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  Discussion on Fungal Keratitis
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Posted on Monday, Sep 11, 2000 - 10:18 pm:

My 26yo TB Gelding has now been in a large animal hospital for almost 3 weeks with a severe fungal keratitis infection. Since he has minimal vision, due to a senile cataract in his other eye, I am doing all I can to save his eye. I have many concerns, however, because there is no resident equine ophthalmologist so I am consulting one outside the hospital whose speciality is small animals.

For about the past year my horse has always had a lot of clear/whitish tearing from this eye, but my vet attributed it to a blocked tear duct.

Then, this August 17th he came in from the paddock with a swollen, closed, and tearing eye. He was treated locally at that time with subconjunctival injections of gentomycin and atropine. When the original 2mm ulcer increased to 6mm four days later, the treatment was repeated. I had not been advised to cover the eye with anything besides a fly mask and I assumed his continual rubbing had worsened the eye. A second vet advised hospital admission on August 24th when the eye still failed to improve. There, a cytology/culture test identified a mixed bacterial/fungal keratitis. Now his eye looks 3/4 covered with a whitish growth. The hospital has been treating the eye aggressively with topical treatments every 2 hours (intraconizole/DMSO amongst others) but progress has been very slow and dubious. The ophthalmologist I contacted visited and aggressively debrided the eye. How often should this be done? The hospital doctors have suggested having him do it again, less than one week since the original debriding, but I am worried that this will weaken and possibly perforate the cornea and/or allow the infection to get more deep-seated. A recent stain showed all areas of the eye accepting the dye, despite concerns over a visible "white line". A blood vessel has since appeared, but everyone is remaining guarded.

My concerns are that we follow a correct course of treatment, given the lack of equine eye specialist advice, and I read the fungal keratitis article here with great interest. How critical is covering the eye with an eye cup? The hospital rarely uses it, saying that my horse feels more comfortable in just a fly mask. But I'm worried that his occasional rubbing will strain the cornea, as well as introducing dirt and leaking the medicines out. My other concern, of course, is financial. No-one will give me an idea of when I will be able to resume care of my horse. I am prepared to sleep at the stable and provide continuous care, but when I suggest this the vets express concern that the eye has yet to reach a turning point, either for better or worse. Since the hospital is over 100 miles away I can only visit at weekends (preferring to save my vacation time for when I will be caring for him) and my horse seems markedly depressed during my absence, and has lost about 50 lbs. However, when I visit he is high spirited and enjoys walks and grazing, leading me to think his depression is related to environment and hopefully not to pain. Any advice you have in addition to my specific points will be appreciated. I feel I am in a Catch-22 situation of paying huge money for well-intentioned but, nonetheless, experimental care. Thank you.

Posted on Tuesday, Sep 12, 2000 - 6:55 am:

If your number one desire is to save the eye: you should follow the advice of the professionals giving care. You are right despite doing this you may lose the eye. But this might be at the end on any road you take: we cannot know the future so you must make your decisions based on what you know now and realize the road may take a turn up ahead.

The debridement needs to be done anytime there are significant amounts of nonviable tissue on the cornea. I dont think the eye cup is a critical part of treatment. I hope things improve soon.
DrO

Posted on Wednesday, Sep 20, 2000 - 12:39 pm:

Update: It's now 4 weeks and finally I have to decide about removing his eye. The vets say his cornea is so thin it's melting. I'm having a tough time deciding what his life will be like after the surgery, if it's kind to put him through that after all he's already been through, and if he'll be rideable at all. I've heard and read lots of conflicting things - from horses coping perfectly, to being picked on and getting injured. Of course, I probably know best and the decision is on me, but any thoughts you have will be welcomed.

Posted on Wednesday, Sep 20, 2000 - 1:26 pm:

This is a terrible decision for you. You say he is a thoroughbred, and 26 years old, so he has reached a very good age for this breed.

My thoroughbred had to have his eye removed due to glaucoma when he was 17 years old, and it was a traumatic operation for him I must say.

Other people have said their horse sailed through such an operation, but my horse did not, and it took months to heal properly and for him to regain condition. He has had a couple of accidents since then, due to lack of vision, as he also does not see well with the other eye. I have to be extremely careful with his companion, as not every horse is safe to put with a semi-blind horse. They have to be gentle, and not bullies.

He refused to be ridden from that point on, which was fine by me as I totally understood that he did not feel secure and in control, which he needed to feel due to his highly-strung temperament. He is now 21 years old, and is totally retired, and we are very careful with him - no wheelbarrow is ever left in a paddock; all fences have white painted tyres on them so that he can see the boundaries, etc. etc.

If he had been 26 years old, I doubt I would have put him through this.

Please forgive me if I sound pessimistic, or negative, but you obviously care a great deal for your horse and need to look at all viewpoints. I'm sure you will decide to do what is best for the horse.

Posted on Wednesday, Sep 20, 2000 - 2:32 pm:

Our horse had Eosinophilic Keratitis which caused that white plaque like substance. We treated and tried to save the eye for months which was very painful for him. Finally it was too much, we removed the eye knowing that the remaining eye had compromised vision due to a cataract. The surgery was hard but he bounced right back and is back on the trail with the knowledge that sometimes we have to be his eyes.

It was a terrible decision to make and I was riddled with guilt but now I wish I had spared him the pain much sooner! I would not hesitate if faced the same situation again.

Posted on Thursday, Sep 21, 2000 - 7:19 am:

These are tough decisions but in my experience one eyed horses do well under just about any management situation.
DrO

Posted on Thursday, Sep 21, 2000 - 1:29 pm:

As I write this my horse is in surgery having his eye removed. I had gone to the hospital yesterday more or less decided to have him euthanized. But it's a tough decision because, as the replies above illustrate, half the people I talk to have great experiences; the other half have bad ones. I spoke to his doctors yesterday and they unanimously were against putting him down. They said he was in great shape and the fact I've had him for so many years with an obvious strong relationship was in all my favor. They recommended I give him the chance and that if I saw he was losing his will to live I could decide on a final solution then. My emotions are really mixed now. I'd like to think it was going to be as simple as that, but I'm worried about complications. So far all my instincts have proven right and logic has failed me. But I do have this little window in my head in which I see myself returning from a great ride on him saying, "I can't believe I was ever even THINKING of putting him down." The hospital called while he was in surgery and asked me if I wanted a prosthesis inserted. So I didn't exactly have time to make an informed decision. They were in favor of it so I agreed, only then to read on this site of possible consequent infections.

Two overwhelming considerations have struck me so far in this whole experience. One is how the owner is called upon to make decisions that he/she has no real knowledge about, besides instinct. (Having to decide on courses of treatment, etc. - it seems the vet does not always know best and will readily admit it). The other is the awful burden of what it's like to play God and have to think about ending your best friend's life. I always thought it would be a clear decision but the doubts and debate almost made me insane.

Finally I'm left not even really knowing what my horse had/has. When I mentioned his eye had been tearing for a year before this, they thought he could have uveitis, so I've ordered him a special fly mask to take steps to protect his other eye in case. There's no real decision on the state of his remaining eye either. Some vets think there is a cataract; others say it's normal for his age. He seems to see well from it in the outside, but less so in semi-dark conditions.

Thanks everyone for your input - I'll keep you posted.

Posted on Friday, Sep 22, 2000 - 12:16 pm:

Wow, Rachel, what an ordeal you are going through. Only knowing you and your horse from these threads, I'd say you are making the best decision you can right now in removing his eye and giving him a chance at many more happy years with you. You can always proceed with the "other" decision later, but you can't undo that once it's done. Please keep us posted on his progress.

Posted on Monday, Sep 25, 2000 - 11:59 am:

Rachel, my thoughts are with you. He will be so much happier with out the eye. It only took a short time for our horse to recover (we did not have the prosthesis put in), the first 3 days were the worst, after that it was smooth sailing. If you keep a close watch for infection I think you'll be gld you did not euthanize him. the vets are right about the bond, it truely make all the diffrence in the world. When you bring him home start teaching him a que that lets him know he has to step over an obstical. At first they are stumbley but the do get better so don't get discouraged.

Posted on Tuesday, Sep 26, 2000 - 11:11 am:

Just to thank everyone for your good advice and to let you know that hopefully tomorrow I'm bringing my horse home. It's seemed like an eternity and I'm totally exhausted from travelling to and from the hospital and the constant ups and downs of this dilemma. He had the operation last Thursday and apparently sailed through it. Since the eye ruptured on removal the surgeon decided NOT to put in a prosthesis, and I'm so glad about that, after reading of possible complications. The vets say it's looking good and my horse seemed much "higher" spirited, although I did notice more stumbling when I took him for a walk. However, whether that's due to stiffness and not being exercised or altered depth perception I can't tell. Now I guess I'll be posting in a new area as I try to work through getting back into the saddle! Thanks again...
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