KCS in Persian cat. Any suggestions?

RE: KCS in Persian cat ?

Kate Lord — Mon, 27 Jan 2025 12:56:28 GMT

I think it's definitely a conversation to start having with the owners, especially if repeated ulceration or sequestration occurs.

RE: KCS in Persian cat ?

Rob Loxley — Sat, 25 Jan 2025 14:56:25 GMT

[quote userid="30226" url="~/f/clinical-questions/31118/kcs-in-persian-cat/246409#246409"] These are labour intensive cases and I would counsel the owner thoroughly on the fact that if that cat can't close its lids adequately and mix its tear film, then they're going to have to help it (for the rest of its life).[/quote]

Is there a role for medial canthoplasty in these cases?

RE: KCS in Persian cat ?

Kate Lord — Fri, 24 Jan 2025 13:36:34 GMT

I've never used pilocarpine drops in a cat and would question their efficacy if there's no evidence of a neurogenic KCS (and there isn't as the nares are moist). And both ciclosporin and tacrolimus can be lacrimomimetuc but there are much cheaper options out there in the form of lubricants, so I wouldn't rush to use these.

In an adult cat, it's difficult to justify the cost of viral testing given the large percentage of false negatives.

RE: KCS in Persian cat ?

Stigen — Fri, 24 Jan 2025 09:50:28 GMT

Thank you , that really helps! I already gave owner some lubricants and hyaloronic acid drops, but just wonder if even in the case of exposure keratitis it would`nt benefit from eydropes that supposedly stimulate increased production of tears like Pilocarpine,Cyclocsporine or Tacrolimus, or will they only have that effect in the case of autoimmune diseases?
Also would there be value in testing the cat for feline herpes and consider antiviral drops? This is an indoor cat.

RE: KCS in Persian cat ?

Kate Lord — Fri, 24 Jan 2025 08:44:27 GMT

Schirmer tear test values are sadly highly variable in completely normal cats and are often a bit more valuable if the problem is unilateral (for comparison). These photos show a linear opacificiation centrally in each eye which would fit with exposure keratitis - a sadly common finding in these brachycephalic breeds. I often perform a palpebral reflex during the consult and actually show the owners that the blink in these individuals can often be incomplete/poor. Exposure keratitis can progress to ulceration or sequestration so lubricants are the main course of action here if the cat hasn't ulcerated yet. I usually go for a hyaluronic preservative free preparation and would advise lubricating the eyes upwards of 4 times daily. Then reassess the degree of opacification after a few weeks. These are labour intensive cases and I would counsel the owner thoroughly on the fact that if that cat can't close its lids adequately and mix its tear film, then they're going to have to help it (for the rest of its life).

Also, when considering dry eye, I think it is common to overlook the problems with a "qualitative" dry eye (a deficiency in the mucin or lipid portion of the pre-ocular tear film/POTF), and focus instead on a "quantitative" dry eye (a deficiency in the aqueous portion of the POTF). I find in 1st opinion practice that more middle aged/elderly brachycephalic cats probably have a qualitative problem rather than a quantitative problem.

Hope that helps!

RE: KCS in Persian cat ?

Rob Loxley — Fri, 24 Jan 2025 08:41:36 GMT

I am not an ophthalmologist (and don't remember having treated KCS in a cat), but the corneal changes seem quite central and horizontal, is there lagophthalmos and exposure keratopathy going on +/- tear film deficiency? similar to brachycephalic ocular syndrome in dogs?

RE: KCS in Persian cat ?

Stigen — Fri, 24 Jan 2025 07:50:39 GMT

no one ever treated dry eye in cat ?