Treatment of straightforward conjunctivitis

RE: Treatment of straightforward conjunctivitis

Roland Bulkyn-Rackowe — Thu, 06 Sep 2018 11:20:19 GMT

Sorry to resurrect this. I came across Olopatadine (Opatanol) as an antihistamine eye drop yesterday via a client. Anyone else has personal experience with this one or used it with a patient? I have a few dogs that seem to get a seasonal conjunctivitis that responds well to maxitrol and somewhat to cromoglycate.

RE: Treatment of straightforward conjunctivitis

Anthony Todd — Sun, 15 Jul 2018 17:07:34 GMT

[quote user="Anthony Todd"]Skin disease10.40%[/quote]

Of the skin disease:

Flea derm	48%
Allergic derm	15%
Acute pyo-traumatic	6%
Probably, mostly fleas therefore fleas actually !!	69%
Pyoderma	12%
Pedal dermatitis	7%
Seborrhoea	4%
Alopecia	3%
Scabies [suburban foxes!!]	3%
Fungus	2%
"Lick dermatitis"	2%
Demodex	1%

Be interesting to see how modern insecticides have altered these rough incidences.....

Both of these lists were from around 800 contacts in one quieter branch a month, 10000ish annually in northish London.

RE: Treatment of straightforward conjunctivitis

Anthony Todd — Sun, 15 Jul 2018 16:51:05 GMT

[quote user="David Mills"]In response to my previous question, skin makes up 40pc of our caseload and eyes 8pc. And that's of around 100k unique animals per year. There be data out there! [/quote]

I gave a talk to a meeting of Vet pharmaceutical firms in the late 70s [I think] and produced this:

Attendances	Percentage
Vaccination	16.90%
Surgery teeth	15.50%
Skin disease	10.40%
General medical	9.03%
Respiratory	8.40%
Ears	7.20%
De-sexing	6.10%
Gastro-intestinal	5.50%
Cat bite sepsis	5.20%
Ocular [eyes]	4.90%
Trauma	2.60%
"Advice"	1.40%
Skeletal	1.40%
Neurological	1.10%
Not defined	4.37%

Surgery [of all attendances]	21.40%
Desexing	28.50%
Teeth	35%
Tumour	25.70%
Miscellaneous	10.80%

Might make an interesting comparison with today's data.

RE: Treatment of straightforward conjunctivitis

Tom Ward — Sat, 14 Jul 2018 22:46:43 GMT

[quote user="Linda Filshie"]

I have a suspicion many are irritant rather than truely allergic, secondary to foraging through dusty undergrowth - many cases have responded well to rinsing the eyes with saline and getting the owners to wipe the eyelids with moist cotton wool pads on return from walks. If very inflamed and fluro negative with no suspicion of systemic disease or more serious ocular disease then I like maxitrol - I've found isathal can seem stingy in some patients

[/quote]

+1 - a lot of these recurrent cases (especially in young dogs) seem to respond well to regular lubrication.

RE: Treatment of straightforward conjunctivitis

Liz Barton — Sat, 14 Jul 2018 17:00:15 GMT

[quote user="Andrew Mellor"]does this not sting as it goes in? [/quote]

I used to use them on myself frequently and never experienced discomfort, but instant relief. It was the Opticrom I brand I used, but haven't done so for a few years, so provided they haven't changed the formulation...

RE: Treatment of straightforward conjunctivitis

Andrew Mellor — Fri, 13 Jul 2018 18:44:52 GMT

[quote user="Laurence Webb"]If I am happy that it is allergic I use sodium chromoglycate drops (Opticrom) from a chemists or from a wholesaler which prevents mast call degranulation.[/quote]

does this not sting as it goes in? I have avoided using it as the most common side effect in the BNF is stinging and irritation on application which then makes owner / pet compliance difficult,

RE: Treatment of straightforward conjunctivitis

Clare Tapsfield-Wright — Tue, 10 Jul 2018 17:30:25 GMT

My lab had a bright yellow cornea while out in a walk and on inspection a buttercup petal was masquerading as a contact lens . Was quite tricky to get it off. I assume canine corneas are less sensitive than ours , she seemed unaware though she is retrieving obsessed to the exclusion of everything else.

RE: Treatment of straightforward conjunctivitis

Neil Wheadon — Tue, 10 Jul 2018 11:51:01 GMT

Totally unscientific with a total of one case, but had a labrador with conjunctivitis and treated with Isathal. I asked the client if he'd take pictures and report back.

Neil

From Client

Thank you for seeing barney our yellow Labrador the other day. We were extremely pleased with the performance of the eye drops. There was a noticeable difference within the first 24 hours which has continued. Chronological pics included below. Apologies for their poor quality.

DAY 1

DAY 2

DAY 3

RE: Treatment of straightforward conjunctivitis

David Mills — Fri, 08 Jun 2018 00:24:12 GMT

[quote user="Robert Lowe"]Wasn't extrapolating[/quote]

I know, sorry, it wasn't directed at you. It was more about the huge amount of these cases seen in primary practice which resolve undramatically with eye drops of anyone's persuasion.

Its really not a referral hating thing. It's just one of those things (like bitch spays, for instance) that are treated in their thousands, and, if they were truly allergic then like skin one would assume they would come back quite quickly once the anti inflammatory component was stopped, or wouldn't resolve purely with lubricant.

In response to my previous question, skin makes up 40pc of our caseload and eyes 8pc. And that's of around 100k unique animals per year. There be data out there!

RE: Treatment of straightforward conjunctivitis

David Mills — Fri, 08 Jun 2018 00:07:27 GMT

[quote user="Clive Ansell"]contains corticosteroid so would therefore be c/i in the presence of infection.[/quote]

So do you not use preds where there is allergic skin and pyoderma??

Corticosteroids at anti inflammatory doses don't interfere with the immune system. On another note, saw a dog today with classic allergic skin that had been refused roids because it had an asymptomatic heart murmur and they are "contraindicated" in heart disease. Mind boggles sometimes, I think they are at times as poorly understood as medetomidine.

RE: Treatment of straightforward conjunctivitis

Clive Ansell — Thu, 07 Jun 2018 21:13:03 GMT

In direct answer to the OP, I tend to use Isathal first line. On reflection though, I wonder if just a lubricant would suffice in some of the less severe cases?

I'm a bit loath to use Maxitrol first line unless there is a direct clinical indication to do so, given it is off licence and contains corticosteroid so would therefore be c/i in the presence of infection.

My own experience; I occasional suffer with immune mediated blepharitis and conjunctivitis , secondary to chronic idiopathic urticaria. Advised by ophthalmologist to use lacrilube, and add in Maxidex when, and only when, needed. No antibiotic containing drops.

RE: Treatment of straightforward conjunctivitis

Linda Filshie — Thu, 07 Jun 2018 10:37:43 GMT

RE: Treatment of straightforward conjunctivitis

Liz Barton — Wed, 06 Jun 2018 22:14:44 GMT

[quote user="Laurence Webb"] I use sodium chromoglycate drops (Opticrom) from a chemists [/quote]

Me too - worked wonders in me, though thankfully I seem to have grown out of my own seasonal allergy ocular irritations. I have used them in cats/dogs in the past, including my own.

RE: Treatment of straightforward conjunctivitis

Robert Lowe — Wed, 06 Jun 2018 21:33:37 GMT

[quote user="David Mills"]It does, for me, somewhat highlight the problem with extrapolating from referral practice to general practice for common conditions [/quote]

Wasn't extrapolating. I was talking about allergic conjunctivitis. I made no mention of frequency as I wouldn't have a clue. The caseload I see is the recurrent seasonal conjunctivitis that by and large occurs in young dogs and self resolves with age.

With reference to the OP, I would treat with topical antibiotic first and if not resolving consider topical steroid/antibiotic drops next. If it then reoccurs then consider allergy.

RE: Treatment of straightforward conjunctivitis

Lucy Fleming — Wed, 06 Jun 2018 19:49:56 GMT

[quote user="David Mills"]Anyone want to guess the percentage of cases that derm and eyes make up in our hospital? [/quote]

97.5%

RE: Treatment of straightforward conjunctivitis

David Mills — Wed, 06 Jun 2018 19:47:16 GMT

Some cpd I went on suggested that most canine conjunctivitis was allergy based. I don't get that impression from clinical practice, equally the vast majority of cases have no underlying trigger, so I don't agree with Francisco - they are possible but not at all common IME.

The issue with allergic is that these garden conjunctivitis cases by and large don't return once the isathal stops, unlike the vast majority of skin dogs when the preds do.

It does, for me, somewhat highlight the problem with extrapolating from referral practice to general practice for common conditions

Anyone want to guess the percentage of cases that derm and eyes make up in our hospital?

RE: Treatment of straightforward conjunctivitis

Robert Lowe — Wed, 06 Jun 2018 16:44:11 GMT

Allergic conjunctivitis tends to occur in dogs under 4 and they appear to grow out of it as they get older. Occasional Maxidex/Maxitrol helps if they are sore otherwise I just use hyaluronic acid tear replacements as a soothing lubricant/barrier.

RE: Treatment of straightforward conjunctivitis

Laurence Webb — Wed, 06 Jun 2018 16:29:40 GMT

If I am happy that it is allergic I use sodium chromoglycate drops (Opticrom) from a chemists or from a wholesaler which prevents mast call degranulation.

RE: Treatment of straightforward conjunctivitis

Bob Russell — Wed, 06 Jun 2018 15:53:45 GMT

CPD in the dim and distant past included the idea that most red eyes in dogs (simple conjunctivitis) are allergic.

Strangely I have a similarly impressive response to Isathal in my patients. I seem to remember Rob Lowe telling me that he almost never uses Isathal and leaves that for us, mere mortals, to use/abuse!

He will correct me if I am wrong!!

RE: Treatment of straightforward conjunctivitis

Bob Russell — Wed, 06 Jun 2018 15:52:57 GMT

CPD in the dim and distant past included the idea that most red eyes (simple conjunctivitis) are allergic in dogs.

He will correct me if I am wrong!!

RE: Treatment of straightforward conjunctivitis

Neil Wheadon — Wed, 06 Jun 2018 15:52:12 GMT

[quote user="Matt Hilary"] where I've wondered about an allergic component but difficult to tell for sure.[/quote]

No such thing as a silly question then as I'm never sure and have always wanted to ask

Rob Lowe - help us out here

Neil

RE: Treatment of straightforward conjunctivitis

Matt Hilary — Wed, 06 Jun 2018 15:21:04 GMT

Majority of mine go on Isathal with a little bit of reluctance about over-prescribing antibiotics.

I've had a couple of seasonal recurrent (treatment-responsive) cases where I've wondered about an allergic component but difficult to tell for sure.

Is Maxidex still available?

RE: Treatment of straightforward conjunctivitis

Martin Atkinson — Wed, 06 Jun 2018 14:55:22 GMT

[quote user="Francisco Gomez"]

[quote user="Neil Wheadon"]

Do many dogs get allergic conjunctivitis during the summer?

[/quote]

I'm sure they do.

But Don't fall for underlying causes. Intraocular pathology, chronic glaucomas, dry eyes, 3rd eyelid foreign bodies, obstructed ducts, ectopic cilia to name a few... And cats are a completely different world as their causes are often viral or bacterial.

[/quote]I'm not sure they do, I've never diagnosed one as such. Rule #1: humans get URT/occular symptoms with hay fever, dogs get itchy skin.

I've seen a couple of cats come back with conjunctivitis when they been outdors and them improve when indoors but I'm more inclined to think its activation of FHV.

As for treatment I like Isathal first choice as the base is very soothing and its easy to apply, if there's no actual purulent discharge could use just Lubrithal.

RE: Treatment of straightforward conjunctivitis

Francisco Gomez — Wed, 06 Jun 2018 14:22:49 GMT

[quote user="Neil Wheadon"]

Do many dogs get allergic conjunctivitis during the summer?

[/quote]

I'm sure they do.