Severe, Chronic Dry Eye

Background

Jessie is an 11-year-old female, pure-bred, Chocolate Labrador Retriever. She first began developing eye problems around the age of two, and they grew progressively worse through the years. The underlying condition also created a tendency to frequent, serious eye infections and a chronic, thick, mucus discharge. Concurrently, she developed an extremely dry coat, paw pads and nose.


History of Treatment

I began seeking veterinary care for Jessie's eyes when she was 2 years old. The first symptom was a prolapsed third eyelid. Dogs actually have three eyelids, two you can always see and a third that normally remains hidden in the corner of the eye. It is supposed to protect the eye from debris and injury. Jessie's third eyelid was extended up onto the eyeball and remained visible at all times.

We live in a rural area, and our country vet did all he could for her, prescribing assorted antibiotics for the infections. These did nothing to help with the dryness, however, and it was getting worse.

We were finally referred to a canine Ophthalmologist. I was unaware there even was such a thing, but in our area of Michigan there is a clinic offering vets in a variety of specialties, including the eyes.

The specialist tested her eyes for tear production and found almost none. He prescribed a custom-compounded eye drop containing cyclosporine, and we waited to see if there was improvement. There was little change.

Next he took samples from the tissues of the lids and sent them to a lab for culturing. He also sent copies of her file to friends at several prominent veterinary schools around the country, asking for their input and advice. Unfortunately, the test results were inconclusive and the vet schools felt he was pursuing the only course of treatment available.

At the same time, I also began using a series of eye wash products to keep the mucus flushed out so Jessie could see. It would get so heavy that it coated the entire eye, which looked horrible and must have felt worse. I also eventually began experimenting with human over-the-counter dry eye drops.

In 2007, we were introduced to a new vet practice in our area and I began having the dogs treated there. The new doctor had seen cases of severe dry eye like Jessie's, and offered a few options for treatment, including the possibility of surgery - but he did not recommend it except as a last resort because of the complications. He prescribed steroid drops, Prednisolone Acetate, and a combination drop of Neomycin, Polymyxin B and Dexamethasone.

We used the antibiotic-based drops when an infection was present and the plain steroid all other times. I also discovered a wonderful, all natural eye wash called Eyes So Bright, which works to dissolve the accumulated mucus immediately, enabling me to keep Jessie's eyes clean. I settled on the line of human eye lubricants from Novartis called GenTeal. The extra-thick, gel products for severe dry eye relief have been a God-send for Jessie!

The combination of these treatments was keeping Jessie comfortable, but years of suffering had caused a network of blood vessels to grow over the surface of her eyeballs, leaving her almost completely blind. I was prepared to be her 'seeing eye person' for the rest of her life. My only desire was that she spend her golden years as comfortably as possible.

The new vet then recommended we try inserting what he calls 'blebs' of steroid into the tissue of the upper eyelid, allowing for continuous, slow release of the medicine over a three-month period. I agreed, and he numbed her eyes and placed the small, white 'blebs' in place with a needle. By the next morning, I could see marked improvement in the inflammation of her eyes.

About half-way through the three months, I was performing our morning eye-cleaning ritual when I noticed that I could see the brown pupil of Jessie's right eye again. It had been years since I could look in my girl's eyes and "see her". I cried.

The 'blebs' cannot be repeated continuously, so we are using the drops for now and may insert more 'blebs' in the future. The routine of flushing, medicating and moisturizing her eyes 4-5 times per day has been keeping them much healthier, and Jessie happier. None of the treatments we tried over the past 8 years has ever addressed the other dryness issues she seemed to have, though. I asked every vet who treated her if she might have some systemic problem, such as a lipid imbalance, contributing to her eye problems. None was very responsive - I am NOT a veterinarian, after all.

Recently, another of our dogs developed a condition which was causing her to go bald. Look for details on her diagnosis and treatment in another post soon. Part of the recommended treatment for her was 1000 mg of fish oil per meal, to help restore the luster and sheen of her coat. Figuring it couldn't do any harm, and might actually help Jessie with her dry, brittle, discolored coat and crusty nose and paw pads, I put her on a mega-dose of 4000 mg of fish oil daily.

I had been supplementing her food with organic extra-virgin olive oil and organic flax seed oil for several years, but our vet stressed the importance of animal fats in their diets, so I bought fish oil capsules. They are regular, at-the-corner-drugstore, made for human consumption, fish oil supplements. They are also a very inexpensive treatment.

In just one week, the changes in Jessie's skin, coat, pads and nose have been nothing short of remarkable. I wish I had photographed her before starting the fish oil treatment, but I didn't. The photos below show her as she is now, in the middle of May, 2008.

I expected to see some improvement in her coat, but the most amazing benefit of all to date has been in her eyes! The discharge has been reduced to almost nothing, she can open her eyes and see first thing in the morning without drops, and they require much less frequent use of the moisturizing gel.

The redness of the third eyelids is diminishing, and her eyes look so much healthier and improved that I cried again. So far, the improvement has been near miraculous.

I will continue to update this post with progress reports. Hopefully, Jessie will continue to improve, but even if this is as good as we can get, it is allowing my sweet old woman to enjoy the last years of her life. That's all I ever hoped and prayed for.


Current Treatment Protocol

Jessie's eyes are flushed out with Eyes So Bright Eye Wash as often as needed, usually 3-4 times per day. Then I administer steroid drops at least 3 times daily, substituting the antibiotic / steroid combo drop as needed.

For moisture, I use the GenTeal Severe Dry Eye Relief Gel at least 3 times per day, or as often needed. Before bed, I use the GenTeal PM Severe Dry Eye Relief Gel. It is specially formulated to lubricate throughout the night.

I am currently administering 4000 mg of fish oil per day, divided into two doses. I put two 1000 mg capsules in Jessie's breakfast, and two more in her dinner.

SEE UPDATE POSTED DECEMBER 6, 2008.

Photographs

Jessie's eyes. Note the flap of tissue protruding
from the inner corner. That is the 3rd eyelid.



Here is a close-up of Jessie's left
eye, taken May 19, 2008

This is another one of my female Labs,
Cocoa Chanel. Her eyes are normal. You
can clearly see the difference.



This is Jessie's behind. Note
the discoloration and uneven
tone of her fur.



This is a close-up of Cocoa
Chanel's coat. It is glossy, even
and deep chocolate in color.
This is a normal coat.



Related Links

http://www.peteducation.com/article.cfm?cls=2&cat=1606&articleid=451

http://pet-diseases.suite101.com/article.cfm/keratoconjunctivitis_sicca_or_kcs

http://www.us.novartisophthalmics.com/info/products/genteal-types.jsp

http://www.arknaturals.com/products/index.cfm?fuseaction=DisplayProductPage&Product_ID=7