Keratoconjunctivitis Sicca (KCS) in Dogs

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Keratoconjunctivitis Sicca (KCS) in Dogs

By: Dr. Alexandra Van der Woerdt

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Section: Veterinary Care In-depth

Veterinary care includes diagnostic tests and subsequent treatment recommendations.

Diagnosis In-depth

It is important to inform your veterinarian of all the medications your dog is currently taking because KCS may be an uncommon side effect associated with some medications. Diagnosis often includes the following:

Examination of the eye including a thorough evaluation of the eyelids, conjunctiva and cornea.

Schirmer Tear Test. This test measures tear production. Normal tear production is usually more than 15 mm/min. Caution should be used when interpreting this test. If another disease is present that increases the tear production, the Schirmer Tear Test may reveal borderline normal values, masking the KCS. Alternatively, some conditions also falsely lower the results. For these reasons, the test may be repeated several times before a definite diagnosis of KCS is reached.

Fluorescein stain. The dye is applied to the cornea to check for the presence of a corneal ulcer.

Culture of discharge. A culture may be submitted if a secondary bacterial infection is suspected.

Routine blood work. Your veterinarian may recommend blood tests including a complete blood count, serum biochemistry profile and thyroid hormone assays if an underlying disease is suspected.

Treatment In-depth

Treatment is aimed at increasing tear production, applying artificial tears, and reducing any bacterial infections, and decreasing inflammation and scarring of the cornea.

When using eye medications, be sure to ask your veterinarian whether the medications can be administered at the same time, or whether they should be separated by several minutes. Some medications can be administered together; others need to be administered alone. In general, drops are applied prior to ointments and no more than two medications are given together at one time.

Application of 0.2% cyclosporine ointment is designed to increase tear production. This product is most effective in increasing tear production if some residual tear production is still present. It is less effective in dogs that have no tear production prior to starting this medication. When used on a long-term basis, this medication may also help to decrease some of the pigmentation that is commonly present on the cornea in chronic KCS. It is usually applied twice daily, and it must be used on a continual basis for the rest of the dog's life. There are times when this product is not available, and it is necessary to obtain a solution of cyclosporine from a licensed compounding pharmacy.

Pilocarpine drops given by mouth are occasionally tried to increase tear production, but they are not very successful. They may taste bitter to the dog, and may also induce vomiting and diarrhea if given in excessive amounts.

In moderate to severe cases of KCS, artificial tear solutions and ointments are used in addition to cyclosporine. Drops provide moisture and ointment provides lubrication to the surface of the eye. They are particularly important in the early stages of treatment, because it may take several weeks for the cyclosporine to increase the tear production. They are also important when tear production does not return to normal with cyclosporine therapy.

Antibiotic drops or ointment may be used if a secondary bacterial infection is present.

Corticosteroid drops or ointment may be used to decrease inflammation. These medications are only used after fluorescein staining of the cornea has determined that there is no ulceration present. Corticosteroids cannot be used in the presence of a corneal ulcer because they delay healing.

In severe cases of KCS that do not respond to medications, surgery may be performed in which a salivary duct is moved from the mouth to the eye. This results in saliva flowing over the eye to keep the eye moist. It is not an ideal treatment for KCS because saliva is not the same as tears, and the flow of saliva cannot be controlled very well. The surgery is helpful, however, for those dogs that remain persistently painful and squinty despite trying all forms of medical therapy.

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Keratoconjunctivitis Sicca (KCS) in Dogs

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