In the blink of an eye

Disclaimer:

Information presented in the “Living With…” sections of the SCARF website represent the personal viewpoint of the individual who made the journal entry and do not represent the opinions, positions, or viewpoints of SCARF or the veterinary community. [see complete disclaimer at bottom of page]

LIVING WITH KCS OR “DRY EYE”

If your Sammy is diagnosed with “dry eye,” join the club. More and more dogs and more and more people are being diagnosed with this condition.

I have two Sammies with “dry eye.” They have made me an expert on the topic because they presented me with different symptoms, different tear production measurements, different protocols and different levels of response to treatment.

PATIENT #1

Age at Onset: 6 years, 2 months.

Sex: Spayed female

How the Diagnosis was made: The patient was presented to her veterinarian with red, inflamed eyes and dull corneas. The onset of symptoms was immediate. Because the corneas appeared dull, a “Schirmer Tear Test” was done to measure the level of tear production. Both eyes had a measurement of less than 2mm. Fluorescein stain was applied to detect any corneal scratching. None was detected.

Prescribed Medications: The patient was prescribed Optimmune®. I was instructed to apply a ¼ inch strip to each eye, 2x a day, once every 12 hours for the duration of the patient’s life. I was also instructed to apply a ¼ inch strip of artificial tears lubricating eye ointment to each eye at bedtime for the duration of the patient’s life.

The patient was re-evaluated in 4 days, 2 weeks, 4 weeks, 8 weeks, 12 weeks and every month thereafter until the tear production levels measured 15mm. It took almost 12 weeks for the patient to exhibit a response to the medication and almost 12 months for the levels to measure 15mm.

Additional Tests: A blood test was done to test for Hypothyroidism. The test results were negative.

PATIENT #2

Age at Onset: 6 years, 3 months.

Sex: Neutered male.

How the Diagnosis was made: The patient was presented to his veterinarian with thick, white mucus covering both eyes and a greenish mucoid discharge around both eyes. The onset of symptoms was immediate. A “Schirmer Tear Test” was done to measure the level of tear production. The right eye had a measurement of 6mm, the left eye had a measurement of 9mm. Fluorescein stain was applied to detect any corneal scratching. None was detected.

Prescribed Medications: Because the patient has a concurrent unrelated eye condition, he was referred to his veterinary ophthalmologist for evaluation/treatment. The ophthalmologist prescribed Optimmune® and Refresh® Celluvisc® (carboxymethylcellulose sodium – 1.0%) lubricating eye drops. I was instructed to apply a ¼ inch strip of Optimmune® to each eye, 4x a day (once every 6 hours) and one drop of Refresh® Celluvisc® in each eye 5 minutes later.

The patient was re-evaluated in 2 weeks. At 2 weeks, the patient showed an immediate response to the medication. At six months, the patient had a tear production measurement in excess of 22mm in each eye.

The medications (Optimmune® and Refresh® Celluvisc®) have been reduced to 2x a day, once every 12 hours, for the duration of the patient’s life. I was also instructed to apply a ¼ inch strip of artificial tears lubricating eye ointment to each eye at bedtime for the duration of the patient’s life.

**What you need to know about Optimmune® Ophthalmic Ointment:**Optimmune® is prescribed for ophthalmic use in dogs only and U.S. Federal law restricts this drug to use by or on the order of a licensed veterinarian. Each gram of Optimmune® contains 2 mg of cyclosporine, USP; petrolatum, USP; corn oil, NF; and Amerchol® CAB base.

Precautions: A target animal safety study and clinical field studies with Optimmune® showed a wide safety margin in adult dogs. In the 6-month target animal safety study, dogs were subjected twice daily to up to 10 times the approved concentration of Optimmune®. No apparent toxicity or adverse reactions were observed. Dogs in this study were vaccinated with commercially available vaccines. No effect on antibody titer response was noted. Epiphora was noted in all groups, including the placebo group, and was not associated with any inflammatory change, nor was there any correlation to gross and histopathological changes.

The safety of Optimmune® has not been determined in puppies, pregnant bitches or dogs used for breeding. (See Breeding Recommendations below.)

Adverse reactions: In one trial, of 36 cases evaluated for safety, adverse reactions were noted in 2 animals (5.6%). One involved transient hyperemia (redness), epiphora (excessive tearing) and mild discomfort of the eye. The other involved pericocular/palpebral (eyelid) inflammation and mild alopecia (hair loss).

On rare occasions, instillation of Optimmune® may be associated with local irritation as manifested by periocular redness, lid spasm, and excessive rubbing. As the eyes of dogs with “dry eye” often demonstrate considerable inflammation, it is difficult to determine whether this local irritation constitutes a hypersensitivity to Optimmune®. If this ocular irritation persists beyond 7 days, hypersensitivity to a component of Optimmune® should be suspected and therapeutic options reassessed.

My male’s veterinary ophthalmologist indicated that “white coated” dogs are more likely to experience sensitivity to Optimmune®.

About the tube: Optimmune® is 3.5g in a 10g tube. This means that more than half of the tube is full of air. The air needs emptying out initially when the tube is first opened. The first time the tube is squeezed, the product in the nozzle is ejected suddenly and the small amount in the nozzle will be ejected suddenly. This is inevitable.

The tube should be kept at room temperature. Store between 36° and 86°F. If it is particularly warm, the base becomes oily and it is difficult to administer the ¼ inch dose.

Don’t roll up the tube – this will crack the tube and contaminate the drug.

Schering-Plough (the manufacturer) recommends that you discard any unused product 4 weeks after opening. The tube does not contain any preservatives or antimicrobials.

Dosage and Administration: Remove any eye debris with a suitable nonirritating solution prior to application. Aim to apply a ¼ inch strip to the affected eye(s) every 12 hours. It is recommended to keep treatments evenly spaced and results are best when just a ¼ inch strip is applied twice daily. The ointment may be placed directly on the cornea or into the conjunctival sac. The ointment will spread over the eye with normal blinking.

For best results, cyclosporine ophthalmic ointment should be administered early in the course of the disease before irreversible damage to the lacrimal tissue or corneal scarring or pigmentation occurs.

Dogs with “dry eye” will most likely require lifelong consistent therapy. Withdrawal of Optimmune® will result in rapid clinical regression.

HINTS OR HOW I FIGHT THE DAILY BATTLE AGAINST “DRY EYE” AND WIN!

To my babies, I’m a super hero. I made their eyes feel better and all it took was a little bit of cyclosporine applied to their eyes 2x a day. My female patient insists on getting her “treatment” first. This is how I do it:

• I apply the ointment every morning and evening between 7 and 7:30 and apply a ¼ inch strip of artificial tears lubricating eye ointment to each eye at noontime, if I’m at home, and always at bedtime.

• I make every effort and care (I’m not always successful) to apply just a ¼ inch strip to their corneas (the first application is, as mentioned above, tricky). Why? Because this ointment is very oily and some of the ointment will “ooze” onto the skin and hairs surrounding the eyes. Every effort must be made to reduce the amount of ointment leakage/discharge. I know from experience that excess oil can, during heat spells, create yeast that will cause periocular/palpebral inflammation and temporary hair loss (alopecia). Obviously, the greater the amount of ointment applied, the greater the amount of discharge.

• Five minutes after I apply the Optimmune®, I apply one drop of Refresh® Celluvisc® in each eye. This is not only soothing to the eye but my male’s veterinary ophthalmologist finds that the drop acts as a barrier against any ointment discharge.

• Five minutes later, I apply a warm compress to each eye for about a minute and wipe away any oily discharge.

• I am always careful to administer lots of kisses after each treatment. My male patient returns the favor by licking my eyes (I guess he thinks he’s giving me drops!).

• Each dog has their own tube of Optimmune® and artificial tear lubricating eye ointment. The Refresh® Celluvisc® comes in sterile, one dosage containers.

BREEDING ADVICE

All the literature I’ve read indicates that affected dogs should not be used for breeding. This may be because the safety of Optimmune® has not been determined in pregnant bitches or dogs used for breeding.

Disclaimer:

Information presented in the “Living With…” sections of the SCARF website represent the personal viewpoint of the individual who made the journal entry and do not represent the opinions, positions, or viewpoints of SCARF or the veterinary community. There may be discussions of drugs, devices, additives, foods, vitamins, herbs or biologicals that have not been approved by the FDA/CVM for the particular use being discussed. SCARF assumes no liability for the accuracy or outcomes of any suggestions, advice or other information provided by the “Living With…” postings on the SCARF website. All treatment decisions should only be made after discussion with your pet’s veterinary health professional, and no changes in your pet’s treatments or diet should be made based on any information found on the SCARF website.