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  Discussion on Complications of a Lacerated Cornea
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Posted on Monday, Jul 5, 1999 - 8:03 pm:

Dr. O
11 days ago our appy somehow lacerated his cornea.
It initally acted like the eyeinfactions he is
prone to get in the summer, however in 2 days when
it did not respond to normal treatment (tripple
antibiotic eye ointment) he was taken to the vet,
that is when they found the laceration. Treatment
consisted of clearing the eye, patching, and
continueing the ointment. The eye swelling went
down and you could see a cloudy area around the
laceration and a caulifour looking deposit at the
site of the laceration. He is very light sensitive
and there is consistant tearing in the eye. My vet
said it has developed a calcium deposit which
could be caused by bacterial or fungal Kerotitis.
On this comming friday I will take him to see an
opthimologist.

There is the history... now the question...
This horse has reoccuring eye infections in the
summer and is what would call "a weapy eyed appy".
He also nearly lost his life 2 years ago due to a
hepitital infection of the liver... So, would one
or both of these make it easier for an infection
to take hold in the eye? I am not one to use
antibiotic or cortizone type meds unless I have to
and are directed by my vet. Could the simple use
of the eye ointment 1 or maybe 2 times a year
cause a resistance?

Thanks for any help I sure don't want this guy to
loose his eye and would like to go in armed with
knowledge. Thanks

Posted on Tuesday, Jul 6, 1999 - 8:25 am:

No I do not think the earlier problems would make him more prone to infection but the ocassional use of antibiotic ointments will undoubtably create resistant organisms.
DrO

Posted on Tuesday, Jul 6, 1999 - 1:09 pm:

Thanks DrO, we'll have to figure another way to handle the pesky eye infections if they pop back up in the future. As for this possible keratitis we are holding our breath, the appt with the specialist has been bumped up to Thursday, I let you know what happens.

--

Posted on Tuesday, Jul 6, 1999 - 5:43 pm:

Emily,
I don't know if you are aware of Equine Recurrent Uveitis or Moonblindness. It is a disease that horses develop where their own immune systems attack the eyes. I mention this because Appys seem to be particularly disposed to developing this disease. Some of the symptoms regarding this disease is tearing of the eyes, cloudiness, a sensitivity to light, etc. I suggest you read DrO's article on this disease so you can become familiar with it. I'm not saying your Appy has this but you should be aware of it and the symptoms. When I got my Appy, I had heard that they are prone to develop this disease so I was always looking for the signs. Like you, my Appy started having episodes in the summer when his eye would tear. And unfortunately, he did develop the disease. Because I caught it somewhat early, I think I got an extra year or so before he went blind in his eye. There is no cure for moonblindness and the more episodes your horse has, the more damage is done to the eye.

I hope all goes well at your appt on Thursday.

Posted on Wednesday, Jul 7, 1999 - 5:03 am:

Appys, with their unpigmented areas around their eyes, seem to be prone to another condition Judy: actinic conjunctivitis, which is just a fancy term for saying they light irritation of the structures of the outer eye.

It is bilateral, creates redness, tearing (clear to slightly mucoid), and some light sensitivity when severe (squinting). One way to know if it is the problem is does improve vastly during the cold months. Knowing what we know about periodic opthalmia it may even predispose to it as in your case.

The only successful treatment is keeping the horses eyes out of the sun. I have some clients that have sewn extra fabric into the areas just above the eyes, to provide shade of their fly masks.

Concerning the eye dilemma. If you must use abiotics periodically use a drug like tetracycline (Terramycin), it is not as hard on the normal population and would not cause resisitance to the more powerful drugs.
DrO

Posted on Wednesday, Jul 7, 1999 - 4:24 pm:

Judy- That was oe of the first things I quized my vet about. He said that this current situation is not related to Moonblindness, but rest assured when I talk to the specialist tomarrow that will be among the questions I have for her. As for the weapy eyes, he has them all year round. They just tend to be worse in the summer I think because fo the viscious cycle with flies and the increased intensity of the sun. We are verry religious about double fly masks for the flys and sun protection. He did however become much more light sensitive after he nearly died from the hepititis. During that he became jaundice and the toxins caused a burning from the inside out on all skin that was not pigmented. So anything on his body that was white with no hair blistered and cracked from the photosensitivity caused by the jaundice. Very scarry, he had a 3% chance of survival we found out latter, so I think he will come through this, he is a tough old booger! I will let you all know what the specialist says.

Emily--
--

Posted on Wednesday, Jul 7, 1999 - 6:53 pm:

judy- I just read the stuff on moon blindness, now I am concerned! You can bet a lot of hard questions will be thrown around tomarrow! Thanks, I knew Appys were prone to it but I wasn't aware of how prone!

-Emily

Posted on Thursday, Jul 8, 1999 - 5:33 am:

Be sure we are not confusing the inherited (?) night blindness of appy's, a non-inflammatory disease whose only symptom is decreased visual acuity as it gets dark, with moonblindness another name for recurrent uveitis.

Emily was the cause of the hepatitis ever determined?
DrO

Posted on Thursday, Jul 8, 1999 - 12:45 pm:

He does have night blindness aswell, if we feed at night I have to show him to his bowl. *sigh*

His light sensitivity has increased since the Hep. If you try to snap a photo of him he goes nut and runs to the far end of the field and hides his head. We now realize that he has come to associate the sound and sight of a camera with the painfull flash that sometimes accompanies it.

As for the cause of hep, well we like to say he got some bad chinese take out!

They did a biopsy on the liver and said he should have been dead a long time ago. The liver was so bad that it had changed it's basic function and crystalized, as well as infect all the surrounding tissue. They felt that he had a low grade persistant infection in his body some where, possible a small scrape on the intestinal wall that persisted for years. The liver filtered enough and finaly said good night. He was on HIGH doses of every antibiotic known to man for nearly 2 months. I can't imagine how he would develop any resistant strains of something *grin*?!?!

He's an amazing horse! Only a few more hours to the appt.. gotta run and get things ready!

-Emily

Posted on Friday, Jul 9, 1999 - 1:15 am:

Ok. Were back. I wish I could say I had
encourageing news to report. The Dr set the tone
when she took the mask off and said
"Wow, I've only seen that one other time, and that
was in vet school!"

She has taken srapeings and cultures to test for
both fungal and bacterial organisiasms. Her
feeling is that it is Fungal Keratitis, not good.
She does feel that it probably is caused by
Candida as that is the only fungal agent that she
knows of that would producve the plak like
substance that was on the eye. She was able to
easily remove the deposit, but it revealed worse
news. The eye is not healing, she said what it is
called but I couldn't remember. Maybe Dr. O can
help, she said it was something inherint in horses
where a wound wont heal, the new cells degenerate
and fall off. Anyway, thats not good either.

So moving on, it gets better... come to find out
that the reason he is so light sensitive is that
his pupils can't constrict all the way in either
eye. She wants to try to save this eye if possible
because the "good" eye has a small cateract in it
and the retina is getting damaged by the
unrestricted light flowing in. She also said that
she saw one of the two signs that show up in
horses that have had moonblindness or other
disesas but she didn't feel it was indicative of
moonblindness.

So now at best the prognosis is gaurded, we have a
50/50 chance to retain the eye with 50% vision.
worst case he looses the eye if it won't start to
heal.

She said the eye might respond to treatment once
we get the tests back, or it may rupture before
then, there is no way of knowing.

Were frustrated and conconcerned but I guess we
just keep going and hope for the best. I suppose
50% odds are a lot better that the 3% odds he beat
two years ago.

The results might be back by Saturday mnorning,
I'll post what the out come is

Posted on Saturday, Jul 10, 1999 - 6:35 am:

I can't think of a single term for the healing complication. Generally ulcers that are not healing are doing so because of contined degradation by the infectious organism. Besides a fungus, pseudomonas needs to stay on the list of organisims that can rapidly ulcerate a eye and requires a different antibiotic. Has a conjuntival flap been discussed to give the ulcer some support? I am saying my prayers, these can be tough.
DrO

Posted on Saturday, Jul 10, 1999 - 4:35 pm:

Emily,
I'm sorry to hear the news, but 50% chance of losing the eye is better than no chance at all. I'm glad to hear he doesn't have Moondblindness and there is a chance to save the eye and some of his sight. With my guy and his moonblindness, there is no cure and no chance to save his sight. When I first found out about the disease, I learned that most horses experience severe pain in their eye when they go through an episode of Moonblindness. Fortunately, for my horse, he never seemed to experience the pain. His eye would just cloud over and tear very badily. No matter what my vet or I could do, we couldn't stop the progress of the disease. Fortunately, I think the loss of sight was so gradual that my horse has adapted pretty well and seems to be handling it ok. He just got over a real bad episode and my vet said that now he is completely blind in that eye. Now, I just worry about his eye collapsing and that we would have to remove it. So far, so good and no sign of Moonblindness in his other eye. Now, I have to adapt to having a one-eyed horse and learn to do things on his good eye. But everyone I talk to tells me that there are a lot of one-eyed horses out there who are doing fine and so I pass that on to you. I will be praying that your horse can beat the odds once again and keep his eye and his sight. But, if the worst happens, remember horses adapt to things a lot better than us humans do. And when I get down about my horse being blind in one eye, I think of John Lyons and his completely blind horse, Zip, that he still travels the country with. And being blind, in one eye or two, does not mean it's the end of your horse's life. As I am researching blindness in horses, I am finding that owners have a harder time adapting than the horses do.
Please keep us posted on his progress and I will be praying that your horse will surprise the vets and beat the odds once again.
-- Judy

Posted on Saturday, Jul 10, 1999 - 6:55 pm:

Well all, the results are back, and once again my
horses have evoked comments like
"I've never seen this combination of things
before" or "This is highly unusual"...

I am at the point that I laugh everytime I hear
that...It's either that or cry!

The official diagnosis (so far):
-Right eye: Eosinophilic Keratitis / Erosion of
the eye. Ulceration of the eye. Yeast infection
present.
-Both Eyes: Atrophy of the Iris causing sever
light sensitivity
-Left Eye: Cataract, small in the center of the
visual field.

He is now on Genticine, Optimune, and Vira A
ointments three times a day. (BOY is that a
joy!)

The results of the bacterial culture will be back
on tuesday.

The Eosinphilic Kerititis she said could be caused
by either and autoimune organisim, or by herpese
virus. There has been some speculation about the
autoimune organisiams and a link to using
ivermectrin wormers, so we are not to use them on
him for a while. He once was treated for the
snotts and Herpese usually first shows as a
respiratory infection so we are treateing for this
with the Vira A because there is no way to test
for the herpese virus in horses, cats yes, horses
no.

All in all, the prognosis has been upgraded from
"gaurded" to "gaurded to good".

So Dr.O what can you tell me about that type of
Keratitis??? We did discuss the surgury but
weighing the odds, benifits, and unfortunatly the
cost we could not justify putting him or us
through that. If it was 100% I would say yes but
its not. If this does not work I am afraid that we
would have to go the route of haveing the eye
removed. But lets hope we don't have to cross that
bridge.

Currently the cloudyness has decreased a bit since
she removed the plak and the eye is begining to
look smother on th outside so I am hopeing that I
is begining to heal. We have made adjustments for
him and his pasture buddy is escorting him around
the field since his one eye is patched now.

Judy, I had the pleasure of going to a John Lyon's
symposium when Zip (blind) was with john. Zip
didnot come out and play because of a recent
tendon injury but he was "Meeting and Greeting"
everyone at the door. What an incredible team. No
matter what, he allways had one ear locked on
Johns voice. To give you an idea, our appy looks
like Zips brother. I have kept that experince in
my thoughts to keep the discouragement away, they
will over come.

Well I'm off to search the web...

Posted on Sunday, Jul 11, 1999 - 7:12 am:

Let's deal with the acute problem.
The official diagnosis (so far):
-Right eye: Eosinophilic Keratitis / Erosion of
the eye. Ulceration of the eye. Yeast infection
present.

With the exception of Yeast Infection, these are not diagnosises but descriptions of lesions and histopathology. From the path report of eosinophils being in the damaged tissue they are making a set of rule outs:
virus
parasite
allergic and autoimmune
All these diseses are losely associated with eosinophils.

Herpes virus keratitis is not common but well reported about. I have seen two in 15 years, (one was in a opthamologists hores!). Herpes is actually in all our horses all the time, why it decides to attack the eye is unknown. The two cases I have sen have cause mild to moderate irritatinon and where quite distinctive appearing: many (6 - 12) tiny (2-3mm) clouds on the cornea with evidence on slight pain and inflammation of the conjuntivia. Scrapes where not done.

Onchocerca has long been known to be able to get into the eye and may be one of the causes of recurrent uveitis. People may be surprised to find out Onchocerca is a major cause of blindness in people in the third world. Though I have not seen similar reports in horses a neutrophillic followed by a eosinophillic keratitis does occur in humans when the larvae are killed. It is possible, not likely in a horse that has ivermectin for most it's life I would say, but possible.

Now they say they found some yeast, yet there are no antifungals in the treatment regimen you gave(?).

Anyway, this seems very relevant:

Eosinophilic keratoconjunctivitis in seven horses.
J Am Vet Med Assoc 1996 Oct 1;209(7):1283-6
Yamagata M, Wilkie DA, Gilger BC

Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Ohio State University, Columbus 43210, USA.

Eosinophilic keratoconjunctivitis was diagnosed in 7 horses at The Ohio State University between 1976 and 1994. All horses had moderate-to-severe blepharospasm, chemosis, and conjunctival hyperemia; epiphora; and extensive yellow-to-white caseous mucoid discharge. Corneal ulcers associated with this disease were perilimbal and extended centrally. All ulcers were covered with a white necrotic plaque firmly attached to the underlying cornea. Other ophthalmic abnormalities were not detected. Corneal scrapings examined cytologically contained numerous eosinophils interspersed between epithelial cells, few mast cells, and neutrophils. Microbial organism were not seen. Bacterial and fungal cultures were negative for ocular pathogens. The initial diagnosis of eosinophilic keratoconjunctivitis was made on the basis of clinical and cytologic findings. In 5 horses, the condition completely resolved after topical treatment with corticosteroid (0.05% dexamethasone) and triple antibiotic ointments. However, the duration of treatment was prolonged, with a mean treatment time of 64 days (range, 45 to 106 days). All corneal ulcers remained superficial, and despite the prolonged duration of treatment, none of the horses developed secondary bacterial or fungal keratitis. One horse underwent superficial keratectomy and had the shortest resolution time (14 days).

DrO

Posted on Sunday, Jul 11, 1999 - 7:01 pm:

Dr O-
I'll double check on the yeast, there were so many
terms going round I may have messed that one up,
from paper you posted the plak may not have been
the yeast as she had expected. I remeber she said
the lab was quite surprised at the results and
actually ran them 2 times cuz they thought they
screwed up (she made several slides and smeares
from the gunk she got off his eye).

The plak has not returned and to me it apears the
the cloudieness had decreased. The swelling has
gone down a tiny bit but he continues to be in
pain. So as I am reading this, Eosinophilic
Keratitis is really just a broad description of
the symptoms, yes? That the actual nitty gritty
cause of this is yet undetermined. I know she made
the comment that it would be hard to know weither
he (the horse) lacerated the eye rubbing an
already ulcerated cornea or if the ulceration
happend because of an injury. She had suspicions
on the herpese and therefor recommended that I go
the route of the expense of the Vira A ointment
(not cheap!).

She did say that if there was not a marked
improvement that we would then go the the
corticosteroid ointment. Maybe I'll have to ask a
few more questions about that, I wouldn't want to
delay this.

I guess I need to go find out exsactually what an
Eosinophil is to get this all straight in my head.

Thanks Dr.O, I'll post the results of the
bacterial culture and double check on yeast thing.

Posted on Monday, Jul 12, 1999 - 6:17 am:

No, symptoms has a very specific meaning. They are what a patient reports is wrong with themselves. We in the vet profession have corrupted it to mean what the owner reports is wrong and even sometimes use it as synonymous with clinical signs: what we can detect wrong on the physical exam.

Eosinophilic keratitis means the cornea is inflamed and that the cells mediating that inflammation is predominantly eosinophils, one of our white blood cells that help us deal with infection. What it does not tell us is why are the eosinophils and the inflammation there. Eosinophils are associated with certain type of infections (usually parasitic), allergies, and autoimmune diseases.

The problem here is you have a therapeutic dilemma: if it is an allergic or overly aggressive inflammatory reaction you want steroids to cool this down. If it is a infection that is producing collagenase to melt the ulcer deeper into the eye the topical steroids potentiate the collagenase by a factor of 14 virtually insuring loss of the eye if used!

There are some medium grounds: nonsteroidal antiinflammatory drugs is one. Also systemic steroids are not supposed to potentiate the collagenase like topical steroids do. I am not sure why this is but have seen the statement in the ophthalmic literature several times. It still worries me however.

The organisms that produce collagenase are fungi and the bacteria Pseudomonas so they should be looked for and ruled out before steroids are begun. It requires experience to accurately culture these bugs out and the histopath slides needs to be scoured for signs of these.
DrO

Posted on Monday, Jul 12, 1999 - 11:57 am:

Ahhhh, I see,... Clear as mud! *grin*

Actually that did help, and now I understand why both vets are so hesitant on the steriod issue. Also why the lab ran the tests again. Well, with my luck it will be the most outlandish thing... that seem to be the pattern with my horses. *sigh*

Till tomarrow-

Posted on Tuesday, Jul 13, 1999 - 6:30 am:

My impression is: if it is infection, rapid and agressive treatment with appropriate antimicrobials without steroids is imperative. If it is idiopathic (that means we do not know why this is happening) eosinophillic keratitis you have a little time to figure this out. In either case nonsteroidal antiinflammatories are indicated and helpful.
DrO

Posted on Tuesday, Jul 13, 1999 - 10:18 pm:

Well, The results on the culture came back. The
opthomologist said that "Pasturalla" (sp) grew,
she said that is not what they expect to find
growing but that the Gentamicine will be effective
on that. We are to cointinue the current
treatment, Optimune, Vira A, and Gentamicine (no
fungals were present, I did have that wrong)
untill the two week check up.

My regular vet said his eye looks really good, I
had to bring him in for another problem that just
surfaced last night. He stocked up in the rear
legs badly, and was depressed. We administered
Pennicillin, Lasix, and Dexamethazone. These had
no effect on the swelling and by midnight he was
down and not wanting to get up, acting verry
groggy and out of it. His temp was 101.3 at
midnight and 98.8 at 8:00am. The swelling had not
gone down significantly and I just got back from
haveing blood drawn at my vets. My vet is
concerned that we may have the liver issue that
nearly took him 2 years ago rearing it's ugly
head... but that is another subject heading...

Looks like were on our way to saveing the eye, now
if we can save the horse....

God give me the strength to do all I can and the
wisdom to know when to let go.

Posted on Wednesday, Jul 14, 1999 - 6:09 am:

When it rains it pours sometimes. Hope this goes well. Don't despair, when problems line up and you are not getting proper sleep everything looks so much worse, but when you look at the problems singly you realize the reality is not near as bad as it feels.
DrO

Posted on Wednesday, Jul 14, 1999 - 12:03 pm:

At this rate I should start building an Ark! I guess one good thing is that I have decided to go back to college... I figure it would be chaper to Be a Vet than to Pay a Vet, thats where my passion lies anyway. Good news is the leg swelling has finally come down. Yahhh!

Posted on Wednesday, Jul 14, 1999 - 1:01 pm:

Our paint gelding got a rope burn (from cross ties) on his cornea two weeks ago. My local vet gave me the antibiotic ointment and thought he would be ok. The eye turned cloudy (blue/gray) and slowly cleared up. He still can not see out of it and it it looks murkey with broken blood vessels. The vet said this takes a long time to go away. Have you had any experience with this type of injury? Is there anything else I should be doing? Susan

Posted on Thursday, Jul 15, 1999 - 7:45 am:

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Posted on Friday, Jul 16, 1999 - 4:32 pm:

Susan- The one thing I have learned with my
expereince is that you should get a vetrinary
opthomogist involved asap if healing doesn't go
quickly. It's not cheap but it's worth it if you
can save the eye. I wouldn't even hazzard a guess
as to what might be going on in your horses eye.
They just can't know untill they test and ususally
that goes beyond the expertise of a general vet.
Good luck, no matter what it is not a quick
process

Posted on Thursday, Jul 29, 1999 - 2:07 pm:

Well we had the recheck on the eye, there was still uptake of dye in the eye so the optomogist has now decided that we need to move forward with the steriod ointment. She felt that the risk of infection present thet would conflict with the steriod ointment was minimal bcause I have been faithfull with the 3x a day on the other ointments. She has now prescribed Actrol Ointment 2-3 x day and ViraA 1-2 x day. Because of the previouse liver issue neither her or my regular vet are very comfortable with systemic steriods.
She felt that with the risk of ointments was worth it and we do it knowing that it could go ugly but with only minimal significant improvement recently we don't have a lot of choices. The Eosinophilic Kertoconjunctivitis she said is another name for what is happening. I am nervous about this but my gut tells me that it is time to get more aggressive.
He's stocking up has minimized, although he has minor swelling between the base of his ears and jowls. Odd...hmmm, well I off to call my general vet to see what he says about that. My regular vet found your post on the research paper verry interesting. Good job Dr. O.
Thanks

Posted on Wednesday, Aug 4, 1999 - 8:01 pm:

Dr O. -HELP!!! it went from bad to ugly! I found this morning that he was extreemly sensitive and last night a dark white spot had appeared on the eye, this morning there was brownish-red bumps on the eye encircleing the dark white spot... we are assuming the worst, rupture.

The opthomogist said there is a chance that it could be superficial rupture and if so might be able to heal itself, but I need to bring him in to tell for sure. I am haveing a lot of internal conflict in trying to determine if paying $300+ to see her for that answer on a slim chance, when I might still have to spend $500 to have the eye removed. If there is a chance to save the eye I worry about prolonged pain of treatment stressing him and causing more problems with his liver... Aaaah!

I am trying not to make this a financial decision but it does play a part. Everything I have read does not give me much hope that I have anything to gain by not just haveing the eye removed to end his pain and let him get on with life and the things he loves.

Any thoughts or information on this would be appreciated and assist me in makeing an informed decision. I certialy would not ask you for an opinion on what I should, that is my cross to bare. Thanks!

-Emily

Posted on Thursday, Aug 5, 1999 - 7:44 am:

You need to take him in: remember you still do not know what the new problem is and until it is defined, we will hope for the best. If you could ask: would you perfer to keep that eye I am sure he would answer a resounding yes!
DrO

Posted on Thursday, Aug 5, 1999 - 12:03 pm:

Dr O-
We I got home last night I had the opportunity to talk further to the Opthomogist. I was able to further understand our range of best and worst case scenarios, that information combined with the fact that he is now in extreem pain we made the difficult decision to have the eye removed. As best that we can tell, if he has any vision left it is now only minimal, he turns his head to see out of the good eye even when the bad one is open. I can't justify putting him through anymore pain on the slim chance we might be able to save an eye with compromised vision. She said that at best the chance we have is not a really good chance now that there is compounding of problems on an eye that was not healthy to begin with, and if we did get this resolved there is no garentee that what ever caused it won't happen again. I can't justify those odds, not with the fact that both vets feel that prolonged stress would be risky for him considering the previous liver issue.
We are more convinced of this now that this morening the eye is looking worse. Thank you Dr O for all you excelent information, it has definatly helped haveing a better understanding of this. It's time to let go and let him move on with his life without any more pain, enough is enough.
-Emily

Posted on Friday, Aug 6, 1999 - 4:37 am:

That's fine Emily,
It sounds like you are ready for this and from the yours and the vets response the horse may be too.
DrO

Posted on Friday, Aug 6, 1999 - 11:29 am:

DrO- One more question, I have heard of implants
for the eye socket that give the impression of an
eye under the skin. I am told they are like ping
pong balls that stop that sunken look. I have
heard that glass eyes for horses have a lot of
problems with infections, is this also the case
with those implants since they are sealed form the
outside?
-Emily

Posted on Saturday, Aug 7, 1999 - 4:59 pm:

Hello Emily,
I do my own enucleations but do not put in the prosthesis. If clients want it, I send them to the local state university. In the last 10 years the two who have elected for prosthesis have had to have them removed later do to complicating infection. This occurs sometimes years after the surgery suggesting to me that even if the surgery is done correctly, the foreign body makes the chance of infection much greater. I have never had trouble with nonprosthetic surgerys even when done in the field. If money where no object I still would not choose it, though it is a bit more cosmetic.

Take the extra money and have the eye submitted for culture and histopath so you, and we, can better understand what has happpened.
DrO

Posted on Sunday, Aug 8, 1999 - 3:56 pm:

You brought a very good point that we (my husband
& I) had already talked about. I will probably
do that seeing as now the Opthomoligist
is telling me to get a good look at what
this eye looks like and to remember it. I am
to call her emmediatly if I see any sign of
it in the remaining eye in the future. She is
very concerned with it because we don't know what
caused this and that the eye failed to responded
in any "normal" manner to any of the prescribed
treatments. She admitteded after I told her of our
decision that "if she was a betting woman she
would lay odds on the idea that no matter how much
money or time we threw at the eye we would end up
in the same place." I still have pangs of guilt
that I am giving up him, but then I see him out
there misreable when the bute wears off and I know
this is the best thing. Two more days.... god I
hope I am doing thing.

Posted on Monday, Aug 9, 1999 - 11:14 am:

Emily,
I know this was a very hard decision for you but I really think you made the right one. I think you will realize that when you see your Appy finally pain free from that eye. If the idea of him being able to only see out of one eye bothers you, don't worry. As I said before, I have a one-eye blinded Appy myself and he is fine. Yes, I've had to learn some new things in my care and riding of him, but nothing major and I still do all the things with him that I did when he could see with two eyes. Plus, when I started doing research and talking to people when he started to go blind, everyone that I talked to said that after they had removed the eye, it was such a relief for their horses to be finally pain-free and they were doing fine. Yes, it is an adjustment cosmetically to get used to your horse's new look, but you will. Plus, your Appy probably hasn't been able to see out of that eye for a while so he's probably already used to just using one eye. I really think us humans have a harder time adjusting to a blind horse than the horses do. Once the pain is gone, you'll be glad you did it.
-Judy

Posted on Monday, Aug 9, 1999 - 11:49 am:

Judy- I think and hope your right. The more I watch his behavior the more convinced that in this last week he has lost most if not all of the vision in that eye anyway. How does your appy deal with the lack of depth perception, we trail ride pretty narly trails and will do pack trips once a year. will this be too dangerous for him?
Emily

Posted on Monday, Aug 9, 1999 - 12:40 pm:

Emily,
Regarding depth perception, I've noticed now that he now turns his good eye to see, especially when he is unsure of something or in unfamiliar territory. Around his home turf, there's no difference. He has started to sometimes swing his head back and forth to see. Also, I've been working on teaching him voice commands for step up, step down, step over, and stand. That way, he knows what's coming up and what he needs to do.

Your biggest adjustment will be doing everything on his good side. Always approach him on his good side and always let him know where you are. I keep a conversation going with him all the time I'm around him so he always knows where I am at. When I'm on his blind side, I try to keep a hand on him so he knows I'm there. When you lead him, always lead him on his good side (which I'm still having a hard time getting used to because it's his right eye that's blind so its awkward). And, if you can get used to it, mount him on his good side. For me, that was an adjustment, mounting him on his left side. (Yes, I know, a good horseman should be able to mount from both sides anyway.)

As for trail riding and your pack trip, that should be no problem. But your days of sitting blissfully in the saddle, enjoying the scenery, and riding on auto-pilot are over. You now have to pay attention. You have to be his missing eye. You just have to make sure you make adjustments if he starts to drift over on his blind side or is coming to close to a tree on his blind side, etc. Or,if you start getting him used to your voice commands, when you come to a log, you can say, step over, and he'll know what's coming up and what to do. Trail riding is no problem -- like I said before -- you can still do everything with him you did before, just with a few adjustments on your part. Go slowly and you'll do fine.
Judy

Posted on Wednesday, Aug 11, 1999 - 1:27 pm:

Thank you Judy, It is now done and he is
recovering in his stall. He had a bad go of it
with colic after the surgery (the Dermosidan realy
corked him up) but he is feeling better this
morning.

I am convinced that Appys are the smartest horses
in the world when it come to eating... His face
hurts so bad he dosen't want to chew, sooo he
spent all last night sloshing his hay in watter to
soften it! He even figured out that I was at his
beck and call (I slept in the barn) he would paw
at the door when it was time for a fresh bucket of
watter or time to have drainage wiped from his
face, which was atleast 8 times last night! *Yawn*

Dr O, We have sent the eye in for a biopsy, what
other things might you suggest that would help us
determine the cause of the condidtion. I really
want to get as much info as possible incase this
happens in the other eye. My vet said that it had
not yet ruptured but it was darn close. I have to
say that is a really icky surgury to watch,
especially for the first one I've seen. I new
there was a lot of blood supply to the eye but
wow! Guess I'm gonna have to get used to that if I
intend to got back to school. Hope that gets
easier to deal with.

-Emily
--

Posted on Thursday, Aug 12, 1999 - 8:15 am:

That is about it, you could culture the eye using the most diseasesd tissue. But they should be able to determine in a general way if and what organisms are responsible by their location in the tissue, the way they stain, and their morphology.
DrO

Posted on Monday, Aug 16, 1999 - 1:56 pm:

Dr O - We got the preliminary results back on the biopsy of the eye. The good news is we definatly made the right decision to take the eye. I tried to take notes when my vet was reading off the laundry list of stuff, but gave up and just requested a copy of the results.

The things I remember were: puss producing organisims, granualation, scaring, inflamtion in diffrent areas of the eye, cataract, extreem pressure in the eye causing "cupping" at the optic nerve, retinal degeneration, blah, blah, blah. Other terms were thrown around such as Glacoma, and Anterior Uveitis but he said it's not exsactly what you might normally think of as Moonblindness.

My vet said that the cupping was a sure sign that there was no vision left in the eye, so all he lost was a painfull sightless eye.
-Emily

Posted on Monday, Aug 16, 1999 - 11:42 pm:

OK here it is:

Diagnosis: Severe, suppurative to pyogranulomtous
and fibrosing anterior uveitis, regional
scleritis, and peripheral kerititis, and with
slight cupping of the optic disc, regional retinal
degeneration and lenticular cateract formation-
eye.

Comment: The preliminary lesion is felt to be the
anterior uveitis. Because of the extent of the
suppuration, an infectious agent would be suspect.
Primary trauma with introduction of foregin and/or
infectious material would be suspect.
Alternitivly, this may represent a primary
anterior uveitis of idiopathic origion that is
common in equines. As intimated above, the
suppuration does indicate otherwise. There almost
certainly was occlusion or atleast impediment of
the filtration angle, and the other changes except
for the cateract are considered secondary to
developing glaucoma most likely. The lenticular
cateract is felt to be a degerative change and may
be age related. Notably, if this lesion is from
primary trauma with introduction of foreign and/or
infectious material, it would be suspect to be
unilateral where as if it represents anterior
uveitis, bilateral lesions would be expected.

So I am interpreting this as he poked his eye, got
some bad nasty bacteria in it, like Pasturella,
and an eye that wasen't a healthy eye to begin
with just went to *&%$ in a hand-basket. What I
don't understand yet is the part of glaucoma, and
the filtration angle, and... well all of it.*grin*

Help... Why can't they just speak english....

Posted on Wednesday, Aug 18, 1999 - 5:39 am:

Hello Emily,
Possibly, but that does not explain the eosinophillia. How about an anterior uveitis of allergic or (much less likely) parasitic origin that developed a secondary infection with a collagenase producing organism. This secondary infection was aided and potentiated by treatment for the eosinophillic keratitis: the corticosteroid. A case of darned if you do and darned if you don't.

Where the eye filters and removes excess fluid in the eye is in the angle formed between the iris and the globe where they join. The lesions in the back of the eye are a bit of a surprise and I do not know whether to relate them to the acute episode or dhronic problem and exactly what effects they may have had on vision.
DrO

Posted on Wednesday, Aug 18, 1999 - 12:10 pm:

I too wondered why the eosiophilic keretitis was not mentioned in this lab result, other than "periphial keretitis". Is that what they ment or could the eosinpohils have not been present any longer? I did dig through the OMD and found that the treatments for the diffrent problems listed deffinatly did not go to gather and that several of the condidtions were consisdered very painfull, so I am glad we didn't mess around any more. And BTW the horse is so much happier now! He is back to his Appy Butt-head self again, boy did I miss that attitude!

Posted on Monday, Aug 23, 1999 - 1:45 pm:

Possibly,
The corticosteroid was resolving the allergic component when the bad guy came along and took advantage of the environment. Delighted to here he is feeling better.
DrO

Posted on Friday, Sep 3, 1999 - 2:10 pm:

Hey all' just wanted to wrap this Opthomalic Soap
Opera up...

Diablo, our appy is doing well after his surgury
to remove his eye. We have been riding him, and he
is getting better about picking his feet up on the
trail. All in all he has adjusted to this quite
well. Thanks for all the support and info, I
learned quite a bit in all this!
-E
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