Peer-reviewed veterinary case report
Bilateral parotid duct transposition for keratoconjunctivitis sicca in a Connemara stallion.
- Journal:
- Veterinary ophthalmology
- Year:
- 2013
- Authors:
- Montgomery, Keith et al.
- Affiliation:
- Department of Clinical Sciences · United States
- Species:
- horse
Plain-English summary
A 7-year-old Connemara stallion had been suffering for four months from symptoms like squinting, repeated eye ulcers, thick eye discharge, and dry eyes (keratoconjunctivitis sicca) that didn't get better with medication. After thorough examinations, the cause was identified as an immune system issue affecting tear production. The horse underwent surgery to move the salivary duct to help produce tears, first on the right eye and then on the left eye a month later. The right eye showed good improvement two years later, but the left eye developed a complication that made further surgery unsuccessful. Eventually, the left eye's tear production improved with long-term medication, but the surgery had significant risks and complications.
Abstract
A 7-year-old Connemara stallion was presented with a 4 month history of blepharospasm, recurrent corneal ulcerations, mucopurulent ocular discharge, and keratoconjunctivitis sicca (KCS) in both eyes unresponsive to medical therapy. Ophthalmic examination revealed lackluster corneas, axial corneal scarring and pigmentation with associated neovascularization, and absolute KCS in both eyes. Computed tomography scan and endoscopic evaluation of the upper airway and guttural pouches revealed no structural abnormalities to indicate neurogenic KCS. The stallion was diagnosed with immune-mediated dacryoadenitis as all other causes of KCS were excluded. Parotid duct transposition (PDT) was performed in the right eye followed by PDT in the left eye 4 weeks later. The right PDT was functional 2 years post-operatively with significant improvement in ocular comfort and reduced corneal fibrosis and neovascularization. The left PDT developed a salivary-cutaneous fistula over the left masseter muscle post-operatively due to avascular necrosis of the distal parotid duct (PD). Surgical reconstruction of the PDT using an expanded-polytetrafluoroethylene (e-PTFE) tube graft, an e-PTFE tube graft to autogenous caudal auricular vein graft, and an autogenous saphenous vein graft were all unsuccessful. Tear production in the left eye improved at 1 year post-surgery as a result of long term lacrostimulant therapy, and a permanent PD-cutaneous fistula was performed on the left PD at the level of the ventral mandible. Bilateral PDT in the horse is effective in resolving clinical signs associated with KCS; however, morbidity associated with avascular necrosis of the transposed PD may be significant and can result in surgical failure.
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Search related cases →Original publication: https://pubmed.ncbi.nlm.nih.gov/23067239/