orbitotomy is indicated for discrete retrobulbar masses when globe salvage is feasible. The dorsal approach is technically straightforward and provides adequate exposure for masses dorsal to the optic nerve. The lateral approach requires zygomatic arch osteotomy and offers the widest exposure of the caudal orbit. The ventral approach is used for masses arising from the zygomatic salivary gland or the ventral extraocular muscles. Selection among these approaches depends on tumor location as determined by preoperative imaging, and the surgeon should be prepared to convert to exenteration if the mass proves to be infiltrative.

Step-by-Step Checklists

Transpalpebral Enucleation Checklist

1. Position the patient in lateral recumbency with the affected eye uppermost. Clip and aseptically prepare the periocular region, including the entire eyelid margin.
2. Place a temporary tarsorrhaphy suture to protect the cornea during preparation.
3. Incise the skin 2 to 3 mm from the eyelid margin, following the palpebral fissure. Extend the incision through the full thickness of the eyelids.
4. Grasp the eyelid margin with forceps and dissect subcutaneously to expose the orbital rim.
5. Incise the conjunctiva at the fornix and continue dissection along the globe, staying close to the sclera.
6. Identify and transect the extraocular muscles as they are encountered. The medial and lateral rectus muscles are the most prominent landmarks.
7. Isolate the optic nerve with a curved hemostat or Babcock forceps. Ligate the nerve and the accompanying ciliary vessels before transection. Use a transfixing ligature for large optic nerves.
8. Remove the globe and inspect the orbit for hemorrhage. Place a closed suction drain if oozing persists.
9. Place an orbital implant if desired. Silicone or expanded polytetrafluoroethylene spheres are commonly used. Close the subcutaneous tissues over the implant in two layers.
10. Close the skin with simple interrupted or cruciate sutures. A pressure bandage is applied for 24 hours.

Lateral Orbitotomy Checklist

1. Position the patient in lateral recumbency. Prepare the skin over the zygomatic arch and the lateral canthus.
2. Make a curvilinear skin incision from the lateral canthus, curving ventrally along the caudal border of the zygomatic arch.
3. Incise the subcutaneous tissues and the superficial fascia to expose the zygomatic arch.
4. Reflect the temporalis muscle dorsally and the masseter muscle ventrally to expose the arch.
5. Perform an osteotomy of the zygomatic arch using an oscillating saw or osteotome. Preserve the periosteum for later repair.
6. Retract the osteotomised segment laterally to expose the orbital contents.
7. Identify the mass and dissect it from surrounding tissues. Protect the optic nerve and the ophthalmic artery where possible.
8. Obtain biopsy samples if the mass is infiltrative and complete excision is not feasible.
9. Replace the zygomatic arch and stabilize it with wire or a miniplate and screws.
10. Close the subcutaneous tissues and skin in layers. Apply a light bandage.

Intraoperative Complications and Management

Hemorrhage is the most common intraoperative complication during enucleation and orbitotomy. The ophthalmic artery and its branches are the principal sources of bleeding. Careful blunt dissection, prompt ligation of the optic nerve, and the use of hemostatic agents such as gelatin sponges or bone wax for osseous bleeding are the mainstays of control. Hypotensive anesthesia, where appropriate, reduces intraoperative bleeding but must be balanced against the risk of optic nerve ischemia when the nerve is to be preserved.

Traction on the optic nerve during enucleation can cause bradycardia or cardiac arrhythmias through the oculocardiac reflex. The surgeon should alert the anesthetist before applying traction, and the reflex typically resolves when traction is released. Atropine or glycopyrrolate may be administered prophylactically, but current formulary guidance should be consulted for dosing.

Inadvertent penetration of the globe during dissection is a recognized risk in the transpalpebral approach, particularly when the globe is phthisical or when severe scarring is present. If the globe is entered, the surgeon should complete the enucleation without delay and irrigate the orbit copiously. The transconjunctival approach should not be used in this situation because of the risk of seeding infectious or neoplastic material.

Postoperative Care and Monitoring

Postoperative monitoring focuses on pain control, hemorrhage detection, and wound healing. The patient should be hospitalized for at least 12 to 24 hours after enucleation or orbitotomy. The pressure bandage is removed after 24 hours and the surgical site is inspected for swelling, discharge, or dehiscence. Serosanguineous discharge is expected for the first 48 hours, but frank hemorrhage or purulent discharge warrants immediate investigation.

Analgesia is provided with systemic opioids in the immediate postoperative period, followed by non-steroidal anti-inflammatory drugs where not contraindicated. The MSD Veterinary Manual provides species-specific guidance on analgesic selection and monitoring. The owner should be instructed to monitor for excessive swelling, bleeding, or signs of pain such as pawing at the face or reduced appetite.

Skin sutures are removed 10 to 14 days after surgery. The orbital implant, when placed, should be assessed for migration or extrusion at each recheck. Orbital implants can become exposed or infected, and the owner should be advised to return for evaluation if the surgical site appears abnormal. The AVMA practice resources offer guidance on professional standards for postoperative care and client communication.

The histopathology report should be reviewed with the owner at the recheck appointment. For malignant neoplasms, the prognosis depends on tumor type, completeness of excision, and the presence of metastatic disease. Adjuvant therapy, including radiation or chemotherapy, may be recommended for specific tumor types, and referral to a veterinary oncologist should be offered where appropriate.

Recognized Complications and Early Detection

The most consequential complications after ocular surgery are orbital hemorrhage, infection, implant extrusion, and corneal exposure. Postoperative hemorrhage typically presents within 12 to 24 hours as progressive periocular swelling, bruising, or sanguineous discharge. Early detection relies on serial assessment of globe position, eyelid tension, and mucous membrane color. A rapidly expanding retrobulbar hematoma can compress the optic nerve or central retinal artery, so any progressive exophthalmos or resistance to retropulsion warrants immediate decompression.

Infection is uncommon after clean ophthalmic procedures but becomes a genuine risk when the surgical field is contaminated by dacryocystitis, prior trauma, or chronic blepharitis. Fever, malodorous discharge, and wound dehiscence are late signs. Earlier indicators include persistent periocular edema beyond 72 hours, increasing pain on palpation, and a rising leukocyte count. Wound inspection under sedation should be performed if any of these appear.

Implant extrusion after enucleation or orbitotomy is detected by wound breakdown, serous discharge, or visible implant material. Palpation of the socket for implant mobility and assessment of conjunctival closure integrity should occur at each recheck. Corneal exposure after eyelid surgery or lateral orbitotomy manifests as persistent epiphora, corneal edema, or a positive fluorescein stain. Lagophthalmos should be assessed before discharge and again at suture removal, because postoperative swelling can mask an inadequate lid closure.

Common Errors and Corrective Actions

Inadequate exposure is the most frequent error in orbital surgery. A skin incision placed too close to the orbital rim limits retraction and forces the surgeon to work in a deep, poorly visualized field. The corrective action is to extend the incision or convert to a more extensive approach before struggling with inadequate access. Struggling in a tight field increases the risk of iatrogenic trauma to the optic nerve and extraocular muscles.

Failure to identify and protect the parotid duct during lateral orbitotomy can result in salivary fistula formation. Less experienced surgeons may also mistake the zygomatic salivary gland for a neoplastic mass and excise it unnecessarily. The gland is pale, lobulated, and located ventral to the zygomatic arch, it should be retracted instead of resected.

In enucleation, the most common errors are leaving remnants of lacrimal tissue or conjunctiva, and applying excessive traction on the optic nerve. Traction can avulse the nerve and cause fatal hemorrhage from the orbital plexus. The corrective action is to use gentle, steady tension with curved scissors placed along the medial wall, cutting the nerve under direct visualization where possible.

Students frequently close the subcutaneous layer with excessive tension, creating dead space and compromising skin perfusion. Closure should appose without strangulation, and a passive drain should be placed when dead space cannot be eliminated.

Evidence Limitations and Divergent Expert Opinion

The evidence base for specific orbital surgical techniques in dogs and cats is largely composed of retrospective case series and expert opinion instead of prospective comparative trials. There is no consensus on the optimal implant material for orbital reconstruction after enucleation, with some surgeons favouring porous polyethylene and others preferring autogenous fascia or no implant at all. Similarly, the role of prophylactic antibiotics in clean ophthalmic procedures remains contested. Some specialists advocate a single perioperative dose, while others reserve antibiotics for contaminated cases. The ACVS small animal resources provide procedure-specific guidance but do not resolve these controversies.

The application of growth factors and platelet-rich plasma to orbital and eyelid wounds is extrapolated from orthopedic and human wound healing literature. A review of platelet-rich plasma biology describes its growth factor content and potential to enhance soft-tissue healing, but the evidence in veterinary ophthalmic surgery is limited to small case numbers. Similarly, a review of growth factor applications in surgery notes that most growth factor therapies have yet to demonstrate significant impact in animal studies. Clinicians should therefore regard these adjuncts as experimental in the orbital context.

Expert opinion also differs on the management of the optic nerve stump during enucleation. Some recommend ligation to prevent hemorrhage, while others prefer hemostasis by packing and pressure alone. Both approaches are defensible, and the choice should reflect the surgeon's experience and the available instrumentation.

Referral, Consultation, and Reporting

Referral to a veterinary ophthalmologist is warranted when the surgeon lacks experience with orbital dissection, when imaging suggests an intraconal or apical mass, or when a previous procedure has failed and revision is required. Orbital neoplasia with suspected extension through the orbital fissure or into the calvarium should be staged with advanced imaging before any surgical attempt. The MSD Veterinary Manual provides guidance on recognizing orbital disease that exceeds the scope of primary care surgery.

Laboratory involvement is indicated when cytology or histopathology is needed to guide adjuvant therapy. Fine-needle aspiration of orbital masses carries a risk of hemorrhage and should be performed with ultrasound guidance or deferred until surgical exposure. Submission of all excised tissue for histopathology is mandatory, even when the gross appearance suggests a benign process.

Regulatory reporting may be required when a procedure is performed on a food-producing animal, although ocular surgery in production species is uncommon. The WOAH terrestrial animal health standards address surgical welfare and reporting obligations that may apply in some jurisdictions. Clinicians should also be aware that certain orbital neoplasms, particularly those with suspected viral aetiology, may carry reporting obligations under local animal health legislation. When in doubt, consultation with the relevant veterinary authority is appropriate.

Frequently Asked Questions

How do I choose between a transpalpebral and a subconjunctival enucleation when I have limited surgical experience?

The transpalpebral approach is preferred for most enucleations in dogs and cats because it avoids corneal contact and is more forgiving of tissue handling errors. It provides better protection against intraocular content spillage in cases of suspected neoplasia or infection. The subconconjunctival approach offers a smaller incision and faster closure but requires more precise dissection and carries a higher risk of incomplete removal of conjunctival tissue. If you are early in your learning curve, select the transpalpebral technique. Refer cases with suspected orbital extension of neoplasia regardless of approach, as complete excision may require orbitotomy. The American College of Veterinary Surgeons small animal resources provide procedure-specific guidance on case selection and expected outcomes.

What can I do when a full orbitotomy instrument set is not available?

A standard general surgery pack can support most orbital procedures if you adapt your technique. Use a No. 10 or No. 15 blade for skin and orbicularis dissection, Stevens tenotomy scissors for fine periorbital work, and a small periosteal elevator such as a Freer or Molt for subperiosteal elevation. A Gelpi or West retractor provides adequate exposure for lateral orbitotomy in most dogs. If rongeurs are unavailable, use a mallet and osteotome for the zygomatic arch osteotomy, but expect rougher bone edges. For enucleation, only a scalpel, scissors, forceps, and a hemostat are strictly required. The MSD Veterinary Manual professional edition describes standard instrument requirements and can help you identify which substitutions are safe for a given procedure.

How does the surgical approach differ in cats compared with dogs?

Feline orbital anatomy differs in several ways that affect approach selection. The feline orbit is shallower and more open laterally, which improves access for lateral orbitotomy but reduces protection of the globe during dissection. The zygomatic arch is thinner and fractures more readily, so osteotomy closure requires smaller implants or simple wire fixation. Feline extraocular muscles are more delicate and the optic nerve is shorter, increasing traction risk during enucleation. Use gentle, steady traction instead of forceful retraction. Cats also have a higher incidence of chronic keratitis and corneal sequestrum, so protect the cornea with lubricant even during extraocular procedures. Postoperative analgesia requirements differ, and feline patients require more careful monitoring for bradycardia from the oculocardiac reflex. Consult WOAH terrestrial animal health standards for species-specific welfare considerations during recovery.

What documentation should I include in the medical record for an orbital or eyelid procedure?

Record the preoperative ophthalmic examination findings, including vision status, intraocular pressure, and any suspected neoplasia. Document the surgical approach selected and the rationale, particularly if you chose a more invasive exposure than the minimum required. Note the method of hemostasis, any intraoperative complications, and how they were managed. Include a description of tissue removed, with orientation markers if histopathology is planned. For enucleation, record whether the procedure was transpalpebral or subconjunctival and whether the orbital fat was submitted for culture or biopsy. Postoperative records should include pain scores, medication administration, and recheck intervals. The AVMA practice resources offer guidance on medical record standards that support continuity of care and medicolegal defensibility.

How do I explain the need for enucleation to a client who is reluctant to proceed?

Focus on pain relief and quality of life instead of cosmetic outcome. Explain that a blind, painful eye cannot be restored and that enucleation removes the source of discomfort. Describe the procedure in plain terms: the eye and its contents are removed, the socket is closed, and the fur over the site grows back normally. Clarify that most animals adapt quickly to monocular vision and that the procedure does not change personality or behavior. Address the fear of disfigurement directly by showing a healed enucleation site photograph if available. Offer a referral for a second opinion if the client remains hesitant. The American College of Veterinary Surgeons small animal resources include client-facing summaries that can support your explanation.

When should I refer an orbital case instead of attempt primary surgical management?

Refer when the procedure exceeds your comfort level, when imaging suggests orbital neoplasia with possible bony involvement, or when you lack the equipment for adequate exposure. Refer also when vision is potentially salvageable but the diagnosis is uncertain, as inappropriate exploration can compromise later specialist surgery. Cases with suspected optic nerve or chiasmal involvement, bilateral disease, or recurrence after prior surgery warrant referral. If you cannot obtain advanced imaging such as CT or MRI, referral is strongly advised before orbital exploration, because blind dissection risks damage to the optic nerve and orbital vasculature. The MSD Veterinary Manual professional edition provides guidance on when specialist evaluation is indicated for orbital disease.

Related Clinical & Scientific Guides

• Perioperative Antibiotic Prophylaxis: Timing and Selection
• Surgical Approaches to the Femur and Stifle
• Fracture Healing Assessment: Radiographic and Clinical Evaluation

References and Further Reading

• The biology of platelet-rich plasma and its application in trauma and orthopedic surgery: a review of the literature.. 2009.
• Bone morphogenetic proteins: facts, challenges, and future perspectives.. 2014.
• Reperfusion injury: a review of the pathophysiology, clinical manifestations and therapeutic options.. 1997.
• Gastrointestinal stromal tumors: a comprehensive review.. 2019.
• All bariatric surgeries are not created equal: insights from mechanistic comparisons.. 2012.
• Advances in surgical applications of growth factors for wound healing.. 2019.
• American College of Veterinary Surgeons Animal Health Resources. American College of Veterinary Surgeons.
• MSD Veterinary Manual, Professional Edition. MSD Veterinary Manual.
• American Veterinary Medical Association Practice Resources. American Veterinary Medical Association.

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This article is educational professional reference material for veterinary audiences. It is not a substitute for veterinary diagnosis, individual clinical judgment, current product labeling, or applicable regulatory requirements.