Eye removal. Prosthesis or no?

[MojitoMare]

My mare Mojito was injured in a barn accident on May 8th. Her right eye was completely destroyed. We called the vet out right away and she came and did first aid and said that after the trauma has calmed down some, we will have to have her eye removed. The surgery for eye removal is scheduled for May 24th. So far Mojito is adapting better to her loss of vision than I expected her to.

My vet has asked me to decide if I want to put a prosthesis in Mo’s eye socket during the surgery. She says the prosthesis is just flat and will help to fill in the hollow that you some times see when a horse has lost an eye. I’m inclined to go without the prosthesis and here is my thinking. First, it seems a foreign body under the skin would have the potential to become infected or irritated, requiring removal surgery. And second, when people look at Mo, I want it to be obvious that she is blind on one side. I’m hoping it will be a reminder to people to be cautious on her blind side.

The empty socket look doesn’t bother me. But I also don’t want people to be repulsed by Mo. She’s such an amazing mare that has been through so much and she’s not letting this get her down. So I want to make the best decision for her. What do you guys think?

[Foxglove]

I think I’d ask the vet what her recommendation is —seems like an open socket might collect debris. But I can see why you would be concerned with a prosthesis, too.

[Belowthesalt]

When my old gelding developed glaucoma, it was too far gone to treat medically, so the eye had to be removed. The veterinarian who did the surgery sewed the eyelids together, then made an incision above the eye and removed it that way, then drawing the skin over the socket so that there were two layers of skin over the empty socket. The horse was a dark blue roan./black, and when it completely healed, from a distance you couldn’t tell he was missing an eye. He continued to be able to jump safely, though at that time, the late '70s, I could not event him any longer. The rules are different now and a one-eyed horse can be competed. I continued to ride and show him at the high schooling show level, and eventually sold him to a family who wanted a field hunter/trail horse. The kept and rode him until he died at age 25.

[clint]

Years ago I boarded my vet’s horse, who needed to have an eye removed because of advanced uveitis. They tried a prothesis, and the mare developed an infection from it. Ultimately the prothesis required a second minor surgery as it had to be removed, and she did fine for the rest of her life without it.

[furlong47]

I rode a one eyed horse, and he did not have a prosthesis. Aside from occasionally having to clean out the sunken in area (and not very often - stuff really did not accumulate in there like you would think) there weren’t any complications. I would agree that you probably want to avoid adding a foreign object to the body if at all possible. It’s not going to look like a normal eye either way.

They adjust quite well to being blind in one eye. Being careful approaching the blind side was the only real thing I had to be aware of. Don’t walk up on that side quietly.

[rockonxox]

I’ve known quite a few horses in my lifetime that only had one eye. None of them had a prosthesis. I would say go without.

[Training_Cupid]

Sorry about your horse’s injury, but glad she’s handling it well. I think you are correct, the prosthesis is mainly for our benefit not the horse’s - the horse doesn’t care and it does carry some risk of infection, but many people think it gives a more normal appearance. Discuss the risks with your vet and decide based on that.

[fanfayre]

I had a prosthesis put in a mare’s eye socket. It lasted ~5 years before it had to come out. She spent the rest of her life with a sunken socket that made not one bit of difference to her, except she no longer had pus :eek: (still shuddering from the experience- ook) and the associated pain.
I 2nd rock’s suggestion above^

Also sorry about your poor girl’ injury

[DoubleDown]

I just talked with my vet about this. Her 25yo appy gelding is missing an eye, she removed it about 6 years ago. He does completely fine without it, and she did say that she has seen infections come from the prosthesis, and didn’t even consider doing it for her personal horse. He packs her 12YO daughter around like a champ teaching her how to jump. He’s a saint!

[BeeHoney]

No prosthesis. The shadow created by the empty socket is dark and sort of looks like an eye is there unless you look closely. I had a one eyed horse–most people did not immediately notice the missing eye. Part of it may have been that she tended to position herself so that she could see what was going on, which meant that people were usually facing her good side. If you are worried about the look, just let the horse’s forelock grow a little longer.

[Pennywell_Bay]

My horse lived with the empty socket with no issues for years. Looking back, if the accident happened when he was younger I would have done a prosthesis- not the fake eye, an internal sterile ball to keep the socket from sinking. I rode and jumped him tiny jumps even after his enucleation. He was in his 20s when it was removed, hence not implant.

Hey- they make Neuticals for dogs for people who don’t want their pets to have empty sacks

[Toblersmom]

I vote no. I’ve regularly heard of complications with implants, never heard of any long-term problems with leaving the socket (leaving aside the kind of complications that can happen with or without an implant, like leaving behind a bit of tear gland). Not to say they can’t ever happen, or that some implants do just fine forever and ever, but the odds are definitely higher for running into problems sooner or later with than without.

[fanfayre]

Ah, actually my mare’s was the sterile rubber ball like Pennywell Bay mentioned, not an actual prosthetic eye, if it matters.

[findthedistance]

I have handled a horse with a prosthesis and a horse without. I think the prosthesis is a little more attractive, but it’s really not a big deal either way. Whatever makes you (and the checkbook!) happiest.

I wouldn’t worry about needing to remind people about the blindness. Horses generally adapt incredibly well, and people generally overreact. There’s a one-eyed horse at my farm right now and I spend most of my time begging people to treat him like a normal horse. He has really good spatial awareness. The only accommodation he needs is not running him into things when going through doors and the like.

[Hopeless]

Like so many others here have said, I had a one eyed horse and did not have a prosthesis put in. She wasn’t bothered and neither was her best mare friend.

I didn’t care, but as I was a teen at the time I did make her an eye patch just for fun. I didn’t really use it except for fun. I mean who wouldn’t want to ride a pirate horse! Arrrr!!!

Stuff doesn’t really collect in there, but just use a regular face brush to brush the area. She did like to be rubbed on that spot. Oh she was a good horse. (sniff … now I am sad thinking about her)

[VFT]

Not a horse, but I have a one eyed dog and he does have a prosthetic. It is silicon and the lids were stitched closed over it. i think it helps keep some of the muscles in the face normal and functioning normally. He even " blinks" that eye still. I am happy I chose to go with the prosthetic, and have had no complications from it.

[BeastieSlave]

I considered it just another thing that could be a problem and chose to go without for my mare. I don’t think prosthetics really look that natural - since the eyelashes are removed. FYI, they still ‘blink’ with an empty socket.

[Toblersmom]

As a veterinary radiologist, I am very, VERY dubious of ANY procedure described as “very perfect, NO disadvantages, NO complications.” Doubly (maybe even quadrupally?) so with any procedure that involves cutting open any portion of the body and sticking something else in there that is intended to stay for the rest of the patient’s life. I’m prepared to accept that complications are low, but the possibility that they are non-existent is vanishingly small. Here’s an excerpt I found

“(b) Scleral cup prosthesis: In this technique, the entire contents of the eye (vascular coat, lens, retina, vitreous etc.) are removed (evisceration) and a spherical silicone implant is placed within the scleral shell. There are ethical arguments for and against doing this procedure because of potential complications after surgery. It is a valuable procedure for owners who would have their animal euthanised rather than lose the globe / globes completely. Not all cases are suitable for this procedure. It is contraindicated where neoplasia or infection within the eye are suspected. It is also contraindicated with pre-existing corneal disease. The intact globe is not available for histopathological examination, which may result in the failure to diagnose the underlying problem. Tear production can decrease after this procedure. There is a risk of corneal ulceration and of delayed corneal healing, which could lead to globe rupture. Occasionally, the sutures may dehisce and the implant may be extruded. There will be ongoing care required and there is a greater risk of complications. The advantages of this procedure are that it is less traumatic overall, and a mobile globe and adnexa are maintained. Some owners prefer this technique as they feel that they do not want to reduce the emotional bond with the animal’s appearance. However, the appearance of the eye will be different, and ideally the owner should be shown a photograph of the typical outcome to ensure that they find it cosmetically acceptable (Figure 11). Evisceration is a difficult technique which should only be performed by veterinary surgeons familiar and competent with the procedure.”

Here’s one specific to horses:
"The main complications of evisceration and intrascleral implants are extrusion of the implant and corneal ulcers. Protective eyecups will help prevent irritation from head rubbing. The scleral incision can dehisce to reveal the prosthesis and necessitate implant removal.(30) The silicone implants can be rejected due to intrascleral infection and necessitate removal of the globe. Corneal ulcers can occur due to reduced corneal sensation. Placement of too small an implant will result in a cosmetically unacceptable eye. Owners should also be warned that corneal opacification and vascularization will occur in some animals such that cosmesis is not completely normal. Corneal opacification in show horses can be masked for short times with tinted contact lenses. x

Emphasis mine. Veterinary ophthamologists or other surgeons with the skill sets to do this competently are not exactly thick on the ground, particularly in rural areas where the horses are. I’m sure the risks are low in your skilled hands, but to suggest that they don’t exist is, frankly, malpractice.

[Ksenia_Esenina]

Thanks for you qualified reply and sorry, I’m not skilled enough in English to write a lot of words quickly but I’ll try…

1. For my opinion, all type of operation MUST performs by skilled surgeon. Simple operations do not exist in principle. Operation without complication - do not exist in principle. If we have sever, erreversible eye pathology and we can’t save the eye - we MUST make the operation despite of the risk and complications.

2. Enucleation or exenteration (if sever infections or oncology process in eyeball or orbit) - are MUCH MORE dangerous, difficult, complicated, traumatic, painfull and bleeding operation than evisceration+intrascleral implantation.
   As an operation syrgeon (not radiologist), I realy saw the fatal complications in enucliation (if this type of operation performs NOT skilled doctors) and never saw fatal complication in evisceration. This are not only literaly facts but also my more than 20 years practical experience.

3. If we talk about “military field surgery” for horses - doubtless, enucleation- the only choice. If the horse lives in heavy, rough conditions in dirty invironment, enucleation- the only choice (BUT in that environment the horse have NO chance after ever type of operation, infectious complications - inevitable). If the horse costs nothing - it will not operate at all and will be handed over to the meat - this is the real life and I know that. But if we compare which type of surgery to choose for favorite horse if the eyeball is not destroyed, the Intraocular Prostesis Insertion - the best type of operation. Let me explain:

The time of operation (Intraocular Prostesis Insertion): 20-30 minutes.
Depth of anesthesia: middle
Painfulness: middle
Traumaticity: minimal
Risk of fatal complications: minimal
Functional resulf: perfect
Cosmetic result: very good

Certanly, if the horse has infectious or oncology process - only enucleation.

4. The “horrors of the intraocular prosthesis” about which you write -are not your own experience. These are consolidated literature data for all huge history of surgery of horses. But thank God - the veterinary medicine does not stand still, what used to be extremely complicated, today it is effectively, reliable, and absolutely real. Certanly ONLY IN SKILLED HANDS. If the surgeon does not have skilled hands -why do you need such a surgeon??

5. For my opinion, your fears about “cutting open any portion of the body and sticking something else in there” strange sound from the doctor’s mouth. If this is you principal position, what do you say about: cardiosurgery, cataract extraction, spinal and neurosyrgery and what about stomatology and traumatology??? Enucleation, amputation and appendectomy - the only types of operation that you prefer in humans??? Veterinary medicine does not need in progress???

I apologize in advance if you find it too emotional.

[alibi_18]

@Ksenia Esenina
I reported both your post.

I suggest you go sell your « medecine » elsewhere.