Third Eyelid Removal for Squamous Cell Carcinoma - at clinic, or ok at barn...? And biopsy - yay or nay?

A couple of ophthalmologists said, based on looking at photos, my 11 year old gelding probably has squamous cell carcinoma of the third eyelid. 2 of the 3 different vets who examined him in person (primary reason they were out was for a lameness exam & the eye was a “by the way, can you look at this?”) said it could be UV irritation or SCC & one of them gave me an ointment to use, saying if it didn’t clear up it could be biopsied; one said the eye looked fine to him. It was first noticed in July of this year. The ointment didn’t seem to have an effect.

My options - biopsy, wait for results, and if positive for SCC, remove the third eyelid.
Or skip the biopsy, based on the opinions of the two ophthalmologists, and just have the eyelid removed and sent to histopathology for confirmation.

Less money and stress for my horse, and I don’t have to wait for lab results back.

Is it foolish to remove the eyelid based on photo diagnosis alone, and not do a biopsy (SCC is pretty small small… also wondering whether it could give a false negative)?

RE: eyelid excision - I’ve read a number of posts here where the excision was done at the barn, under standing sedation. One of the ophthalmologists who looked at the photos said that she does eyelid removal with the horse in stocks under deep standing sedation. So another consideration is whether to have the excision done at the barn - again, less money and less stressful for him, and also I’d be avoiding hauling him on potentially snowy roads - or haul him to a clinic for the procedure. The barn where he’s boarded is heated and has access to hot/cold/boiling water, if needed.

I’m still trying to decide who would do the excision - a local vet who does have a special interest in eyes and is considered the local “go to” for eye care (not a board certified ophthalmologist, though), has done procedures at my barn/my trainer’s barn, who I believe is very careful and who is well-thought of, and who recently built a clinic at his home about an hour away. Although he’s not my main vaccination-giving vet since moving to this barn 2 years ago, he’s taken care of my horses in the past and I have a good relationship with him.

Another option is a traveling ophthalmologist (board certified, does work on horses, but is primarily a small animal vet) who would want to do the excision in stocks, which would be at the clinic of another vet in the area (coincidentally, at the clinic of the vet who said he thought my horse’s eye was fine). An alternative is to visit her clinic which is about 2.75 hours away (again, more stressful due to hauling/hauling in winter). We’ve corresponded via email; she comes across as very professional and knowledgeable. I don’t know if she’d want him to stay at her clinic, or whether he could come home same day as the excision.

I feel like I’m going in circles on this. I want to balance not having to haul in the winter/haul more than an hour away (I don’t have a trailer and would need to figure that aspect out), stress my boy as little as possible (at his barn would be least stressful for him), and give him the chance for the best outcome possible.

Not having gone through this before, I’m not sure if I’m making a mountain out of a molehill RE: the excision - it’s been described as a simple snip - but also want to be diligent about choosing the right care, since this is his eyesight we’re messing around with. (PS sorry the pics are massive - not sure how to adjust that)

Any input/advice/shared experience would be greatly appreciated!




What are the risks/downsides to removing the whole eyelid? If they are significant, I’d just biopsy it first. If removing it doesn’t really do anything, then it might be easier to just remove it.

As far as where/when to do it - do you know how quickly this area has grown? If it’s been very slow, can you wait until the weather is better to haul him? Eyes always worry me, and unless you have a very, very knowledgeable barn manager, I’m not sure that is after care that I’d trust someone at my home barn to do, especially if there are eye drops to administer afterwards. FWIW I did eye care myself as a tech in a hospital, and I’d probably still take a horse to a clinic for eye procedures/care instead of doing it at home. They do surprisingly well at the hospital even if they have to stay for a few days. Every time I’ve taken one in (including my personal horse who can’t stand change/moving barns), I’ve been shocked at how well they adapt.

As far as which vet - is it an option to go to a large equine hospital with an experienced equine opthalmologist? Both of your options seem less than ideal, but maybe those are the only options?

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My mare had a mass on her 3rd eyelid removed at a university hospital about 7 years ago. It was an outpatient procedure. The hospital is about 1.5hrs from my home.

Several vets over the years had offered to remove it at their private clinics or even at home in the barn, but I’m glad I went to the university hospital.

We did not biopsy first. Several of my home vets were sure it was SCC. One even thought it metastasized to my horse’s brain, which is what prompted me to finally schedule the procedure.

Well, I’m glad I went to the university hospital because it wasn’t SCC or even a tumor. It was prolapsed fat from an internal conformational defect with her third eyelid. Even though that didn’t change the outcome, I’m glad I had the ophthalmologist handling it who was experienced with these types of abnormalities. A general practice vet unfamiliar with such defects could have really screwed my horse up when it turned out not to be a simple mass excision.

We still sent the eyelid to histology and found no signs of pathologies.

Also, the university was surprisingly affordable. I would have paid the same or more with a general vet.

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I think the hospital would try to do it standing as well, so I don’t know that I’d hesitate to use someone with a lot of experience with the procedure at the farm versus travel if you get winter weather. CSU was researching a treatment for this with the goal of avoiding surgery (not an uncommon cancer out here at elevation, especially for paints). I am not sure what came of this or if it’s still in trials.

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My horse (a pinto) developed a squamous cell carcinoma on his third eyelid when he was 10. Local vet did not know what it was, but did not like the look of it, recommended horse going to Cornell Veterinary Hospital, 4 hours away.

We went up, had a biopsy done, vet tried to remove all of the lesion at the same time, but the biopsy came back with no clear margin.

Returned for more surgery. Went up one day, surgery the next, went home on third day. General anesthesia (they dropped him) with follow-up radiation immediately post-surgery. Cornell vet told me he was to wear an eye-covering mask when outside all the time (when turned out and when being ridden).

Surgery was a success–he lived another 10 years, no recurrence, before suffering a fatal stable accident.

The mare my friend bought had SCC. Hers had already invaded the cornea so they removed the entire eye.

Then her good eye developed a white mushroom looking something when you looked into eye itself. I don’t know what that was. I can’t imagine it was anything good.

My dog had to have his third eyelid removed. There was no recurrence and it was a straightforward procedure.

As far as I can tell, the main concern is that the eye needs to be protected from UV rays after a third eyelid excision, i.e. wear a protective eye/fly mask while outside. Living in Michigan, the UV exposure is pretty low in the winter and not as bad in the summer as it is in the south/sunny areas of the country, so this might not be that big of a deal. And then in general, the risks that are associated when any type of medical procedure is performed - infection, irritation, mistake in the procedure.

First noticed it in July; it doesn’t seem to have changed much. But I’ve read and heard enough accounts from people who ended up having disastrous consequences because it wasn’t taken care of sooner rather than later that I’d like to get this done as soon as possible. I was so focused on his tendon healing that I set his eye issue aside, but I feel that now is a good time, before it gets too close to show season, to take care of it.
And yes, I agree with you - I think my horse would do fine at a clinic, even though he’d be happier at his own barn.

The nearest equine ophthalmologist I know of is in Kentucky. Michigan State is about 1.5 hours away; at first I thought I’d go there, but their ophthalmologists are small animal specialists who also do equine, similar to the traveling ophthalmologist I mentioned in my first post. They would not be doing the surgery - a resident would be. I’m not comfortable with my boy having a procedure where I don’t have a say in who and/or I don’t know beforehand the person who is doing it.

I’ve actually heard nothing but good things about the local vet with RE: enucleation, eyelid and cancer/tumor removal, cornea treatment, etc. So even though he’s not a board certified equine ophthalmologist, he has had a lot of experience with eyes.

Thank you very much for your input!

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Interesting that it wasn’t SCC but you had vets who thought that it was. The equine ophthalmologist and small animal ophthalmologist-who-also-does-horses were fairly strong in their opinion that it was SCC, but…medicine is an inexact science, after all. It’s a story like yours that makes me think I should take the time/extra step and do the biopsy.

Thank you for your insight!

If your horse has developed this because the inner eyelids are pink and not brown or black (even if the eye is not blue or wall eyed), you will want to use UV protection anyway to keep it from developing in the other eye. My solid chestnut has pink third eyelids, and the first thing my vet said when horse got to Colorado and we were catching up on some vaccines was that he’d need to wear a mask. Even in winter, I’ll still use a fly mask unless it’s actively precipitating for things like snow glare. I don’t typically cover his eyes for most rides though, but they do make goggles for that.

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As a veteran of what turned out to be SCC and third eyelid excision with my then 16 y.o. chestnut gelding, if I could have done it at home, I would have.

The procedure, outpatient, over in about two and a half hours, including waiting for him to be perky enough to ride home two hours on winding roads, was successful. We’re just under two years out, so that’s good. Staying at home would have reduced both the stress and expense, though.