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Recurrent uveitis

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  • Recurrent uveitis

    My horse has recurrent uveitis in one eye only. Last time he flared up, he was treated for about 3 weeks before discontinuing treatment. Now he has flared up again. My vet did not mention anything about maintenance therapy. I know some people use daily aspirin? At what dosage?

    I took this horse on as a rescue with the intention of rehoming him once he recovered. I never intended to keep him and i need to down size. I'm considering offering him for free lease and transferring ownership if i can find him the right home. He's young, and sound. He's trained under saddle but is rather hot/high strung. Do you think i have any chance of rehoming him? Or would it be better to euthanize? I really hate to put him down as he is so young and healthy with the exception of his eye problem. I just don't have unlimited funds and i know uveitis treatment can quickly get expensive. He still has sight in both eyes. The affected eye has a cataract.

    If this is leptospirosis related, has anyone had success with antibiotic treatment?


  • #2
    I've had two horses with it over the years and both did really well with good management. The management we used at the time - one 20 years ago, one more like 15 years ago - was less sophisticated than I hear about now. Our vet is now quicker to remove the eye, which makes the horse's daily life (and the owner's) much less painful and often preserves a useful career.

    In any case, I'd try to get the horse as well trained as possible, as soon as you can, because that will go a long way towards making sure he finds a good home if you don't plan to keep him. One of ours with uveitis was an eventer who loved to jump, and as time went on we just made sure the jumps were brightly painted and contrasted with the background (XC was harder) and he jumped happily until the day before he died (of causes unrelated to the uveitis). My mare was a great trail horse and we never really knew what she could or couldn't see, she still loved going for easy trail rides past the age of 30. Get your guy out, let him experience the world and learn to take things in stride, and see how he does.


    • Original Poster

      I have an appointment with the vet this afternoon so I'll get her opinion as well as far as treatment options. He's not a very good patient. I tried putting him in his stall and he was screaming and pacing and generally throwing a tantrum. For his last flare up he was stalled for 3 weeks and was fine. I guess he is going in the pasture and I will have to sew an eye patch over his fly mask.

      He can be a brat about eye medications but so far I've been able to manage. I just hope he doesn't have an ulcer in addition to uveitis. It looked worse today then yesterday. He tends to rub his eye on anything within reach so i suspect he's making it worse. Any idea what eye removal costs?

      It may be better to just remove it, if this is going to keep happening.


      • #4
        I use 10 grams of MSM daily to control the flare ups, which works pretty well for us. The Guardian Fly Mask comes with removable eyes (velcro attachment) and an eye patch you can insert into the eye cup before reattaching it to the mask. It is also good for removing the eye cup, dosing the eye with meds, then reattaching the eye cup back onto the mask. If the horse has flare ups after getting him on MSM, we call the vet. Good luck with your horse!
        "The difference between genius and stupidity is that genius has its limits." Albert Einstein


        • Original Poster

          It turns out he has an ulcer in addition to a uveitis flare. His pupil is dilated so the atropine is working.


          • #6
            My daughters mare has it as well. I use the antibiotic eye ointment if she has a flare up and only use it till the eye is normal again ( 3 days max usually). I wouldn't euthanize for this condition , especially if his sight is not impaired.

            With 24/7 fly mask we have only had 2 flare ups this year.

            Why the stall rest for your guy? I just treat and keep her turnout the same.


            • Original Poster

              The vet wanted him out of the sun and bugs. He is very bug sensitive. With the atropine, his eye is dialated so being in the sun isn't good.

              He was dripping wet under his fly mask this afternoon. I had to hose him and tie him in front of the fan before I could put his meds in. He was so wet, there was no way to open his eye.

              The vet didn't think aspirin or MSM would help. She suggested cyclosporine drops but I heard those aren't real effective.


              • #8
                Originally posted by 4horses View Post
                The vet wanted him out of the sun and bugs. He is very bug sensitive. With the atropine, his eye is dialated so being in the sun isn't good.
                If you have a good UV-protection mask, he should be okay outside as far as the dilation goes. If he's nuts in his stall, it's sometimes better and safer to just leave them outside. Yes, dilation is going to allow more UV light into the eye which contributes to cataract formation and possible retinal damage, but you should be fine as long as the mask blocks it.

                Originally posted by 4horses View Post
                She suggested cyclosporine drops but I heard those aren't real effective.
                Now, I'm not a vet, but I am an optometrist. As far as human eyes go, Restasis (cyclosporin) is FDA approved as a medication drop for dry eyes. It's not really used to control inflammation such as cases of ulcers or iritis, although it is classified as an immunosuppressant. Based on it's action on the human eye, I would be doubtful of its usefulness to prevent an equine uveitis from flaring back up. You don't really need to suppress the immune system -- you need to control the inflammatory response! I think it would be more beneficial to do some sort of NSAID eye drop as maintenance, if something like that is needed.
                It is not enough to know how to ride; one must know how to fall.


                • #9
                  My mare was prescribed flurbiprofen ophthalmic ointment for daily use between flares.

                  Cyclosporin implants (rather than drops) have seen good results since uveitis is immune mediated.


                  • Original Poster

                    It looked like the ulcer was healing well, but i checked again today and he has a new (small) ulcer. Either that or the edges healed inward leaving just the center left to close. The eye itself looks much better. Swelljng is down and eye is open instead of swollen shut.

                    Are ulcers common with uveitis? Is it possible to cross tie your horse for a day or two to prevent them from rubbing the eye on something and making the situation worse? Other than constantly checking on him and offering water, how would you manage water and feed while cross tied? Or would it be possible to put up an electric fence so he can't find something to rub on?

                    Can horses get corneal ulcers without rubbing on anything? Or will he just rub his eye on his leg instead?

                    Trying to come up with ideas for managing this in the future and it seems like he is making things worse by rubbing his eye or face on things.


                    • #11
                      I wouldn't cross tie him. They must make something that is rub proof to protect an eye injury that a horse can wear.


                      • #12
                        He's telling you it still hurts. Can your vet give him something more for pain management? Is the medication actually reaching the ulcers? Are there other ulcers or maybe also a fungal infection? Is it time to consider a few days of inpatient treatment, where he can get meds every hour and/or with a small catheter?


                        • #13

                          Originally posted by 4horses View Post
                          It looked like the ulcer was healing well, but i checked again today and he has a new (small) ulcer.
                          Are ulcers common with uveitis?

                          Can horses get corneal ulcers without rubbing on anything? Or will he just rub his eye on his leg instead?
                          Again, I'm not a vet so take this with a grain of salt but in humans uveitis is common to see with ulcers (as the ulcer inflammation will cause the uveitis reaction) but not so much the other way around. If the uveitis is primary, you do not normally get an ulcer. So it kind of depends what is primary and what was there first.

                          Has your horse had ulcers before in previous flare ups?

                          Of course, it is entirely possible he has scratched his eye due to rubbing it, which was a corneal abrasion that turned into an ulcer and so it's not at all related to the uveitis. A corneal abrasion is basically a scratch. If the scratch become infected, then it can turn into an ulcer. But not all ulcers are infectious in nature, they can be sterile (non-infectious).

                          It is possible for ulcers to form on their own due to inflammation without any preceding scratch or abrasion.

                          So the answer is probably "maybe" to all your questions, unfortunately!
                          It is not enough to know how to ride; one must know how to fall.


                          • Original Poster

                            He is on banamine. The eye is looking better. No need to take him back in just yet.

                            The vet believed that it started as uveitis, and then he rubbed it. Months ago I noticed during a flare up that he was rubbing it on the barn wall. So obviously it itches. No ulcers last time, just uveitis, despite him rubbing it. He did get lots of swelling in his eyelids last time.

                            I will ask the vet on Monday if they have an eye shield to prevent rubbing.


                            • #15
                              Here is one article on ERU. There is no cure. There are management steps that can be taken.


                              Mangalarga Marchador: Uma Raa, Uma Paixo


                              • #16
                                If what you are looking for is a good fly mask and are willing to spend for one, you should consider the Guardian fly mask/


                                • #17
                                  Generally with ERU, they will eventually lose the vision in the affected eye(s). It often starts in one eye but ends up in both--hopefully that won't happen to you.

                                  Vet costs vary by location, of horse's eye removal (due to trauma, not ERU) was around $1200 (not including the initial emergency call when he got hurt) and done standing. It would have been more if they'd had to put him under. That does include a farm call to check and remove his stitches a couple weeks after the surgery and the three days he spent at the clinic.

                                  I borrowed a hood with a hard eye cup after his surgery that he wore outside for a couple weeks. He couldn't rub while wearing it. I'd have gotten a Guardian mask had I not been able to borrow the hood from a friend. It looks like a racehorse hood with one full eye cup.

                                  I did daily aspirin for my ERU mare while she was flaring up. I did not keep her on it all the time because it's hard not he stomach, but had better luck with it than bute. There are implants that can be put in the affected eye that release antibiotics (IIRC) continuously. I know NC state does them, and a couple other hospitals.


                                  • #18
                                    I'll add to the advice here that the earlier you can catch and start treating flare-ups aggressively, the better. My mare's "early warning sign" was getting spooky about transitions from light to dark (e.g., walking into shadows). If I started treating her when she displayed that sub-clinical indicator, she wouldn't get to a full flare-up. I sold her with full disclosure about 2 years after her diagnosis. She's blind in that eye now, but since the eye hasn't been removed (to my knowledge), it seems like she's got a relatively easy case to manage.