Balancing benefits and risks in veterinary ophthalmology

Sponsored by Sentrx Animal Care

Alex Sigmund, DVM, DACVO, recently spoke at the 2024 Fetch dvm360® Kansas City Conference, leading multiple ophthalmology sessions. The dvm360® editorial team sat down with Sigmund to discuss the relationship of eyedrops, systemic medications, and potential side effects in small animals.

A closer look at eye drops and systemic medications

"The talk was born from the realization that even eye medications can have side effects you might not expect," Sigmund explained. "For example, non-steroidal anti-inflammatory eye drops might seem harmless, but a recent study found that certain anti-inflammatory eye drops can cause gastrointestinal bleeding in some patients."

Speaking from his own experience, he said, "I’ve personally seen dogs experience life-threatening GI bleeds from an eye drop, which was quite shocking." This led him to advocate for a more deliberate approach: "When I’m considering adding a medication, it’s always for a specific reason backed by research, not just uncertainty."

One of the core messages Sigmund wanted to share with attendees was was the importance of intentionality in treatment plans. "Adding a treatment just for the sake of it is never a good idea," he advised. Instead, he encourages veterinarians to establish check-in points for both themselves and their clients to assess progress and ensure the treatment is still necessary. "It’s essential to ensure that you’re still on the right track and not just continuing a treatment out of habit or uncertainty," he noted.

Real cases

Sigmund’s approach is rooted in real-world experience. He recalled a memorable case involving a cat with conjunctivitis. "The cat had been on a topical antibiotic ointment for months, but the condition wasn’t improving," he said. Sigmund realized that the treatment might be the issue rather than the solution. "When I examined the cat, I didn’t see anything seriously wrong, so we stopped the ointment—and all the symptoms disappeared."

Another case that stands out is that of a Rottweiler on TMS, a common oral antibiotic. "The dog had been on TMS for about 6 months and developed absolute dry eye and hypothyroidism," Sigmund recalls. These conditions, linked to TMS’s glandular toxicity effects, underscored for him the significant impact systemic medications can have on the eyes. "This case reminded me that we need to be cautious about what we prescribe," he said

Remaining vigilant

While some side effects, like those associated with TMS, are well-known within veterinary circles, Sigmund stressed the importance of ongoing vigilance. "TMS causing dry eye in dogs is fairly well-known in my field, but it’s always good to remind people because it’s a commonly used antibiotic in small animal medicine," he pointed out.

Before starting a patient on TMS, Sigmund recommended performing a Schirmer tear test to establish a baseline. "If you see any signs of redness or discharge, stop the antibiotic, redo the Schirmer tear test, and monitor the dog’s recovery," he suggested. This level of attentiveness is crucial to avoid unnecessary complications. "It’s crucial to know what and why you’re treating a condition and to be vigilant about potential side effects," he says.

Failing to consider these factors can have consequences, Sigmund warned. "The issues that can arise are multifactorial," he explained. “Clients who don’t understand the treatment plan or its purpose may become frustrated and non-compliant, leading to delays in proper care. "In my field, this could lead to vision loss or chronic irritation," he said.

Furthermore, unnecessary medications can cause side effects that complicate the pet’s condition rather than improve it. "It’s essential to consider the why, what, and when of any treatment plan," Sigmund said.