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.     

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.     

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.     

Keratoconjunctivitis sicca associated with administration of etodolac in dogs: 211 cases (1992-2002)

OBJECTIVE: To characterize features and response to treatment of keratoconjunctivitis sicca (KCS) associated with oral administration of etodolac in dogs. DESIGN: Retrospective case series. SAMPLE POPULATION: 65 cases obtained from a survey of veterinary ophthalmologists (group A) and 146 cases reported to Fort Dodge Animal Health (group B). PROCEDURES: Data analyzed included breed, sex, age, weight, dose and duration of etodolac administration, results of Schirmer tear test at the time of diagnosis and last follow-up, treatments, and response to treatments. Groups A and B were analyzed separately by use of forward stepwise logistic regression models developed to predict probability of complete remission or clinical improvement as a function of several variables. RESULTS: Most dogs developed severe KCS (84 eyes of 50 dogs [group A]; 111 eyes of 62 dogs [group B]). Resolution of KCS occurred in 7 of 65 (A) and 23 of 146 (B) dogs. No response to treatment was observed in 26 of 65 (A) and 27 of 146 (B) dogs. Fifty-one (A) and 52 (B) dogs had records that were sufficiently complete to use in models. In group B, dogs with etodolac treatment intervals < 6 months prior to the onset of KCS were 4.2 times as likely to have remission as were dogs with treatment intervals > or = 6 months. CONCLUSIONS AND CLINICAL RELEVANCE: Shorter duration of etodolac administration (< 6 months) was associated with improved outcome in 1 population of dogs. Monitoring of tear production should be considered prior to and during administration of etodolac 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 in the dog produced by oral phenazopyridine hydrochloride

Phenazopyridine hydrochloride is a widely used urinary analgesic in man. Its use in the dog is followed by ketatoconjunctivitis sicca. The clinical, cytological and histopathological features of this keratoconjunctivitis sicca and toxic adenopathy of the lachrymal and nictitans gland and the glands of Moll are presented. Résumé. L'hydrochloride phénazopyridine est un analgésique urinaire très utilisé chez l'homme. Son emploi chez le chien entraine une Kératoconjonctivite sèche. On présente les caractéristiques cliniques, cytologiques et histopathologiques de cette Kératoconjonctivite sèche et de I'adénopathie toxique de la glande lacrimale et nictitante et de la gland de Moll. Zusammenfassung. Phenazopyridin hydrochlorid ist beim Menschen ein weitgebrauchtes Harnanalgetikum. Seinem Gebrauch im Hund folgt Keratoconiunctivitis sicca. Die klinischen, cytologischen und histopathologischen Merkmale von diesen Keratoconiunctivitis sicca und toxischer Adenopathie der Tränen- und Nictitansdrüse und der Molldruse wurde dargestellt.     

Keratoconjunctivitis sicca: immunological evaluation of 62 canine cases

The etiology of keratoconjunctivitis sicca (KCS) in 62 dogs was evaluated, using immunologic techniques. Using direct fluorescent antibody testing, autoantibodies within the lacrimal, salivary, or pancreatic glands were detected in 5 of 8 dogs tested. Circulating antibodies to the nictitating membrane gland, main lacrimal gland, parotid salivary gland, or mandibular salivary gland were detected using indirect fluorescent antibodies in 9 of 31, 3 of 31, 5 of 31, and 5 of 31 sera, respectively. Using radial immunodiffusion, hyper-gamma-globulinemia was detected in 21 of 30 dogs with KCS. Antinuclear antibodies, primarily in a nucleolar pattern, were demonstrated in 20 of 50 dogs with KCS. Lymphocytic infiltrates were evident in 5 of 9 labial salivary biopsies, 2 of 4 parotid gland specimens, 2 of 4 mandibular gland specimens, and 2 of 3 thyroid gland specimens taken from dogs with KCS. Autoimmune diseases had been previously documented in 4 of 62 dogs. Twenty-five of the 62 dogs (40%) had concurrent problems indicative of an underlying immunologic disorder.     

Keratoconjunctivitis sicca associated with fracture of the stylohyoid bone in a horse

Keratoconjunctivitis sicca developed in a mare with fracture of the stylohyoid bone. Treatment was directed at preserving the health of the globe while local inflammation at the fracture site was resolved.     

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.     

Canine neurogenic Keratoconjunctivitis sicca: 11 cases (2006-2010)

Objective To describe the clinical data of dogs with neurogenic Keratoconjunctivitis sicca (KCS) and an ipsilateral dry nose without other neurologic deficits. Procedure The retrospective case study included 11 dogs diagnosed with neurogenic KCS and an ipsilateral dry nose between 2006 and 2010. Medical records were reviewed for breed, age, sex, history, suspected cause of neurogenic KCS, clinical signs, and treatment modalities. Follow‐up information was obtained by re‐examination of patients or completion of a telephone survey with the referring veterinarian or the owners. Results Mean age of the dogs was 6.6 ± 4.5 years. Neurogenic KCS was diagnosed in three females, five spayed females, one male, and two castrated males representing 10 different breeds. Ophthalmic signs of KCS (mean Schirmer tear test [STT] value of 1.9 ± 2.9 mm/min) combined with an ipsilateral dry nose were diagnosed in seven left and four right eyes. The suspected cause of neurogenic KCS was idiopathic in nine and trauma in two cases. Systemic therapy consisted of oral pilocarpine 1–2% eye drops combined with case‐specific topical treatment with cyclosporine 0.2% and tear substitutes. Duration of systemic treatment with pilocarpine until healing was 125 days (range 84–204, median 98 days) for five dogs. One dog was lost to follow‐up, and the remaining five dogs are still under systemic treatment with pilocarpine. Conclusions Neurogenic KCS with an ipsilateral dry nose seems to be a predominantly idiopathic disease of middle‐aged female dogs without breed predisposition, which may be self‐limiting in some cases.     

Keratoconjunctivitis sicca in the dog associated with the administration of salicylazosulphapyridine (sulphasalazine)

Thirteen cases of iatrogenic and bilateral keratoconjunctivitis sicca following the administration of the sulphonamide salicylazosulphapyridine (sulphasalazine) for the treatment of colitis were studied. No breed, age or sex incidence was noted in this series, unlike in keratoconjunctivitis sicca cases due to other causes. The lacrimotoxic effect of sulphasalazine was permanent except in one case and it is suggested that dogs on this drug should be monitored for tear secretion at regular intervals. Reports of a similar association between keratoconjunctivitis sicca and this drug and between the disease and other sulphonamides and compounds are discussed.     

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.     

Infrared ocular thermography in dogs with and without keratoconjunctivitis sicca

Infrared thermography was used to measure temperature differences of the corneal surface between nasal and temporal limbus regions and central cornea of normal dogs and dogs with keratoconjunctivitis sicca (KCS), in order to establish temperature values in normal canine eyes and in patients with decreased Schirmer tear tests (STT) values. Dogs investigated were all either patients seen at the Veterinary Teaching Hospital of Federal University of Paraná or normal dogs that belonged to the same institution. STT were performed in all eyes. A total of 40 control eyes (STT ≥15 mm/min) and 20 eyes with low STT values (STT ≤14 mm/min) were examined. The mean STT value for eyes with normal STT values was 22.9 ± 3.9 mm/min (mean ± standard deviation), and the mean STT value for eyes with low STT value was 7.2 ± 4.8 mm/min. The mean corneal temperature was significantly lower in eyes with low STT values than in control eyes (P < 0.0001). The following significant correlations were found: (i) Schirmer and breakup time (BUT) (P = 0.0001, r = 0.5); (ii) STT values and corneal surface temperature (P = 0.001, r = 0.256); (iii) STT values and age (P = 0.0001, r = ?0.448); (iv) age and corneal surface temperature (P = 0.0001, r = ?0.281); and (v) BUT and corneal surface temperature (P = 0.0001, r = 0.36). Thermography is a method that can differentiate between eyes with normal and abnormal STT values. In the future, thermography might be incorporated as part of the ophthalmic examination and perhaps become a popular ancillary test for the diagnoses of ocular surface disorders.