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568 Keratoconjunctivitis Sicca

Acute General Treatment
• Prednisone or prednisolone 2 mg/kg PO q
VetBooks.ir lesions resolve (≈1-4 weeks), then reduce to
24h, or total dose can be divided q 12h until
2 mg/kg PO q 48h for 2 weeks, then taper
prednisone over the next 2-3 weeks
• Some dogs respond better to dexamethasone
0.2 mg/kg PO q 24h. Gradually taper dosage
(similar to prednisone).
• Oral cyclosporine can be combined with oral
prednisone in recalcitrant cases.
• Bactericidal antibiotics for 3-4 weeks
required with cytologic evidence of secondary
pyoderma.
• Warm water soaks to remove crusts and
exudates; topical astringents (e.g., 2%
aluminum acetate [Burow’s solution] q 12h)
can be attempted.
PROGNOSIS & OUTCOME
JUVENILE CELLULITIS Typical lesions in a 9-week-old rottweiler with edematous eyelids and papules,
pustules, and swelling of the muzzle. (Courtesy Dr. Jocelyn Wellington.) Prognosis is good. Scarring may be extensive
in severe cases.
• Fistulation of affected lymph nodes is variable. Initial Database PEARLS & CONSIDERATIONS
• Affected skin is frequently painful but rarely • Impression smears and cytologic evaluation
pruritic (p. 1091). of pustule (p. 1091): numerous neutrophils Comments
• Rarely, sterile subcutaneous nodules with or and macrophages (pyogranulomatous inflam- • Taper glucocorticoids gradually (over a few
without fistulation develop on the trunk, mation) without bacteria weeks) to reduce the risk of relapse.
preputial, or perineal regions. • Skin scrapings: negative for Demodex • Adult dogs and dogs with panniculitis
• ≈50% of affected puppies are lethargic. mites (subcutaneous nodules) require a longer
• Anorexia, fever, and lameness (sterile sup- treatment duration.
purative arthritis) are inconsistent findings. Advanced or Confirmatory Testing • If relapse occurs, restart immunosuppressive
Rarely required: dosage of glucocorticoid immediately.
Etiology and Pathophysiology • Aerobic bacterial culture and susceptibility: • Avoid routine vaccinations during therapy.
• The cause and pathogenesis of juvenile usually sterile
cellulitis are unknown. The presence of • Skin biopsy of nontraumatized pustules Technician Tips
sterile lesions that respond to systemic or nodules: multiple discrete or confluent Gentle wound care with an antimicrobial solu-
glucocorticoids suggest immune dysfunction. granulomas and pyogranulomas composed tion to remove crusts and exudate can reduce
• Any evidence of infection usually reflects of nodular clusters of large epithelioid the need for systemic antibiotics.
secondary pyoderma. macrophages with variably sized neutrophilic
centers SUGGESTED READING
DIAGNOSIS • Lymph node aspiration: pyogranulomatous Miller WH Jr, et al: Muller & Kirk’s Small animal
lymphadenitis dermatology, ed 7, St. Louis, 2013, Saunders, pp
Diagnostic Overview 708-709.
The diagnosis is suspected from the signalment, TREATMENT AUTHOR: Jocelyn Wellington, DVM, DACVD
history, and physical exam. EDITOR: Manon Paradis, DMV, MVSc, DACVD
Treatment Overview
Differential Diagnosis Early and aggressive immunosuppressive
• Angioedema: vaccine reaction or insect bite systemic therapy with predniso(lo)ne or dexa-
reaction methasone is indicated to prevent secondary
• Deep pyoderma/muzzle folliculitis scarring. Concurrent systemic antibiotics are
• Demodicosis recommended if secondary pyoderma is found
• Drug eruption (cutaneous drug reaction) cytologically or marked fistulation is present.

Keratoconjunctivitis Sicca Client Education
Sheet

deficiency in the aqueous portion of the tear Epidemiology
BASIC INFORMATION film
SPECIES, AGE, SEX
Definition Synonyms • Common in dogs; rare in cats
A common inflammatory condition of KCS, dry eye, quantitative tear film abnormality • Age of onset varies, depending on underlying
the cornea and conjunctiva secondary to a or deficiency, xerophthalmia cause

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