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Brittany B McKinney (Bmckinne)
| | Posted on Wednesday, Sep 4, 2002 - 5:32 pm: |   |
My four-year old quarter horse was diagnosed with RU one month ago. She orginially had very mild symptoms. She was squinting occasionally for a two-week period before I had her checked by the vet. Her regular vet found inflammation in her eye. The blood vessels in her eye were also irritated. He started treating her with Neopolydex, Antropine and aspirin twice daily for one week and then once daily. She stopped squinting within one to two days of treatment. We took her to an ophthalmologist after two weeks of treatment. At this time she had no signs of damage to her eye, no inflammation, or loss of vision. She tested negative for Lepto. Under the instruction of the ophthalmologist we took her off of the Antropine immediately and the Neopolydex after one more week of treatment. Taking her off of the Antropine did not have an effect, however, her eye swelled shut and became extremely sensitive to light after only one day of discontinuing the Neopolydex. The ophthalmologist instructed me to put her back the Neopolydex four times per day, Antropine two times per day, and Banamine two times per day for four days then go back to the Neopolydex and aspirin treatment on a daily basis. Again, this treatment worked within one to two days. She will be going back to the ophthalmologist in one week.
I have a few questions that I would like to ask to get a second opinion. I would also like to make sure I am asking my ophthalmologist the right questions. My understanding is that the RU episodes are extremely harmful to the eye. Therefore, aggressive treatment is needed immediately. Should I try to get my horse off of the medication to see if the episode is over if there is evidence that the attack will occur as soon as I stop medicating? The ophthalmologist said that my horse could remain on low dosages of Neopolydex forever. Is this the best medication for her? He also mentioned the Cyclosporine implants as an alternative. How soon should I consider the Cyclosporine implants? Should I try the topical treatment for a period of time first?
My horse is usually on a rigorous training and show schedule. She is shown year round and often hauled long distances. She has been out of training for a couple of months; originally to give her a short break and now to treat her eye. I have been riding her lightly during treatment with the exception this last week following her more severe attack. I would like to get her back in training as soon as possible and start showing again. However, I do not want to jeopardize her health. My ophthalmologist said we should try to get her back to a “normal” life to see what she can handle. What precautions should I take? How many horses with RU have a “normal” life and for how long? |
Robert N. Oglesby DVM (Dro)
| | Posted on Thursday, Sep 5, 2002 - 6:22 am: | |
Hello Brittany,
A problem is the variable course of RU so the answer to some of your questions is unknown at this time.
When things are going well I would recommend you wean the horse off the dexamethasone ointment rather than discontinuing it. Decrease the frequency by once a day, give it for 3 to 5 days, repeat until you are off the medication. The best ointment would be the one with the lowest concentration of dex that controls the inflammation. If the neopolydex does it that is fine. The cyclosporine should be considered when it is apparent that topical treatment only leads to temporary improvement and the recurrence rate is frequent. Usually you are going to see how big a problem this will be in the first 6 months. I see no problem with working while the eye is comfortable however when atropine is used you must protect the eye from bright light until the dilated pupil resolves, perhaps working at dusk or an eye cup would help.
DrO |
Brittany McKinney
New Member
Username: Bmckinne
Post Number: 2
Registered: 9-2002
| | Posted on Monday, Sep 9, 2002 - 4:07 pm: | |
Thank you for your quick response. I really appreciate your advice.
If the inflammation/swelling is severe after one day of not medicating, should I resume the once a day treatment with the neopolydex and aspirin or should I treat more aggressively?
|
Robert N. Oglesby DVM
Moderator
Username: Dro
Post Number: 6879
Registered: 1-1997
| | Posted on Tuesday, Sep 10, 2002 - 5:52 am: | |
When severe or worsening you should use aggrssive treatment, you reduce only when things are normal or at least near normal and rapidly improving.
DrO |
Brittany McKinney
New Member
Username: Bmckinne
Post Number: 3
Registered: 9-2002
| | Posted on Monday, Nov 4, 2002 - 1:19 pm: | |
My horse is doing very well. She is back in training and her eye appears to be doing fine. However, we are still medicating – neopolydex and aspirin one time per day. She went back to the ophthalmologist in mid September. Prior to visiting the doctor, I tried to wean her off the neopolydex by increasing the time between applications (from 24 hours to 28-30 hours). Her eye would start to swell within 30 hours of no meds. The ophthalmologist recommended that we continue to treat her eye once a day with the neopolydex and aspirin as long as it works. He believed that the flare-ups while weaning her off the meds were worse than continuing to treat her long-term. She is now in training in a different state with a new general veterinarian. Her new veterinarian is concerned that the long-term treatment with the neopolydex will hurt her immune system. I am not sure which is the lesser of the evils or how to proceed. My horse’s ophthalmologist recommended that she be checked every 3-4 months by an ophthalmologist, which I plan to do (December-January time frame). Should I wait that long? Have there been other cases where the neopolydex is used long-term? |
Robert N. Oglesby DVM
Moderator
Username: Dro
Post Number: 7236
Registered: 1-1997
| | Posted on Tuesday, Nov 5, 2002 - 4:22 am: | |
I do not believe there are many systemic concerns about the long term use of neopolydex, the dosage that enters the system is just too small. However there are local concerns with the suppressed immune function around the eye: fungal keratitis. But if the RU goes untreated you lose the eye. You should continue with your opthamologist plan, I believe.
DrO |
Jose J Fuentes
New Member
Username: Bajamari
Post Number: 1
Registered: 1-2004
| | Posted on Friday, Jan 9, 2004 - 1:41 pm: | |
Dear Horsemen's Advisor, I live in Baja, Mexico where equine vets are not available. I adopted a three year old wild horse two years ago. He was healthy when I got him but developed bacterial infections in both eyes. The first episode was found by the lab test to be pseudomonas. I treated him with sulpha trim and it cleared up. The second episode was found to be caused by staphylococcus. Again the sulphatrim worked and in adition I used optical gentamacin. This also cleared up . He is now having a third episode found to be caused by staphlococcus and streptococcus. I am using the same medication and it is slightly better. The lab told me to try vancocin but I can find no information on dosage or side effects. I have two main questions .What do you recomend for treatment and 2. I have another horse brought down from the States. They are kept in a large enclosure together and the other horse has healthy eyes. Is this problem contagious? I believe this is some kind of uveitus. I would appreciate any help you could give me |
Robert N. Oglesby DVM
Moderator
Username: Dro
Post Number: 9745
Registered: 1-1997
| | Posted on Sunday, Jan 11, 2004 - 11:58 am: | |
Since we cannot examine your horse we cannot make specific treatment recommendations. If you believe this to be a bacterial infection you must use the results of the culture to match up with medications you have available locally. 1% vancomycin hydrochloride (VCM) ophthalmic ointment has been investigated and found suitable for treating eyes (once every 6 hours)of some species but I do not know if it is available commercially. I would check with a regular opthamologist. I have not seen any work in horses but do not know why it should not be used.
Nor do we know if this is a transmissable disease for your other horse so recommend you keep them seperate until a firm diagnosis is established.
Recurrent primary bacterial infections of the eyes is quite rare in horses so I wonder if you are having trouble with Recurrent Uveitis which is not a primary infection. All of these organisms, including pseudomonas, can be found in healthy eyes so I am uncertain of their significance. For more on this see, Equine Diseases » Eye Diseases » Anterior Uveitis, Recurrent Uveitis, Periodic Opthalmia, and Moonblindness.
DrO |
Jose J Fuentes
Member
Username: Bajamari
Post Number: 2
Registered: 1-2004
| | Posted on Monday, Jan 12, 2004 - 10:46 am: | |
Dear Horsemen's advisor: Thankyou for your response. I think I jumped into this from the middle instead of at the beginning. At his ist episode Monty had reddened, swollen schlera in the eye. It was weeping and as the episode conttinued the eye became more red and swollen and started producing mucous. I did not notice any cloudiness in the eye. when I called the vet he thought it was an eye infection. When I had it cultured the lab reported abundant amounts of pseudonomus so we used sulpha trim to treat that. The second and third episodes were the same except the lab reported abundant staphylococcus, the third episode was reported as moderate amounts of staph and strep. I have been treating this as a bacterial infection not knowing specifics about recurrent uveitis. I know you cannot examine the horse but the one and only horse vet here has not heard of uveitis. Can you give me a recommendation for treating the redness and swollen schlera. I know these are not an ideal situations but given the restraints on competant equine vetinarians I have nothing to lose and without help would end up putting the horse down which I wouild hate to do,. I can fing nothing on neopolydex so I do not know what this medication is and what it does. My husband is contactting the lab today to find out whether lepto was present in the sample.Many thanks for your hepl |
Donald W. Goddard
Member
Username: Gafarm
Post Number: 27
Registered: 1-2000
| | Posted on Monday, Jan 12, 2004 - 2:06 pm: | |
There is a support group for owners of blind and partially blind horses at http://www.smartgroups.com/groups/blindhorses
The most common cause is ERU, cataracts, or direct injury to the eye. There is lots of information and other people's experiences with treating the disease as well as handling and training of blind horses in the archives. The one thing we have all noted is that not all horses respond to the same treatment so you really need to explore all the options and see what works best for your horse! "There Is Life After Blindness" is our motto. There are two members who have trained their totally blind horses and used them in hunter/jumper events and endurance rides! The extent to which their other senses take over and how well they adapt never ceases to amaze all of us! |
Robert N. Oglesby DVM
Moderator
Username: Dro
Post Number: 9754
Registered: 1-1997
| | Posted on Tuesday, Jan 13, 2004 - 6:39 am: | |
Neopolydex is a standard eye ointment that contains antibiotics and a steroid. The steroid is a powerful antiinflammatory that as a general rule should not be used in the prescence of infection. Note the problem with lepto induced recurrent uveitis, is that it is in the eye not an external infection: it will not usually be detected in a conjunctival culture.
So you are saying you seem to have a bilateral conjunctivitis and not a keratitis? I would have the conjunctivia carefully examined for foreign bodies, like splinters or plant awns. This will require sedation and blocking of the motor nerves to the lids. For more on this condition and possible causes see, Equine Diseases » Eye Diseases » Inflammed, Tearing, and Swollen Eyes.
DrO |
Jose J Fuentes
Member
Username: Bajamari
Post Number: 3
Registered: 1-2004
| | Posted on Friday, Jan 30, 2004 - 2:40 pm: | |
Dear Dr.Oglesby, many thanks for your help I had been injecting Monty with Septetrim for about six weeks without much improvement , after your last reply I went to the pharmacy with a list of medications and they had Blephamide ( sulpacetamide and prednisolone). A week ago I stopped the shots and started applying the blephamide. In one week his eyes are almost better, the redness is gone, the mucous discharge is ggone and the swelling has almost disappeared. The vet here who I dont think knows about uveitis,thinks it may be some form of conjuctivitis triggered by flies or insects. The flies are not a problem right now so I'm leaning toward uveitis given his rapid response to the cream. Can you give me some suggestions for maintaining this improvement and preventing or delaying another outbreak? |
Robert N. Oglesby DVM
Moderator
Username: Dro
Post Number: 9883
Registered: 1-1997
| | Posted on Saturday, Jan 31, 2004 - 5:50 pm: | |
The article has treatments and suggestions for prevention Jose.
DrO |
