兽研[内容请查看原文]
引言
眼眶由围绕眼球的骨骼、眶脂肪、筋膜平面、眼外肌以及供应眶内容物或仅穿过眼眶支配鼻部或其他筋膜结构的传入和传出神经组成[1]。在犬和猫中，眼眶是开放的，其特征是由骨性成分和眶韧带组成的眶缘[2]。眼眶疾病通常在张口时产生疼痛状况、眼球突出、瞬膜突出、眼周炎症和眼球偏斜，尽管这些重叠的临床体征往往使仅通过检查难以确定潜在病因[2, 3]。准确的诊断对于建立正确的治疗和预后至关重要[3]。
眼球突出的原因最常见为炎症性或肿瘤性，尽管其他情况（如囊性、血管性或创伤性）也可能发生。眼部肿瘤在犬中相对不常见，但可能对视力、舒适度和寿命产生显著影响[4]。在眼眶中，恶性肿瘤最为常见，而良性肿瘤占少数[5]。
脂肪瘤是由脂肪细胞组成的良性肿瘤性肿块[6]。该肿瘤累及眼部组织是非典型的。眶脂肪瘤是一种罕见疾病，具有产生眶后疾病相关临床体征的强烈潜力[7]。虽然皮肤和皮下脂肪瘤在临床上常见[6]，但有报道称这种间充质肿瘤出现在眼眶以外的其他非典型部位，如肺叶和腹腔[8, 9]。超重、老年和去势犬往往有更高的患病可能性[6]。
眶脂肪瘤的诊断方法和手术治疗在兽医学中仍描述甚少，特别是关于能够保留眼球和视觉功能的技术[7, 10]。本研究旨在通过报告巴西首例犬眶脂肪瘤病例，促进对犬眼眶疾病的认识。
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病例报告
一只14岁雌性边境牧羊犬，体重15.9 kg，因右眼出现肿块，在里约热内卢联邦农村大学兽医医院眼科就诊。犬的看护者寻求第二兽医意见，报告右眼肿胀外观已持续10个月，最近6个月快速进展。该犬未表现出明显不适、饮食习惯改变或全身性疾病。此前已进行过头颅计算机断层扫描，该犬一直接受多佐胺盐酸盐2%滴眼液（EMS，圣保罗，巴西；右眼每日一次）和泼尼松龙5 mg（口服给药，约0.3 mg/kg，每日一次）治疗10天。
眼科检查显示右眼眼球突出和兔眼（图1）。双眼威胁反射和眩光反射测试均为阳性。与对侧眼相比，右眼（OD）眼球后退减少。右眼裂隙灯生物显微镜检查（便携式裂隙灯Apramed）显示球结膜充血，伴有明显的弥漫性肿胀，质地柔软，粉红色伴暗色色素沉着，触诊可部分复位。角膜显示鼻侧象限因暴露性角膜炎导致的角膜色素沉着和角膜混浊。左眼（OS）仅观察到轻度佛罗里达斑点，其特征为前角膜基质圆形灰白色混浊，符合佛罗里达斑点角膜病变[11]。进行回弹式眼压计（Tonovet眼压计）测量，OD值为20 mmHg，OS值为15 mmHg。使用双目间接检眼镜和Volk 20屈光度透镜进行眼底检查，显示双眼后段完整。
[图：右眼明显突出的犬（A）。患病的右眼更详细展示（B），以及完整的]
通过细针抽吸（FNA）获取球结膜肿块的细胞学样本，未在超声引导下进行，特征为正常细胞量样本，由成熟脂肪细胞的三维簇组成。此前已进行的头颅计算机断层扫描（CT）（图2）显示一个边界清晰的肿块，高4.4 cm，宽3.5 cm，脂肪密度提示右眼球周和眶后区域脂肪瘤。该肿块未侵犯眼部和/或颅内结构。基于这些发现，该犬被指示进行前部结膜下眶切开术，随后将切除的肿块送组织病理学检查。术前检查要求进行胸部X线摄影、心电图、超声心动图以及血液学和生化检查。术前检查未观察到值得注意的改变，该犬被批准进行手术。血液分析显示轻度高蛋白血症（总蛋白8.2 g/dL）、脂血血浆（+）和白蛋白升高（3.6 g/dL）。
[图：犬颅骨的计算机断层扫描。]
患犬接受了眼球周围及球后区域肿物的手术切除（图3）。患犬在气管插管后维持全身麻醉。患犬取腹卧位，剪除眼周区域毛发。使用无菌纱布和0.5%聚维酮碘溶液冲洗进行标准手术消毒。手术野准备完成后开始手术。于背侧结膜做约12 mm的角膜缘切口，随后进行结膜下钝性分离。分离后可直达位于结膜与巩膜之间、有包膜的眼球周围肿物，从而将其分块破碎并切除。随着眼球周围内容物被切除，球后肿物突入眼球周围区域，亦被切除。无法直视并分离内直肌，该肌肉可能在手术操作过程中发生断裂。瞬膜保持完整。肿物切除后，患犬的突眼在术中即得到缓解。使用8-0聚乙醇酸缝线以简单间断缝合方式对眼球结膜进行锚定缝合，随后以简单连续缝合方式关闭。手术最后使用4-0尼龙缝线以水平褥式缝合方式在支撑物上施行临时性部分睑缝合术。肿物所有碎块均送检进行组织病理学检查。麻醉术中过程保持稳定，患犬整个手术过程中心率和全身动脉压均维持在正常范围内。患犬麻醉苏醒无并发症，继续在家进行术后治疗，包括休息、佩戴伊丽莎白圈以及局部和全身用药。
[图：前部结膜下眶切开术。通过角膜缘入路对肿物进行结膜下钝性分离，在b]
术后用药包括妥布霉素0.3%滴眼液（Tobrex，Alcon，圣保罗，巴西）每6小时一次，连用14天；透明质酸钠0.15%滴眼液（Hyabak，Laboratoires Théa，洛里什，葡萄牙）每12小时一次，长期使用；泼尼松龙10 mg（Predsim，Mantecorp Farmasa，圣保罗，巴西；3/4片，0.5 mg/kg）每24小时一次，连用7天；氨甲环酸250 mg（Transamin，Eurofarma，圣保罗，巴西；1/2片，8 mg/kg）每12小时一次，连用3天；阿莫西林三水合物与克拉维酸钾250 mg（Agemoxi CL，Agener União，圣保罗，巴西；1片，15 mg/kg）每12小时一次，连用14天；以及安乃近500 mg（Medley，圣保罗，巴西；3/4片，25 mg/kg）每8小时一次，连用5天。鉴于眶部手术床血管丰富，处方氨甲环酸以预防和控制术后出血。患犬保持稳定，眼部外观舒适，无局部肿胀。
组织病理学检查中，肉眼观察描述为不规则、白色碎块，质软至易碎且具黏聚性。最大者测量为8.5 × 2.0 × 1.0 cm，最小者为1.5 × 0.5 × 0.1 cm。显微镜下（图4），组织切片由广泛出血区域内大量分化良好的脂肪细胞构成。在所述脂肪细胞群周边，多灶性可见一薄层纤维性包膜。多形性、细胞大小不均及核大小不均均轻微，10个高倍视野（40×物镜）内未见核分裂象。
[图：组织病理学检查的显微镜图像，放大倍数分别为10×（A）和40×（B）。]
术后21天拆除部分睑缝合术，右眼有视力，突眼明显减轻（图4）。术后两个月，患犬返院复查，并进行了新的眼科检查：威胁反应阳性（双眼），泪液分泌试验20 mm/min（右眼）和18 mm/min（左眼），眼内压（IOP）17 mmHg（右眼）和12 mmHg（左眼），右眼外斜视，右眼部分角膜色素沉着，左眼Florida斑。术后斜视的具体原因未能通过额外检查确定；然而，该斜视归因于上述术中内直肌损伤。其余检查结果（包括神经眼科检查、眼内检查和眼底镜检查）未见异常。术后11个月患犬仍在监测中，保持舒适、有视力，体格检查时观察到的眼部病变无复发（图5）。
[图：术后随访第21天（A和B）、7个月（C和D）和11个月（E和F）的犬。]
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讨论
在一只14岁雌性犬中观察到眶内脂肪瘤，这与其他作者的发现一致，他们报道此类肿瘤在老年犬中发生率较高[6, 12, 13]。尽管眼球突出和斜视是眶部疾病中常见报道的非特异性表现[3]，但本病例中观察到的肿物柔软且部分可复位的质地可能代表一个提示脂肪瘤性病变的临床相关特征，而这一点在既往报道中并未经常强调。该病的慢性且无痛性进展进一步支持肿瘤性病因，因为炎性眶部疾病通常与疼痛和急性发作相关[3, 7, 13, 14]。
细胞学评估作为一种微创且可及的诊断方法进行，为临床决策和手术规划提供了重要的初步信息。成熟脂肪细胞的鉴定支持脂肪瘤的推定诊断，并与既往描述一致[12]，尽管细胞学在明确表征脂肪细胞性肿瘤方面存在已知局限性[15, 16]，这仍强化了细胞学作为诊断筛查方法和用于手术规划的作用。
计算机断层扫描在本病例中至关重要，不仅用于病变检测，还用于特征描述和手术规划。Coall等[15]在一项涉及97只眶部疾病动物的研究中强调，高级影像学检查（CT或磁共振成像）可以检测支持炎性或肿瘤性疾病诊断的异常，还可以帮助识别异物。识别出具有脂肪衰减的边界清晰肿物强烈支持脂肪瘤的推定诊断，并直接影响采取保留眼球的保守手术入路的决定。这些发现与既往描述的脂肪性肿瘤断层扫描特征一致[17]，突显了CT作为眶部疾病决策工具的价值。
在检查表现为球结膜体积增大、呈脂肪样外观的临床征象的动物时，应将眶脂肪脱垂作为鉴别诊断考虑，类似于所报道的情况[10, 18]。在本报告中，该犬显示眶部病变进行性增大、明显的占位效应和眼球突出，这些发现与Williams和Haggett[10]及Charnock等[7]所描述的脂肪瘤病例一致。
眶部肿瘤的手术管理主要涉及保留眼球或行眶内容物摘除术的决定。在本病例中，影像学和细胞学支持的病变推定良性性质证明了以保留视力和眼部结构为目标的保守入路是合理的。只要解剖位置允许，应进行肿物手术切除，根据病变的位置、范围和质地，可采用不同的眶切开术手术入路[12]。在条件允许时，三维（3D）打印可能是改善眶部和眶周肿物病例手术规划的有价值工具[13]。
在眶切开术入路中，选择了前部结膜下入路，因为它是一种侵入性较小的手术技术，并且鉴于脂肪性肿物的流动性仍允许充分的通路，从而获得了与Williams和Haggett[10]相似的满意结果。我们采用前部眶切开术管理脂肪瘤的经验证实了Caro-Suarez等[12]对该技术的发现，因为它允许充分的肿瘤暴露而无需广泛破坏眶部组织，确保眼球突出的逆转，并避免大范围截骨。该入路提供了有效的肿瘤切除和眼球突出的立即缓解，证实了既往报道中描述其在选择性眶内脂肪瘤中的实用性[10, 12]。然而，该技术需要仔细的病例选择，因为术中操作眶部结构可能对视力构成风险[7, 12]。
其他手术选择包括外侧和经额眶切开术联合截骨术。然而，这些手术通常侵入性更大，需要更长的手术时间，并且通常需要轴型皮瓣来重建大的皮肤缺损[19]。手术入路的选择应根据眶内脂肪瘤的解剖位置进行调整[12]。
组织病理学检查仍然是确认眶部肿瘤的金标准[16]，并应与犬的临床病史、临床发现和影像学结果相关联。在我们的报告中，高分化脂肪细胞和薄纤维性包膜的组织病理学结构与Dorbandt等[13]及Williams和Haggett[10]所描述的一致，两者均报道为眶内脂肪瘤。
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结论
本报告表明，前部结膜下眶切开术技术成功用于切除该犬的病变，允许保留视力并获得满意的长期结果。早期整合高级影像学和细胞学对于适当的病例选择和手术规划至关重要。
作者贡献
Isabela Pessôa Barbieri Bastos：调查、写作——原稿撰写、写作——审阅与编辑。Adriano de Sales Araujo：调查、写作——原稿撰写、方法学、写作——审阅与编辑、形式分析、数据管理。Lucas de Souza Viana：概念构思、调查、写作——原稿撰写、方法学、写作——审阅与编辑、形式分析、数据管理。Bruno Alberigi：概念构思、调查、写作——原稿撰写、方法学、验证、写作——审阅与编辑、形式分析、数据管理、监督。Francis Arthur Seco Prando：调查、写作——审阅与编辑、写作——原稿撰写。
资助
本研究由巴西高等教育人员改进协调委员会资助，代码001。
伦理声明
本病例报告描述了一只客户所有犬的临床管理；因此无需正式的伦理委员会批准。所有诊断和手术操作均在主人授权下进行，并已获得主人关于发表该动物临床数据和图像的书面知情同意。
利益冲突
作者声明无利益冲突。
致谢
本研究在巴西高等教育人员改进协调委员会（CAPES）的支持下完成——资助代码001。作者感谢使用人工智能工具（Claude，Anthropic）协助英文语言修订以及参考文献的格式化和核查。该工具未用于生成数据、解释或科学结论，所有内容均由作者独立审阅和批准，作者对稿件承担全部责任。本研究发表的论文处理费由巴西高等教育人员改进协调委员会（CAPES）资助（ROR标识符：00x0ma614）。
数据可用性声明
支持本研究结果的数据可向通讯作者合理索取。
参考文献
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关联数据
数据可用性声明
支持本研究结果的数据可向通讯作者合理索取。
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Introduction
The ocular orbit is composed of the bones that surround the eye, orbital fat, fascial planes, extraocular muscles, and afferent and efferent nerves that supply the orbital contents or simply pass through the orbit to innervate the nose or other fascial structures [1]. In dogs and cats, the orbit is open, characterized by an orbital margin composed of bony components and the orbital ligament [2]. Orbital diseases commonly produce a painful condition when opening the mouth, exophthalmos, protrusion of the nictitating membrane, periocular inflammation, and deviation of the globe, although these overlapping clinical signs often make the underlying etiology difficult to determine on examination alone [2, 3]. An accurate diagnosis is essential to establish the correct management and prognosis of the case [3].
The causes of exophthalmos are most often inflammatory or neoplastic, although other conditions (e.g., cystic, vascular, or traumatic) may also occur. Ocular neoplasms are relatively uncommon in dogs and may have a significant impact on vision, comfort, and longevity [4]. In the orbit, malignant tumors are the most frequent, whereas benign neoplasms represent a minority [5].
Lipomas are benign neoplastic masses composed of adipocytes [6]. The involvement of this neoplasm in ocular tissues is atypical. Orbital lipoma is a rare condition with a strong potential to generate relevant clinical signs of retrobulbar disease [7]. Although cutaneous and subcutaneous lipomas have a common clinical occurrence [6], there are reports of this mesenchymal tumor in other atypical locations besides the orbit, such as the lung lobe and the abdominal cavity [8, 9]. Overweight, elderly, and neutered dogs tend to have a greater likelihood of developing the disease [6].
The diagnostic approach and surgical management of orbital lipomas remain poorly described in veterinary medicine, particularly regarding techniques that allow preservation of the globe and visual function [7, 10]. This study aims to contribute to the understanding of orbital diseases in dogs by reporting the first case of orbital lipoma in Brazil.
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Case Report
A 14‐year‐old female Border Collie weighing 15.9 kg, presenting with a mass in the right eye, was examined at the ophthalmology service of the veterinary hospital at the Federal Rural University of Rio de Janeiro. The dog's caregiver sought a second veterinary opinion, reporting a swollen appearance in the right eye over a 10‐month period, with rapid progression in the last 6 months. The dog did not show significant discomfort, changes in feeding habits, or systemic diseases. A computed tomography scan of the skull had been previously performed, and the dog had been receiving dorzolamide hydrochloride 2% ophthalmic solution (EMS, São Paulo, Brazil; once daily in the right eye) and prednisolone 5 mg (oral administration, approximately 0.3 mg/kg, once daily) for 10 days.
Ophthalmic examination revealed exophthalmos and lagophthalmos in the right eye (Figure 1). The menace and dazzle reflex tests were positive in both eyes. Retropulsion decreased in the right eye (OD) compared with the contralateral eye. Slit‐lamp biomicroscopy (Portable Slit Lamp Apramed) of the right eye revealed a hyperemic bulbar conjunctiva with a marked, diffuse swelling, soft consistency, pink coloration with darkened pigments, and partially reducible upon palpation. The cornea showed corneal pigmentation due to exposure keratitis in the nasal quadrant and corneal opacities. In the left eye (OS), only mild Florida spots were observed, characterized by round, grayish‐white opacities of the anterior corneal stroma consistent with Florida spot keratopathy [11]. Rebound tonometry (Tonovet tonometer) was performed, with values of 20 mmHg in OD and 15 mmHg in OS. Fundoscopic examination performed with a binocular indirect ophthalmoscope and a Volk 20‐diopter lens revealed an intact posterior segment in both eyes.
[图：Dog with evident exophthalmos in the right eye (A). The affected right eye is shown in greater detail (B), and the intac]
Cytological samples of the bulbar conjunctival mass were obtained through fine‐needle aspiration (FNA), performed without ultrasound guidance, characterized by a normocellular sample composed of three‐dimensional clusters of mature adipocytes. Computed tomography (CT) of the skull (Figure 2), which had been performed previously, revealed a well‐defined mass measuring 4.4 cm in height and 3.5 cm in width, with fat density suggestive of a lipoma in the peribulbar and retrobulbar region of the right eye. This mass did not invade ocular and/or intracranial structures. Based on these findings, an anterior subconjunctival orbitotomy was indicated for the dog, followed by histopathological submission of the excised mass. Thoracic radiography, electrocardiography, echocardiography, and hematological and biochemical tests were requested as preoperative examinations. No noteworthy alterations were observed in the preoperative tests, and the dog was cleared for the surgical procedure. Blood analysis revealed mild hyperproteinemia (total protein 8.2 g/dL), lipemic plasma (+), and elevated albumin (3.6 g/dL).
[图：Computed tomography of the dog's skull.]
The dog underwent surgical excision of the mass in the peribulbar and retrobulbar region (Figure 3). The dog was maintained under general anesthesia following endotracheal intubation. The dog was positioned in ventral recumbency and the periocular region was clipped. Standard surgical antisepsis was performed using sterile gauze and washes of 0.5% povidone‐iodine solution. After preparation of the surgical field, the procedure was initiated. A perilimbal incision of approximately 12 mm was made in the dorsal conjunctiva, followed by subsequent subconjunctival blunt dissection. The dissection allowed direct access to the encapsulated peribulbar mass located between the conjunctiva and the sclera, permitting fragmentation and excision in blocks. As the peribulbar content was excised, the retrobulbar mass projected into the peribulbar region and was also excised. It was not possible to visualize and isolate the medial rectus muscle, which may have been ruptured during surgical manipulation. The nictitating membrane remained intact. After excision of the mass, the dog's exophthalmos resolved during the intraoperative period. The bulbar conjunctiva was closed using a simple interrupted pattern for anchorage, followed by a simple continuous pattern, using 8–0 polyglycolic acid suture material. The surgical procedure was concluded with the performance of a temporary partial tarsorrhaphy using 4–0 nylon suture in a horizontal mattress pattern placed over stents. All fragments of the mass were submitted for histopathological examination. The anesthetic intraoperative period remained stable, and the dog maintained heart rate and systemic arterial pressure within normal limits throughout the procedure. The dog recovered from anesthesia without complications and continued postoperative treatment at home, which consisted of rest, use of an Elizabethan collar, and topical and systemic medications.
[图：Anterior subconjunctival orbitotomy. Subconjunctival blunt dissection of the mass through a perilimbal approach in the b]
Postoperative medications included tobramycin 0.3% ophthalmic solution (Tobrex, Alcon, São Paulo, Brazil) every 6 h for 14 days, sodium hyaluronate 0.15% ophthalmic solution (Hyabak, Laboratoires Théa, Loures, Portugal) every 12 h for continuous use, prednisolone 10 mg (Predsim, Mantecorp Farmasa, São Paulo, Brazil; 3/4 tablet, 0.5 mg/kg) every 24 h for 7 days, tranexamic acid 250 mg (Transamin, Eurofarma, São Paulo, Brazil; 1/2 tablet, 8 mg/kg) every 12 h for 3 days, amoxicillin trihydrate with potassium clavulanate 250 mg (Agemoxi CL, Agener União, São Paulo, Brazil; 1 tablet, 15 mg/kg) every 12 h for 14 days, and dipyrone 500 mg (Medley, São Paulo, Brazil; 3/4 tablet, 25 mg/kg) every 8 h for 5 days. Tranexamic acid was prescribed to prevent and control postoperative bleeding, given the vascular nature of the orbital surgical bed. The dog remained stable, and the eye appeared comfortable, without local swelling.
On histopathological examination, irregular, white fragments, soft to friable and cohesive, were described macroscopically. The largest measured 8.5 × 2.0 × 1.0 cm, and the smallest measured 1.5 × 0.5 × 0.1 cm. On microscopy (Figure 4), the histological sections were composed of abundant well‐differentiated adipocytes within extensive areas of hemorrhage. At the periphery of the described adipocyte population, a thin fibrous capsule was multifocally observed. Pleomorphism, anisocytosis, and anisokaryosis were mild, and no mitotic figures were observed in 10 high‐power fields (40× objective).
[图：Microscopic images from histopathological examination at 10× (A) and 40× (B) magnification.]
The partial tarsorrhaphy was removed 21 days after the surgical procedure, and the right eye appeared visual with a marked reduction in exophthalmos (Figure 4). Two months after surgery, the dog returned for follow‐up, and a new ophthalmic examination was performed: menace response positive (both eyes), Schirmer tear test 20 mm/min (OD) and 18 mm/min (OS), intraocular pressure (IOP) 17 mmHg (OD) and 12 mmHg (OS), lateral strabismus in the right eye, partial corneal pigmentation in the right eye, and Florida spots in the left eye. The specific cause of the post‐operative strabismus was not identified by additional testing; however, the strabismus was attributed to intraoperative disruption of the medial rectus muscle as described above. The remaining findings (including neuro‐ophthalmic tests, intraocular inspection, and fundoscopic examination) did not show alterations. The dog continues to be monitored 11 months after surgery and remains comfortable, visual, and without recurrence of the ocular condition observed during physical examination (Figure 5).
[图：Dog during postoperative follow‐up at 21 days (A and B), 7 months (C and D), and 11 months (E and F).]
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Discussion
The observation of an orbital lipoma in a 14‐year‐old female dog is consistent with the findings of other authors, who report a higher occurrence of this type of neoplasm in elderly dogs [6, 12, 13]. Although exophthalmos and strabismus are nonspecific findings commonly reported in orbital diseases [3], the soft and partially reducible consistency of the mass observed in this case may represent a clinically relevant feature suggestive of a lipomatous lesion, which is not frequently emphasized in previous reports. The chronic and nonpainful progression of the condition further supported a neoplastic etiology, as inflammatory orbital diseases are typically associated with pain and acute onset [3, 7, 13, 14].
Cytological evaluation was performed as a minimally invasive and accessible diagnostic method, providing important preliminary information for clinical decision‐making and surgical planning. The identification of mature adipocytes supported the presumptive diagnosis of lipoma and was consistent with previous descriptions [12], reinforcing the role of cytology as a diagnostic screening method and for surgical planning, despite its known limitations in definitively characterizing adipocytic tumors [15, 16].
Computed tomography was essential in this case, not only for lesion detection but also for characterization and surgical planning. Coall et al. [15], in a study of 97 animals with orbital diseases, emphasized that advanced imaging examinations (CT or magnetic resonance imaging) can detect abnormalities that support the diagnosis of inflammatory or neoplastic disease and can also help identify foreign bodies. The identification of a well‐defined mass with fat attenuation strongly supported the presumptive diagnosis of lipoma and directly influenced the decision to pursue a conservative surgical approach with globe preservation. These findings are consistent with previously described tomographic characteristics of adipose tumors [17], highlighting the value of CT as a decision‐making tool in orbital diseases.
Prolapse of orbital fat should be considered as a differential diagnosis when examining an animal presenting clinical signs of increased volume in the bulbar conjunctiva with a fatty appearance, similar to that reported [10, 18]. In the present report, the dog showed progressive enlargement of the orbital lesion, a marked mass effect, and exophthalmos, findings consistent with the lipoma cases described by Williams and Haggett [10] and Charnock et al. [7].
The surgical management of orbital neoplasms primarily involves the decision to preserve the ocular globe or perform exenteration. In this case, the presumed benign nature of the lesion, supported by imaging and cytology, justified a conservative approach aimed at preserving vision and ocular structures. Surgical excision of the mass should be performed whenever the anatomical location permits, and different surgical approaches to orbitotomy are possible depending on the position, extent, and consistency of the lesion [12]. When available, three‐dimensional (3D) printing may be a valuable tool to improve surgical planning in cases of orbital and periorbital masses [13].
Among the orbitotomy approaches, an anterior subconjunctival approach was chosen because it is a less invasive surgical technique and still allows adequate access given the fluidity of the fatty mass, resulting in a satisfactory outcome similar to that obtained by Williams and Haggett [10]. Our experience with anterior orbitotomy for the management of lipoma corroborates the findings of Caro‐Suarez et al. [12] for this technique, as it allows adequate tumor exposure without extensive disruption of orbital tissues, ensures reversal of exophthalmos, and avoids large osteotomies. This approach provided effective tumor removal and immediate resolution of exophthalmos, corroborating previous reports that describe its utility in selected orbital lipomas [10, 12]. However, this technique requires careful case selection, as intraoperative manipulation of orbital structures may pose a risk to vision [7, 12].
Other surgical options include lateral and transfrontal orbitotomies combined with osteotomies. However, these procedures are generally more invasive, require longer surgical times, and often necessitate axial pattern flaps to reconstruct large cutaneous defects [19]. The choice of surgical approach should be tailored to the anatomical location of the orbital lipoma [12].
Histopathological examination remains the gold standard for confirming orbital neoplasms [16] and should be correlated with the dog's clinical history, clinical findings, and imaging results. In our report, the histopathological architecture of well‐differentiated adipocytes and a thin fibrous capsule is consistent with that described by Dorbandt et al. [13] and Williams and Haggett [10], both reported as orbital lipoma.
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Conclusion
This report demonstrates that the anterior subconjunctival orbitotomy technique was successfully used to remove the lesion in this dog, allowing preservation of vision and satisfactory long‐term outcomes. Early integration of advanced imaging and cytology is essential for appropriate case selection and surgical planning.
Author Contributions
Isabela Pessôa Barbieri Bastos: investigation, writing – original draft, writing – review and editing. Adriano de Sales Araujo: investigation, writing – original draft, methodology, writing – review and editing, formal analysis, data curation. Lucas de Souza Viana: conceptualization, investigation, writing – original draft, methodology, writing – review and editing, formal analysis, data curation. Bruno Alberigi: conceptualization, investigation, writing – original draft, methodology, validation, writing – review and editing, formal analysis, data curation, supervision. Francis Arthur Seco Prando: investigation, writing – review and editing, writing – original draft.
Funding
This work was supported by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Code 001.
Ethics Statement
This case report describes the clinical management of a client‐owned dog; formal ethics committee approval was therefore not required. All diagnostic and surgical procedures were performed with the owner's authorization, and written informed consent was obtained from the owner for the publication of the animal's clinical data and images.
Conflicts of Interest
The authors declare no conflicts of interest.
Acknowledgments
This work was carried out with the support of the Coordination for the Improvement of Higher Education Personnel—Brazil (CAPES)—Funding Code 001. The authors acknowledge the use of an artificial intelligence tool (Claude, Anthropic) to assist with English‐language revision and with the formatting and verification of references. The tool was not used to generate data, interpretations, or scientific conclusions, and all content was independently reviewed and approved by the authors, who take full responsibility for the manuscript. The Article Processing Charge for the publication of this research was funded by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior ‐ Brasil (CAPES) (ROR identifier: 00x0ma614).
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
References
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Associated Data
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.