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Lipid Keratopathy

Lipid keratopathy is the accumulation of fatty substances, ususally cholesterol, in the cornea of the eye

Causes

There are three main causes:

·       Spontaneous, inherited forms in many breeds including Siberian Husky, Cocker and King Charles Spaniels, Beagle, German shepherd and Boston Terrier. The reason for deposition is unknown and both eyes are usually affected.

·       Lipid may be deposited in the eye as a result of other ocular disease such as ulceration, inflammation or dry eye.

·       Lipid may occasionally occur as a result of high blood cholesterol (hypercholesterolaemia), affecting both eyes. Causes include high dietary fat intake and underlying causes of hypercholesterolaemia such as hypothyroidism, Diabetes mellitus and Cushings

Clinical Signs

Lipid appears as a shiny, crystalline material in the front third of the cornea. The surface (epithelium) is usually unaffected, and with the exception of lipid punctate keratopathy in Shetland Sheepdogs, is not painful.

Location, progression and shape may vary depending on the cause

Diagnostic Tests

A thorough eye exam is performed to look for any prior or active inflammation and damage, and may include fluorescein dye, tear testing and pressure measurements.

A 12 hour fasting blood sample may be measured to rule out high cholesterol and underlying causes of hypercholesterolaemia such as hypothyroidism.

A diagnosis of the inherited form is made when all other causes are ruled out.

Treatment

No specific drugs exist for this condition. No topical or systemic drugs are available to remove the lipid, which will also invariably return if removed surgically.

Fortunately vision is not affected to a significant degree and most inherited versions progress to a certain point and then remain static.

For dogs with high cholesterol low-fat diets are indicated, and any underlying causes such as hypothyroidism should be corrected.

Control of any inflammation or dry eye is also important.

Monitoring and Follow Up

Most monitoring is related to the presence of underlying inflammation or metabolic or hormonal problems. Cholesterol and thyroid tests may be repeated periodically.

The owner should notify their vet if the lesions change appearance or size.

Long term prognosis is normally good as it does not usually affect vision and is painless. Most animals are not at all bothered by it.