Louie, a 5 year old male neutered Shih Tzu, presented for about a 2 week history of eye discharge. His owner reported that the discharge started out mild and he was able to clean his eyes using warm water and a washcloth. According to the owner, the discharge has now gotten to the point where he cannot keep up with the amount of discharge and Louie now has a degree of eye irritation apparent. The owner had just rescued Louie about 2 weeks ago and he has had these issues ever since. Louie is otherwise eating, drinking, and acting normally at home.
On physical exam, Louie had severe yellow mucoid discharge from both eyes and discharge crusted around them. There was hair loss around both of his eyes as well as evidence that he had been rubbing his eyes at home due to the degree of redness. The rest of the physical exam was within normal limits.
Recommended an ocular work-up to determine a cause for Louie’s eye discomfort. Owner consented.
A Schirmer Tear test, which measures the amount of tear production was performed. An eye with adequate tear production produces a result of >15 mm. Louie’s tear test results were 9 mm in both eyes. Therefore, it was determined that Louie has a condition called dry eye or Keratoconjunctivitis sicca.
Keratoconjunctivitis sicca (KCS or “dry eye”) is a disease that results when the eye does not produce enough tears. This results in the outermost layer of the front of the eye (cornea) as well as the conjunctiva (membranes around the eye) to become dry and inflamed. The dryness and inflammation can result in discomfort and secondary issues such as corneal ulceration. If left untreated, this condition can even lead to blindness. Therefore, it is important that your pet be examined by a veterinarian as soon as possible if any redness or squinting of the eyes and/or recurrent thick, yellow ocular discharge is noted.
KCS more commonly affects dogs and appears disproportionately more often in certain breeds such as the Cocker Spaniel, Shih Tzu, and Pug. The most common cause is immune-mediated, where the dog’s own immune system is “mistakenly” attacking the tear-producing glands and reducing their function. Therefore, the mainstay of treatment is focused on suppressing the immune system at the level of the eye to slow the attack down.
KCS is a chronic disease for which there is no cure. However, with medication given at home, the majority of dogs with the disease will maintain normal vision, have comfortable eyes, and the discharge will resolve completely. When this disease is identified early and treated appropriately, it can be kept at bay and affected dogs can enjoy a normal quality of life and life expectancy.
Louie was started on Cyclosporine ophthalmic ointment (an immune suppressing drug), an antibiotic eye drop to prevent any secondary infections, and artificial tear therapy. His ocular discharge and crusting has greatly improved at home so far but he will return in 3- 4 weeks to recheck his tear production and assess his response to the medication.