Keratoconjunctivitis sicca

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Sections available in full article Introduction, Presenting signs, Acute presentation, Age predisposition, Sex predisposition, Breed predisposition, Cost considerations, Pathogenesis, Etiology, Predisposing factors, Pathophysiology, Timecourse (incubation, duration), Diagnosis, Presenting problems, Client history, Clinical signs, Diagnostic investigation, Confirmation of diagnosis, Differential diagnosis, Treatment, Initial symptomatic treatment, Standard treatment, Monitoring, Subsequent management, Sequelae, Prognosis, Expected response to treatment, Reasons for treatment failure, Sources, Publications, Vetstream contributor(s),
Contributors Dr Dennis E Brooks DVM PhD DipACVO
Dr David L Williams MA VetMB PhD CertVOphthal FRCVS
Synonyms Dry eye

Introduction

  • Corneal disease resulting from deficiency of aqueous phase of precorneal tear film.
  • Cause : secondary to systemic metabolic disease, drug induced, traumatic; auto-immune destruction of lacrimal gland; congenital; idiopathic.
  • Signs : tacky discharge and conjunctival hyperemia, unresponsive to antibiotics; corneal edema; deep circular subcentral ulceration; pigmentation and vascularization as chronic change; dull, lustreless cornea; conjunctival hyperplasia and corrugation Keratoconjunctivitis sicca: West Highland White male 3 years.
  • Diagnosis : clinical signs, Schirmer tear test.
  • Treatment : palliative medical therapy - artificial tears, prophylactic antibiotics, anti-inflammatories. Treat underlying cause if appropriate. Topical cyclosporin A stimulates tear production in the majority of cases. Surgical therapy - parotid duct transposition.
  • Prognosis : may be reversible if secondary to systemic disease. Iatrogenic/auto-immune cases in susceptible breeds generally progressive, life-long treatment necessary. Loss of eye rare, with good owner compliance and monitoring.
    Print off the owner factsheet Keratoconjunctivitis sicca ('Dry eye') Keratoconjunctivitis sicca ('Dry Eye') to give to your client.

Diagnosis

Clinical signs

  • Unilateral or bilateral.
  • Acute:
    • Itching.
    • Ocular pain.
    • Conjunctival hyperemia Keratoconjunctivitis sicca: Bichon Frise male 3 years.
    • Corneal ulceration .
    • Lustreless cornea Keratoconjunctivitis sicca: Cavalier King Charles Spaniel female.
    • Ocular discharge.
    • Nictitating membrane prominence.
    • Iridocyclitis (secondary).
  • Chronic:
    • Ocular discharge.
    • Conjunctival hyperplasia/corrugation/chemosis.
    • Corneal pigmentation/vascularization/xerosis.
  • Discharge typically adherent to cornea, forms ropy deposits in upper and lower conjunctival fornices Keratoconjunctivitis sicca: West Highland White female 2 years.
  • Ulcer typically deep, non-vascularised, circular, subcentral .
  • May progress rapidly to perforation.
  • Corneal malacia possible, resulting in dehiscence, iris prolapse.

    Needs emergency intensive treatment.

Diagnosis

Differential diagnosis

  • Abnormalities in spreading of precorneal tear film due to contenital/acquired lid defects:
    • Agenesis.
    • Coloboma.
    • Entropion Entropion.
    • Ectropion Ectropion.
    • Macropalpebral fissure Macropalpebral fissure.
    • Prominent eyes (proptosis Proptosis prolapse orbit globe /exophthalmos - breed related or due to retrobulbar space-occupying lesions Retrobulbar space-occupying lesions - or hydrophthalmos).
  • Bacterial conjunctivitis.
  • Corneal epithelial cell degeneration, keratinization, pigmentation and vascularization. Epithelial pegs form in chronic cases with plasma cells and lymphocytes in the anterior stroma.
  • Lymphocytic/plasmacytic infiltration of the lacrimal gland with acute atrophy.

Sequelae

Prognosis

  • Depends on etiology.
  • May resolve if secondary to systemic or metabolic disease.
  • If permanent, can be well controlled if adequately treated and regularly monitored.
  • Post-duct transposition usually successful but eyes still need daily attention.

    Not suitable for very greedy dogs or dogs producing copious saliva - overflow may result in calcium deposits on cornea/periorbital skin/hair → periorbital dermatitis.

Expected response to treatment

  • Return of tear production.
  • Resolution of tacky ocular discharge, conjunctival hyperemia, corneal pigmentation and vascularization.

Reasons for treatment failure

  • Advise owner permanent care necessary even with successful treatment.
  • Cyclosporin failure.
  • Lack of saliva prevents surgical correction of KCS.
  • Anatomical abnormalities resulting in lagophthalmos and permanent exposure of central cornea.

Sources

Publications

Refereed papers

  • Sansom J, Barnett K C, Neuman W et al(1995) Treatment of KCS in dogs with cyclosporine ophthalmic ointment- a European clinical trial field. Vet Rec 11 , 504-507.
  • Stiles J, Carmicheal P, Kaswan R et al(1995) Keratectomy for corneal pigmentation in dogs with cyclosporine responsive chronic KVS. Vet Comp Ophthal 5 , 25-34
  • Morgan R V & Abrams K L (1991) Topical administration of cyclosporine for treatment of keratoconjunctivitis sicca in dogs. JAVMA 199 , 1043.
  • Salisbury M A, Kaswan R L & Ward D A et al(1990) Topical application of cyclosporine in the management of keratoconjunctivitis sicca in dogs. JAAHA 26 , 269.

Other sources of information

  • Gelatt K N (1999) Veterinary Ophthamology. 3rd edn. Williams & Wilkins.

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