Page 4 - RVC Clinical Connections - Spring 2025
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RVC RESEARCH STUDY VETERINARY SERVICES RVC.AC.UK
Ophthalmology
EYE SAVED AFTER UNUSUAL NEUROGENIC
DRY EYE DIAGNOSIS
Serena Maini, Lecturer in Ophthalmology
ily, a 10-year-old Parson Russell There are various causes of neurogenic The right eye had continued to respond
terrier, was scheduled to undergo KCS, including otitis media and interna, well to cyclosporine ointment and had
L enucleation surgery but her eye but many incidences are idiopathic and normal tear production.
was saved due to the interventions of the often enter spontaneous remission. In the On a return visit a fortnight later, Lily
Ophthalmology Service and efforts of her presence of denervation hypersensitivity, showed significant progress. The stromal
owners in administering medication. which takes at least two weeks to abscesses and corneal ulcer had resolved.
Her owners noticed that Lily was squinting develop, treatment with oral pilocarpine Lily seemed to be experiencing some
in the left eye, and her primary care vet (parasympathomimetic) can be beneficial nausea, a likely side effect of the pilocarpine,
identified a very low tear production in both while the parasympathetic nerve heals. so we split the dose between morning and
eyes and a superficial corneal ulcer in her In addition to neurogenic KCS, Lily's left evening to alleviate that.
left eye. She was started on lubrication in eye exhibited two stromal abscesses within A return visit to the RVC Ophthalmology
both eyes and chloramphenicol in the left. the cornea. This development worsened the Service the next month and subsequent
Lily returned a few days later and was prognosis for her left eye, and her owners visits have showed an ongoing good
started on cyclosporine ointment in both were warned about possible corneal melting response to treatment thanks to the
eyes. When she returned to the primary (keratomalacia) or even corneal perforation diligent efforts of owners to administer her
care vet, there was a concern that the ulcer (rupture). medication. Within two months her tear
had become much deeper. Cyclosporine production had returned to normal and by
was discontinued in the left eye and Lily was Decisions three months both eyes were wide open,
referred to the RVC team. After discussion with the clients about the bright and shiny.
guarded prognosis for the left eye, and their
At the RVC options for management (continuation of the
Lily was found to have a dry appearance medical treatment versus enucleation), they
to the surface of both eyes, with the left made the difficult decision to remove Lily's
eye more affected than the right. The tear left eye. This was booked for the following
production in the right eye had improved day, following a CT scan of Lily鈥檚 head
but was still very low. Cyclosporine ointment to investigate for an underlying cause of
was restarted in the left eye to support ulcer neurogenic KCS.
healing. Topical lubrication was increased, The following day, the clients reported
and Lily was sent home, to be re-examined that Lily's left eye seemed more comfortable
in a few days鈥� time. since commencing oral paracetamol. Lily
When returning a week later, the tear reluctantly accepted her eye medication
production from Lily鈥檚 right eye had through her owners鈥� firm but gentle approach.
further improved and was nearly normal. The stromal abscesses had deteriorated, Lily鈥檚 left eye after six months of treatment:
However, her left eye remained very however, and a third one was now present the abscesses and ulcer had healed and the
cornea is clearer, shinier and more comfortable
painful and there was minimal (if any) 鈥� three regions (approximately 2-3 mm)
tear production. An ipsilateral dry nostril of yellow stromal infiltrate were visible on
(xeromycteria) developing, in addition slit lamp examination and a presumptive
to near absent tear production and lack diagnosis of idiopathic neurogenic dry
of response to cyclosporine ointment, eye was made. Most such cases resolve
was strongly suggestive of neurogenic within 4-6 months. Her owners at this point
keratoconjunctivitis sicca (KCS) affecting decided to attempt medical treatment rather
the left eye. than enucleation.
During the 4-6 month period, while the
nerve would heal and regenerate, use of
pilocarpine eye drops (given orally) were
used to increase Lily's tear production,
thereby improving her comfort and helping
her cornea to heal.
By the following week, Lily's left cornea
had shown significant signs of improvement CT scan demonstrating absence of otitis
鈥� the stromal abscesses and the ulcer had media and interna
virtually healed. The tear production in the
left eye had not yet responded to pilocarpine, For small animal referrals, please call:
Lily鈥檚 left eye prior to pilocarpine treatment: dull so we began to gradually increase the dose. 01707 666399
and dry corneal surface with cream coloured Email:
areas of stromal abscessation qmhreception@rvc.ac.uk
4 Spring 2025
