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Epistaxis 305

• ± Topical cyclosporine 0.2%-2% q 12h, used months; occasional gastrointestinal side effects PEARLS & CONSIDERATIONS
in addition to corticosteroids in refractory from niacinamide Comments
VetBooks.ir Chronic Treatment Possible Complications Lifelong treatment is typically required. Diseases and Disorders
cases.
• Chronic ocular pain
Technician Tips
NGE and scleritis often require topical (see
• Secondary glaucoma
Acute General Treatment above) and systemic • Uveitis Some ophthalmic drugs have virtually identi-
therapy(ies): • Blindness cal names for formulations with and without
• Prednisone 1-2 mg/kg PO q 24h until clini- • Azathioprine may cause severe life-threatening corticosteroids. This similarity presents a risk of
cal improvement, then gradually tapered over myelosuppression; potentially hepatotoxic using the wrong drug. Before topical applica-
3-4 weeks until maintenance dose reached tion, it is extremely useful for technicians to
• ± Azathioprine 1.5-2 mg/kg PO q 24h until Recommended Monitoring carefully read the label of the tube/vial and
clinical improvement, then gradually tapered • Monitor for regression of disease every identify whether it contains corticosteroids and
to as low a dose as possible (e.g., 0.75-1 mg/ 2-3 weeks until clinical signs resolve, to check the medical record for consistency.
kg PO q 24h, then q 48h, then once weekly then as needed depending on response to Substitution error (especially administering
for maintenance) therapy. corticosteroids when they are contraindicated)
• Oral cyclosporine 5 mg/kg PO q 24h for 30 • In animals receiving azathioprine therapy, can be devastating and has been made by
days, then 5 mg/kg PO q 48h or 2.5 mg/ CBC and liver enzymes should be assessed veterinarians, technicians, and clients.
kg q 24h every 1-2 weeks for the first 2 months, then
• Options if medical management ineffective regularly (e.g., monthly) once clinically SUGGESTED READING
○ Cryosurgery stable. Grahn BH, et al: Canine episcleritis, nodular
○ Surgical excision episclerokeratitis, scleritis and necrotic scleritis.
Alternative medical treatment includes tetracy- PROGNOSIS & OUTCOME Vet Clin North Am Small Anim Pract 38:291-308,
cline (doxycycline 10 mg/kg PO q 24h), with 2008.
or without niacinamide 125 mg/DOG PO q 8h • Varies, depending on underlying condition AUTHOR: Ursula M. Dietrich, Dr.med.vet., DACVO,
for dogs < 5 kg, 250 mg/DOG PO q 8h for and cause DECVO, MRCVS
dogs 5-10 kg, or 500 mg/DOG PO q 8h for • Episcleritis: prognosis usually good EDITOR: Diane V. H. Hendrix, DVM, DACVO
dogs > 10 kg); clinical response may take 1-2 • Relapse possible

Epistaxis Client Education
Sheet

BASIC INFORMATION RISK FACTORS PHYSICAL EXAM FINDINGS
• See Genetics and Breed Predisposition • Nasal hemorrhage, alone or mixed with
Definition • Exposure to ticks mucopurulent discharge
Bleeding from the nasal cavity • Exposure to anticoagulant drugs or toxins • Melena: from swallowing blood, or associated
• Systemic hypertension with concurrent gastrointestinal bleeding
Synonym • With intranasal disease (neoplasia, sino-
Hemorrhagic nasal discharge, nosebleed CONTAGION AND ZOONOSIS nasal aspergillosis): mucopurulent nasal
• Vector transmitted infection: canine leish- discharge, nasal deformation, regional
Epidemiology maniasis, rickettsial infection lymphadenopathy, obstruction of airflow,
SPECIES, AGE, SEX • Fungal infections (transmission potential nasal depigmentation (p. 678)
Dogs more commonly affected than cats; minimal) • With bleeding disorder: petechiae, ecchy-
depends on underlying cause: mosis, hematomas, hematochezia, melena,
• Young, purebred animals: hereditary GEOGRAPHY AND SEASONALITY and hematuria (p. 433)
coagulopathies Areas where leishmaniasis, rickettsial diseases • Fundic changes possible if bleeding disorder,
• Young to middle-aged animals: infectious are endemic hyperviscosity, systemic hypertension
diseases, trauma, immune-mediated diseases
• Older animals: neoplasia Clinical Presentation Etiology and Pathophysiology
HISTORY, CHIEF COMPLAINT Epistaxis occurs secondary to other disease.
GENETICS AND BREED PREDISPOSITION Some or all may be present: Intranasal disease is more common than
• Platelet disorders: otter hounds, basset • Nasal hemorrhage: usually acute systemic disease as a cause of epistaxis in dogs
hounds, others • Sneezing and cats in North America.
• von Willebrand disease: many breeds • Pawing at mouth and/or nose
(p. 1043) • With bleeding disorder: hematochezia, DIAGNOSIS
• Hemophilia: German shepherds, Kerry blue melena, hematuria, or hemorrhage
terrier, others (p. 431) • Systemic signs (e.g., lethargy, anorexia) Diagnostic Overview
• Nasal lesions common with systemic causes of epistaxis Diagnostic testing to rule out systemic causes (e.g.,
○ Aspergillosis: German shepherd, dolicho- • Central nervous system (CNS) deficits pos- hemostatic disorder) is indicated first because it
cephalic breeds (p. 81) sible with tumor invasion, bleeding disorder, is less invasive. If none, evaluation of the nasal
○ Neoplasia: dolichocephalic breeds (p. 680) hyperviscosity, or systemic hypertension cavities consists of diagnostic imaging and biopsies.

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