Eye disease in horses – when is referral needed?

There will be no doubt in any horse owners mind that it is particularly important to seek veterinary help as soon as you notice any problem with your horses eye. Veterinary surgeons in practice deal with a wide range of conditions from simple conjunctivitis to more complex conditions such as uveitis or trauma. Many cases will be managed by your vet at your premises. However sometimes it is necessary for your vet to refer your horse for specialist evaluation or treatment. In this article we explore some of the more common reasons for your vet to suggest referral. 

In general there are four main reasons for suggesting referral the need for surgery specialist treatment specialist diagnostic modalities or for a second opinion. 
Trauma
The most usual eye injury in horses is a superficial corneal ulcer where several layers of the corneal are removed by abrasion. Uncomplicated ulcers usually resolve with treatment and management at home with topical treatments prescribed by the vet and administered by the owner. However in unusual cases where for example a fungal infection is involved or if the ulcer is not responding to treatment your vet may suggest hospitalisation for further investigation or intensive treatment. Penetrating eye injuries or those that threaten the integrity of the globe often need to be referred immediately for surgical treatment at a veterinary hospital.
Occasionally trauma can lead to damage to the eyelids. It is critically important to treat eyelid lacerations quickly in order to maintain the integrity of the eyelids themselves. Horses are very reliant on their eyelids and eyelashes to keep the surface of the eye moist and clear from dust and dirt. If they lose a significant portion of the eyelid this may lead to secondary ulcerations or damage to the cornea. Many cases of eyelid lacerations can be managed in the field but in severe cases the horse may need repair under surgical conditions.
Ocular or periocular tumours
The most commonly seen tumours in the periocular region are squamous cell carcinomas periocular sarcoids lymphomas mast cell tumours and melanocytic tumours which may also occur in the eye. Simple early cases of for example a squamous cell carcinoma of the conjunctiva or third eyelid are often treated in the field if surgery to remove the third eyelid with or without the addition of a chemotherapy drug if this is likely to be curative. More advanced cases or those in inoperable areas