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Vet Notes: Fungal Corneal Ulcers - A Case study

Posted in Equine general medicine, General, Diagnostic Techniques, News, Blog

drwaston ocular

10 year old, Haflinger, Mare 

Presented for squinting, excessive tearing and recent cloudiness of her right eye. 

Ophthalmic examination: Revealed eyelashes on the upper lid angled down, blepharospasm (closing of the eyelids), and corneal edema (cloudiness of the eye). Reflex tests revealed a positive menace. These include: vision test – a light perception test; palpebral - a sensory test, and pupillary light reflexes (PLR) - evaluating the retina, nerves and muscles. Positive results to these tests yield an improved prognosis.

Diagnosis: Intravenous sedation or a nose twitch is often required to thoroughly exam the eye, especially in painful cases. The patient’s auriculopalpebral nerve, a motor nerve to the eyelid was blocked during the exam so that the lid could be held open for the exam. A fluorescein dye strip was then placed in the eye to identify corneal ulcers, which revealed a positive result. Corneal cytology and culture were obtained by scraping the lesion with a sterile spatula, and swabbing the lesion with a cotton swab for attempted growth on culture plates respectively. The cytology revealed fungal hyphae. Common causes for fungal ulceration in Florida include Aspergillus and Fusarium fungi. 

Treatment: Aggressive medical therapy with topical antifungals, antibiotics, atropine and systemic NSAIDS (non-steroidal anti-inflammatory drugs). Treatment can occur for prolonged periods of time. A corneal scar may be expected but will lessen with time. Some fungal ulcers can require surgical intervention. Occasionally, some will progress to the point where the integrity of the cornea is lost and the eye can rupture. Blindness can occur. Fungal ulcers in the southeast states, especially Florida are common and should be treated aggressively. Voriconazole is an antifungal that, although more costly, proves to be the most efficient in fighting fungal pathogens here. In this case a subpalpebral lavage system was installed to ease the difficulty of frequent eye treatments. This catheter allows treatments to be given without fighting to open the eye. It is sometimes required depending on the frequency of the prescribed treatment. 

Prevention: Limiting exercise and protecting the eye with a mask during treatment can aid in the healing process. Fly masks worn when the horse is outside or exposed to windy conditions can be helpful in preventing corneal injuries. Trimming trees and removing debris from turn out areas is recommended. Overall, paying attention to any changes in horse eye comfort is vital so that aggressive treatment can begin sooner. 

 

About the Author:

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Dr. Watson was raised in Baltimore, 

 MD, until she moved to Charleston, SC, when she was 15. She finished high school at Ashley Hall and immediately went to college to pursue her veterinary passion. She earned her undergraduate degree at Clemson University and achieved her veterinary doctorate from Tuskegee University. Dr. Watson rode and competed in Hunter/Jumper classes and rode collegiately on her IHSA team at Clemson. She currently is the proud owner of a Haflinger , an appendix paint horse, a husky, a chihuahua, and a blue-tongued skink, all of which she brought with her to Ocala. 

Dr. Watson has a wide variety of interests in the veterinary field includ-ing general medicine, ophthalmology, surgery and lameness, thus making Peterson and Smith an ideal hospital for her to complete an internship

In her spare time, she loves to travel, ride her horses and go to the beach.

 

 

References: 

1. Herrera, Daniel, and Dennis Brooks. Oftalmologia equina. Inter-Medica S.A.I.C.I, 2015. 

2. Brooks, Dennis E. Ophthalmology for the Equine Practitioner. Tenton New Media, 2008. 3. http://www.stoughtonvet.ca/images/ClinicPics/10.jpg

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