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Debra Jahnke
| | Posted on Saturday, Jun 17, 2000 - 9:28 pm: |   |
Has anyone had any luck (or heard of) using Cyclosporine eye ointment in treating Recurrent Uveitis? My horse was diagnosed in January. Since then he has been pretty symptom free only because of daily use of Prednisilone eye ointment. The minute we stop the Pred, the symtoms of reddened, swollen and teary eye return. The horse is pretty much blind in the affected eye and to make a bad situation worse, recently injured the eye. We were told that healing was hindered due to the use of the steroidal ointment. Thankfully, it finally did heal up but the vet had us try the Cyclosporine (non-steroid) instead. In reading the indications, it produces the same symptoms as UV and the horse spent his entire time trying to scratch what seemed to be a very itchy teary eye. We were afraid of further damaging the eye so we stopped (with vets ok) and are now back on the Prednisilone. Further reading said that the medication could take weeks to work and I'm wondering if we gave up with it too soon. Although, within 24 hours of being back on Prednisilone, the eye improved immensely. Don't know if we can use it forever though.
Thus, I'm wondering if anybody else has had any luck or used the Cyclosporine and also if we hold the record for an attack that lasts 6 months?
Deb |
Robert N. Oglesby DVM
| | Posted on Monday, Jun 19, 2000 - 7:43 am: | |
Hello Debra,
We have had a difficult case of RU referred to us at this time. It appears as though the horse does have classic symptoms of RU but an unusual feature is a secondary glaucoma.
We have been using subconjunctival injections of long acting pred, which does great for awhile then the cloudy cornea returns. I have a feeling it is becoming less effective. As a result we are pursuing several alternatives:
First, we have put him on systemic antibiotics (6 million units Pro Pen twice daily) for the chance that this may be a Lepto-induced uveitis. We are running titers to double check this thought.
We have changed over to oral prednisolone (prednisone is not recommended)(0.5 mg/lb/day). This is to lower the possibility of a iatrogenic (doctor induced) fungal keratitis.
We are using atropine to help lower the pressure in the eye. It is on a as needed basis to keep the pupil dilated. Of course the horse is stalled while the pupil is dilated.
We are also using cyclosporin in the eye 3 times daily. All I could find was a 0.5% over the counter so, on the advice of a veterinary opthamologist, I had compounded a 2% solution in mineral oil.
We have just begun this regimen this past weekend so I am unsure how this all will work but it might give you some ideas and alternatives.
DrO |
Debra Jahnke
| | Posted on Monday, Jun 19, 2000 - 10:40 am: | |
Dear Dr O.
Thank you for your response. I had considered asking my vet about oral Pred, but had not done it yet due to possible side effects. I've had to take it for my own auto-immune problems and it made me pretty sick (this horse and I make a great pair!) I think I'll bring it up though.
I feel pretty dumb offering you a suggestion, but I swear the solution I have is 2%, and it's an FDA approved ointment used mostly for dogs and cats under the name Optimmune. My vet had to special order it. At least you wouldn't have to mix!
I'm going to call the vet about the Pred right now and try to tough it out longer with the cyclosporine. It's getting very disheartening but I'll try just about anything to make him feel better.
Thank you as always for your time and assistance. |
TERESA HUGHES (Pegasis)
| | Posted on Thursday, Jan 24, 2002 - 1:22 pm: | |
Dear Debra,
My 15yo app gelding was diagnosed with RU yesterday and my vet is recommending the Cyclosporine. He said he would mail it to me today, as he mixes a generic equivalent compound himself. I came to this website to ask the same question you asked and then saw your post. Did you continue the Cyclosporine? How is your guy doing? My vet says that I can take him to OSU and have a tube surgically implanted that would feed the cyclosporine constantly. It's expensive, but I would be willing to do it if it would greatly reduce his odds of losing his sight.
It's a shame that more can't be done to help these
horses. There are lots of heartbreaking stories out there about RU, and not many happy endings. |
Robert N. Oglesby DVM (Dro)
| | Posted on Friday, Jan 25, 2002 - 6:29 am: | |
Hello Theresa,
We did not get a good response to cyclosporin in this case and returned to just corticosteroids, both topical and injected and finally got this under control. However I do not think this is a typical RU with the glaucoma complication.
Actually I do not think the prognosis is quite as grim as you do for most horses with RU. The trick is early very aggressive treatment during the exacerbations. See the article associated with this forum, Equine Diseases: Eye Diseases: Anterior Uveitis, Recurrent Uveitis, Periodic Opthalmia, and Moonblindness for more on this.
DrO |
TERESA HUGHES (Pegasis)
| | Posted on Friday, Jan 25, 2002 - 3:36 pm: | |
You won't believe this and I'm afraid to be overly optimistic, but my horse's eye looks completely healed after just two applications of the cyclosporin. No watering at all, and he's holding his eye completely open. If anything, it might not look quite as bright as his good eye. Actually, it looked greatly improved overnight
after the first application. Have you ever seen results like that? My vet seems to be gone for the day and I'm not sure if I should continue the cyclsporin over the weekend. I think I will.
It's only administered during flare ups, right?
I'm also very encouraged by the updated info on the implants. Hopefully, I won't have to make a trip to Columbus as soon as I thought.
Thanks for your response. |
Robert N. Oglesby DVM (Dro)
| | Posted on Saturday, Jan 26, 2002 - 8:24 am: | |
That is super Teresa. That is the current recommendation for topical cyclosporin, to use during flare ups.
DrO |
Paula Ketner (Pketner)
| | Posted on Monday, Jan 28, 2002 - 6:54 pm: | |
Theresa,
My TWH and I have been dealing with RU for a couple of years now. As soon as his eye even starts to look like and episode is comming on I start treatment and keep it up for at least 10 days after his eye looks better. I use the pred.oint. 3xday plus bute. The first sign of a flare-up with Tango is lowered eye lashes. This happens before any redness or watering. I also use a fly mask with a black patch over the left eye area to protect it form sun and dust during the episode.
I have to add that since I started him on ground flax daily, we have not had any more flairs...I don't know if it just luck or the flax, but I'm not complaining!
One more thing...Tango still has full use of his eye.
Paula |
TERESA HUGHES (Pegasis)
| | Posted on Tuesday, Jan 29, 2002 - 2:51 pm: | |
Paula,
It's nice to hear encouraging stories, like yours.
You say his eyelashes are lowered before they start watering? I'm not sure if I would recognize that but I'll start paying more attention to his eye lashes. Did you buy one of those special masks for RU horses? I noticed Nacho's eye still gets a little watery if I put him out for a few hours on a breezy day. I put fly masks on him, but he always takes them off.
What is ground flax? |
Joni Pasko (3rsatsmf)
| | Posted on Tuesday, Jan 29, 2002 - 3:18 pm: | |
I have the MOST heart-wrenching uveitis story. My beloved Paint, Reno was diagnosed with ERU in Jan '01. He was only 4 years old. The ERU spread rapidly from one eye to another, with only a few weeks between bouts - after I stopped treatments. We did topical antibiotics, prednisolone acetate drops 4x/day, bute 2x/day and near the end I was even administering Dexamethasone IM daily. He went to heaven to be with his best horsey-friend Dallas in Nov. '01. I can't tell you how many times I thought,and hoped, and prayed I had it licked. You just never, ever know.... I took him to equine opthalamologists 3 hours away for treatment, and even planned for implants. But he went blind in his first eye in March '01 and second eye in Oct '01. The blindness and excruciating pain, and the progressing disease were just too much for me to even ask him to bear. I miss him terribly. If I can help in any way, I've done TONS of reasearch please let me know.
Best of luck to anyone battling this perplexing disease.
Joni |
Paula Ketner (Pketner)
| | Posted on Wednesday, Jan 30, 2002 - 6:56 am: | |
Joni,
I am so sorry to hear of your loss. When Tango was first diagnosed, I was heart broken. I count every day and every ride a blessing.
Teresa, I sewed a patch from a black t-shirt on the inside of a regular fly mask. It is soft, absorbs ointment and is easy to clean. (I also noticed wind was a trgger early on.)
I buy flax seed at the feed store and grind it in a coffee grinder. It spoiles quickly after it is ground, so I only grind enough for a day or so at a time. Tango is 1200lbs and gets 1/4 C twice daily.
Paula |
Debra A Jahnke (Bjahnke)
| | Posted on Monday, Jun 3, 2002 - 5:19 pm: | |
Dear Dr. O,
This message is a follow-up to the one where we corresponded in 2000 (your communication in the thread above): You mentioned trying: "We are also using cyclosporin in the eye 3 times daily. All I could find was a 0.5% over the counter so, on the advice of a veterinary opthamologist, I had compounded a 2% solution in mineral oil."
At this point, my horse's left eye is destroyed. His right eye has not reacted well to the prednisolone and had produced several ulcers. Of the three corneal layers, we are down to the last one and we are afraid to continue the pred. We told our vet about your 2% cyclosporin solution and he plans to give it a try. Is it possible that this strength concentration would do as much damage as the steroids? We even stopped the topical pred for awhile and had him on azium but that caused other immune problems (bodywide skin fungal infections).
Have you had any more successes with the 2% cyclosporin in what we consider to be the late stages of this disease? We have determined that, based on his behavior when he has been completely sightless, that he will not have any quality of life if (when) the little sight remaining is gone and we are still looking for alternatives. Any advice would be appreciated.
Sincerely,
Deb Jahnke |
Robert N. Oglesby DVM (Dro)
| | Posted on Tuesday, Jun 4, 2002 - 8:16 am: | |
Hello Deb,
The way you frame your questions suggest a misunderstanding of these medications properties and the disease process in your horse's eyes.
Neither of these medications are likely to directly damage the eye and the current ulcers are not likely to be caused by the steroids unless you have developed a secondary infection do to the immunosuppresive effects of the steroid. If the drugs where the problem simply discontinuing them would make the problems go away.
More likely the problem you are having is that these medications are not controlling the disease process. There can be two reasons for this:
1) the disease process is overwhelming the treatment
2) or the disease is misdiagnosed.
The horse I described above went into remission for a period of about 8 months. What cyclosporins contribution to the initial improvement was I am unsure.
Since then there has either been a low level chronic inflammation or recurring small bouts as evidenced by mild sensitivity to light and a slow increase in corneal scarring. These episodes would probably have been responsive to antiinflammatory treatment but the owners seem to be happy living with this level of problem which is unfortunate as the cornea is progressively getting more scarred. I think more aggressive therapy might slow this scarring down. I have not used cyclosporin since this case.
DrO |
Joni Valerio
Member
Username: 3rsatsmf
Post Number: 90
Registered: 2-2001
| | Posted on Monday, Feb 17, 2003 - 7:35 pm: | |
Hello, all -
Guess what? After I lost my beloved Reno, I got myself a new horse, imported from Holland (a Friesian) with a very low inbreeding coefficiet (didn't want to chance another auto-immune disease). Well, Remy came down with uveitis 4 days ago! I've already had the veterinarian AND the ophthalamoligist out. The opthalamologist told me that usually uveitis is not a primary inflammation, that usually, something else is going on with your horse, that will cause the uveitis to start. So, we are looking into what it could be. Reno was 4 when he started with his moonblindness. Remy is 4, too. I'm scratching my head here, knowing the only common denominator is ME! Now, that would be terrible.
I'll keep everyone posted - it may help with your diagnoses.
Joni |
Robert N. Oglesby DVM
Moderator
Username: Dro
Post Number: 7811
Registered: 1-1997
| | Posted on Tuesday, Feb 18, 2003 - 4:45 am: | |
Hello Joni,
Though this is an autoimmune disorder it does not have a primary genetic component that has been recognized. The cause of the autoimmune component has two aspects:
1) addition or changes in proteins in the eye from the lepto infection
2) inflamation leading to exposure of the immune system to the proteins of the relatively immunoprivledged area inside the eye.
See the article for more on this.
DrO |
