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Dr. Scarlett
Dr. Scarlett, Veterinarian
Category: Vet
Satisfied Customers: 4110
Experience:  I am a practicing small animal veterinarian with 18 years experience.
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My 14 year old King Charles Cavalier has just been diagnosed

Resolved Question:

My 14 year old King Charles Cavalier has just been diagnosed with Dry Eye (in one eye only). Three days ago the vet started her on Optimmune, plus Lubrithal eye gel. Today a Schirmer tear test showed an improvement and so I was advised to keep my dog on Optimmune for life.
However, my question is this: if it takes between 10 days and 6 weeks for Optimmune to become fully effective, could it be that it's the Lubrithal eye gel which is improving the condition and that the cause of the KCS is not immune-related at all? My dog is on a natural diet (BARF) plus a prebiotic/enzyme/Omega 3 etc. supplement and is in good health for a Cavalier of this age.
Submitted: 3 years ago.
Category: Vet
Expert:  Dr. Scarlett replied 3 years ago.
Dr. Scarlett :

Hi,

Dr. Scarlett :

Can you tell me a little more about Tilly? Was she having discharge from the affected eye? Did you take her in because of the eye or some other reason?

Dr. Scarlett :

Do you know what her initial Schirmer tear test was?

Customer:

She was having a yellow/green discharge from the affected eye, but only in the morning on waking. I took her in because I suspected there was a problem with perhaps a blocked tear duct not allowing the eye to be kept properly moist etc. I asked the vet (quite young and not very experienced) if perhaps she could do a tear test but she just gave me some Acuval plus Lubrithal to try for a couple of days. When I went back for a 2nd visit, the Optimmune was prescribed and Tilly's eye checked again today (3rd visit in one week!).

Dr. Scarlett :

So the initial eye lubricant didn't help very much, it sounds like?

Dr. Scarlett :

I suspect that Tilly really does have dry eye. I prescribe Optimmune (or similar) along with a lubricating eye drop. It does take some time for tear production to be increased and it never hurts to have more lubrication for that eye.

Dr. Scarlett :

So as to your question--I would say that the eye gel is making an improvement in her eye and replacing the tears she isn't quite making, but that long-term staying on the Optimmune will be of more benefit than not using it at all. How often are you using the Lubrithal?

Customer:

Apologies, I omitted to say that the vet did not do the Schirmer tear test on the 1st visit, when Lubrithal was prescribed. She did the test at my insistence on the 2nd visit so that's the baseline as it were. It was about 5 I think. Today, on the 3rd visit and after 3 days of Optimmune, the tear test was up to 9.... but hardly enough to credit the slight improvement to just the Optimmune.

Customer:

Am using the Lubrithal twice a day, allowing about 3 hours after Optimmune. Vet now says Tilly only needs Opt. once a day, seems odd as she hasn't been on it that long (3 days) to suddenly reduce.

Dr. Scarlett :

A 9 is still quite low--a normal STT is around 18. So the slight increase could certainly be due to the Lubrithal, especially if you put it in her eye within 4 hours of the test. But because the STT is not even close to normal, I'd definitely continue the Optimmune. I'm not quite sure why the vet rechecked so soon, since we really don't expect to see great improvement for close to a month.

Dr. Scarlett :

Oh, I see. Are you also questioning the decision to go from twice a day Optimmune to once a day? I would keep her at twice a day for at least another month or two, then recheck the STT (don't apply the Lubrithal for a good 24 hours prior to the recheck).

Customer:

Yes,that's exactly what I think... it does seem odd. Anyhow, I've already spent over £200 before even starting the Optimmune regime for life, and I'm beginning to wonder if the vet I saw was a bit out of her depth. She wanted me to see a senior colleague on the last two visits, but unfortunately said colleague had to go out on an emergency, so I was left with the junior vet again!

Dr. Scarlett :

I'd continue the Optimmune twice a day until you are about out of the ointment, then go back for a recheck with the senior vet. Unless the STT strip isn't placed in the eye (ie. it falls out), it is hard to misinterpret. But having someone else do the test with more experience would be good on recheck. That green, thick discharge you first described is pretty classic for KCS dogs. So I'm thinking that the STT was done correctly. I just think the vet erred on having you come back in for a recheck so soon.

Customer:

Yes, I agree. I will continue with the Optimmune twice daily and omit the Lubrithal for a good 24 hours prior to the recheck. Just thought of something, the junior vet wants me to go back for ANOTHER check in 7 days' time!! Can you believe it. No, I've paid for a prescription and will just buy the Opt. at a cheaper on-line vet pharmacy, and go for a check in ONE month! Thank you so much for your advice, you've saved me from near bankruptcy with all these visits in 2 weeks !!

Dr. Scarlett :

My pleasure! :)

Dr. Scarlett :

Here is some additional info on KCS you might not have: http://www.VeterinaryPartner.com/Content.plx?P=A&A=1326

Dr. Scarlett and 3 other Vet Specialists are ready to help you