KCS or Dry Eye

In healthy dogs and cats, the cornea (clear coating of the eye) and conjunctiva (pink part of the eye), are constantly bathed in tear film and kept moistened.  This moisture is due to the water component of tear film.  Dry eye, or keratoconjunctivitis sicca (KCS), is a common eye ailment. Dry eye is a reduction in natural tear production causing drying and inflammation of the cornea. If left untreated, chronic dry eye can lead to ulceration of the cornea, infection and potentially the loss of vision.
Depending upon the cause, KCS can be temporary or a lifelong condition. Left untreated, dry eye can become progressively uncomfortable, causing infections and potentially irreparable damage. Corneal ulcerations and corneal scarring can ultimately lead to loss of visual acuity and blindness.
 
Causes  
Causes for inadequate tear production in dogs and cats, with subsequent KCS, include the following:
  • Immune mediated destruction of the tear producing gland .is the most common cause.   The reason this happens is not fully understood, but certain breeds seem to be predisposed, including:
·         Cocker Spaniels
·         Boxers
·         Pugs
·         Shih tzus
·         Yorkshire Terriers
·         West Island White Terriers
·         Bulldog
·         Miniature Schnauzers
·         Lhasa Apso
·         Pekingese
 
  • Herpes Infection in cats
  • Distemper Infection in dogs
  • Administration of Sulfa Antibiotics - not very common, and commonly subsides once the patient is off the drug.
  • Drug toxicity
  • Removal of the third eyelid (due to Cherry Eye)
  • Low Thyroid levels
  • Sjögren’s syndrome, a condition characterized by autoimmune reactions in the lacrimal and salivary glands.
 
Symptoms of Keratoconjunctivitis Sicca
Symptoms that present will vary depending upon how long the eyes have been impacted by dry eye. Common symptoms include:
  • Chronic redness and swelling of the area around the eye (the conjunctiva)
  • Squinting and excessive blinking
  • Thick, yellowish discharge from the eye
  • Ulceration or cloudiness of the cornea
  • Secondary bacterial infections
  • Prominent third eyelid
  • Impaired vision
 
Diagnosis
Diagnosis of KCS begins with visual inspection.  In advanced cases, the eye or eyes can be observed with a dry and chronically reddened appearance.  However, early to mid stage cases of KCS can look very much like allergic or infectious conjunctivitis.  Diagnosis is confirmed by a painless tear strip test that is done right in the examination room called a SchirmerTear Test. In addition, fluorescein staining of the eye is also performed to detect any corneal ulcers.
 
Treatment
Once diagnosed, treatment is a matter of cleaning the eyes and administering medication. The dog owner should make sure that any discharge is cleaned away with a warm, moist cloth. This is especially important prior to administering the medication.
  • Cyclosporine ointment/drops- is the most commonly utilized drop formulation that stimulates tear production to effectively manage KCS, and remains the preferred treatment. This medication is not ever discontinued unless instructed by your veterinarian.  This is a permanent medication.
  • Tacrolimus Drops –Used in cases where the patient inadequately responds to Cyclosporine.  This medication stimulates tear production to effectively manage KCS.  This is a permanent medication.
  • Artificial tears drops/ Lubricant ointments – Help maintain the eye moist while other medication help improve the production of tears.  This can be a temporary or permanent medication. 
  • Antibiotic ointment/drops- If a secondary bacterial infection has set in or a corneal ulcer has developed, this medication will be required.  This is a temporary medication.
  • Surgical Intervention - In severe cases that do not respond medically, the next option is surgery.  A procedure called the parotid duct transposition effectively alleviates KCS, where the outflow from the salivary glands is diverted into the eye. This operation can be performed by a specialist eye surgeon. However, there are a number of potential problems with this procedure: saliva is not a perfect replacement for tears, saliva flow is much less than tear production, and saliva salt crystals can form in the eye.
Apply all medication as directed, and notify your veterinarian if you are having difficulty treating your pet. When treating your animal with both drops and ointment, use any drops first, followed by the ointment.  Wait at least 5 minutes in between medications.
 
Prognosis
Prognosis is typically good for canine and feline patients with KCS. 
 
Rechecks and Maintenance
Any dog with dry eye should be examined and a Schirmer tear test conducted on a regular basis (at least every 6 months) to ensure that the treatment continues to be effective.  After being diagnosed with KCS all pets should have a recheck Schirmer Tear test 30 days after starting treatment.
Monitor the eye for changes such as increased discharge, squinting or redness, or if your pet starts rubbing or scratching at his eye. Notify your veterinarian immediately.
 
KEY FACTS:
  • Apply all medication as directed.
  • When treating your animal with both drops and ointment, use any drops first, followed by the ointment.  Wait at least 5 minutes in between medications.
  • Some medications for this condition are permanent and they should never be discontinued without talking to the veterinarian.
  • Left untreated, dry eye can become progressively uncomfortable, causing infections and potentially irreparable damage and can ultimately lead to loss of visual acuity and blindness.
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