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  Discussion on Recurrent Uveitis without internal changes?
Author Message
Member:
Brandi

Posted on Sunday, Jan 30, 2005 - 2:44 am:

Dear Dr. O., I have a 24 yo Arab/Qtr exhibiting all the symptoms of ERU. Please bear with me as I relay his history and situation: I've owned him for 16 years, and he came to me with conjunctivitis and a blocked duct in the right eye. Up until 2004, he had occasional (1x per year or so) incidents of a swollen, puffy right eye, always diagnosed by my vet as possible external trauma, and usually with a small corneal ulcer visible with stain. Assumed cause was scratching the chronically weepy eye. Always cleared up within a week, with the standard treatment (as decribed in your articles). In 2004 it began to happen more frequently. After a more than 3 episodes and much more education on my part I finally had the "ah-ha" (or "duh") that I might be dealing with ERU. Not all of the 2004 episodes were seen by a vet because I had become accustomed to treating it. My last visit to the vet about it (late Nov?) was that everything seemed fine, but next time it happens he should see the opthalmologist. Within 45 days we got to do just that. I have the good fortune of having Nick Faber (mentioned in your article as one of the researchers working on the Leptospirosis stuff) as my local specialist. He admitted that my description of the history and symptoms pointed directly at ERU. But after a very thorough exam, he could see no changes or internal evidence (with almost no treatment because I was out of town, the flare up had subsided by the time I got in to see the dr. just 4 days later). Dr. Faber said he had great eyes for a guy his age. Excellent news, of course. I went home with instructions to follow the same old protocol should it happen again.

And it did, just 2 weeks later, and again a week after that--maybe just a continuation of the previous that wasn't really done and came back after I stopped treatment. This last episode, though, I knew to look for the constricted pupil and there wasn't one--infact it was larger than the left eye. I know the atropine takes a while to wear off, but not a week, right? He did have a big corneal ulcer about 3/4 the size of a pencil eraser, easily seen by the naked eye.

Unfortunately I have one big question unanswered: Does my horse have ERU? In your opinion, after all the episodes he may have had over the past 10 years, and so many in 2004 (maybe a total of 6 in the past 12 months), wouldn't there have to be some internal damage?

And if we can't know for sure, what would you do preventatively (is that a word?) for your own horse in this situation? Assume your own horse has no tolerance for bute and gets mouth ulcers after only a couple doses.

I feel like I'm getting this huge opportunity to help my horse before something really bad happens, and if I don't get aggressive about it soon, I will have really blown it, but I'm just not sure whether or not my horse has ERU. Reading the articles here I think yes, but neither Dr. Faber or my regular vet (both of whom know of the recent bouts) are suggesting anything particulary pro-active.

Thanks in advance for your help.
Brandi
Moderator:
DrO

Posted on Sunday, Jan 30, 2005 - 11:16 am:

Unfortunatley I cannot diagnose your horse but the fact that there is no permanant internal damage does not rule it out. If your horse is so sensitive to NSAID's you might consider some of the implants and surgeries discussed in the article for long term control. Atropine has resulted in dilation for up to 14 days in horses following dialation (see the scientific reports section in the atropine article).
DrO
Member:
Brandi

Posted on Monday, Jan 31, 2005 - 12:45 am:

Thanks, Dr. O., for replying, the information on the atropine helps me. Didn't mean to sound like I was looking for your diagnosis, but your comment on ERU not being ruled out is quite helpful. I've read your article, but don't feel I have the understanding I need to feel confident that I'm doing all I should for my horse. Can you answer any of the following questions for me?
Is there any way I can be sure he has ERU?
Do I have to wait until damage occurs to be convinced?
Should I actually consider the treatments of implants and surgeries if I'm not sure of the ERU?
After a bunch of "mild", undamaging episodes, is it possible to have a major one which leads to immediate and significant damage, making my current options "too late" if I wait?
Your input is appreciated.
Brandi
Moderator:
DrO

Posted on Monday, Jan 31, 2005 - 8:19 am:

1) No, ERU is diagnosed by ruling out other causes of uveitis.
2) No.
3) Yes, if both your vet and opthamologist beleive it has a high probability of being ERU you should listen to them.
4) It is possible that there is a severe episode in your future but the first one probably won't be so severe that you cannot get it back under control without significant damage but I cannot rule this out either.
DrO
Member:
Brandi

Posted on Friday, Aug 12, 2005 - 8:51 pm:

Dr. O.,
I'm restarting this discussion from my original post because the history is helpful, but it might make sense to move it corneal ulcers at this point. Taking into consideration the above, my horse is still having recurrent bouts of corneal ulcers. This discussion began in the end of January, I spent the better part of Feb treating the ulcer, and it healed well and I stopped all meds, as usual. However, on May 30th it flared up again. Always the right eye, and the ulcer is typically in the same general location. Dr. Nick Faber once again looked at the eye, and there was nothing going on internally, just the ulcer. We began treating with ciprofloxacin DrOps this time, I guess to just try something different than the other triples/NPB's or whatever we'd tried before. We weren't getting the swift healing we'd gotten before, so in a follow-up a month later done by my regular vet, he stained and saw a rather deep but smaller ulcer in a different location, most are 3/4 of a pencil eraser and easy to see, this was lower on the eye and only a pin-point, but showed some depth to it. We changed from the cipro to compounded cefazolin w/tears 5x/day, monostat cream 2x/day and banamine 500lb doze 2x/day, plus the atropine protocol (just for the first couple of weeks). This regimine was followed and gradually reduced for the entire month of July, and stopped altogether around August 1st. His eye had healed swiftly and though I chose to skip doing a followup staining (due to the fact that for this and various reasons my vet bills for just June/July exceeded $3000), I continued to medicate him, reducing first the banamine and then the cefazolin gradually. With the eye "behaving perfectly" and looking perfect to the naked eye for about 3 weeks on medication and another 2 weeks off, he has now came in yesterday morning, painful, puffy, tearing and with his trademark ulcer. Same size, similar location to the others (the deeper one was the one in a new location).
Obviously I've started him back on meds and put a call into my vet and the specialist, and $3k or not, he'll get checked again, but do you have any feedback on what might be going on, what to check or have you even heard of something like this before? His eye seemed so happy and comfortable that I do not believe there was anything left "unhealed" so to speak, but certainly I could be wrong. I think I'm finally convinced not to be too worried about ERU, but where has there ever been a horse that scratches his cornea several times a year, producing very similar injuries each time? And he's been doing this for at least the last 16 years, but in the beginning he had bouts only about once a year and now he's at about once a quarter or more, with many more complications than ever before. Any thoughts you have or questions you would have me ask my Drs would be greatly appreciated.
Brandi
New Member:
Turning

Posted on Saturday, Aug 13, 2005 - 1:51 am:

Brandt,

If you aren't doing it already, you might want to consider putting a fly mask on your horse. I have one horse with ERU and one who's eyes used to blow up constantly.

I started using a fly mask in the winter to help keep the one with ERU from accidentally scratching her eye on brush since the eye was being treated with steroids. By keeping the mask on 24/7 we reduced her flare ups in her remaining eye much more than we did the previous year with medicine to the other eye.

She lost the right eye and partial sight in the other before I figured out about the mask, but she has retained the partial sight in the remaining eye a couple of years past the vet's "best case" scenario.

The other mare didn't have ERU but her eyes used to blow up a dozen or more times a year. We started putting a mask on her year round a couple of years back and she went down to one sometimes two blow ups a year.

Fly masks aren't a cure-all, but they definitely help. At this point we keep all our horses in fly masks three quarters of the year and the two with eye problems year round. There is no doubt in my mind that it has greatly improved their quality of life.

Good luck.

kat
Moderator:
DrO

Posted on Saturday, Aug 13, 2005 - 4:54 pm:

Brandi,
several things occur to me. First I have seen traumatic eye problems that caused deep damage to the stroma which then were slow to heal, partially because of our efforts to control inflammation. Over time the recurrent inflammation and ulceration resolved usually with a small scar. So this presentation does occur.

Next step would be biopsy and culture of the ulcer. It is much less diagnostic when done following treatment so should be done at the beginning of a episode. Perhaps a resistant organism or perhaps traumatized or dead tissue would explain the problem.
DrO
Member:
Brandi

Posted on Sunday, Aug 14, 2005 - 2:14 am:

Karol, thanks so much for the advice, I think you're right, he would do better with a mask all the time. Though because he's in during the day and out at night, he doesn't wear one much unless he's coming off an episode and I'm transitioning him out of his eye saver mask. I'll take your advice.

Dr O., sounds awful, but thank you so much for the direction, I'll be sure to discuss with my vets.

thank you both for the help...Now I'm off to google to help me find out how to take care of this orphaned baby possum I'm holding in my hand...what kind of a sucker am I?
Member:
Hwood

Posted on Sunday, Aug 14, 2005 - 2:21 am:

LOL . . . Brandi . . . I think I'm more of a sucker as I have an orphaned baby pigeon on my lap as I type this . . . My husband calls them "flying rodents."
Member:
Paul303

Posted on Monday, Aug 15, 2005 - 12:40 am:

If this is "true confessions", I'm ready to own up.....it was an exhausted baby bat. Do we need a 12 step program?
Member:
Hwood

Posted on Monday, Aug 15, 2005 - 2:49 am:

No, no! SOMEone's got to rescue the little critters . . . it's not an addiction, it's a gift . . . LOL . . . I just love bats. (The pigeon's doing great . . . learned how to eat seeds today, and has gotten so that he/she doesn't like to sleep alone in his/her box . . . would much rather be cuddled on my arm . . . Ever tried to wash dishes, type or clean stalls with a pigeon on your arm?? . . . I should never have gotten rid of that old SNUGLI.)
Member:
Gillef

Posted on Monday, Aug 15, 2005 - 6:26 am:

Hi Brandi
I just read this post for the first time and had the weird sensation of being dragged back in time!. I had over a year of trouble with my ,now aged, gelding.I found the eye trouble the most stressful complaint to cope with, even more than dealing with lameness issues, so I send you my best wishes and thoughts and hope you reach some resolution soon.
Your history matches very much what happened with Flynn but I was lucky enough to have the problem resolved in much less time.
Has your horse ever been given the course of anti-viral medication Idox Uridine (?sp). Flynn proved to have a viral keratitis which was successfully dealt with in one week of treatment over 10 years ago.
If diagnosis is helped by recognising a familiar pattern,what I went through almost exactly matches your experiences, albeit, curtailed within a shorter timescale.
Very best wishes
Gillian
Member:
Brandi

Posted on Monday, Aug 15, 2005 - 11:35 am:

Thank you Gillian, I will certainly ask my vet, and I appreciate your good wishes!

And to all my critter-saving friends, bless you! And I love bats too! Baby possum has a broken or dislocated jaw, but went to the wildlife care vet yesterday, so keep all your fingers and toes crossed! He is a sweeeeet little guy (gal?) so I really hope he does well.
Moderator:
DrO

Posted on Monday, Aug 15, 2005 - 6:22 pm:

Brandi, while answering another post a thought occurred to me: your horse may have too little tear production causing the ulcers. This can be tested for (Schirmer tear test) and a rare but treatable cause is Equine Diseases » Nervous System » Neurological Conditions Not Covered Above » Temporohyoid Osteoarthropathy & Hyoid Disease.
DrO
Member:
brandi

Posted on Wednesday, Nov 26, 2008 - 2:47 am:

Hi all,
After a long absence, I have some incredible information to add to this post. At more than 3 years later, in brief I spent Feb thru Sept of 2006 and 2007 dealing with this worsening problem. Rocki's ulcer's began to heal more slowly with each episode, he had to wear an eyesaver or fly mask every single day of that entire time, both years, along with getting varying levels of treatment depending on the severity of his ulcer. It was hard on him with long-term meds and treatments, hard on me to take so much time, and really hard on the pocketbook. We'd considered biopsies and grid keratotomy, but healing was so slow, and it would have increased his pain temporarily, so I kept avoiding it.

Fully aware by then of the "seasonality" of the episodes (3 successive years of Feb-Sept troubles), I was convinced that his root cause was allergies.
In January 2008, we saw Dr. Andrea Cannon, an animal dermatologist, and we did allergy skin testing and set him up on a program of allergy shots. Dr. Cannon was very firm in letting me know that allergy shots often take many months, even up to a year, to make a difference, that less than 10% of her patients responded sooner, so we expected to spend 2008 treating the eye AND doing allergy shots.

However, I am thrilled to say that Rocki obviously responded immediately, and went through all of this 2008 "season" with no corneal ulcer at all, very limited tearing and only 2 or 3 times did I notice him looking slightly uncomfortable, so I would give him one 500-lb dose of banamine or one course of flurbiprofen (eye DrOps for pain), and that is IT!!

It is so rewarding for me to be able to give him this time with no meds and their side effects, no pain, no getting his eye pried open several times a day, etc. And believe me - a year of allergy shots is way less expensive than 5 or 6 vet visits (especially to the opthalmalogist), and all the meds.

I certainly look forward to more years hopefully free from his eye problems. I hope this information helps someone else who might be having similar issues.
Moderator:
DrO

Posted on Wednesday, Nov 26, 2008 - 6:51 am:

Brandi, I am delighted to hear you had fewer problems this last year. However a recurring ulcer on a single eye even with a 2 or 3 years history of seasonality is not likely to be due to allergies. I strongly believe the improvement with treatment coincidental but am delighted the horse is currently not giving you trouble.
DrO
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