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Home , Uveitis

EPIPHORA IN DOGS

Christina Korb, DVM DJ Haeussler Jr, DVM, MS, DACVO The Animal Institute Cincinnati, Ohio

EPIPHORA (IE, OVERFLOW OF TEARS) OBSERVED

Perform STT*

STT >25 mm/min STT 15-25 mm/min

Blepharospasm present? malformation or deformity observed?

YES NO YES NO

DIAGNOSIS DIAGNOSIS DIAGNOSIS h Confirm presence and patency of lacrimal puncta Overproduction of Overproduction of Inappropriate drainage; h Examine for foreign bodies aqueous tears aqueous tears tears draining onto face h For dogs in which diagnostic investigation cannot be pursued from ocular from iatrogenic in-clinic, cleaning the drainage with warm water and a tissue surface due to administration of is acceptable. irritation or pain lacrimostimulants (ie, stimulated (eg, cyclosporine, lacrimation) ) DIFFERENTIALS h Medial canthal or ventromedial • Obstruction of puncta Nonpatent or absent Patent and visible secondary to lacrimal puncta lacrimal puncta DIFFERENTIALS TREATMENT conformation h Distichiasis Discontinue or (brachycephalic dogs) h Ectopic cilia reduce h Medial canthal h Allergic frequency of h Facial nerve paralysis h medication h Perform Jones test or h DIAGNOSIS Eyelid masses Blockage of lacrimal puncta fluorescein dye h passage test to h confirm duct patency h Anterior uveitis h Conduct nasolacrimal h Acute TREATMENT Surgical correction (eg, duct irrigation h Anterior luxation h  modified Hotz-Celsus, Perform MRI, CT, or h DIFFERENTIALS skull radiography with h Medial canthal medial canthoplasty) of h Punctal atresia (ie, congenital eyelid defect; lubrication if dacryocystorhinogra- trichiasis absence of puncta) phy to localize lesion facial nerve paralysis is h Micropuncta diagnosed h Imperforate puncta h Fibrosis from chronic or traumatic laceration resulting in TREATMENT stenosis or occlusion Treat primary disorder h Neoplasia of surrounding tissue resulting in invasion or occlusion h Cyst h Symblepharon

*Normal STT values: ≥15 mm/min TREATMENT Perform surgical correction, if possible

26 cliniciansbrief.com April 2020 DIAGNOSTIC TREE h h PEER REVIEWED

DIAGNOSIS Obstruction of nasolacrimal apparatus (eg, nasolacrimal canaliculi, nasolacrimal duct, nasal punctum)

DIFFERENTIALS DIFFERENTIALS Congenital Acquired h Ectopic nasolacrimal h Severe rhinitis or sinusitis swelling resulting openings in occlusion Suggested Reading h Nasolacrimal atresia (ie, h Trauma or fracture of maxillary or lacrimal Gelatt KN. Canine nasolacrimal duct and absence of all or portion of bone lacrimal secretory systems: diseases nasolacrimal apparatus) h Fibrosis from chronic inflammation or and surgery. In: Gelatt KN. Essentials of traumatic laceration resulting in stenosis or Veterinary Ophthalmology. 3rd ed. Ames, occlusion IA: Wiley-Blackwell; 2014:186-199. h Severe periodontal disease and tooth root Giuliano EA. Diseases and surgery of the abscesses canine lacrimal secretory system. h  TREATMENT Foreign body (eg, fox tails, grass awns) In: Gelatt KN, Gilger BC, Kern TJ, eds. h Remove cause, if possible obstruction Veterinary Ophthalmology. 5th ed. Ames, h  h Irrigate to attempt to (ie, swelling of nasolacrimal IA: Wiley-Blackwell; 2013:912-944. apparatus) resulting in occlusion re-establish patency Grahn BH, Sandemeyer LS. Diseases and h Aneurysmal dilation of duct h Lavage with appropriate surgery of the canine nasolacrimal h Neoplasia of apparatus or surrounding antibiotics and system. In: Gelatt KN, Gilger BC, Kern TJ, tissues resulting in invasion or occlusion h Perform nasolacrimal duct eds. Veterinary Ophthalmology. 5th ed. stenting Ames, IA: Wiley-Blackwell; 2013:894-911. h Perform surgery (eg, Lim CC. The third eyelid, nasolacrimal dacryocystorhinostomy, system, and precorneal tear film. In: dacryocystobuccostomy, Lim CC. Small Animal Ophthalmic Atlas dacryocystomaxillosinusotomy) and Guide. Ames, IA: Wiley-Blackwell; to reposition puncta or 2015:83-90. reconstruct apparatus

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