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Causes of KCS or Dry Eyes and One Dog's Diagnosis

Puppy Girl's eye—dry and inflamed with a discharge of thick "gunk."
Puppy Girl's eye—dry and inflamed with a discharge of thick "gunk." | Source

My Journey With KCS

This is my personal experience with discovering that my beloved 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 they have it. I divided my story up 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, as soon she woke up I saw that my miniature schnauzer Puppy Girl had something wrong. I knew that my plans to buy fresh tomatoes had abruptly changed. I'd be taking a trip to the veterinary clinic.

It was evident that something was very wrong with Puppy Girl's eyes, even before I could look 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'm cleaning the “sleep” from her eyes.)

That morning, the condition of both her eyes was markedly different. They were filled with thick mucus, and 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. 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 Dog Owner's Home Veterinary Handbook to check out potential canine eye disorders.

The book's authors stated that conjunctivitis is not painful, but my dog whimpered and shook as though she were in pain. There are numerous other possibilities for the symptoms she displayed, and some are a threat to vision. I called the 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 could imagine 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, so 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 dog owners.) So, if my dog 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

Soon my dog was back in the “exam room” with me and, shortly afterward, the vet was explaining 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 may be temporary but is most often permanent. Keratoconjunctivitis sicca (KCS) was the tentative diagnosis for Puppy Girl, and it was treatable though perhaps 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.

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 auto-immune 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 anestesia.
  • 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 (Genteal) 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.

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Comments 13 comments

JayeWisdom profile image

JayeWisdom 2 years ago from Deep South, USA Author

Yes, Shyron, KCS is the culprit for Puppy Girl's blindness. I thought I could prevent her from having pain or scarred corneas by applying a thick eye lubricant every couple of hours (day and night). Although I did it faithfully since she was diagnosed in August 2013, it didn't prevent the scarring and blindness. Plus, the vet told me that she was undoubtedly feeling pain though dogs are stoic and try to hide pain.

She's one month on the other side of the enucleation surgery (removal of both eyes) recommended by the vet. It was a difficult decision, but I didn't want her to hurt (even if she kept it hidden), so there was really no choice.

She's recuperating well and getting around the house, even playing with her toys a bit...not sleeping as much (which I think, for dogs, is a way to escape pain).

I kept a diary of the pre-op, surgery day, post-op week (she stayed in the animal hospital) and after she came home, and I've started writing a hub about the experience--how I imagine it from her perspective and its effect on me.

She's still my sweet Puppy Girl. I talk to her a lot, give her massages, hold her in my lap (she puts her head on my shoulder like a baby) and play music for her. Blind dogs need sound and touch to help take the place of sight.

Thanks for reading, the votes/feedback/sharing and for your comment.

Have a great weekend....Jaye


Shyron E Shenko profile image

Shyron E Shenko 2 years ago

I thought I read this but evidently I did not. Is this the condition that caused Puppy Girl to go blind? My heart aches for her. This is so sad.

Maybe I read part two first.

Voted up, UAI and shared.


JayeWisdom profile image

JayeWisdom 2 years ago from Deep South, USA Author

Mary - I'm so sorry about your dog having dry eyes. It's critical to keep the eyes lubricated to prevent corneal ulcers from forming. They are not only excruciatingly painful for the dog, but can destroy the eye. Since my dog didn't like having the drops administered but has never minded the ointment (I think it feels good to her), I've used GenTeal P.M. nighttime eye ointment since late summer, 2012. It takes a lot of it, so I have to periodically search the Internet to find the best price and buy 6-8 tubes at once for free shipping. GenTeal is made for humans, but my dog's vet recommended it for her. I am fortunately retired and home with her all the time because this ointment needs to be put in the eyes every couple of hours.

As for cleaning the "gunk" that collects in the eyes, I use a baby wipe that is moist with aloe, barely touching the mucus on the eyeball and pulling it to the corner of the eye and out. Then I wash her eyes and all around them with a very soft lint-free cloth. You can also wash the eyes out with eyewash, if your dog will tolerate having it poured into his eyes.

This disease requires a lot of care to protect your dog. As my article says, there is a surgery that can reroute the dog's salivary gland to the eyes, but I elected not to pursue it for my girl. It may be something you want to think about since your dog is so young and has his whole life ahead of him.

Chronic KCS, even when you keep the eyes lubricated, may lead to blindness. My dog went blind after a year with it. It's very important that you have a vet in whom you have a lot of confidence.

You may want to read Part 2 of my account of coping with my dog's KCS. Good luck with your fur-baby.

Jaye


Mary 2 years ago

Love the stories my havanise who is 15 month we were told the only thing we could do keep the eyes clean and teer drops In his eyes but he getting a lot of green stuff In both eyes I have seen vets and a doctor who deals with she said It the worse case she seen I need help


JayeWisdom profile image

JayeWisdom 4 years ago from Deep South, USA Author

Thanks, DDE, for reading and for your comments. Both my dog and I are becoming accustomed to the medication routine, and she doesn't resist. However, the drops that are supposed to induce tear production haven't worked well for her. Her vet referred her to a veterinary ophthalmologist, and he prescribed a different formula. He will check her again in a few weeks and, if the new drops aren't working, will put her on oral prednisone. I really hope she doesn't have to take steroids because of the potential side effects, but extreme dry eye is painful and preventing pain is the main priority in her care. Thanks for your good wishes. Jaye


DDE profile image

DDE 4 years ago from Dubrovnik, Croatia

It is sad when such conditions affect our pets it is good to know you have found out about it soon. This was an interesting output on the topic hope all is well


JayeWisdom profile image

JayeWisdom 4 years ago from Deep South, USA Author

Thanks, Til....I wish the next installment could say she's cured, too, but it will focus on all the obstacles we encountered and had to overcome after Part I ended. KCS is something that will require coping and adjustments every day for the rest of Puppy Girl's life. Most cases of this disorder are permanent, and it's probable that hers is immune-mediated.

I think people who love their pets should make the same "for better or worse" vow that's required for marriage and, in addition, pledge never to get a divorce! A dog's love and loyalty are unconditional, so ours should be the same.

This disorder is not an easy one to live with, but I keep reminding myself she could have something even worse. (Schnauzers are also prone to diabetes.) Both PG and I are becoming more accustomed to the treatment routine. Empathy and understanding for her do come more readily to me because of the blepharospasm and accompanying dry eye syndrome I've been coping with personally for 20-plus years. I know what she's experiencing. Other pet owners might not realize the level of pain a corneal abrasion causes. That may not seem like an advantage, but (to me) it is.

Thanks for your kind words.

Jaye


tillsontitan profile image

tillsontitan 4 years ago from New York

I can only echo the sentiments here and say how sorry I am for Puppy Girl and for you. It is always difficult to watch an animal in pain, you can't really communicate with them and they certainly can't communicate with you. I'm hoping the next installment will show she's been cured. Voted up, useful, and interesting.


JayeWisdom profile image

JayeWisdom 4 years ago from Deep South, USA Author

Susan....Thanks for your good wishes. As the old saying goes, "There's good news and bad news", which is why the word "coping" is in the title. I'll take good care of her, and I think she's becoming more accustomed to the routine. This morning she "asked" for a tummy rub--a good sign!

Bob....It is tough not to be able to explain the "why" to her. I give her treats (her fave is a bite of banana). I also play a special CD developed to soothe dogs, and I use lavender essential oils in an attempt to allay her stress. She's not balking so much at the ointment any more--it probably soothes her hurting eyes--but she knows that one drop of Cyclosporine in each eye is going to hurt, and she doesn't like the sight of that bottle.

You made me laugh with the reincarnation remark! Thanks.

DrMark....Since she had other autoimmune issues from that allergic reaction to a vaccination, you're probably right about it causing this problem, too. I now avoid nearly all vaccinations by getting titers, and her immunity is holding. (I truly believe immunity lasts from initial vaccinations, and that dogs don't need all those boosters. After all, some vaccinations last a lifetime for humans.) Unfortunately, there's no choice about rabies boosters, as this state mandates them every three years. She's overdue hers now, but the vet is delaying it until she doesn't have active infection in her eyes.

Paula....Thanks for your kind words. It hurts me to know she's hurting, but the best thing I can do is try to alleviate as much of the pain as possible. Every morning when she wakes up, it's almost impossible for her to open her eyes. I have to gently clean them before the medication routine can begin, and then the Cyclosporine drops go in. (She also gets them at night, so that "fun" happens twice a day.)

Bob's comment was great, wasn't it? I'm still smiling.

Part 2 will be on its way soon with an update. Thanks to all of you for reading and comments.

Jaye


fpherj48 profile image

fpherj48 4 years ago from Beautiful Upstate New York

Jaye......Poor Puppy girl......My eyes actually began to burn as I read this....with sympathy. It is heartbreaking to know our babies are hurting, frightened and confused. As her Mommy, I know how you feel, believe me.

You certainly do the very best you can for her, especially in loving and comforting her, and having a good Vet.

I know her breed is susceptible to "eye issues".....so is my American Cocker. The constant eye "gunk," as I call it and the typical stain at the inside corner. Like you, I am always trying to wipe his eyes gently with warm water. Not much else we can do.

I LOVE the comment from Bob, about coming back as one of your dogs...lol That's cute. You are a good Mommy and I hope that Puppy girl's eye issue is soon taken care of. Keep us posted, Jaye!

Up ++


DrMark1961 profile image

DrMark1961 4 years ago from The Beach of Brazil

This is another good reason to avoid another vaccination for your dog. You had mentioned that she had an allergic reaction, and there is a possibility that she has a genetic predisposition that was aggravated by an autoimmune reaction after a vaccine. Idiopathic, at the moment, but maybe someone will come along and describe this relationship down the road.


Bob Bamberg profile image

Bob Bamberg 4 years ago from Southeastern Massachusetts

Hi Jaye,

I'm so sorry that you and Puppy Girl are going through such an odyssey. It gives one such an empty feeling when we can't explain things to our pet. She must think the whole world is against her.

Would a small treat before and after each vet visit, groomer visit, and at-home treatment help her associate something positive with those events? Even a little extra head or belly rub may help soften those negative experiences for her.

I wonder if her condition might be further aggravated by local pollens? It's never easy, is it?

You're being a good Mom, though. If there's such a thing as reincarnation, I wouldn't mind coming back as one of your dogs.

Here's hoping for a speedy improvement in Puppy Girl's condition. Interesting hub...a nice blend of cold science and warm heart. Voted up and interesting. Regards to you both, Bob


Just Ask Susan profile image

Just Ask Susan 4 years ago from Ontario, Canada

So sorry to read this about your Puppy Girl. I hope that your vet finds a way to make her eye better. Is there nothing else he can try? I'll be watching for part 2 of your hub in hopes that all turns out well for Puppy Girl.

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