Eye Lavage

[Pico_Banana]

I searched for this but seems like the latest threads are from 2016.

I have a 28 year old fully retired horse who has a small but deep corneal ulcer on the edge of her cornea. This occurred over Labor Day weekend, so it’s been a while already. We have already seen an ophthalmologist upon advice of my regular vet.

The ophthalmologist recommended either continue with the medication or remove the eye. (She is too old to be fully sedated for a graft.) We decided to continue the medication, which was going okay even though it was a two person job. But since Sunday, she’s decided she’s had enough and is not being very cooperative, so I’m not sure how much medication is actually getting in. We are using both tobramycin and serum 3 times a day, with atropine every 3 days.

I’m going to ask my vet about installing a lavage system, especially since my second person will be away for 10 days coming up and there’s no way I can do it without a second set of hands.

I’ve googled about lavage systems but am looking to hear from others who have dealt with it. Do you turn the horse out with it in? (This horse 100% needs turnout.) How do you protect it? She’s already wearing the RecoveryVizor and I was thinking I would buy her a sleazy. Any tips/advice?

Just hoping for stories to make me feel better about this.

[cnd8]

With an aged horse like that, and since you’ve already tried so much, why not remove the eye at this point? It’s very simple and the horse will heal quickly and you’ll no longer have to worry about giving it constant attention/treatment. None of my business. Just seems like removal would be so much easier.

[luvmyhackney]

I took care of an older gelding with a lavage. We taped it for turn out and other than keeping the area clean, it was super easy. It was his only eye, the other one had been removed.

Eye removal is not a terrible surgery and can easily recover from even older. If there is no chance of the eye getting better, I would have it removed.

[Pico_Banana]

I am considering removal, but would like to give it some more time to see if it will heal on its own. The ophthalmologist thought continuing with the medication was a perfectly reasonable option given the location of the ulcer and the health of her eye overall.

I adopted this horse two years ago and she came with severe separation anxiety. She relies on her vision to assure herself that she’s not alone when she is stalled (and I have to stall at night to deal with dietary needs) but her vision overall is not great given the natural aging process in her eyes. I am very concerned that removing one of her eyes might exacerbate her anxiety. So I want to explore all options before we go there.

[No1]

I’d take it out. Most horses deal really well with enucleation. Even spooky, nervous ones.

But, that’s not what you asked. So…Turnout is not recommended. If you’re to do it, make sure you have a good understanding of how to install a new injection port to a damaged line, before you leave the vet’s office. A hood of some sort is a good idea. As well as a mask with a cup.

Also, some horses remain terrible to treat, even with a SPL in. While you don’t have to hold the eye open to administer meds, the horse does still have to be reasonably still to stick the injection cap. If you are determined to keep trying to save the eye, consider sending her to the clinic or a rehab facility for a week or so for intensive treatment.

[luvmycabanaboy2]

Mine had a lavage installed for about a month when he was 19 or so. It was braided into his forelock/mane. He lived at the vet for the duration (5x per day treatment), so stall only - this guy is normally 24/7 turnout and actually tolerated the stall rest better than I thought. I hand walked him daily and the vet had a small paddock that I let him out in for ~30 minutes or so under my direct supervision (after I had handwalked to get some of the sillies out - and hes a very chill dude generally…).

Finally healed after 6 weeks total, but to this day, he doesn’t react well to glares (like if I’m riding towards an aluminum trailer in the sun), or sunbeams coming through a window on that side, or the headlights on the goftcart in the dark.

[cayuse]

I had a mare who had a corneal graft and came home from hospital with a lavage in place as she needed to be medicated every two hours with several types of drops. It was braided into her mane and she wore a hood with a full eye cup to keep her from dislodging the tubing. She was not allowed turnout until the lavage was removed. Hand walking and grazing was fine.

[reefy]

The lavage is wonderful, until it isn’t. My experience: my old gelding had his ?3rd eye thing (it was a fungal keratosis) that was not doing great and he was not great about letting us do what needed doing so we put the lavage in and boy was that great! Unless you confine your horse to a stall the entire time, it won’t work great. My horse had a run off his stall and manage to sever the line where it was tied into his forelock we think by rubbing it along the bars of the run. We made a ton of progress in that week until he did it and the part that was up against the inside of the eyelid fell down once the tubing was broken and caused another ulcer at the top part of the eye. So, unless you can contain your horse, well, you might not have great luck with it.

[BrookdaleBay]

A mare at my barn with a corneal abscess currently has a lavage in place. She needs 4 different meds every two hours, but she hates being left in when all the others are out, so we’ve placed her little group in the paddock closest to the barn to make bringing her in for treatment easy. The line is braided in her mane and she’s boss mare, so her two friends haven’t tried fussing with it. She wears a fly mask 24/7 to keep from rubbing.

[syreino]

My mare had a non healing ulcer Sept 2020. We went to see the Ophthalmologist at Penn and she put a lavage catheter in after doing a diamond burr debridement. I can’t imagine that an Ophthalmologist has not suggested that as first line of defense.

It stayed in place for two weeks, was easy to deal with and allowed me to give her four different medications every 6 hours. She stayed in her stall during the two weeks, with a fly mask on. They braid it into their mane and tape it to keep it out of their eye sight. It really is SO much easier than trying to give meds for a non healing ulcer. I don’t remember the pricing, but don’t remember it being too high.

I suppose if you did single turnout in a small paddock, it might be okay, but my out 24/7 horse did fine for the two weeks being in her stall, so sometimes they surprise you. My mare is a very high strung arab, but she was completely chill about the whole process, so she either felt so poorly or knew it was going to help her…either way, she was a champ through the whole thing.

Good luck to you and your mare!

[carman_liz]

I kept a friends yearling warmblood in my 10x12 mesh gate stalls with a spl this summer for a week because of a horrible eye ulcer out of the blue the day before her vacation. He came to me straight from the clinic. God bless that little boy for his patience with me and not breaking himself or my stalls!

Even in the stall, with a mask with a cup on it I was freaking out everyday that he would rub it. The cup had gauze buttoned into it and had to be changed daily and a fuzzy covernaround the edges, cover had to be changed out each time, I had 3 and had to wash them in between each change and air dry. I fed him during the cup cover changing part so he was not tempted to rub while the area “breathed” for a few each day while the mask was off.

He still ended up breaking the iv line… I have never been so scared to see bubbles… I completely agree with other posters to send to a clinic for the treatment especially if stalling is not an option, I honestly do not see how it would work otherwise. Splicing and fixing the line took 2 tries, making my friend stay on facetime with me to keep talking me thru it and keeping me calm and my hands were shaking the whole time. I was so horribly scared I was going to mess it up and he would reinfect the eye! He was not the best about holding still, yearling, lived out till this point, strange place…neighbors fireworks since it was 4th of July week…and thank goodness dh came out and helped hold him for his evening medicines, the other million times a day, I was by myself praying thru each needle push.

UT said 5 min between medications, and 3 pushes of air thru the tube with each med to help it go thru, new needles for each med and 3x push, in a week I went thru over 200 needles… He had 5 meds every 4 hrs the first few days, then every 6hrs or so, atropine
and serum 2x a day and then tobramycin and 2 others still every 6 hrs. I am surprised they only want you to dialate every 3 days?!

If removed, how much stall rest would be required vs continuing with a spl and stalling for medicating? I would weight risk vs reward considering cost/heal and stall time/ your mental comfortableness with treating between the 2 options.

If you go with an spl, stall is the safest option just imo, hay to keep occupied 24/7, and make sure you have the extra materials on hand and get a crash course from the vet on how to splice and fix the line, not that it makes it any less nerve racking.

Oh and I was told to change the rubber gasket on the popsicle stick vial braided into the mane every other day too, lots of rebraiding and retaping the stick to the mane, not to mention wiping the gasket with alcohol wipes each time…because…rolling, laying down = germs that can get into the line, just another worry about something breaking or getting dirty…

Again, clinic/vets office for the spl duration is sooooo worth the cost vs mental stress, just based on my experience this summer. Either way good luck and I hope for healing and happiness no matter which route you take!

[freshman]

Totally recommend placing the SPL at this point. Hopefully her eye will improve with the increased and more regular medication doses that she can get through the lavage system. Since she is getting so resistant to eye meds as it is and you are losing your only helper then it is probably the only way to continue to treat her at all.

Get the sleazy. Can’t hurt and might really help prevent her from snagging the SPL line and either breaking it or pulling the lavage out entirely. Go into it knowing that she may do this anyway. Because it’s not if something goes wrong with a SPL, it is when. Then only the details matter like how badly it gets forked up and how often. The are just an inherently fiddly biz. You can fix most things yourself in most cases if you are just patient and resourceful doing things like splicing the line if it gets pulled a bit and breaks or leaks. And hopefully you have a vet that will be responsive and able to come out to fix anything that you can’t so that she doesn’t miss more medication doses for too long.

That said, do what you can to minimize her risk of catching it on stuff. Now is the time to tape up the j hooks on her water and/or feed buckets if you’ve not already done it. Stall confinement with hand walks only is best. But if she won’t tolerate being stalled 24/7 then some small solo turnout is what most people do. Small space often minimizes the crap she can get it hung up on, but certainly doesn’t eliminate it. Solo completely eliminates the possibility of other horses chewing or dinking around with it. But if she’s gotta go out with company, then at least she’s a mare. Typically mares don’t engage in all the bitey face behavior or regularly nip/grab/play with each other like geldings do. Nor will they usually put up with other horses who do. Hopefully she is mare-ish in this kind of way!

Best of luck. Eye problems are just the worst. Expensive and frustrating to treat at best. And the longer they go on, the exponentially more expensive and more frustrating they get, that’s for sure. But hopefully her eye will turn the corner and start to improve with the SPL in place to get the meds in there more efficiently!

[freshman]

Replying to what @carman_liz said regarding being afraid of the SPL system itself. Most people are actually pretty intimidated just doing the treatments themselves and more so of trying anything to troubleshoot it when things go wrong. This is completely understandable. SPLs are weird and bizarre and unlike anything that most people have ever seen or managed themselves. But bacterial colonization of the lavage system is actually pretty uncommon. They have proven to be very safe in that regard over many years. It is not an IV catheter, so air bubbles won’t kill anything or be anything but annoying to the horse.

And while it is definitely important to be as hygienic as possible when handling the port, etc, just follow the directions your vet gives you as well as possible. I find it helpful to remind myself and others that prior to the SPL placement, that eye meds were being placed in the eye off the finger out of multi dose tubes. Think about that! Obviously you do that as hygienically as possible, too, but it is certainly not a sterile process or even nearly so by any stretch of the imagination. And you can definitely contaminate the eye with new bacteria medicating the eye directly by hand. I knew a horse that got MRSA in its eye after being treated manually for an eye problem for a long period of time. It happens, but rarely, just like with the SPL system. The point is to respect the SPL system but not be afraid of it, either. Hope that helps a little?!

[carman_liz]

All of this, but just to clarify, it was the medicine bubbling out of the hole in the line that made me go “No…NOO…SH^+ NOOOO!!!” And the fact that he was so young and I was by myself for most of the medicating.

[MsM]

Many years ago a fellow boarder’s WB mare punctured her eye. She returned from the clinic with a lavage line. Since she was over17 hands it was really necessary. She wore a slinky and a mask. Treatment worked well and she had private paddock turnout. She likely didn’t have much vision in that eye afterwards but kept the eye with no further problems.

[Pico_Banana]

Thanks to everyone for sharing their experiences. Had the vet out yesterday to take another look and discuss options. It is no longer healing as it should be so we have decided the kindest thing to do is to remove the eye.

[carman_liz]

Big hugs!!!

[Pico_Banana]

In case you are interested . . . vet texted after the last visit and wanted to try a different treatment because why not. New stuff is silver sulfadiazine, which looks like slightly soft zinc oxide. I started treating her with that on Saturday night and stopped the antibiotic and serum. Am not sure how much I’m actually getting in as horse is not tolerating treatment well, per above. But I can apply with a gloved finger and just try to massage it between her clamped shut eyelids. And she is resisting treatment less than she was a week ago.

Vet was out today to do a final recheck before surgery scheduled for Monday. And we were all happily surprised to see her eye is looking noticeably better! She is holding it open more and the ulcer is visibly improved from a week ago.

With the return of healing and a manageable treatment plan, we have cancelled the surgery for now and are going to give it some more time to see if it will heal. Vet believes there may be something fungal going on and the new ointment is addressing that. I wonder if her eye was just irritated from the antibiotics for so long. But whichever one it is, I’ll take it!