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  Discussion on Diagnosis of cataract, possible ERU?
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Member:
sbower

Posted on Thursday, Jun 4, 2009 - 8:24 pm:

I had a routine physical done on my gelding today and the vet said he has a cataract on his left eye.

She suggested that he has ERU and that I would need to have him seen by an opthamologist. She left me with a sample of an eye ointment that I am to use on him twice a day for a week and than once a day for a month. "Neomycin and Polymaxin B sulfates and bacitracin zinc opthalmic ointment USP"

A few questions? If he truly has ERU why haven't I seen any inflamation? He was spooking alot about a year ago but not anymore. I had someone look at his eyes then and there wasn't anything seen. I guess if I were to compare his eyes the left one might be a little more foggy but not much.

She said the back of his eye looked fine and he still had a blinking reflex even in a dark stall.

I am calling around to locate an opthamologist but am wondering if a horse can have ERU without any outward signs like swelling, weepy eyes...

Also I keep seeing references that nutritional problems lead to cataracts but exactly what nutritional deficiencies?

One last item, if the opthamologist takes a set of ocular pressures (the vet suggested we do it as a baseline) can it definitively tell us one way or the other if it is ERU?
Moderator:
DrO

Posted on Friday, Jun 5, 2009 - 8:03 am:

Hello Shelly,
As cataract formation is not a harbinger for ERU I am uncertain what she is talking about. Is it possible she sees other signs of inflammation, and you are confusing "corneal edema" or "keratitis" with "cataract". This would explain the bluer appearance you describe.

To add to the confusion if your horse did have ERU, NPB would be a waste of time and money since this is a autoimmune disease and not an infection and treated with antiinflammatories, chiefly steroids.

I do not know nor can find any reference to nutritional deficiencies that present as cataracts.

Lastly increased ocular pressure, or glaucoma, is not diagnostic of ERU as it can occur for other reasons. We have articles on ERU and glaucoma on the eye disease menu where you can read more about these conditions.
DrO
Member:
sbower

Posted on Tuesday, Jun 9, 2009 - 9:28 pm:

First of all a BIG thank you to Dr.O!!! You made me question the NPB and it turns out that the vet should have given me NPB with Dex but did not! If you hadn't questioned that I would have treated him for the entire month with something that was useless! So nice catch Dr. O!

I think that the vet felt that the cataracts were the result of previous bouts of ERU not a harbinger of it. I am uncertain because my gelding has never shown any inflammation in the eye, nor injury and is not light sensitive.

Regardless, I am taking him to an opthamologist next Friday so we'll hopefully get a handle on this. At least thanks to a routine exam I know about it! I'll keep you posted.

And again thanks Dr O!
Moderator:
DrO

Posted on Wednesday, Jun 10, 2009 - 8:04 am:

You are very welcome Shelly,
DrO
Member:
sbower

Posted on Friday, Jun 19, 2009 - 3:38 pm:

Just thought I'd update this with the Dr's findings.

The diagnosis officially is Anterior cortical immature cataract in the left eye of unknown origin.

His comments on the lens were:

Early immature cataract restricted to the dorsal equatorial to paraxial anterior cortex. Closely associated with the granula iridica on the dorsal aspect of the iris margin. Faint pigment deposition on the anterior lens capsule.

Open for progression of catarct
Open for association of uveitis

He said as a proactive measure I might want to instill 2 DrOps of Flurbiprofen to prevent signs of inflammation associated with the cataract. No inflammation is currently present.

Any comments Dr O? What do you think about using the DrOps as a preventative? Is this likely to be progressive do you think?

The rest of the exam was normal, I include the results below just so you know what was done.

Globe symmetry Normal
Lids Normal
Vision Present
PLR positive Direct and Indirect
Conjuctivia Normal
Third Eyelid Normal
Cornea Normal
Anterior Chamber Normal
Iris Normal
Lens Findings noted above for left, right eye normal
Fundus Normal
Intraoccular Pressure 25 mmHg Right, 26 mmHg Left
Moderator:
DrO

Posted on Saturday, Jun 20, 2009 - 6:36 am:

Shelly,
Not having examined the eyes myself I am not in a position to make predictions but I can comment on the information you provide.

Did the ophthalmologist state whether the cortical lens lesion was perinuclear (paraxial?) and as I understand it, it changes the prognosis some. The dot of pigmentation on the lens that he associates with the iris could be synechia, a sign of past or chronic inflammation. The rest of the normal findings suggest a past discreet episode of inflammation and not necessarily ERU.

I do not understand instilling flurbiprofen to to "prevent signs of inflammation associated with the cataract". Cataracts are not typically inflammatory. Perhaps he is talking about the synechia? Do synechia cause inflammation? I am not aware this is the case but could be corrected.

These DrOps can be irritating themselves and I would only consider their use where clearly indicated to treat inflammation. You have to remember all of this is incidental findings on a horse with no problem, indeed does not even have a history of a problem.
DrO
Member:
sbower

Posted on Saturday, Jun 20, 2009 - 4:42 pm:

Dr O,
Thank you for your comments. They will be sending me a picture of the eye so I will post it here. I'm having trouble understanding some of the terminology (It would be extremely helpful if there was an illustration of the eye with identification of terms like paraxial, perinuclear... even anterior and posterior are foreign words to those of us not familiar with such terminology). And just FYI the eye anatomy link in the "Cataracts in Horses" section does not work although I was able to access it elsewhere in the site.

The cataract is located in the lower left portion of the lens. I am assuming that if it were nuclear it would be the center of the eye? I'll attach a photo as soon as I can.

My impression was that you are correct that there had been a previous inflammation and that there were adhesions (he did not say synechia but perhaps that's what they were).

He said (and I'm paraphrasing with my understanding) that because the medication is not a steroid, that it would not cause harm. I think he's concerned that I might miss further episodes of inflammation given that the horse did not show ANY obvious signs with the first episode. This isn't a horse that's out in a field, he's in a heavily trafficked boarding barn and ridden almost everyday. The chances that we all missed it I have to think are slim??? .... But I will definitely reconsider using the DrOps.

One more question, does UV light worsen cataracts and should I consider using one of those masks that block light (ie Guardian Mask)?
Moderator:
DrO

Posted on Sunday, Jun 21, 2009 - 9:10 am:

For a simple anatomy of the eye ball see:
References » Equine Illustrations » Head, Eyes, and Mouth » Eye: Anatomy and Physiology » Eye Anatomy. Though the lens is not broken down into its component the nuclear portion is the center and surrounded by the cortex.

For a discussion on anatomical orienting see, References » Equine Illustrations » Anatomical Orientation Terms. However the meaning of some of the terms used in the report are a bit uncertain to me.

Is the ophthalmologist recommending the DrOps indefinitely as a preventive? As for the indication of a UV decreasing mask I would be slow to start a preventive of uncertain efficacy for a problem of uncertain origin but you should follow the ophthalmologists direction on this.
DrO
Member:
sbower

Posted on Sunday, Jul 26, 2009 - 5:24 pm:

Sorry it took me so long to post this picture but it was not easy to take a picture of his eye and have it show up! Combined with the fact that he tends to be spooky I usually only got one good chance per session LOL!

To answer Dr O's question, yes it was on a preventative basis, I have opted not to use the DrOps as the expense seemed to outweigh the benefit. So far I haven't seen any signs of progression so for now we will watch closely and have a follow up at the hospital in 4 months.

Anyway here's the picture- its a boomerang shape in the upper left portion of the pupil. The pin point of white is quite obvious to the naked eye. Would this be the adhesion?

This horse had a Vitamin E deficiency at one point that was pretty severe - the vet said that this nutritional deficiency would show up in the back of the eye (which it did not).

Dr O,
Any further comments now that you can "see" the cataract???

https://img.photobucket.com/albums/v672/SBower/IMG_1240.jpg

[IMG]https://img.photobucket.com/albums/v672/SBower/IMG_1239.jpg[/IMG]
Moderator:
DrO

Posted on Monday, Jul 27, 2009 - 8:37 am:

Hello Shelly,
Quite remarkable photos, I know how hard it is to get a clear image of the lens. No further comments however, I believe it is now a waiting game top see how this will progress but don't see any reason to be overly worried this is a progressive lesion.
DrO
Member:
sbower

Posted on Monday, Jul 27, 2009 - 5:58 pm:

Thanks Dr O!
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