Dry Eye Syndrome and the
Cavalier King Charles Spaniel


Many cavalier King Charles spaniels suffer from a painful genetic disorder called dry eye syndrome (keratitis sicca or keratoconjunctivitis sicca -- KCS).  According to research studies, cavaliers are more pre-disposed to KCS -- at a relative risk of 11.5% -- than any other breed.


What It Is

Dry EyeDry eye is an inflammation of the cornea and conjunctiva due to an inability to produce watery tears, and it cannot be cured in cavaliers.

Dry eye prevents the cavalier's eyes from being properly moistened, resulting in chronically dry, burning eyes, and scarring and painful ulceration of the cornea which may lead to decreased vision. The disorder requires frequent medication every day.

A rarer but far more severe form of dry eye syndrome in some cavalier King Charles spaniel puppies is a combination of dry eye and a congenital skin condition called "curly coat" or "rough coat" syndrome (ichthyosis keratoconjunctivitis sicca). See Curly Coat for details.

All CKCSs should be examined at least annually by a board certified veterinary ophthalmologist. They are listed on this webpage of the website of the American College of Veterinary Ophthalmologists (ACVO).

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Symptoms

In the cavalier King Charles spaniel, the most common cause of dry eye syndrome is an immune-mediated destruction of the tear glands. Initial symptoms include chronic redness of the eye, chronic thick, yellow-green discharge, especially in the morning, and the development of a film over the cornea. (See photo below.)

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DiagnosisSchirmer Tear Test

Tear production in the dog's eyes is tested by placing a small strip of treated paper beneath the lower eyelid. This is called the Schirmer tear test.

 

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Treatment

Eyes Being ExaminedEarly treatment of dry eye is crucial to preventing destruction of the CKCS's cornea. Treatment is aimed at increasing tear production, applying artificial tears, and reducing any bacterial infections, and decreasing inflammation and scarring of the cornea. The dog's eyes must be kept clean and free of discharge. The patient may be treated initially with a topical antibiotic or anti-inflammatory.

Lacrimostimulant medications such as cyclosporin 1% and 2%, cyclosporine ophthalmic emulsion (Restasis) or ointment (Optimmune) and tacrolimus ophthalmic suspension are commonly prescribed daily for life to increase tear production, and artificial tear solutions must be applied frequently each day to eliminate bacteria, rinse the eyes, and remove discharge. Cyclosporin 1% and 2% are available at reduced cost, with veterinarians' prescriptions, through an accredited compounding pharmacy on the Internet, Premier Pharmacy Labs, Inc.

NOTE: In a 2008 study of 25 dogs, including a cavalier, researchers observed that "brachycephalic dogs with a background of chronic keratitis that are treated with nonsteroidal anti-inflammatory drugs [including cyclosporine] are at risk to develop axial corneal SCC [squamous cell carcinoma]. The increase in annual cases of SCC suggests that this phenomenon is a developing problem." See also a 2011 study which concluded, "Chronic inflammatory conditions of the cornea and topical immunosuppressive therapy may be risk factors for developing primary corneal SCC in dogs."

Other frequently prescribed products to help relieve discomfort, itching, and burning are sodium hyaluronate (Hy-Optic by Kinetic Technologies) and hyaluronan (I-Drop Vet PLUS by I-MED Pharma Inc.).

In a 2013 study, Dr. David L. Williams reports developing a gel which does not require as many doses per day as do the liquid medications. The gel is a crosslinked hydrogel based upon a modified, thiolated hyaluronic acid (HA), which he has labelled xCMHA-S.  He stated:

"Further, in a preliminary clinical study of dogs with KCS [including 3 CKCSs], the gel significantly reduced the symptoms associated with KCS within two weeks while only being applied twice daily. The reduction of symptoms combined with the low dosing regimen indicates that this gel may lead to both improved patient health and owner compliance in applying the treatment."

Surgery rarely is a successful option. In severe cases that do not respond to medications, an expensive surgical procedure called a parotid duct transposition 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 dry eye, because saliva is not the same as tears, and the flow of saliva cannot be as well controlled. 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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Breeders' Responsibilities

Cavalier's Eyes Being ExaminedThe Canine Inherited Disorders Database recommends that dogs affected with dry eye not be bred. Since dry eye is an hereditary disease in cavaliers, breeders also should never breed any CKCS which has parents or grandparents which have had dry eye. Dry eye in any littermates of breeding stock should be taken into consideration.

The Cavalier King Charles Spaniel Club, USA recommends that, prior to breeding any cavalier, the dog have a normal rating from a screening by a board certified veterinary ophthalmologist.

The Canine Health Information Center (CHIC) is a centralized canine health database sponsored by the AKC/Canine Health Foundation (AKC/CHF) and OFA. The CHIC, working with participating parent clubs, provides a resource for breeders and owners of purebred dogs to research and maintain information on the health issues prevalent in specific breeds.

AKC's national breed clubs establish the breed specific testing protocols. Dogs complying with the breed specific testing requirements are issued CHIC numbers. The ACKCSC requires that, to qualify for CHIC certification, cavaliers must have a CERF eye examination, recommending that an initial CERF exam be performed at 8 to 12 weeks, with a follow up exam once the dog reaches 12 months, and annual exams thereafter until age 5 years, and every other year until age 9 years. However, all that is required to qualify for a CHIC certificate is that the breeding stock be examined by a veterinary ophthalmologist. It does not require that the results of the examination show no eye disorders.

Nevertheless, all cavalier breeding stock should be examined by board certified veterinary ophthalmologists at least annually and cleared by the veterinary specialists for dry eye, the closer the examination to the breeding the better.

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Research News

Dr. David L. WilliamsAugust 2013: Dr. David L. Williams develops a gel for treating dry eye. In a 2013 study, Dr. David L. Williams (at right) of UK's Cambridge University, reports developing a gel which does not require as many doses per day as due the liquid medications. The gel is a crosslinked hydrogel based on a modified, thiolated hyaluronic acid (HA), labelled "xCMHA-S".  He stated:

"Further, in a preliminary clinical study of dogs with KCS [including 3 CKCSs, the gel significantly reduced the symptoms associated with KCS within two weeks while only being applied twice daily. The reduction of symptoms combined with the low dosing regimen indicates that this gel may lead to both improved patient health and owner compliance in applying the treatment."

July 2012: OSU seeks dogs with dry eye for cyclosporine study. Ohio State University's vet school is seeking dogs with dry eye for a study of a new formulation of the topical drug cyclosporine. To qualify for enrollment in this study, dogs must have confirmed diagnosis of dry eye and not be currently treated with a cyclosporine-type drug. All study medication will be provided at no cost; all examination charges following study enrollment will be covered by the study.

Initially, a routine complete ophthalmic examination will need to be performed to determine the patient's eligibility. This includes an evaluation of ocular discharge and comfort, menace and pupillary light responses, penlight examination, slitlamp examination, Schirmer Tear Test (STT), determination of the Tear Break-up time, flourescein stain uptake, determination of intraocular pressure and indirect ophthalmoscopy following dilation of the pupils. If deemed eligible, you are required to fill out a questionaire, and your dog will be randomly assigned to a treatment group (the study drug or 1% cyclosporine). Both medications are to be administered every 12 hours for the duration of the study. The veterinarian will be blinded during the course of the study, i.e. will not know which drug your dog is receiving. A routine STT will need to be performed on Day 7 and 14 which can be performed at OSU or at your local referring veterinarian. A 1 month and 2 month recheck will need to be performed at OSU. During these visits you will need to fill out a questionaire, and a routine complete ophthalmic eximation will be performed on your dog.  Contact Dr. David Wilkie, wilkie.1@osu.edu or Dr. Anne Metzler, metzler.134@osu.edu, or call 614-292-3551 for further information. Click here for their webpage. OSU is offering $500.00 to referral veterinarians, so tell your vet about it!

December 2011: UK researchers find dry eye medications have mixed results. In a 2011 UK study of cavaliers suffering from both dry eye and curly coat syndrome, the researchers found that "lacrimostimulant treatment [e.g., cyclosporin] had no statistically significant effect on Schirmer tear test results, although subjectively, this treatment reduced progression of the keratitis [dry eye]."

April 2011: Animal Health Trust Starts DNA Test for Curly Coat in Cavaliers. On April 18, 2011. Animal Health Trust (AHT) begins offering to cavalier breeders its DNA test to detect the mutations causing dry eye/curly coat syndrome, through the AHT’s online DNA testing webshop.  The DNA test is available world-wide. Read more here.

November 2010: DNA Region for Curly Coat Has Been Found. Animal Health Trust (AHT) veterinary geneticist Dr. Tom Lewis announced at the UK Cavalier Club's "Cavalier Health Day" on November 20 that the DNA region for the curly coat syndrome in cavaliers has been located. The AHT is continuing its research, started by the late Dr. Keith C. Barnett, to identify the precise mutations of gene(s) causing curly coat syndrome (ichthyosis keratoconjunctivitis sicca).  The Trust's future plan is to offer a DNA test for the mutations to cavalier breeders.

March 2009: Dr. Keith C. Barnett died on March 10, 2009.

April 2007: Drs. R. F. Sanchez (England), G. Innocent (Scotland), J. Mould (England), and F. M. Billson (Australia) reported in an April 2007 report that the cavalier King Charles spaniels in their study "showed a more acute disease pattern with a biphasic age distribution at 0 to less than two years of age, and four to less than six and six to less than eight years of age, respectively, with more males affected than females and a significantly higher incidence of ulcerative keratitis in some cases resulting in corneal perforation."

March 2007: The Animal Health Trust (AHT) is conducting research to try to establish the pattern of inheritance of CKCS puppies born with the combination of both dry eye and curly coat syndrome (ichthyosis keratoconjunctivitis sicca), which appears to be unique to the cavalier as a breed. According to Dr. Keith C. Barnett, European specialist in veterinary ophthalmology, who has been studying these conditions for several years, no cases of the two abnormalities occurring together have been recorded in any other breed.

Dr. Barnett and Dr. Cathryn Mellersh, senior canine geneticist at the AHT, are leading a team of AHT colleagues who are researching the DNA of the puppies. Dr. Mellersh reports that twenty-seven candidate genes have been identified and the tests are currently in progress and final results are pending.

Dr. Barnett requests that breeders who have puppies affected with these combined disorders send blood samples and skin tissue samples from the affected puppies, their siblings, and parents to identify the responsible gene. Contact Dr. Barnett at the AHT if you wish to participate in the research project. He may be reached at Animal Health Trust, Lanwades Park, Kentford, Newmarket, CB8 7UU, United Kingdom; telephone: (+44) (0)8700 502424; email: Keith.Barnett@aht.org.uk Blood samples of 3 to 5 ml should be provided in ETDA anti-coagulant tubes. Alternatively, for very young or old donors, cheek swabs may be used. Samples should be marked for the attention of Dr. K. Barnett and sent to: Sarah Gray, The Animal Health Trust, Lanwades Park, Newmarket Suffolk CB8 7UU UK. Please indicate clearly that the samples are Curly Coat affected or related. Dr. Mellersh may be reached at Animal Health Trust, Lanwades Park, Kentford, Newmarket, Suffolk CB8 7UU, United Kingdom; telephone: (+44) (0)1638 750659 ; email: cathryn.mellersh@aht.org.uk 

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Related Links


Veterinary Resources

Keratoconjunctivitis sicca in the dog: a review of two hundred cases. Jane Sansom, K.C. Barnett. J.Sm.Anim.Pract. March 1985; 26(3):121-131. Quote: "Two hundred consecutive referred cases of keratoconjunctivitis sicca in the dog were examined over a 9 year period [including cavalier King Charles spaniels]. The clinical signs are described and the cases discussed in sections relating to the aetiology and in particular, the age and sex incidence in the West Highland White Terrier. The suitability of this animal as a model for Sjögrens syndrome in man is discussed."

A new perspective on canine keratoconjunctivitis sicca. Treatment with ophthalmic cyclosporine. Kaswan RL and Salisbury MA. Vet Clin North Am (Small Anim Pract). 1990;20:583-613. Quote: "Canine breeds predisposed to keratoconjunctivitis sicca: Cavalier King Charles spaniel ... relative risk 11.5%."

Ocular Disorders Presumed to be Inherited in Purebred Dogs. ACVO 1999.

Control of Canine Genetic Diseases. Padgett, G.A., Howell Book House 1998, pp. 198-199, 240.

Dry eye and curly coat in the Cavalier King Charles Spaniel. Barnett, KC, Veterinary Ophthalmology 6 (4), 343-350, Dec. 2003.

Guide to Congenital and Heritable Disorders in Dogs. Dodds WJ, Hall S, Inks K, A.V.A.R., Jan 2004, Section II(179).

Breed Predispositions to Disease in Dogs & Cats. Alex Gough, Alison Thomas. 2004; Blackwell Publ. 44-45.

Ophthalmic Disease in Veterinary Medicine. Martin C.L. Manson Publ. 2005.

Congenital keratoconjunctivitis sicca and ichthyosiform dermatosis in the cavalier King Charles spaniel. K. C. Barnett. J.Sm.Anim.Prac. 2006 Sep;47(9):524-8. Quote: "Objectives: To record a previously unreported congenital and hereditary condition affecting the eyes and skin in the cavalier King Charles spaniel. ... In the cavalier King Charles spaniel, the coat abnormality was noted at birth by the breeders as a 'curly coat', with deterioration of the skin signs as the animal became adult."

Canine keratoconjunctivitis sicca: disease trends in a review of 229 cases. R. F Sanchez, G Innocent, J Mould, F. M Billson. J.Sm.Anim.Pract.; April 2007;48(4): 211-217. Quote: "There were 44 breeds in the study, with four breeds, English cocker spaniels, cavalier King Charles spaniels, West Highland white terriers and shih-tzus, making up 58 per cent of the cases. ... In contrast, cavalier King Charles spaniels and shih-tzus showed a more acute disease pattern with a biphasic age distribution at 0 to less than two years of age, and four to less than six and six to less than eight years of age, respectively, with more males affected than females and a significantly higher incidence of ulcerative keratitis in some cases resulting in corneal perforation. ... In the USA, predisposed breeds include cavalier King Charles spaniels (CKCS), English bulldogs, Lhasa apsos, shih-tzus, West Highland white terriers (WHWT), pugs, bloodhounds, American cocker spaniels, Pekingeses, Boston terriers, miniature schnauzers and Samoyeds (Kaswan and Salisbury 1990)."

Dry Eye in Veterinary Ophthalmology. Cameron Whittaker,  Robin G. Stanley. 32d WSAVA Conf. August 2007. http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2007&PID=18230&Category=2991&O=Generic Quote: "What Causes KCS? The vast majority of KCS cases are caused by the body's own immune system i.e., an autoimmune disease directed against the lacrimal gland. Work done in the early 1980s showed that there was a strong mononuclear cell infiltrate of lymphocytes and plasma cells into the lacrimal gland suggesting an autoimmune basis. There also seems to be a strong breed predilection for dry eye. Breeds predisposed include ... Cavalier King Charles Spaniels."

Immunopathogenesis of Keratoconjunctivitis Sicca in the Dog. David L. Williams. Vet Clin Small Anim 38 (2008) 251–268. Quote: "Canine breeds predisposed to keratoconjunctivitis sicca: Cavalier King Charles Spaniel, relative risk 11.5% [highest risk level of all breeds of dogs]."

Corneal squamous cell carcinoma in dogs with a history of chronic keratitis. R. R. Dubielzig, C. S. Schobert and J. Dreyfus. Vet Ophth; 2008;11(6):413–429. Quote: "Purpose: Corneal squamous cell carcinoma (SCC) is a rare tumor in dogs. The COPLOW has seen a recent increase in primary SCC in the axial cornea. We report here on 25 cases. Methods: Twenty-five cases of primary axial corneal SCC were selected from the COPLOW collection which includes more that 6000 neoplastic specimens. ... Results: The number of canine corneal SCC has risen in the past several years from 1 case per year from 1998 to 2004, jumping to 6 cases in 2005, 8 cases in 2006, and 7 cases in 2007. Brachycephalic breeds are overrepresented. The breed distribution included 8 Pugs, 5 Bulldog, 2 Boxers, 2 Greyhound, 2 Shi Tzu, 2 Border Collie, 2 Pekinese, 1 Bassett, 1 Chow, 1 Cocker, and 1 Cavalier King Charles Spaniel. No correlation to sex was found. Out of the 25 cases, 21 showed signs of chronic keratitis prior to developing SCC. In the remaining 4 cases the prior corneal history was unknown. Within the group of 25, 10 cases had been treated with cyclosporine alone, 4 with tacrolimus alone, 5 with both cyclosporine and tacrolimus, and 6 treated with other drugs or unknown. Follow-up information was obtained from 23 cases with a follow-up interval of between 5 days and 31 months (mean: 7.9 months). Three dogs had died for reasons unrelated to the ocular disease. One dog had recurrent disease extending deeply into the cornea. Conclusions: Brachycephalic dogs with a background of chronic keratitis that are treated with nonsteroidal antiinflammatory drugs are at risk to develop axial corneal SCC. The increase in annual cases of SCC suggests that this phenomenon is a developing problem."

Congenital keratoconjunctivitis sicca and ichthyosiform dermatosis (ckcsid) in the Cavalier King Charles Spaniel (CKCS) dog: a candidate gene study. C. Hartley, K. C. Barnett, C. S. Mellersh, L. Pettitt and O. P. Forman. Vet Ophthal (2009) 12(6):379–385.  Quote: "Purpose: To identify causative mutation(s) for CKCSID in CKCS dogs using a candidate gene approach. Methods: DNA samples from 21 cases/parents were collected. Canine candidate genes (CCGs) for similar inherited human diseases were chosen. Twenty-eight candidate genes were identified by searching the Pubmed database (http://www.ncbi.nlm.nih.gov/sites/entrez/query.fcgi). Canine orthologs of human candidate genes were identified using the Ensembl orthologue prediction facility (http://www.ensembl.org/index.html). Two microsatellites flanking each candidate gene were selected and primers to amplify each microsatellite were designed using the Whitehead Institute primer design website (http://frodo.wi.mit.edu/cgibin/primer3/primer3_www.cgi). The microsatellites associated with all 28 CCGs were genotyped on a panel of 21 DNA samples from CKCS dogs (13 affected, 8 carriers). Genotyping data was analysed to identify markers homozygous in affected dogs and heterozygous in carriers (homozygosity mapping). Results: None of the microsatellites associated with 25 of the CCGs displayed an association with CKCSID in the 21 DNA samples tested. Three CCGs associated microsatellites were monomorphic across all samples tested. Conclusion: Twenty five CCGs were excluded as cause of CKCSID. Three CCGs could not be excluded from involvement in the inheritance of CKCSID."

Breed Predispositions to Disease in Dogs & Cats (2d Ed.). Alex Gough, Alison Thomas. 2010; Blackwell Publ. 51, 54.

New DNA tests for Cavalier King Charles spaniels. Vet Rec 2011 168(14):370. "NEW DNA tests to detect the mutations causing congenital keratoconjunctivitis sicca and ichthyosiform dermatosis (dry eye and curly coat syndrome) and episodic falling in Cavalier King Charles spaniels will be available from the Animal Health Trust (AHT) later this month. Episodic falling is a neurological condition induced by exercise, excitement or frustration. The dog's muscle tone increases and the animal is unable to relax its muscles, becomes rigid and falls over. Dry eye and curly coat syndrome results in an affected dog producing no tears, so its eyes become sore. The skin becomes flaky and dry, particularly around the feet, which can make standing and walking difficult and painful. The syndrome appears to be unique to Cavalier King Charles spaniels and most dogs diagnosed  with it are euthanased. Researchers at the Kennel Club Genetics Centre at the AHT have now identified the mutations responsible  for the two conditions. This has allowed the development of the new DNA tests, which will be available from the AHT from April 18. Cathryn Mellersh, head of canine genetics at the AHT, said: To date there has been no long-term effective treatment  for either dry eye and curly coat syndrome or episodic falling so the development of the DNA tests is an important breakthrough for breeders and owners of Cavalier King Charles spaniels. As with all inherited disease, it's important that breeders  are armed with the facts and that they still continue to use carrier dogs in their breeding programmes. Breeding a carrier with a non-carrier will not produce affected puppies; however, breeding just clear dogs with other clear dogs could reduce  the gene pool within the breed and this could lead to other health problems in the future."

Superficial corneal squamous cell carcinoma occurring in dogs with chronic keratitis. Jennifer Dreyfus, Charles S. Schobert, Richard R. Dubielzig. Vet Ophth; May 2011;14(3):161-168. Quote: "Objective: Canine corneal squamous cell carcinoma (SCC) is a rare tumor, with only eight cases previously published in the veterinary literature. The Comparative Ocular Pathology Lab of Wisconsin (COPLOW) has diagnosed 26 spontaneously occurring cases, 23 in the past 4 years [three of which were cavalier King Charles spaniels]. This retrospective study describes age and breed prevalence, concurrent therapy, biologic behavior, tumor size and character, and 6-month survival rates after diagnosis. Results: A search of the COPLOW database identified 26 corneal SCC cases diagnosed from 1978 to 2008. There is a strong breed predilection (77%) in brachycephalic breeds, particularly those prone to keratoconjunctivitis sicca. The mean age was 9.6 years (range 6–14.5 years). Follow-up information >6 months was available for 15 of 26 cases. Recurrence occurred in the same eye in nine cases, seven of which were incompletely excised at the time of first keratectomy. No cases were known to have tumor growth in the contralateral eye and no cases of distant metastases are known. Where drug history is known, 16 of 21 dogs had a history of treatment with topical immunosuppressive therapy (cyclosporine or tacrolimus) at the time of diagnosis. Conclusion: Chronic inflammatory conditions of the cornea and topical immunosuppressive therapy may be risk factors for developing primary corneal SCC in dogs. SCC should be considered in any differential diagnosis of corneal proliferative lesions. Superficial keratectomy with complete excision is recommended, and the metastatic potential appears to be low."

Genetic Connection: A Guide to Health Problems in Purebred Dogs, Second Edition. Lowell Ackerman. July 2011; AAHA Press; pg 168. Quote: "Table 11.5 -- Breeds Most Commonly Affected with Keratoconjunctivitis Sicca (KCS): ... Cavalier King Charles spaniel...."

Keratoconjunctivitis associated with eosinophils in dogs: A retrospective study of 35 cases (2004–2009). G. de Geyera, I. Raymond-Letronb. Pratique Médicale et Chirurgicale de l'Animal de Compagnie.  doi:10.1016/j.anicom.2011.09.002. Quote: "The objective of this study is to present the clinical and histopathologic features of dogs with keratoconjunctivitis selected based on eosinophils detected in corneal histopathology. Thirty-five cases were reviewed focusing on breed, history, ophthalmic lesions, results of cytology and intradermal allergy testing for 19 allergens, and response to treatment which included keratectomy, topical antibiotics, and corticosteroids in variable conjunction with cyclosporine. Results are: patients included 18 males and 17 females, 9 months to 12 years of age (mean 6.8 years). Among the 34 pure bred dogs were seven Boxers, five French Bulldogs and four Labrador Retrievers. History was that of uni- or bilateral chronic or recurrent corneal ulcers or chronic keratitis. Lesions most commonly were located in the temporal cornea with vessels extending from the limbus centrally to the mid-periphery to form a dense meshwork of thin vessels with an associated superficial stromal infiltrate and a superficial ulcer and associated corneal edema. Conjunctival inflammation and follicular hyperplasia of the bulbar surface of the third eyelid were a consistent finding. Ocular surface cytology showed a predominance of neutrophils and lymphocytes and infrequently eosinophils. Intradermal allergy testing showed a positive reaction to injected aeroallergens in 23 of 26 tested dogs with house dust mite the most common positive allergen. Corneal histopathology showed a hyperplasic epithelium, a lacking basal membrane in the area of corneal defect, an epitheliostromal clivage, a hyalinized acellular zone on the superficial stroma, and corneal infiltrate with neutrophils, monocytes and variable eosinophils. Treatment was effective in all dogs with complete resolution of the ulcers; variable recurrence was successfully managed by topical corticosteroids. In conclusion, this study indicates that eosinophils may participate to the corneal infiltrate of dogs with keratitis associated or not with chronic or recurrent ulcer. Hypotheses include an allergy."

Canine Inherited Disorders Database: http://ic.upei.ca/cidd/disorder/keratoconjunctivitis-sicca-kcs-dry-eye  http://ic.upei.ca/cidd/disorder/ichthyosis

Congenital keratoconjunctivitis sicca and ichthyosiform dermatosis in 25 Cavalier King Charles spaniel dogs – part I: clinical signs, histopathology, and inheritance.  Claudia Hartley, David Donaldson, Ken C. Smith, William Henley, Tom W. Lewis, Sarah Blott, Cathryn Mellersh, Keith C. Barnett. Vet.Opht. 29Dec2011. Quote: "The clinical presentation and progression (over 9 months to 13 years) of congenital keratoconjunctivitis sicca and ichthyosiform dermatosis (CKCSID) in the Cavalier King Charles spaniel dog are described for six new cases and six previously described cases. Cases presented with a congenitally abnormal (rough/curly) coat and signs of KCS from eyelid opening. Persistent scale along the dorsal spine and flanks with a harsh frizzy and alopecic coat was evident in the first few months of life. Ventral abdominal skin was hyperpigmented and hyperkeratinized in adulthood. Footpads were hyperkeratinized from young adulthood with nail growth abnormalities and intermittent sloughing. Long-term follow-up of cases (13/25) is described. Immuno-modulatory/lacrimostimulant treatment had no statistically significant effect on Schirmer tear test results, although subjectively, this treatment reduced progression of the keratitis. Histopathological analysis of samples (skin/footpads/ lacrimal glands/salivary glands) for three new cases was consistent with an ichthyosiform dermatosis, with no pathology of the salivary or lacrimal glands identified histologically. Pedigree analysis suggests the syndrome is inherited by an autosomal recessive mode."

Keratoconjunctivitis Sicca in the dog. Sarah Cooper. UK Companion Animal. Oct. 2012; 17(8):37-42.. Quote: "Dry eye or keratoconjunctivitis sicca is a reduction in the aqueous component of the pre-ocular tear film causing inflammation of the ocular surface. It is an important condition in dogs and diagnosis with a Schirmer Tear Test at an early stage can aid in successful treatment."

A Crosslinked HA-Based Hydrogel Ameliorates Dry Eye Symptoms in Dogs. David L. Williams, Brenda K. Mann. Int.J. of Biomaterials. 2013. Quote: "Keratoconjunctivitis sicca, commonly referred to as dry eye or KCS, can affect both humans and dogs. ... With immune-mediated KCS in dogs, there is a predisposition for specific breeds having a higher prevalence. These breeds include English Bulldogs, West Highland White Terriers, Cavalier King Charles Spaniels, American and English Cocker Spaniels, and Pugs, with the prevalence reaching as high as 20% in these breeds. ... The standard of care in treating KCS typically includes daily administration of eye drops to either stimulate tear production or to hydrate and lubricate the corneal surface. Lubricating eye drops are often applied four to six times daily for the life of the patient. In order to reduce this dosing regimen yet still provides sufficient hydration and lubrication, we have developed a crosslinked hydrogel based on a modified, thiolated hyaluronic acid (HA), xCMHA-S. This xCMHA-S gel was found to have different viscosity and rheologic behavior than solutions of noncrosslinked HA. The gel was also able to increase tear breakup time in rabbits, indicating a stabilization of the tear film. Further, in a preliminary clinical study of dogs with KCS [including 3 CKCSs], the gel significantly reduced the symptoms associated with KCS within two weeks while only being applied twice daily. The reduction of symptoms combined with the low dosing regimen indicates that this gel may lead to both improved patient health and owner compliance in applying the treatment."

Diagnosis & Treatment of Keratoconjunctivitis Sicca in Dogs. Lori J. Best, Diane V.H. Hendrix, Daniel A. Ward. Today’s Veterinary Practice. July 2014;16-22. Quote: "Many breeds are predisposed to primary KCS, including, but not limited to, the American cocker spaniel, cavalier King Charles spaniel, West Highland white terrier, and brachycephalic breeds (eg, English bulldog)."

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