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Corneal Opacities and Pannus in a Dog

Corneal Opacities and Pannus in a Dog

-by Yumiko Bannai, DVM, CVA, CVCH, CVTP Rieko Tran, DVM, CVA, CVCH Naomi Aoki, DVM, CVA, Yokohama, Japan

Author: Chi Institute/Thursday, February 13, 2014/Categories: TCVM Newsletter, 2013 Winter Issue

Yume, a four-year old female spayed Cavalier King Charles Spaniel, had presented with red eye and corneal opacity for a month. She was initially brought to her regular veterinarian in spring of 2012 for right eyelid swelling, red eye, and corneal opacity, and was diagnosed with keratitis with pannus formation in the right eye. Her veterinarian prescribed eye drops antibiotics, hyaluronic acid, and cyclosporine), but she became worse. Two weeks later, she saw another veterinarian and received fluorometholone. She had a history of cherry eye surgery on the right at six-months old. A few months ago, she had a dental extraction under anesthesia. One year ago, the owner adopted a new dog, and Yume had been under more stress ever since.

 

Traditional Chinese Medicine (TCM) Examination

Yume was a Fire constitution. She was friendly to everyone including other dogs, hyperactive and her body always feels tense. She ate homemade dog food (a grain-free, raw chicken and raw vegetable diet). She was thin despite having a good appetite. Her pulse was wiry and forceful.

 

TCM Diagnosis

Yume was diagnosed with Liver (LIV) Excess Heat with LIV Qi Stagnation. The eyes are the opening orifice of the LIV. The LIV Meridian connects exteriorly with the eyes forming a link between them. Excessive Heat of the LIV may cause redness, swelling, and pain of the eyes. Her red and swollen eye, corneal opacity and forceful pulse indicated LIV Fire. LIV Fire generated internal Fire which flared up and resulted in eye disorders. Her LIV Qi Stagnation was caused by stress from the dental extraction and the new house-mate. Pannus (blood vessel) is associated with the Fire element. Since Wood (mother) was in Excess, Fire (child) also became Excessive. Excess Fire appeared as blood vessels (i.e. pannus) in the eye. She also had Spleen (SP) Qi Deficiency since she was thin despite having a good appetite. This can be explained by the Ke Cycle relationship between the LIV (grandparent) and the SP (grandchild). The LIV has an important role in digestion. It controls the flow of Qi to maintain its smooth ascending in the SP and descending in the Stomach. Stagnation of the LIV Qi will cause disorder of the Qi flow, obstruction of food transport and transformation, and results in SP Qi Deficiency pattern. SP Qi Deficiency might also be due to her diet as some dogs cannot digest raw food diet well.

First Visit on May 4, 2012

Yume had red eye and swollen eyelid. Apparent pannus had formed in the eye. Only acupuncture was used at this visit since she was slightly agitated. Points included BL-18, BL-19, LIV-3, GV-14, GB-37, BL-23, Bai Hui, An Shen, GV-20 and Circle the Dragon (BL-1, BL-2, GB-1, TH-23, ST-1) around the right eye. She was prescribed with Liver Happy and Wei Qi Booster, each 0.5g PO q 12 hours. She was also treated with hyaluronic acid eye drop. Other ophthalmic medications were discontinued after TCVM treatment had started.


Second Visit on May 4, 2012                                          Yume had improved and was doing well overall. However, the eye was still inflamed. The owner reported that her eye appeared moister and brighter after the last acupuncture treatment. Her pulse was wiry. Dry needles were placed in BL-18, BL-19, GV-14, LI-4, LI-11, GB-37, Long Hui, GV-20 and Circle the Dragon. Since Yume tolerated the treatment, aquapuncture with vitamin B12/saline was injected into GV-14, BL-18, BL-19, BL-23, GV-20, BL-1, BL-2, GB-1, TH-23 and ST-1. Continued with the same herbal medicine.


Third Visit on May 17, 2012

Inflammation in the eye disappeared. Corneal opacity resolved. Her pulse was wiry and the tongue was red. Acupuncture was given at the same acupoints as the second visit, with the addition of Long Hui. Aquapuncture was given at BL-1, BL-2, GB-1, TH-23 and ST-1. The same herbal prescription was continued.


Fourth Visit on June 1, 2012

The owner reported that Yume had developed turbidity of the cornea and acute conjunctivitis after playing outside for a long time two weeks ago. Her pulse was wiry and ears were hot. Acupoints were the same as the third treatment, with LIV-3, BL-23, Bai Hui and GB-20 (for dissipating Wind) added. Aquapuncture was given at BL-1, BL-2, GB-1, TH-23, ST-1, BL-18 and GB-20. Liver Happy was switched to Long Dan Xie Gan, which emphasizes nourishing Blood and Yin and is stronger in clearing the Heat of the LIV. Owner was advised to avoid having Yume play in the summer heat for long hours as it may cause Excess Heat to the body and worsen the eye problem.


Fifth Visit on July 5, 2012

The eye was not inflamed, and the patient made a quick recovery after the last treatment. Pannus in the eye was no longer evident. The owner reported that after starting TCVM treatment, she became much more active, more joyful, and even a little noisy. Dry needles were placed at the same acupoints as the fourth treatment with the addition of An Shen. Aquapuncture was given at BL-2, GB-1, TH-23 and ST-1. No herbal medicine was prescribed.



Case Progress and Summary

After the fifth visit, all issues in Yume’s eye had resolved and she never needed to come back for another treatment. Even during the hot summer season, she remained in good health without any eye problems. The owner also reported that she had become more expressive and social. Pannus is also called chronic superficial keratitis (CSK). It is characterized by neovascularization and invasion of inflammatory granulation tissue of the cornea, causing progressive vision impairment. In general, the lesions are found bilaterally, but they can be unilateral in the early stage of the disease. Its etiology is unclear. Possible causes included autoimmune conditions, exposure to ultraviolet light or breed predisposition. Many cases can be controlled with corticosteroid or other immunosuppressive drugs. Complete cure is difficult, and most cases require long term medical management.


The key success to the eye problem of the patient is the use of aquapuncture around the eyes. Aquapuncture clears Heat in the inflamed eye and is used to extend the effect of acupuncture. In this case, the eye improved after being treated by aquapuncture and hyaluronic acid eye drops.

 

The main strategy of the whole body treatment is to treat LIV excess Heat pattern. I used herbal medicines that target LIV and chose Wood element points for the the eyes. In addition, blood vessels (pannus) are related to Fire. Fire and Wood have a mother and child relationship (Sheng cycle). Therefore, treatment to clear LIV Heat leads to diminished blood vessels of the eye.

 

Generally, Wei Qi Booster is not considered the first choice for ophthalmic cases. However, in my experience, I’ve found Wei Qi Booster an effective cataract treatment for my geriatric patients. It increases tear production and moistens eyes. In addition, it boosts Qi. I believe that Yume's dental surgery caused Qi Deficiency. In addition, it is suspected that pannus is an immune-mediated disorder although the exact etiology remains unclear. I, therefore, used Wei Qi Booster. As for

 

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