Case 1: A stubborn corneal ulcer.
March 18th, 2011
Rusty is a 32-year-old Quarter Horse gelding. He had been battling a persistent corneal ulcer for several weeks when North Florida Equine first examined him. A thorough ophthalmic exam was performed, including a good search for any pieces of grass or debris that could be causing the ulcer to persist. The cornea was debrided and samples were collected for cytological analysis.
The green color of the ulcer in the picture below comes from a special stain used during the ophthalmic exam. The stain only adheres to areas of the cornea that are damaged, allowing the presence and extent of a corneal ulcer to be accurately determined.
Fungal infections are always a concern in Florida - so treatment with topical anti-fungal medication was initiated in addition to the topical antibiotics Rusty was already receiving. We also wanted to make sure his pupil was well dilated, so a drug called atropine was also used. This helps with pain and prevents the pupil from getting stuck shut! Rusty was also started on a systemic pain reliever because these ulcers can be very painful. A good fly mask was recommended to be worn at all times.
March 22nd, 2011
By now Rusty had been having his eye treated for several weeks. He was tiring of ointments being placed on his eye and was getting difficult to treat - as most of us would be at this point! The decision was made to place a "Subpalpebral Lavage" (SPL) system - a long medical term for a tube that would go under Rusty's eyelid and deliver the medications directly onto his cornea - without having to pry his eyelid open. This makes treatments much easier on horse and owner. The small tubing makes it necessary to use liquid medications instead of ointments. Liquids don't last as long on the surface of the cornea, so Rusty's owner made the commitment to treat Rusty's eye SIX times a day - sometimes even more often when he could. This was an immense undertaking from a very devoted owner. Some changes were also made in Rusty's medications, including the addition of using his own serum on his cornea to help with healing.
In the picture you can see the tubing which runs from a braid on Rusty's mane - where his owner can insert the medications - to under his eyelid - where the medications are deposited directly onto his cornea.
- March 28th, 2011
The ulcer appeared to be holding ground, possibly even larger and definitely no smaller. You can see in the picture above that the blood vessels have made it to the site of the ulcer - a very good sign for healing. Although not seeing any reduction in the size of the ulcer was quite frustrating. Older horses can be slow to heal, especially when they have Equine Cushing's Disease. The possibility of Rusty having Equine Cushings Disease complicating the rate of his healing was discussed. The treatment for Cushing's is a drug called pergolide. Rusty's owner decided to start him on pergolide in the hopes that it would help. All other topical treatments (antibiotic, antifungal, atropine, & serum) and the pain medication were continued without change.
- April 4th, 2011
Finally, evidence of healing! The ulcer was dramatically decreased in size. Although faint, stain uptake is evident in the upper right hand corner of the picture. All treatments were continued without change.
- April 11th, 2011
More progress! Although the ulcer continues to heal - stain uptake was still present. We knew we were on the right track and scheduled a recheck in one week - hoping to find the ulcer would finally be gone. Fingers crossed!
- April 18th, 2011
Four long weeks of treatments every 4 hours and the cornea was healed! There was no evidence of stain uptake. Some corneal scarring was evident (the whitish haze) - but Rusty was comfortable. We planned for 5 more days of treatment with an artifical tears solution to ensure complete corneal healing before we removed the subpalpebral lavage.
- April 23rd, 2011
This is Rusty's eye on the day of lavage removal. His eye is comfortable and he was very much looking forward to some increased turnout time! It was a long four weeks (even longer when you include the time prior to the lavage placement!) for Rusty and his owner - but thanks to a very dedicated owner who spent long hours administering medications, Rusty's eye was saved. What a lucky horse!