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Decreased Tear Production in Dogs

Ian Herring, DVM, MS, DACVO, Virginia–Maryland College of Veterinary Medicine

Ophthalmology

|May 2017|Peer Reviewed

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Clinician's Brief
Clinician's Brief

Table 1

TREATMENT FOR IDIOPATHIC/IMMUNE-MEDIATED KCS

Treatment Application
Topical ophthalmic cyclosporine (1%-2% solution, 0.2% ointment), tacrolimus (0.03%) Apply to affected eye(s) q12h; lifelong therapy required
Topical lacrimomimetic PRN (ie, artificial tears; products containing sodium hyaluronate may be particularly beneficial) Apply until signs resolve (usually unnecessary when STT >8 mm/min)
Topical ophthalmic broad-spectrum antibiotic (eg, neomycin, polymyxin B, gramicidin solution) Apply to affected eye(s) q8h for 10-14 days or until corneal ulceration (if present) is healed
Topical mucolytic medication (2.5%-5% N-acetylcysteine) Apply q6-8h if copious mucopurulent discharge is present
Warm compress to eyelids, periocular hair trimming, facial cleaning Apply as warranted

Table 2

TREATMENT FOR KCS SECONDARY TO RISK FACTORS

Treatment Application
Discontinue lacrimotoxic medication if suspected in KCS pathogenesis N/A
Topical ophthalmic cyclosporine or tacrolimus can be attempted (see Table 1) but is generally ineffective in these cases Apply to affected eye(s) q12h
Topical lacrimomimetic PRN (ie, artificial tears; products containing sodium hyaluronate may be particularly beneficial) Apply until signs resolve (usually unnecessary when STT >8 mm/min)
Topical ophthalmic broad-spectrum antibiotic(eg, neomycin, polymyxin B, gramicidin solution) Apply to affected eye(s) q8h for 10-14 days or until corneal ulceration (if present) is healed
Topical mucolytic medication (2.5%-5% N-acetylcysteine) Apply q6-8hif copious mucopurulent discharge is present
Warm compress to eyelids, periocular hair trimming, facial cleaning Apply as warranted

Table 3

TREATMENT FOR CONGENITAL ALACRIMA

Treatment Application
Topical lacrimomimetic PRN (ie, artificial tears; products containing sodium hyaluronate may be particularly beneficial) Apply until signs resolve (usually unnecessary when STT >8 mm/min)
Topical ophthalmic broad-spectrum antibiotic (eg, neomycin, polymyxin B, gramicidin solution) Apply to affected eye(s) q8h for 10-14 days or until corneal ulceration (if present) is healed
Topical mucolytic medication (2.5%-5% N-acetylcysteine) Apply q6-8h if copious mucopurulent discharge is present
Warm compress to eyelids, periocular hair trimming, facial cleaning Apply as warranted

Table 4

TREATMENT FOR NEUROGENIC KCS

Treatment Application
Topical ophthalmic 0.2% pilocarpine q6-8h or 2% oral pilocarpine Initial oral dose, 2 drops/20 pounds (10 kg) body weight q12h; increase 1 drop at a time to effect or until systemic toxicity (eg, salivation, vomiting, diarrhea) is evident
Topical lacrimomimetic PRN (ie, artificial tears; products containing sodium hyaluronate may be particularly beneficial) Apply until signs resolve (usually unnecessary when STT >8 mm/min)
Topical ophthalmic broad-spectrum antibiotic(eg, neomycin, polymyxin B, gramicidin solution) Apply to affected eye(s) q8h for 10-14 days or until corneal ulceration (if present) is healed
Topical mucolytic medication (2.5%-5% N-acetylcysteine) Apply q6-8h if copious mucopurulent discharge is present
Monitor for blepharospasm N/A

*Spontaneous resolution may occur; therapy can be discontinued after resolution.  

KCS = keratoconjunctivitis sicca, STT = Schirmer tear test

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