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748 Pannus (Chronic Superficial Keratitis)

• Vitamin E 10-20 IU/kg PO q 8-12h may Recommended Monitoring • Owners should minimize pets’ access to
control mild cases. CBC, platelet count, serum chemistry profile, high-risk areas (swamps, riverbeds) and
VetBooks.ir for dogs > 10 kg or 250 mg of each for tially) to q 3-6 months (when stable) if using Technician Tips
and urinalysis typically after 2-4 weeks (ini-
should rinse/bathe the pet after high-risk
• Tetracycline and niacinamide 500 mg of each
area exposure
dogs < 10 kg, PO q 8h until improvement
immunosuppressive agents
(about 2-3 months), then taper gradually;
doxycycline 5-10 mg/kg PO q 12h or PROGNOSIS & OUTCOME • Wear gloves when patients with draining
minocycline 10-25 mg/kg PO q 12h may nodules present in the exam room.
be used in place of tetracycline. • Variable, from guarded to good; healed • In some cases, a biopsy punch may not reach
• Pentoxifylline 20-30 mg/kg PO q 12h until lesions may leave scars. the hypodermis (subcutaneous fat), impeding
resolved, then taper gradually • Most cases of panniculitis involve lengthy proper diagnosis. Therefore wedge biopsy
• Topical or intralesional glucocorticoid (e.g., treatment (months). may be preferred if panniculitis is suspected.
dexamethasone, triamcinolone) administra-
tion when systemic/oral glucocorticoids are PEARLS & CONSIDERATIONS Client Education
not tolerated • Extensive diagnostic testing can be involved;
• Systemic glucocorticoid: prednisone 2 mg/ Comments need to determine infectious versus noninfec-
kg PO q 24h (dogs), prednisolone 3-4 mg/ • A complete diagnostic workup to identify tious cause
kg PO q 24h (cats) until resolution (about the underlying cause leads to the most • Treatment is generally lengthy, especially
2-6 weeks), then gradually taper appropriate and successful treatment plan when addressing atypical mycobacteria,
• Azathioprine 1.5-2 mg/kg PO q 24h (dogs), and outcome. Actinomyces, Nocardia, and intermediate/
chlorambucil 0.1-0.2 mg/kg PO q 24h (cats • Clinicians should review the complexity of systemic fungal infections; but with appro-
and small dogs), mycophenolate 10-15 mg/ the differential diagnoses with clients and priate therapy, the prognosis in most cases
kg PO q 12h or cyclosporine 5-10 mg/kg PO ensure they are willing to pursue prolonged is positive. Healed lesions may leave scars,
q 24h or divided q 12h are glucocorticoid- treatment before starting extensive diagnostic however.
sparing alternatives for long-term treatment. testing beyond histologic confirmation.
After a 2- to 6-week lag phase, q 48h (or Consider referral to dermatology or internal SUGGESTED READING
longer) administration can be staggered with medicine specialist. Hnilica KA, et al: Small animal dermatology—a color
q 48h glucocorticoids (if still required). • A biopsy punch may not reach the hypo- atlas and therapeutic guide, ed 4, St. Louis, 2017,
dermis (subcutaneous fat), impeding proper Elsevier, pp 279-280.
Nutrition/Diet diagnosis. Wedge biopsy may be preferred.
Dietary elimination trial: adverse food reaction • Nonsteroidal immunosuppressive drugs are AUTHOR: Adam P. Patterson, DVM, DACVD
EDITOR: Manon Paradis, DMV, MVSc, DACVD
may be a trigger in immune-mediated pan- sometimes prescribed for long-term control
niculitis (rare). to minimize glucocorticoid side effects.
Possible Complications Prevention
Adverse effects of treatments (e.g., glucocor- • Weight loss for obese animals reduces amount
ticoids) of fat to which the body can react.

Pannus (Chronic Superficial Keratitis) Client Education
Sheet

Clinical Presentation
BASIC INFORMATION • Breed predisposition: German shepherd,
greyhound, Belgian Tervuren, Belgian DISEASE FORMS/SUBTYPES
Definition sheepdog, dachshund, border collie, Shetland • Early pannus: lesions occur in the lateral to
The typically bilateral, progressive, immune- sheepdog, Siberian husky, Scotch collie, lateroventral cornea
mediated, inflammatory disease of the cornea Australian shepherd, miniature pinscher, • Chronic pannus: lesions may extend across
is characterized by infiltration of vessels and pointer, Dalmatian, English springer spaniel, the entire cornea
granulation tissue and/or pigmentation. Airedale terrier • Pannus may present as a
○ Vascular form
Synonyms RISK FACTORS ○ Pigmentary form
Chronic superficial keratitis (CSK), pannus, Ultraviolet radiation exposure ○ Combination of vascular and pigmentary
degenerative pannus, German shepherd pannus, forms in same eye or between eyes
Uberreiter’s syndrome GEOGRAPHY AND SEASONALITY
Increased incidence and severity of disease in HISTORY, CHIEF COMPLAINT
Epidemiology geographic regions with high altitude (≥4500 • Corneal discoloration: rapidly or slowly
SPECIES, AGE, SEX feet [1500 m]) and intense sunlight. Dogs progressive; reddish and/or brown film
• Dogs only that live at lower altitudes respond better to covering surface of the eyes
• Age of onset: 2-5 years of age; depends on therapy. • Progressive loss of vision
breed and altitude
ASSOCIATED DISORDERS PHYSICAL EXAM FINDINGS
GENETICS, BREED PREDISPOSITION Lymphocytic/plasmacytic conjunctivitis (atypi- • Typically bilateral; often symmetrical
• Primarily affects large-breed dogs but may cal pannus, plasmoma) (p. 970) • Generally nonulcerative, pinkish red, vascular-
occur in any breed ized, cloudy, and/or pigmentary superficial

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