The Missed Quill

D. E. Larsen, DVM

Bob had already lifted Rex onto the exam table by the time I entered the exam room. Rex was an Australian Shepherd. At one time, he had been a cow dog, but Bob sold the cows. Now Rex had little to do except to patrol his property.

“Hi, Bob, what brings you and Rex in today?” I asked as I shook hands with Bob.

Rex is really painful this morning,” Bob said. “Something around his head really hurts.”

I raised Rex’s head with my hand under his chin. I could sense a reluctance for him to allow this. I looked close and could only see a slight swelling around his left eye.

Rex pulled away when I reached to feel the area.

“He is really painful, Doc,” Bob said. “He really yipped when I just brushed the side of his face this morning.”

I tried to feel the eye again, Rex recoiled and growled this time. He was not going to tolerate any palpation around the left side of his face.

The pupil of the left eye was constricted to a pinpoint. I instilled a couple of drops of medication to dilate the pupil.

“Do you know of anything that could have injured this eye?” I asked Bob.

“No, he was in the house last night and doing fine,” Bob said. “Then this morning, he is really painful.”

With the pupil dilated, I carefully held Rex by the chin and looked at the back of the eye with my ophthalmoscope. Starting from a distance and then slowly closing in close to his face to avoid alarming him.

It took me a couple of seconds to figure out what I was looking at. Projecting from the back of the eye, near the optic disc (that spot where the optic nerve connects with the retina), was a porcupine quill. It was probably penetrating over a centimeter into the eye.

“Bob, has Rex ever had porcupine quills?” I asked.

“Oh, yes,” Bob said. “We had quite a struggle pulling a mouthful of quills out of him a couple of months ago.”

“Will, it looks like you must have missed one,” I said. “It has entered his eye through the back of the eye. This one is for the books. I always hear stories of the quills that are left in the tissues migrating to odd places. But I have never read of one puncturing the eye from behind.”

“Can you get it out?” Bob asked. 

“I can’t, and I don’t know if a specialist could or not,” I replied. “Getting to that area behind the eye would be extremely difficult. And after removing the quill, you might lose the eye anyway.”

“I don’t have the cows anymore,” Bob said, “And old Rex doesn’t have much to do. He just lays around the house and chases a stick once in a while. I don’t think a specialist is in the cards for him.”

“I think the best thing to do is to remove this eye,” I said. “He will do fine with one eye. We will get rid of the pain.”

With that, we set up to remove Rex’s left eye. Enucleation of an eye in the dog was relatively straightforward surgery. I incised around the margin of the eyelids and dissected to the surface of the globe behind the conjunctiva. Then working around the globe, I severed the ocular muscle at their attachment to the globe. I was able to keep bleeding to a minimum this way. Finally, ligating the optic stalk and removing the eye. This was complicated just a bit by the presence of the quill.

Once the eye was removed, I closed the dense fascia over the eye socket so the socket would remain smooth, rather than sinking back into the head when the muscles atrophied. The skin was then closed, and if you didn’t look twice, you might not notice the missing eye.

Rex recovered uneventfully and immediately felt better. Opening the eyeball after it was removed, the quill was halfway into the eye. The track was infected, I doubt if the eyeball could have been saved under any circumstances.

Late that afternoon, Rex bounced out of the clinic with Bob and the kids, acting like nothing was wrong.

Photo by Alana Sousa from Pexels