Pannus
Pannus is also called German Shepherd Pannus, but other breeds will also develop the same eye changes (these breeds include Collie, Poodle, Dachshund, Greyhound, mixed breeds). It is a serious disease that can lead to blindness.
The cornea is the outer, clear, portion of the eye. Normally, the cornea has no blood vessels, no pigmentation, and should be smooth and convex shaped.
Pannus is a disorder that affects the cornea of the eye. It is not painful, causes no eye discharge in its early stages, and most concerning, and it is insidiously progressive. It is thought to be an autoimmune disorder, worsened by exposure to ultraviolet radiation (sunlight).
For reasons unknown, the body's own immune system reacts to the cornea producing neovascularity (blood vessels grow onto the cornea), pigment deposition into the cornea, and eventually enough scar tissue to completely block all vision.
It is considered by many to be a disease that can not be cured, and even with continual treatment can lead to blindness in many of the affected dogs.
Traditional Western therapy for Pannus includes the use of eye drops or ointments containing steroids (prednisone, dexamethasone) and/or cyclosporine ointments. In the most advanced cases, surgery is performed to remove the outer layers of the cornea, allowing for some vision to return.
In our experience, when seen early enough, some cases are curable and much more easily maintained so that your dog never goes blind. If seen early, I suspect we can either cure or provide excellent life-long palliation in 90% of the cases.
What Causes Pannus from a Holistic View
From a Traditional Chinese Medical perspective, these animals are Yin deficient and often Blood deficient.
I have the most success with Chinese herbal remedies, combined with nutraceuticals.
My favorite formula is Ming Mu Di Huang Wan. I also have success with Qi Ju Di Huang Wan (Lycii, Chrysanthemum, and Rehmannia Teapills). One of these formulas forms the basis of therapy.
I then will often add Reconciling Tablets, a formula that treats autoimmune diseases.
A few cases seem to respond well when I add Tang Kwei; some seemed to need Aloe vera (using a fresh plant, not any extract).
Some are placed on glucosamine sulfate, and most are placed on Thorne Research's Super EPA (this has a much higher level of EPA, less DHA).
All are placed on diets rich in carotenoids (usually sweet potato, kale, etc.), along with my typical diet recommendations.
Acupuncture seems to help all cases (don't rely on the GB, ST, BL eye points; use points for Blood (ST 36), Yin (CV 4, LU 7), and Spleen Qi (SP 3). Of course, the point selection always varies by the animal, and most have other issues that need addressing.
The environment is critical, especially early on, meaning they must be kept out of the sun until the Yin is replenished.
I always work with constitutional homeopathy as time goes by, and how much that helps is always hard to say. Homeopathy is powerful but slow to act in chronic miasms making it hard at times to know what good I do with it. There is a wealth of rubrics to look in, and the entire Repertorium Generale is needed to select the appropriate remedy.
To prevent permanent corneal changes, steroid eye drops are used at the start, but these are usually stopped after a while. I used to think the dogs always needed ocular steroids but found out that over time people stopped using the eye treatments because it was inconvenient, and things went along just fine. And, I used to think I needed to keep up some therapy or another, but again I kept seeing dogs 2-3 years later doing well with no therapy... same reason, the owners just stopped everything on their own. Again, the eyes stayed normal.
The most frustrating aspect of Pannus is that I see far too many cases when they have been on steroids and cyclosporine for years, and the eyes are now a mess. Those cases are not curable, not easily treated, and at best only suppressed, meaning they need to stay on steroids, and I can barely arrest the advancement of the corneal dystrophy.
Therapies to consider:
- Ming Mu Di Huang Wan
- EPA/DHA
- Reconciling Tabs
- Small Animal Antioxidants
- Arthroplex
- Immuplex