Management of Haws Syndrome in Cats With Gastrointestinal Diet: A Case Series

Background: Haws syndrome (HS) in cats is characterized by bilateral protrusion of the third eyelid and ptosis, often accompanied by gastrointestinal (GI) symptoms such as diarrhea. Emerging evidence suggests disruption of the gut-brain axis, linked to GI microbiota dysbiosis, may play a role in HS development. Objective: To describe the clinical features and outcomes of five cats with HS managed with a gastrointestinal diet targeting presumed dysbiosis. Methods: This study included five cats diagnosed with spontaneous HS. Each cat underwent thorough ophthalmic and physical examinations, as well as fecal Giardia testing and pharmacological testing with 1% phenylephrine. All cats were managed with Hill's Gastrointestinal Biome diet for 3 months. Results: Ocular signs transiently resolved following topical administration of 1% phenylephrine, indicating sympathetic neuropathy. Physical examinations were unremarkable, except for diarrhea in 3/5 cats. Fecal tests for Giardia were initially positive in 4/5 cats and became negative in 3 upon recheck. GI symptoms resolved within 4 to 14 days in 2/3 cats with diarrhea, although only partial improvement was noted in one. Ocular signs resolved in all cats within 11 to 39 days and did not recur during the follow-up period of 327 to 438 days. Conclusion: The improvement in ocular and GI signs following dietary management with a prebiotic-enriched gastrointestinal diet suggests that this approach may be beneficial for cats with HS, potentially by addressing underlying GI microbiota dysbiosis. However, it may be insufficient in refractory cases or when GI symptoms do not fully resolve.