Diagnosis and Medical Management of Keratoconjunctivitis Sicca (KCS) in the Dog

犬乾眼症之診斷及內科治療

林中天(Chung-Tien Lin) ； 吳思穎(Szu-Ying Wu)

《臺灣獸醫學雜誌》 28卷2期 (2002/06) Pp. 99-105

https://doi.org/10.7009/TVJ.200206.0099

摘要

乾眼症為犬隻常見之眼科疾病。本篇介紹利用Schirmer式淚液試紙來確診犬乾眼症，並配合使用眼科檢查裂隙燈、檢眼鏡、角膜螢光染色及微生物培養來評估乾眼症患犬眼睛病變的情形。我們統計並分析50隻至國立台灣大學附設動物醫院眼科門診就診的乾眼症病犬之診斷方式、診斷及治療結果。在病犬發病率方面，乾眼症在母犬及公犬的發生率相似（約1:1），平均發病年齡為6.1歲，好發率前三高之犬種依序為西施犬、可卡犬及約克夏犬。全身理學檢查方面，發現最常見之同時患有之其他疾病為免疫異常相關之皮膚疾病，包括過敏性異位性皮膚病以及毛囊蟲感染，其中有12%的乾眼症患犬經檢驗患有全身或眼睛周圍的毛囊蟲感染。我們利用Schirmer式淚液產量試紙以及眼科檢查儀器對所有乾眼症患犬進行詳細之眼科學檢查。經檢查後，發現患有雙側性乾眼症者佔所有患犬數之60%，而患有單側性乾眼症者佔患犬數之40%。所有的患犬之共同臨床特徵為不等程度的淚液產量減少、黏液樣或膿樣分泌物、角膜失去光澤及結膜充血。此外，其他常見之臨床症狀包括，在嚴重慢性乾眼症者有色素性角膜炎（42 %）、角膜潰瘍（38%）、角膜血管新生（32%）及失明（20%）。細菌培養結果，最常造成二次細菌感染的病原為葡萄球菌。治療方式依患犬之症狀決定，我們採用人工淚液點眼劑（所有病例）、1-2%環胞靈（成分cyclosporine）點眼劑（80%之病例）、局部眼用抗生素（40%病例）或口服1% pilocarpine（4個病例）來治療乾眼症患犬。在治療後經半年以上至一年之追蹤檢查，發現79%的病犬其眼部之病變，特別是角膜及結膜的症狀，有明顯之改善：此外，有58 %病犬之淚液產量增加。經分析了解，所有眼部病變或淚液產量改善之患犬，均曾給予cyclosporine點眼劑治療，故由本次追蹤分析之結果可證明cyclosporine點眼劑確為治療犬乾眼症最重要及有效之治療用藥。

關鍵字

環胞靈 ； 犬 ； 乾眼症 ； 乾性角膜結膜炎 ； Schirmer式淚液試紙

並列摘要

Keratoconjunctivitis sicca (KCS) is a common ophthalmic disorder in the dog. The diagnosis and medical management of 50 dogs suffering from KCS were studied and reviewed. The sex ratio of the 50 KCS affected patients between males and females was 1:1. The mean age of affected dogs was 6.1 years old. The leading KCS affected breeds were Shih-Tzu (20%), Cocker Spaniel (16%), and Yorkshire Terrier (16%). On physical examination, the most commonly concurrent diseases are dermatological disorders associated with imbalanced immune response, such as atopy and demodicosis. Tear production and ocular lesions were assessed by Schirmer tear test (STT), slit-lamp biomicroscope, ophthalmoscope, fluorescein stain, and microbiological cultures. Following ophthalmic examination, 30 dogs showed bilateral disease and 20 dogs had unilateral disease. Bilateral KCS cases tend to have more severe clinical lesions compared with the unilateral ones. Among the 17 KCS bilaterally affected dogs with STT readings, 10 eyes were mild or early KCS (STT: 11 to 14 mm/min), 4 eyes were moderate KCS (6 to 10 mm), 20 eyes were severe KCS (0-5 mm). Among the 10 dogs with unilateral disease, 6 eyes were moderate KCS (6 to 10 mm) , 4 eyes were severe KCS (0-5 mm). Abnormal ocular findings included mucoid or mucopurulent discharge, loss of normal corneal luster, conjunctival hyperemia, pigmentary keratitis, ulcerative keratitis, corneal vascularization, and vision loss. Pigmentary change of cornea were found in 21 dogs (42%), corneal vascularization in 16 dogs (32%), 19 dogs with ulcerative keratitis (38%), and 10 dogs with vision loss (20%). Microbiological cultures, obtained by conjunctival sac sampling of infected KCS cases, revealed that Staphylococcus spp. (aureus or intermedius) was the leading bacterial pathogen. Medical management of the KCS cases included the use of tear replacement ointment (all 50 cases), 1%-2% cyclosporine solution (80% cases), antibiotics (40% cases), and 1% pilocarpine in food (4 cases). Twenty (79%) of 38 follow-up cases showed improvement of corneal and conjunctival lesions , while 22 dogs (58%) of 38 follow-up cases showed improved tear production. AII improved cases have been treated by topical cyclosporine solution. The improvement of corneal and conjunctival lesions was significant and dramatic within a couple of weeks particularly following treatment by topical cyclosporine solution.

並列關鍵字

Cyclosporine ； Dog ； KCS ； Keratoconjunctivitis sicca ； Schirmer tear test