Keratoconjunctivitis sicca and diabetes mellitus in a dog.

Diabetes mellitus and keratoconjunctivitis sicca were diagnosed in a female Poodle. The dog was treated for diabetes and keratoconjunctivitis sicca until blood glucose concentrations were within normal limits. Treatment for keratoconjunctivitis sicca was suspended then, and signs of this disorder did not appear again. Most of the factors known to predispose to keratoconjunctivitis sicca were not applicable to this dog. On the basis of observations made in this dog, we suggest that diabetes mellitus and keratoconjunctivitis sicca may be linked. Clinical signs of the disorders developed simultaneously and resolved when diabetes mellitus was controlled with insulin.     

Biomicroscopy of the tear film: aqueous and lipid tear substitutes in the normal and abnormal eye

Polarised light biomicroscopy was used to assess the behaviour and interactions of two polymer-containing preparations of artificial tears, and two lipid-containing ointments, with the normal and abnormal pre-corneal tear film. The preparations were used topically in six normal dogs, and three dogs with keratoconjunctivitis sicca. A transient morphological alteration of the surface lipid layer of the tear film was commonly observed after the use of polymer solutions. The ointments spread as a continuous or semi-continuous layer over the normal, or polymer-supplemented, aqueous tears. Further applications of artificial tears produced only a temporary disruption of this layer. In dogs with keratoconjunctivitis sicca, thickening of the lipid layer of the tear film was observed for over 20 hours after the administration of ointment. These observations are discussed in relation to the prospects for the improved medical treatment of keratoconjunctivitis sicca by the use of polymer-containing solutions and ointments in combination.     

Congenital keratoconjunctivitis sicca and ichthyosiform dermatosis in the cavalier King Charles spaniel

OBJECTIVES: To record a previously unreported congenital and hereditary condition affecting the eyes and skin in the cavalier King Charles spaniel. METHODS: Nineteen cases (13 litters) were investigated, with particular reference to eye and skin clinical signs. In addition, five generation pedigrees were obtained and studied from all cases with the exception of one. RESULTS: The eye signs were due to keratoconjunctivitis sicca, a common ocular disease in the dog, but rarely of congenital origin. The skin signs were of an ichthyosiform dermatosis; ichthyosis being a rare skin disease in the dog. In human beings, ichthyosis is a similar disease, mainly inherited and with a neonatal onset, and sometimes accompanied by other developmental defects. In the cavalier King Charles spaniel, the coat abnormality was noted at birth by the breeders as a 'curly coat', with deterioration of the skin signs as the animal became adult. CLINICAL SIGNIFICANCE: These two conditions occurring together in this breed is well recognised by some breeders but rarely by the veterinary profession. Successful treatment is not possible, although some improvement, particularly of the keratoconjunctivitis sicca, can be obtained. The probable hereditary nature of the condition is an important factor for control.     

Keratoconjunctivitis sicca in the dog: a review of two hundred cases

Two hundred consecutive referred cases of keratoconjunctivitis sicca in the dog were examined over a 9 year period. The clinical signs are described and the cases discussed in sections relating to the aetiology and in particular, the age and sex incidence in the West Highland White Terrier. The suitability of this animal as a model for Sjögrens syndrome in man is discussed.     

Breed predisposition to congenital alacrima in dogs

Objective  To evaluate the clinical characteristics and breed predisposition of congenital alacrima in dogs.
Animals studied  Dogs with congenital keratoconjunctivitis sicca.
Procedures  A search of the medical records of the University of Tennessee Veterinary Teaching Hospital from 1974–2005 and the University of California–Davis Veterinary Teaching Hospital from 1986–2006 for dogs under 1 year of age with a diagnosis of keratoconjunctivitis sicca (KCS) was performed. These cases were further reviewed for dogs with a Schirmer's tear test I of ≤ 5 mm/min before 6 months of age, with no known causes for KCS, which did not respond to appropriate KCS therapy; these cases were considered to have congenital alacrima. These breeds were compared to all other breeds using the Fisher's exact test with correction for multiple comparisons.
Results  Congenital alacrima was identified in 19 dogs representing 11 breeds and mixed breeds. Yorkshire Terriers and Bedlington Terriers were statistically overrepresented compared to reference populations ( P  < 0.01 and P  = 0.04, respectively).
Conclusions  Yorkshire terriers are significantly at risk for congenital alacrima compared to other breeds. The significance of the increase in congenital alacrima in Bedlington Terriers in this study may not be clinically relevant and may be due to the small total number of dogs of this breed that presented to the both hospitals. Based on the poor response to therapy in humans with congenital alacrima, it may be prudent to offer guarded prognoses for KCS in juvenile Yorkshire terriers.     

Feline herpesvirus ocular disease

Infection by FHV-1 is one of the most common ophthalmic diseases of domestic cats worldwide. Although the usual manifestations are conjunctivitis and keratitis, infection with this virus has been linked to a variety of other ophthalmic syndromes of cats, including keratoconjunctivitis sicca and corneal sequestration. Ocular FHV-1 infection of cats provides a significant diagnostic challenge to the practicing veterinarian because, in chronic cases, antigen detection tests often yield negative results. Although therapy for FHV-1 infections of cats is often difficult, the recent development of nontoxic antiviral drugs that demonstrate considerable efficacy against FHV-1 offers hope for improved therapeutic success in the future.     

Superficial keratectomy and topical mitomycin C as therapy for a corneal squamous cell carcinoma in a dog

A 10-year-old female West Highland white terrier was presented with refractory hyperplastic keratitis of the left cornea of one month's duration. At this time, a vascularised and rough lesion 5 mm in diameter was observed on the left cornea. No other abnormality was recognised on the affected eye. The corneal neoplasm was surgically removed and histologically diagnosed as a squamous cell carcinoma. For two months after the surgery, 0.04 percent mitomycin C (MMC) eye drops were applied as adjuvant chemotherapy. Primary corneal squamous cell carcinoma with no history of keratoconjunctivitis sicca is rare in dogs. In the present report, surgical removal of the neoplasm was combined with the topical administration of the anticancer drug mitomycin C and a good prognosis was obtained. The result indicates that the combination treatment used in this case may be an appropriate therapeutic choice for corneal squamous cell carcinoma in dogs.     

Keratoconjunctivitis sicca exacerbation in a dog treated with systemic atenolol

A 6‐year‐old, intact, male English cocker spaniel was referred for treatment of chronic conjunctivitis and unilateral keratitis. The dog was diagnosed with bilateral immune‐mediated keratoconjunctivitis sicca, treated with topical cyclosporine 0·2% ointment and sodium hyaluronate eye drops and improved considerably. After 2 months, pulmonic stenosis was diagnosed, and the dog commenced treatment with oral atenolol; the ophthalmological disease worsened dramatically within a few days. The ophthalmic signs rapidly improved after discontinuation of atenolol, and there was bilateral complete remission after 3 weeks. No oral β‐blocker therapy was reintroduced, and thereafter, keratoconjunctivitis sicca was well‐controlled with topical therapy.     

Keratoconjunctivitis sicca: histopathologic study of nictitating membrane and lacrimal glands from 28 dogs

Forty nictitating membrane glands and 9 main lacrimal glands were obtained for histologic evaluation from 28 dogs with keratoconjunctivitis sicca as the result of azosulfapyridine toxicity, canine distemper, multisystemic autoimmune disease (Sj?gren's syndrome-like syndrome), congenital origin, and unilateral and bilateral idiopathic keratoconjunctivitis sicca. Similar glands from 6 control dogs were studied. The most prevalent (87%) histopathologic finding was variable degrees of multifocal chronic adenitis, characterized by acinar atrophy and replacement with increased numbers of plasma cells and lymphocytes within increased amounts of interacinar fibrous connective tissue stroma. Occasional tubular structures were dilated and filled with neutrophils and cellular debris.     

Squamous cell carcinoma of the corneoscleral limbus in a dog.

Squamous cell carcinoma is an uncommon tumor of the cornea in dogs. A 12-year-old Shih Tzu with a history of chronic keratoconjunctivitis sicca was diagnosed as having squamous cell carcinoma of the corneoscleral limbus. The lesion was treated by surgical resection and cryotherapy. One year after surgery, multiple tumors, apparently unrelated to the first tumor, appeared on the same cornea. Keratoconjunctivitis sicca may have predisposed the dog to corneal squamous cell carcinoma development.     

Keratoconjunctivitis sicca associated with sulfonamide therapy in dogs

During a 4-year period, keratoconjunctivitis sicca developed in 14 dogs treated with sulfonamides (13, sulfasalazine; 1, sulfadiazine and trimethoprim). Diagnosis was made in 3 dogs by clinical signs and in 11 by evaluation of the Schirmer tear test. Management of the problem included discontinuance of the sulfonamide, then use of ophthalmic preparations topically and antibiotics systemically. Pilocarpine was administered orally and topically to 11 dogs, with variable success. Lacrimation remained inadequate in 10 dogs and returned to normal in 3. One dog was lost to follow-up. Parotid salivary duct transpositions were performed in 3 dogs (in 2 successfully) with severe, unresponsive keratoconjunctivitis sicca.     

Intra-canalicular gelatin implants in lacrimal punctum surgery

Implants of gelatin rods into the lacrimal canaliculus have been used in the human as a means of assessing the advantages of permanent punctum occlusion in cases of keratoconjunctivitis sicca. Their use in the dog is suggested in similar circumstances but more especially following surgery of the puncta and canaliculi where haemorrhage might produce further post-operative occlusion.     

Reduced tear production in three canine endocrinopathies

OBJECTIVES: Previous reports have suggested that hypothyroid and diabetic patients can be predisposed to keratoconjunctivitis sicca. This study aimed to measure tear production in dogs with diabetes, hypothyroidism and hyperadrenocorticism using the Schirmer tear test and to compare these results with Schirmer tear test values for a group of normal dogs. METHODS: Schirmer tear tests were performed on 16 dogs with hyperadrenocorticism, 18 with diabetes and 12 with hypothyroidism together with 100 control dogs. Corneal sensitivity was also measured in 12 of the 18 diabetic dogs with a Cochet Bonnet aesthesiometer and compared with age- and breed-matched normal dogs. RESULTS: Schirmer tear test values in dogs with hypothyroidism, hyperadrenocorticism and diabetes were 12.3+/-3.2, 14.0+/-4.0 and 12.3+/-5.3 mm/minutes, respectively. Schirmer tear test values were significantly lower than that for the control group (19.6+/-4.2 mm/minutes) in all dogs with an endocrinopathy. Only in two hypothyroid dogs and three diabetics, this was manifested as profound keratoconjunctivitis sicca with Schirmer tear test value lower than 5 mm/minutes. Diabetic dogs had significantly reduced corneal sensitivity compared with a matched set of control dogs. CLINICAL SIGNIFICANCE: This study shows a significant reduction in tear production in animals with diabetes mellitus, hypothyroidism and hyperadrenocorticism. Further research is needed to elucidate the mechanisms by which this reduction in tear production occurs. Assessment of tear production should be undertaken in animals diagnosed with these endocrinopathies, as these animals may progress to clinical keratoconjunctivitis sicca.     

Use of conjunctival pedicle grafts in the management of feline keratitis nigrum

Feline keratitis nigrum (necrosis, sequestrum or sequestration) usually presents as a black plaque in the axial or paraxial cornea. Most cats can be treated by excision of the lesion and covering the defect with a third eyelid flap. This technique did not provide satisfactory results in some cases. This paper describes microsurgery using conjunctival pedicle grafting following keratectomy to provide a one step technique to manage recurrent feline keratitis nigrum, feline keratitis nigrum with full thickness lesions of corneal stroma and eyes also affected with keratoconjunctivitis sicca.     

Polarized light biomicroscopic observations on the pre-corneal tear film. 2. Keratoconjunctivitis sicca in the dog

Polarized light biomicroscopy was used to examine the pre-corneal tear film in 16 dogs which were suspected of, or confirmed to be, suffering from keratoconjunctivitis sicca. One animal displayed a normal tear film, while the other 15 showed variable degrees of abnormality. The abnormal features included: contamination of the ocular surface with particulate debris and plaques of mucus, discontinuity and excessive granularity of the surface lipid film, pronounced thinning of the aqueous phase, and breakup of the tear film. After parotid duct transposition, the tear film of some animals was almost indistinguishable from normal. However, in others the surface lipid layer was thinned, discontinuous, or virtual absent. Discontinuity of surface lipid was most obvious in animals with marked salivary epiphora, and was associated with a variable amount of crystalline concretion over the ocular surface. The clinical usefulness of polarized light biomicroscopy for the diagnosis, and subsequent monitoring, of keratoconjunctivitis sicca is discussed.     

The use of hydrophilic contact lenses in corneal diseases of the dog and cat: A preliminary report

ABSTRACT
Two types of hydrophilic contact lenses were tested in dogs and cats as part of the therapeutic régime of recurrent corneal erosions, superficial corneal ulcers and keratoconjunctivitis sicca. It was found that the lenses are well tolerated by these species when properly fitted to the cornea. If the lenses were not properly fitted, they were lost before their therapeutic effectiveness could be evaluated. The use of hydrophilic contact lenses appeared to be beneficial in the treatment of superificial corneal ulcers and recurrent corneal erosions in the dog and cat, but ineffective in the treatment of keratoconjunctivitis sicca.     

Corneal stromal sequestration and keratoconjunctivitis sicca in a horse

A 19-year-old Shetland pony presented with unilateral ocular discomfort and abnormal ocular appearance. Keratoconjunctivitis sicca, ulcerative keratitis and brown discoloration of the corneal stroma were identified on ophthalmic examination. The etiology of keratoconjunctivitis sicca was not determined in this case. For practical and financial reasons, the owners requested enucleation of the affected eye. Histopathologic examination revealed extensive loss of corneal epithelium overlying a zone of hypereosinophilic, degenerate, and necrotic corneal stroma. This well-circumscribed region of corneal stromal sequestration was surrounded by stromal vascularization, and an intense inflammatory, predominantly polymorphonuclear, cellular infiltrate. The clinical and histopathologic features of this case were considered remarkably similar to those observed in feline corneal stromal sequestration.     

Topical administration of cyclosporine for treatment of keratoconjunctivitis sicca in dogs.

Sixty dogs with chronic keratoconjunctivitis sicca were treated by topical administration of 2% cyclosporine twice daily. Causes and duration of keratoconjunctivitis varied. Tear production improved in 75 of 100 eyes, and corneal pigmentation decreased in 45 of 67 eyes. Six factors were evaluated to determine their influence on treatment outcome. The only significant variable was the initial Schirmer tear test value. Side effects were few. Evidence of burning in response to application of cyclosporine resolved with change in the formulation of the topical solution.     

Tear-deficient and evaporative dry eye syndromes of the horse

Tear-deficient dry eye (keratoconjunctivitis sicca), and evaporative dry eye, with some overlap between these two categories, are two major categories of dry eye recognized in the horse. Careful examination of the eyelid margins, the inner and outer surfaces of the upper and lower eyelids, assessment of blink and third eyelid movement, specific testing of tear production, assessment of corneal sensitivity, and slit-lamp examination of the ocular surface before and after fluorescein dye application is recommended to detect dry eye problems. Rose Bengal dye application is also recommended in many cases. Facial nerve paresis is a possible complicating factor in some instances. Evaporative dry eye deserves closer scrutiny for it may be a contributory factor when ocular surface disease such as keratomycosis is present. Factors which influence ocular surface health need more close examination in horses.     

Evaluation of the Schirmer tear test in clinically normal rabbits

Mean (+/- SD) value for results of the Schirmer tear test without use of topical anesthesia on 142 rabbit eyes was 5.30 (+/- 2.96) mm/min; range was 15 mm/min, with low value of 0 and high value of 15 mm/min. Two SD from the mean provided a normal clinical range of 0 to 11.2 mm/min for inclusion of 95% of the population. Significant differences were not evident between eye (right vs left) or gender or among breeds; interaction among eye, gender, and breed also was not observed. Although mean values for 2 breeds were significantly different from values in the other 10 breeds and from each other, they were still within the proposed normal range of 2 SD. The Schirmer tear test without topical anesthesia may be useful in rabbits for evaluation of increased values correlated with ocular irritation, rather than for determination of decreased values associated with keratoconjunctivitis sicca.