Eye Ulcers & Keratoconjunctivitis Sicca (KCS) also known as Dry Eye
Many eye ulcers in Shih Tzus are due to the condition Keratoconjunctivitis Sicca (KCS), dry eye, which is insufficient tear production exacerbated in our breed by the large, round eye which means that there is more tear evaporation. Cod liver oil may appear to help because it provides lubrication; however there are better ways of lubricating the eye which are more effective and don’t involve the blurred vision which results from oil in the eye.
Symptoms of dry eye include eye ulcers, a mucous type discharge in or around the eye and rubbing the eyes. Dry eye is diagnosed with a simple, quick test called a Schirmer tear test. This involves putting a strip of “blotting paper” under the eyelid and seeing how much fluid is absorbed in one minute. It’s quick, cheap and worth considering as an annual check.
There are no recognised “home remedies” or homeopathic treatments for eye ulcers and anybody attempting to treat an eye ulcer themselves could, in theory, be prosecuted for failing to provide veterinary treatment. If your dog has an eye ulcer make an appointment to see your Vet. Treatment of eye ulcers has moved on considerably from the days when the only options were anti-biotics and /or the third eyelid stitched. Eye ulcers are very painful and mine are always prescribed a pain killer in addition to anti-biotics. Artificial tears might also be prescribed as well as an anti-coagulant which can prevent the eye ulcer worsening. A soft contact lens might also be put over the eye as an alternative to stitching. If the ulcer fails to respond a graft can be carried out to plug the hole.
Due to its potential to permanently impair vision or perforate the eye, a corneal ulcer is considered an ophthalmologic emergency. While corneal ulcers occasionally may be sterile, most are infectious in etiology. Ulcers due to viral infection occur on a previously intact corneal epithelium. Bacterial corneal ulcers generally follow a traumatic break in the corneal epithelium, thereby providing an entry for bacteria.
What is keratoconjunctivitis sicca (KCS)?
KCS or "dryeye" is an eye disease caused by abnormal tear production. The lacrimal glands produce the watery secretions that make up the bulk of the tears. A deficiency in this secretion causes KCS in small animals.
Normal tears are essential for the health and transparency of the cornea (the surface of the eye). Tears cleanse and lubricate the cornea, carry nutrients, and play a role in the control of infection and in healing. Deficient tear production as in KCS causes chronic irritation of the cornea and conjunctiva. Corneal ulcers and eventually corneal scarring occur, and blindness can result.There is a predisposition to this condition in some breeds as listed below. KCS can also occur in any breed as a result of viral infection, inflammation, drug-related toxicity, or immune-mediated disease. There is an association between removal of a prolapsed nictitans gland ("cherry eye") and the development of KCS.
How is KCS inherited?
The mode of inheritance is not known.
What breeds are affected by KCS?
There is a predisposition to the development of KCS in the bloodhound, Boston terrier, bull terrier, English bulldog, English and American cocker spaniel, Kerry blue terrier, Lhasa apso, miniature poodle, miniature schnauzer, Pekingese, pug, Sealyham terrier, Shih tzu, standard schnauzer, West Highland white terrier, Yorkshire terrierCongenital KCS (ie. the dog is born with the condition) is rare. It may be one-sided and has been seen in toy breeds such as the Yorkshire terrier, pug, Pekingese, and Chihuahua. These dogs have very small or absent tear-producing (lacrimal) glands.
For many breeds and many disorders, the studies to determine the mode of inheritance or the frequency in the breed have not been carried out, or are inconclusive. We have listed breeds for which there is a consensus among those investigating in this field and among veterinary practitioners, that the condition is significant in this breed.
What does KCS mean to your dog & you?
KCS may develop very quickly or more slowly, in one or both eyes. Commonly it is diagnosed in 1 eye first and develops in the other eye within several months. The extent of discomfort depends on the severity of the tear deficiency and how long it has been present. People with KCS say it feels like they have sand paper under their eyelids with every blink. Dogs show their discomfort by rubbing their eyes, squinting, and being sensitive to light. Your dog's eye(s) may be reddened and inflamed, or the cornea may appear dull and dry. There is commonly a thick mucousy discharge in the eye or in the area around the eye.Problems associated with KCS include chronic or recurring irritation or infection of the conjunctiva and cornea, and corneal ulcers. These conditions are painful and, if KCS is untreated, over the long term the normally transparent cornea becomes thickened and scarred. Blood vessels and pigmented cells move in to the cornea because of the chronic inflammation, and blindness may result.
How is KCS diagnosed?
Your veterinarian may suspect KCS based on the kinds of clinical signs mentioned above, particularly in a breed with a predisposition to this disorder. KCS is confirmed by measuring your dog's tear production. Your veterinarian will also perform a fluoroscein dye test to check for corneal ulceration.
FOR THE VETERINARIAN: A Schirmer tear test (STT) should be performed before the use of any drops or ointments in any dog presenting with ocular discharge, irritation, or corneal lesions. Normal STT values in the dog are 15 to 25 mm/minute. Dogs with exposed corneas due to conformation require relatively more tears so may show KCS even with marginal deficiencies.
How is KCS treated?
The goals of treatment are to restore moisture to the eye and to treat conditions such as infection or ulceration that develop because of the lack of normal tears.
Tear stimulants and artificial tear replacements are used to treat KCS. Generally it will take a period of trial-and-error for your veterinarian to determine what is best for your dog. A response to tear stimulants may not occur for a few weeks or even longer, and during this time artificial tears must be used as well. Once tear production has been established, often the use of a tear stimulant once daily, or sometimes once every 2 days, will be sufficient to control KCS.
It is important to recognize that this treatment is not a cure for KCS but rather a way to manage a frustrating, painful, and potentially blinding condition. Clinical signs will slowly return If treatment is stopped.
When medical therapy as outlined above is unsuccessful, surgery can be done to transport one of the salivary ducts to provide moisture to the eye. This is generally less satisfactory.
FOR THE VETERINARIAN: Cyclosporine is the treatment of choice due to its efficiency at stimulating tear production, the need for fewer applications, and the lack of undesirable side effects with long term use. The time required to achieve sufficient tear production varies; usually a response is seen within a few weeks but several weeks may be required. Artificial tears should be supplied until tear production is established.
Affected dogs should not be used for breeding.FOR MORE INFORMATION ABOUT THIS DISORDER, PLEASE SEE YOUR VETERINARIAN.
Where to find more information?
Salisbury, M.A. 1995. Keratoconjuctivitis sicca. In J.D. Bonagura and R.W. Kirk (eds.) Kirk's Current Veterinary Therapy XII Small Animal Practice. p. 1231-1239. W.B. Saunders Co., Toronto.
Copyright © 1998 Canine Inherited Disorders Database. All rights reserved.
Objectives: To investigate the disease patterns in dogs with keratoconjunctivitis sicca referred to the University of Glasgow Small Animal Hospital.
Methods: A retrospective study of 229 cases was carried out.
Results: There were 44 breeds in the study, with four breeds, English cocker spaniels, cavalier King Charles spaniels, West Highland white terriers and shih-tzus, making up 58 per cent of the cases. Among these four breeds, two breed-dependent disease patterns, one chronic and one acute, were identified. English cocker spaniels and West Highland white terriers had a mean age at onset of clinical signs of five years and one month and five years and six months, respectively, with more females affected than males. Clinical signs consisted predominantly of conjunctival hyperaemia and mucopurulent discharge, with a relatively low incidence of ulcerative keratitis. In contrast, cavalier King Charles spaniels and shih-tzus showed a more acute disease pattern with a biphasic age distribution at 0 to less than two years of age, and four to less than six and six to less than eight years of age, respectively, with more males affected than females and a significantly higher incidence of ulcerative keratitis in some cases resulting in corneal perforation.
Clinical Significance: The study reveals interbreed differences with respect to sex, age and risk of ulcerative keratitis which have not been detailed previously in a referral population.