Lacrimal System

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Lacrimal System

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

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KCS

• Keratoconjunctivitis inflammation of the cornea
  and the conjunctiva
• Sicca due to drying

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Medical Treatment
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Medical Treatment
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• 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

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  AQUEOUS TACROLIMUS SOLUTION IN CANINE KCS One
hundred five dogs diagnosed with KCS Schirmer
tear test (STT) lt 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.
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Surgical Treatment

• PDT
• When a steak will truly bring tears to your pets
  eyes

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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

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Quantitative Tear Disorders(abnormal
STT)Qualitative Tear Disorders(STT may be
normal)
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Tear Break Up Time (TBUT)

• Fluor dye, eyes open,examine with blue light or
  Woods lamp, measure time elapsed until black
  holes appear in tear film
• Difficult to perform

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Rx qualitative tear disorders
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Epiphora

• Overproduction
• Ulcer
• Irritation
• Uveitis

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Epiphora

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

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Jones Test

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

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-Jones Flush Functional Obstruction
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Dacryocystitis
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Rabbit Epiphora
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