Dry Eye
And Our Experience With It


Numerous links for more information on Dry Eye follows Taffy's story....

One beautiful day in August of 2000 our Taffy (Woodlyn Reicrist Pink Taffeta) left our home as a youngster to go and live with Jim Icenogle in Quincy, Ill. Taffy was then about 12 weeks of age. Jim and Taffy bonded immediately and I had a constant barrage of emails telling me how great she was doing, how easily she adjusted to everything, how beautiful and how smart she was. Then, about a week after going to her new home, Jim wrote me to tell me she had a yellow discharge from one eye. I told him it was probably a slight infection, or an allergy, and to take her in to his vet and have it checked. Jim did - and then wrote to tell me that his vet said she had "Dry Eye", with very poor tear production in her left eye. Jim kept Taffy on the prescribed eye medications and artificial tears for a couple of weeks - but to no avail. Since we were both going to the Nashville Specialty in September, I told him to bring her with with plans to return her to me for either a replacement or a refund. Despite the fact that Jim was heartbroken to have to give up Taffy, he realized that he couldn't handle her problem and would be happy to wait for another pup. He now shares his life with Kaji, a black and white half sister of Taffy.

...

Taffy came back to us at those Specialties - and was every bit as beautiful at that stage as I had hoped she would be when she left our home a month earlier. Her eye looked fine - as long as it was kept constantly lubricated with artificial tears and a medication to help with the pain. When we woke up that first morning after her return it was obvious that this was a serious problem. Taffy's eye was completely glued shut with a yellow goo that had dried to a hard, crusty finish. We cleaned her eye, remedicated it and within minutes she looked just fine.

Upon arriving home I immediately made an appointment with my own vet - who took one look and sent us to Dr. Lindley of Animal Eye Consultants. We had been using Dr. Lindley for several years for our annual CERF exams so knew she was at least familiar with the breed - and appeared to like them. We did not receive good news on this first visit of many..............

Taffy definitely had "Dry Eye", caused by a congenital condition called "lacrimal gland hypoplasia". In simple terms, it is a birth defect that results in the lack of growth of the tear producing glands. In Taffy's case she had no tear gland in her left eye. Our options for Taffy's health and comfort were as follows:
Constant treatment with artificial tears and a medication for the pain. By "constant" Dr. Lindley meant 8-12 times a day - likely for the rest of Taffy's life. Without this treatment she would be in constant pain and would likely have even more severe damage to the eye itself.

We could wait a couple of months, until Taffy was closer to her adult size, and remove the eye.

We could do Parotid Duct Transposition surgery.............bringing a salivary gland from her mouth up to her eye to keep it lubricated.

Treating Taffy 8+ times a day was just not an option. We work, we travel, we aren't always available every hour on the hour - as much as we'd like to be. If Taffy missed having her eye lubricated she would immediately be in discomfort..........certainly not fair to her.
The Parotid Duct surgery was expensive. It also meant many trips back and forth to see Dr. Lindley. Even before the surgery could take place Taffy would have to be medicated for a couple of months while waiting for some scar tissue to build up on the eye. Dr. Lindley did assure me that her success rate with this surgery was very high..........but that it might not work.
So................I opted for total removal of the affected eye. It would be a one time surgery. Once done, Taffy would never again have a problem or be in pain because of her eye. I did not see going through life with one good eye as a horrible end for Taffy, but as a pain free beginning...........and it was a surgery that would not "break the bank". Money was not the reason I decided to go with this choice, but it couldn't be totally ignored either.

Few people knew of Taffy's 'problem' but I did correspond with a a couple of close friends. Two of those were Tom and Lois Verso - who already owned Taffy's littermate and an older sister. Tom and Lois immediately wrote and asked if they could have Taffy, have the Parotid Duct surgery done and hopefully give her a chance at life with two normal eyes. They were prepared to have the eye removed at a later date if things didn't work out, and they were prepared to nurse her for as long as it took. Knowing Lois and Tom for the caring people that they are, I quickly agreed.
Of course we immediately ran into problems! Lois and Tom checked with a number of ophthalmologists in their home state of Texas. None felt qualified to do this surgery and highly recommended that Taffy remain here for the surgery as Dr. Lindley was among the best! Another trip to Dr. Lindley, a course of medication to take us through a couple of months, and then another check-up. This time all looked like a go and surgery was tentitively set for January 3rd of 2001........with pre-surgery tests being run by our regular vet.

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Taffy pictured with Deb and with LynnE on the day of surgery

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Taffy with Dr. Lindley on the day ofsurgery

Taffy is pictured above on the day of surgery - happily smooching Deb and I - and anyone else who would get close enough!! We dropped her off early in the morning and picked her up later that same afternoon. Dr. Lindley assured me that the surgery went beautifully - "text book perfect" were her words! Taffy came home wearing a collar that prevented her being able to scratch or rub her face. She spent the next two weeks being miserable while we medicated her eye constantly and kept a close watch on her so she couldn't injure herself trying to remove that dreaded collar! Her one week check-up went well and everyone was pleased. At the next check-up we were able to remove the collar and brought home a very happy puppy! All looked well...........and the eye was working as it should. Overtime when cookies and other dog goodies were handed out! Even then there was almost no excessive tearing and we seldom had to wash her face.


Taffy's scar will most likely be all but invisible in a few months.

Taffy had her share of problems over the next couple of months. She started squinting and acting like she was in pain almost constantly - being comfortable only immediately after putting her meds in her eye. Another trip to Dr. Lindley and another delay in sending her to her home in Texas. The way I understand it, she had developed an ulcer on the eye. I also understood that this was not all that unusual and while it might mean a delay in going to her permanent home, it was only temporary. We continued to work with Dr. Lindley and finally received the OK to ship Taffy in late March.


Taffy before her eyelid surgery, showing ulcerated left eye

Things should have been over for little Taffy..........but it was not to be! Everything went smoothly for a while...........then Lois noticed that Taffy was again squinting and uncomfortable. And the tearing was excessive. Off to their eye vet! For some unknown reason Taffy's eyelid had decided to turn inwards, with eyelashes rubbing the eye itself and causing an ulcer. Lois had at first thought it was just swelling, but it quickly became apparent that there was more to it than just that. On top of the ulcer, the cortisone ointment that Taffy was on supressed her immune system and allowed the ulcer to get worse at a very rapid rate.Back to surgery for an eyelid lift!

A note (or three!) from Lois:
"Yes the eye doc here thinks that the eye lid lift will fix the whole thing. She still has not been neutered so she has that to contend with when she is better; we just didn't want to put her thru that too yet. She acts like she is feeling better, the eye is beginning to clear somewhat, and the excessive tearing is gone. The Parotid Duct surgery is now working like it was supposed to, and probably was working when you had her, but for some reason the eyelid just turned in, maybe because she was still growing and the eyeball on that side stopped growing...just a guess. The eye is open most of the day now and like I said she has not required anything to slow the secretions. She really deserves to have the pain gone, she is so sweet about everything."

...

"This is a close up of Taffys' eye after the eye lid lift. It looks nasty right now because the sutures are disolving....that is the white stuff around the eye. Overall the eye looks much better, and Taf is finally out of pain for the first time in a long time. Her vision is very good in that eye, in spite of the way it looks right now. She is on her way back to the surgeon right now, but we dont expect any other treatment to be necessary, she is good as gold. I will take some pictures when the sutures are gone. You should see a normal eye at that stage (except for the slight clouding on the lens)."

"We had a bit of a scare with Taffys' eye yesterday and this A.M. She started to over produce tears, closed the eye and when she opened it was very uncomfortable, just like before the operation. I numbed it up and removed a stitch last nite, but she was still having problems this A.M. I had called the eye surgeon last evening, but hadn't heard from him this A.M., so I took her to the regular vet. He removed another stitch and recommended that if it didn't get better to go see the surgeon as soon as possible. When I got back, the surgeon had called and told us to bring her right in. Well, he removed three more stitches, and checked her eye really well, the eye is still very good, and it looks like that was the whole problem. She is doing fine ever since. Taf is a happy dudette!! So am I."

Taffy will be going to live with Tom and Lois' grand daughter Mandy as soon as she gets the all-clear from the vets. Mandy is hoping to train Taffy for agility............and Tom and Lois will be right there cheering for them both. I just want to say a personal "thanks" to two kind and generous people that were determined that Taffy would have the very best life that it was possible for her to live......................






Clinical Signs

The hallmark clinical sign of keratoconjunctivitis sicca (KCS)is the presence of mucoid or mucopurulent ocular discharge.

Other signs may include:
lackluster dry eyes
hyperemia
chemosis
blepharospasm
corneal neovascularization
corneal ulceration
blindness

Factors Associated with KCS

The majority of cases of KCS are idiopathic but are thought to be immune related.KCS is also seen in association with:

distemper virus
sulfonamide toxicity
congenital lacrimal gland hypoplasia
injury or neuropathology of facial nerve
surgical removal of nictitating membrane gland
neutering

The Schirmer Test



The Schirmer Test is a quick, easy and reliable test for "Dry Eye". This test is done prior to any topical medications or manipulation of the eyelids. Topical Anesthesia is not used to perform the standardized Schirmer Test.

Procedure:
Hook the rounded notched end of the sterile test strip owver the lower eyelid.
After 60 seconds have passed, remove the strip and immediately measure the length of the moistened area.
Schirmer Test Values In Dogs:
Normal: 15-25 mm/min
Borderline: 10-15 mm/min
Below Normal: less than 10 mm/min



Below are links to some of the best information available on "Dry Eye":

Parotid Duct Transposition
What Is Dry Eye?

C.E.R.F.
Eyevet
Dry Eye syndrome
KCS
Dry Eye
Dry Eye In Shih Tzu





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