A 9-year-old female spayed mixed breed dog was initially examined for severe bilateral entropion secondary to enophthalmos from chronic oral steroid use for immune-mediated thrombocytopenia as well as potential historic masticatory muscle myositis. Surgical intervention with entropion surgery was pursued; however, trichiasis secondary to laxity of the periocular muscles, eyelid tissues, and tarsal plate developed several months later. Hyaluronic acid (HA) filler (Alayna SG 24 Distinct, BSC Medical Devices GmbH, Munich, Germany) was injected into the superior and inferior eyelids of both eyes to correct recurrent ocular irritation. One month later, the patient developed severe, presumed pyogranulomatous blepharitis in both eyes suspected to be a delayed hypersensitivity reaction to the HA filler. The condition worsened despite medical management. Due to the patient's previous, chronic history of oral steroid use, the owners declined administration of oral steroids at that time. Oral Zenrelia (ilunocitinib) and topical neomycin-polymyxin-dexamethasone ointment were instituted, which resulted in a rapid resolution of the patient's clinical signs. This is the first known report of a dog experiencing a severe hypersensitivity reaction to hyaluronic acid used as an eyelid filler and successful treatment with Zenrelia for this purpose.

A 7-month-old intact female mixed-breed dog presented emergently for inability to walk, lethargy, and vomiting. The patient was diagnosed with immune-mediated polyarthritis (IMPA) and secondary systemic inflammatory response syndrome (SIRS). Bilateral keratouveitis and secondary glaucoma developed within 24 h of presentation. Thorough diagnostic testing failed to identify an underlying etiology. Despite aggressive medical management, the patient developed rapid vision loss. Due to poor visual prognosis and anticipated need for long-term medical management, both eyes were enucleated. Histopathological evaluation of both globes revealed severe corneal endothelial injury most consistent with endotheliitis with associated uveitis and endophthalmitis. Testing of ocular tissue with PCR and immunohistochemistry for canine adenovirus was negative, and comprehensive infectious disease screening, joint cultures, and ocular histopathology identified no other causative agents. Following enucleation, the dog systemically improved with anti-inflammatory and antimicrobial medical management. This report highlights a unique and severe case of bilateral keratouveitis with glaucoma following a systemic inflammatory event.