Sunday, October 29, 2017

3169. Dry eyes in a 14-year-old Jack Russell - keratoconjunctivits sicca (KCA)

Sunday Oct 29, 2017

"The dog was a puppy when we consulted you," the man said. That was in 2003. Today, he had a left ear haematoma and two painful half-shut eyes with thick mucus and pus. The eyes were dry eyes. I checked my medical records. This 14-year-old male Jack Russell who moved his head whenever I tried to examine his eyes had a left eye corneal ulcer in 2012 and was treated.

"We went to other vets for treatment of the eye," the owner did not follow up with me. "But there was no improvement. Now the dog is blind."

"He had been rubbing his eyes," I showed a large bald brownish hairless circular patch around both eyes. "He has dry eyes in which tears are not produced sufficiently or not produced," I said. "This is a case of keratoconjunctivitis sicca. Now the cornea had been damaged badly due to rubbing and the dog is blind."

The dog came in for treatment of aural haematoma and had dental scaling.
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KCA

Two basic causes
1.  Immune-mediated. Altered blood-tear barrier of lacrimal glands
2. Genetic.  Incorrect development of lacrimal glands e.g. Yorkshie terriers.

Signs
mucopurulent  strands of mucus, corneal ulcers, edema, melanisation and pruritus

Diagnosis and monitoring
Schirmer test
More than 15 mm/min - normal secretion
10-15                               suspected hyposecretion
Less than 10mm/min       hyposecretion
*In breeds with physiological ectoprion like Bulldog, a greater amount of tears is needed. Therefore high Schirmer test values may be insufficient. 

Treatment
1. Clear ocular secretions e.g. lactated Ringer's solution or low-mineral bottled water
2. Moisture the eye - based on carbomer or hyaluronic acid. Both give prolonged effect.
3. Stimulate tear secretion - Tacrolimus in severe cases below 5mm/min
                                              Cyclosporine where Schirmer test values above 5 mm/min
.                                              These two are immunolators, ocular lubicrants and have anti-inflammatory lacrimomimetic effect. Review after 2 months.   
   

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