Open Veterinary Journal, (2023), Vol.

13(3): 388–393
ISSN: 2226-4485 (Print) Case Report
ISSN: 2218-6050 (Online) DOI: 10.5455/OVJ.2023.v13.i3.17

Submitted: 19/12/2022 Accepted: 16/02/2023 Published: 23/03/2023

Eye trauma from a cat scratch with retention of the claw in the
anterior chamber in a dog
Thomas Dulaurent* , Laure Steun and Pierre-François Isard

Centre Hospitalier Vétérinaire Saint-Martin, Allonzier-la-Caille, France

Abstract
Background: Cat scratches and ocular foreign bodies are frequent reasons for consultation in veterinary ophthalmology.
Case Description: We here present an unusual case combining trauma to the cornea and lens by a cat scratch with
retention of the claw in the anterior chamber. Management consisted of the removal of the claw, reconstruction of the
cornea, and mechanized ablation of the lens by phacoemulsification with implantation of an artificial lens.
Conclusion: The progression during the follow-up period was considered satisfactory, with positive responses to
visual tests and intraocular pressure within the norms. Only dyscoria and a tear of the endothelium and Descemet
membrane, secondary to the trauma, remained.
Keywords: Claw, Cornea, Endothelium, Lens, Wound.

Introduction more difficult to establish than surface FB because of

The trauma of the ocular surface by a cat scratch (CS) their sometimes marginal location (iridocorneal angle)
is a common reason for veterinary ophthalmology and the often intense inflammatory reaction that masks
consultation (Davidson et al., 1991; Spiess et al., 1996; them (fibrinous-hemorrhagic exudate) (Tetas Pont et al.,
Denis, 2002; Paulsen and Kass, 2012). In dogs, this 2016). As with CS trauma, lesions associated with ocular
situation occurs most often in adolescent subjects, FB are variable and range from benign conjunctivitis to
following their introduction into a new home where a more serious lesions that can involve the cornea, lens,
cat is already in residence (Paulsen and Kass, 2012). The and posterior segment (Tetas Pont et al., 2016).
young dog, by its naive attitude and exploratory behavior, Although both situations (CS to the eye and ocular
goes to meet the house cat, which is a territorial animal FB) are very common and have been described in case
and potentially aggressive by nature. The deleterious reports, cases series, and textbooks (Root, 2010), the
effects of CS are related to trauma (Davidson et al., combination of a CS and the retention of the claw into
1991; Spiess et al., 1996; Doi et al., 1999; Denis, 2002; the eye has, to the authors’ knowledge, never been
Sylvester et al., 2002; Williams et al., 2002; Paulsen published. The clinical case presented here describes
and Kass, 2012; Borkar et al., 2021), the septic risk the management of an unusual case of laceration of the
(Tanasescu et al., 1996; Oehler et al., 2009; Weinberg and cornea and lens by a CS, with retention of the claw in
Branda, 2010; Veraldi and Minuti, 2018), and the immune the AC after trauma in a Bichon.
response involved (Wilcock and Peiffer, 1987; Streilein,
Case Details
2003; Caspi, 2008; Perez et al., 2013). The claws of cats
are indeed naturally sharp, in connection with predation. An 8-year-old castrated male Bichon was presented for
The lesions are often severe and correspond to a sharp emergency ophthalmology consultation for evaluation
trauma. They range from a simple tear of the conjunctiva of a FB located in the AC of the right eye following a
to corneal lacerations sometimes associated with tears of walk that same afternoon. The dog was not kept on a
the anterior capsule of the lens with the release of lens leash and was free to go where it wanted.
material into the anterior chamber AC (Davidson et al., General review
1991; Paulsen and Kass, 2012). The general examination did not reveal any anomaly.
Ocular foreign bodies (FB) are quite common in Eye examination
veterinary ophthalmology (Slatter and Bryan, 1972; The responses to visual tests were positive on the
Schmidt et al., 1975; Bussanich and Rootman, 1981; left. The menace response was positive on the right,
Grahn et al., 1995; Cullen and Grahn, 2005; Sandmeyer while the dazzle reflex was variable and difficult to
et al., 2007; Belknap, 2015; Lew et al., 2015; Tetas Pont interpret as a result of eye pain due to blepharospasm
et al., 2016). The diagnosis of intraocular FB is often of moderate intensity. The left eye examination did not

*Corresponding Author: Thomas Dulaurent. Centre Hospitalier Vétérinaire Saint-Martin, Allonzier-la-Caille, France.
Email: t.dulaurent@chvsm.com
Articles published in Open Veterinary Journal are licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

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T. Dulaurent et al. Open Veterinary Journal, (2023), Vol. 13(3): 388–393

reveal any abnormalities. The right eye examination intravenous injection of morphine, supplemented by
revealed the presence of sparse epiphora. A curvilinear, local instillation of oxybuprocaine hydrochloride. After
white, FB was present in the AC. Close examination positioning the patient in a supine position, with the
with a biomicroscope revealed that it was a cat’s head held on a vacuum cushion, the surgical site was
claw, for which the point of the corneal penetration prepared for the procedure by six consecutive cleanings
was located in the upper quadrant. The latter was using a solution of 1% diluted povidone-iodine.
filled by a fibrin clot. Discrete corneal edema was The AC was stabilized by intracameral injection of a
present, as well as a uveal reaction manifested by tight viscoelastic gel (hyaluronic acid 1.6%, Ophteis Bio)
myosis precluding observation of the lens (Fig. 1). by a perforating keratotomy port at 12 o’clock. As the
The intraocular pressure was 7 mmHg, measured by base of the claw was crenelated, it was not possible
rebound tonometry. Given the nature of the signs, FB to remove it through the site of penetration, which is
extraction surgery was undertaken, associated with the why another perforating keratotomy port was made at
perioperative exploration of the lens. 10 o’clock. The claw was grasped with Bonn’s pliers
Surgical procedure and then gently removed. The entry point of the claw
Induction was achieved by intravenous injection and the 10 o’clock port were sutured by single stitches
of propofol after tranquilization by intravenous using polyglactin 9/0 (Vicryl 9/0). The pupil was
administration of valium. Anesthesia was then then dilated by injection of 1 ml of epinephrine at a
concentration of 1 mg/ml into the AC. The anterior lens
maintained by the administration of a mixture of
was ruptured, and a heterogeneous traumatic cataract
oxygen and isoflurane via the respiratory route after
had already developed (Fig. 2). The lens was, therefore,
endotracheal intubation. Analgesia was achieved by
removed by phacoemulsification via the port at 12
o’clock. After removal of the masses by irrigation/
aspiration, the tear of the anterior capsule was shaped
before injection of an implant (PFI 4X, Medicontur).
The keratotomy port at 12 o’clock was sutured by
three single stitches with Vicryl 9/0 after the removal
of residual viscoelastic material by suction irrigation.
At this stage of the surgery, a tear of the endothelium
and Descemet membrane was visible, following the
most likely trajectory of the claw into the AC (Fig. 3).
Water bubbles were already forming in the corneal
stroma. An injection of 0.25 μg of tissue plasminogen
activator (Actilyse®, BOEHRINGER INGELHEIM)
was performed in the AC at the end of the intervention
to limit postoperative fibrinous collection. The claw
was sent to the laboratory for bacteriological analysis.
Fig. 1. Appearance of the eye at admission. Note the broken Postoperative medical treatment
claw in the AC, corneal edema, fibrin clogging the entry The prescribed medical treatment consisted of the
point, and uveal reaction materialized by myosis. administration of local (tobramycin eye drops,

Fig. 2. Appearance of the eye after claw excision, corneal

reconstruction, and pharmacological mydriasis. The tear of Fig. 3. Appearance of the eye after implantation. The
the anterior capsule is large and complex. The architecture of endothelium and Descemet membrane are torn, which causes
the lens is turned upside down. early formation of water compartments in the corneal stroma.

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T. Dulaurent et al. Open Veterinary Journal, (2023), Vol. 13(3): 388–393

Tobrex®, ALCON, TiD) and general (amoxicillin and The follow-up visit at 3 weeks revealed marked
clavulanate, Bioclamox®, Axience, 12.5 mg/kg PO improvement in the corneal transparency, with the
BiD, 10 days) antibiotics and systemic steroidal anti- persistence of edema at the ports, the point of penetration
inflammatory drugs (prednisolone, Megasolone®, of the claw, and the tear area of the endothelium and
DOPHARMA, 0.5 mg/kg PO SiD, 1 week), combined Descemet membrane. The patient’s comfort was
with local administration of a cycloplegic (atropine eye satisfactory, with the almost total disappearance of
drops 1%, ALCON, TiD 1, week). the blepharospasm (Fig. 5). The intraocular pressure
Follow-up was measured to be 8 mmHg by rebound tonometry.
The bacteriological analysis revealed contamination The medical treatment consisted of local instillation of
of the claw with Pasteurella spp., which is sensitive dexamethasone (Maxidex®, ALCON, TiD) for 3 months.
to tobramycin. The follow-up visit at 1 week showed The various follow-up visits revealed improvement in
significant degradation of the corneal edema, which comfort, with the disappearance of the blepharospasm.
then occupied the entire corneal surface. The pupillary The corneal edema was greatly improved. The visual
light reflex was not discernible and the keratotomy tests were positive and the intra ocular pressure
wounds and the point of entry of the claw appeared (IOP) was stable. Six months after the surgery, the
excessively edematous (Fig. 4). The patient’s comfort observable sequelae were the persistence of discrete
was slightly improved, with the persistence of discrete corneal edema in the area of the point of penetration
blepharospasm increased by the examination. The of the claw as well as dyscoria (Fig. 6). The tear area
intraocular pressure was measured to be 10 mmHg of the endothelium and Descemet membrane was still
by rebound tonometry. It was decided to continue the visible at high magnification (Fig. 7). One year after
medical treatment without any modifications. the surgery, the vision tests were positive. The cornea

Fig. 4. Appearance of the eye 1 week after the procedure. Fig. 6. Appearance of the eye 6 months after the procedure.
Note the corneal edema masking the AC, the ciliary injection, The edema is reduced. The cornea is fibrosed at the point of
and the swelling of the keratotomy port at 12 o’clock. impact.

Fig. 5. Appearance of the eye 3 weeks after the procedure. Fig. 7. High magnification of Figure 6 showing the
The intensity of corneal edema has decreased. The tear of the endothelium and Descemet tear and the associated corneal
endothelium and Descemet membrane is still visible. edema.

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T. Dulaurent et al. Open Veterinary Journal, (2023), Vol. 13(3): 388–393

had fibrosis at the point of impact and opposite the

endothelium and Descemet membrane tear, which was
still visible (Fig. 8). The pupil was slightly deformed
and the capsule of the lens was partially fibrosed.
Optical coherence tomography (OCT) of the cornea
revealed fibrous metaplasia of the endothelium and
probable duplication of the Descemet membrane. The
intraocular pressure was measured to be 13 mmHg by
rebound tonometry (Fig. 9).
Discussion
The unusual nature of this case lies in the combination
of a scratch of the cornea and lens by a cat, and in
the retention of the claw in the AC after the trauma.
Claws naturally carry many bacteria, which are Fig. 8. Appearance of the eye 1 year after the surgery. The
likely to inoculate in the eye at the time of the cornea has a slight degree of fibrosis at the point of entry
trauma (Escherichia coli, Pseudomonas aeruginosa, of the claw and at the separation of the endothelium and
β-hemolytic streptococci, Pasteurella multocida, Descemet membrane.
Bartonella henselae, Moraxella spp., Staphylococcus
spp., Streptococcus spp.), which can cause bacterial
endophthalmitis (Oehler et al., 2009; Weinberg and
Branda, 2010; Veraldi and Minuti, 2018). In our
case, the claw carried Pasteurella spp., a ubiquitous
microorganism, although no sign of infection was yet
visible as the patient was presented only a few hours
after the trauma. The retention of the claw in the AC
represented a reservoir of germs, increasing the risk of
endophthalmitis in the short term. Organic FB (e.g.,
plant spines, needles, bark, porcupine spines) are more
often associated with bacterial endophthalmitis than
non-organic FB (e.g., glass, plastic, metal, etc.) (Lit and Fig. 9. OCT of the cornea 1 year after the surgery. Note
Young, 2002). the fibrous metaplasia of the endothelium (blue arrow) and
In our case, the claw entered the AC through a fairly probable duplication of the Descemet membrane (green
small corneal entry point. The most likely scenario arrow).
is that the claw broke at the beginning of the scratch
and not at the end, minimizing the corneal laceration.
for tears greater than 1.5 mm, especially when lens
However, by entering the AC, the claw lacerated the
material has been expelled into the AC after the
endothelium, the Descemet membrane, and the anterior
trauma (Davidson et al., 1991). The main argument
capsule of the lens, also disorganizing the anterior
for an interventionist attitude is the risk of developing
cortex. When the lens is injured during trauma, the
phacoclastic uveitis or septic implantation syndrome
immune system may come into contact with lens
(Davidson et al., 1991; Bell et al., 2013). This syndrome
proteins that were initially sequestered (Wilcock and
results in severe and uncontrollable endophthalmitis,
Peiffer, 1987; Streilein, 2003; Caspi, 2008; Paulsen
of slow progression, occurring a few weeks or months
and Kass, 2012; Perez et al., 2013). The resulting
after eye trauma and rupture of the anterior capsule,
phacoclastic uveitis is often severe and associated with
with inoculation of microorganisms (bacteria, fungi)
inflammation involving intralenticular neutrophils and
(Bell et al., 2013). The study Paulsen and Kass (2012),
perilenticular fibroplasia (Wilcock and Peiffer, 1987;
regarding the management of 77 cases of corneal
Paulsen and Kass, 2012). Here, the diagnosis of a
laceration associated with a tear of the anterior capsule,
FB was easy due to its large size and the surprisingly
showed that medical management alone had a better
weak corneal edema and uveal reaction. When FB
long-term prognosis than surgical management of the
is located only on the surface of the cornea, ablation
cornea and lens, provided that the corneal wound offers
by hydropulsion may be sufficient (Labelle et al.,
good apposition, the AC is reconstituted by the second
2014). When FB is penetrating, management often
aqueous humor (AH) without iridocoele, and the Seidel
requires surgery consisting of removal of the FB and
test is negative. The authors refer to the healing capacity
reconstruction of the cornea (Lew et al., 2015; Tetas
of the anterior capsule by fibrin effusion and fibrous
Pont et al., 2016). The guidelines for the management
metaplasia of the capsule, again allowing sequestration
of anterior capsule tears are, however, contradictory.
of the lens material initially released in the AC, even
Some authors recommend surgical management
after a few months. This conclusion, which is rather

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T. Dulaurent et al. Open Veterinary Journal, (2023), Vol. 13(3): 388–393

counterintuitive, had no influence on the management pattern of endophthalmitis with lenticular abscess.
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trauma, thus requiring a surgical approach anyway. The Borkar, D. and Avendano, P. 2021. Cat-inflicted eye
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of the cornea. The corneal and lens lesions were treated superficial corneal foreign bodies: 15 cases (1999-
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Conflict of interest Dis. 9, 439–447.
The authors declare that there is no conflict of interest. Paulsen, M.E. and Kass, P.H. 2012. Traumatic corneal
laceration with associated lens capsule disruption:
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