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

[MaddiesMommie]

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. My poor baby girl.

[MaddiesMommie]

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.

[Sweet Apple]

I don't have any suggestions, other than to go w/your gut feeling about what to do...On the outside looking in, I don't think it is even feasible or practical to think you could do drops every 2 or 3 hrs...I'm just posting to tell you how sorry I am that you and maddie are having to deal w/this ...I hope you come to a workable solution for you both....I will pray and ask that you are given guidance to make the best decision...

[MaddiesMommie]

Originally Posted by Sweet Apple

I don't have any suggestions, other than to go w/your gut feeling about what to do...On the outside looking in, I don't think it is even feasible or practical to think you could do drops every 2 or 3 hrs...I'm just posting to tell you how sorry I am that you and maddie are having to deal w/this ...I hope you come to a workable solution for you both....I will pray and ask that you are given guidance to make the best decision...

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.
Thanks so much for your prayers.

[rilysmom]

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

[Ladymom]

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.

[MaddiesMommie]

Originally Posted by Ladymom

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.

[Ladymom]

Originally Posted by MaddiesMommie

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.

[viviansnickers]

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

[MaddiesMommie]

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!

[juliaw04]

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.

[MaddiesMommie]

Originally Posted by juliaw04

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.

[juliaw04]

Originally Posted by MaddiesMommie

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.

[shodanusmc]

Originally Posted by MaddiesMommie

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.

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.

[MaddiesMommie]

Originally Posted by shodanusmc

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 -----.

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.
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.