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  Discussion on Insidious Uveitis?
Author Message
Member:
kathjune

Posted on Tuesday, Sep 22, 2009 - 3:56 pm:

Hi

I have an 8yr old gelding who last October (2008) had a white mark appear on his left eye (iris) - a very small irregular mark which disappeared in about 4 days. He had no signs of discomfort at all or redness. I assumed it was a minor trauma which quickly healed.

Last week I noticed he had a similar mark in his left eye again and two in his right eye. All were on the iris and again only millimeters across and irregular. Four days later I can hardly see them. Again he shows no pain or redness. I imagine by tomorrow I will not see them at all. I disregarded uveitis initially due to lack of discomfort etc but with research I believe there is insidious uveitis which may occur without discomfort.

Could trauma cause these marks on the iris?
Could this be insidious uveitis?
Can uveitis be diagnosed/recognied by a vet when it is not flaring? (If so I have probably missed my chance till next time).
When not flaring (if uveitis) is damage still ongoing?
Any other possibilities I may have overlooked?

Thankyou
Moderator:
DrO

Posted on Tuesday, Sep 22, 2009 - 7:06 pm:

Hello Kath,
Taking your questions in order:
1) No
2) I don't think so. While it may cause depigmentation I don't think of it turning on and off quite so quickly.
3) Possibly, there may be other signs of chronic inflammation that you cannot see without an ophthalmoscope.
4) Possibly a very low level but have not seen evidence of this.
5) I do not know of any cause but it seems more likely this may represent the laying down of lighter pigments, like lipofucshin, over the melanin. I do not know what might be turning it off and on however.
DrO
Member:
kathjune

Posted on Wednesday, Sep 23, 2009 - 12:01 pm:

Hi
Thanks for the fast response. I checked his eyes today again. All three marks are still there and I noticed a bluey/white coloured halo around the edge of his iris of his left eye which I have not noticed before.

Whilst I think the marks are smaller than when I first saw them last Thursday I do no think they have reduced any less since Monday. Although I found them last Thursday they may of been there longer (as could the one I found last October). So one more question -

If the white marks on the iris are lasting more than just days (I may of just not noticed them earlier) could this indicate uveitis. I cannot find anything that indicates anything else it could be. He is also a susceptible breed:-(

thanks
Moderator:
DrO

Posted on Wednesday, Sep 23, 2009 - 9:58 pm:

One of the signs of inflammation is changes in pigmentation Kath but it usually does not fluctuate over several days time. Then again your experience of white marks coming and going as you describe is not a phenomena I have seen.
DrO
Member:
kathjune

Posted on Thursday, Sep 24, 2009 - 4:15 pm:

Thanks again,

I checked his eyes again today and in his left eye there seems to be a very tiny mark on his cornea and the mark further in the eye (I did initially believe the iris but may be anterior chamber) which before looked like an irregular dot now looks like a tiny piece of sewing thread. I could of easily thought something had burrowed in to live there!
On his right side I could only see a very small dot at the edge of his iris and nothing else.

Why would an irregular dot now look like a s-shaped piece of white sewing thread? Lepto?

I guess I better call my vet.
Moderator:
DrO

Posted on Friday, Sep 25, 2009 - 8:46 am:

Leptospira are so tiny that they can only be seen with high power microscopes and a very unlikely source of your 'spot'.

Horses often have small inactive scars on the cornea however. The shape is not really indicative of any disease process Kath but am uncertain what you are seeing.
DrO
Member:
kathjune

Posted on Tuesday, Sep 29, 2009 - 5:30 pm:

An update:-

I had his eyes assessed today by a vet. The marks in his eyes have changed/moved again! Two in the left and one in the right. The marks are keratin precipitates on the inside of the cornea of both eyes and there is also a very small amount of shadowing at the bottom of both optic discs, not butterfly lesions. Nothing to make a firm diagnosis from. I should hear more later this week when more research has been done. I may not of explained all this too well but it is the best I can remember from our discussion.

Please let me know if you ave any further thoughts now I have a more professional explanation!
Moderator:
DrO

Posted on Thursday, Oct 1, 2009 - 9:56 am:

Keratin precipitates onto the cornea are associated with anterior uveitis.
DrO
Member:
kathjune

Posted on Thursday, Oct 1, 2009 - 2:07 pm:

Thanks for your input, this is still very much my concern although my vet didn't seem to think this alone would be indicative of uveitis without outward signs of inflamation etc.

I will hopefully speak with him tomorrow and see what his thoughts are.
Moderator:
DrO

Posted on Friday, Oct 2, 2009 - 7:00 am:

I too would not use this change alone to diagnose recurrent anterior uveitis. It may represent a past trauma or other event, be incidental, or some other change. If I was really worried, I would get a referral to an equine ophthalmologist. But I don't see you have that much to worry about at this time.
DrO
Member:
kathjune

Posted on Friday, Oct 2, 2009 - 8:13 am:

Thanks, having spoke with my vet today he is awaiting feedback from an equine opthamologist.
Member:
kathjune

Posted on Wednesday, Oct 14, 2009 - 1:55 pm:

Hi

Having spoke with my vet again regarding discussion with an equine opthamologist the feeling is that my horse may have some indication of panuveitis but the marks that changed then disappeared were a mystery to him also.

The last 3 marks which I mentioned on 29th Sept have remained the same since. He shows no sign of pain or tearing and I am currently monitoring his eyes and have to call the vet back if I notice any changes. I am still esp. worried about insidius uveitis and that damage could be quietly ongoing.

Disregarding the cyclosporine implants etc are other treatments for uveitis only carried out when actually flaring? Part of me feels like I should be doing something now rather than just observing for changes.
Member:
kathjune

Posted on Thursday, Oct 15, 2009 - 4:47 am:

Apologies for posting again before even giving you a chance to reply but I have read a lot of info in the last 12hours (as well as sleeping for 8)!

From what I can ascertain chronic low grade (insidious) uveitis is much more common in appaloosa's esp the lighter colour varieties (spotted etc),of which mine is, and that damage can be ongoing and often unnoticed due to lack of obvious outward signs of inflammation.

Appaloosa's are much more a minority in the UK than the US and I worry that the condition may be more serious but is being overlooked due to lack of appaloosa experience in the UK. I worry that maybe although signs of inflammation are minimal maybe something should be being done rather than waiting for further signs to occur. Maybe I am worrying without cause, I have an equine specialist vet who has consulted with equine opthomologists so maybe I should accept their view.

If I can summarise a question -

Considering the findings in my horses eyes (keratin precipitates & some shadowing on bottom of optic discs)and no other outward signs of inflammation or irritation to the horse does it seem valid to wait for now?

I appreciate I should discuss with my vet, which I will do although I would appreciate your input on the assumption that you may have much more experience of uveitis in appaloosas.
Moderator:
DrO

Posted on Thursday, Oct 15, 2009 - 8:36 am:

Hello Kath,
As there is no demonstrable active inflammation I see no indication in any of the above information for any treatment at this time. You have to remember that treatments have their own significant risk associated with their use.

As there is no clear indication anything is going wrong at this time, check the eye occasionally and then have the vet check it during his regular visits. Photos really help with comparing changes over time but it can be challenging to accurately image the cornea as the ambient light greatly effects appearance and most horses get a bit nervous when you point a camera at the eye.
DrO
Member:
kathjune

Posted on Thursday, Oct 15, 2009 - 2:33 pm:

Thankyou, I feel happy that you have further confirmed the advice I recieved. Photographing his eyes is difficult as you say and so I have taken to drawing sketchs so I can remember where the white marks are.

Thanks again
Kath
Member:
vickiann

Posted on Thursday, Oct 15, 2009 - 5:38 pm:

Kath,

My daughter has a warm blood horse who has been diagnosed as having "superficial keratitis."

The symptoms sound like what you describe though on the cornea rather than the iris.

When the condition is not active, veterinarians (such as at the pre-purchase exam and presently as the condition has been inactive for quite some time) have looked at the horse's eye and said that what they see is just "old scaring" but that is not what it is at all.

The horse has been through extensive periods of treatments over the past few years, but it seems that when treatment is necessary is when the spots pick up staining when the eye is dyed for examination.

This horse is now 15 years old and the condition is thought to be an autoimmune disorder, which for him, for some unknown reason tends to flare up in the autumn months.

The most recent exam showed the horse is now beginning to get cataracts.

When there is a flare up, the horse goes to the state veterinary college, which has eye specialists available for whatever treatment is deemed appropriate.
Member:
kathjune

Posted on Thursday, Oct 15, 2009 - 6:09 pm:

Hi
Thanks for your input VickiZ. Although I initially thought the marks were on the iris they are clearly (when examined by the vet) on the inside of the cornea. There is nothing on the external surface of the cornea at all. I guess keratitis as your daughters horse has is external if it picks up dye?
Member:
vickiann

Posted on Thursday, Oct 15, 2009 - 8:13 pm:

Kath,

It is a mystery to me.

Very frustrating to have the veterinarians diagnose that there is no problem while there very much is a problem.

With regard to my daughter's horse, we have been able to manage the problem without any assurance that our good fortune will continue.

Bills for eye medications and veterinary procedures have been rather high!
Member:
kathjune

Posted on Friday, Oct 16, 2009 - 3:14 am:

Hi

As you say there is no diagnosis as such but the symptoms do indicate panuveitis (according to the equine opthamologist). There is an indication that there has been a problem but nothing that seems to be currently active or treatable.

As you say the frustration without any assurance of outcome is very wearing. We are currently dealing with immune mediated illness with my little dog which has cost over £5000 in 2 months and yet prognosis is guarded at best. Thank goodness for insurance.

I hope your daughters horse continues to do well.
Moderator:
DrO

Posted on Friday, Oct 16, 2009 - 6:50 am:

Vicki the kind of chronic corneal changes you describe is a a common finding in horses and often not associated with a recurrent problem. That your horse has acute exacerbations of inflammation is a important difference in your case and Kath's case and without that history it is hard to justify worry about this at least until we see evidence of progression.
DrO
Member:
vickiann

Posted on Friday, Oct 16, 2009 - 11:10 am:

Thanks Dr. O.

Your advice to Kath is right on target, in my opinion.

I did not mean to imply that there were similarities in the two cases, just that I can sympathize with Kath about her concern, especially after having been told in a pre-purchase exam that the funny looking eye spots including blue clouding were not important for my daughter's horse.

It is good, I think, that Kath has an ophthalmologist involved in her horse's case as this has been helpful for my daughter's horse, and it has also been helpful to have his eye checked and stained by other Veterinarians who come to the barn from time to time to help ensure retreatment is not implicated.
Member:
kathjune

Posted on Friday, Oct 16, 2009 - 5:14 pm:

Hi again,

Sorry for the misunderstanding vicki, I had also initially thought that you were implying similarities as well. What a shame that you recieved such poor advice at prepurchase.

My vet was at the yard today and took the chance to check my horses eyes again. The two marks in his left eye remain the same although to a lesser degree but the one at the back at the right eye has gone but another appeared at the front! My vet knew from memory, and he is right I checked my sketches - wow, I was impressed. He is very confused about the shifting keratin precipitates (assuming that is what it is)as is the opthamologist.
Member:
kathjune

Posted on Thursday, Jan 21, 2010 - 7:08 pm:

An update on my horse. My vet was out to give my horse his annual vaccinations today (flu & tetanus) and checked his eyes again. There are no further changes to his eyes at all since the last visit 3 months ago. There are still the two marks in his left eye and the one at the front of the right as I last described. My vets advice is some evidence of panuveitis but quiescent at the moment and to monitor for any changes.
Very nervous what this might mean for the future but taking each day as it comes for now.
Member:
vickiann

Posted on Thursday, Jan 21, 2010 - 8:34 pm:

Sounds as though this is going as well as you could hope for, Kath.

My daughter's horse seems to remain in an inactive phase but the worry is always present as the condition does not go away for her horse.

Very wisely, you continue to monitor the situation so that if needed, you can react accordingly.

There are so many wonderful advancements with such care, hopefully you can control this if you keep on top of the situation.
Moderator:
DrO

Posted on Friday, Jan 22, 2010 - 12:49 pm:

Good to hear Kathy,
DrO
Member:
kathjune

Posted on Thursday, Jun 2, 2011 - 1:40 am:

18 months on now ....
after the episodes above everything seemed to settle down and no issues or white spots have been noticed on my horses eyes over the last year - and I have checked regularly.
However, about a week ago I noticed some mild tearing/discharge of his right eye - it's been windy and didn't look inflamed so I just cleaned it (although he did seem a little more sensitive than I expected.) Yesterday I noticed the eye now looks inflamed also - some redness and some blinking - I also noticed a white spot (Keratin Precipitate) on this eye also - literally appeared overnight.
Today I will contact my vet.
I feel now that I am seeing the first truly obvious signs of RU in my horse.
As he is a spotted appaloosa I do worry that the long term prognosis is perhaps bleaker than it may be otherwise.
Moderator:
DrO

Posted on Thursday, Jun 2, 2011 - 7:48 am:

Hello Kath,
"The first truly obvious signs of RU" overstates it a bit. Inflamed horse eyes from trauma is very common. If it is RU, early aggressive treatment (see the article for more on this) is your best guard against permanent changes.
DrO
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