Equine Eyelid Diseases Equine Ophthalmology Service University of Florida
“Pretty Lids”
Eyelids 1. 2. 3. 4.
Skin Orbicularis oculi muscle Tarsal plate/glands Conjunctiva
83% of lid movement is from the upper lid! 5-25 (14.2 mean) blinks per minute.
Distichia
Distichia arise from the meibomian gland openings
Inversion of the lower or upper lids may be secondary to microphthalmia, prematurity, or scar formation following eyelid trauma. Rarely from dehydration or malnutrition Ocular pain may exacerbate the degree of anatomic entropion.
Entropion
Lacrimation Blepharospasm Conjunctivitis ulceration
Evert the lid with 4-0 sutures in a vertical mattress pattern.
Permanent entropion surgeries should be reserved for older horses. Staples can help.
Entropion from lid laceration
Ectropion: lid margin rolls outward
Ectropion: lid rolls outward
Cicatricial ectropion from a barn fire
Blepharitis
Fungal
Blepharitis/Orbital Cellutis
Meibomianitis
ERU and meibomianitis
Blepharitis from trauma
Eyelids 4 month old Tb colt presents with this acute lid laceration.
What is the probable cause?
The J shaped hooks on stall buckets are the most common cause of eyelid tears.
Tape these up!!
Ideal repair would be on a table, but most in field are done standing. Use a “bale table” to support head.
Illumination important-hang a Halogen light, use a head band light.
A lid tear this extensive should be repaired with a careful two layer closure.
A cruciate pattern should be used at the tarsal margin so that the suture tags do not abrade the cornea. Same lid 6 wks after repair
Eyelid Trauma
Upper and/or nasal lid lesions are more serious than lower eyelid injuries. Preserve the eyelid margins. Do not excise pedicles of lid margin. The eyelids have a prominent blood supply.
Tupelo 198627
Lid lacerations need to be repaired surgically!!
What can happen if lids are not sutured.
Then you get sued for $500K cause he cannot breed?!
Nonhealing ulcers
SCC is the most common tumor of the eye and adnexa in horses.
Pathogenesis: – UV exposure from solar radiation – periocular pigmentation – increased susceptibility to carcinogenesis
– The tumor suppressor gene (p53) is altered in equine SCC
Squamous Cell Carcinoma
There is increased SCC with increasing altitude, longitude, and solar radiation. (UV exposure) White hair colors predispose to SCC SCC increases with age Draft horses, Appaloosas and Paints have a high prevalence The least prevalence in Arabians, TB and QH.
The eyelids, TE, conjunctiva, and limbus are commonly affected. – Diagnosis by biopsy. Ocular SCC DDX: – papilloma, sarcoid adenoma, mastocytoma – melanoma, fibroma – Habronema and onchocerca – abscesses, granulation tissue, foreign body
Ocular SCC can invade local soft tissues, the bony orbit, sinuses, brain, and metastasize to regional lymph nodes, salivary glands and thorax. Tumor recurrence is highest in the eyelid and nictitans.
Surgical excision of SCC should be followed by either radiation, cryotherapy, hyperthermia, or intralesional chemotherapy.
Surgery alone: – TE SCC 33% recur in 4 years (21% w/ beta) – Limbal SCC 21% recur in 4 years (< w/ beta)
Cryosurgery with liquid nitrogen or nitrous oxide.
Beta radiation for superficial SCC of the cornea and limbus following keratectomy. Interstitial radiation therapy: continuous exposure to high levels of radiation over a period of time. Hyperthermia of small, superficial SCC. CO2 laser ablation of superficial SCC can be effective.
CO2 laser
Immunotherapy with BCG. Chemotherapy with intralesional cisplatin with and without surgical debulking.
– One year relapse-free rates approach 90%.
Four sessions at 2 week intervals with 1 mg/cm3 of tumor for tumors 10-20 cm3 in size. – (3.3 mg/ml of cisplatin in medical grade sesame oil is used.)
SCC
Post-cisplatin
Topical 5-fluorouracil (1% 5-FU TID) Topical mitomycin C (0.04% QID) Corneal and conjunctival SCC. Piroxicam (Feldene): – COX-2 inhibitor – 150 mg PO SID
Paint Marr
Sarcoids are solitary or multiple tumors of the eyelids and periocular region of the horse. The fibroblastic form is more aggressive Intervention can convert the verrucous form to the fibroblastic type Retroviruses and papilloma viruses may be involved Sarcoids are generally found in horses
