Am I missing possible treatments?

[~Lin]

Hi all, I'm new. I'm not actually the one with dry eye, its my service dog. She was diagnosed with chronic dry eye in March of last year. Dry eye in dogs is essentially the same as in humans and has pretty much the same treatments, except no punctal plugs yet that I've been able to find. There is a clinical trial going on with punctal cautery though. Dogs do have a treatment that humans do not, a surgery where the salivary glands are routed into the eye to keep it moist with saliva. I cannot afford that surgery at this time, and would prefer the punctal cautery so hopefully the trials go well.

Its really hard to determine what treatments are helpful since Tessa can't tell me what it feels like! I have to go by tear production and redness. When Tessa was diagnosed she was started on cyclosporine ointment, and neomycin/polymyxin/dexamethasone. They only increased her tear production (as measured by schirmir strips) slightly. I weaned her off those as I didn't feel the improvement was enough to justify long term on those medications.

I've tried dog goggles to increase the humidity around the eye, but her eyes were more red when I took them off than put them on so I was concerned it was making things worse. I use Refresh gel throughout the day, and Genteal pm ointment at night. I had her on similasan homeopathic drops but my vet was concerned with one of the ingredients actually increasing dryness (I can't remember which one.) I put drops of fish oil (nordic naturals) directly in her eyes as recommended by a holistic vet. I have her on oral vitamin A, vitamin E, Ocuvite, Lutein, and a large amount of fish oil.

I am wanting to try Dwelle and Dakrina drops after finding this site. Dakrina doesn't seem to be available any longer though? Am I missing any treatments, is there anything I haven't tried yet? Thanks guys!

[RobLIC]

This is a wonderful question, and not the kind often seen on this board. I wish I could help. Have you tried calling Guiding Eyes? I wonder if they've gotten the question before.

[Rebecca Petris]

I am sorry Dakrina is no longer made - hopefully it will eventually be back. I know quite a number of people whose dogs used Dakrina successfully. It is so closely similar to Dwelle that I hope that would help though... certainly worth trying.

I'm not sure we've ever had a post here about canine dry eye - surprising. I get calls every now and then about it.

[mary kenny badami]

~Lin --

Over on our sister bulletin board LaserMyEye (mostly frequented by post-refractive surgery patients, such as Lasik and PRK) we have a long-time and knowledgeable poster who is, in fact, a practicing veterinarian.
He and I just exchanged Private Messages a few minutes ago, and so, with his permission (since he is not a member over here), I am posting this message to you:

Salivary gland transposition creates its own set of problems, the main one being that saliva leaves crusty precipitates on the eyes under the eyelids.

For serious dry eye in a dog cyclosporine seems to work much better than any OTC medications. Initially some need steroid drops but most eventually do well on cyclosporine. The commercial veterinary product Optimmune is 0.2% cyclosporine. In some cases that's not strong enough. There are veterinary pharmacies that can make cyclosporine in oil at any strengths. I've had to order up to 0.5% for some cases. Actually any pharmacy can mix pills with corn oil to make cyclosporine eyedrops.

If this service dog is a German Shepard, they can develop dry eye syndrome but it eventually turns into Pannus, a form of pigmentary keratitis that ultimately causes blindness. These cases require life-long steroid eyedrops. Even 0.5% cyclosporine doesn't seem to work. At least not for my patients.

Optimmune initially causes some stinging. But it stops in a few minutes. I've used it on myself. I put some in my eye at bedtime and am asleep soon enough to not feel the stinging. If Optimmune isn't working then stepping up the the stronger versions is necessary. These don't seem to sting any worse than Optimmune.

Good luck,

Kevin O'Neall, D.V.M.

~Lin, I am also sending you a Private Message (look at the top right of your screen to see your PM box) with Dr. O'Neall's direct e-mail, which he says you are welcome to use if you wish to contact him. Good luck!

[odydnas]

I really wish I could help.... I think Mary's advice sounds wonderful! I have also read that the salivary surgery for dogs is problematic and not very helpful.


One thing my doctor has told me is that redness doesn't correlate with dryness or comfort level. I know that's not a great thing to hear since your dog cannot tell you how she is doing, but redness of the eye does not always mean she is feeling worse.

If lack of tear production is her problem, and it sounds like it, I would continue with cyclosporine, especially at a higher dosage. A couple posters here have seen improvement by upping their dose to 1-2%. The fact that your dog had some improvement in Schirmers scores is a good sign.

Another drop that is by Dr. Holly is Freshkote. It is a tear lubricant that needs a prescription and is similar to Dwelle, Freshkote, and Nutratear. You can find more info at www.freshkote.com

Keep us updated!

[spmcc]

My dog has problems with her eyes also. I sometimes wonder if I jinxed her through my own eye problems (ocular rosacea, MGD, dry eye)!

I took her to a doggie ophthalmologist (yep!!) a couple of years ago and she had two lid biopsies. The result was "bacterial blepharitis". In dogs, they actually surgically remove the eyelids!! I'm so glad I didn't do this... it started out as two lids but now all four have been affected.

She's a bichon and, after a couple of years of eye problems, she started having tear stains along with the lid swelling, crusting, and bleeding, I googled the problem and found something called "Angel Eyes". Its active ingredient is tylosin as tartrate which is a mild antibiotic.* After one month of use (sprinkle it on their food), her eyes are much better. I figure this is just like our taking a daily dose of doxycycline. I'm going to continue her on this and hope!! *my vet was fine with this

I've also thought about using my restasis in her eyes... but it's sooooo expensive!!! I would get her a compounded version, I think...

I just hate the thought of my doggie being in pain the way that I am....

Good luck.

[odydnas]

spmcc,

I had no idea those tear stains could be irritating for dogs and could lead to more problems. Wow, I am going to take care of that! I hate to think that my baby could be in pain that way that I am because I didn't treat his problem early enough.

[spmcc]

odydnas,

I don't know much about tear stains... my dog only started in Oct/Nov 2009 after 4 years of having eye problems (lid swelling, crusting, bleeding). I think excessive tearing could be due to dry eye (they never did a Schirmer's or mentioned dry eye). I know that the excessive tearing can cause an environment favourable to bacteria... which I think is the reason for the red/brown color.

Anyway, I just figured that putting her on a low-dose antibiotic wasn't a terrible thing to do as I've been on antibiotics for decades (for rosacea and ocular rosacea)!!!

[Lucy]

Oh, Gloomsssssssssss. You are just so quick. When I started reading the post, I was thinking of our vet on the other board, too. He probably would know how to help this lady's dog.

If there is one good thing about our eye situation, it's that we have "known" so many people. At times this has helped in one way or another. Good luck to this lady and the situation. Lucy

[~Lin]

Thanks guys! Wow, lots of replies!

Rob- She isn't a guide dog, but rather a mobility assistance service dog. There are many types of service dogs actually! Guide dogs for the blind, mobility assistance, medical alert (diabetes and seizure usually), hearing alert, and psychiatric. Tessa was owner-trained, so I don't have an organization that I got her from to contact.

Rebecca- shucks I was really wanting to try dakrina! Guess I'll have to stick with trying dwelle for now. If you ever want to pass along my email to anyone with a dog with dry eye I've done LOADS of research! lol.

Thanks Mary! I will consider giving cyclosporine (optimmune) another shot and discuss trying a higher concentration with Tessa's new vet (moved, and though I love my vet I can't handle the hour drive to keep seeing her.) Tessa is a German Shepherd, but there is a difference between Pannus and Dry Eye. In Pannus tear production is normal, it is an auto immune inflammation of the corneal surface and conjunctiva. It only mildly resembles chronic dry eye, or Keratoconjunctivitis sicca (KCS) though some dogs have both. In Pannus inflammation and pigmentation starts at the outer corner of the cornea and slowly progresses over the cornea towards the inner corner.

Odydnas- Yea I really was not very enthusiastic about the salivary surgery though I have talked with some people who were very glad they went that route. I really wanted to get Tessa in to the clinical trial on punctal cautery, but a requirement was to have been on the current treatment regimen for 3-4 months so by the time she hit that mark they were full up. With her being my service dog though I am treating as aggressively as I can to prevent any damage to her eyes. I'm hesitant on the cyclosporine because the improvement was VERY minimal, but my vet hadn't mentioned higher dosages of it. There is another medication used that some dogs have better results with, tacrolimus. I don't like overmedicating so I won't use something if its not proving to work. I feed my dogs a raw (meat) diet so they don't consume tons of preservatives or fillers, and I do titers rather than vaccinating annually blind.

spmcc- I'm not sure how much restasis is, but optimmune is around $30 a tiny tube.

[Judy]

Lin, Have you tried warm compresses for Tessa? Just curious as they certainly have worked for me and also my husband (who had lasik surgery a little over a year ago much to my chagrin)... The rice baggies sold at the dry eye shop work fabulously (unless Tessa likes rice TOOOOO much, that is!!). Best wishes for success with Tessa...

[~Lin]

How do the warm compresses help? What is it that they improve exactly? Its not something I've tried yet. I was also thinking about trying some lid wash from the store. Tessa hates when I have to clean off the dried gunk, maybe a lid wash would help soften it and be less unpleasant? She hasnt had an eye infection in a while which is good, she had a bunch in the beginning (actually I think her dry eye was caused by an infection, because she had a recurring one before proper diagnosis and I wonder if it was never fully gone inbetween the bouts)

[Lucy]

Ot

Hi Lin-

I just wated to make an "off topic" statement about Tessa's name. I have two grandcats and each are 18 years old (sisters). One's name is Tessa! The other is Whiskey and not quite sure what my daughter was thinking. Tessa is a pretty name, for sure. Lucy

[spmcc]

I forgot to mention that my vet and doggie ophthalmologist (who did her biopsies) also prescribed warm compresses for my dog. Imagine the two of us on the sofa with wet, warm compresses over our eyes 3-4 times per day...

Also... one day I accidentally used her steroid drops! Nothing bad happened...

[~Lin]

Oh I had wanted to reply about tear stains but forgot.

In tear stains the cause of the red/brown pigment is from porphyrin which is red and present in tears and saliva. In small breeds excessive tearing is really common so tear stains are often not a concern. But there are things such as allergies, diet, infection that can cause excessive tearing.

What do you guys feed your dogs? That makes a HUGE difference in pet health, especially for any pet that already has health concerns. Most people don't know how to read the ingredient label and know which food is better; and there are many low quality pet foods out there. Some pets can survive fine (but survive isn't the same as thrive!) on low quality foods while with others its life or death. I almost lost a cat due to food intolerances, and when she did pass away suddenly at only 6 years old I think the rapid weight loss from when she was so sick caused permanent heart damage.