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Iatrogenic keratoconjunctivitis sicca in a dog

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This document reports a case study of a 10-month-old male Boston Terrier that developed iatrogenic keratoconjunctivitis sicca (KCS) in its right eye. Three months prior, the dog had undergone surgery to remove its prolapsed third eyelid lacrimal gland. Upon examination, the right eye showed signs of dryness including mucous discharge, conjunctival hyperemia, blepharospasm, and a Schirmer tear test value of 0 mm/min, consistent with KCS. The diagnosis of iatrogenic KCS was based on the history of lacrimal gland removal and clinical signs. Removal of the third eyelid gland can cause KCS due

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Iatrogenic keratoconjunctivitis sicca in a dog. Ci棚ncia Rural, Santa Maria, v.34, n.3, p.921-924, mai-jun, 2004 921 ISSN 0103-8478 Iatrogenic keratoconjunctivitis sicca in a dog Ceratoconjuntivite seca iatrog棚nica em c達o Denise Eliza de Almeida1 Fabricio Villela Mamede2 Juan Pablo Duque Ortiz3 Jos辿 Luiz Laus4 - RELATO DE CASO - ABSTRACT redu巽達o da vis達o. Devido contribui巽達o significativa da gl但ndula da terceira p叩lpebra na produ巽達o da por巽達o aquosa do filme Qualitative and quantitative abnormalities in lacrimal, a remo巽達o desta gl但ndula, quando prolapsada, primary components of the tear can alter the dynamics of the constitui-se em importante causa de CCS iatrog棚nica. Este lacrimal film, compromising its function. Lipids, an aqueous trabalho relata um caso cl鱈nico de ceratoconjuntivite seca fraction and mucoproteins constitute the lacrimal film. iatrog棚nica, em um c達o da ra巽a Boston Terrier de 10 meses de Keratoconjunctivitis sicca (KCS) is a disease commonly idade, causada pela remo巽達o cir炭rgica da gl但ndula lacrimal da diagnosed in dogs. It is characterized by the deficiency of the terceira p叩lpebra, quando esta encontrava-se prolapsada. aqueous fraction in the lacrimal film that results in dryness, inflammation of the conjunctive and cornea with progressive Palavras-chave: ceratoconjuntivite seca iatrog棚nica, olho seco, corneal illness and reduction of vision and pain. Due to the prolapso da gl但ndula lacrimal. significant contribution of the third eyelid lacrimal gland to the production of the aqueous fraction of the lacrimal film, the removal of this gland when prolapsed is an important cause of INTRODUCTION iatrogenic keratoconjuctivitis sicca. This paper describes a clinical case of iatrogenic keratoconjuctivitis sicca in a 10 month- old Boston Terrier which was caused by the removal of the third Keratoconjunctivitis sicca (KCS) is a eyelid lacrimal gland due to its prolapse. chronic inflammatory disease frequently diagnosed in dogs and is caused by the deficiency of the aqueous Key words: iatrogenic keratoconjunctivitis sicca, dry eye, cherry eye. component of the lacrimal film (MOORE, 1998; RESUMO MORGAN et al., 1991; WILKIE, 1993). GELLAT et al. (1975), GELLAT (1991) and SAITO et al. (2001) Anormalidades quali-quantitativas em componentes reported that the production of the aqueous fraction prim叩rios da l叩grima podem alterar a din但mica do filme lacrimal, comprometendo sua fun巽達o. O filme lacrimal 辿 composto por of the tear is done by the main lacrimal gland (70%) lip鱈dios, uma fra巽達o aquosa e por mucoprote鱈nas. A and the third eyelid lacrimal gland (30%). ceratoconjuntivite seca (CCS) 辿 uma enfermidade freq端entemente Abnormalities within the quality and quantity of the diagnosticada em c達es, caracterizada pela defici棚ncia da fra巽達o aquosa do filme lacrimal, resultando em desseca巽達o e inflama巽達o aqueous component can alter the dynamics of the da conjuntiva e c坦rnea, dor, doen巽a corneana progressiva e lacrimal film and compromise its function 1 M辿dico Veterin叩rio P坦s-graduando do Programa de P坦s-gradua巽達o em Cirurgia Veterin叩ria, 叩rea de concentra巽達o em Cirurgia Veterin叩ria, Curso de Doutorado, Faculdade de Ci棚ncias Agr叩rias e Veterin叩rias (FCAV), Universidade Estadual Paulista (UNESP, Campus de Jaboticabal. 2 M辿dico Veterin叩rio P坦s-graduando do Programa de P坦s-gradua巽達o em Medicina Veterin叩ria, 叩rea de concentra巽達o em Cirurgia Veterin叩- ria, Curso de Mestrado, Faculdade de Medicina Veterin叩ria e Zootecnia, Universidade Estadual Paulista, C但mpus de Botucatu. 3 M辿dico Veterin叩rio, P坦s-graduando do Programa de P坦s-gradua巽達o em Cirurgia Veterin叩ria, 叩rea de concentra巽達o em Cirurgia Veterin叩- ria, Curso de Mestrado, FCAV, UNESP, Campus de Jaboticabal. 4 M辿dico Veterin叩rio, Professor Titular, Departamento de Cl鱈nica e Cirurgia Veterin叩ria, FCAV, UNESP, Campus de Jaboticabal. Autor para correspond棚ncia: Prof. Dr. Jos辿 Luiz Laus, Professor Titular do Departamento de Cl鱈nica e Cirurgia, FCV, UNESP, Campus de Jaboticabal. End.: Via de Acesso Prof. Paulo Donato Castellane, KM 5, Rural, 14884-900, Jaboticabal, SP, E-mail:jllaus@fcav.unesp.br Ci棚ncia Rural, v.34, n.3, mai-jun, 2004. Recebido para publica巽達o 11.11.02 Aprovado em 16.07.03
922 Almeida et al. (McLAUGHLIN et al, 1988; MOORE, 1998) due to The iatrogenic condition happens especially when the the complex interaction between the primary lacrimal function is already compromised or when the components of the tear (lipid, aqueous fraction and procedure is performed in breeds predisposed to the mucoprotein). disease (KASWAN & MARTIN, 1985; The aqueous component of the tear is McLAUGHLIN et al., 1988; DUGAN et al., 1992; responsible for the maintenance of the corneal MORGAN et al., 1993; STANLEY & KASWAN, integrity. Moreover, the aqueous component decreases 1994). HELPER et al. (1974) and GELLAT et al. the friction attributed to the movement of eyelids, (1975) described that the excision of the third eyelid removes debris, moistens the cornea, and serves as a gland promoted a decrease in the STT1 lacrimal source of oxygen and glucose to the cornea. The volume of 29 to 57%, but no clinical signs of KCS deficiency of the aqueous fraction of the tear increases were evident. BROOKS (1991) described in his study the lacrimal film osmolarity, promotes conjunctivitis, that the excision of the prolapsed gland is potentially keratitis and progressive corneal disease. In some able to induce KCS. cases, secondary corneal ulcers may be observed. The chronic deficiency of the lacrimal film usually causes CASE REPORT pigmentation and vascularization of the cornea, along with pain and decrease in vision (SANSOM et al., A 10-month-old male Boston Terrier 1995; MOORE, 1998; WILKIE, 1993). (Figure 1A) was presented to the ophthalmologic The pathogenesis of KCS may be related service of the Hospital Veterin叩rio Governador Laudo to a single process or a combination of conditions that Natel at the Faculdade de Ci棚ncias Agr叩rias e affect the lacrimal glands. Some of the major causes Veterin叩rias, Universidade Estadual Paulista, S達o of KCS are: chronic blepharoconjuctivitis, congenital Paulo, Brazil, with a history of discomfort in the right hypoplasia of the main lacrimal gland, use of eye for one month. During anamnesis it was reported sulfonamides and topical atropine, loss of that the dogs third eyelid lacrimal gland had been parasympathetic innervations of the lacrimal gland, removed due to a prolapse three months earlier. metabolic diseases, immune mediate diseases, At the exam, the dog presented good distemper and iatrogenic disease (GELLAT, 1991; clinical condition. Ophthalmologic exam revealed the MOORE, 1998). One of the most common etiology right eye with mucous discharge over the eyelid and and pathogenesis of the iatrogenic KCS is the excision ocular surface. Moreover, hyperemic conjunctiva, of the prolapsed third eyelid lacrimal gland (DUGAN blepharospasm and photophobia were also observed. et al., 1992; HELPER et al., 1974; KASWAN et al., Schirmers tear test 1 (STT1) was performed and 1985; MOORE, 1998; MORGAN et al., 1991). The revealed values of 0 mm/min. and 28 mm/min. for the diagnosis of KCS is based on clinical signs and Schirmers Tear Test (STT1) values less than 10 mm/ min (SANSOM et al., 1995; MOORE, 1998). A variety of breeds are predisposed to the dorsal prolapse of the third eyelid lacrimal gland, known as cherry eye. Some authors describe that, in dogs with this disease, the connective tissue located between the base of the gland and the periorbital tissue may be poorly developed (STANLEY & KASWAN, 1994; KASWAN & MARTIN, 1985). The prolapse is frequently observed in dogs like American and English Cocker Spaniel, English Bulldog, Beagle, Pekingese, Boston Terrier, Basset Hound, Lhasa Apso and Shih Tzu (KASWAN & MARTIN, 1985; DUGAN et al., 1992; MORGAN et al., 1993). The surgical treatment consists of excising or replacing the prolapsed gland (DUGAN et al., 1992; STANLEY & KASWAN, 1994). However, its removal may promote or increase Figure 1A - Photographic image of a male, 10 months old, Boston the development of KCS because of the important Terrier. Note the loss of brightness of the cornea and contribution of the third eyelid lacrimal gland on accumulation of mucous discharge, characteristics of producing the aqueous fraction of the lacrimal film. dry eye. Ci棚ncia Rural, v.34, n.3, mai-jun, 2004.
Iatrogenic keratoconjunctivitis sicca in a dog. 923 right and left eye respectively. After removing the keratoconjunctivitis sicca in the right eye was based discharge and cleaning the corneal epithelium of the on the Schirmers Tear Test 1 (STT1) values (0mm/ right eye, slit lamp biomicroscopy revealed moderate min.-OD) and the clinical signs. The iatrogenic KCS congestion of the episcleral capillaries, corneal occurred due to the excision of the lacrimal gland. The neovascularization, and edema. Based on these short period of time between the excision of the gland findings, an ophthalmologic scenario of chronic and the occurrence of the first clinical signs of ocular keratitis was found (Figure 1B). The use of fluorescein discomfort (2 months) in this young Boston Terriers stain showed that the corneal epithelium was caught the researchers attention for the iatrogenic preserved. condition. Based on STT1 and clinical signs the The possibility of KCS occurrence after diagnosis of KCS was made. Moreover, iatrogenic excision of the third eyelid lacrimal gland in young KCS was diagnosed due to the history of third eyelid dog breeds, that have not been considered predisposed lacrimal gland removal. to this disease leads us to cite HELPER et al. (1974). The treatment of the choice was 1% He described the reduction of STT1 values of 29% to ciclosporine 1, twice a day, along with polyacrylic acid 2 57% in dogs subjected to the removal of this gland. In eye drops every 8 hours. Subsequently, response to the addition, this case report leads us to mention the study treatment was mild with the right value of STT1, which performed by MORGAN et al. (1993). He described was not adequate. that the removal of the third eyelid lacrimal gland can contribute to the development of KCS even if the main DISCUSSION lacrimal gland is present and producing 43% to 65 % of the aqueous fraction of the lacrimal film. Authors have reported qualitative (SAITO et al., 2001) and quantitative changes (DUGAN et al., CONCLUSIONS 1992; KASWAN & MARTIN, 1985; STANLEY & KASWAN, 1994; MORGAN et al., 1993) in the It is important to emphasize that the lacrimal film due to the excision of the prolapsed third preservation of the third eyelid lacrimal gland in dogs eyelid lacrimal gland. HELPER et al. (1974), GELLAT with cherry eye condition is essential during the surgery et al. (1975) and McLAUGHLIN et al. (1988) for its treatment. The reason for this is due to the described the occurrence of iatrogenic induction of ophthalmic disturbances associated with keratoconjuctivitis sicca induced by the excision of keratoconjunctivitis sicca in response to the removal this gland in dogs and cats. MORGAN et al. (1993) of this gland. concluded that the replacement of the gland is the treatment of choice in breeds predisposed to KCS in SOURCE AND MANUFACTURES which the prolapse of third eyelid gland is common. 1 In this case report, the diagnosis of iatrogenic Ciclosporina 1%, Ophthalmos Ind. e Com. de Prod. Farmac棚uticos Ltda, S達o Paulo, Brazil. 2 Viscotears速, Ciba Vision AG, Novartis Company, Basileia, Swiss. REFERENCES BROOKS D.E. Canine conjunctiva and nictitanting membrane. In: GELLAT, K.N. Veterinary ophthalmology. Philadelphia : Lea & Febiger, 1991. Cap.8, p.290-306. DUGAN, S.J. et al. Clinical and histologic evaluation of the prolapsed third eyelid gland in dogs. Journal of American Veterinary Medical Association, v.201, n.12, p.1861-1867, 1992. GELLAT, K.N. Canine lacrimal and nasolacrimal diseases. In: GELLAT, K.N. Veterinary ophthalmology. Philadelphia : Lea & Febiger, 1991. Cap.7, p.276-289. GELLAT, K.N. et al. Evaluation of tear formation in the dog, using a modification of the schirmer tear test. Journal of Figure 1B - Note (A) conjunctival hyperemia, (B) corneal American Veterinary Medical Association, v.166, n.4, p.365- vascularization and (C) thick mucous discharge. 370, 1975. Ci棚ncia Rural, v.34, n.3, mai-jun, 2004.
924 Almeida et al. HELPER, L.C. et al. Surgical induction of keratoconjunctivitis MORGAN, R.V.; DUDDY, J.M.; McCLURG, K. Prolapse of the sicca in the dog. Journal of American Veterinary Medical gland of the third eyelid in dogs: a retorspective study of 89 cases Association, v.165, n.2, p.172-174, 1974. (1980 to 1990). Journal of the American Animal Hospital Association, v.29, n.1, p.56-60, 1993. KASWAN, R.L.; MARTIN, C.L. Surgical correction of third eyelid prolapse in dogs. Journal of American Veterinary Medical SAITO, A. et al. The effect of third eyelid gland removal on the Association, v.186, n.1, p.83, 1985. ocular surface of dogs. Veterinary Ophthalmology, v.4, n.1, p.13-18, 2001. McLAUGHLIN, S.A. et al. Effect of removal of lacrimal and third eyelid glands on schirmer tear test results in cats. Journal SANSOM, J. et al. Treatment of keratoconjunctivitis sicca in of American Veterinary Medical Association, v.193, n.7, p.820- dogs with cyclosporine ophthalmic ointment: a European clinical 822, 1988. field trial. Veterinary Record, v.137, n.11, p.504-507, 1995. MOORE, C.P. Diseases and surgery of the lacrimal secretory STANLEY, R.G.; KASWAN, R.L. Modification of the orbital rim system. In: GELLAT, K.N. Veterinary ophthalmology. anchorage method for surgical replacement of the gland of the Baltimore: Williams & Wilkins, 1998. Cap.16. p.586-599. third eyelid in dogs. Journal of American Veterinary Medical Association, v.205, n.10, p.1412-1414, 1994. MORGAN, R.V.; ABRAMS, K.L. Topical administration of cyclosporine for treatment of keratoconjunctivitis sicca in dogs. WILKIE, D.A. Management of keratoconjunctivitis sicca in dogs. Journal of American Veterinary Medical Association, v.199, Continuing Education for the Practicing Veterinary, p.58- 63, n.8, p.1043-1046, 1991. 1993. Ci棚ncia Rural, v.34, n.3, mai-jun, 2004.

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Iatrogenic keratoconjunctivitis sicca in a dog

  • 1. Iatrogenic keratoconjunctivitis sicca in a dog. Ci棚ncia Rural, Santa Maria, v.34, n.3, p.921-924, mai-jun, 2004 921 ISSN 0103-8478 Iatrogenic keratoconjunctivitis sicca in a dog Ceratoconjuntivite seca iatrog棚nica em c達o Denise Eliza de Almeida1 Fabricio Villela Mamede2 Juan Pablo Duque Ortiz3 Jos辿 Luiz Laus4 - RELATO DE CASO - ABSTRACT redu巽達o da vis達o. Devido contribui巽達o significativa da gl但ndula da terceira p叩lpebra na produ巽達o da por巽達o aquosa do filme Qualitative and quantitative abnormalities in lacrimal, a remo巽達o desta gl但ndula, quando prolapsada, primary components of the tear can alter the dynamics of the constitui-se em importante causa de CCS iatrog棚nica. Este lacrimal film, compromising its function. Lipids, an aqueous trabalho relata um caso cl鱈nico de ceratoconjuntivite seca fraction and mucoproteins constitute the lacrimal film. iatrog棚nica, em um c達o da ra巽a Boston Terrier de 10 meses de Keratoconjunctivitis sicca (KCS) is a disease commonly idade, causada pela remo巽達o cir炭rgica da gl但ndula lacrimal da diagnosed in dogs. It is characterized by the deficiency of the terceira p叩lpebra, quando esta encontrava-se prolapsada. aqueous fraction in the lacrimal film that results in dryness, inflammation of the conjunctive and cornea with progressive Palavras-chave: ceratoconjuntivite seca iatrog棚nica, olho seco, corneal illness and reduction of vision and pain. Due to the prolapso da gl但ndula lacrimal. significant contribution of the third eyelid lacrimal gland to the production of the aqueous fraction of the lacrimal film, the removal of this gland when prolapsed is an important cause of INTRODUCTION iatrogenic keratoconjuctivitis sicca. This paper describes a clinical case of iatrogenic keratoconjuctivitis sicca in a 10 month- old Boston Terrier which was caused by the removal of the third Keratoconjunctivitis sicca (KCS) is a eyelid lacrimal gland due to its prolapse. chronic inflammatory disease frequently diagnosed in dogs and is caused by the deficiency of the aqueous Key words: iatrogenic keratoconjunctivitis sicca, dry eye, cherry eye. component of the lacrimal film (MOORE, 1998; RESUMO MORGAN et al., 1991; WILKIE, 1993). GELLAT et al. (1975), GELLAT (1991) and SAITO et al. (2001) Anormalidades quali-quantitativas em componentes reported that the production of the aqueous fraction prim叩rios da l叩grima podem alterar a din但mica do filme lacrimal, comprometendo sua fun巽達o. O filme lacrimal 辿 composto por of the tear is done by the main lacrimal gland (70%) lip鱈dios, uma fra巽達o aquosa e por mucoprote鱈nas. A and the third eyelid lacrimal gland (30%). ceratoconjuntivite seca (CCS) 辿 uma enfermidade freq端entemente Abnormalities within the quality and quantity of the diagnosticada em c達es, caracterizada pela defici棚ncia da fra巽達o aquosa do filme lacrimal, resultando em desseca巽達o e inflama巽達o aqueous component can alter the dynamics of the da conjuntiva e c坦rnea, dor, doen巽a corneana progressiva e lacrimal film and compromise its function 1 M辿dico Veterin叩rio P坦s-graduando do Programa de P坦s-gradua巽達o em Cirurgia Veterin叩ria, 叩rea de concentra巽達o em Cirurgia Veterin叩ria, Curso de Doutorado, Faculdade de Ci棚ncias Agr叩rias e Veterin叩rias (FCAV), Universidade Estadual Paulista (UNESP, Campus de Jaboticabal. 2 M辿dico Veterin叩rio P坦s-graduando do Programa de P坦s-gradua巽達o em Medicina Veterin叩ria, 叩rea de concentra巽達o em Cirurgia Veterin叩- ria, Curso de Mestrado, Faculdade de Medicina Veterin叩ria e Zootecnia, Universidade Estadual Paulista, C但mpus de Botucatu. 3 M辿dico Veterin叩rio, P坦s-graduando do Programa de P坦s-gradua巽達o em Cirurgia Veterin叩ria, 叩rea de concentra巽達o em Cirurgia Veterin叩- ria, Curso de Mestrado, FCAV, UNESP, Campus de Jaboticabal. 4 M辿dico Veterin叩rio, Professor Titular, Departamento de Cl鱈nica e Cirurgia Veterin叩ria, FCAV, UNESP, Campus de Jaboticabal. Autor para correspond棚ncia: Prof. Dr. Jos辿 Luiz Laus, Professor Titular do Departamento de Cl鱈nica e Cirurgia, FCV, UNESP, Campus de Jaboticabal. End.: Via de Acesso Prof. Paulo Donato Castellane, KM 5, Rural, 14884-900, Jaboticabal, SP, E-mail:jllaus@fcav.unesp.br Ci棚ncia Rural, v.34, n.3, mai-jun, 2004. Recebido para publica巽達o 11.11.02 Aprovado em 16.07.03
  • 2. 922 Almeida et al. (McLAUGHLIN et al, 1988; MOORE, 1998) due to The iatrogenic condition happens especially when the the complex interaction between the primary lacrimal function is already compromised or when the components of the tear (lipid, aqueous fraction and procedure is performed in breeds predisposed to the mucoprotein). disease (KASWAN & MARTIN, 1985; The aqueous component of the tear is McLAUGHLIN et al., 1988; DUGAN et al., 1992; responsible for the maintenance of the corneal MORGAN et al., 1993; STANLEY & KASWAN, integrity. Moreover, the aqueous component decreases 1994). HELPER et al. (1974) and GELLAT et al. the friction attributed to the movement of eyelids, (1975) described that the excision of the third eyelid removes debris, moistens the cornea, and serves as a gland promoted a decrease in the STT1 lacrimal source of oxygen and glucose to the cornea. The volume of 29 to 57%, but no clinical signs of KCS deficiency of the aqueous fraction of the tear increases were evident. BROOKS (1991) described in his study the lacrimal film osmolarity, promotes conjunctivitis, that the excision of the prolapsed gland is potentially keratitis and progressive corneal disease. In some able to induce KCS. cases, secondary corneal ulcers may be observed. The chronic deficiency of the lacrimal film usually causes CASE REPORT pigmentation and vascularization of the cornea, along with pain and decrease in vision (SANSOM et al., A 10-month-old male Boston Terrier 1995; MOORE, 1998; WILKIE, 1993). (Figure 1A) was presented to the ophthalmologic The pathogenesis of KCS may be related service of the Hospital Veterin叩rio Governador Laudo to a single process or a combination of conditions that Natel at the Faculdade de Ci棚ncias Agr叩rias e affect the lacrimal glands. Some of the major causes Veterin叩rias, Universidade Estadual Paulista, S達o of KCS are: chronic blepharoconjuctivitis, congenital Paulo, Brazil, with a history of discomfort in the right hypoplasia of the main lacrimal gland, use of eye for one month. During anamnesis it was reported sulfonamides and topical atropine, loss of that the dogs third eyelid lacrimal gland had been parasympathetic innervations of the lacrimal gland, removed due to a prolapse three months earlier. metabolic diseases, immune mediate diseases, At the exam, the dog presented good distemper and iatrogenic disease (GELLAT, 1991; clinical condition. Ophthalmologic exam revealed the MOORE, 1998). One of the most common etiology right eye with mucous discharge over the eyelid and and pathogenesis of the iatrogenic KCS is the excision ocular surface. Moreover, hyperemic conjunctiva, of the prolapsed third eyelid lacrimal gland (DUGAN blepharospasm and photophobia were also observed. et al., 1992; HELPER et al., 1974; KASWAN et al., Schirmers tear test 1 (STT1) was performed and 1985; MOORE, 1998; MORGAN et al., 1991). The revealed values of 0 mm/min. and 28 mm/min. for the diagnosis of KCS is based on clinical signs and Schirmers Tear Test (STT1) values less than 10 mm/ min (SANSOM et al., 1995; MOORE, 1998). A variety of breeds are predisposed to the dorsal prolapse of the third eyelid lacrimal gland, known as cherry eye. Some authors describe that, in dogs with this disease, the connective tissue located between the base of the gland and the periorbital tissue may be poorly developed (STANLEY & KASWAN, 1994; KASWAN & MARTIN, 1985). The prolapse is frequently observed in dogs like American and English Cocker Spaniel, English Bulldog, Beagle, Pekingese, Boston Terrier, Basset Hound, Lhasa Apso and Shih Tzu (KASWAN & MARTIN, 1985; DUGAN et al., 1992; MORGAN et al., 1993). The surgical treatment consists of excising or replacing the prolapsed gland (DUGAN et al., 1992; STANLEY & KASWAN, 1994). However, its removal may promote or increase Figure 1A - Photographic image of a male, 10 months old, Boston the development of KCS because of the important Terrier. Note the loss of brightness of the cornea and contribution of the third eyelid lacrimal gland on accumulation of mucous discharge, characteristics of producing the aqueous fraction of the lacrimal film. dry eye. Ci棚ncia Rural, v.34, n.3, mai-jun, 2004.
  • 3. Iatrogenic keratoconjunctivitis sicca in a dog. 923 right and left eye respectively. After removing the keratoconjunctivitis sicca in the right eye was based discharge and cleaning the corneal epithelium of the on the Schirmers Tear Test 1 (STT1) values (0mm/ right eye, slit lamp biomicroscopy revealed moderate min.-OD) and the clinical signs. The iatrogenic KCS congestion of the episcleral capillaries, corneal occurred due to the excision of the lacrimal gland. The neovascularization, and edema. Based on these short period of time between the excision of the gland findings, an ophthalmologic scenario of chronic and the occurrence of the first clinical signs of ocular keratitis was found (Figure 1B). The use of fluorescein discomfort (2 months) in this young Boston Terriers stain showed that the corneal epithelium was caught the researchers attention for the iatrogenic preserved. condition. Based on STT1 and clinical signs the The possibility of KCS occurrence after diagnosis of KCS was made. Moreover, iatrogenic excision of the third eyelid lacrimal gland in young KCS was diagnosed due to the history of third eyelid dog breeds, that have not been considered predisposed lacrimal gland removal. to this disease leads us to cite HELPER et al. (1974). The treatment of the choice was 1% He described the reduction of STT1 values of 29% to ciclosporine 1, twice a day, along with polyacrylic acid 2 57% in dogs subjected to the removal of this gland. In eye drops every 8 hours. Subsequently, response to the addition, this case report leads us to mention the study treatment was mild with the right value of STT1, which performed by MORGAN et al. (1993). He described was not adequate. that the removal of the third eyelid lacrimal gland can contribute to the development of KCS even if the main DISCUSSION lacrimal gland is present and producing 43% to 65 % of the aqueous fraction of the lacrimal film. Authors have reported qualitative (SAITO et al., 2001) and quantitative changes (DUGAN et al., CONCLUSIONS 1992; KASWAN & MARTIN, 1985; STANLEY & KASWAN, 1994; MORGAN et al., 1993) in the It is important to emphasize that the lacrimal film due to the excision of the prolapsed third preservation of the third eyelid lacrimal gland in dogs eyelid lacrimal gland. HELPER et al. (1974), GELLAT with cherry eye condition is essential during the surgery et al. (1975) and McLAUGHLIN et al. (1988) for its treatment. The reason for this is due to the described the occurrence of iatrogenic induction of ophthalmic disturbances associated with keratoconjuctivitis sicca induced by the excision of keratoconjunctivitis sicca in response to the removal this gland in dogs and cats. MORGAN et al. (1993) of this gland. concluded that the replacement of the gland is the treatment of choice in breeds predisposed to KCS in SOURCE AND MANUFACTURES which the prolapse of third eyelid gland is common. 1 In this case report, the diagnosis of iatrogenic Ciclosporina 1%, Ophthalmos Ind. e Com. de Prod. Farmac棚uticos Ltda, S達o Paulo, Brazil. 2 Viscotears速, Ciba Vision AG, Novartis Company, Basileia, Swiss. REFERENCES BROOKS D.E. Canine conjunctiva and nictitanting membrane. In: GELLAT, K.N. Veterinary ophthalmology. Philadelphia : Lea & Febiger, 1991. Cap.8, p.290-306. DUGAN, S.J. et al. Clinical and histologic evaluation of the prolapsed third eyelid gland in dogs. Journal of American Veterinary Medical Association, v.201, n.12, p.1861-1867, 1992. GELLAT, K.N. Canine lacrimal and nasolacrimal diseases. In: GELLAT, K.N. Veterinary ophthalmology. Philadelphia : Lea & Febiger, 1991. Cap.7, p.276-289. GELLAT, K.N. et al. Evaluation of tear formation in the dog, using a modification of the schirmer tear test. Journal of Figure 1B - Note (A) conjunctival hyperemia, (B) corneal American Veterinary Medical Association, v.166, n.4, p.365- vascularization and (C) thick mucous discharge. 370, 1975. Ci棚ncia Rural, v.34, n.3, mai-jun, 2004.
  • 4. 924 Almeida et al. HELPER, L.C. et al. Surgical induction of keratoconjunctivitis MORGAN, R.V.; DUDDY, J.M.; McCLURG, K. Prolapse of the sicca in the dog. Journal of American Veterinary Medical gland of the third eyelid in dogs: a retorspective study of 89 cases Association, v.165, n.2, p.172-174, 1974. (1980 to 1990). Journal of the American Animal Hospital Association, v.29, n.1, p.56-60, 1993. KASWAN, R.L.; MARTIN, C.L. Surgical correction of third eyelid prolapse in dogs. Journal of American Veterinary Medical SAITO, A. et al. The effect of third eyelid gland removal on the Association, v.186, n.1, p.83, 1985. ocular surface of dogs. Veterinary Ophthalmology, v.4, n.1, p.13-18, 2001. McLAUGHLIN, S.A. et al. Effect of removal of lacrimal and third eyelid glands on schirmer tear test results in cats. Journal SANSOM, J. et al. Treatment of keratoconjunctivitis sicca in of American Veterinary Medical Association, v.193, n.7, p.820- dogs with cyclosporine ophthalmic ointment: a European clinical 822, 1988. field trial. Veterinary Record, v.137, n.11, p.504-507, 1995. MOORE, C.P. Diseases and surgery of the lacrimal secretory STANLEY, R.G.; KASWAN, R.L. Modification of the orbital rim system. In: GELLAT, K.N. Veterinary ophthalmology. anchorage method for surgical replacement of the gland of the Baltimore: Williams & Wilkins, 1998. Cap.16. p.586-599. third eyelid in dogs. Journal of American Veterinary Medical Association, v.205, n.10, p.1412-1414, 1994. MORGAN, R.V.; ABRAMS, K.L. Topical administration of cyclosporine for treatment of keratoconjunctivitis sicca in dogs. WILKIE, D.A. Management of keratoconjunctivitis sicca in dogs. Journal of American Veterinary Medical Association, v.199, Continuing Education for the Practicing Veterinary, p.58- 63, n.8, p.1043-1046, 1991. 1993. Ci棚ncia Rural, v.34, n.3, mai-jun, 2004.