Corneal sequestrum in a dog with chronic unilateral keratoconjunctivitis sicca

Alexis J. Dubin Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA 01536.

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Stefano Pizzirani Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA 01536.

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Gillian L. Beamer Department of Infectious Disease and Global Health, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA 01536.

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Abstract

Case Description—A 14-year-old 8.2-kg (18.04-lb) castrated male Cairn Terrier with chronic keratoconjunctivitis sicca in the left eye was evaluated because of severe blepharospasm and a black plaque of 3 weeks’ duration.

Clinical Findings—Abnormalities of the left eye included a decreased Schirmer tear test value and the presence of a brownish-black plaque in the center of the cornea. The plaque was surrounded by fibrovascular tissue except at the medial aspect where there was mild malacia of the adjacent corneal stroma.

Treatment and Outcome—The plaque was removed by superficial keratectomy, and a conjunctival graft was performed. Histologic evaluation of the plaque and surrounding cornea revealed ulceration, stromal necrosis, and chronic suppurative keratitis with fibrosis and neovascularization. Evaluation of plaque sections that were stained with Gram and Von-Kossa stains yielded negative results for bacteria and mineralization, respectively; examination of sections stained with periodic acid–Schiff stain revealed multiple intracytoplasmic inclusions in macrophages. Virus isolation and a PCR assay for canine herpesvirus yielded negative results. Transmission electron microscopy revealed collagen disruption with interspersed macrophages and apoptotic keratocytes; no viral particles or evidence of other infectious agents was observed. The graft healed without complication and was trimmed 2 weeks after surgery. Four months after surgery, the Schirmer tear test value remained decreased from reference limits despite topical tacrolimus treatment, and pigmentary keratopathy was present surrounding the graft.

Clinical Relevance—Corneal sequestra are rare in species other than cats. In this dog, it was possible that chronic keratoconjunctivitis sicca might have contributed to the development of the corneal sequestrum.

Abstract

Case Description—A 14-year-old 8.2-kg (18.04-lb) castrated male Cairn Terrier with chronic keratoconjunctivitis sicca in the left eye was evaluated because of severe blepharospasm and a black plaque of 3 weeks’ duration.

Clinical Findings—Abnormalities of the left eye included a decreased Schirmer tear test value and the presence of a brownish-black plaque in the center of the cornea. The plaque was surrounded by fibrovascular tissue except at the medial aspect where there was mild malacia of the adjacent corneal stroma.

Treatment and Outcome—The plaque was removed by superficial keratectomy, and a conjunctival graft was performed. Histologic evaluation of the plaque and surrounding cornea revealed ulceration, stromal necrosis, and chronic suppurative keratitis with fibrosis and neovascularization. Evaluation of plaque sections that were stained with Gram and Von-Kossa stains yielded negative results for bacteria and mineralization, respectively; examination of sections stained with periodic acid–Schiff stain revealed multiple intracytoplasmic inclusions in macrophages. Virus isolation and a PCR assay for canine herpesvirus yielded negative results. Transmission electron microscopy revealed collagen disruption with interspersed macrophages and apoptotic keratocytes; no viral particles or evidence of other infectious agents was observed. The graft healed without complication and was trimmed 2 weeks after surgery. Four months after surgery, the Schirmer tear test value remained decreased from reference limits despite topical tacrolimus treatment, and pigmentary keratopathy was present surrounding the graft.

Clinical Relevance—Corneal sequestra are rare in species other than cats. In this dog, it was possible that chronic keratoconjunctivitis sicca might have contributed to the development of the corneal sequestrum.

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