Lacrimal

Lacrimal System: 

Lacrimal System Christopher J. Murphy, DVM PhD Department of Surgical Sciences School of Veterinary Medicine University of Wisconsin-Madison

Slide3: 

http://www.marvistavet.com/assets/images/dry_eye_diagram.gif http://www.city.ac.uk/optometry/Biolabs/Tissue/diaggob.JPG

KCS: 

KCS Keratoconjunctivitis: inflammation of the cornea and the conjunctiva Sicca: due to drying

Slide5: 

http://www.darwinvets.plus.com/images/topical/kcs/schirmer%20tear%20test%20eye.jpg

Slide7: 

http://dro.hs.columbia.edu/ced2/gvhb.jpg http://images.google.com/imgres?imgurl=http://www.marvistavet.com/assets/images/dry_eye_diagram.gif&imgrefurl=http://www.marvistavet.com/html/body_kcs__dry_eye_.html&h=187&w=286&sz=10&tbnid=UIms85WfeDkJ:&tbnh=71&tbnw=110&hl=en&start=13&prev=/images%3Fq%3Dkeratoconjunctivitis%2Bsicca%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8

Slide8: 

Medical Treatment

Medical Treatment: 

Medical Treatment Cyclosporin/tacrolimus (decrease inflammation, increase tearing) ± Mucolytics (decrease mucous congestion) ± Artificial Tears (palliative) ±Antibiotics (to combat secondary infection) ±Steroids (to decrease inflammation) New systemic meds (eg Theratears®- an omega-3 supplement) coming our way http://www.spcoopers.com.br/manutencao/Arquivos/Produtos/30.jpg

  AQUEOUS TACROLIMUS SOLUTION IN CANINE KCS One hundred five dogs diagnosed with KCS [Schirmer tear test (STT) < 10 mm/min and clinical signs of dry eye] were included in this study. Eyes with marginally decreased STT (11-15 mm/min) and clinical signs of dry eye were also evaluated. The investigation was conducted in two parts: an initial efficacy study and a subsequent double blinded controlled study. In the efficacy study, the effect of topical tacrolimus (formerly FK-506) on tear production in dogs with primary KCS was evaluated. Dogs were divided into four categories: 1) 59 eyes (38 dogs) naïve to tear stimulation therapy with initial STT 10 mm/min; 2) 28 eyes (21 dogs) naïve to tear stimulation therapy with initial STT 11 15 mm/min; 3) 30 eyes (15 dogs) maintained successfully on CsA therapy; 4) 47 eyes (24 dogs) unresponsive to CsA therapy. STT and clinical signs were evaluated prior to and after 6 to 8 weeks of twice daily tacrolimus administration. Tacrolimus was substituted for CsA therapy in categories 3 and 4. The controlled study compared the effect of topical tacrolimus in aqueous suspension to administration of the aqueous carrier alone on tear production in 20 dogs with primary KCS. Results: In the efficacy study, STT increased by 5 mm/min in 84.7%, 25.0%, 26.7% and 51.1% of eyes in categories 1, 2, 3 and 4 respectively after tacrolimus administration. Eighty-three percent of eyes with extremely low initial STT ( 2 mm/min), increased 5 mm/min after tacrolimus. In the controlled study, STT increased by 5 mm/min in 7/10 dogs (14/20 eyes) that received tacrolimus and in none of the 10 dogs that received aqueous carrier alone. Dogs receiving just the aqueous carrier were subsequently treated with tacrolimus, and STT increased 5 mm/min in 9 dogs (18/20 eyes) after administration. Conclusions: Twice daily administration of 0.02% tacrolimus in aqueous suspension effectively increased tear production in dogs with KCS. Topical tacrolimus is a promising alternative to topical CsA for treatment of KCS and may be beneficial in patients with less than optimal response to topical CsA. Source: Berdoulay, Andrew, English, Robert V. & Nadelstein, Brad (2005): Effect of topical 0.02% tacrolimus aqueous suspension on tear production in dogs with keratoconjunctivitis sicca. In: Veterinary Ophthalmology 8 (4), 225-232. : 

  AQUEOUS TACROLIMUS SOLUTION IN CANINE KCS One hundred five dogs diagnosed with KCS [Schirmer tear test (STT) < 10 mm/min and clinical signs of dry eye] were included in this study. Eyes with marginally decreased STT (11-15 mm/min) and clinical signs of dry eye were also evaluated. The investigation was conducted in two parts: an initial efficacy study and a subsequent double blinded controlled study. In the efficacy study, the effect of topical tacrolimus (formerly FK-506) on tear production in dogs with primary KCS was evaluated. Dogs were divided into four categories: 1) 59 eyes (38 dogs) naïve to tear stimulation therapy with initial STT 10 mm/min; 2) 28 eyes (21 dogs) naïve to tear stimulation therapy with initial STT 11 15 mm/min; 3) 30 eyes (15 dogs) maintained successfully on CsA therapy; 4) 47 eyes (24 dogs) unresponsive to CsA therapy. STT and clinical signs were evaluated prior to and after 6 to 8 weeks of twice daily tacrolimus administration. Tacrolimus was substituted for CsA therapy in categories 3 and 4. The controlled study compared the effect of topical tacrolimus in aqueous suspension to administration of the aqueous carrier alone on tear production in 20 dogs with primary KCS. Results: In the efficacy study, STT increased by 5 mm/min in 84.7%, 25.0%, 26.7% and 51.1% of eyes in categories 1, 2, 3 and 4 respectively after tacrolimus administration. Eighty-three percent of eyes with extremely low initial STT ( 2 mm/min), increased 5 mm/min after tacrolimus. In the controlled study, STT increased by 5 mm/min in 7/10 dogs (14/20 eyes) that received tacrolimus and in none of the 10 dogs that received aqueous carrier alone. Dogs receiving just the aqueous carrier were subsequently treated with tacrolimus, and STT increased 5 mm/min in 9 dogs (18/20 eyes) after administration. Conclusions: Twice daily administration of 0.02% tacrolimus in aqueous suspension effectively increased tear production in dogs with KCS. Topical tacrolimus is a promising alternative to topical CsA for treatment of KCS and may be beneficial in patients with less than optimal response to topical CsA. Source: Berdoulay, Andrew, English, Robert V. & Nadelstein, Brad (2005): Effect of topical 0.02% tacrolimus aqueous suspension on tear production in dogs with keratoconjunctivitis sicca. In: Veterinary Ophthalmology 8 (4), 225-232.

Surgical Treatment: 

Surgical Treatment PDT “When a steak will truly bring tears to your pets eyes”

Slide12: 

http://images.google.com/imgres?imgurl=http://137.222.110.150/calnet/H%2BN/image/location%2520%26%2520innervation%2520of%2520parotid%2520glanddog.jpg&imgrefurl=http://137.222.110.150/calnet/H%2BN/page4.htm&h=340&w=600&sz=25&tbnid=RAPVGJL63p8J:&tbnh=75&tbnw=133&hl=en&start=1&prev=/images%3Fq%3Dparotid%2Bgland%2Bdog%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8

Slide13: 

http://www.dogstop.com/helpzone/images/dryeye.gif

PDT: Disadvantages: 

PDT: Disadvantages Owner could spend as much time cleaning face post-op as treating with tears pre-op $$$ Mineral deposition on cornea and lid margins. Rare incompatibility between saliva and cornea

Quantitative Tear Disorders(abnormal STT)Qualitative Tear Disorders(STT may be normal): 

Quantitative Tear Disorders (abnormal STT) Qualitative Tear Disorders (STT may be normal)

Tear Break Up Time (TBUT): 

Tear Break Up Time (TBUT) Fluor dye, eyes open,examine with blue light or Wood’s lamp, measure time elapsed until black holes appear in tear film Difficult to perform

Rx qualitative tear disorders: 

Rx qualitative tear disorders

Epiphora: 

Epiphora Overproduction Ulcer Irritation Uveitis

Epiphora: 

Epiphora Poor Drainage: 1º or 2 º imperforate/hypoplastic puncta Entropion, malpositioned puncta Blockage Due To: Foreign Body Inflammation Neoplasia

Jones Test: 

Jones Test Place fluorescein in Hold nose pointed downward Observe for fluorescein exit from nares + Jones test

-Jones & + Flush = Functional Obstruction : 

-Jones & + Flush = Functional Obstruction

Dacryocystitis: 

Dacryocystitis

Slide32: 

Rabbit Epiphora