Equine Eye Infection Treatment and Recovery: What You Need to Know

By TheDaughter, 02/01/2020

Equine Eye Infection Treatment and Recovery: What You Need to Know

When I wrote this post some time ago, it was more function than emotion. I slept on it, mulled it over, and realised the message I wanted to send wasn’t precisely what I wrote. So, here’s a postscript and revision to the original post. I’m not rich.

Introduction

I have had horses for most of my life, and they have been my life. They are expensive, and sometimes people think of the privileged. I agree that it is a privilege to have them, but I’m no longer privileged. So, it’s not an upper-class problem; it’s an animal lover’s problem.

There are a lot of forums about buying or having a horse with an enucleated eye. There’s not much out there in what to expect if your horse needs a corneal transplant. I’ve not seen much about how an infection can develop, the work involved in the healing process, and how it feels to know how the horse copes with the situation. Without further adieu, here is the revised post. Thank you for rereading it.

The National Dressage Championships were in October 2019. My seven-year-old mare, Fendi44, qualified to go as she won most of her competitions throughout the year. We were on the road to a successful end to her first year of competing—the start of a fabulous career.

The Initial Symptoms and Diagnosis

But a few days before the finals, she wouldn’t open her eyes, which meant pain. After two days of not opening her eye, I saw it was turning blue and white and knew it wasn’t good. My first reaction was to find the best specialist in the country for equine ophthalmology to come and look at her and fix the problem; she deserved to go to the finals, and she’s my baby.

The Treatment Process

Administering Medication

The specialist vet arrived on a Monday, and then we had the animal ophthalmologist out on Wednesday. Things were going so wrong so quickly. By the end of the week, a catheter in her eye was necessary to administer all the drugs properly. It was a tedious process getting the drugs into the catheter, and I could see that it caused her pain.

She wasn’t keen on getting them and would shake her head up and down every time I put a drop in, followed by the air to push the drops into the eye, showing me her disdain for this procedure. Soon after, she knew anytime someone would approach her on the side of the catheter, the drugs were coming. She’d walk around in circles or kick out to try and get us away from her. To cause her pain was heartbreaking, but I knew I was doing it to help her. It made me sick to my stomach. I would break out in a sweat every time I had to put them in, feel nauseous, and my hands would shake violently (this was not a good thing as trying to get the syringe into the catheter was precise, so I’d have to hold my hand with my other hand to steady it).

We had to wait five to ten minutes between each drug (there were six to start); at times, I would leave her box and breathe in between each one, or I’d stroke her and talk to her to tell her it would be okay. Sometimes, I’d groom her in between to show her I wasn’t only there to give her pain. It helped a little, but horses generally aren’t stupid. She knew what was coming next.

They rarely see this type of infection. But it’s a very aggressive fungal infection that needs immediate treatment. The ophthalmologist may even scrape out the fungus or apply the anti-fungal medication directly into the eye.​

Hospitalisation and Specialist Care

Another few days pass, and we all decide she should go to the hospital. The drugs are not touching the infection. The animal ophthalmologist performs the procedure of injecting the eye directly with Voriconazole, the anti-fungal treatment. The eye stabilises, and he leaves for a conference in Hawaii two days later, along with every other ophthalmic specialist worldwide.

Over the next week, the eye destabilised again, and we were referred to the university hospital in Lisbon to get a corneal transplant done that day. We didn’t have any more time to continue with the treatment, and the operation was the only hope we had to save her eye. I’m running on adrenaline and Snickers bars. Finding transport in the middle of the biggest equine festival wasn’t easy. Everyone was at the festival in Golega. I needed to get her to Lisbon. I paid triple the standard rate for the transport company to take her. Whatever it takes.

Lisbon didn’t agree with the diagnosis and recommended enucleation of the eye (removal of the eye). It was around 3 pm that they made this recommendation. I was to meet with the surgeon who would remove her eye at 5 pm, and surgery would be that day. It was the first time I completely lost it. I was sobbing uncontrollably, and I refused to accept that this was her fate.

I needed some time to think. In my wildest imagination, I couldn’t believe that I would be removing my horse’s eye after just a short period with the medication or removing her eye. It’s just not something you think about when owning a horse. I accept that there are risks. I expect orthopaedic issues, tendon issues, sore backs, pulled shoes, and even the odd abscess in the foot, but I have never thought of something like this in the forty-plus years of having horses. I needed to talk to my family and vet and see what other options were available.

I called a specialist in Spain; she was one of the best for severe eye cases in horses. However, her colleague was in Hawaii as well, so she wasn’t available to come see her. My ophthalmic specialist told me to get her to Spain the next morning, but I didn’t want to put her through a ten-hour journey for the same thing they said to me in Lisbon. My head was reeling. I was home alone and on the phone through the night with specialists, family, and close friends, trying to get some small glimmer of hope that this was going to be okay.

My vet was furiously trying to find another diplomat to examine her eye and see if there was any way to save it. I moved her back from Lisbon to the hospital the next day, and on Friday, another diplomat examined the eye and said the cornea was again stable; the medication was starting to work. Finally, I saw the small glimmer of hope I sought! This news took us more time until my specialist returned from Hawaii. We hoped.

The Corneal Transplant Surgery

The specialist arrived on Tuesday and was out to see her that day. The news was not great. Her iris had prolapsed, and while she did have some regeneration of the cornea itself, the infection was still raging in her eye, and it needed to come out through surgery. We scheduled the corneal transplant for the next day and looked for a donor’s eye that afternoon through the following day but were unable to secure one. He would have to use a membrane; not as good, but better than nothing.

I realised that my liver transplant was almost seven years prior, during the same week that she had her transplant. Another thing we would have in common! We were both going to be transplant recipients; not sure if this was a comfort or a curse. I was still running on my adrenaline and Snickers bars.

The transplant went well. I wasn’t at the hospital when they did it. Something about seeing the hooks, pulleys and recovery bay that just said we were both better off without me in that space. I wanted her to be calm, and I was a total wreck. I gave her a lot of cuddles, left while they did the procedure, and went back after she had time to recover.

Post-Surgery Complications and Care

A week later, the stitches came out. To their surprise, she had some vision in the eye. But, one part of the flap was lifted near the nasal cavity, so a couple more stitches were required, and then we would have to wait again. Unfortunately, she couldn’t do this standing, so a second surgery was needed. What I thought would be a 30-minute procedure led to another four-plus hours. I was only down the road for a coffee but ended up having more coffee than I’d have in a week and panic not hearing from anyone for that long.

After almost five hours, I decided to message the vet from the hospital and find out what was happening. She explained that they needed to do a few more stitches than initially thought as a precaution and then pull her third eye over the eye and stitch it all up. This time, her eye was shut entirely, unlike the first week, when the stitches were thin, and she could almost pull at them to try and open her eye a little.

Three and a half weeks, she would have to keep her eye stitched shut to be on the safe side. It was now over a month in the hospital. It wasn’t so much that she was in the hospital for that time but that it was hard seeing her there, in the box, with one eye stitched so tightly, and she was sad, bored and missing her home and her friends. My other horse was also not getting the most of me either, as the hospital was over an hour’s drive from me.

Driving back and forth daily, making some trips to Lisbon for special serum and medications, was time-consuming. I was dead on my feet most of the time and sweating all the time. My body was in bad shape, my diet non-existent, and sleeping on the sofa or in my chair in the lounge became a nightly habit. Hygiene had seen better days: laundry piled up, dust bunnies were part of the furniture, and my car was a sandbox in the front seat, but at least I still fed the cats.

Recovery

Once the stitches had been out for a couple of weeks, it was time for her to go back home. I had been waiting for this moment for two months. What we all forget as horse owners, parents, or carers is that going home is not always easy. The recovery from a transplant is long, up to a year. I did ‘hear’ this when we decided to do it, and in my mind, enucleation was not an option. If she had a chance to retain some vision, I would not take that chance away from her by removing her eye. Once the eye is gone, there’s no turning back.

She’s been home for over two weeks, which feels like months. I’m still not able to cope with what’s happened. My mind is always busy with grief, disappointment, and fear of the unknown. When the flap finally disappears, we will know how much vision she will have. There are no guarantees. At the moment, it’s just more drops (thankfully, my trainer is better at administering these than I am), trying to relearn to do work in hand and keeping her happy and calm.

Remaining calm is critical as she cannot have pressure on the eye. We have to be careful about how we handle her, walking on her impaired vision side and talking to her when we are near her so she can work out who is where and what is what. My other horse still suffers from my fears of horse life post-transplant. We can see that it’s getting better and better every day, but the days seem long, the weeks longer. I don’t know how I will manage a year of this.

Emotional and Physical Impact

I can’t work (or I can’t look for work). I can’t ride. I can’t play tennis. I am tired all the time. I don’t eat. I don’t want to socialise. I am nervous, anxious and afraid something will go wrong again. I want to sleep the months away until she is healed, wakes up, and sees that she’s back to herself again.

The cost was more than double what I thought it would be, and I am waiting to complete the forms for the insurance company, so I’m feeling the squeeze financially and mentally, although these two things go hand in hand, without a doubt. I know it’s a depressive state that I am in, but I do remain hopeful for her. I pray daily that she will be okay, have some vision, and get back to training and dancing across the arena, as she did so beautifully and well.

She had a positive checkup on New Year’s Eve but is not out of the woods yet. She has to have a recheck in two weeks. I’ve started to reeducate myself with work-in-hand basics so I can try to rebuild her lost muscle with as little stress as possible for her eye. I also started doing the job with my other 23-year-old horse, so this work is also good for him. It’s a big commitment—horses always are.

Since this started, I’ve wanted to throw in the towel almost daily and give up horses altogether. Something I never thought about before. I get a hard time from others for not riding anymore, but I can’t do it. I don’t know if it’s fear or shame or both. But right now, it’s work on the ground for us. It’s not something people on the outside can understand. I don’t understand it myself; this place I find myself.

Riding has always been my escape; through my divorce, my transplant, my dark days, it’s always been my coping mechanism. Now it’s my nemesis, taunting me, and I struggle to be around the horses that I have loved for so long. I go through the motions, but my heart is not in it yet. Maybe it’s seeing them both with their faults; Wills getting older and things aren’t as easy for him anymore and her with her vision impairment.

It’s not judgmental; it’s sad to see each of them having problems. I want to wave a magic wand and make it all disappear. I want Wills to not be sore, weak, and grumpy because he can sense he’s not the same. I want Fendi to make her see everything instead of making her muddled, hazy, and afraid.

They’re both afraid in their way. That’s what I find hardest to cope with. I’m helpless, but I keep trying to calm them, soothe them and tell them both that it’s okay. I’m sure they feel my lack of conviction in my hand and voice. I do believe that things will go back to normal one day, but I think health will never be the same as it once was. Time moves on in life. I’m older, and I have limitations. Why should it be any different for the animals we love so much?

The stables where they live are busy, so I have to do the work early in the morning. With all of the problems I still have from my bowel resection, being consistently there at 8 a.m. is difficult on the best of days and impossible on the worst, making the work inconsistent. She has a walk and lunge if I’m not there, but it’s not the same. She needs to work without being worked. They need me, and I am struggling to stay healthy for them.

Maybe their unhappiness directly reflects my emotional state, and I need to be stronger.

I’m tired and feel alone. I know I’m not truly alone. My trainer is immensely helpful. But nobody can feel the way I feel when I look at her face and see sad ears or dwindling muscles. Or look at my older boy with his ears back and a look of horror whenever I approach him as if he thinks I’ve caused her all these problems and he’s afraid perhaps that he will suffer from the same fate if I’m around. That’s a crazy thought to have. It’s how I feel: life is spiralling out of control, and nobody can catch me as I fall.

I know that this is only the beginning of the recovery process, and I have a very long way to go. On day one, when she was back home, she was all over the place, rearing up and afraid of every sound, person, horse, and leaf rustling. I thought that day I’d never get to day two. But I did, and now we are approaching week three. I hope it gets easier. I hope I stop being so resentful about the situation: about having to work early in the morning and her not being keen on things and life. I hope to see happy ears on both of my horses, even once a week, to reignite my hope that they’ll be happy again one day.

Conclusion

I hope my insurance company pays me soon and that I can return to riding, working (looking for work), playing tennis, being with my friends and having a holiday. But the biggest hope is that I want both horses to be healthy and happy.

Our holiday season consisted of doing drops, in-hand work, and lighting the Chanukah candles. No presents, no fanfare, no parties. Maybe a little too much chocolate.

Now, it’s back to translating invoices for the insurance company. I may be avoiding both of my horses today with their sad ears and being a little selfish, but I also need to be productive at home, getting rid of those dust bunnies, catching up on laundry and paying the bills.

Thanks for visiting. Wish us luck!

Cheers x

Check these links for more information on equine eye infections and corneal transplants.

https://www.dvm360.com/view/equine-corneal-transplants-success-rate-growing

https://www.dvm360.com/view/the-largest-equine-corneal-transplant-ever-reported

https://pubmed.ncbi.nlm.nih.gov/15271428/

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