Corneal Ulcers. Improving or....?

[HunterEqGirl]

I Just hit the 8 week mark of dealing with corneal ulcers in my 6 year old WB mare. Likely due to some kind of impact. There is a bit of a long story associated… 8 weeks ago took my horse to the vet to get her teeth done and had noticed a slightly droopy eyelid in right eye a couple of days before. No discharge or redness so just waited until vet appointment to get it checked. Vet looked at the eye and stained it with no uptake. However, put something in her eye that was supposed to drain out her nose and it never did. Vet gave me Tobradex ointment to put in twice a day. I diligently did the treatment, at 10 days didn’t see much improvement. Vet told me to take her off the ointment on the Saturday and do nothing so she could take a swab on Monday. By Sunday her eye was getting droopy with discharge. Called the vet, she said bring her in on Monday.

Brought her in on Monday morning and her eye looked terrible, getting cloudy and swollen. Vet put her on Atropine drops 2x daily, Tobradex ointment 2x daily and Tobradex drops 1x daily. 10 cc banamine 2x day. Recheck 2-3 days. Couldn’t get a hold of the vet after day 2, day 4 brought horse to the vet and still not seeing much improvement. Vet said she was going to call a specialist. Didn’t call the specialist… Fast forward another week and my #2 vet (who is now #1) was on vacation but had the fill-in come to the barn and he essentially said the same thing, she needs to see a specialist. Great.

Finally got a hold of my vet and brought her to the clinic, she seemed to think her eye was improving. Took her off the banamine and switched to bute and continued treatment minus the atropine and midday drops. 72 hours later the eye looked awful, AWFUL. Cloudy, and now 3 dots forming. Called vet and of course couldn’t get a hold of her. Called other vet who was back from vacation. He came out immediately, restained the eye and sure enough, there were 3 small ulcers on her cornea. Switched meds to Tobramycin ointment 4x a day, plus atropone 1x a day, plus previcox. A few days into new treatment eye was getting droopy and inflamed again. Vet consulted with equine ophthalmologist and tried new treatment of Coproflaxacin every 4 hours, Fluconazole (antifungal) 4x day, atropine 1x a day and 5 cc banamine twice a day.

2 weeks into treatment and vet checked again and no stain uptake anymore (fungal or bacterial), but looks to be healing very very slowly. Vet rechecked three days ago and thought her eye was open much wider and suggested taking off the atropine and banamine and going with Coproflaxacin treatment 4x a day and same with antifungal. After about 12 hours coming off the banamine the swelling and droopy eyelid had returned. Contacted vet and he advised to put back on the Atropine and banamine. Last night gave 5 cc banamine and this morning it didn’t seem to make a difference, eyelid still droopy. Eye itself doesn’t seem to be changing much (worse or better), if anything maybe a tad more cloudy, but hard to say if it is just the light coming off her very dilated pupil, or if it is just the result of the increased inflammation. Vet is coming out later today to have another look…

SO. Those with corneal ulcer experience (or other eye issues), any ideas? Do you think the swelling is due to something else, maybe the associated Uveitis? Should we be seeing more progress by now? I know it can take a long time for corneal ulcers to heal, but I am wondering what kind of progress we should be seeing along the way? The fact we were treating steroids to begin with didn’t help. but that was 4 weeks ago now. Any experience with other meds?

I live in a fairly remote area where there are only so many large animal vets, and we don’t have any local equine ophthalmologists. Other challenge I am running into is that the specialists all require referrals from a vet, and for some reason none of mine are at that point of referral yet. Mare is outside but wears a fly mask with one side covered to keep her out of the light.

[Cayusepapoose]

where in Canada are you?

[AKB]

I would email the closest equine ophthalmologist and explain the situation. Then, I would call for an immediate appointment. Where is your closest vet school? You could bring the horse in as an emergency, and they could have their ophthalmologist see the horse.

[Arbitrary]

My gelding had an indolent corneal ulcer - for him, serum helped turn the corner. The prior meds and debridements had not worked.

Best of luck to you and your horse.

Here are a couple threads on the subject: http://www.chronofhorse.com/forum/showthread.php?369010-Indolent-Corneal-Ulcer

and

http://www.chronofhorse.com/forum/showthread.php?414370-non-healing-eye-ulcer-going-on-for-2-months!/page2http://www.chronofhorse.com/forum/showthread.php?414370-non-healing-eye-ulcer-going-on-for-2-months!/page1

[HunterEqGirl]

Located in the Okanagan. Vet did another check and another stain and looks like a new corneal ulcer has emerged since Monday, although he thinks the others are slowly healing. Back to every 4 HR treatment. Going to try the previcox again for inflammation to see if we can get her off the banamine, I’m cross my fingers but not very optimistic. He sent new pictures to the opthamologist and I am hoping she may suggest the serum. I have read a few posts that suggest that or even adequan drops. I contacted the specialist office directly a few weeks ago and explained the situation and they said my vet needs to contact them. No vet school around… Here we go again…

[keysfins]

I had a horse with a corneal abrasion, that was initially treated with standard eye meds: antibiotics, ointment and atropine (which dilates the eye and makes it a bit more comfortable, but the horse then cannot constrict the pupil, so needs a cover over the eye to block light. Applying duct tape to a fly mask that covers the affected eye works.

After several days of treatment, the horse’s eye changed from a corneal abrasion to a corneal ulcer, all in a matter of three hours The eye went cloudy, had more drainage and had an irregular surface where the ulcer developed. The vet was concerned that the damage would go through all the layers of the cornea, which is called a melting ulcer, and there was a possibility that the horse might lose the eye! Emergency trip to the clinic happened immediately for more comprehensive treatment.

A subpalpebral lavage was installed, which allowed frequent treatment with meds without having to pry open the eye. (The eyelids spasm and make it really difficult to apply the needed meds. And wrestling with a horse that has a painful eye, trying to apply drops or ointment to the eye while trying to avoid poking the container into the eye is a challenge.) The lavage system made everything much easier for all involved. We hoped that medicating every three-four hours round the clock would do the trick, but things didn’t turn around immediately.

We had the ophthalmology specialist on the case. What he explained was that the body’s immune system goes in to action to try to clean up the debris and damaged corneal cells. The immune cells release substances that damage more cells, creating more inflammation and making things worse at first. The big “NO” in treating this injury was steroids-- it generally is counterproductive, makes things worse in a hurry if given at the wrong stage if healing, and can slow the normal healing process.

He debrided the cornea to stimulate healing, rubbing it lightly with a swab after numbing the eye. He did this twice, to encourage the body to heal on its own. (I also have a dog that had a corneal ulcer a couple of years later, treated by the same opthamologist. He did the same with the dog, save the lavage system, because my dog was cooperative for meds.)

What we ended up doing was adding in the use of the horse’s own serum, spun down from a tube of blood drawn about every other day. The plasma was applied using the lavage tube to bathe the eye. It was very helpful. But he was still concerned that the ulcer wasn’t healing, and recommended a surgical procedure to place a graft over the ulcer.

The horse was sedated and laid down in the pre-surgical room. The ophthalmologist spent quite a bit of time examining the eye, and finally said that he was not going to do the surgery. The body was finally cleaning up the debris, and new corneal cells were growing.

Of course, that wasn’t the end of treatment. Plasma was continued, along with antibiotics and an anti-fungal. Horse came home and we treated via the lavage for several more weeks. Once the cell layer had covered the ulcer, and blood vessels were growing in as well, the horse could go back to turnout. But we needed to still protect the eye from light, wind and debris.

We used a Guardian eye mask that had 95% light block over the affected eye, and an 80% shade on the healthy eye. Over several weeks, the ulcer healed, and eventually the cornea was healthy and smooth.

There was no deficit to vision. This was due, in part, to the location of the ulcer; it was not in the center of the eye, but at about the 4:00 position of the eye. That meant that healing from the edges inward was a bit easier, particularly once blood vessels began growing into the injured area.

Vet recommended keeping the Guardian mask on for several months in total, just to protect the eye from the dust, wind and debris. The horse resumed training after a total of about 7-8 weeks.

I still have the Guardian mask, with replacement eye covers, so I could clean them if they got gunky and have spares. I have since loaned it out locally a few times for other horses that needed one.

Feel free to PM me if I can help in any way.

[keysfins]

Wanted to add that I believe topical eye meds are most effective for treatment. It can be very difficult for oral or IV meds to reach the eye where they are needed.

The lavage system can easily be installed at home, and makes treatment SO much easier than wrestling with a painful horse several times a day. My horse went to the clinic for intensive care 'round the clock. I simply could not medicate and monitor every three hours.

If you can’t find an equine eye specialist, call around to find a small animal/ canine specialist. My opthalmologist works with multiple species. I believe there is a national registry so you can search in your area. I will post if I remember the organization.

Also ETA: timeline was treatment at home for about four days for the corneal abrasion, at which time it became an ulcer. Treatment at the clinic was about a week. Treatment back at home went on for a good 8 weeks until things were really healed. It was extremely helpful to take photos daily with my phone. I could then send them to the attending vet and the opthalmologist to give updates, or ask questions if I saw changes and wanted to verify that things were progressing normally and positively.

[AKB]

Tell your vet, in writing, that you want a referral to see ophthalmology ASAP. Also, how far is the closest vet school with a ophthalmologist? Even if you have to drive 8 hours, I would make the drive and leave the horse there.

[keysfins]

This refers to the US, but may give you leads for your area:

http://acvo.org/new/public/locate.shtml

[keysfins]

Info on the subpalpebral lavage system:

http://www.thehorse.com/articles/33432/a-better-way-to-treat-equine-eyes-subpalpebral-lavage

[Cayusepapoose]

Dr. Marnie Ford is at the Okanagan veterinary hospital Equine ophthalmologist
(250) 765-5132, get a hold of her. The Okanagan area is lucky to have her. The best of outcomes to you.

[keysfins]

[QUOTE=HunterEqGirl;8621410]
Located in the Okanagan. Vet did another check and another stain and looks like a new corneal ulcer has emerged since Monday, although he thinks the others are slowly healing. Back to every 4 HR treatment. Going to try the previcox again for inflammation to see if we can get her off the banamine, I’m cross my fingers but not very optimistic. He sent new pictures to the opthamologist and I am hoping she may suggest the serum. I have read a few posts that suggest that or even adequan drops. I contacted the specialist office directly a few weeks ago and explained the situation and they said my vet needs to contact them. No vet school around… Here we go again…[/QUOTE]

Frustrating, no doubt. If you can swing it, spending a few days in the clinic could help get a jump start on healing. They could treat much more frequently, and monitor changes, better than I could. I can’t do round the clock dosing and still work!

[keysfins]

Another bit on the lavage system, with photos (warning, some may find them graphic):

http://www.milainternational.com/MILA_MEDIA/EyeLavagePlacement-Dr.%20Ann%20Dwyer.pdf

[jrscomet]

I agree with the others, I would haul to a vet school or ophthalmologist.

Quite a few years ago my gelding had a corneal ulcer…we hauled him to MSU and they did surgery to place a corneal graft and lavage system. If I recall correctly, it took about 8 weeks of meds, stall rest, and mask, but things healed so well.

I wish I hadn’t waited as long as I did before going to the university

[sascha]

[QUOTE=HunterEqGirl;8621410]
He sent new pictures to the opthamologist and I am hoping she may suggest the serum.[/QUOTE]

I’m a bit confused why your vet hasn’t just taken a vial of blood and spun it up for you. Easy peasy lemon squeezy and it’s fast, it’s cheap, and it works. And you get to tell your horse, “Here’s blood in your eye, Kid.” every time you put it in :lol:

The only thing it complicates is it takes a few more minutes to do a treatment each time because you’ve got to wait I think 8? minutes after antibiotics/whatever else you’re putting in there before you put the serum in. No biggie really.

My horse had an ulcer after a little romp on the beach last fall. Stupid sand! lol It was like 2 days after I started her on meds that I called and said how fast can you spin that blood up for me because I’m not really getting anywhere with this eye. The serum helped very promptly.

[TrueColours]

REALLY consider getting a Recovery Visor for her. They are specifically made for just these issues and come in light and dark tint specifically if uveitis is at play

They protect the eye, they shade the eye. Its pointless to treat her if she rubs that eye on something because it is irritating her so all the good the drops are doing are for naught as she continues to rub it when you’re not around

www.truecoloursproducts.com

Let me know if we can assist at all …

[HunterEqGirl]

HI all, Update! After the vet finally admitted he was unsure of what was going on, he booked an appointment with the specialist. Specialist came out last weekend and was optimistic. She diagnosed her with superficial stromal edema and mild fibrosis.

She said the cornea along the palpebral fissure line was grey secondary to edema and scarring (hence the cloudy appearance). The surface of the cornea was irregular secondary to very superficial facets and mild edema. All fibrosis and edema appeared to be superficial in the stroma. No fluorescein stain retention this time and the anterior chamber was clear. The lens and fundus were within normal limits. No abnormal hairs were identified on or ulcer the eyelid margins. So essentially she has corneal changes consistent with prior superficial ulcers. The specialist did not see evidence of a corneal fungal infection (whew!). She thought the more recent ulcer was due to the amount of edema in the cornea, and that the edema (from her original ulcers) resulted in a bulla formation that ruptured (like a blister) to create the third ulcer.

So to reduce the amount of fluid that remains in her cornea and help prevent additional ulcer formation, a hypertonic saline ointment (Muro 128) was recommended twice a day for a month. Continued use of Ciloxan and topical fluconazole for safety’s sake until her cornea is more dehydrated and durable (twice a day for about 2 weeks). DMSO was added to fluconazole to improve penetration through the intact cornea.

Crossing fingers all goes as planned!

[Cayusepapoose]

Very glad to hear that you’ve gotten answers and a positive game plan for the eye. I’ll be jingling away…!

[jawa]

I’m glad you didn’t have to do the lovage system. My cousin’s mare had a melting ulcer, (24 years ago) the vet spun down the serum, created a lava get system and was able to dom2 treatments before the mare ripped the system out rubbing. Sigh…