What are Episcleritis?
The location of the nodule can vary and can include the iris, eyelid, oral mucocutaneous junction (the area between the skin and the moist lining of the oral cavity), or the nictitans, the translucent inner eyelid, sometimes called the third eyelid. In rare cases, episcleritis can cause the deadening of eye tissues, and can progress into more serious intraocular disease, such as retinal detachment. In many affected dogs, a long term treatment plan is needed.
Episcleritis is an inflammatory disease affecting the eye. Solitary nodules are seen on the eye and accompanying areas, often with inflammation around the nodule itself. Symptoms can be similar to other conditions of the eye, and can be positively confirmed through diagnostic testing.
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Symptoms of Episcleritis in Dogs
Symptoms of episcleritis include:
- Red eye
- Irritated eye
- Inflammation in eye
- Alteration in clarity of eye
- Nodules or lesions on eye, often pink to tan in color
- Nodules or lesions on the nictitans, or the translucent inner eyelid, or other areas of the eye, often pink to tan in color
Episcleritis can be differentiated into two forms:
- Diffuse - Also called simple episcleritis, it can affect one or both eyes and is most common in Golden Retrievers and Cocker Spaniels. It manifests as an elevated lesion in the limbic area, between the cornea and the white of the eye, with accompanying inflammation in both tissues.
- Nodular – Also called nodular granulomatous episclerokeratitis, nodular fasciitis, proliferative conjunctivitis, pseudotumor, fibrous histiocytoma, or collie granuloma, this condition usually affects one eye and is most common in Collie breeds. It manifests as a raised pink mass in the cornea or nictitating membrane, the translucent inner eyelid.
Causes of Episcleritis in Dogs
The direct cause of episcleritis isn’t always clear, but it is believed to be immune-mediated. Some accepted causes of this condition include:
- Ocular disease
- Auto-immune disease
- Toxoplasmosis, an infection of the Toxoplasma gondii organism
- Breed predisposition (Golden Retrievers, Cocker Spaniels, Collies, Airedales)
Diagnosis of Episcleritis in Dogs
Your veterinarian will conduct a complete eye exam, taking into considerations visual appearance of the eye, medical history, and any other symptoms present. Symptoms of episcleritis are similar to other conditions and infections, so testing is conducted to make a positive diagnosis.
A biopsy is conducted to differentiate episcleritis from any other kind of abnormal growth, usually with anesthesia. An exam of the biopsied tissue can discover any infectious agents or foreign materials, such as the Toxoplasma gondii organism. Other tests for toxoplasmosis include blood counts, serum panels, and immunohistochemical staining for antigens. Surgical debulking to remove as much of the nodule as possible may be performed in conjunction with the biopsy.
Treatment of Episcleritis in Dogs
Biopsy and Surgery
Once a biopsy has been performed, antibiotics and steroid medications are often prescribed to prevent bacterial infection and address the inflammation. A re-evaluation is conducted to assess the condition, usually in about 4 weeks. If needed, treatment will continue or change.
Severe cases may need surgery to remove the lesions with cryotherapy, or a freezing procedure, and can often induce remission. If it wasn’t done previously, surgical debulking of the lesion may be performed.
Corticosteroids are the main treatment for episcleritis. Topical and oral corticosteroids, such as prednisone, are often used in combination with immunosuppressive drugs, such as oral azathioprine, mycophenolate mofetil, or cyclosporine. Several weeks of treatments can cause a remission of symptoms. Doses are usually reduced over time.
An alternative course of treatment that has had success with some dogs includes oral tetracycline and niacinamide (Vitamin B3) taken over many weeks to months. Doses are decreased once improvement is seen.
Once episcleritis goes into remission, treatments can be tapered gradually over several months. While some cases will see the episcleritis completely resolved once treatment has ended, other dogs may need a long-term treatment plan to maintain remission. This is often done with immunosuppressive medications, such as azathioprine, mycophenolate mofetil, or cyclosporine in low doses.
Side effects from mycophenolate mofetil or cyclosporine can include vomiting, diarrhea, and anorexia. Effects seen from azathioprine can be more severe and include liver disease, bone marrow suppression, and pancreatitis. With any drug that suppresses the immune system, there is always an increased risk of developing infections and some cancers.
Treatment for toxoplasmosis includes oral antibiotics and antiprotozoal medications over several weeks.
Recovery of Episcleritis in Dogs
In many cases, recovery is quick after topical steroid treatments or surgical removal of the nodule. You may have special instructions after surgery that can include cleaning and changing bandages. You will most likely have medications to administer at home, and your dog may need future veterinary visits to test for the success of the therapy. Be sure to monitor your dog for any unwanted side effects and report those immediately to your veterinarian.
Episcleritis Questions and Advice from Veterinary Professionals
3 year old Rottweiler. DX with Episcleritits. Was on drops but didn't seem to help. Vision seems to be worse. We do have a follow-up appointment with a vet.
Could a dog go blind or have irreversible side effects if treatment is discontinued?
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I took our 11 year old puggle to see a specialist today and she said that they have found that Ivermectin has been found to irritate or make episcleritis worse (he was just diagnosed today), however I am not finding any info regarding this online. Have you heard of this before? I am having trouble finding an alternative heartworm prevention medicine that has good reviews. Thank you.
There is no known cause for episcleritis, but toxins, auto-immune disease, eye diseases are accepted but not proven causes. I haven’t read about ivermectin causing or exasperating episcleritis, but if ivermectin’s administration coincides with the symptoms a presumptive diagnosis can be made. Medications like milbemycin may have high numbers of reported side effects or adverse reactions; but you need to remember that all medicines have a side effect whether minor or adverse and using any medication is a balance between risk versus reward. If ivermectin isn’t suitable for Kahn, trying milbemycin may be more favourable in Kahn’s specific case. Regards Dr Callum Turner DVM
Episcleritis can occasionally be caused by parasites in or near the eye. When the ivermectin kills the parasites increased inflammation results.
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The white part of my dogs eye was red yesterday. Today morning, she woke up with that same part swollen and puffed out &bright pink color. It doesn't seem to be bothering her but I am worried. What might it be, and what can I do to help treat it?
There are a few possible reasons including allergies, chemical irritation, scratches or infection; I would recommend you visit your Veterinarian for an examination but until then you should rinse out the eye with lukewarm saline (we don’t know the extent of the damage) and you may give Benadryl at a dose of 1mg/lb in case it is allergies. Since the eyes appear puffed out, it would be best to see your Veterinarian to rule out a few serious causes. Regards Dr Callum Turner DVM
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My dog is vomiting and she has a big white lump in her eye and it is getting worse and worse she is a 6 year old saintbernard please help me
The eye nodule and the vomiting may not be connected unless there is the presence of an auto-immune disease. The nodule is probably a benign mass which may respond to steroid treatment or your Veterinarian may biopsy or remove it depending on Lily’s overall symptoms upon physical examination. Vomiting maybe caused by many different causes including infections, allergies, foreign bodies, parasites, tumours, poisoning among other causes; try feeding Lily a bland diet of boiled rice and chicken to see if she can keep it down. I recommend you visit your Veterinarian anyway to check the episcleritis (eye nodule) and to check Lily’s abdomen. Regards Dr Callum Turner DVM
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