Complications with 3 year old enucleation site

[Promise_No_More]

Hi COTH friends!

Disclaimer: I’m a DVM who practices in small animal but did mixed track with a fair amount of equine in vet school. I’m working with my barn vet on this issue, as well as with a friend who is a boarded Ophthalmologist, but am REALLY curious to see if anyone has encountered similar issues.

I have a 7yo TB who had his left eye enucleated as a 3yo after a track accident. I got him as a late 4yo and had no problems with the surgery site until May 2013 at which time it swelled up over the course of 2 days. Aspirated the swelling and we got serum and could feel something firm and “rubbery” in the socket. We assumed hematoma, treated with topical and systemic NSAIDs as well as a pressure bandage for a couple days, swelling resolved, socket went back to normal. Our theory at the time was he had knocked his head on something and bumped a vascular bundle and bled into the socket.

Fast forward to about 10 weeks ago, I got a text from BM with photo saying socket was swollen. I blew it off as a repeat of the 2013 incident and we just put surpass on it every day for a few days. Resolved on it’s own again.

Fast forward to last Saturday, skin around the socket is puffy AGAIN (for those counting that’s 3x in 1yr). Surpass and bute have no effect, swelling gets worse, skin at medial edge of surgery scar ruptures and… ta da! Purulent discharge!

I cultured it today and flushed w/dilute betadine. The pocket of infection is quite small. I can’t palpate any instability or crepitus in his zygomatic arch (read: I don’t think he has a fractured eyesocket). I’m in CA and he lives in pasture so foxtails are always a possibility although how one would have majikally gotten inside his head, IDK. Started TMS today, we can radiograph or ultrasound if swelling returns. Barn vet doesn’t think it’s a tooth root abscess since he has no nasal discharge. Honestly it doesn’t seem to bother him at all unless I am trying to poke the sterile culture swab in it, LOL. I’m keeping a fly mask on him, obviously, and he did come in from pasture while we sort this out.

Anyone with one-eyed ponies ever have any weird complications several years after the surgery?? The equine vet at my small animal practice (large animal folks rent the facility out back) said he’d never heard of anything like it.

[Rudy]

Possibly irrelevant question…

Is the socket empty or was there a rubber prosthetic, mesh or other material put in there? If there is, there is a fair chance of rejection of the foreign body which you know can lead to interesting things occurring.

If he does have a prosthesis, I would probably do standing sedation, block him, and remove it. It would also give you a chance to better clean it out.

I think my personal favorite is when the original surgical site pops open and the prosthesis goes bouncing down the barn isle…owners do not generally find it quite so amusing.

[Chall]

Ha,ha but eww. My only input: why was they eye removed in the first place?
Could it have involved an accident ( wood stick into the eye) that might have left small embedded particles behind, now body slowly pushing it up to the surface?

[Promise_No_More]

Rudy - socket is empty, no prosthesis. I would probably die laughing if I saw a prosthesis bounce down the aisle as described! When these mysterious swellings occur, enough fluid builds up in the socket that the extra skin bulges out and it looks just like he has a prosthetic eye! It’s hilarious/weird. I can try to post photos if you guys want to see. Although the only ones I have of this particular episode were taken after it started draining.

Chall - the story I got from CANTER was that he had some trauma to the eye during his 3rd and final start as a racehorse. The theory was that he possibly caught a whip. I do not know whether his former owner enucleated right away or whether they tried to save the eye and did surgery later, and I’m not aware of any complications during the original surgery. He went into the CANTER program about 6mo after surgery and I got him another 6 or 8 months later. He is not particularly head shy and I regularly take a damp hand towel and scrub out the socket to keep the skin in there clean, he usually leans into me when I do this, it’s weird/cute.

ETA: I didn’t read for comprehension on Rudy’s post - I hadn’t thought about mesh or anything other than a rubber prosthetic in the socket. I don’t put anything other than gelfoam and maybe one ligature in a socket when I do a small animal enuc so I didn’t stop to think about other materials in a horse. Definitely something I will keep in mind as we figure this out!

[Chall]

You’re a dvm, you probably can call the vet who did the surgery for a friendly chat. If he was on Canter his owner is probably not adverse to giving you the vet’s name. You might just make the owner happy to know his horse ended up in such good hands!

[CrowneDragon]

Hmm…any chance there was some kind of something left in there (sequestrum–assuming orbital trauma, clump of eyelashes??, surgical stuff, sutures) that was initially walled-off and is now attempting to make a repeat appearance?

[Promise_No_More]

Chall - I contacted Ali at CANTER CA and she think she remembers the vet and is going to try to put me in touch

Another random idea: coryne? Seems like a weird-as-heck place to get a pigeon fever abscess, but he was my “free vet school horse” so I expect him to break all the rules LOL. We don’t have a lot of coryne on our property but this is Northern California and it is around.

Of course now he is super lame on his (newly barefoot) left hind so I have to dig out the hoof testers, poultice, and diapers because I think he’s brewing an abscess in there too! When it rains it pours! At least this means I have an excuse not to ride him in the 100 degree heat this week

Culture/sensitivity is at the lab and I should have some preliminary results back tomorrow. I sprung for aerobic and anaerobic just for funsies. Who wants to start a betting pool on what yummy bacteria it might grow?!

[Promise_No_More]

For anyone still interested: the culture grew a beta hemolytic strep and a staph pseudintermedius. Both sensitive to TMS. Swelling is completely gone and draining tract healed. Per advice of barn vet he’s staying on TMS for another week.

I did manage to get the phone number of the vet who may have done his surgery several years ago. I am going to try to give her a call and get his old medical records and ask for details of the surgery. I imagine that if we get another abscess in there I should do a good standing and open up the suture line and see if I can find out what’s acting as a nidus!