The four dogs described below underwent a complete ophthalmic examination, which included a Schirmer tear test (Dina strip Schirmer-Plus, GECIS sarl, France), basic neurophthalmic assessment, slit-lamp biomicroscopy (SL-17, Kowa Company, Japan), rebound tonometry (Tonovet®, Icare, Finland), and fundus ophthalmoscopy (Omega 180, Heine, Germany). Fluorescein staining was also performed.
Case 1
A 1-year old, female, mixed-breed dog was referred with unilateral, mucopurulent discharge from the left eye of 14 days’ duration. The ocular problem was acute in onset and developed after a walk in a meadow. The referring veterinarian had prescribed 0.3% tobramycin eye drops some days previously, but no ocular improvement had been apparent during this therapy. At ophthalmic examination, the dog showed an abundant mucopurulent to haemorrhagic discharge and a moderate conjunctival hyperemia in the left eye. No other ocular abnormalities were observed in this eye. The right eye did not show any abnormalities. The presumptive diagnosis was unilateral dacryocystitis due to a foreign body.
Case 2
An 8-year-old, male, English setter was referred for bilateral conjunctivitis treatment. The ocular problem had been present for at least 12 months, and had started at the end of the hunting period. Unspecified topical antibacterial therapy had previously been performed. The owner had seen no improvement during this therapy. An abundant mucopurulent discharge associated with a severe conjunctival inflammation and a mild ocular mucous discharge with conjunctival hyperemia were observed in the left and right eyes, respectively. Nucleosclerosis was present in both eyes and ophthalmoscopic signs of a previous focal chorioretinitis were detected in the left eye. A presumptive diagnosis of bilateral dacryocystitis of unknown origin was made.
Case 3
A 11-year-old, neutered male, Shih-tzu was presented with bilateral severe chronic ocular problems. The left eye showed buphthalmos, intraocular pressure elevation (35 mmHg), and chronic exposure keratitis with neovascularization and pigmentation. The problem started around 4 years prior to the ophthalmic examination, and no drug protocol had been previously performed in this eye. In the right eye, a moderate mucopurulent discharge, conjunctival hyperemia and superficial keratitis were present. Two fistulas were also detected, one in the margin of the right lower eyelid close to the medial cantus, the second on the skin at the level of the frontal region, between the two eyes. The problem of the right eye started with an ocular discharge 18 months prior to the ophthalmic examination, and the palpebral and skin fistulas had been observed for 6 and 4 months, respectively. The owner was unaware about the possible cause, and no drug protocol had been previously performed also in this eye.
Chronic glaucoma of the left eye, and suspicious complicated dacryocystitis of the right eye were diagnosed. On the basis of Schirmer tear test (STT)-1 readings, a diagnosis of moderate keratoconjunctivitis sicca was also formulated in the right eye.
Case 4
A 4-year-old, female, Labrador retriever had an abundant mucopurulent and hemorrhagic discharge from the left eye of 7 months’ duration. The ocular problem was acute in onset and developed after a walk in the park. A conjunctival hyperemia and mild chemosis were also present. No other ocular abnormalities were observed in this eye. In the right eye ocular abnormalities were not found. The presumptive diagnosis was unilateral dacryocystitis of unknown origin.
A preliminary ultrasound of the palpebral medial cantus was performed in the eyes with the presumptive diagnosis of dacryocystitis to examine the superficial portion of the nasolacrimal system, before its entrance into the lacrimal bone. No attempts to flush the nasolacrimal system were performed before the ultrasonographic evaluation. An ultrasonographic device (Aplio 400, Toshiba, Japan) with multifrequency linear probe (Mhz 8–14) was used. The dogs were only manually restrained, and placed in sternal recumbence. The eye was maintained closed, and ultrasound gel was placed between skin and transducer surface. The area was examined by B-mode scanning in the sagittal and cross-sectional planes. In four out of the five examined eyes, a foreign body in the lacrimal sac was identified by ultrasound. In fact, in the case where the dacryocystitis was bilateral (case 2), the foreign body was identified only in the left lacrimal sac. The foreign bodies always appeared as linear spear-shaped hyperechoic structures with dimensions variable from 0.6 cm to 1.8 cm. In all cases a hypoechoic halo attributable to inflammatory fluid was present. In case 1 an edge shadowing originating in the surface of the hypo/anechoic tissue around the foreign body was identified (see Additional file 1). In case three a draining tract between the lacrimal sac and the frontal region was also observed.
After identification of the foreign bodies, the dogs were anesthetized and, under ultrasonographic guidance, a Hartmann alligator forceps was inserted through the upper puncta, and directed toward the foreign body. The forceps was opened and the foreign bodies grasped and pulled out (see Additional file 2). At the end of each procedure, a normograde lavage of the nasolacrimal system with 0.9% saline solution was performed. Topical tobramycin (Stilbiotic 0.3% eye drops, Ceva, Italy) q6h for 7 days, amoxycillin /clavulanic acid (Synulox, Zoetis Italia S.r.l., Italy) 12.5 mg/kg q12h PO for 7 days, and carprofen (Rimadyl, Pfizer Italia S.r.l., Italy) 2 mg/kg q24h PO for 7 days were prescribed. At the 21-day follow-up, ocular signs of dacryocystitis had disappeared in cases 1, 3, and 4. No information was available for case 2 because the dog was lost to follow-up.
The cases of the English setter (case 2) and the Shih-tzu (case 3) are reported in Figs. 1 and 2, respectively.
