title: Keratoconjunctivitis sicca attributable to parasympathetic facial nerve dysfunction associated with hypothyroidism in a horse.
abstract: METHODS
  A 6-year-old 680-kg (1,496-lb) German Warmblood gelding was evaluated because of bilateral blepharospasm and head shaking.
  
  
  RESULTS
  Moderate blepharospasm was evident bilaterally, and both eyes had hyperemic and edematous conjunctivas and lusterless corneas. For each eye, the Schirmer tear test value was only 7 mm/min. The horse's nasal mucosa was dry. Abnormal behaviors included mild repetitive vertical movement of the head, snorting, and flehmen response (classic signs of head shaking). Touching the horse's nostrils and face revealed paresthesia and dysesthesia with slight nasolabial muscle hypertrophy bilaterally. Cranial nerve examination revealed no other abnormalities. Serum thyroxine concentration was low, and results of thyrotropin-releasing hormone and thyroid-stimulating hormone stimulation tests were negative, indicating that the horse had hypothyroidism. The diagnoses included keratoconjunctivitis sicca and dry nares attributable to parasympathetic facial nerve dysfunction, head-shaking syndrome with paresthesia and dysesthesia of the face attributable to sensory trigeminal nerve disorder, and hypothyroidism. The 2 nerve dysfunctions were considered peripheral neuropathies that were most likely caused by hypothyroidism.
  
  
  RESULTS
  Treatment of both eyes was initiated with topical applications of cyclosporine, 0.5% sodium hyaluronate, and vitamin A ointment. Levothyroxine (20 microg/kg [9.1 microg/lb], PO, q 24 h) was administered. Within 3 weeks to 4 months, serum thyroxine concentration was within reference range, and clinical signs and Schirmer tear test values improved.
  
  
  CONCLUSIONS
  Hypothyroidism should be considered as a differential diagnosis in horses with peripheral neuropathy or keratoconjunctivitis sicca. In affected horses, administration of levothyroxine may lead to resolution of neurologic signs.
authors.affiliation: Clinic for Internal Medicine and Infectious Diseases, Department for Small Animals and Horses, University of Veterinary Medicine Vienna, Veterinärplatz 1, 1210 Vienna, Austria.
authors.forename: Bianca C
authors.initials: BC
authors.lastname: Schwarz
authors.forename: Tamara
authors.initials: T
authors.lastname: Sallmutter
authors.forename: Barbara
authors.initials: B
authors.lastname: Nell
mesh_terms: D000818:Animals; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis / Q000209:etiology / Q000662:veterinary*; D016572:Cyclosporine / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005155:Facial Nerve Diseases / Q000175:diagnosis / Q000209:etiology / Q000662:veterinary*; D006734:Horse Diseases / Q000175:diagnosis* / Q000188:drug therapy; D006736:Horses; D007037:Hypothyroidism / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000662:veterinary*; D007638:Keratoconjunctivitis Sicca / Q000188:drug therapy / Q000209:etiology / Q000662:veterinary*; D008297:Male; D013974:Thyroxine / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D016572:Cyclosporine; D013974:Thyroxine