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Joyce Ip Joyce is a student studying veterinary medicine at the Royal Veterinary College, London
Financial stress is often a problem encountered in the veterinary profession. In this instance, I agree with how Williams would handle the case, as although treating the dog and improving its quality-of-life is most important, the cascade would deem cyclosporine diluted in corn oil an inappropriate treatment, despite being the cheaper option.
However, I do have some concerns with prescribing topical tear replacement. Depending on the dog’s temperament, would frequently applying the drops be stressful and, in time, reduce the quality-of-life for the dog? It can also be difficult to identify when a dog’s eyes are irritated compared to human dry eye, where people self-apply when the irritation becomes apparent.
Additionally, is it feasible for the owner(s) to apply the drops multiple times throughout the day? And, if the tear replacement is not as effective as the licensed cyclosporine would the treatment prove less cost effective if the dog has to undergo further, perhaps more major, treatment in the future anyway?
Another treatment option that came to my mind was surgical parotid duct transposition. Or alternatively you could recommend that the dog is given up for rehoming, in the hope that a shelter could find an owner that could manage the long-term treatment costs. However, I do not believe these options are effective in terms of cost and welfare for both the dog and owner, and they may damage the reputation of the practice too. Therefore, I believe that tear replacement therapy is the most appropriate treatment option currently available for this scenario.
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