My 28-year-old mare developed a corneal ulcer in August. The vet came on the 11th. I am still treating it. The cloudy

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Customer: My 28-year-old mare developed a corneal ulcer in August. The vet came on the 11th. I am still treating it. The cloudy spot initially shrunk to just one spot in the middle of the eye, but it seems to have stopped healing. My current vet keeps giving me neo-poly-back which I administer 2x a day. What should I do? Shouldn't it be healed by now, almost 8 weeks later?
Answered by Dr. Mike in 34 mins 9 years ago
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Dr. Mike
25+ years of experience
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510 satisfied customers

Specialities include: Horse Veterinary, Large Animal Veterinary, Small Animal Veterinary

Sorry to hear about Katrina's eye problems.

I've got a few questions to help me answer you.

When was the last time the eye was stained?

Did the white area hold stain, and if so, was it uniform or did it have a ring-like appearance?

Are both pupils equal size?

Is there any squinting or excess tearing in the affected eye?

Is there any way you could take a close-up photo and attach it to a response?

DrMike
Customer
The eye was stained twice. Both times the green area was uniform. Initially it was the size of the end of a tube of bute paste, and the second time had shrunken to the size of an ink dot. But the cloudy area around this was larger. Both pupils are the same size. There's not excessive tearing, but more so than the "good" eye in response to weather (wind). There is squinting, but it's getting better. She responds to the diclorfenac. She was wearing an eyesaver mask, but it slipped and irritated her good eye, so I'm protecting it using a fly mask with duct tape on the area above the eye. I was able to take a fairly good photo, but I am unsure of how to attach it. I tried copy and paste, but that only seems to work with text in this format. I'll go back through the website and see if I can figure out how to send it.
Customer
I sent a photo by replying to the email and not through the website. Hope you receive it.
Haven't seen it yet, I'll check back in a bit.

DrMike
I still haven't seen a photo, but I can give you my approach for similar situations.

If the area still retains stain, I scrape the lesion and do a culture and a cytology. Fungal infections don't respond to antibiotics and can take many weeks to heal.

If the white area does not hold stain, I switch to an ointment that has dexamethasone in it, and sometimes add a hypertonic saline ointment as well.

I'd also try to medicate at least 4 times daily, and 6x is even better. Small amounts more frequently is better than large gobs twice daily.

DrMike
Customer
All right. I'll have him come and stain it again and I'll administer the ointment 4-6x a day.
Great! Let me know how it goes.

If the white area is stain-negative, is flat and has well-demarcated margins, the ulcer may be healed, but still contains fibrous tissue, which can take months to resolve. In some cases, these small residual spots are permanent, but if they're just a few millimeters in diameter they don't seem to affect the horse's vision.

DrMike
Customer
I had my vet out. He stained the eye and it took up stain. He said we should switch back to the tetracycline ointment, and that it's decreased in depth. It's touchy. I don't want to offend him, and he's really more of a cow vet. So I said could it have a fungal infection? And he said he didn't think so. I'll go with treating it 4x a day for another week and if it's not better I guess I'll have to make suggestions. As you are a vet, how can I say something and not seem like an annoying, Internet diagnosing, know-it-all?
Wow! Great question.

I guess I can't begin to recommend what you should do/say in your specific situation, I can tell you what I would be (and have been) comfortable with if one of my clients approached me.

As much as I cringe when someone offers a diagnosis or treatment plan offered by "Dr. Google", I do deal with it with some frequency.

I'm on the way out the door to an emergency now, but I'll get back to you as soon as I can.

DrMike
If a client asks me something like "We don't seem to be making as much progress with Katrina as we have with other eye cases.... is there anything else we can pursue?" or "In researching indolent ulcers, I came across mention of culture and sensitivity, as well as scraping for cytology evaluation. Could we get more aggressive with diagnostics?", I'd be happy to dig deeper into my bag of tricks, or refer to a veterinary ophthalmologist if I felt the eye(s) needed therapy beyond what I can do on the farm or at my clinic. I'm sending a horse to the University next week for eye surgery that I don't have the specialized instruments for.

Once a fungal component has been ruled out, and if there is no strong evidence of a primary bacterial involvement, other things can be done on the farm in many cases (like a keratotomy), but your vet should be comfortable with those procedures before heading down that road.

Another wrinkle I failed to mention is the possibility of an endocrine disorder slowing Katrina's healing ability. Specifically, at her age, I wonder if she could have some degree of Cushings syndrome (pituitary pars intermedia dysfunction - or PPID). Not to open another can of worms, but it may be a piece of the puzzle.

DrMike
Customer
I wish I had a vet like you in my area. Thanks so much for taking so much time to consider my case! I don't know much about Cushing's, other than people get it mixed up with insulin resistance and the horse usually has excess hair that sheds unevenly. Katrina is not particulary hairy and it's all smooth and even. She's just been put on senior feed though. She was not maintaining her weight and the feed rep (I feed Progressive) said he thought she might not be digesting fiber as well as she used to. Switching to senior, and getting some better quality hay, has helped. She doesn't have bulgy eyes or any lameness issues. I can still ride her and she has lots of energy. But she does heal so slowly. I've battled scratches twice with her, and it was a long and arduous process of trial and error. It was at least 3 months. I was keeping it contained, but it wouldn't heal, just like this eye. Finally someone suggested Tomorrow Dry Cow and it cleaned it up in 4 days. But if there's a next time, who knows? Thank you again! Despite many stops and starts with this website, it's been well worth it.
Glad I can help a bit, best of luck with Katrina.

DrMike
Hi, I'm just following up on our conversation about your pet. How is everything going? Dr. Mike
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