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HiCustomer Dr. Hurst here.
Occasionally these styes are merely an infected or abscessed meibomium gland or eyelash. These can be treated with hot packs, oral antibiotics and topical antibiotic/steroid eye ointments.
Other times they must be opened up and scraped out under sedation.
Sometimes what appears to be a stye is actually a tumor. These need to be cut out.
As long as he is not too uncomfortable, I think it's definitely worth trying non-surgical treatment. If there is no improvement after a week or so, then that would indicate the need for a surgery.
Anesthesia is much safer than it used to be. However a 14 year old dog has more of a chance of having problems with anesthesia because they are more likely to have underlying problems. I would request a comprehensive profile and an EKG before any anesthetic procedure. If these check out okay, then he will likely do just fine with anesthesia. I would also request that an IV be placed for two reasons. Running IV fluids during the procedure helps keep blood pressure stabilized and that can help prevent adverse reactions to the anesthesia. Additionally, should he start to have problems it is much easier to give reversal agents and other emergency drugs, if needed.
I have operated on many old dogs and the only ones who had problems were the ones we thought would (they had preexisting heart disease for example), but the procedures were necessary. I'd have to say probably only 1 or 2 in 1000 older dogs had problems.
I think the conservative approach is appropriate, but if he doesn't respond and the lesion is causing discomfort, then it may be necessary to take the risk of anesthetic. Just make sure he is properly screened and prepared first.
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