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Keratoconjunctivitis Sicca

By: Laura Switkowski, LVT

Keratoconjunctivitis Sicca, also known as KCS, is an ophthalmic disease in pets that causes dry eye. This disease is more common in dogs than in cat, and also can be more common in certain breeds of dogs such as Cocker Spaniels, Shih Tzus, and West Highland Terriers. The cause of dry eye is unknown, but it is known that the pet’s immune system attacks the lacrimal gland, which is the main producer of tears.

Symptoms and Testing for KCS

Symptoms of dry eye include thick green or yellow mucopurelent discharge from the eyes, conjunctivitis, neovascularization on the cornea, and a dull cornea. The way to diagnose KCS is to perform a Schirmer Tear Test. This test is performed by placing a Schirmer Tear Test strip, which is a strip of paper labeled zero to thirty, and placing it in the inferior fornix, also known as inside the lower eyelid, for a total of sixty seconds. After sixty seconds, the number on the strip is recorded. A normal Schirmer Tear Test should be between 15mm/min up to 25mm/min. If the test reads below 15mm/min the diagnosis is Keratoconjunctivitis Sicca.

Treatment for KCS

Treatment for KCS can vary due to the severity of the case. Most often, immune mediated eye drops are used in order to get the pet’s immune system to stop attacking the lacrimal gland. Examples of these medications are Cyclosporine, Tacrolimus, and Optimmune. These medications are life long and should not be stopped unless directed by a Veterinarian. Since these medications allow the production of tears to increase, if the medications are discontinued, the tear production will fall to below average again. These medications can take up to 4-6 weeks before improvement is noted, therefore, topical lubrications may be used until the immune mediated medications take effect. Lubricants such as Artificial Tear ointment, Genteal Gel, or Optixcare are often used to lubricate the eyes. Antibiotic drops may be used additionally in order to offset any secondary bacterial infection that may have occurred. Bacterial infections are common with KCS because tears are used to flush bacterial and foreign material out of the eye. With KCS, there is a lack of tears to flush bacteria out.

Tear production should be retested in about 6 weeks to be sure that the medications are helping increase tear production. If tear productions are still low, the percentage of the medication may be increased or other medications may be tried to find the correct medication for the pet. It is important to increase tear production for the pet not only because discomfort can result from consistent dry eye, but it can also permanently affect vision. If eyes are dry and irritated for too long, the body will lay down brown pigment onto the cornea. The brown pigment on the cornea is very difficult to see through; it is like driving with a muddy windshield. If this is the case, the medication Tacrolimus may be prescribed because it increases tear production, and helps to thin out the brown pigment, which can help improve vision.

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