Podcast
Questions and Answers
What is the limitation of a study that suggests a causal relationship between nKCS and medication application in dogs?
What is the limitation of a study that suggests a causal relationship between nKCS and medication application in dogs?
- The study only included dogs with previous ophthalmic signs
- The study was prospective in nature
- The study did not use a control group
- The sample size was small and the data was retrospective (correct)
What is the primary mechanism of action of pilocarpine in treating canine neurogenic keratoconjunctivitis sicca?
What is the primary mechanism of action of pilocarpine in treating canine neurogenic keratoconjunctivitis sicca?
- Inhibition of parasympathetic denervation
- Induction of hypothyroidism
- Activation of otic nerve pathways
- Stimulation of lacrimal gland postganglionic innervation (correct)
What is the suspected cause of neurogenic keratoconjunctivitis sicca in dogs?
What is the suspected cause of neurogenic keratoconjunctivitis sicca in dogs?
- Application of otic medications containing terbinafine and florfenicol (correct)
- Poor diet and nutrition
- Viral infections
- Genetic predisposition
Which of the following is a potential complication of otic medication use in dogs?
Which of the following is a potential complication of otic medication use in dogs?
What is the primary objective of the study?
What is the primary objective of the study?
What is the potential complication of using otic medications in dogs?
What is the potential complication of using otic medications in dogs?
What is the name of the condition characterized by reduced tear production in dogs, often associated with endocrinopathies?
What is the name of the condition characterized by reduced tear production in dogs, often associated with endocrinopathies?
What is the name of the statistical method used to control the false discovery rate in multiple testing?
What is the name of the statistical method used to control the false discovery rate in multiple testing?
What is the diagnostic criterion used to confirm neurogenic keratoconjunctivitis sicca in the study?
What is the diagnostic criterion used to confirm neurogenic keratoconjunctivitis sicca in the study?
What is the term for the association of otitis media with chronic otitis externa in dogs?
What is the term for the association of otitis media with chronic otitis externa in dogs?
How many client-owned dogs were included in the study?
How many client-owned dogs were included in the study?
Which of the following is a common symptom of canine neurogenic keratoconjunctivitis sicca?
Which of the following is a common symptom of canine neurogenic keratoconjunctivitis sicca?
What is the timeframe for the onset of clinical signs of neurogenic keratoconjunctivitis sicca in dogs after application of otic medications?
What is the timeframe for the onset of clinical signs of neurogenic keratoconjunctivitis sicca in dogs after application of otic medications?
What is the application of nonhypotensive autonomic agents in veterinary ophthalmology?
What is the application of nonhypotensive autonomic agents in veterinary ophthalmology?
What is the term for the study of the diagnosis and treatment of disorders of the eye?
What is the term for the study of the diagnosis and treatment of disorders of the eye?
What is the name of the medication combinations suspected to cause neurogenic keratoconjunctivitis sicca in dogs?
What is the name of the medication combinations suspected to cause neurogenic keratoconjunctivitis sicca in dogs?
What is the neurological manifestation of ear disease in dogs?
What is the neurological manifestation of ear disease in dogs?
Which of the following is a potential cause of canine neurogenic keratoconjunctivitis sicca?
Which of the following is a potential cause of canine neurogenic keratoconjunctivitis sicca?
What is the term used to describe the dryness of the eyes in dogs?
What is the term used to describe the dryness of the eyes in dogs?
What is the purpose of using magnetic resonance imaging (MRI) in dogs with chronic otitis externa?
What is the purpose of using magnetic resonance imaging (MRI) in dogs with chronic otitis externa?
What is the name of the medical condition characterized by a deficiency in tear production in dogs?
What is the name of the medical condition characterized by a deficiency in tear production in dogs?
What is the regulatory agency responsible for overseeing the use of otic medications in dogs?
What is the regulatory agency responsible for overseeing the use of otic medications in dogs?
What is the primary mechanism by which otic medications are thought to cause neurogenic keratoconjunctivitis sicca in dogs?
What is the primary mechanism by which otic medications are thought to cause neurogenic keratoconjunctivitis sicca in dogs?
Which of the following is a potential complication of canine neurogenic keratoconjunctivitis sicca?
Which of the following is a potential complication of canine neurogenic keratoconjunctivitis sicca?
What is the primary site of lesions that result in postganglionic innervation defects leading to nKCS in dogs?
What is the primary site of lesions that result in postganglionic innervation defects leading to nKCS in dogs?
Which nerves are affected in dogs with unilateral, severe ocular discomfort and a Schirmer tear test (STT) value of close to zero?
Which nerves are affected in dogs with unilateral, severe ocular discomfort and a Schirmer tear test (STT) value of close to zero?
What is the common ocular symptom observed in dogs with nKCS, in addition to reduced tear production?
What is the common ocular symptom observed in dogs with nKCS, in addition to reduced tear production?
What is the suspected cause of nKCS in dogs that develop the condition within 1 day of applying otitis externa medications?
What is the suspected cause of nKCS in dogs that develop the condition within 1 day of applying otitis externa medications?
What is the site of synapse of preganglionic fibers that innervate the lacrimal gland in dogs?
What is the site of synapse of preganglionic fibers that innervate the lacrimal gland in dogs?
What is the nasolacrimal duct anatomy relevant to nKCS in dogs?
What is the nasolacrimal duct anatomy relevant to nKCS in dogs?
What is the documented median time from application of ear medication to documented return of clinically normal tear production in dogs with nKCS?
What is the documented median time from application of ear medication to documented return of clinically normal tear production in dogs with nKCS?
What is the percentage of dogs in the study that developed a corneal ulcer as a complication of nKCS?
What is the percentage of dogs in the study that developed a corneal ulcer as a complication of nKCS?
What is the potential underlying cause of keratoconjunctivitis sicca in horses with hypothyroidism?
What is the potential underlying cause of keratoconjunctivitis sicca in horses with hypothyroidism?
What is the potential consequence of otic medication use in dogs?
What is the potential consequence of otic medication use in dogs?
What is the role of metalloproteinases in ocular diseases?
What is the role of metalloproteinases in ocular diseases?
What is the significance of the nasolacrimal duct in ocular health?
What is the significance of the nasolacrimal duct in ocular health?
What is the potential association between otitis externa and neurogenic keratoconjunctivitis sicca in dogs?
What is the potential association between otitis externa and neurogenic keratoconjunctivitis sicca in dogs?
What is the significance of parasympathetic denervation in the lacrimal gland?
What is the significance of parasympathetic denervation in the lacrimal gland?
What is the potential consequence of hypothyroidism on ocular health in horses?
What is the potential consequence of hypothyroidism on ocular health in horses?
What is the role of the facial nerve in lacrimal gland innervation?
What is the role of the facial nerve in lacrimal gland innervation?
What is the result of pathology at any point along the efferent lacrimal gland innervation pathway?
What is the result of pathology at any point along the efferent lacrimal gland innervation pathway?
What is the role of matrix metalloproteases in KCS?
What is the role of matrix metalloproteases in KCS?
What is the effect of denervation of postganglionic fibers in mice on basal tear secretion?
What is the effect of denervation of postganglionic fibers in mice on basal tear secretion?
What is the consequence of loss of globulins and the flushing action of tears in KCS dogs?
What is the consequence of loss of globulins and the flushing action of tears in KCS dogs?
What is the timeframe for return of normal tear production in nonreferral dogs?
What is the timeframe for return of normal tear production in nonreferral dogs?
What is the neural structure that was transected in rabbits to result in loss of tear production and decreased lacrimal gland size?
What is the neural structure that was transected in rabbits to result in loss of tear production and decreased lacrimal gland size?
What is the presumed cause of corneal ulcers in dogs with nKCS?
What is the presumed cause of corneal ulcers in dogs with nKCS?
What is the tendency of primary care veterinarians compared to ophthalmologists in rechecking dogs with nKCS?
What is the tendency of primary care veterinarians compared to ophthalmologists in rechecking dogs with nKCS?
Flashcards
Neurogenic Keratoconjunctivitis Sicca (nKCS)
Neurogenic Keratoconjunctivitis Sicca (nKCS)
A rare and uniquely presenting form of dry eye caused by the loss of nerve signals to the lacrimal gland.
Aqueous portion of the tear film
Aqueous portion of the tear film
The watery part of the tear film. It is produced by the lacrimal glands.
Schirmer Tear Test (STT)
Schirmer Tear Test (STT)
A test to measure the amount of tears produced by the lacrimal glands.
Otitis media
Otitis media
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Otitis interna
Otitis interna
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Petrositis
Petrositis
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Total ear canal ablation
Total ear canal ablation
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Bulla osteotomy
Bulla osteotomy
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Orbital trauma
Orbital trauma
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Efferent nerves
Efferent nerves
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Superficial petrosal nerve
Superficial petrosal nerve
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Prognosis for return of normal tear production
Prognosis for return of normal tear production
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Terbinafine and florfenicol
Terbinafine and florfenicol
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Claro and Neptra
Claro and Neptra
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Osurnia
Osurnia
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Time to documentation of Schirmer tear test ≥ 15 mm/min
Time to documentation of Schirmer tear test ≥ 15 mm/min
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Xeromycteria
Xeromycteria
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Corneal ulceration
Corneal ulceration
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Acute, complete loss of the aqueous portion of the tear film
Acute, complete loss of the aqueous portion of the tear film
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nKCS
nKCS
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Dry eye
Dry eye
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Conjunctivitis
Conjunctivitis
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Cornea
Cornea
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Conjunctiva
Conjunctiva
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Lacrimal gland
Lacrimal gland
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Efferent lacrimal gland innervation pathway
Efferent lacrimal gland innervation pathway
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Anterior chamber
Anterior chamber
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Iris
Iris
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Pupil
Pupil
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Lens
Lens
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Miosis
Miosis
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Mydriasis
Mydriasis
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Study Notes
Neurogenic Keratoconjunctivitis Sicca (nKCS) in Dogs
- nKCS is a suspected novel cause of neurogenic keratoconjunctivitis sicca (nKCS) secondary to florfenicol, terbinafine hydrochloride, mometasone furoate (Claro and Neptra) or florfenicol, terbinafine, betamethasone acetate (Osurnia)
Clinical Course and Long-term Prognosis
- 29 client-owned dogs were identified with clinical signs of nKCS after application of otitis externa medication containing terbinafine and florfenicol
- Onset of clinical signs of nKCS within 1 day after application of otitis externa medications
- Low Schirmer tear test value (< 15 mm/min) of affected eyes
Research Methodology
- Online survey and word-of-mouth recruitment were conducted to identify dogs that developed clinical signs of nKCS
- Retrospective analysis of medical records of dogs meeting inclusion criteria
Otitis Externa Medications
- Terbinafine and florfenicol are suspected to cause nKCS in dogs
- Claro and Neptra, and Osurnia are otitis externa medications containing terbinafine and florfenicol
Related Research
- Neurological manifestations of ear disease in dogs and cats (Garosi et al., 2012)
- Occult otitis media in dogs with chronic otitis externa (Lorek et al., 2020)
- Ototoxic effect of topical oxiconazole and terbinafine in rats (Aydın et al., 2012)
- Canine neurogenic keratoconjunctivitis sicca (Matheis et al., 2012)
- Evaluation of novel dry eye model (Toshida et al., 2007)
Neurogenic Keratoconjunctivitis Sicca (nKCS)
- nKCS is a rare and uniquely presenting form of dry eye caused by the loss of efferent innervation to the lacrimal gland.
- It can lead to acute, complete loss of the aqueous portion of the tear film.
- Dogs typically present with unilateral, severe ocular discomfort and a Schirmer tear test (STT) value of close to zero.
- Concurrent ipsilateral xeromycteria and secondary corneal ulcerations are common.
Causes of nKCS
- Preganglionic lesions: otitis media or interna, petrositis.
- Postganglionic lesions: total ear canal ablation, bulla osteotomy, orbital trauma.
Efferent Lacrimal Gland Innervation Pathway
- The pathway is complex, and pathology at any point along this pathway can result in nKCS.
- The transection of the superficial petrosal nerve in rabbits led to loss of tear production and a decrease in lacrimal gland size.
Clinical Relevance
- Dogs that developed nKCS within 1 day after application of otitis externa medications containing terbinafine and florfenicol had a good prognosis for return of normal tear production within 1 year.
- The median time from application of ear medication to documented return of clinically normal tear production was 86 days (range, 19 to 482 days).
- Being referred to an ophthalmologist and having a deep ulcer were associated with a longer time to documentation of Schirmer tear test ≥ 15 mm/min.
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Description
This quiz is based on a study on the signs of nKCS in dogs after medication application. It explores the causal relationship between the medication and the signs of nKCS.
