Variation in the Reported Management of Canine Prolapsed Nictitans Gland and Feline Herpetic Keratitis

Abstract

Treatment variation in medicine may be driven by evidence gaps, clinician factors, and patient preferences. Although well-documented in human medicine, variation in clinical management is relatively unexplored in veterinary practice. Clinical vignette questionnaires were administered to a cross section of general practitioners (GPs) and veterinarians with postgraduate training in ophthalmology (PGs) to survey recommended management of canine prolapsed nictitans gland (“cherry eye”, PNG) and feline herpesvirus (FHV-1) keratitis. The majority of veterinarians (96.2%) suggested surgical replacement of cherry eye, with a pocketing technique being the most frequently nominated procedure. GPs were more likely to suggest gland excision in the event of surgical failure, while PGs more frequently nominated techniques incorporating a periosteal anchor for salvage repair. Most respondents managed FHV-1 keratitis with topical antibiotics (76.4%), with a minority suggesting topical antivirals (32.2%). GPs favoured topical acyclovir whilst PGs more frequently recommended topical trifluorothymidine. A significantly larger proportion of PGs nominated systemic famciclovir and lysine supplement for FHV-1 keratitis. This survey revealed moderate treatment variation for these conditions, both between and within practitioner groups. Additional research is needed to assess the reasons for this variation, particularly for conditions in which high quality evidence is scant.

‘Ideal’ versus ‘real-world’: Application of vignettes to investigate antibiotic prescribing decisions by farm vets.

“…Moore 2003, Collins and others 2009, Espetvedt and others 2013, Mateus and others 2014, although a number of recent studies suggest this may be changing (e.g. Magalhães-Sant'Ana and others 2016, White et al 2018, Goins and others 2019, Shalvey and others 2019. Within the context of AMR, however, only a handful of published studies in veterinary medicine have made use of vignettes (e.g.…”

Could it be osteoarthritis? How dog owners and veterinary surgeons describe identifying canine osteoarthritis in a general practice setting

“…Research has not previously explored whether this expert opinion is followed by, or suitable for, general practitioners who are responsible for the majority of diagnoses of canine osteoarthritis ( Belshaw et al, 2016b ; van Cleven et al, 2018 ). Variance in decisions and treatments between general practitioners and specialists have been described in veterinary ophthalmology ( White et al, 2018a , 2018b ) and cardiology ( Davies et al, 2015 ). The reasons for this variance may be multifactorial since general practice consultations often cover a wide range of problems and co-morbidities ( Robinson et al, 2015a ) whereas specialists are likely to focus on a single problem.…”

Surgical correction of a unilateral cherry eye in a bull dog using Morgan’s pocket technique

“…Prolapsed nictitans gland ("cherry eye", PNG) of dogs is an ailment commonly encountered by veterinarians, particularly in predisposed breeds and can be defined as outcrop of gland of third eye lid manifested by glandular swelling at the medial canthus shadowed by development of hyperaemia and escalation in gland volume [15] . Some of the breeds which are more prone to this pathological condition include Neapolitan Mastiff, Cocker Spaniel, Pekingese, bull dog, beagle and basset hound [6,7] .…”

“…There is secondary inflammation and swelling due to abrasion and drying of the exposed gland [12] . Multiple surgical techniques for improvement of prolapsed nictitans have been described in the veterinary literature which entail varying surgical proficiency and equipment, of which gland excision has been dejected due to beneficial contribution of the gland to tear production and a study showing higher risk of keratoconjunctivitis sicca (KCS) in dogs following excision and thus to avoid the development of keratoconjunctivitis sicca (KCS) replacement of the gland with Morgan's pocket technique is preferred [1,15] . The present case records successful surgical correction of cherry eye condition by using Morgan's pocketing technique.…”