I know that you said that your dog has been on cyclosporine in the past for the treatment of KCS, however has she ever used a product called 'Optimmune"? It's a preparation that contains cyclosporine but it's different from the cyclosporine drops.
When eyedrop preparations to treat KCS are made up, they have stabilizers put in so that they don't lose their potency too quickly before the whole preparation can be used. One of the most common stabilizers that is used is, of all things, SOAP! So while these preparations are supposed to help because the cyclosporine jump-starts the lacrimal gland back into working to produce actual tears, the soap that is in them actually serves to irritate the eyes, pretty much negating any beneficial effects of the cyclosporine.
Optimmune contains no soap and it has been proven to be EXTREMELY effective in helping dogs with even advanced cases of KCS. I have seen dogs whose eyes are so heavily overpigmented because of the KCS return to having almost normal-looking eyes after using Optimmune for a while. Of course, your dog will need to use it for the rest of her life because as soon as you stop using it the lacrimal gland will stop working again, however you can buy an awful lot of Optimmune for the cost of having that surgery on both eyes, and the surgery is not without its problems either.
In Parotid Duct Transposition surgery, the parotid duct that carries saliva to the mouth is re-routed to deposit the saliva in the eye instead. Even though the duct is now acting as a tear duct, it will still act as a salivary duct and when the dog is excited, hungry, or otherwise stimulated in some way it will salivate copious amounts of liquid into the eye(s). If your dog gets carsick, you can imagine how something like this would play out. Also, there are minerals in the saliva that can end up irritating the eye, and depending upon the amount of saliva that is produced, it can cause quite a bit of staining around the eyes. However, if every other option has been tried and has failed, this is truly a last-ditch attempt to give the dog some quality of life.
So if you have not actually used Optimmune on your dog, request that you be able to try it before putting yourself to the expense and your dog through the trials of the surgery. However, if you have already used it to no avail, short of actually removing the eyes themselves to get the dog out of pain, the PDT surgery is the only remaining answer.
Ghilly
Hello....My dog had dry eye....the vet was originally spinning a serum from a donor dogs blood....It seemed to work great...! Two Bits eyes were clear and full of sparkle....Then the owner of the donor dog, decided not to have the blood drawn from his dog anymore....We couldn't use Two Bits blood, It was a long time ago, and I don't really remember why, but I think it was just because she would not cooperate with the blood draws....eventually she ended up with cyclosporine...but I don't really think that worked the best for her...She hated the drops...and her eyes were never the same as they were with the serum.
Anyway....if this is something that you have not tried....you might want to look into it.....Good Luck....Connie