Preventing further attacks essential in treating dog bites

Salt Lake City-Ophthalmologists have responsibilities to patients with dog bites that extend beyond providing medical and surgical care, according to John R. Burroughs, MD, Center for Facial Appearances, Salt Lake City.

"As physicians, our responsibility to our patients does not end with surgical reconstruction," Dr. Burroughs said. "We must also be vigilant regarding future attacks by the same animal and counsel victims accordingly."

Rule of 50s

Physicians have the ethical, and perhaps legal, responsibility to inform the victim's family of the risk of subsequent attacks and to discuss prevention strategies, Dr. Burroughs said. In addition, ophthalmic surgeons are legally obligated to report incidents to the health department, animal control agency, or police department, depending on local regulations, and notify a local social services agency if child neglect is suspected.

Dr. Burroughs and several colleagues published a study of periocular dog bite injuries and responsible care in Ophthalmic Plastic and Reconstructive Surgery in 2002 (Burroughs JR, Soparkar CNS, Patrinely JR, Williams PD, Holck DEE. Periocular dog bite injuries and responsible care. Ophthal Plast Reconstr Surg. 2002; 18:416-419; discussion 419-420). At that time, Dr. Burroughs was the head of the ophthalmology department at Eglin Air Force Base, FL. His colleagues Charles N.S. Soparkar, MD, PhD, and James R. Patrinely, MD, currently practice at Plastic Eye Surgery Associates, Houston.

The investigators conducted a single-practice prospective case series of dog attacks on 18 victims. Patients treated in the oculoplastic practice for periocular dog bite injuries were followed and asked about repeat attacks by the offending dog. Of the 18 patients, 16 were available for follow-up.

Seven of the animals involved in these attacks were primarily euthanized after the first episode, and one was sent away. Of the remaining eight animals, five (63%) bit again. Four of these animals were eventually euthanized.

"The fact that more than half of the noneuthanized animals continued their aggressive behavior underscores the very real potential for repeat attacks," Dr. Burroughs said. "This risk must be discussed with the victims' families and dog owners to help reduce subsequent attacks."

Enforcement of leash laws and other animal control laws is critical to bite prevention, the authors noted in the study, and suggested that physicians learn about municipal and state ordinances covering dog ownership, control, and attacks so they can counsel their patients appropriately.

Steps for prevention

Most dog bites occur in the home, and there are many bite prevention steps that can be implemented there, the study suggested. Approximately 50% to 70% of bite victims are children, and adults should be advised never to leave children alone with a dog. Although the presence of an adult will not prevent bites, injuries that occur under adult supervision tend to be less severe.

Other subjects that could be discussed with patients include careful breed selection, obedience training, pet sterilization, and behavior management.

In terms of medical treatment, physicians need to protect patients against infection by following public health protocols for tetanus and rabies and prescribing antibiotics to prevent bacterial infection. About 50% of dog bites are culture-positive for pathogens.

Care for periocular wounds should include meticulous wound exploration, irrigation, and debridement; careful physical examination and ancillary studies should be carried out as clinically indicated to search for occult injuries to the globe, canaliculi, levator, facial bones, and intracranio-orbital structures. Close follow-up is also highly recommended.