Dear Dr. Fleming,
Last night when I was on the couch watching television the light from my lamp shined just right into my dog’s right eye and I saw some spots I’ve never seen before. They look like miniature crystals on his eye on the front of the eye where a contact lens would sit. Poncho is a Boston terrier who is about 6 years old. Can you tell me what this is?
I’d need to see Poncho to be more certain, but it sounds like a condition called lipid keratopathy (Lipid = Fat, Kerat=cornea, opathy=pathology of). Lipid keratopathy (LK) is an accumulation of fatty substances (usually cholesterol) in the corneal.
The condition occurs in cats, but more often in dogs.
There are three main causes of LK. First is genetic, or inherited, especially in Cavalier King Charles spaniels, Afghan hounds, Cocker spaniels, Siberian huskies, Boston terriers, Shelties, Airedales, Beagles and German Shepherds. Secondly, some primary eye diseases allow LK to establish itself in the cornea; these include dry eye, corneal ulcers, corneal or scleral (the white shell of the eye) inflammation or inflammation inside the eye (uveitis). Finally, fat or cholesterol deposition can occur when the blood level of cholesterol is too high. This condition is usually seen in dogs with low thyroid levels (hypothyroidism). Due to the various possible primary eye diseases and the possibility of hypothyroidism, it is a good idea to have your vet examine his eyes (fluorescein staining of the cornea, tear testing, glaucoma testing and intraocular exam) and check his thyroid level.
There is no specific treatment for this condition. No topical or systemic drugs exist that will remove the deposits from the cornea and the lipid usually returns even if it is removed surgically. Fortunately the condition does not affect vision very much and only occasionally does it cause itchy eyes. The inherited forms seem to reach a certain degree of deposition and then do not progress from that point. For dogs with high cholesterol, low fat diets are indicated and human cholesterol-lowering drugs are not used due to side effects. Thyroid supplementation is started in dogs with hypothyroidism and correction of the high cholesterol may prevent the condition from worsening. Control of any ocular inflammation and dry eye is critical. Shetland sheepdogs can be treated with topical antibiotics and pain meds when they have episodes of discomfort. Topical cyclosporine has also been used in these dogs to slow progression.
We have been seeing an increase in the number of cases of autoimmune immune mediated hemolytic anemia (AIHA) in the past two months. I may write an article about this later but for now you should familiarize yourself with your dog’s normal gum color. Lift the lip and study the color of his or her gums. Learn normal. One of the clinical signs in pets with AIHA is pale gums. If you don’t know what normal looks like you could miss this critical sign. You can read about AIHA at www.veterinarypartners.com. In the search bar type in AIHA then click search.