Sight for sore eyes

We have a two-year-old Scottish Terrier who presented with what we thought was a problem with her eyes. After a number of consults with a vet we were referred to an eye specialist, who in turn gave us the diagnosis of corneal ulcers, then punctuated kyritonitus and finally immune deficiency.
Her treatment consists of a steroid and an immune suppressant - these she was on for a period of six months. When we were advised to reduce the meds the symptoms became aggressive once again and after more consults have been told that she could well be needing the meds long-term.
Our concerns are the long-term use of the meds and how her body will cope as her heat cycle has already been affected. Is there any alternative to the meds and we would be very grateful for any other suggestions that we could look into for her lifelong comfort. I know that I'm going to be biased but she is the most wonderful dog, full of fun and character.
Lynne Vaughan, by email

I would imagine your Scottie has an immune-mediated condition rather than deficiency, given that she is needing immunosuppressive therapy. The mainstay of most immune-mediated disease in conventional veterinary medicine is, sadly, often high levels of corticosteroid which will have other effects within the body as well as controlling the condition in question. One of these is, indeed, interference with the seasons.
The eye specialist will, however, have been fully aware of the other effects of immunosuppressive therapy when he recommended it. Many decisions we make in life are a balancing act, weighing up the pros and cons, assessing the risks relative to the advantages of a particular course of action. This treatment will therefore have been advised as being the most likely to control your dog’s condition whilst being aware of potential adverse effects. This is why reducing the levels of medication was tried once the condition had improved, in the hope that your dog’s condition would stabilise on lower doses and thus reducing the risks of side effects.
Alison Logan, vet