Non-topical treatment for KCS

Re: Non-topical treatment for KCS

Anthony Dennison — Sun, 23 Nov 2014 11:19:01 GMT

Actually lol'd at that! Rutland House have a good opthalmology team, could be worth talking to them?

Re: Non-topical treatment for KCS

Ian Mostyn — Fri, 21 Nov 2014 23:23:42 GMT

[quote user="Anthony Dennison"]Apologies if I am completely wrong in this: I may have dreamt it (4th year lectures involved a lot of napping on my part) but I think I can remember an opthalmology lecture that has a slide describing implantation of a cyclosporin tablet/implant underneath the sclera? [/quote]

I'm referring him to you for that - not sure I fancy that procedure

Ian

Re: Non-topical treatment for KCS

Anthony Dennison — Fri, 21 Nov 2014 12:29:05 GMT

Apologies if I am completely wrong in this: I may have dreamt it (4th year lectures involved a lot of napping on my part) but I think I can remember an opthalmology lecture that has a slide describing implantation of a cyclosporin tablet/implant underneath the sclera?

It does sound daft so I've probably made it up.

Re: Non-topical treatment for KCS

Ian Mostyn — Fri, 21 Nov 2014 10:53:46 GMT

Just a quick update. 10 days or so of fucithalmic has settled the worst of the eye down and I have done a repeat Schirmer Tear Test today. Last time they were 15 & 22mm (R & L) and today they were down to 7mm & 13mm. I guess it is true that an actively inflamed eye will produce more tears (thanks for that suggestion). Eye drops are still out of the question so I am trying oral cyclosporin and I will write an update when / if it works.

Cheers for everyone's help,

Ian

Re: Non-topical treatment for KCS

Michael Woodhouse — Wed, 12 Nov 2014 00:46:02 GMT

[quote user="Hannah Wynne Richards"] One advantage of the liquid formulations of cyclosporin is that it should be easier to regulate the dose so as to minimise side-effects[/quote]

And to fit the same product to different sized dogs.

Re: Non-topical treatment for KCS

bob lehner — Tue, 11 Nov 2014 17:35:08 GMT

[quote user="karen jones"]Virbac just launched an oral liquid too.[/quote]

[quote user="Michael Woodhouse"]Dechra just launched Sporimune- oral cyclosporin liquid. Not had chance to compare cost[/quote]

From recent ads;

Cyclavance (Virbac) - 'Priced to give greater appeal'.

Sporimune (Dechra) - '...at a highly competitive cost to treat'.

Re: Non-topical treatment for KCS

Hannah Wynne Richards — Tue, 11 Nov 2014 15:26:23 GMT

One advantage of the liquid formulations of cyclosporin is that it should be easier to regulate the dose so as to minimise side-effects

Wynne

Re: Non-topical treatment for KCS

Ian Mostyn — Tue, 11 Nov 2014 13:14:29 GMT

[quote user="Martin Atkinson"]I would question whether this client should be indulged so much with all these alternative therapies with potential side effects/complications when basically she just needs to get a grip and be firm with the dog![/quote]

I would normally agree but we are almost as concerned about the owner and her health as we are about the dog. Her daughter rang us with her concerns and we have had a chat and she is aware of what is happening.

From reading everyone's comments I am going to do weekly STT and see what happens when the eye looks settled (she doesn't normally bring the dog in when his eyes are ok). It would make sense for there to be more tear production when the eye is irritated and it isn't sore all the time - just monthly at the moment. Oral cyclosporin seems to be a good option and I think we can manage that better than eye drops daily. I need to keep any treatment as simple as possible.

Ian

Re: Non-topical treatment for KCS

Ceri Gruffudd Jones — Tue, 11 Nov 2014 11:45:48 GMT

Sorry, folks. Didn't mean to 'verify' this answer (though it is a perfectly good one)- was absent mindedly brushing a crumb off my iPad screen and don't know how to reverse my action!

Re: Non-topical treatment for KCS

Martin Atkinson — Tue, 11 Nov 2014 11:03:06 GMT

[quote user="Gerry Henry"]If you confirm KCS then a parotid duct transposition might be the answer but do a blood calcium first. I did one a few months ago[/quote]I haven't done one for donkey's years (since cyclosporin topical treatment indeed) though they were usually uncomplicated.

I would question whether this client should be indulged so much with all these alternative therapies with potential side effects/complications when basically she just needs to get a grip and be firm with the dog!

Re: Non-topical treatment for KCS

Bob Russell — Tue, 11 Nov 2014 09:56:27 GMT

Cyclosporin seems to improve the quality of the tear film as well as the quantity so may still be of value in borderline cases. I will sometimes try optimmune in patients with borderline STT for a months trial. Retesting generally shows significantly improved results.

If owners resist continuing (usually on cost grounds) then I check them every three months or so. Almost invariably they seem to progress.

Usually westies and cavaliers of course!

Re: Non-topical treatment for KCS

Gerry Henry — Tue, 11 Nov 2014 09:11:04 GMT

If you confirm KCS then a parotid duct transposition might be the answer but do a blood calcium first. I did one a few months ago, surgery fine but persisting red eye/irritation even though globe nice and moist; referred to my local friendly opthalmology expert who diagnosed calcium grit from the parotid due to dogs relatively high resting calcium; put on low ca diet and condition resolved. Wouldn't have sussed it myself in a month of sundays.

Re: Non-topical treatment for KCS

Andrew Kent — Tue, 11 Nov 2014 08:49:38 GMT

[quote user="SER"]

I remember being told that an eye with normal tear production would probably have a higher STT when inflamed, so a low normal result, in a sore eye is probably supportive of KCS.

[/quote]

Hopefully a friendly ophthalmologist will be along at some point but this is what I have always been led to believe too. The response of the eye to irritation should be to increase tear production and so interpreting this STT in the context of conjunctivitis would make me think KCS too. Clearly its a bit easier to trial topicals and assess response than having to trial oral drugs so perhaps they should at least give topicals a go initially to see if there is an improvement.

I can see that if you had severe inflammatory disease it could theoretically damage the lacrimal gland but would think this would be less likely than an increase.

Andy

Re: Non-topical treatment for KCS

Braden Collins — Tue, 11 Nov 2014 06:30:32 GMT

I've seen cases of conjunctivitis before with a reduced tear production (in the range of 10-15mm) which have returned to normal when the conjunctivitis resolves. I checked this with an ophthalmologist (because I was convinced one was a KCS case) and they agreed that this can be the case.

I would think that KCS isn't your underlying problem as if it's producing 15mm, that should be enough to keep the eye comfortable and "normal". I think you have to keep looking for other causes, including environmental or allergic causes.

Re: Non-topical treatment for KCS

Sara Ramsey — Mon, 10 Nov 2014 23:30:36 GMT

I remember being told that an eye with normal tear production would probably have a higher STT when inflamed, so a low normal result, in a sore eye is probably supportive of KCS.

Re: Non-topical treatment for KCS

Ian Mostyn — Mon, 10 Nov 2014 22:53:19 GMT

[quote user="Robin Grimmer"]

I wouldn't have thought a STT of 15mm would show any signs of dry eye.

[/quote]

I know but if the STT had said 10mm I would be convinced because the other signs fit. Could the tear production vary over time? Maybe at another time it would be less than 15mm? The main signs are recurrent inflammation and a gunky, green discharge but normally there is no corneal damage.

Ian

Re: Non-topical treatment for KCS

Robin Grimmer — Mon, 10 Nov 2014 21:54:37 GMT

I wouldn't have thought a STT of 15mm would show any signs of dry eye.

Re: Non-topical treatment for KCS

Rob Loxley — Mon, 10 Nov 2014 19:48:11 GMT

[quote user="Michael Woodhouse"]Not had chance to compare cost[/quote]

not markedly cheaper was my thought...

Re: Non-topical treatment for KCS

Martin Atkinson — Mon, 10 Nov 2014 19:28:29 GMT

[quote user="karen jones"]Apoquel is a possibility when it reappears[/quote]I'd be interested to hear the logic of the use of this but you won't be able to use it until next November as that is the earliest ii is likely to be available according to out rep!

Re: Non-topical treatment for KCS

karen jones — Mon, 10 Nov 2014 18:31:18 GMT

Virbac just launched an oral liquid too. Apoquel is a possibility when it reappears

Re: Non-topical treatment for KCS

Michael Woodhouse — Mon, 10 Nov 2014 18:21:03 GMT

Dechra just launched Sporimune- oral cyclosporin liquid. Not had chance to compare cost

Re: Non-topical treatment for KCS

Bob Russell — Mon, 10 Nov 2014 17:22:32 GMT

There are some generic cyclosporine looming or recently available so may be more cost effective than Atopica. I have used Atopica on occasions with good results (having got a disclaimer signed) and it is nice to see some support for its use!

Re: Non-topical treatment for KCS

Andrew Kent — Mon, 10 Nov 2014 15:44:57 GMT

Hi Ian,

You could also consider oral cyclosporine as an alternative. It is likely to be more expensive but our ophthalmologist did a pilot study comparing it to topical and found a similar effect. There was a discussion about it some time ago you may be able to find in the archives.

Andy