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Keratoconjunctivitis Sicca (KCS or Dry Eye Syndrome) - Treatment

Dhicon_thumb By DogHeirs Team | June 16, 2011 | Comments (0)

Overview | Symptoms | Treatment | Management

Keratoconjunctivitis Sicca, also known as Dry Eye Syndrome, keratitis sicca or KCS, is a potentially blinding condition that develops due to decrease of tear production in the eye. Early identification and treatment is crucial to preventing the destruction of the cornea. Two forms of treatment are available:  drug therapy and surgery.

 

Pharmaceutical therapy

Treating KCS medically is important for increasing tear production, applying artificial tears, reducing any bacterial infections, and decreasing inflammation and scarring of the cornea.

Replacement therapy includes:

  • Artificial tears, used to wet the eye must be applied frequently each day to eliminate bacteria, rinse the eyes, and remove discharge. These preparations are slightly viscous drops that wet the eye, rather than dropping instantly away like water would. The problem with these artificial tears is that they have to be applied to the eye very frequently to be successful. Typically this means every 2 hours, although more frequently is desirable if it is at all possible. There are a number of brands available, including Viscotears, Hypromellose and Lacrilube.
  • Eye ointments and drugs that work by stimulating the tear gland to produce more tears
    • Cyclosporine A (Restasis) - cyclosporine ophthalmic emulsion or (Optimmune) - ointment that is applied to the eye usually twice a day. Optimmune is usually very successful in managing KCS, and an increase in tear production is usually seen within one month of the start of its use. This drug restores natural tear production and is preferable to any other form of treatment, and in the vast majority of cases is the treatment of choice.
      • Cyclosporin A is a powerful suppressor of the immune system, and when applied to the eye acts to prevent the immune system from destroying the tear glands, without effecting the rest of the dog’s immune system. In very advanced cases, where all of the tear glands have been destroyed, this drug is not effective.
    • Tacrolimus ophthalmic suspension
    • Pilocarpine, given orally to stimulate tear production by the tear glands. It has proved useful when nerve damage is the cause of the KCS, but otherwise is rarely used anymore.
  • Sodium hyaluronate (Hy-Optic by Kinetic Technologies) and hyaluronan (I-Drop Vet PLUS by I-MED Pharma Inc.) are prescribed drugs that help relieve discomfort, itching, and burning
  • Mucolytics (a class of drugs that act by decreasing the mucous production and the density of mucous or viscosity)

 

Surgery

Surgery may include Parotid Duct Transposition, an operation to move the salivary duct from the mouth up to the eye, so that the eye is kept wet by saliva rather than tears. Normally the parotid salivary gland empties saliva into the mouth. If this gland is working properly, and has not been affected by the cause of the KCS, this operation can be performed by a specialist eye surgeon. The surgery is helpful for those dogs that remain persistently in pain and squinty despite trying all forms of medical therapy.

Parotid Duct Transposition does not cure the KCS completely and life long medication will be administered to keep the eye and face clean and to manage the condition of the affected eyes.

 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 cannot be as well controlled
  • saliva salt crystals can form in the eye

For this reason, a Parotid Duct Transposition should not be undertaken lightly, and only after medical treatment has proven unsuccessful.

 

Treating Dogs Affected with Dry Eye/Curly Coat (DE/CC) Syndrome

Most dogs diagnosed with Dry Eye/Curly Coat (DE/CC) Syndrome are euthanized. DE/CC dogs require consistent daily care and attention, including medicinal bathing to treat the skin disorder. No standardized medical treatment guidelines have been establishe for dogs with this condition.

 

Diagnosing KCS

created at: 2011-06-13Most cases of KVS have very characteristic symptoms that can resemble simple conjunctivitis. A correct diagnosis of KCS involves measuring the dog’s tear flow. This is done by the "Schirmer Tear Test", which takes just one minute.

The Schirmer Tear Test involves placing a standard paper strip between the lower eyelid and the eyeball for 60 seconds, and measuring the distance that the tears move along the strip. If the tears have moved more than 15mm, the dog is normal. If the tears have moved less than 10mm, the dog is considered to be abnormal and affected with KCS. In cases where the tears have moved between 10-15mm, affected individuals could be either normal or abnormal. In dogs that have very characteristic symptoms, the usual practice is to treat the eye symptomatically, and retest one month later if the symptoms have not subsided.

 


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