Dry Eyes in Bulldogs and French Bulldogs (Bulldog KCS)
Dry Eyes Bulldogs KCS
Dry Eyes Bulldogs KCS are a very common ophthalmic condition in the breed, characterized by chronic inflammation of the ocular surface, conjunctiva, cornea, and sclera. KCS is short for Keratoconjunctivitis Sicca which is Latin for dryness of the membrane that covers the surface (white part) of your bulldog’s eyes.
Dry Eyes in Bulldogs and French Bulldogs often affects both eyes, but could initially be diagnosed in just one eye, and only later in the other.
The dryness is due to decreased tear production, and in bulldogs and French bulldogs, it is most often an immune-mediated disease (auto immune).
Inadequate tear production and dryness of the eyes can lead to painful corneal inflammation, scarring, ulcers and vision impairment.
Dry Eyes KCS in Bulldogs and French Bulldogs, MULTILAYER TEAR FILM
Your bulldog’s tear film is composed of three layers.
- MUCIN: is the inner part that helps stick the tears to the cornea.
- LIPID: is the outer oily layer that helps prevent the evaporation of the tear.
- AQUEOUS: is the middle watery part you all associate with tears. It contains vital compounds and is critical for the lubrication of the cornea.
Tear production is tested by a tear test named “Schiemer Tear Test”. The aqueous part is quantitative and is the only tear film part tested. The mucin and lipid parts are qualitative and are not measured by that test.
In the early stage of your bulldog’s dry eye disease, mucin and lipid production is low, but the aqueous production could still be normal. Therefore, because the tear test only measures the aqueous part, it is often interpreted erroneously as “normal” despite clinical findings consistent with bulldog-KCS. An experienced bully veterinarian is likely to factor all that into his or her diagnosis and initiate appropriate bully dry eye treatment.
Dry Eyes KCS in Bulldogs and French Bulldogs OTHER CAUSES:
Other less common non-autoimmune dry eye conditions include:
- TRAUMA: Trauma to the bulldog’s eye, skull, or orbit.
- NEUROLOGICAL: Injury to your bulldog’s cranial nerve 7 (Facial Nerve Paralysis) or CN5 (Trigeminal nerve).
- DRUG INDUCED: (Sulfa Drugs, see “tips & warnings”).
- HORMONAL DISEASE: Such as Bulldog Hypothyroidism.
- CHERRY EYE REMOVAL: The cherry eye must be preserved when repaired due to prolapse.
WARNING: Up to 30% of the aqueous part is produced in the cherry eye. Therefore, it is critical the surgeon operating on it must preserve the cherry (nicotinic membrane with gland). Removing the cherry could lead to a bully dry eye or exasperate it.
Dry Eyes KCS in Bulldogs and French Bulldogs CLINICAL SIGNS:
Most bulldogs with KCS present with a history of chronic, recurrent, nonspecific keratoconjunctivitis. Low tear production leads to corneal dehydration and hypoxia. Here is a list of the most common findings noted with bully dry eye:
DISCHARGE: Mucoid chronic d/c
REDNESS: Red injected conjunctiva and sclera
FOGGY CORENA: Discolored, pigmented, vascular, and fibrotic cornea (should be clear)
INFECTION: KCS can breakdown the cornea protective barriers thus predispose your bulldog to secondary bacterial conjunctivitis.
BLINDNESS: Partial or complete loss of vision.
The diagnosis of bulldog dry eyes is two parts:
- TEAR PRODUCTION TEST: “ A simple tear production “litmus test” named “Schiemer Tear Test” will be conducted to help measure your bulldog’s quantitive tear production.
- Normal Bulldog: 20 mm or more wetting/minute
- Early Bulldog KCS: 15-19 mm wetting/minute
- Mild Bulldog KCS: 11-14 mm wetting/minute
- Moderate Bulldog: KCS: 6-10 mm wetting/minute
- Severe Bulldog: KCS: <5 mm wetting/minute
- CORNEA STAIN: First, in order to detect if there an active corneal ulcer, your vet will conduct a fluorescein staining of your bully’s cornea and then examine the stained area under a UV light source in a dark room.
While ophthalmic steroids help to reduce inflammation, they can also exasperate an active corneal ulcer. Dry eye topical ophthalmic medication containing steroids should only be used after staining the cornea.
- REMOVE MUCUS: First, clean and remove all the debris and mucus from the eyes. A simple, inexpensive OTC hypotonic eyewash will do (sterile water).
- IMMUNE SUPPRESSANTS: Dry eye medications are based on immune suppressant topical ophthalmic ointments or drops, like Cyclosporine and Tacrolimus.
- ANTI-INFLAMMATORY: such as ophthalmic hydrocortisone or dexamethasone.
- ANTIBIOTICS: Sometimes short-term topical ophthalmic antibiotics are needed.
- LUBRICANTS: I like ones that include hydronic acid. They are often adequate for early-stage Bulldog KCS.
Dr. Kraemer’s V4B Dry Eyes Bulldogs and French Bulldogs KCS RULE OF THUMB
To prevent the deterioration of your bulldog’s cornea, to avoid vision loss, and to manage discomfort, treatment must be applied every day for the rest of your bulldog’s life.
I recommend testing your bully’s tear production any time your bully has an eye problem, particularly a corneal one.
Dr. Kraemer’s V4B Dry Eyes Bulldogs and French Bulldogs KCS TIPS & WARNINGS
Dry Eyes KCS Dry Eyes Bulldogs KCS Tip #1 OTC LUBRICANTS: OTC lubricants and irrigating eye drops are allowed, but not as a replacement for the ophthalmic Rx listed above. My preference is those with hyaluronic acid.
Dry Eyes KCS in Bulldogs and French Bulldogs Tip #2 WASTE: Some of the prescription dry eye ophthalmic drops are expensive, so don’t be wasteful. One drop on the eye is enough. Ointments are pressurized and hard to control, I prefer the drop form.
Dry Eyes Bulldogs KCS Tip #3 RINSE: To optimize the Rx impact, always clean the mucus and debris from the eyes with sterile water and/or a clean wipe.
Dry Eyes Bulldogs KCS Tip # 4 CHERRY EYE: I recommend surgically fixing your bulldog puppy’s cherry eye. Leaving your bulldog’s “cherry eye” and postponing surgical correction can cause chronic corneal irritation of your bulldog puppy’s eyes. To learn more click here.
Dry Eyes KCS in Bulldogs and French Bulldogs Tip # 4 AUTOIMMUNE: immune-mediated KCS should be your presumptive underlining cause.
Dry Eyes Bulldogs KCS Warning #1 CHERRY EYE: Surgically removing your bulldog puppy’s “cherry eye“ can cause bulldog dry eyes (KCS) due to its aqueous contribution to your bulldog’s tear film. To learn more click here.
Dry Eyes Bulldogs KCS Warning #2 STEROIDS: Ophthalmic steroids should not be used on an active corneal ulcer because it can impede healing. Always check with your veterinarian before using one.
Dry Eyes Bulldogs KCS Warning #3 COMMITMENT: Failing to treat your bulldog dry eye will likely lead to a continuous corneal deterioration, pain, infection, and impaired or loss of his/her vision.
Treating bulldog dry eye (KCS) must be done DAILY for the remainder of your bully’s LIFE.
Dry Eyes KCS in Bulldogs and French Bulldogs Warning #4 SULFA DRUGS: Sulfa drugs can cause dry eyes (KCS). They should be prescribed cautiously or avoided. When prescribed, tear production should be checked prior to starting and again in 5 days.
Dry Eyes KCS in Bulldogs and French Bulldogs Warning #5 CAR RIDES: Do not let your bulldog puppy stick his or her head out of your car windows while driving. When doing so, make sure to place protective goggles over the eyes.
Dry Eyes Bulldogs KCS Warning #6 ANTIHISTAMINES: Antihistamines like Benadryl can reduce tear production.
Dry Eyes KCS in Bulldogs and French Bulldogs Warning # 7 VISINE: I don’t recommend using Visine tear lubricants on your bulldog because it can cause vasoconstriction of blood vessels and eventually worsen your bulldog’s KCS dry eye condition.
Dry Eyes KCS in Bulldogs and French Bulldogs Warning # 8 OPPOSITE EYE: If your bulldog has one dry eye, the other one should be monitored. There is a high chance that over time it will also suffer from tear deficiency.
Dry Eyes Bulldogs KCS Warning # 9 CORNEAL ULCER: Cornea stain should be done in addition to the tear production test (STT) to help rule out corneal ulcers.
Dry Eyes KCS in Bulldogs and French Bulldogs Warning # 10 Unfortunately, some veterinarians fail to diagnose the true underlying problem, erroneously misdiagnosing and treating your bulldog’s dry eye as bacterial conjunctivitis. The error could lead to a false sense of security, and a delay of the needed treatment. The combined errors could end with blindness.
An Ounce of PREVENTIVE is Worth a Pound of CURE