Maddie Update...parotid duct transpositions anyone?????
 

We just returned from the ophthalmologist. He is suggesting we try ONE more medication, an oral for this time, Pilocarpine hydrochloride 2%. We go back in 2-3 weeks to recheck.
He was honest and stated that he was not optimistic this would work since there has been NO improvement with Cyclosporine or Tacrolimus. Today her tear production was still decreased in her left eye.

:(Here is the sad part. He said he believes Maddie was born without the lacrimal gland. Otherwise the previous medications would have stimulated it to produce glands. These medication work in 95% of the time. The other cause is a decreased neurological stimulation. That is why he wants to try the Pilocarpine. This medication is supposed to increase neurological stimulation. If this doesn't work, either Maddie will have to have drops placed in her eye at least once every 1-2 hours. or He suggested a surgery: parotid duct transposition. Basically, in case anyone is unfamiliar with it like I was, he will make a small incision on the side of her face and re-route saliva into her eye.
We could do an MRI to try find see if the gland is missing, but he said this is often costly and not always possible to see.
I am freaking out on what to do!
Anyone have any experience with this? He did discuss some possible minor complications with the surgery but stated it is usually successful.:confused: My poor baby girl.

These complications may include excess mineral deposits from her saliva on her cornea. In this case, her procedure would be reversed or the saliva would be cut off and we would be right back to where we are now. Also, she may have excess tear production when she has excess salivation, like at food. This would require her face be cleaned more often. I do not mind the extra work on myself. However, I cannot be home every 1-2 hours to keep drops in her eyes.

That's what I am thinking. I gathered the ophthamologist felt the same way. He explained to me this would need to be done to prevent further corneal damage to her eye. :confused:
Thanks so much for your prayers.:)

I'm so sorry to learn about this. Hope the medication works.

Unfortunately, as I told you before, I suspected this all along. It is a condition that is genetic in Yorkies. I don't suppose you got a health guarantee that covers congenital conditions for the first year? I know the surgery is very expensive.

Thanks heavens UT is close to you. Maddie is in excellent hands. I feel like I have adopted your little Maddie in my heart since she and Lady share KCS.

I will pray that this new medication does the trick.

Thanks so much. No health guarantee. She is 2 1/2 anyway.:( They told me to day it will be $1000-$1200.

Oh, that's not too bad. I think that surgery is three times as much at the ophthalmologist Lady goes to. UT is a wonderful facility and so reasonable.

Oh Amanda!!!!!!!!!!!! I'm so sorry hun!!!!

We just bit the bullet with Snick's surgery...was around the same price! I know how you feel, like a ton of bricks is on your chest.

Be strong Amanda...Maddie can sense everything. I pray the meds will work............xoxoxoxoxoxox

BIG HUGGIES!!!!
-Vivian

Thank you all so much for your support! You are right Viv, it does feel like that. This is her eye! I think we are leaning toward doing the surgery if this doesn't work but praying, praying, and praying it does.
Thanks!

I know this is an old thread but I was curious to see how Maddie is doing. Did you go ahead with the surgery?

My 3 year old KaCee was just diagnosed with dry eye so I'm trying to do as much research as I can.

Hi. I hope you have better luck with tear stimulators than we did.
Is KaCee currently using a tear medication?

Maddie's eye has us all confused. Like now, she only needs drops a few times a day and I clean it twice a day. However, back in the summer, I was cleaning it several times and using drops often. It is almost like the weather or seasons have some kind of affect.

I was told Tacrolimus or Cyclosporin can take up to 6 mo to work fully.

She is on Cyclosporin (Optimmune) 2x a day and Neo-Poly-Dex drops 4x a day. The vet just diagnosed her today so tomorrow will be the first full day of treatment. We go back on Thursday for a recheck.

I just found this tread. So sorry little Maddie is having this problem. I have no idea on it, outside for humans Restasis seems to be the drug of choice. A few times a day is do-able, but how can you do it every 1-2 hours? You still considering surgery? Also, how do they route saliva into the eye, that is going against gravity. I wish the best for her.

I have thought about asking about Restasis. I am just so afraid of "new" to the market drugs. One day they are running commercials all over t.v. and next, there are running the warning commercials about if you or a loved one have ever use -----.:rolleyes:

Right now, a few times a day is working for her. If she gets like she was before, I will def. have the surgery performed.

Here is a wonderful video clip to show the actual sugery. It is GRAPHIC, I get a bit squeemish when I see it.:confuse2:
Parotid Duct Transposition Surgery (Excerpts) on Vimeo

This is a surgical procedure to move the outflow from the salivary glands into the eye, called ‘Parotid Duct Transposition’. Normally the parotid salivary gland empties saliva into the mouth. If this gland is working properly, and has not been affected by the cause of the KCS, this operation can be performed by a specialist eye surgeon. However, there are a number of potential problems with this procedure:
saliva is not a perfect replacement for tears;
saliva flow is much less than tear production;
saliva salt crystals can form in the eye.

sorry about maddie, cooper also has kcs, restasis is cyclosporine, but dogs need a higher dosage than humans, but most dogs that have a lacrimal gland problem do better with tacrolimus than cyclosporine. I am glad that cooper responded well with the tacrolimus, when cooper was first diagnosed with kcs and sjogrens i asked about pilocarpine, my eye dr said its not the best idea, and that he doesnt use it because of the fine line between helpling and death. He said we would go that way as a total last resort, but he also said that if he did the surgery it may not work well at all because most dogs with kcs bilaterally have sjogrens syndrome, and to take the saliva from his mouth to his eyes would make it hard for him to swallow and that he would really have horrible teeth. Im sorry sorry maddie isnt better with the tacrolimus, there is a new t cell inhibitor on teh market did you try that yet? I dont know the name of it but i can call my eye vet and ask him if you like.

Don't waste time and money on Restasis as it is just the brand name for cyclosporin, which you've already tried.

I spoke extensively to my ophthalmologist about partoid duct surgery even though Lady isn't a candidate for it due to her age. While there are potential complications, it really is the only alternative for a young dog like Maddie who doesn't produce tears because she has no lacrimal glands IMO. She will eventually lose her eyesight from scar tissue. Dogs adapt very well to vision loss, but KCS is so uncomfortable.

Can you get a second opinion? You might feel more comfortable about it if you did.

just seeing this thread. prayers to you and the family and maddie .hope you figure this one all out and things get better for her.

I certainly don't want her to loose her sight. What is so confusing is it is almost like it comes and goes. I know that makes no sense, but right now, drops keep her eye looking great. However, a few months ago it was much more work keeping hers eye clear.:confused: I read and read and read more about it.

Watching the procedure being done literally made me feel sick. I have an extremely hard time immagining putting her through that. The surgeon at UT told us that there was a chance that he would perform the surgery and it would not work or have to be reversed becuuse sending saliva to the eye can cause a new set of problems. I feel like a horrible mom becuase I don't know what is right for her.

Lady's ophthalmologist told me the same thing, that some dogs can be allergic to their saliva.

It's definitely not a simple procedure. I spoke to Dr. English about it four years ago, though. I'm sure it has improved since then.

Can you get a second opinion from an ophthalmologist in private practice? That way you can weigh the pros and cons. Not getting the surgery done doesn't mean Maddie will never need eye surgery. Ulcers are so common with KCS and they can require surgery. Lady came very close to needing surgery to remove an infection that had actually penetrated the surface of her eye a few years ago. Thank heavens we caught it early enough and $1,000 later it did clear up with topical antibiotics. Lady has also had uveitis twice which is terribly painful.

Wow. I had no idea you were dealing with all this. The surgery sounds tough. Sounds like this are going well, at this moment, with the drops. Hopefully, they will continue to.

Won't Maddie need the saliva for her mouth? Or perhaps the surgery just diverts some of it to the eye.

Yes, they do only divert some, but we have not tested her saliva prodution. A lack of saliva can also cause health problems.:confused:

The Dr. at UT was more concerned with her not producing enough saliva. In successful cases, dogs usually have to have feedings,snacks every few hours to continue the saliva production. However, it is common with dogs having KCS, to have lower saliva production. Both he and her vet mentioned several times that salt crystals form in the eye from the saliva. This irritates the cornea and can be so significant that it warrants a further operation to close it off.

I may seek a second opinion, however, I really trust her vet and felt like th UT specialist knew what he was talking about, not looking at her as a potential costly surgery. You know?