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Old 07-10-2009, 03:20 PM
 
Location: Naples, FL
376 posts, read 1,718,860 times
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Good afternoon all,

Anyone living with this? Vet thinks my little buddy may have this. Right now we are treating for a corneal ulceration that she thinks may be caused by KCS, but won't be able to test for same until this treatment done. Can it be spread to other eye? Other dogs? Expensive or difficult to live with? If you could share your experience, would greatly appreciate it. Thanks for your help.
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Old 07-10-2009, 04:45 PM
 
7,079 posts, read 36,428,332 times
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Brachycephalic dogs (dogs with flat faces) frequently have problems with keratoconjunctivitis sicca (KS, also called dry eye) OR with eyelashes or nose roll hairs that irritate the eye. My pug has a nose-roll hair issue.

Both of these conditions can result in pigmentary keratitis, which means that the irritation produces an immune reaction that, in turn, produces the formation of a dark pigment, starting at the nasal border of the eye and gradually enlarging toward the temporal edge, effectively blinding the dog.

The only thing that works to prevent this is liberal use of lubricating ointment and cyclosporine (Optimmune). My pug gets lubricant three times daily and cyclosporine ointment twice daily (and always with chicken before and after!). But I do worry about his eyes, because they're also very vulnerable to injury: while other dogs can poke their noses into things to check out what's going on, if pugs do this, they often injure their eyes, because there really IS no muzzle!

KS isn't a contagious condition: it's due to structure/anatomy of the skull and face of the dog. You're going to have to watch for this every single day, and be very aggressive with the lubricant.

Lubricants come in many formulations (drops, ointments, gels) but the ointments are the best, because their effects last the longest. Drops may be easiest to put in (at least in the beginning) but they don't have long-lasting activity. It's worth it to train your dog to let you put in ointments.

You'll need chicken (tiny pieces are fine), and a quick hand. You'll get quicker with practice, so don't get discouraged if you don't have much success right off the bat!

This is a well-known problem with the brachycephalic breeds, which is why it's important to research every dog breed before committing!
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Old 07-10-2009, 04:46 PM
 
4,116 posts, read 10,543,599 times
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Hi - we have 2 Shih-Tzus. One with no eye problems, one who has had recurrent corneal ulcers. We brought her to the doggie ophthamologist and she was diagnosed with entropian lashes. These are lashes that grow inside the eyelid, causing irritation and ulcers. Our dog had surgery on both eyes yesterday! She is doing wonderfully and recovering nicely. I would definitely recommend finding out if there is a canine eye specialist in your area.
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Old 07-10-2009, 05:10 PM
 
7,079 posts, read 36,428,332 times
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Try this to find a veterinary ophthalmologist: Locate an Ophthalmologist (http://www.acvo.org/locate_an_ophthalmologist.htm - broken link)
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Old 07-11-2009, 12:08 AM
 
Location: Chicago
6,025 posts, read 14,430,829 times
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my old shih tzu had this issue and was partially blind b/c of it. I remember the ointment we got for her wasn't terribly expensive (less than $20, I want to say around $10, but not 100% sure). she was pretty good about sitting still long enough for me to apply the ointment (I had to pull out her lower eyelid to apply it then very gently rub it in). her eyes always produced a lot of greenish gunk that had to be cleaned off every day, but over time, the ointment took care of this (note sure if it was connected or not). this, along w/ the fact that she HATED to be groomed, was the reason why we kept her clipped very short year round. the hair around her face was kept short and away from her eyes
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Old 07-11-2009, 09:23 AM
 
Location: Georgia
399 posts, read 2,146,797 times
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It is a condition known in the veterinary world as KCS. It is extremely common in particular breeds such as the Cocker Spaniel, Lhasa Apso, Shih Tzu, pugs, English bulldogs among others. It is a painful, painful condition and can lead to scarring of the cornea.

For many possible reasons, the eye(s) are not producing the water part of the tear. What is left of the tear is the mucous part ---- and we all know what happens when there is no water in mucous....it leaves basically what grows in your nose...a boogie! Just kidding, but that's basically it in a nutshell....the tear has an incredible amount of water in it and only a tiny amount of the mucous part.

The hospital that I worked at had a veterinary opthamologist come see our patients at our hospital for two days each month and I had the pleasure of helping her. In her opinion what we were already doing was the ideal treatment.....dispensing cyclosporine eyedrops which is basically Cyclosporine suspended in a particular oil. The Cyclosporine helps the eye resume making the water part of the tear again, and some but not all dogs can eventually get fewer treatments daily. The ointment, in her opinion, didn't quite work as effectively as the eyedrops. Occasionally she would recommend an antibiotic eye ointment in addition to the Cyclosporine drops.

We routinely flushed the eye with a saline solution before the Cyclosporine drops, to remove the thick mucousy buildup in the eye which help the drops do a better job. I know that we found it to be terribly easy and not a problem, but I understand a typical owner might not really feel that way. The Cyclosporine eye drops are pretty pricey, as is the Cyclosporine ointment.....I feel you would end up better $$$wise with the drops.

It is important to have a Schirmer tear test done every so often to assess how well the condition is improving. Your dog can have beautiful, glassy clear corneas if you stay on top of treatments. I don't know where you are located, but the opthamologist that I worked with was phenomenal!!
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Old 07-11-2009, 10:01 AM
 
7,079 posts, read 36,428,332 times
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Again, to reiterate what I stated in my post:

The OINTMENT is much more effective for treating keratoconjunctivitis sicca (KCS) than the drops! It takes a little more effort to work with your dog to get the ointment in, but it's worth it.

In addition, it should be noted that in addition to cyclosporine, sirolimus, another immunosuppressant, is also available, should the cyclosporine not be effective. Ophthalmologists (note that this is one of the few English words with 'phth') have been very aggressive in treating this, with excellent results.
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Old 07-11-2009, 10:20 AM
 
Location: Georgia
399 posts, read 2,146,797 times
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Sorry, the veterinary opthalmologist that I worked with was insistant that the Cyclosporine drops were by far more effective. Because there is a grey line were veterinarians are compounding their own suspension drops after an ointment became available (and I remember when it did come out on the market)...some are hesitant to make their own drops, even though the ointment wasn't nearly as effective. I'm not going to spout what was not relayed to me and she is a well-known opthalmologist. The ointment does help keep the eye lubricated longer, but you can also get an ointment for that, just to keep the eye lubed.

Here's a reference for ya:

Cylosporine 2 % solution is the most commonly utilized drop formulation that stimulates tear production to effectively manage KCS, and remains my preferred treatement. In cases where the patient inadequately responds to cyclosporine, then tacrolimus drops are a good second option, with potential for successwhere cyclosporine has fallen short. Tacrolimus is an acceptable first option for treatment as well as cyclosporine, but due to its higher cost and occacional lack of availability, I tend to reserve it only for patients that do not respond to cyclosporine.



here's another:

[SIZE=1]Since 1987 we have used a drug called Cyclosporine to accomplish all three objectives. This relatively new drug is considered a breakthrough in the treatment of this disease, since it is about 75% effective in stimulating new tears in dogs. Although veterinary ophthalmologists have been using Cyclosporine to treat dry eye for years, the 2% solution is not yet approved by the FDA for use in the eye. Therefore, 2% solution is compounded by an approved pharmacy; a 0.2% ointment is commercially available (Schering) but many of our cases are very severe and require the more potent concentration of cyclosporine.[/SIZE]
[SIZE=1][/SIZE]
[SIZE=1][/SIZE]
[SIZE=1][/SIZE]
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Old 07-11-2009, 11:19 AM
 
7,079 posts, read 36,428,332 times
Reputation: 4076
Thanks, but one of my best friends is a veterinary ophthalmologist and my dog has seen two veterinary ophthalmologists in NYC and they all prefer the ointment.

It might be that for KCS it produces more tears (although I haven't seen any head-to-head clinical trials in the literature), but my dog has nose roll issues, and and excellent Schirmer tear test results. It's not KCSm so we take advantage of the extra lubrication of the ointment.

And here's at least ONE published paper comparing cyclosporine and pimecrolimus (which is very similar to tacrolimus) and the conclusion, in this head-to-head study, was that the tacrolimus cognate (pimecrolimus) is superior: http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum
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Old 07-11-2009, 12:08 PM
 
Location: Georgia
399 posts, read 2,146,797 times
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But you aren't every pet owner, nor do you know every opthalmologist. The thing is is mine SAID that the drops are far more superior, less expensive, not to mention easier for all........BUUUUUUTTTTT, since there is a licensed product available - the ointment - she felt her hands were tied....as an opthalmologist. The ointment is in a .2% formulation....the drops are BY FAR stronger. And when you see so many dogs with complete lack of tear production, frustrated owners, painful and crusty eyes....you do what is best. Your dog may have had a decreased tear production and you may have more money to pay for the weaker formulation...and it is good that the ointment works just fine for your dog. Many pets have inherited the condition, yours might not be one, but many are. But to tell someone that the drops AREN'T better...that's just wrong? I've seen pigmented corneas regain 'some' transparency over time. Most dogs were always on an antibiotic eye ointment for the infection part in the initial stages so they did have ointment lubrication, but the maintenance of the Cyclosporine drops usually prevented that need because so many dogs were able to regain their proper tear production on the eyedrops and the proper tear production lubricates the eyes normally...you don't need additional lube. And lots of owners were able to eventually reduce treatment drastically.

I've seen all walks of life come into the vet and not all have a huge income...and some of our best clients devoted the majority of their small income to their babies...spent their last dime, and I guess we were sensitive to lots of needs of our various clients and patients. Our hospital was top-notch, AAHA, tons of continuing eductation for all staff, exceptionally equipped for a veterinary hospital, and we did many drug trials there for many products on the market today. I certainly don't want to get in a spitting match but there are many, many opinions out there, and many more opinions on those opinions. Cyclosporine eyedrops are very effective, a better product, more economical and much easier to apply --- in many people's opinions. It is okay that I have mine, right?


Here's another:
[SIZE=2][SIZE=2][LEFT]In conclusion, eye drops containing 0.05%
cyclosporrine was stable, homogeneous, clearness
without sedimentation, suggesting that the drops
posses reliable quality and can be supplied with low
prime cost. In addition, dogs treated with 0.05%
cyclosporine showed better results in clinical test
than dogs with 0.025% cyclosporine. Based on these
results, eye drops containing 0.05% cyclosporine
may be applicable in the field of Veterinary
Ophthalmology for the treatment of KCS.[/LEFT]
[/SIZE]
[/SIZE]
[SIZE=2][SIZE=2][LEFT]Reference[/LEFT]
[/SIZE][/SIZE][SIZE=2][SIZE=2][LEFT]1. Wilcock, 2007. Jubb, Kennedy & Palmer's[/LEFT]
[/SIZE]
[/SIZE]
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