The incidence of KCS or “dry eye” is increasing in veterinary patients. An integrative approach to managing the condition includes “nutrinourishment” as well as other modalities such as TCM and laser treatment.
The condition known as “dry eye” or keratoconjunctivitis sicca (KCS) affects many of us, both human and animal. The medical terminology refers to an inflammation of the cornea and surrounding tissues, with severe desiccation, often causing a sticky mucus or exudate to accumulate near the medial canthus. This common eye condition results from an inadequate production of the aqueous tear film by the lacrimal tear gland and/or the third eyelid gland. In this article, we will explore the integrative options that can be used to treat KCS in pets.
LACK OF MOISTURE LEADS TO KCS
It is normally essential for eyes to have a protective tear film, a mixture of mucus, fatty liquid, and water. Tear production must be adequate enough to lubricate the cornea and keep it healthy, supplying it with moisture, oxygen and precious nutrients. Tears also assist with removing particulate debris or possible infectious agents.
Dry eye results from a lack of enough moisture to protect the outer layers of the eye. When injured, the cornea can become pigmented, scarred, and ulcerated. Ultimately, if the dry eye condition is left untreated, vision loss may result.
ETIOLOGY OF KCS
What is commonly understood as “immune-mediated” challenges to the “physical body temple” may cause damage to the tear-producing glands. Immune-mediated conditions are the most common cause of dry eye (KCS). For the most part, this condition’s pathogenesis is poorly understood. It appears the body’s own immune system attacks the cells that produce a portion of the tear film. This reduction of tear film results in decreased overall tear production. Many identify dry eye (KCS) as an inherited disorder. Other considerations include:
- Nutritional deficiency
- Systemic distress/inflammation/infection/“dis-ease” (e.g. canine distemper), and overall “stress”.
- Congenital disorders
- Breed predisposition, particularly in Cocker Spaniels, Shih Tzus, Bichon Frises, Lhasa Apsos, Bulldogs, Schnauzers, and Terriers
- Pharmaceutical drugs (e.g. sulphonamides — sulfa-based drugs)
- Endocrine abnormalities (e.g. low-functioning thyroid gland, hypothyroidism)
- Neurological/nervous system symptomatology (e.g. inner ear malady, “neurogenic KCS”)
- Surgical “excision” of the third eyelid gland in cherry eye cases.
INTEGRATIVE NAVIGATION PLAN UPON SCHIRMER’S TEAR TEST CONFIRMATION
“Nutrinourishment” assessment – dietary and supplementation options
Not all nutrition is nourishing. Review the patient’s daily regimen, along with any previous immune/allergic reactions such as “allergic dermatitis” (e.g. food, contact).
Novel primary proteins such as fish, lamb, duck, bison, and wild hog are suggested. Also consider whole food nutrition and supplements:
- A whole food approach is optimal, so that vitamins A, C, B-6, magnesium, and others will biochemically and synergistically collaborate toward homeostasis. Nutritional cofactors are required for all fatty acid enzymatic metabolism activity. Vitamin A nourishes healthy goblet cell/lacrimal gland mucin production for the tear film’s base layer. These nutrients are all significant in maintaining normal eye function and optimal health.
- Black currant seed oil provides the most biologically stable source of vegetable-based Omega-6 fatty acids. It supports normal eye function by aiding in tear film production (e.g. aqueous water layer).
- Omega-3 fatty acids from fish oil (e.g. krill) are needed. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are important fatty acids for tear film production (e.g. lipid top layer). EPA plays an important role in supporting a normal inflammatory response in the presence of noted symptoms (e.g. systemic inflammation commonly associated with dry eye).
- Proteins such as apo-lactoferrin (iron-binding) and lactoferrin support the entire “physical body temple”, including the overall health and well-being of the animal’s eyes.
- Curcumin naturally supports an overall healthy inflammation response when there has been disruption or malfunction of the immune system.
- Standard Process offers the best whole food daily nutritional supplement for canine, feline, and equine species. It is best to avoid fractional nutrition. Whole Body Support is a daily multiple vitamin complex (Veterinary Formulas). Oculotrophin PMG is a supplement formulated to support eye health.
2. Traditional Chinese Medicine
TCM offers multiple options for KCS, such as acupuncture or acupressure. For dry eye, initial treatments may be intense — twice per day (BID) for one week. Reassessments and follow-up may be completed via TeleVetMed for Veterinary-Client-Patient-Relationship (VCPR) and daily regimen, along with any previous immune/allergic reactions such as “allergic dermatitis” (e.g. food, contact continuation of care. The TCM assessment is considered alongside patient compliance levels with the integrative nature of the prescribed plan. Acupoint options for owners who wish to do acupressure are BL2, ST4, LIV3 — rotate both clockwise and counterclockwise for 15 to 20 seconds, and alternate the eyes
3. Home treatment applications and air purifiers
These approaches are beneficial because they’re easily accessible to the owner. A treatment may be simply applied to a pet’s eyes, while keeping the area around the eye well-groomed and free of debris minimizes the challenges faced with KCS. As well, air purifiers are absolutely necessary in many regions, such as Southern California. Cost range is wide, yet often dictates quality. The Vollara is highly recommended for households.
For a simple direct treatment, apply warm compresses to each eye for ten minutes twice per day. This may be especially necessary in very dry climates with high winds, to help with dust, allergens, and poor air quality. Establishing a client practice of checking and cleaning both eyes is also important.
Home remedies have a lot of appeal with our renewed sense of “One Wellness” — realizing that the connections between humans and animals cross-pollinate into overall health and well-being for both species. In other words, when an owner is able to access a KISS-principled (aka “Keep It Super Simple”) home remedy for themselves, they may consider similar options for their animal’s health. However, it’s crucial to proceed using great caution with owners who seek health solutions without professional veterinary consultation.
Outside of warm compresses, here are some other home remedies to consider:
- Sterile castor oil may be used as a topical at one drop per day (SID) q seven days. Reassess in one week, then again in three weeks. Monitor for long term continuation of care.
- Green tea is another option. Some practitioners have experienced great results applying it as “topical eyedrop”. The main concern with any eye product is sterility; be mindful of sterility for any option applied directly to the eye. If using a green tea extract, look for one that is alcohol-free. Begin with one drop per eye per day. Reassess in one week, then three weeks.
- Medicinal cannabis (CBD) must be considered, systemically and immunologically. Start at 0.1 mg per pound, twice per day (BID). The entourage effect offers the entire “physical body temple” relief from inflammation, and helps it back toward homeostasis. Similarly, the immune-modulating benefits of medicinal cannabis are well-established in medical literature.
- Other products to be considered, on an individual patient basis, include natural eye drops and organic tears.
The incidence of dry eye is increasing and “remains a major challenge in ophthalmology”.3 It may be an indicator of “nutrinourishment” issues, Qi energy imbalances, poor air quality, potential allergen exposure, and other etiologies. Using an integrative approach, a thorough intake and consultation exam is warranted, based on the skill set of the practitioner.
Dry eye involves management, and this is what most practitioners have come to realize. Certainly, prevention is important and “nutrinourishment” is of utmost concern. The challenge is for animal stewards to focus on label reading and provide their pets with nutrition that is actually nourishing the “physical body temple”. This is a core value for holistic and integrative care, not just for the eyes, but for overall health and well-being.