Causes of KCS or Dry Eyes and One Dog's Diagnosis
My Journey With KCS
This is my personal experience with discovering that my beloved miniature schnauzer had a condition called Keratoconjunctivitis Sicca (KCS) or extreme dry eye. It has been a long journey, with many visits to the veterinarian and some difficult decisions about medical care. Along the way, I learned volumes about this condition, available treatments, and how to help keep a dog comfortable when she or he has it. I divided my story into two separate articles, this one and another that picks up from after my dog was diagnosed. I hope you'll find some support by reading both of them.
An Unexpected Trip to the Veterinary Clinic
During the summer, I usually head for the farmers market early on Saturday mornings. One summer morning in 2012, I realized that something was wrong with the miniature schnauzer who shares my life, Puppy Girl.
It was evident something was very wrong with Puppy Girl's eyes, even before I looked closely at them. Schnauzers routinely wake from a night’s sleep, or even from a brief nap, with a crusty substance in the corners of their eyes. (I always say I have to clean the “sleep” from her eyes.)
That morning, the condition of both her eyes was markedly different. They were filled with thick mucus. Even after I gently washed it away with a soft cloth and warm water, she could barely open one eye at all and squinted with the other, which indicated pain. The eye she could open slightly appeared inflamed, so my first thought was conjunctivitis. I took a quick look in my much-used copy of to check out potential canine eye disorders. Dog Owner's Home Veterinary Handbook
The book's authors stated that conjunctivitis is not painful, but my dog whimpered and shook, so she was obviously experiencing pain or discomfort. I'd read of numerous other possibilities for the symptoms she displayed, and some are a threat to vision. My plans to buy fresh tomatoes abruptly changed. We would go to the veterinary clinic instead.
I called All Creatures Animal Care Clinic, in Madison, Mississippi, where the wonderful vets and staff care for my pet. I was told they would “work her in” between scheduled appointments, and we were sitting in an exam room about 40 minutes later.
This was, of course, after the crying, shaking, and panting caused by the sight of the animal clinic after our car turned into its drive. I’m referring to Puppy Girl’s behavior—not mine! She is afraid of both the animal clinic and the grooming “salon,” undoubtedly due to unpleasant memories of discomfort she’s experienced at both places. She obviously has excellent recall of injections and rectal thermometers! I always take a few baby wipes and a zip-up plastic bag when we visit the clinic in case her nervous tension leads to an impromptu potty break. Fortunately, there’s a grassy area beside the building!
A veterinary technician took Puppy Girl off to be weighed, checked her vital signs, and let the vet examine her eyes. (I think the “exam room” where we waited is more for "Mom" and her shaking fur-kid to relax than it is for actual exams.) She looked back at me as she followed the tech holding her leash through the door. I imagined her thinking, “Gee, Mom . . . why can’t you come with me?” Even with one of her eyes nearly shut, I thought my dog looked sad.
Dogs and Emotions
Don’t stop reading at this point to accuse me of anthropomorphism. I know better than to attribute all human emotions and behaviors to my dog. For instance, dogs live in the “now," and my dog does not worry about what will happen in the future.
However, scientific research confirms that animals do have such emotions as love, grief, jealousy, and fear. Researchers at the University of Texas at Austin have found dogs to be emotionally complex animals, showing definite personality traits in the areas of competence, emotional stability, affection, and sociability. These are similar to the categories of human personality. (I doubt the result of this study comes as a surprise to most people who live with and love dogs.) So, if Puppy Girl can feel these particular emotions, who can say with certainty she doesn't experience sadness when taken out of my presence? Okay . . . I've got that off my chest. Back to the topic at hand.
A Tentative Diagnosis
She was soon back in the “exam room” with me and, shortly afterward, the vet explained that Puppy Girl's eyes were extremely dry. Since I have the same problem, which often leads to painful corneas, my sympathy level went off the charts. Poor girl!
A test strip similar to litmus paper with numbers (a Schirmer test strip) was placed in her eyes to measure tear production. The strip showed a severe lack of tears. A secondary infection was causing the thick light-colored discharge, composed of debris, pollens, dust, and concentrated bacteria—all "foreign objects" normally eliminated by natural tears.
Depending on the cause of dry eye in dogs, the condition might be temporary, but is most often permanent. Keratoconjunctivitis sicca (KCS) was the tentative diagnosis for Puppy Girl, and I was told there were treatments, but it was possibly incurable.
The vet prescribed an antibacterial ophthalmic ointment to be placed in the affected eyes every twelve hours. A follow-up appointment was scheduled in ten days. If further testing at that time showed there was still no tear production, a medication to stimulate tears would be in order.
I brought my unusually quiet girl home and moved her softest pillow bed to a cool shadowy place away from any A/C vent or fan, either of which could worsen the dry condition of her eyes. She lay there lethargically, apparently in no mood to play or even look out the window at the neighborhood, which she usually enjoys. Dry eyes are very sensitive to sunlight or glare from indoor lighting. She was protecting her poor eyes.
I understand, sweet girl.
What Is KCS in Dogs?
Keratoconjunctivitis sicca (KCS), or “dry eye,” is a disorder of the lacrimal glands that normally produce the liquid element of tears. Dogs with KCS don’t produce enough tear film to keep their eyes lubricated adequately. Sometimes there are no tears at all.
The cornea is the transparent, outermost part of the eyeball, fitting much like the skin on a grape. The conjunctiva is a delicate membrane lining the eyelids and a small portion of the eyeballs. Lack of tear production causes the cornea and conjunctiva to become dry, painful, and inflamed. If the disorder goes untreated, there will also be a thickening of the cornea and conjunctiva.
If not properly diagnosed and managed in the early stages, KCS can lead to excruciatingly painful corneal ulceration, eye infection, impaired vision, and even total blindness. A responsible dog parent will never ignore the symptoms of KCS.
There are various reasons for the lacrimal glands to cease making tears, but it is often difficult or impossible to determine the actual cause. For that reason, most KCS is diagnosed as "idiopathic," or of unknown cause. All breeds and all ages of dogs can have KCS; however, some breeds of companion dogs are predisposed. They include miniature schnauzers, miniature poodles, American and Cavalier King Charles Spaniels, Bulldogs, Shih Tzus, Lhaso Apsos, and West Highland and Yorkshire Terriers.
Some instances of this painful condition are caused by an autoimmune disorder. In effect, the dog's immune system attacks its own tear glands and damages the tissue. Why this occurs is not known. Other causes of KSC can include:
- Hereditary disposition in certain breeds.
- Trauma to the eye.
- Use of certain drugs, including topical anesthetics on the surface of a dog's eye, sulfonamides, and aspirin.
- General anesthesia.
- Bacterial or viral eye infections.
- Chronic conjunctivitis.
- Systemic diseases, including diabetes, Cushings disease, or hypothyroidism.
- Damage to the facial nerve or even chronic middle ear infections (because the facial nerve innervates the tears glands after passing through the dog's middle ear from the brain.
There is very little that can be done to prevent KCS other than managing any systemic diseases the dog may have, protecting the dog from facial or eye trauma, keeping the ears clean to prevent infection, and not using the medications that may cause the condition. Because of the hereditary aspect, dogs affected by KCS should not be bred.
My Dog's Eyes Worsen
Rather than improving, Puppy Girl's eye problems continued to worsen. She didn't act at all like her normal self. She wouldn't play with her toys, but spent most of her time lying on a sofa with closed eyes in the den, a room that's relatively dark when the light is off and the window shutters closed.
We returned to the vet clinic several times, and each time I became more anxious. A second round of the antibiotic ointment was prescribed, plus Cyclosporine, a medication specially compounded in a base of olive oil for twice-daily administration as drops to Puppy Girl's eyes. An over-the-counter eye ointment normally used for humans was also needed several times per day to keep her eyes moistened and (hopefully) to reduce pain.
The schedule of various meds that began at 8:30 a.m. and continued every hour or two until 11:30 p.m. was stressful for both my pet and me, especially since she quickly grew resistant to the whole idea of treatment. I understood her reluctance. Her eyes were already hurting, and here I was dropping stuff into them throughout the day. I realized she was avoiding me. When I went near her, she would go into another room. One day I couldn't find her and began calling her name. When she didn't appear, I looked all over the house. I found her hiding under folds of the living room drapes.
Ah, Puppy Girl! Mom's so sorry you're having a rough time!
Cyclosporine is used to stimulate the lacrimal glands to produce tears. (It's the active ingredient in Restasis®, a medication for humans with dry eye syndrome.) It works for many dogs, but isn't 100% successful. It didn't seem to be working for Puppy Girl.
Part Two Tells the Rest of the Story
- Dry Eye in Dogs -- Coping with Keratoconjunctivitis Sicca (KCS) - Part 2: “Aftermath of t
After the diagnosis of KCS, my dog and I faced many obstacles. This final segment tells which were possible to overcome.