Introduction

According to the most recent census, money spent on nonveterinary pet-related services such as grooming, boarding, and training has doubled over the last decade, to a total of $5.8 billion per year.¹ Grooming is an important part of wellness care for many dogs, but groomers are often challenged by patient behavior and conformation, particularly when working around the face and head, and pets are sometimes inadvertently injured while being groomed. Dogs presenting to our hospital for ocular complaints are often reported to have been groomed immediately before onset of ocular issues, and pet owners often question whether the grooming visit caused their dog’s eye problems. The purpose of this retrospective study was to characterize grooming-associated ocular lesions and identify factors associated with their occurrence.

Materials and Methods

An electronic medical records search was performed to identify dogs presenting to the ophthalmology or emergency services at either the Foster Hospital for Small Animals at the Cummings School of Veterinary Medicine at Tufts University or Tufts Veterinary Emergency Treatment and Specialties between 2004 and 2020 with an ocular complaint first noticed within 24 hr of a commercial grooming appointment. The timeframe relative to the grooming appointment was elected to maintain a conservative bias for patient inclusion. Search terms consisted of “groomer” or “grooming” paired with “eye,” “ulcer,” “laceration,” “hemorrhage,” “injury,” or “trauma.”

Records were retrieved and reviewed. Dogs with coexisting ocular disease potentially related to the presenting complaint (dogs with keratoconjunctivitis sicca or entropion presenting for a corneal ulcer, for example) were excluded from the study. If the coexisting ocular disease could not have accounted for the presenting complaint (such as a dog with keratoconjunctivitis sicca or entropion with an eyelid laceration), the record was included for review. Dogs with ocular disease judged to be unrelated to the grooming appointment (such as cataracts, glaucoma, or eyelid masses) were also excluded from the study. Dogs with hyphema or subconjunctival hemorrhage were included only if sufficient testing (at minimum a platelet count, prothrombin time/partial thromboplastin time measurement, and blood pressure measurement) was performed to rule out alternative causes.

Data collected from remaining records included breed, age, sex, diagnosis, and initial treatment. Records were also reviewed for owner- or clinician-generated comments regarding patient behavior, including caution notations, mention of the need for a muzzle or sedation to complete the ocular examination, or a note attributing incomplete examination findings to uncooperative behavior. Descriptive statistics were generated.

Results

One hundred sixty-one episodes were identified that met inclusion criteria, involving 159 dogs (2 dogs presented twice, with 4 and 13 mo between incidents). The study population comprised 92 males (74 castrated) and 67 females (61 spayed). Median age at presentation was 59 mo (range 4–173 months). Fifty-one breeds were represented, with shih tzu accounting for 54 incidents (34% of total incidents; Table 1). As expected for dogs requiring grooming services, 94% of the dogs included in the study were identified as belonging to breeds with long- or wire-haired coats. Small-breed dogs (breeds with an average adult weight <10 kg) were involved in 71% of incidents.

TABLE 1 Breeds Represented in Study Population

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Ocular lesions are listed in Table 2. Three dogs with eyelid lacerations had concurrent corneal ulcerations or lacerations and are therefore represented twice in the table. Five of the dogs (four shih tzu, one Pekingese) with corneal ulcers had evidence of corneal perforation at time of presentation.

TABLE 2 Ocular Injuries Reported in Association with Grooming Visits

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Medical management alone was elected in 137 episodes. Globe-sparing surgical procedures were performed on 18 dogs, including eyelid laceration repair (9 dogs), conjunctival pedicle graft with or without underlying biomaterials (6 dogs), proptosis reduction and temporary tarsorrhaphy (2 dogs), and eyelid tacking to relieve spastic entropion (1 dog). Enucleation was elected for 4 dogs (2 with corneal ulcer and perforation, 1 with proptosis, and 1 with severe penetrating trauma). Surgical interventions were recommended for 2 additional dogs (1 with corneal ulceration and perforation, for which enucleation was recommended, and another with an eyelid laceration for which surgical repair was recommended) but were declined by the owner. Three of the dogs for whom medical management was elected (1 dog with corneal perforation, 1 with hyphema, and 1 with a corneal ulcer and a retinal detachment (the latter injury could not be specifically linked to the grooming visit)) were reported to be blind in the affected eye by virtue of an absent menace response and dazzle reflex.

Notations suggesting aggression or other potentially contributory behavioral issues were identified in the records of 52 dogs (33%).

Discussion

This study identifies common ocular injuries associated with grooming visits in dogs and suggests that breed and behavioral issues may predispose dogs to injury. Regular grooming is important for the health and comfort of many dogs, but injuries associated with grooming visits are poorly documented in the veterinary literature. The one major study published to date presented necropsy findings from 94 dogs in Brazil who died during grooming visits, all of whom had evidence of either blunt trauma or pulmonary injuries.² Although most of the grooming-related ocular injuries described in the current study were minor and did not lead to permanent harm, 14% of dogs required surgery and 4% of dogs either lost vision in the affected eye or underwent enucleation. Even dogs with minor injuries experienced discomfort and required treatment, however, and owners were impacted financially and emotionally. Evaluation of the relationship between grooming and ocular injury is therefore important.

In three of the incidents reported here, the groomer acknowledged causing an injury and brought it to the attention of the pet owner. However, in most cases, the record suggests that dog owners themselves noticed signs of an ocular issue after the grooming visit. As such, it is difficult to state with absolute certainty that the injury was caused by the grooming visit. We therefore attempted to make our inclusion criteria as conservative as possible by specifying a narrow time window following the grooming visit and excluding dogs with underlying ocular disease that could account for the presenting complaint. For the dogs included in this study, both the timing of the injury and the lack of other apparent causes are suggestive of an association between ocular injury and grooming.

The professionals who provide pet grooming services are generally well trained and skilled at handling dogs with a variety of temperaments and needs. Groomers also serve as an important part of the veterinary care team: in fact, owners of pets presenting to the ophthalmology service at our hospital for nontraumatic ocular conditions frequently report that ocular changes were initially brought to their attention by their pet’s groomer. We have no reason to believe that any of the injuries described in this study were inflicted deliberately or through negligence. Canine grooming services do, however, have the potential to cause inadvertent ocular injury by several mechanisms, including exposure to shampoo or other grooming products or warm air drying devices, partial strangulation by restraint devices, and blunt, lacerating, or penetrating trauma.

Corneal ulcers were the most common injury in our study population, representing 71% of the ocular lesions documented (Figure 1). Even superficial corneal ulcers can cause significant discomfort, and vision or globe loss is possible if corneal perforation occurs or scarring is excessive. Treatment costs for more complicated corneal ulcers may also be considerable, particularly if surgical management is required. Given the frequency of this injury, avoidance of corneal injury during grooming visits should be prioritized.

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Most of the mechanisms listed above could induce corneal ulceration in a dog during a grooming visit. Shampoo and other grooming products have been demonstrated to cause chemical injury to the cornea, conjunctiva, and periocular skin in experimental settings and in pets.^3–5 Medicated shampoos and grooming products may have additional toxic effects.^6,7 Increased airflow across the corneal surface from warm air dryers can trigger desiccation and discomfort, potentially leading to epithelial damage.^8–10 This may be particularly damaging in dogs with lagophthalmos and/or decreased corneal sensation like shih tzu, who were markedly overrepresented in this study.¹¹ Physical trauma is likely also a significant cause of corneal ulceration during grooming services. Agitation or sudden movement could cause blunt, lacerating, or penetrating trauma due to contact with scissors, clippers, or other objects or falls from the grooming table. Blunt trauma has been specifically associated with corneal trauma in cats, dogs, horses, and people.^12–14

The most severely injured dog described in the current study sustained major penetrating corneal trauma believed to have been caused by scissors (Figure 2). Scissors and clippers may also cause eyelid lacerations or traumatize the periocular skin.¹⁵ Eyelid lacerations were sustained by 11 dogs in this study. Eyelid lacerations can result from lacerating or blunt trauma or from bite injuries.¹⁶ Most of the eyelid lacerations documented in this study were suspected to have been caused by inadvertent contact with grooming scissors (including one case in which the groomer acknowledged having accidentally lacerated the eyelid with scissors [Figure 3]), but it is also possible that contact with other objects such as hooks or cage latches or interactions with other pets present at the grooming salon were responsible. Lacerations involving the eyelid margin should be repaired under general anesthesia by an experienced surgeon.^11,16 If allowed to heal by second intention or if proper surgical apposition is not achieved, eyelid lacerations may lead to trichiasis and/or malpositioning of the lids and in turn to chronic discomfort, corneal ulceration, pigmentary keratitis, and other vision-threatening complications.^11,16

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Various forms of ocular hemorrhage were also commonly documented in this study. Subconjunctival hemorrhage was noted in 10 dogs, 3 of whom presented with bilateral hemorrhage (Figure 4). An additional 3 dogs had bleeding involving other ocular structures. There are many potential causes of subconjunctival or other ocular hemorrhages, including trauma, acute inflammation, vasculitis, systemic hypertension, and coagulation abnormalities.^{13,14,17–21} All dogs included in this study had systemic blood pressure measurement performed along with coagulation testing to rule out systemic causes.

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Blunt trauma has been suggested as the most common cause of subconjunctival hemorrhage in dogs and may have been the cause for some of the dogs with this lesion in this study, particularly those with unilateral hemorrhage.¹⁸ However, simple trauma seems a less probable explanation for bilateral subconjunctival hemorrhage. Partial strangulation by restraint devices was suspected in the three dogs with bilateral findings. Many groomers use an elevated table with an arm holding a noose-style collar that is placed around the dog’s neck. An excited or nervous dog trying to escape the table could fall, jump, or strain against the collar, leading to a short, sudden period of increased intravenous and intraocular pressure and temporary suffocation. Strangulation has been associated with ocular injury, particularly subconjunctival hemorrhage, in both humans and animals.^13,17,18 Specifically, bilateral subconjunctival hemorrhage has been reported in an 8 yr old mixed-breed dog following an episode of hanging by a choke collar and in two dogs with partial strangulation injury caused by straining against neck leads.^18,22 Because the dogs with ocular hemorrhage were not presented for follow-up, we generally assume that they did not suffer permanent injury, although this assumption may be incorrect. Subconjunctival hemorrhage without accompanying ocular findings is considered largely a cosmetic issue, but it is possible that these dogs also sustained less visible injuries to choroidal or retinal vasculature, or to other nonocular sites like the lungs, cervical spine, trachea, or brain. Strangulation or excessive restraint may also lead to proptosis in breeds with lagophthalmos or shallow orbits, like the three shih tzu with proptosis included in this study.^23,24

Finally, conjunctivitis was also commonly noted in this study, affecting 18 dogs, with blepharitis diagnosed in 3 additional dogs. None of the dogs included in this study with conjunctivitis or blepharitis had a significant history of dermatologic or allergic disease before the grooming visit, so we believe the association is meaningful. Conjunctivitis or blepharitis could result from trauma or from exposure to shampoo or other grooming products or devices, including clippers.^4,15,25,26 Antibiotic-resistant bacteria were commonly recovered from grooming tools and fixtures at commercial salons in one recent study,²⁷ making the incidence of postgrooming blepharitis and conjunctivitis in dogs a finding with potential implications for pet and human health.

Several common factors can be identified in our study population of dogs with groomer-associated ocular injuries. Most dogs included in this study were young, active small-breed dogs. Although this finding likely aligns with population demographics for dogs commonly presented for grooming, small-breed dogs may also have more of a predilection for reactive or aggressive behaviors than individuals from other breeds.²⁸ Notably, 33% of the dogs in this study had some comment regarding behavior entered in the medical record. Aggression toward or fear of strangers, aggression toward or fear of unfamiliar dogs, separation anxiety, and fear of loud noises are among the most common behavioral issues reported in dogs, and bathing and grooming may themselves cause stress or physical discomfort in some dogs.²⁹ Depending on the design and protocols of the grooming facility, most dogs will experience one or more of these stimuli during a grooming session. In susceptible individuals these stimuli may then trigger potentially injurious behavior, including aggression, agitation, or attempts to escape.

Veterinarians therefore have an opportunity to intervene to prevent grooming-related ocular injury. Owners of breeds likely to require frequent grooming should be counseled from puppyhood on the importance of training and acclimatizing their dog to handling. Owners should also be queried during wellness visits regarding their dog’s behavior during grooming appointments, and veterinarians should assess patient behavior in the clinic. Anxiolytic or sedative drugs can then be prescribed and administered before scheduled grooming appointments for anxious or aggressive dogs.³⁰ In extreme cases, grooming under heavy sedation or general anesthesia at the veterinary clinic may be warranted.

Veterinarians can also partner with groomers by providing education regarding mitigation strategies for ocular injury and making recommendations for individual canine patients. Applying ointment-type lubricants to the eyes before shampooing, rinsing eyes with eyewash following shampooing or grooming, and using lubricating drops during and after warm air drying may all help to limit development of corneal ulcers after grooming. Dogs at significant risk of ocular complications, such as brachycephalics or individuals with preexisting eye disease like keratoconjunctivitis sicca, might further benefit from the use of goggles, Elizabethan collars, or other shielding devices. Alternative restraint systems such as slings or harnesses could also provide an additional measure of safety for some dogs.

Conclusion

Ocular injuries associated with grooming visits can have significant consequences for the ocular health of dogs. Corneal ulcers, conjunctivitis, and eyelid lacerations were the most frequently documented injuries in this study. Patient age, breed, and behavior likely predispose to injury. Grooming is an irreplaceable part of many dogs’ lives, and it is important to reduce risk during grooming appointments. Veterinarians should consider behavioral and pharmacological intervention for their patients before grooming visits to reduce the number of ocular injuries sustained and should engage with groomers in their local communities to protect the health and well-being of dogs.