Over the past week, dog food company Years has recalled its Fresh Meals after receiving reports of dogs developing sudden, severe dry eye. So what should you - as a first-opinion vet on the front line - actually be looking for, and does management differ from the KCS cases you see routinely?
The history
According to Years, the company began receiving multiple reports in late July and launched an investigation on 1 August. By 16 August, it had received 57 suspected cases; on 17 August it decided to recall all Years Fresh Meals, excluding its Chef's Collection. By 9pm on 18 August, Years said 192 customers had reported potential, as yet unverified, eye problems. The company is currently investigating whether contamination within part of its buckwheat supply could be involved, but no cause has yet been confirmed and a link between the food and the reported cases has not been proven.
Victoria Jordan MA VetMB MRCVS PGCertSAO, RCVS Advanced Practitioner in Veterinary Ophthalmology and ECVO Resident in Veterinary Ophthalmology told us that their team had noticed an unusual increase in severe KCS cases even before the recall was announced.
“Earlier this year, we noticed an increase in the number of cases of dry eye, or keratoconjunctivitis sicca, compared to what we would normally see," she said.
We also spoke to Lorraine Fleming BVetMed, CertVOphthal, MRCVS, senior ophthalmologist at DWR Veterinary Specialists, who reported much the same pattern:
“My first case was in March,” Lorraine said. “I did all the bloods, tried all the usual medications, and just nothing has helped this dry eye at all.”
At that stage, there was nothing to connect the case with a wider problem. But as ophthalmologists began comparing notes, it became clear that several were seeing unusually severe cases that did not fit the normal KCS pattern.
We asked both ophthalmologists what front-line clinicians need to know while that work continues.
The right eye of an 8 year old MN greyhound with sudden bilateral dry eye which was fed Years fresh food. The thick, sticky discharge is stuck to the cornea, there is conjunctival hyperaemia, and a distorted Purkinje image indicating poor/absent tear film
The left eye of the same dog. Again, the very dry ocular surface is notable by the distorted Purkinje image, and there is thick, sticky discharge stuck to the cornea and more conjunctival hyperaemia.
The red flag: sudden bilateral dry eye
Victoria says the cases seen by her service have looked noticeably different from much of the KCS they would usually expect to see.
The main features have been:
- sudden onset, with owners often describing signs developing over days to weeks
- bilateral disease
- very low or completely absent tear production, including dogs recording 0 mm/min on Schirmer tear testing in both eyes
- no associated dry nose
- cases occurring across a wide range of breeds and ages
“Notably, we were seeing cases that were presenting acutely, with severe, bilateral disease,” Victoria said. “Many of these patients were presenting with completely absent tear production (STT 0mm/min both eyes), which was unusual.”
Lorraine has seen much the same thing.
“They’re definitely less than 5mm/min,” she said. “They’re low, they’re bilateral, and you just think, ‘What’s going on here?’ You know, this is not normal.”
Owners have frequently reported that signs appeared over a period of days to weeks, rather than the more chronic presentation commonly associated with KCS.
The patients themselves have also been less predictable than the ophthalmologists’ usual KCS caseload.
“We noted that we were seeing these cases across a spectrum of breeds and ages, which differed to our ‘normal’ or expected KCS patients — generally middle aged and older dogs,” Victoria said.
Be careful not to jump to conclusions
That does not mean every Years-fed dog presenting with dry eye should automatically be considered part of the current cluster. Feeding history is one part of the picture, and vets should still consider other recognised causes of KCS and assess each case on its own clinical findings.
And, importantly, Lorraine says there appear to be dogs developing the same acute, bilateral pattern without a history of eating Years food. That makes it particularly important not to use diet as the sole criterion for recognising or reporting a possible case.
Another potentially useful distinction is the nose. Neurogenic KCS can cause an ipsilateral dry nose alongside the dry eye, but Lorraine says that has not been a feature of the cases ophthalmologists are currently investigating.
“You might think it’s neurogenic, but they don’t have a dry nose,” she said. “That’s an important distinguishing factor on these cases.”
Some ophthalmologists have trialled pilocarpine in suspected cases without seeing the response they would expect from neurogenic KCS.
What should vets do when a possible Years dry eye case presents?
A history of eating Years Fresh Meals should prompt a few additional questions, but it should not replace a proper ophthalmic work-up.
1. Ask about feeding history
Establish whether the dog is currently eating, or has recently eaten, Years Fresh Meals, and when the diet was started.
If possible, record when clinical signs first appeared and whether the food has subsequently been stopped.
Years is currently advising owners to stop feeding its recalled Fresh Meals and not to donate or sell remaining food.
But don't stop at the diet history. With similar cases apparently occurring in dogs that have not eaten Years, the clinical presentation remains important.
2. Carry out an appropriate eye examination
It's important not to jump to conclusions, and instead examine the eyes as usual.
Schirmer tear testing should form part of the assessment where KCS is suspected, alongside examination of the ocular surface, assessment of the cornea and fluorescein staining where appropriate. With severe tear deficiency, the cornea can quickly become vulnerable to desiccation, trauma and ulceration.
Recording the STT result for each eye is particularly useful in these suspected cases. Both ophthalmologists have seen extremely low or absent tear production in both eyes.
The combination of sudden onset, bilateral disease and severe tear deficiency should therefore raise suspicion, whether or not the dog has a Years feeding history.
Other possible causes should still be considered rather than assuming the recalled food is responsible.
3. Treat the eye in front of them
The underlying cause of the reported cases is still being investigated, but vets do not need to wait for that investigation before treating the ocular disease in front of them.
“With absent or severely reduced tear production, timely and intensive treatment is essential,” Victoria said.
Initial treatment
If the dog is currently eating Years food, the company’s advice is to stop feeding it.
From an ophthalmic perspective, Victoria recommends starting immunomodulatory treatment where the Schirmer tear test result is below 15mm/min, alongside topical lubrication.
Lorraine also recommends initially treating these dogs as KCS rather than assuming they have a completely different disease process.
“I think you’ve got to assume that it’s a normal dry eye first,” she said.
In her approach, that means starting with the licensed ciclosporin product Optimmune and allowing time to assess the response before considering alternatives such as tacrolimus where appropriate.
Even where the underlying problem ultimately turns out not to be immune-mediated, Lorraine says these treatments can still benefit the ocular surface.
“They still reduce inflammation, they reduce vascularisation, they reduce the conjunctival hyperaemia,” she said. “They do actually help the ocular surface, but they’re not stimulating tears, which is what you primarily want them to do.”
For both ophthalmologists, however, ocular lubrication is central to managing the severely affected cases.
“With 0mm/min tear production, corneal lubrication should be applied as frequently as possible — at least 6–8 x a day,” Victoria said. “With production of 10–15mm/min, application around 4x daily may be sufficient.”
Formulation can also make a difference to how practical that treatment is for an owner.
“Gel lubricant formulations [like Xailin Night and Hylo Night] tend to last longer than drops but may cause a degree of vision blurring,” Victoria said. “These are useful at nighttime and when people need to leave their pets for >3hrs.”
For daytime lubrication, Victoria said they aim for drop-based products with a high percentage of sodium hyaluronate, such as Hyabak and Hylo-Forte.
Lorraine takes a similar approach, often combining a thicker hyaluronate product for longer-lasting lubrication with something more fluid where there is a large amount of discharge.
“The discharge is quite profound, so you also need something a little bit more watery to help flush the discharge out,” she said.
She has been using sterile saline to help owners clear discharge before applying lubricants.
Pain management should not be forgotten either.
“These dogs are painful,” Lorraine said. “Pain relief is important.”
She would generally start with an NSAID where appropriate and increase analgesia if needed, although she cautioned that pain relief alone cannot compensate for an inadequately protected ocular surface.
What if there is corneal ulceration?
“Without adequate tears, the cornea is extremely vulnerable to desiccation, abrasion and ulceration,” Victoria said.
Lorraine is particularly cautious about ulcers developing in these patients because the absence of a normal tear film may impair healing.
“They’re probably going to start off as superficial, but then they are going to have their predisposition to go stromal because there’s nothing there to promote healing in the tears,” she said.
She recommends treating ulcerated eyes proactively and monitoring them closely. Where infection is present, topical antibiotics may be required, while eyes at risk of stromal degradation or melting may need anti-collagenase treatment such as serum or plasma.
“I think you have to treat them as if they might start to melt,” Lorraine said. She would consider introducing serum or plasma early in an ulcerated case, and to consider referral early on.
4. Offer referral early
Not every suspected case needs to go straight to an ophthalmologist, but the two vets we spoke to would both keep referral firmly on the table.
“If vets are struggling to manage these cases, and particularly if they cannot manage comfort levels, we would recommend referral,” Victoria said.
Lorraine recommended being open with owners and offering referral from the beginning, as part of the options.
“I think I would be speaking to owners and saying, ‘This could be one of those cases, in which case we know it’s going to be complicated,’” she said. “So I would offer it from the outset because some owners are going to take it and some owners aren’t.”
If the eye becomes ulcerated or develops other complications, she would recommend referral is sought, because the healing is likely to be impaired by the lack of tears.
For first-opinion vets, the decision will depend on the individual dog, the severity of the disease and whether they feel able to maintain comfort and protect the cornea. But offering owners the option of referral early may be sensible, particularly given that some cases have proved difficult to control.
What other options are there for these dry eye cases?
Referral ophthalmologists may be able to consider additional medical treatment as well as surgical management of complications.
Some ulcerated dogs have required procedures such as conjunctival grafting where corneal disease has progressed.
For KCS that cannot be controlled medically, parotid duct transposition (PDT) may also be considered. The procedure redirects the parotid duct so that saliva wets the ocular surface.
“The next step if medical treatment isn’t working is surgery,” Lorraine said. “Parotid transposition isn't a simple operation. It comes with its own issues and complications and side effects, but it will ultimately give them wet eyes.”
She said several veterinary ophthalmologists involved in discussing these cases have already resorted to PDT in severely affected dogs.
In general practice, and in referral, enucleation remains a possible final option where an eye cannot be kept comfortable.
5. Monitor closely for a response or deterioration
There is still limited information on the expected course of these suspected cases.
Monitoring should include repeated STT results alongside comfort, discharge, inflammation and the health of the corneal surface. This should be done frequently - every week to start with. However, Lorraine advises allowing enough time to judge the response when treatment is changed - at least two weeks - to see if a difference has been made. And if there is to be any recovery, it could take several months.
Vets should remember to give owners clear warning signs that should prompt an earlier recheck, particularly a marked increase in redness, pain or a sudden change in the appearance of the eye.
Can tear production recover after Years food is stopped?
At the moment, the picture appears mixed. Some of the suspected cases have improved, while others have proved far harder to manage.
“Many of the cases have been refractory to treatment,” Victoria said. “For these patients, we are heavily reliant on frequent corneal lubrication.”
Even in those patients, she said immunomodulatory treatment often remains indicated “to manage the local environment and to minimise secondary inflammation”.
But the experience has not been uniformly poor. There are reports circulating among owners of dogs improving after the recalled food is withdrawn, including suggestions that tear production can begin to recover within a matter of weeks. Both ophthalmologists think recovery may be possible in at least some dogs, but it is far too early to give owners a reliable timeframe or prognosis.
“Some cases have responded,” Victoria said. “Hence, seeking timely veterinary advice and instigating treatment early remains essential.”
Lorraine suspects that how advanced the damage is when the dog is first identified may matter.
“I suppose it depends on how much of the gland is destroyed and whether or not that can then regenerate,” Lorraine said. “We’re yet to answer that question.”
“I think there will be cases that reverse, and that’s great, but there will be other cases that are too far down the line. I think only time now is going to tell.”
That uncertainty also influences when Lorraine would consider moving from intensive medical management to irreversible or major surgical options.
“I would be giving these serious amounts of time,” she said.
Where an owner can maintain the treatment burden, the corneal surface remains healthy and vision is not deteriorating, she would be prepared to persevere for months rather than weeks to give tear production a chance to return.
“If they can do things for six months and the corneal surface is not deteriorating — it’s not becoming pigmented, or they’re not losing their vision — then I think it’s worth persevering and seeing if it is reversible,” she said.
For now, vets should therefore be cautious about giving owners a specific recovery timeframe. Rapid recovery may occur in some dogs, but others may need prolonged and intensive management.
6. Report potential Years food dry eye cases
The investigation into the reported cases is continuing, and the cause has not yet been established.
Years is encouraging owners to report suspected cases through their usual contact form, after which owners will be sent a form to fill out.
In addition, BrAVO is now gathering information from vets seeing sudden-onset bilateral dry eye, regardless of diet. This may be particularly important in establishing whether the Years recall explains the whole cluster or whether a wider problem is also occurring. Vets should report their cases using this form.
Conclusion
For vets seeing affected dogs in the meantime, the key points are to:
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Ask about feeding history (without allowing it to dictate the diagnosis)
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Look for the unusually acute, bilateral and severe pattern described by ophthalmologists
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Assess and record tear production and corneal health properly
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Protect the ocular surface aggressively, and
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Offer referral where appropriate.
- Fill out BrAVO's form to get the researchers the information they need.
Some dogs appear to improve. Others may need intensive management for considerably longer. But as Lorraine says, some severely affected dogs may need months of medical management before it becomes clear whether tear production is going to recover.
As more cases are followed and more information becomes available from Years and veterinary ophthalmologists, the clinical picture — particularly around cause, treatment response and prognosis — should become clearer.
Improve Veterinary Education will update this article as further evidence, investigation results and specialist guidance become available.
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