Feline Eosinophilic Keratoconjunctivitis: Nonsteroidal vs Corticosteroid Topical Treatment

Authors

  • Gabrielly Costa Gomes Rodrigues Faculdade de Medicina Veterinária e Zootecnia (FAMEZ), Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil. https://orcid.org/0000-0001-6575-1815
  • Ana Maria Tatoni Pereira Coelho Faculdade de Medicina Veterinária e Zootecnia (FAMEZ), Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil.
  • João Pedro Brochado Souza Faculdade de Medicina Veterinária e Zootecnia (FAMEZ), Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil. http://orcid.org/0000-0002-8816-5859
  • Joyce Maira Araújo Faculdade de Medicina Veterinária e Zootecnia (FAMEZ), Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil. http://orcid.org/0000-0001-8064-1905
  • Márcio Virgílio Figueiredo Silva Faculdade de Medicina Veterinária e Zootecnia (FAMEZ), Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil. http://orcid.org/0000-0002-2089-4991
  • Polyana Mayume Pereira Silva Faculdade de Medicina Veterinária e Zootecnia (FAMEZ), Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil. https://orcid.org/0000-0001-5884-5143
  • Gabriel Utida Eguchi Faculdade de Medicina Veterinária e Zootecnia (FAMEZ), Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil. http://orcid.org/0000-0002-1214-6977

DOI:

https://doi.org/10.22456/1679-9216.107032

Abstract

Background: Feline eosinophilic keratoconjunctivitis is a proliferative eye lesion of chronic aspect with usually unilateral presentation that may initiate as a superficial vascularization that evolves to a proliferative, granular, irregular lesion of whitish-pink aspect. With its association with an immune-mediated response, nonsteroidal anti-inflammatories do not appear to be efficient, although few studies describe its use. This case report describes a case of a feline eosinophilic keratoconjunctivitis with its clinical evolution since the use of nonsteroidal topical anti-inflammatory drug in an undiagnosed patient and the transition to a topical corticosteroid and cure after 14 days since diagnosis.

Case: An 8-year-old female cat was attended at the Veterinary Hospital of the Dom Bosco Catholic University (UCDB), with main complaint being an eye injury with at least 36 days of evolution andunresponsive to treatment (topical tobramycin 0.3% every 12 h / ketorolac trometamol 0.5%/ every 12 h and ophthalmic lubricant/every 4 h). Since the patient had free access to the street, the owners suspected of trauma-induced lesion. At physical examination, it was observed a proliferative lesion at the peri-limbal superotemporal quadrant of the right cornea with approximately 0.4 cm diameter, with color varying of pale to pink, with irregular surface and low vascularity, the adjacent conjunctiva was also affected with similar multiple nodular lesions (0.1 cm). Fluorescein test was negative as well as FIV/FeLV immunochromatography testing. Feline herpesvirus investigation was not possible. The patient was anesthetized and a lesion specimen was acquired with a cotton swab scraping and a fine needle aspiration. Cytology showed predominance of eosinophils and mast cells, with rare corneal epithelial cells, with smear background containing mast cell granules and free eosinophils. Presumptive diagnosis was eosinophilic keratoconjunctivits. After 14 days of topical corticosteroid (prednisolone acetate 1% every 8 h) the patient showed complete remission of the lesions with no relapse in 48 days.

Discussion: Misdiagnosis and consequently mistreatment seems a greater prejudice than the risks associated with sample collection of keratoconjunctival proliferative lesions. Due to the lack of cytobrush or cotton swab, apparently, the reported patient was not submitted to ophthalmic cytology due to reluctance of the staff regarding fine needle aspiration of the cornea lesion. Despite a greater risk of iatrogenic trauma with needle aspiration, with eye anatomy well defined, level size and movement amplitude respected, it is unlikely that severe complications could occur. In this case, the undiagnosed patient was submitted to unnecessary 15 days of topical antibiotic and nonsteroidal anti-inflammatory, and no improvement of the clinical signs was observed. Despite non-recommended, few clinical trials as well as case descriptions are available comparing nonsteroidal and corticosteroid treatment of the disease. Once with diagnosis and beginning of topical prednisolone acetate 1% exclusively, the patient showed continuous improvement until complete remission of clinical signs after 14 days. This report reinforces the recommendation of corticosteroid therapy for feline eosinophilic keratoconjunctivitis and the absence of efficacy of nonsteroidal drugs. It also highlights the importance of diagnosis before any medical treatment is considered.


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References

Ahn J., Jeong M., Kim S., Park Y., Kim T., Ahn J., Lee S., Lee C. & Seo K. 2010. A Case of Feline Proliferative Eosinophilic Keratitis Treated by Topical Cyclosporine and Corticosteroids. Journal of Veterinary Clinics. 27(6): 751-754.

Cortes M., D’Angelo G., Bonini S., Scipioni M., Lamagna A., Sgrulletta R. & Bonini S. 2002. Preservative Free Diclofenac Sodium 0.1% for Vernal Keratoconjunctivitis. Investigative Ophthamology & Visual Science. 43(13): 2229.

Day M.J. 2008. Immunomodulatory therapy. In: Maddison J.E., Page S.W. & Church D.B. (Eds). Small Animal Clinical Pharmacology. London: Saunders, pp.270-286.

Dean E. & Meunier V. 2013. Feline eosinophilic keratoconjunctivitis: a retrospective study of 45 cases (56 eyes). Journal of Feline Medicine and Surgery. 15(8): 661-666.

González-Medina S. 2018. Equine eosinophilic keratitis: An emergent ocular condition? Equine Veterinary Education. 31(11): 609-616.

Henriksen M.L. & Lim C.C. 2020. Collection of Ophtalmic Cytology Specimens. In: Sharkey L.C., Radin M.J. & Seelig D. (Eds). Veterinary Cytology. Hoboken: John Wiley & Sons, pp.184-187.

Peleteiro M.C., Marcos R., Santos M., Correia J., Pissarra H. & Carvalho T. 2011. Atlas de Citologia Veterinária. Lisboa: Lidel, 308p.

Pereira F.Q., Faganello C.S., Bercht B.S., Lacerda L.A. & Pigatto J.A.T. 2009. Feline eosinophilic keratitis. Acta Scientiae Veterinariae. 37(4): 393-396.

Sharma A., Gupta R., Ram J. & Gupta A. 1997. Topical ketorolac 0.5% solution for the treatment of vernal keratoconjunctivitis. Indian Journal of Ophthalmology. 45(3): 177-180.

Spiess A.K., Sapienza J.S. & Mayordomo A. 2009. Treatment of proliferative feline eosinophilic keratitis with topical 1.5% cyclosporine: 35 cases. Veterinary Ophthalmology. 12(2): 132-137.

Stiles J. & Coster M. 2016. Use of an ophthalmic formulation of megestrol acetate for the treatment of eosinophilic keratitis in cats. Veterinary Ophthalmology. 19(Suppl 1): 86-90.

Venancio S.A.S., Vieira A.B., Alencar N.X. & Soares A.M.B. 2012. Avaliação da técnica de esfoliação com escova citológica para coleta de células conjuntivais em gatos sadios: comparação entre a face palpebral da membrana nictitante e a conjuntiva palpebral. Pesquisa Veterinária Brasileira. 32(11): 1199-1204.

Published

2021-01-01

How to Cite

Rodrigues, G. C. G., Coelho, A. M. T. P., Souza, J. P. B., Araújo, J. M., Silva, M. V. F., Silva, P. M. P., & Eguchi, G. U. (2021). Feline Eosinophilic Keratoconjunctivitis: Nonsteroidal vs Corticosteroid Topical Treatment. Acta Scientiae Veterinariae, 49. https://doi.org/10.22456/1679-9216.107032

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