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| Discussion on Stromal abscess | |
| Author | Message |
| New Member: Gaelwolf |
Posted on Friday, Aug 1, 2003 - 3:54 pm: We have a horse who has a stromal abscess of the eye that we are treating as aggressively as possible, and would like to pass along some information that might prove useful to other owners who encounter this problem.Two weeks ago, our TB hunter-jumper and all-around Good Guy presented with a corneal abrasion that was diagnosed by our vet, and treated routinely. The next day, the eye had improved, though there was a small white spot on the cornea. The following morning, the white spot was no longer small, and the eye was in much worse condition, with the anterior chamber becoming cloudy, with increased conjuntival swelling and discharge. It was a Sunday, and there was only one vet available in the region...fortunately the best one possible for this case. When she arrived, she diagnosed the stromal abscess, and prescribed an aggressive treatment course for both bacterial and fungal sources of infection, though bacterial was the more likely, given the speed with which the abscess developed. The animal opthalmologist who lives in town was gone for two weeks, so she consulted with one of the other three good ones who work within three hours' drive. His treatment course so far includes... ============================= A five day course of Uniprim, one pack with breakfast for the first five days Atropine gel 2x per day for dilation, later switched to liquid (0.05 cc) via catheter 10 ml Banamine paste, once a day (morning) Bute paste, once a day (evening...but wisest choice is not to give this at mealtime...), discontinued mid-way into the second week, once the eye started showing noticeable improvement 0.3 cc hypertonic saline 3x per day, alternating with 1 cc sterile normal saline 0.2 cc Occuflox 6x per day (we're experiencing antibiotic resistance issues with pseudomonas infections in the area...Allergan's patent has not run out on Occuflox, and it's available only as a human Rx...and $42.00 per 5 ml at Costco was the best price we found...) Monistat 7, 6x per day, internal pH (since discontinued when scrapings confirmed it isn't a fungal infection) Following the injection of meds into the catheter with an injection of just enough air to push all of the medication through the end of the catheter and onto the eye He is fly-masked 24 hours a day, with the affected side occluded by duct tape on the inside and outside of the mask screening. ============================= Two days later the vet was back to put in a medication catheter above his eye and to take corneal scrapings for more definitive diagnosis. The catheter is a godsend, because we can precisely meter the dosage of medications, and because the horse doesn't fight the treatment, the way he does when you are poking medication DrOppers and gloved fingers in his eye to administer the meds. Our horses are managed through natural horsemanship, and combining that with the catheter means that we are able to treat the horse solo, without having him yanking and banking all over the aisle. We are taking daily progress photos and forwarding them to the vet and the consulting animal opthalmologist with the day's update report via e-mail. Here's links two samples, taken a week apart... https://www.gaelwolf.com/images/stromal_0723.jpg https://www.gaetwolf.com/images/stromal_0730.jpg When we start our treatments, the first thing we do is to dampen a 4x4 gauze pad with normal saline and gently remove any drainage from the corner of the horse's eye, and then use a clean part of the pad to gently clean and massage his face below the eye, which he finds very soothing and helps establish additional compliance between him and ourselves. Once the treatment is finished, we repeat the process, helping build a better emotional place for him to be more accepting of the next treatment time. A small thing, perhaps, but every bit helps. This also gives us a chance to massage along the tear duct, helping keep it clear. The final action is to use the pad to wipe the discharge from his nose, helping to reduce the area's attractiveness for flies. It's still going to take a few weeks, and then we'll still have to keep on top of things with less frequent medication, or so we are informed at this point by the vet and opthalmologist. I'd like to pass along some recommendations, based on our experience with this case. The foremost is to get a treatment catheter into place as soon into the treatment regimen as possible. Eye infections like this are very painful, and this is going to be a rather long course of treatment if you are going to get ahead of it and keep ahead of it to give your horse the best chance of full recovery. Every time you have to mess around applying medication directly to the eye with an eye DrOpper or your finger you are going to get your horse a bit more agitated and resistant to the whole business. That catheter has saved us untold amounts of grief and opportunities for injury to either the horse or ourselves. For at least some owners, I would say that the catheter will markedly increase treatment course compliance...it's not a lot of fun to have to fight with your horse, even for its own good, and some folks just don't want to go there. Medications are pushed into the catheter using a separate 1 cc tuberculin syringe for each medication. We go in the following order... Saline (whichever type is being used for the treatment) Atropine Occulflox This allows the highest concentration of antibiotic on site possible. When the catheter is placed, have the vet be generous with the length. If and when you get pinhole leaks near the locking injection hub, it's handy to have enough length left to take a bit off. Also, if you inject too quickly, or don't have the liquids at close to body temperature, there's going to be a bit of head movement in reaction to the strange sensations, and it's probably best not to be yanking on the sutures that hold the catheter in place. At those cooler times of the day, put the medication bottles into an inside pocket while you are catching the horse. Body temperature meds are tolerated much better when they get onto the eye than cold liquids are... Ask the vet to provide you with several of those locking injection hubs that go on your end of the catheter. They have this annoying tendency to fall off in the pasture from time to time, and it's not easy to find replacements. Use a binder clip to clip the end of the catheter to the top of the fly mask between treatments, with the catheter itself splipped in between the horse's face and the inside of the mask, so that it won't get caught on anything. Wash the horse's face under the eye and down to the mouth after completing a treatment. The eye discharge is sticky, and highly attractive to flies. The stickiness holds sand pretty well, too, if any is availble, and will help abrade the skin at the lower edge of the mask whenever the horse rubs it face against something. Rinse and towel dry the lower edge of the fly mask on the affected side to get rid of the material the eye produces between treatments. When you are injecting the air to push the last of the meds through, make sure you are standing on the affected side and watch the tube at the point where it goes under the skin above the eye. You can see when the air you are pushing is entering the eye area. You can also hear when it starts coming out the end of the catheter, which is going to tickle the horse...something it might not care for overmuch... Be sure to buy more of any particular medication at least a day before you are going to run out of the bottle or tube you are using,particularly during the more acute phases of the infection. Once you start pulling ahead of one of these, you don't want to fall behind again. Also, we've been known to waste some meds through the simple action of accidentally DrOpping the bottle with the inner cap off...something that you don't really want to do at these prices! When you are pushing the medications through the catheter, have them somewhere around body temperature and push the syringe plunger R-E-A-L slow. The better you are at keeping the medication flow below sensation threshold the easier it's going to be on both the horse and yourself. When you put the duct tape on the fly mask on the affected side, make sure you apply it on most of the screen area...on both sides of the screen material. You are keeping the eye dilated, and anyone who's ever had a serious corneal abrasion or eye infection will tell you that there is a whole lot less pain when the eye is in the dark. So...that's where we are today, with the vet coming late this afternoon for a follow-up. This is the two week point since the intial vet visit, and we are a couple of thousand dollars into this thing. It's not cheap, but our horses depend on us to be there for them...so what are you going to do? |
| Moderator: DrO |
Posted on Saturday, Aug 2, 2003 - 7:43 am: Hello Norman, I corrected the URL above and this gives me the chance to remind members you can edit your post for up to an hour after posting.Thanks for the case summary I am sure there will be those who find it useful. DrO |
| Member: Gaelwolf |
Posted on Thursday, Aug 21, 2003 - 2:48 pm: We're now a month into this operation, and have learned a lot...including how to schedule our lives around a six treatments per day regimen.Our guy managed to hook his catheter one day, eventually snapping off the trailing 4" or so, and pulling on his face to the point where the uppler eyelid was held open...fortunately not long enough for the eye's surface to dry out. Realizing that something was not exactly working as advertised, we looked around for a better mask solution, and found it with a Cashel Crusader riding mask, which has finer mesh than a standard pasture mask, which makes it better for the dark times in that 24-hour-a-day wear. The ace in the hole with this mask, though, is that it goes over and behind the ears, completely covering where the cathether runs. It also has an opening for the forelock, so that the braid we are running the catheter through won't press uncomfortably on his head. We completely covered the right side of the mask with duct tape, and made sure that the corners of the tape were anchored, so that he couldn't rub the tape off. Very stylish... Cashell has a lot of anti-insect "clothing" that would be useful for a number of injuries that you want to keep bugs away from, and we think that it's a company everyone should be aware of. You can find them on the Internet at... https://www.cashelcompany.com/ Today we've finally gotten approval to move to a three-times-a-day treatment regimen. HOORAY!!!! We are now providing... Atropine 0.1cc daily Ocuflox 0.2cc three times a day Saline flush as needed if debris and mucous accumulate Bute 2 grams every morning 10 coated Aspirin with evening grain Continued 24-hour fly mask The anterior chamber is now highly vascularized, and appears quite opalescent. The equine opthalmologist is telling us that we should begin seeing clearing in the peripheral cornea fairly soon, but that it's going to take another 6-8 weeks to get to the final product. The catheter should be able to come out well before that time... ...On that catheter removal, though...I think we'll have to discuss that when we arrive at that particular bridge. I'm not looking forward to having to battle our guy to get daily meds into his eye if he's still going to be highly head shy about our putting medicine DrOppers directly into his eye... We shall see what we shall see... |
| Moderator: DrO |
Posted on Monday, Aug 25, 2003 - 7:10 am: Congratulations on the progress. Do you mean the cornea when you say anterior chamber above?DrO |
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