Older dog with painful eyes: What's the best treatment and cost?

I think a full ocular exam would give you more information on whether one or both eyes need to come out. The small eye may be congenital or may have already ruptured and may not be painful any longer. The larger eye could be large just because it looks bigger as compared to the small eye or could have glaucoma. KCS can easily be diagnosed with a vet, but will likely need life-long medications to manage, and these can be expensive depending on the medication and formulation used. Many dogs with severe KCS have their eyes enucleated and become much more comfortable.

My impression from reading her file is that she has very painful eyes, and that this is a chronic pain. Bilateral enucleation would easily resolve this pain and may improve her quality of life drastically. The cost for this surgery can vary depending on the vet clinic chosen, you may call around and ask for rough quotes for bilateral enucleation. It could range from $700 to $1500 or more. I would recommend that she have both eyes done at the same time (if the vet performing the ocular exam thinks they are both defective eyes) as this will decrease total time under anesthesia and make Lia only have to recover from a painful procedure once. If both eyes are removed, then she may not need significant medical care or follow-ups (cost-wise) after she is fully recovered.

Her file tells me that she may be a great one to rescue if your group can cover the costs of surgery. I admire the work you do and appreciate your compassion more than you will ever know!