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Help for tear stains for my dog

[From Tufts June 2012 Issue]

My 4-year-old shih tzu, Piccolo, gets tear stains frequently. When he develops conjunctivitis a few times a year because of his unspecified allergies, the stains drip onto the hair underneath his eyelid. His black hair then becomes matted and turns an unsightly pink. He scratches the stained areas while I’m not around to catch him in the act until he reaches the skin, which becomes tender. I can live with his appearance but not the itchy eyes and irritated skin.

The Internet has all kinds of “remedies” from vinegar to Tums. I’ve also read that a popular over-the-counter product is verboten because it contains the antibiotic Tylosin. I don’t want to practice medicine on my little guy. Piccolo’s veterinarian said to clean the stains with hydrogen peroxide, which works well, except while it’s being applied, Piccolo squirms and sometimes the cotton pad with the peroxide heads right for his eyes. Suggestions, please?
R. Calvano Smith
San Diego, Calif.

Tear staining is a common sign in certain breeds and shih tzus are among the breeds mostly commonly affected. The condition is also well recognized in white poodles. The brown-reddish color, usually more evident in white- or light- colored furs, is due to the iron content in tear proteins that gets “rusty” when exposed to air. That is why some medications (including a few antibiotics) that bind iron in the blood may prevent its exposure to oxygen and avoid the staining.

By itself, tear overflow should not represent a clinical concern. It is just a cosmetic issue. The solution would be to investigate if and why there is a tear overflow over the face at the side of the nose. There are a few possible causes. Considering Piccolo’s age and breed, I would dare to make few guesses. I would suggest investigating the presence of nasal trichiasis and/or distichiasis. The former is a condition very common in brachycephalic dogs — those with a short nose and shallow orbit of the eyes. It is caused by the presence of hairs in the medial canthus (nasal skin and nasal portion of the eyelids) that directly rub on the surface of the eye. It is easily corrected with a surgical procedure called medial canthoplasty.

Distichiasis refers to the presence of extra lashes positioned just on the eyelid edge. They can irritate the surface of the eye with every blink. The ideal correction is to remove the hair follicle with a cryoprobe (medical freezing device). Both the aforementioned abnormalities are very common in shih tzus and can cause corneal and conjunctival irritation (hairs that rub the surface of the eye) and could explain why Piccolo rubs his eyes.

Something else to consider is a lack or stenosis (stricture) of the lacrimal puncta, two small orifices located on the inside of each eyelid, near the nasal angle. These orifices drain tears into the nasal duct, and if they are lacking or small, can cause tear overflowing on the face. The correction is again a simple and effective surgical procedure.

To remove the discharge, I would simply use over-the-counter Eye Wash Solution because hydrogen peroxide can be irritating if it gets into the eye and may also contribute to the reddening of the hair. However, the best advice is to have Piccolo evaluated by a veterinary ophthalmologist for a proper diagnosis. Local ophthalmologists can be found at www.acvo.org.

Stefano Pizzirani, DVM, DACVO
Cummings School

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