Uveitis questions

[Pehsness]

Hi all, I’ve done a search and read/learned a lot, but thought I’d see if I could glean any more information from people who have BTDT. This will be long, sorry.

I have a horse with uveitis. I’ve had him for 3 years or so. He came to me with a scar on his eye (it was disclosed) but presented no issues. Then one summer it got inflamed, vet was out, said it was uveitis and gave me the tobramycin. Cleared right up, no more issues. Until now. He had another flare up this summer that was easily controlled. Then he got late fall needles/dewormed and it flared up and now that I know (much, much) more about the disease, I can see it’s not getting as better as I would have thought with the treatment regimen (tobramycin and banamine).

I understand the disease and the progression, I know it can have varied initial onset triggers. I believe his was trauma due to the scar on his eye. He still has vision in the eye.

I have a regular UV fly mask, and I bought the Guardian Mask. He won’t keep the Guardian mask on, so I have to get creative with extending the velcro straps to try to get a better fit.

Does any one have any suggestions for further treatment or even alternative therapies? I’m steaming his hay in case it is allergies. He wears the mask all daylight hours. Not at night because he lays down in his stall and I worried the mesh would be pressed on his eye. I googled and found an equine opthalmologist and reached out, but they only take referrals from vets. Would that be worth pursuing, or is a regular vet going to be enough?

He’s otherwise fine and going better than ever. But now that I know more about the disease I know it’s painful, so I want to make sure I am doing everything possible and not asking him to work if in fact he is feeling pain I’m not aware of.

Appreciate any insights!

[pokie]

I’m so sorry to hear about your horse. I have a cushinoid mare who also is having severe eye problems. I have had multiple vet visits from multiple vets, and no diagnosis yet so I’m taking her to the equine ophthalmologist next week (the local vets don’t want to diagnose a chronic ailment maybe?) I’ll be interested to see what responses you get. So far she has only been prescribed dex and something to dilate her pupil, but she’s in so much pain and the treatment isn’t working at all…

[XXS]

Uveitis there is a possible surgery (aqueous humor, if caused bei Leptospira). Boost the immune system, avoid stress, offer a shed. One of my horses was misdiagnosed with ERU, turned out it was an allergy to polls -> ophthalmologist or clinic only for diagnosis!

[No1]

Tobramycin is an antibiotic. I’m not sure why it is being used in a horse that doesn’t have a corneal ulcer.

Diclofenac or flurbiprofen are usually the ophthalmic ointment of choice for non-ulcerative uveitis. Both are topical anti inflammatories.

You definitely need a consult with an ophthalmologist or at least an internal medicine specialist.

Recurrent uveitis is very common in Appaloosas but may also be caused by immune mediated disease or tick born diseases. Has any blood work been done on the horse?

If you can say what state you’re in people may be able to offer suggestions for a DVM that will not need a referral. Most vet hospitals have ophthalmologist and will see you with no referral.

[No1]

Just wanted to add that, if your vet insisted on an antibiotic AND the horse does not uptake stain, neo-poly-dex would be a much better choice.

[theresak]

There’s a horse at my barn with reoccurring uveitis and her regular treatment is oral banamine and neo-poly-dex ointment twice a day, atropine once a day, and a UV mask 24/7.

This horse actually just had surgery to insert a cyclosporine implant, which should last several years.

[Pehsness]

Maybe I’m getting the name wrong on the ointment? It’s a steroid. Same one my daughter had after cataract surgery. I’ll have to check.

Old threads suggested the cyclosporine implant was no longer recommended?

[candyappy]

We have a mare who battles it too. As per my vet— I try to identify what has triggered any current episode and treat accordingly. I use either Banamine, eye ointment and on occasion a round of Dex if it is suspected to be allergy triggered.

Now that colder weather is here we are trying to leave her unmasked and so far so good. Sometimes she may rub it ( masked or not) and we find it swollen and weepy. If not painful I put ointment in. If painful I do Banamine and 99% of the time it is normal the next day.

With a bad flare up we do Dex and Banamine or Ointment/ Banamine but that happens very rarely. It seems so many horses are different in their affliction.

[Pehsness]

yes - it does really seem to vary, the more I read!

I just googled, and the ointments it Torbadex (still may be spelling that wrong). So the tobramycin not indicated for a virus, but yes to bacterial. So how do you determine?

I am going to ask for the referral to the ophthalmologist, see if that sheds any more light.

[candyappy]

My ointment is Poly --something or Neo Poly - something?? My vet only had 1 tube and couldn’t get any more as it was back ordered at the time so I try to use it sparingly if I can.

[fatappy]

I’m a few years removed from treating ERU, but i can speak to the masks. I had one with a hard bubble that was completely blocked out sunlight and while i thought it was cruel at first, my horse really did well in it, and if the horse really has ERU and not allergies, you’ll probably get to that stage eventually. Mine had snap-in fleece around the cup, but i never saw my mare laying on that side so know if it interfered with her sleep.

[Pehsness]

I bought one of the Guardian Masks - they have the hard eye bubble things. Holy $$! And this was after spending $100+ on a regular UV fly mask this summer. Hey, if it works, right? But it doesn’t seem to fit well. It’s the right size (unless he needs custom, but I doubt it) but it just doesn’t seem comfortable. too big over the crown, too small across the jowls. But I’m going to see if I can get creative with it.

[No1]

Uveitis is not (necessarily) a virus. None of the meds mentioned above are antivirals.

Uveitis gold standard treatment is usually an immune suppressant and/or anti inflammatories. Cyclosporine implants are more often used for keratitis. Enucleation should be considered if the eye is refractory to treatment. However, uveitis usually effects both eyes to some degree.

[No1]

I’m guessing based on the name, but the ointment you use probably contains Tobramycin (the antibiotic) and dexamethasone (the immune suppressant).

[Pehsness]

Vet is coming for a recheck today and to see if it warrants a referral. I know I can always insist on the referral (at least, I assume I can). Appreciate all the insight and thoughts! Even if the end result remains the same, I always feel so much better when I understand what is going on.

[Simkie]

@candyappy

My ointment is Poly --something or Neo Poly - something?? My vet only had 1 tube and couldn’t get any more as it was back ordered at the time so I try to use it sparingly if I can.

I’ve just gone through three tubes in three weeks (stubborn scratch that was slow to heal, finally looking better!) so it seems like it’s available again

@Pehsness I’d pursue getting an opthalmologist’s view of things. Generalists have a pretty basic toolbox for eyeball stuff. A specialist should be able to guide you much better.

[4horses]

I have one with the condition. My advice would be to remove the eye as soon as he starts losing vision. As over time you will easily spend that money with daily treatment… On the 1st flare, my boy was diagnosed with conjunctivitis. Didn’t get better with ointment over the weekend. Took back to the vet, was then correctly diagnosed but at some point over the weekend he had rubbed his eye and gotten a cataract. Started on banamine, neo poly dex and atropine. Then he went and put an ulcer in the eye, had to stop the neo poly dex and start antibiotic ointment.

Next flare went the same way. This time a big ulcer in the eye, had the ulcer debrided (uses a q tip to give it a clean surface for healing). If you treat for ulcers, you can’t treat for the inflammation uveitis causes. So more vision loss.

After that I started daily treatment with eye drops for months. Discontinued them and had another flare. Bought a hood with a plastic cup to protect his bad eye. Like the blinker hoods used in racing except with a full plastic cup. Started attaching that to his halter with Velcro.

It does not get better. It does not go away. Better to just remove the eye immediately. As each flare required multiple vet visits due to him scratching it and causing complications. $$$.

Treating him was difficult because he started flinging his head violently and pushing you around, trying to get away from you, rearing up. I stopped treating the eye and just give oral steroids and banamine for pain. Not worth getting injured over and with uveitis it generally resolves in 10 days even without eye drops, provided you can keep him from trying to scratch the eye.

I retired him out to pasture. He viewed every treatment as a personal attack.

Try the eye drops, use the masks, get a hood with a cup and see how things go, but start planning ahead as to if/when you want to have the eye removed and how much you want to spend before that point.

With a more willing horse, you may have better luck with treatment.

I know someone with an old blind horse and why she didn’t just put the poor thing down, is beyond me. As it continues to have flares over the years and scratch the eyes… Can’t be comfortable. So be prepared for euthanasia if the horse should go blind or if you can’t afford to continue treatment. Eye removal is the only way to stop the painful flares.

The only good news is that it may never jump to both eyes and it is very slowly progressive. So you may have many years together yet. It may go several months without a flare even without treatment.

[Pehsness]

Revisiting this to see if anyone has any tips when your amazing, placid, let’s you do anything to him gelding has decided he doesn’t want 3 different ointments in his eye every two hours…

I’ve googled and already do the trick where I slide my hands under his halter. I’ve tried with gloves and gauze on my fingers. I treat after every administration. He’s just pissy and puts his head up and says no. I don’t have a helper.

[Pehsness]

4 horses I appreciate your post. I’m pretty certain at this point enucleation is in our future but want to give it a good try first.

[Hippolyta]

Sorry, but I am bored/avoiding work and want to add nothing to this conversation.

My boss was diagnosed with autoimmune uveitis. My response: “Appaloosas get that”

Sorry, he shared, I commented