By Mary Routson

Spring 2002

Duncan, a wonderful Westie who lived 15 and a half years provided my introduction to "dry eye" when he was eight years old.  He was one of two Westies who lived with his companion, T.S. and me.  They shared a big yard in North Carolina accessed by a deck from the house.  Duncan stopped coming up the stairs to the deck on occasion so our vet X-rayed him and nothing appeared to be wrong with his legs or back.  His regular vet referred him to the North Carolina State Veterinary School for evaluation.  I recall dropping him off on the way to work and thinking it would be a short appointment since they wanted him all day.  The student assigned to his case kept going over him from stem to stern and I almost mentioned that his back end was sitting on the ground, not his head, when she started on his eyes.  At which point she looked at me and said "Do you know that Duncan is going blind?"  After explaining to me that his tear production had stopped and that his eyes had developed ulcers, the reassuring news came: it was not too late to scrape his cornea and allow the layer to reform.  Daily medication would also be needed.

We started the process and it took several scraping treatments before the layer was smooth.  Duncan bumped into furniture and walls during this time and had to be carried up and down stairs.  He had fooled me by following close behind T.S. when they went in and out of the house.  T.S. was the more athletic of the two and eventually Duncan could not see well enough to stay close enough to climb the stairs in T.S.'s paw steps.  Many Westie owners think "more is better than one" and could miss this first sign of trouble.

The medication sequence that Duncan was prescribed is fairly typical.  We began with a saline solution to wash his eyes out each morning followed by drops of cyclosporine dissolved in avocado oil formulated by the vet school.  The next group that Duncan met at the NC State Vet School was dermatology.  He was allergic to the avocado oil and big, black, scabby patches developed around both eyes--sort of reverse panda in appearance.  They consulted with his ophthalmologists and switched him to a cream-based cyclosporine ointment.   It was less concentrated but still worked for him.  Placing a strip of ointment on the eye was a level of difficulty higher than putting in drops, but he was quite cooperative.

Over the next seven years, Duncan's treatments became more aggressive and we moved to San Francisco, CA.  Eventually we increased the regimen to twice a day for the ointment and added a triple antibiotic ointment at night.  He had started sleeping with his eyes partly open so his eyes needed the protection.  At 15 and a half, Duncan did not have great eyesight but he certainly could see well enough to go about living a high quality life until he died last February.

Duncan was hospitalized a few times in his last three years for pancreatitis and other illnesses.  Vets do not always carry these specialized eye medications so it is important to take the medications with you if you expect to leave a dry eye Westie overnight.  Even if the specialists have the medications on hand, it will be a more costly hospitalization if you have to repurchase them.  Provide written directions for application as some technicians will not have treated a patient with dry eye before. 

After Duncan died, someone in the Northern California Westie Rescue group heard that I had lost my friend and told someone else who knew about a couple of Westies who were looking for a home.  Gail Krieger was fostering a darling girl who was rescued from the shelter in Martinez, CA and there was another girl in the Carmel, CA area looking for a new Mom.  Both of these Westies had dry eye disease. 

My experience with Duncan was very helpful since I fell in love with them and had no doubt that I could handle their eye problems.  Tessa came first and had eye discharge and obvious vision problems.  Annie arrived four days later and her eye discharge was worse than any I had ever seen. 

I took both girls to see Duncan's Ophthalmologist, Dr. Cynthia Cook, at Veterinary Vision, Inc. in San Francisco.  I expected that she would start the scraping procedure and they would recover nicely, an optimistic belief on my part.  Dr. Cook explained that their disease had not been caught in the early stages and their eyes were deeply scarred. Treatment would be medication only and some improvement could be expected but not dramatic improvement.   Since May she has seen Tessa and Annie several times.  We started out with the saline flushing.  I was able to clean Tessa's eyes adequately but had to go back for further training for Annie.  Her eye "gunk" was green and sticky and resistant to normal flushing.  Dr. Cook literally flooded her eyes for minutes to get them clear enough for medication.  It was the difference between hosing off the sidewalk with the hose and using one of the attachments to increase pressure and velocity.  I used bottles and bottles of saline solution until finally her eyes started producing enough tears to preclude production of discharge.  With Tessa it required about a month and Annie took about three months to return to that bright-eyed, brown-eyed Westie look.  We use the cyclosporine in oil solution and also the triple antibiotic cream that I used with Duncan.  Dr. Cook added a prednisolone solution after about a month and a half which significantly improved Annie's progress.  She decided I should use it for Tessa too.

My new girls have been with me for almost five months now.  Tessa produces tears and can see as well as Duncan could in his later years.  Annie could see about a foot when she arrived.  She is a very needy dog and wants to be with me all the time.  I had to put my hand a foot in front of her face to coax her to come (she is totally deaf) in the beginning.  Now she follows my progress around a large room.  As with all new pets, I am learning new things regularly.  Unbeknownst to me, Annie likes to bark at and chase bikes.  Last week she was sitting on the sidewalk helping me sweep leaves when she barked at a cyclist and gave chase.  A Mom has never been so proud of "bad dog" behavior.  The cyclist was at least 15-20 feet away and Annie not only saw "something," she knew what she saw and acted like all good Westies with trigger points.  Needless to say, her days as sweeping assistant are over and I avoid kids on bikes on the sidewalk when walking her.

All of this good news comes with lots of attention paid to what Dr. Cook recommends.  Duncan had trained me well for these girls but taking care of him was much less work.  Annie and Tessa get eye wash, pred. solution, oily ointment, and cream ointment THREE times a day, every day, seven days a week for the rest of their lives.  And maybe Dr. Cook will prescribe more meds as time goes on.

I think that the "dry eye" terminology used for Keratoconjunctivitis may lead Westie owners to assume that the condition is similar to a human whose eyes feel "dry."  In our case, adding saline solution does the trick and our eye feels better.  For a Westie with dry eye, the saline only lasts for seconds and then your dog is in pain and could lose their vision without using the medications.  Most importantly, after I experienced Annie's and Tessa's more advanced disease, I realized that my other two Westies, Phoenix and Skyrin, are nine years old and they had never been tested.  I took them immediately to the regular vet and they both have excellent--ABOVE average--tear production.  The test is real easy--the vet places a paper wick in the bottom eyelid and measures the distance the tears travel up the wick in a given time interval. 

All Westie owners should make the tear production test a regular part of your dog's annual checkup.  Start early enough to get a good baseline tear production value and it will be easy for your vet to see changes.  If your Westie starts to develop "dry eye" there will be time to reverse the disease before regular treatments become your only option.  Also, there are surgical means to replace the tear ducts that can be used in younger dogs.  The earlier the diagnosis, the fewer treatments per day will be needed to keep those bright eyes seeing you, and all those other critters of interest, as your Westie becomes a respected senior citizen. 

Update Spring 2003

There is good to news to report for Annie's condition. She demonstrated the lowest tear production of any of my dry-eyed Westies and has shown marked improvement with a new medication. Her December checkup showed only 3-7 millimeters of tear flow using the wick test. Dr. Cook prescribed a new drug for her (Tacrolimus 0.02 % solution added last in the sequence); her eyes appeared to get clearer in a few weeks and discharge disappeared altogether. The positive results were confirmed when she was rechecked in February--I saved the wicks showing 12-20 millimeters. Dr. Cook was ecstatic and has renamed her "Double-Digit Annie." Her eyesight has significantly improved to seeing me when I am 40-50 feet away. Such a pleasure to see her look around for me and then make a dash in the correct direction from that distance.