Equine Eyelid Diseases - Large Animal Hospital

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
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Distichia arise
from the
meibomian
gland openings
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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
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Evert the lid with
4-0 sutures in a
vertical mattress
pattern.
Permanent entropion surgeries should be
reserved for older horses.
 Staples can help.
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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
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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
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SCC is the most common
tumor of the eye and
adnexa in horses.
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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
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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.
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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
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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)
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Cryosurgery with liquid nitrogen or nitrous
oxide.
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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.
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– 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
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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
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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 <7 years
of age.
Lipizzaners are resistant.
Sarcoids

Histologically, sarcoids are characterized by
epidermal hyperplasia and dermal
fibroplasia with pegs of hyperkeratotic
epithelium extending into the depths of the
dermal lesions.

Treatments include surgical resection of
necrotic tissue, BCG therapy, cryotherapy,
hyperthermia, CO2 laser excision, caustics,
radiotherapy, intralesional cisplatin or 5-FU,
and autogenous vaccines.
Sarcoids
9 months post RX
Thrombotic Disease