Does your pug rub his/her eyes often? Does s/he lick a paw, then rub same paw against one or both eyes? Or does your pug have some brown pigment-like spots that show on the white of the eye in the inside corner(s)? If your answer is yes to any of these questions, then there's a good chance your pug has, or is developing, a condition common to pugs known as pigmentary keratitis, which can lead to blindness in a few short years.
What does pigmentary keratitis look like? In the beginning, it looks like a small black or dark brown glob of pigment that begins on the white of the eye in the inside corners. Gradually it grows, and spreads across the eye until it completely covers it, looking very similar to an all-brown contact lens placed on top of the eye. Although the pug's eye is healthy underneath it, the brown pigment blocks the vision and the pug cannot see through it -effectively rendering it blind.
There appears to be a difference of opinion on what causes this condition. Some veterinarians believe that Keratoconjunctivitis sicca (dry eye), or entropion is the precursor.
According to Dr. Brian Golden, of La Mesa, CA dry eye is a common culprit, due to lack of proper tear production. This means the eye is not getting bathed properly with the natural tear, which is antibacterial and a lubricant. Imagine how your eyes would feel with no fluids bathing them regularly. Every time you blinked, it would be painful. Once there isn't adequate tear production then we start to get all kinds of different eye diseases, and mucousy discharges (which can turn into crusts) building up in the eye, Dr. Golden says. Then secondary to that the cornea starts to dry out, starts to get irritated and we start to get this pigment infiltration, and all this black coloration, which is called pigmentary keratitis, which is getting deposited on the surface of the cornea.
Entropion can also contribute to pigmentary keratitis. Entropion is a slight rolling inward of the eyelids to the point where the little hairs and lashes, which are like little brushes, are rubbing against the cornea and irritating it. Even a pushed-in wrinkle may rub against the eye, and again is uncomfortable or painful. Causes of entropion can include birth defects, injuries, or other eye disorders, and can occur at any age, beginning when the pug's eyes open at 2 weeks of age. (Most veterinarians who are knowledgeable about eye disorders like to operate on puppies as early as 4-9 weeks of age if they exhibit entropion right away.)
Dr. Alan MacMillan, of the Animal Eye Clinic of San Diego, is a veterinary ophthalmologist. This means he specializes in eye disorders, and although he agrees the Keratoconjunctivitis sicca (also known as KCS or dry eye) and/or entropion can be contributing causes, they are not always the culprit.
Veterinarians are taught to look for a cause of the abnormal pigmentation. While entropion may be a cause of this pigmentation, it is usually not the cause ... I recently saw a dog who had no entropion, but it [the pigment] covered the entire eye. So where is it coming from? Perhaps from God, in Pugs.
So there doesn't have to be a cause? we asked.
There's a cause, but it's not always a mechanical kind of a cause. It is just from being a Pug. Dr. MacMillan says Collies and Miniature Schnauzers don't get this.
Perhaps because a pug's eyes are so prominent, they are vulnerable to the elements and irritants around them such as dust particles blown into them from air conditioners or heaters. Or just the wind. Who knows? Nevertheless, the fact is, Pugs, Bulldogs, Bostons, Chihuahuas, Pekingese, Lahsas, Shih Tzus, and other breeds with "bulged" eyes, are all vulnerable to pigmentary keratitis.
First, if there is an underlying cause such as entropion or dry eye, the cause should be treated before tackling the keratitis problem. However, if no obvious cause exists, the severeness of the pigmentary keratitis will determine the appropriate treatment.
Dr. Golden says that pigmentary keratitis is an inflammation on the cornea, So what we want to do is use an anti-inflammation product like Pred Forte drops (which range in strength from mild to very strong) If your vet doesn't carry these drops s/he can call in a prescription for them from any pharmacy since it's a "people" medicine, too. Your veterinarian will prescribe the dosage, but often it is suggested the owner put the drops in the pug's eye(s) twice a day. Hopefully, the drops will arrest the spread of this black pigment, and in some cases, even push it back a little.
In addition to the Pred Forte, pugs who do not have adequate tear production should be treated with Cyclosporine drops, which can stimulate tear production, says Dr. Golden. The nice thing about cyclosporine is you only need to give the pug one drop in the morning and one drop at night for a week or so. If the drops work and we're getting good tear production, then you can drop to once a day for a few weeks, and if all is going well, you can then go to once every other day (probably for the rest of the pug's life). Pred Forte drops are usually for life also. (Cost averages about $10 a month.)
Dr. Golden uses the following analogy: The cornea is like 16 pieces of clear Saran Wrap all stacked on top of each other, so theoretically you could peel that Saran Wrap one piece at a time--or in this case, you could peel the first layer off, which would have the black pigment tissue on it.
If surgery is ever suggested, this is when you must go to a veterinary ophthalmologist such as Dr. MacMillan, who will be the first to tell you he tries to avoid surgery if at all possible. However, once the eye clouds over completely with pigment, then surgery is usually called for if you want to restore your pug's eyesight. The corneal procedure is called a Keratectomy and runs anywhere from $400-$500 per eye, depending ont he severeness.
Dr. MacMillan has an entire scrapbook devoted to pictures of his K9 clients with various degrees of pigmentary keratitis, ulcers, cataracts, and you-name-it. He also has before and after photos once he's performed the operation. One photo shows him literally peeling a layer of tisue right off the cornea. Not a gory photograph, it basically looks like he's lifting a soft, brown contact lens off the dog's eye.
Recovery involves your pug wearing an Elizabethan collar so s/he cannot scratch the stitches that are temporarily keeping the eye closed while it heals. In a few weeks the collar comes off, the stitches are taken out, and you will have the joy of watching your pug look around the room and into your eyes, absolutely astounded that he or she can actually see once again.
How successful will the operation be? Every dog is different; some have complete recovery of eyesight, some eyes get cloudy and take months to clear up, and some eyes will have scar tissue buildup and only gain partial vision. Nevertheless, any improvement is better than complete blindness.
Some owners who cannot afford the eye operation have wondered if they should put their blind pug down. The answer, of course, is never. Pugs are very clever, and have their living quarters completely memorized whether their eyes work or not. Some of you have blind pugs and don't know it. But you'd find out in a hurry if you moved to a new house and they suddenly began bumping into things.
Having fostered many pugs with severe pigmentary keratitis, I have had them walk into me, walk into walls, not be able to navigate stairs--particularly a flight of stairs--and walk into the cats. Within days their seeming clumsiness miraculously disappears. Did they regain their sight suddenly? No. I have also had this happen with pugs who have just lost one eye due to an injury. Remember, pugs are adaptable little survivors, and as long as their quality of life is good there is no reason to put them down prematurely. If they are suffering from dry eye, however (and your vet can test them for this quite easily), it is only humane to give them lubricant eye drops such as cyclosporine to ease their discomfort.
I cannot stress the importance of going to a veterinarian who is knowledgeable about pigmentary keratitis. I have had unknowledgeable veterinarians tell me to use an over-the-counter eye lubricant such as Tears 4-5 times a day, instead of Cyclosporine 1 or 2 times a day. I know people who came home from work during the day to make sure their pug got Tears every four hours before they heard of Cyclosporine. I have had veterinarians tell me they don't believe in prescribing Pred Forte or Cyclosporine for dog eye problems because they are human drugs. I have even had a veterinarian look at a pug who was almost completely blind from pigmentary keratitis and tell me the pug's eyes were fine.
Both Dr. Golden and Dr. MacMillan laugh when they hear stories like this, but there's really nothing funny about it. If you do not have a veterinarian knowledgeable about eye problems in pugs, run to your nearest veterinary ophthalmologist. Call Dr. Mary Glaze, Secretary, American College of Veterinary Ophthalmologists, (504) 346-3333 for one near you (in the U.S.). In San Diego, Dr. MacMillan can be reached at 619-293-7055 to make an appointment.
Dr. Golden can likewise be reached at 619-464-3177 (and he's a pug owner, too).
Always take your pug to the veterinarian appropriate to your pug's problem at the first sign of a symptom. If you have doubts, get a second or even third opinion.
For veterinarians unfamiliar with the products in this article, Dr. Golden has supplied the following information:
In order to stop or reverse pigment migration (in pigmentary keratitis)
the use of Pred-Forte eye drops can be used for the life of the pug. Pred-Forte
is a 1% solution of prednisolone, sodium phosphate, and can be called in to a
local pharmacy since it is a human ophthalmic preparation (manufactured by Steris
Laboratories, Inc.).
Also for Keratoconjunctivitis sicca (dry eye), the instillation of
cyclosporine in the eyes has been very effective. Cyclosporine is called
Sandimmune and is manufactured by