Pemphigus

Question
Dear Dr. Gotthelf,
I have a 7 year old chocolate lab that has been diagnosed with Pemphigus via biopsy.  The skin on her nose is cracked and peeling and sometimes bleeds.  It looks painful.  I apply hydocortisone cream 2.5% bid. which she immeditately licks off her nose.  It doesn't seem to improve.  She has also recently developed "dry eye" in her left eye.  The lower lid contains a purulent exudate.  I have been applying Neomycin, Polymixin B sulfates and dexamethasone drops: 2 drops bid. and Optimmune ointment: bid. for about a week.  The exudate remains, and I am concerned that a foriegn body may be lodged in her eye.  Can you advise me?

Thank you very much for your time and consideration in this matter.
Sincerely,
J. Douglas Thran, DMD

Answer
Without an exam I cannot tell you if something is lodged in the conjunctiva.  Dry eye results in a mucopurulent exudate until the aqueous layer of the tear film is re-established by the Optimmune.  That can take a month or so. You will know based on a Shirmer Tear Test of greater than 10 mm.