Fungal corneal ulcers are a serious and often frustrating cause of eye disease in horses. In this episode of StallSide, Dr. Kimberly Lam explains what causes corneal ulcers to develop, why fungal infections are especially problematic, and how these cases are diagnosed and treated. This conversation highlights early warning signs, risk factors, and why prompt, targeted treatment is critical for preserving vision.
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Today's episode of the Stall Side Podcast is brought to you by Rood & Riddle Veterinary Pharmacy.
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How are you doing today,
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Bert?
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It's an excellent day.
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How about you?
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It's a really good day.
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Very excited today.
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We have our ophthalmologist,
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Dr.
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Kim Lamb,
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coming in to see us.
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Yeah,
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she's just started with the practice and very excited to have her here.
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You know,
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that's one of those things as a veterinarian,
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when you are,
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you know,
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we deal with a lot of eye stuff.
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But boy,
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they can get complicated really,
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really quick.
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And I'm so grateful to have somebody who is so focused and has such a large array of expertise that she can rely on,
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that you can call in and help you out.
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Yeah,
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you hit the nail on the head.
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Eyes can go bad really quickly.
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You don't get too many second chances with an eye.
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You can be just a few hours from,
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"Eh,
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what's going on here?" to an irretrievable situation.
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So yeah,
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I'm really excited that she's in the practice.
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And I think that there's going to be a lot of,
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you know,
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learning go backwards and forwards,
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and she's going to lift everybody's boat.
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Yep,
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yep.
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We've had a lot of great experience with Dr.
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Latimer,
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and now Dr.
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Lam is joining us too,
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and I couldn't be happier.
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Yeah,
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yeah.
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Really good.
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So at Stoolside this week,
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we're going to be talking to Dr.
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Kim Lam about her ophthalmology skills,
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especially corneal ulceration with a focus on fungal.
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welcome to Stoolside.
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Thank you for having me.
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Thank you for joining us today,
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and thrilled to have you in the practice.
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It's good to have you here and introduce you to everybody.
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We're looking forward to lots of years together.
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Yes,
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me too.
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Absolutely.
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So,
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Kim,
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tell us a little bit about yourself.
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I'm Canadian.
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I'm originally from the Toronto area,
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and I did my vet school actually in Australia,
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at the University of Queensland.
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And I loved it in Australia.
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It was a five-year program.
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And then I came back to the United States,
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and I did an internship at Tufts University,
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and that's where I kind of found my passion for ophthalmology.
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I did a large animal medicine and equine ambulatory,
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and it just happened that we did a lot of eyes,
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and then that kind of brought my interest in it.
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Did a lot of years at Auburn.
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I did my residency there.
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I did my specialty internships.
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And then I ended up here.
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Yeah.
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Well,
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as Bart said,
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we're really glad to have you here.
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Also,
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Toronto.
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You've been up the Canada National Tower?
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Yes.
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Yeah.
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You've ever been up?
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No.
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I mean,
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that place just terrified me.
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Like,
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years ago,
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I was up there,
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and you know,
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you've got that glass floor,
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where you just,
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like,
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walk out over space,
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and it took me about 20 minutes to walk onto that glass.
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And there were people jumping up and down on it,
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and,
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like,
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taking selfies.
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And I just couldn't do it.
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I just couldn't walk out over that.
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So I have to go back there one day to just get over that fear.
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So you never did it?
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Oh,
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I did,
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eventually.
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Oh,
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you did?
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I walked out,
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took a picture of my feet,
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and then just walked back again.
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Because,
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yeah,
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I'll just have to break that fear.
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So,
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yeah,
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we're really glad you're here.
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And because there's a lot of horses,
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there's a lot of eyes.
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And so,
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what would you like to tell us about corneal ulcers today?
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So,
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probably one of the most common problems that we deal with in ophthalmology in any species is definitely corneal ulcers.
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Horses,
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specifically,
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they are just the perfect specimen to have an ocular injury.
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They've got large eyes.
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They get spooked quite easily from anything in the environment.
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And also the environment that they live in just kind of increases their chances of injury.
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And we do see a lot of infection,
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specifically bacterial,
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and also fungal.
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And that is also location-dependent as well,
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too.
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Yeah,
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so you say it's location-dependent,
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and probably implying that Kentucky's bad for that.
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So,
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what specifically about the environment around here makes this such a hot bed for fungal ulcers?
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So,
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my time here,
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and also my time down south at Auburn,
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it's just,
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you know,
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we have humidity in the air.
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It gets warm,
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it gets hot,
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and that is just a perfect area for bacteria and fungal organisms to just kind of proliferate through.
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I also think about,
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you know,
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just the barn environment as well.
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We've got horses that are stalled in areas that just may not have a lot of ventilation.
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And so,
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when it's hot and humid in the barn,
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they stick their head down to eat some hay.
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There's a lot of particulates in the air that are getting into their eyes and,
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you know,
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that just increase the risks for something bad to happen.
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You mentioned about injuries.
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Is that more likely to cause,
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does day-to-day wear and tear or any injuries,
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is that more likely to promote the onset of bacterial or fungal ulcers?
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Definitely,
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for sure.
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You know,
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there usually is a predisposing factor for why these animals are getting an ulcer.
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A lot of what we're seeing,
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especially in the horses,
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is trauma-related,
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but we also have to think about,
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you know,
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the health of the eye itself.
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If their tear film is deficient,
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maybe they're not producing enough tears or maybe their tear quality is just not as good,
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that decreases the immunity of the eye itself and the ability to fight off that infection,
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you know.
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So,
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I think it's a combination of,
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you know,
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looking at ocular health itself and also the environmental factors at play.
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Yeah,
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just picking up on that,
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I mean,
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I have no trouble producing tears around here every day,
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especially when I've got to work with this guy.
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So what factors would affect tear production?
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Because that's probably something people don't think of a lot as being protective to the eye.
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Yeah,
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so the tears are very important because,
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you know,
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obviously we keep things lubricated,
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keep everything comfortable,
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but there are normal organisms that live in the tear film as well,
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too.
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So if you're not producing enough tears,
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you're not having enough protection.
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So your corneal surface is drying out,
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You stare outside too much and it's windy,
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your eyes start to tear a little bit,
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and that's just kind of the protective aspect of the eye itself.
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If we're not able to produce enough tears,
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we don't have that protective ability.
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And if our tear quality is poor,
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so let's say we don't have the fat that's within the tears that,
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you know,
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we need to coat the surface of the eye,
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that is also going to be a risk factor for just not having adequate protection.
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And that's a lot of the time what we're dealing with with these cases is,
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have they had some sort of trauma,
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do they have a lack of tear production?
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It's hard to know,
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but it's all one system kind of together,
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thinking about it.
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So if we have a situation where the eye has been predisposed to an infection,
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and an infection of any type starts to take root,
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what are we going to see as the first signs?
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What do owners need to be looking for to say,
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"Hey,
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you know,
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my eyes and my horse is not right". And what would lead them to sort of think,
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"Hey,
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maybe I have an ulcer". How do those first appear?
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Yeah,
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so the biggest thing that most of our owners are going to pick up is just the appearance of the eye itself.
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You know,
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when you look at the horse straight on,
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you expect eyelashes to be pointing upwards.
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But a lot of the times when they're uncomfortable,
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those eyelashes start to point down towards the ground.
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You'll see the eye itself is not as open as it normally is.
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You know,
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maybe they're closing it a little bit more.
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Maybe they're squinting it,
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keeping it closed.
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And they may notice more discharge coming from the eye,
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whether it's tears,
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just wetness on the face.
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And sometimes you'll see even more thicker material coming from the eye,
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whether it's a mucoid discharge.
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They may also notice,
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you know,
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that they're just shy on that side,
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too.
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And if that horse had never really had that behavior before,
00:07:46.649 - 00:07:50.500
that might be indicating that it's having discomfort on that side.
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And a lot of the times,
00:07:51.449 - 00:07:51.899
you know,
00:07:51.899 - 00:07:53.649
they've got really strong eyelids,
00:07:53.649 - 00:07:56.500
so it's hard to look at the eye itself.
00:07:56.500 - 00:07:57.620
Those changes,
00:07:57.620 - 00:08:00.019
you'll be able to pick up swelling,
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redness,
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increased discharge.
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So if an owner is concerned that there may be something going on with the horse's eye,
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and they call you to have a look at that,
00:08:08.500 - 00:08:10.500
what's your approach to diagnosing that eye?
00:08:10.500 - 00:08:13.579
What are the steps you go through to be systematic,
00:08:13.579 - 00:08:15.500
to find out all the things that you need to find out?
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Yeah,
00:08:15.980 - 00:08:20.500
so it's definitely a process to kind of figure out what's going on,
00:08:20.500 - 00:08:23.939
but I think the most important thing is to get a good background on,
00:08:23.939 - 00:08:24.589
you know,
00:08:24.589 - 00:08:25.500
what happened.
00:08:25.500 - 00:08:27.439
We're trying to figure out,
00:08:27.439 - 00:08:30.500
when did you start noticing those issues?
00:08:30.500 - 00:08:31.959
Was it just acutely,
00:08:31.959 - 00:08:33.279
like yesterday?
00:08:33.279 - 00:08:35.500
Or was it a couple weeks ago?
00:08:35.500 - 00:08:40.889
And you also want to kind of just have a look at where the horse is located as well,
00:08:40.889 - 00:08:41.500
too.
00:08:41.500 - 00:08:41.860
Like,
00:08:41.860 - 00:08:42.759
are we outside?
00:08:42.759 - 00:08:44.649
Did the injury happen outside?
00:08:44.649 - 00:08:46.500
Was it in the stall?
00:08:46.500 - 00:08:52.500
Or what kind of environment are they living in that could have resulted in whatever happened to them?
00:08:52.500 - 00:08:53.519
The other thing is,
00:08:53.519 - 00:08:54.059
you know,
00:08:54.059 - 00:08:57.500
once you start putting hands on the horse itself,
00:08:57.500 - 00:08:58.350
you'll notice,
00:08:58.350 - 00:08:58.629
like,
00:08:58.629 - 00:09:00.649
if they're having an ocular problem,
00:09:00.649 - 00:09:03.000
they're going to be more shy on that side,
00:09:03.000 - 00:09:03.500
too.
00:09:03.500 - 00:09:06.649
So what I usually like to do is I take a step back.
00:09:06.649 - 00:09:07.589
You know,
00:09:07.589 - 00:09:08.679
if the horse is in a stall,
00:09:08.680 - 00:09:09.500
I step back,
00:09:09.500 - 00:09:14.500
and I let them behave how they would in the stall without anybody putting any hands on them,
00:09:14.500 - 00:09:16.149
just to see how they're behaving,
00:09:16.149 - 00:09:17.649
how their comfort level is,
00:09:17.649 - 00:09:19.120
and how they're acting as well,
00:09:19.120 - 00:09:19.500
too.
00:09:19.500 - 00:09:23.589
I can sometimes give you a really good idea on how they're feeling,
00:09:23.589 - 00:09:23.769
like,
00:09:23.769 - 00:09:25.500
how uncomfortable they truly are.
00:09:25.500 - 00:09:25.879
And,
00:09:25.879 - 00:09:26.559
you know,
00:09:26.559 - 00:09:27.919
once we get in there,
00:09:27.920 - 00:09:31.500
that's when you want to look at everything involved.
00:09:31.500 - 00:09:33.769
So I always start looking from outside,
00:09:33.769 - 00:09:34.649
inwards.
00:09:34.649 - 00:09:36.490
So I look at externally.
00:09:36.490 - 00:09:37.500
I look at the face.
00:09:37.500 - 00:09:39.049
How are we looking in general?
00:09:39.049 - 00:09:40.619
Do we seem uncomfortable?
00:09:40.620 - 00:09:42.500
Is there a grimace that we're seeing?
00:09:42.500 - 00:09:43.910
Do we see discharge?
00:09:43.910 - 00:09:46.500
Do we see asymmetry in the face itself?
00:09:46.500 - 00:09:47.660
And then I evaluate,
00:09:47.660 - 00:09:48.240
you know,
00:09:48.240 - 00:09:49.509
the light reflexes.
00:09:49.509 - 00:09:50.500
Do we respond to bright light?
00:09:50.500 - 00:09:52.500
Do we respond to hand motion?
00:09:52.500 - 00:09:55.500
What is the pupil doing in that situation?
00:09:55.500 - 00:09:57.500
And that's when I get a little bit closer.
00:09:57.500 - 00:09:58.000
You know,
00:09:58.000 - 00:10:00.500
start looking at the different aspects of the eye.
00:10:00.500 - 00:10:02.950
Look at the back of the eye as well,
00:10:02.950 - 00:10:03.649
too.
00:10:03.649 - 00:10:06.500
But I always try and be as systematic as I can.
00:10:06.500 - 00:10:07.870
But I always like to kind of,
00:10:07.870 - 00:10:08.379
you know,
00:10:08.379 - 00:10:10.500
start from afar and then work my way in.
00:10:10.500 - 00:10:12.169
And I always try and,
00:10:12.169 - 00:10:13.000
you know,
00:10:13.000 - 00:10:14.750
look at normal first,
00:10:14.750 - 00:10:16.500
and then abnormal.
00:10:16.500 - 00:10:19.500
first thing you want to go to is you want to go to that eye that's problematic.
00:10:19.500 - 00:10:21.500
But I want to have a general baseline.
00:10:21.500 - 00:10:24.500
I want to make sure that I'm looking at all aspects of the eye.
00:10:24.500 - 00:10:26.070
Even the normal eye as well,
00:10:26.070 - 00:10:26.500
too.
00:10:26.500 - 00:10:28.750
So you mentioned horses have really strong eyelids,
00:10:28.750 - 00:10:29.500
which they do.
00:10:29.500 - 00:10:32.500
How do you get around that when you're performing your examination?
00:10:32.500 - 00:10:34.500
You guys amaze me.
00:10:34.500 - 00:10:36.210
I've been around Dr.
00:10:36.210 - 00:10:37.500
Latimer forever.
00:10:37.500 - 00:10:38.559
She's got both hands up there,
00:10:38.559 - 00:10:39.500
prying this thing open.
00:10:39.500 - 00:10:40.649
She just flicks it open,
00:10:40.649 - 00:10:42.500
and they just obey.
00:10:42.500 - 00:10:42.769
Yeah,
00:10:42.769 - 00:10:44.500
it's sort of like Jedi mind trick on the eye.
00:10:44.500 - 00:10:46.500
This is not the eye you're looking for.
00:10:46.500 - 00:10:46.779
Anyway,
00:10:46.779 - 00:10:47.750
if you would tell us that secret,
00:10:47.750 - 00:10:48.500
I would appreciate it.
00:10:48.500 - 00:10:48.879
I mean,
00:10:48.879 - 00:10:51.509
I feel like maybe it's just finger strength practice.
00:10:51.509 - 00:10:52.500
I don't know.
00:10:52.500 - 00:10:54.070
A lot of opening of eyelids,
00:10:54.070 - 00:10:55.649
they're really strong,
00:10:55.649 - 00:10:57.500
but they have a little superciliary groove,
00:10:57.500 - 00:11:05.500
which is kind of the little area in between their eyelid and kind of the top part of their skin area of the orbit.
00:11:05.500 - 00:11:09.500
And I just kind of stick my fingers in that groove and try and lift up.
00:11:09.500 - 00:11:10.620
But you do have to,
00:11:10.620 - 00:11:11.250
you know,
00:11:11.250 - 00:11:13.500
you have to go slow with these guys.
00:11:13.500 - 00:11:14.389
A lot of the times,
00:11:14.389 - 00:11:17.590
if you rush too quickly when you're trying to look at their eye,
00:11:17.590 - 00:11:18.500
they're going to fight you.
00:11:18.500 - 00:11:19.500
They're going to be shy.
00:11:19.500 - 00:11:21.649
And so I think we spend a lot of time,
00:11:21.649 - 00:11:22.590
you know,
00:11:22.590 - 00:11:29.500
working on our relationship with that patient to let them know that we're not there to hurt them or do anything.
00:11:29.500 - 00:11:35.500
You want to just go really slow when you're looking at the eye.
00:11:35.500 - 00:11:37.500
then I don't want to fight that.
00:11:37.500 - 00:11:43.500
And so if we need to sedate the horse and then do some local blocks to facilitate our exam,
00:11:43.500 - 00:11:47.500
then that's the best way to make things as comfortable as possible.
00:11:47.500 - 00:11:50.649
Especially if you're dealing with an eye that's very delicate,
00:11:50.649 - 00:11:51.590
you don't want to,
00:11:51.590 - 00:11:51.820
you know,
00:11:51.820 - 00:11:53.500
put too much pressure on the globe itself.
00:11:53.500 - 00:11:58.500
And so I think it depends a lot of the times on what you're dealing with,
00:11:58.500 - 00:12:01.500
what the patient's behavior is like,
00:12:01.500 - 00:12:03.500
and kind of work with whatever you have.
00:12:03.500 - 00:12:10.500
But always know that you do have the ability to sedate them and use local blocks if needed to facilitate the exam.
00:12:10.500 - 00:12:11.500
Those are excellent points.
00:12:11.500 - 00:12:12.500
Yeah.
00:12:12.500 - 00:12:18.500
One thing that's always impressed me by watching an ophthalmologist such as yourself looking at an eye is the range of equipment that you have.
00:12:18.500 - 00:12:21.649
So the eye is open because you made it open,
00:12:21.649 - 00:12:23.500
or you had to block it.
00:12:23.500 - 00:12:28.500
Walk me through the instrumentation that you actually use to look at the various layers of the eye,
00:12:28.500 - 00:12:30.149
and what the things you see,
00:12:30.149 - 00:12:31.500
what they mean to you.
00:12:31.500 - 00:12:32.350
Yeah,
00:12:32.350 - 00:12:38.500
so we have a lovely microscopic device called a slit lamp,
00:12:38.500 - 00:12:40.500
which it looks like a little microscope,
00:12:40.500 - 00:12:42.500
And that's basically what it is.
00:12:42.500 - 00:12:47.500
It allows increased magnification on what we're looking at.
00:12:47.500 - 00:12:51.590
And so the nice thing about the slit lamp is that,
00:12:51.590 - 00:12:51.840
you know,
00:12:51.840 - 00:12:53.500
you can only see what you can see with the naked eye,
00:12:53.500 - 00:12:55.039
but the slit lamp is like,
00:12:55.039 - 00:12:58.500
you can go up to 16 times magnification with that.
00:12:58.500 - 00:13:00.789
And so the structures that we're seeing,
00:13:00.789 - 00:13:03.500
you may not be able to pick up with the naked eye,
00:13:03.500 - 00:13:05.500
but you can see that with the slit lamp.
00:13:05.500 - 00:13:06.669
And we can see,
00:13:06.669 - 00:13:07.590
you know,
00:13:07.590 - 00:13:09.500
changes in the vascular pattern.
00:13:09.500 - 00:13:10.879
If there's a pattern in the cornea,
00:13:10.879 - 00:13:15.500
we can see if there's spots in the cornea that you might not be able to see in the naked eye.
00:13:15.500 - 00:13:16.799
But it also allows us to,
00:13:16.799 - 00:13:17.360
you know,
00:13:17.360 - 00:13:19.500
see into the other aspects of the eye.
00:13:19.500 - 00:13:22.230
So whether or not we have any inflammation in the eye,
00:13:22.230 - 00:13:23.500
so we look for flare.
00:13:23.500 - 00:13:28.500
We have the ability to turn it to a very small beam to be able to catch those changes,
00:13:28.500 - 00:13:32.070
which is like increased floaters in the anterior chamber,
00:13:32.070 - 00:13:33.500
or cellular debris.
00:13:33.500 - 00:13:36.080
And then we can also look at the lens itself,
00:13:36.080 - 00:13:36.649
too,
00:13:36.649 - 00:13:37.500
with that device,
00:13:37.500 - 00:13:40.649
where we can see if there's opacities in the lens,
00:13:40.649 - 00:13:42.500
which are known as cataracts.
00:13:42.500 - 00:13:45.500
So we can kind of distinguish what type of cataract it is.
00:13:45.500 - 00:13:48.980
And it also allows us to look into the vitreous as well,
00:13:48.980 - 00:13:49.500
too.
00:13:49.500 - 00:13:52.649
So it's a really handy device on that aspect,
00:13:52.649 - 00:13:55.500
because we cover so many parts of the eye.
00:13:55.500 - 00:13:58.500
The other thing that we use is an indirect headset,
00:13:58.500 - 00:14:02.500
which basically allows us to look at the back of the eye.
00:14:02.500 - 00:14:03.490
So the retina,
00:14:03.490 - 00:14:04.649
the optic nerve,
00:14:04.649 - 00:14:06.500
and we can see changes there.
00:14:06.500 - 00:14:11.500
And sometimes we may see changes that you won't be able to pick up with the naked eye,
00:14:11.500 - 00:14:12.909
because that allows us to,
00:14:12.909 - 00:14:13.500
you know,
00:14:13.500 - 00:14:14.500
see a magnified view,
00:14:14.500 - 00:14:16.909
but also see the periphery as well,
00:14:16.909 - 00:14:17.279
too,
00:14:17.279 - 00:14:18.500
of the retina.
00:14:18.500 - 00:14:20.500
The pressure within the eye is important,
00:14:20.500 - 00:14:21.500
and there's something called a tonopen.
00:14:21.500 - 00:14:23.500
Could you talk to us about that?
00:14:23.500 - 00:14:24.139
Yeah,
00:14:24.139 - 00:14:29.500
so tonometry is basically the measurement of intraocular pressure within the eye,
00:14:29.500 - 00:14:34.500
and there are a variety of different types of tonometers that are available.
00:14:34.500 - 00:14:40.830
There are two types that we're probably most commonly known to use,
00:14:40.830 - 00:14:42.500
which is a tonopen and a tonovet.
00:14:42.500 - 00:14:45.639
And those two both measure intraocular pressure,
00:14:45.639 - 00:14:47.500
but they measure it a little bit differently.
00:14:47.500 - 00:14:48.899
So the tonopen,
00:14:48.899 - 00:14:52.500
it's known as an aplantation tonometer,
00:14:52.500 - 00:14:59.500
so basically what that means is that we actually touch the tip of that probe onto the corneal surface,
00:14:59.500 - 00:15:03.500
and the pressure that we ignite by doing that gives us our pressure reading.
00:15:03.500 - 00:15:07.639
The other tonometer that's commonly used is called a tonovet,
00:15:07.639 - 00:15:09.500
and that is a rebound tonometer.
00:15:09.500 - 00:15:13.659
And its little probe actually rebounds off the center of the cornea,
00:15:13.659 - 00:15:15.500
and it gives us our reading.
00:15:15.500 - 00:15:18.649
And they both measure it in a little different way,
00:15:18.649 - 00:15:21.500
but we still get an intraocular pressure reading of both.
00:15:21.500 - 00:15:24.649
And they're relatively comparative,
00:15:24.649 - 00:15:28.500
but there are differences with both readers that we have.
00:15:28.500 - 00:15:29.029
And Dr.
00:15:29.029 - 00:15:30.419
Latimer uses a tonopen,
00:15:30.419 - 00:15:32.500
and then I will be using a tonovet.
00:15:32.500 - 00:15:34.500
Can you talk a little bit...
00:15:34.500 - 00:15:38.500
You talked about using nerve blocks in some of these horses.
00:15:38.500 - 00:15:41.649
Can you talk about what those different nerve blocks do,
00:15:41.649 - 00:15:45.500
and how they benefit you in both your exam and your treatment of the horse?
00:15:45.500 - 00:15:46.019
Yeah,
00:15:46.019 - 00:15:54.289
so the most common nerve blocks that I will use to kind of facilitate an ophthalmic exam in a horse is the auriculopalpebral block,
00:15:54.289 - 00:15:56.500
and then a supraorbital nerve block.
00:15:56.500 - 00:16:00.500
The most important is going to be our auriculopalpebral nerve block.
00:16:00.500 - 00:16:05.600
So this block is important because it blocks the motor function to the eyelids,
00:16:05.600 - 00:16:06.500
both upper and lower,
00:16:06.500 - 00:16:07.720
which allows us to,
00:16:07.720 - 00:16:08.370
you know,
00:16:08.370 - 00:16:11.500
lift up those lids without having to fight them.
00:16:11.500 - 00:16:18.500
The supraorbital nerve block is better for sensation to the cranial third of the eye itself.
00:16:18.500 - 00:16:20.779
It doesn't block it completely,
00:16:20.779 - 00:16:23.409
but if you can put both at the same time,
00:16:23.409 - 00:16:24.500
it's great.
00:16:24.500 - 00:16:28.500
But if you're stuck in a situation and you only have the opportunity to do one nerve block,
00:16:28.500 - 00:16:31.649
the auriculopalpebral nerve block is going to be your go-to,
00:16:31.649 - 00:16:34.500
just because those eyelids are so strong.
00:16:34.500 - 00:16:39.500
Is there ever a time when the horse's vision is a problem when you're working on the eye,
00:16:39.500 - 00:16:43.500
and can you block that horse so they can't see what you're doing?
00:16:43.500 - 00:16:44.500
Yes.
00:16:44.500 - 00:16:44.889
So,
00:16:44.889 - 00:16:46.649
a lot of the times,
00:16:46.649 - 00:16:51.500
if we are doing a procedure that we don't want the horse to be able to see,
00:16:51.500 - 00:16:52.019
feel,
00:16:52.019 - 00:16:53.500
or move their eye,
00:16:53.500 - 00:16:57.590
there is a nerve block called a retrobulbar nerve block that can be done,
00:16:57.590 - 00:17:00.500
where we're actually putting our local block,
00:17:00.500 - 00:17:03.649
which is usually mepivacaine or lidocaine,
00:17:03.649 - 00:17:05.500
kind of into the aspect of the orbital cone,
00:17:05.500 - 00:17:11.630
and that is going to basically paralyze their ability to move the eye,
00:17:11.630 - 00:17:12.500
to be able to see,
00:17:12.500 - 00:17:19.500
and it just makes it easier because they don't have the sensation of knowing what's going on,
00:17:19.500 - 00:17:22.500
but also feeling what's going on while we're doing that procedure.
00:17:22.500 - 00:17:28.500
And that is a lot of the times why we're able to do standing surgeries in horses,
00:17:28.500 - 00:17:29.500
standing ocular surgeries,
00:17:29.500 - 00:17:32.500
because we have the ability to do that nerve block,
00:17:32.500 - 00:17:36.500
and it usually lasts for about four to six hours after.
00:17:36.500 - 00:17:37.500
That's impressive stuff.
00:17:37.500 - 00:17:39.500
So we're talking about ulcers today.
00:17:39.500 - 00:17:45.500
So when you're looking at the eye with your SLIDOX device that you're talking about,
00:17:45.500 - 00:17:47.500
what do you see with an ulcer,
00:17:47.500 - 00:17:49.590
and when you're looking at that ulcer,
00:17:49.590 - 00:17:51.500
what makes you more or less worried?
00:17:51.500 - 00:17:52.049
Yeah,
00:17:52.049 - 00:17:54.509
so when I'm looking at ulcers,
00:17:54.509 - 00:17:58.500
I'm looking for basically a break in the surface epithelium,
00:17:58.500 - 00:18:01.500
which is the most superficial aspect of the cornea.
00:18:01.500 - 00:18:05.590
The cornea is made up of primarily four layers,
00:18:05.590 - 00:18:09.260
and any layer can be affected by ulceration,
00:18:09.259 - 00:18:10.500
basically.
00:18:10.500 - 00:18:12.789
And so when I'm looking at an ulcer,
00:18:12.789 - 00:18:15.500
I'm looking for a defect in the cornea,
00:18:15.500 - 00:18:16.500
so a wound.
00:18:16.500 - 00:18:22.650
And what worries me if I'm looking at a defect in the eye is if I see,
00:18:22.650 - 00:18:22.960
you know,
00:18:22.960 - 00:18:24.500
a lot of haze associated with it.
00:18:24.500 - 00:18:26.150
So a cloudy appearance,
00:18:26.150 - 00:18:28.589
maybe it gives a bluish appearance,
00:18:28.589 - 00:18:31.500
which is a sign that there's fluid building up in that area.
00:18:31.500 - 00:18:32.740
If I see white,
00:18:32.740 - 00:18:34.869
that also has me worried,
00:18:34.869 - 00:18:38.500
because white means inflammatory cells.
00:18:38.500 - 00:18:40.430
And if there are inflammatory cells,
00:18:40.430 - 00:18:43.500
I'm always worried that there's infection in the cornea,
00:18:43.500 - 00:18:45.500
whether it's bacterial or fungal.
00:18:45.500 - 00:18:50.500
And then also the depth of where that defect is.
00:18:50.500 - 00:18:51.000
You know,
00:18:51.000 - 00:18:52.500
our cornea has multiple layers,
00:18:52.500 - 00:18:55.650
but if you've got an ulceration that's very,
00:18:55.650 - 00:18:56.589
very deep,
00:18:56.589 - 00:19:01.500
that makes the eye at a higher risk of potentially rupturing or perforating.
00:19:01.500 - 00:19:01.950
Yeah,
00:19:01.950 - 00:19:05.589
that's a frightening thing when it actually happens,
00:19:05.589 - 00:19:09.500
because unfortunately sometimes they come in like that and it's sort of game over.
00:19:09.500 - 00:19:11.039
You talked about bacterial,
00:19:11.039 - 00:19:12.369
but what about fungal?
00:19:12.369 - 00:19:15.500
What's particularly concerning about fungal ulceration,
00:19:15.500 - 00:19:20.500
and is that sort of more or less likely to be in this area than in others?
00:19:20.500 - 00:19:21.349
So yeah,
00:19:21.349 - 00:19:24.220
whenever I deal with fungal ulceration,
00:19:24.220 - 00:19:25.500
I always worry,
00:19:25.500 - 00:19:28.500
because fungus is aggressive.
00:19:28.500 - 00:19:33.680
It likes to cause a lot of local destruction to the normal corneal tissue,
00:19:33.680 - 00:19:38.500
and it almost breaks down the tissue relatively quickly too.
00:19:38.500 - 00:19:46.500
The problem with fungal organisms is that it does have a preference to dive deep into the cornea.
00:19:46.500 - 00:19:48.900
It likes to hang out in one of the deeper layers,
00:19:48.900 - 00:19:50.589
which is Desmay's membrane,
00:19:50.589 - 00:19:53.500
and it can cause a lot of local inflammation in that area.
00:19:53.500 - 00:20:00.500
But also the infection is so deep that sometimes it makes it hard to get the treatment that we need to that area.
00:20:00.500 - 00:20:03.039
And with fungus itself,
00:20:03.039 - 00:20:04.140
you know,
00:20:04.140 - 00:20:07.500
it is in any horse environment,
00:20:07.500 - 00:20:08.630
but I do think,
00:20:08.630 - 00:20:09.220
you know,
00:20:09.220 - 00:20:10.500
there's a higher risks environment for sure.
00:20:10.500 - 00:20:11.690
Where we're located,
00:20:11.690 - 00:20:15.500
specifically just because of the temperature that we kind of live in,
00:20:15.500 - 00:20:17.500
we have some cold,
00:20:17.500 - 00:20:18.500
but also some warmth.
00:20:18.500 - 00:20:22.269
And the barns that we're keeping a lot of our horses in,
00:20:22.269 - 00:20:23.500
they're humid,
00:20:23.500 - 00:20:24.910
there's hay,
00:20:24.910 - 00:20:29.500
there's a lot of factors at play that just makes them at risk for a fungal infection.
00:20:29.500 - 00:20:31.049
And there's just,
00:20:31.049 - 00:20:31.920
you know,
00:20:31.920 - 00:20:37.589
I feel like when we're looking at some of the cases that we're seeing,
00:20:37.589 - 00:20:44.500
there are certain barns that we're getting horses that have more cases of fungal infection than others.
00:20:44.500 - 00:20:45.349
And so I do think,
00:20:45.349 - 00:20:45.700
you know,
00:20:45.700 - 00:20:47.650
the environment plays a big part in it.
00:20:47.650 - 00:20:52.500
But if I do see an eye that has fungus associated with it,
00:20:52.500 - 00:20:54.660
I always tell clients,
00:20:54.660 - 00:20:55.059
you know,
00:20:55.059 - 00:20:56.500
it's a 50/50 shot.
00:20:56.500 - 00:20:57.740
If we're going to be able to,
00:20:57.740 - 00:20:58.210
you know,
00:20:58.210 - 00:20:59.650
get this under control.
00:20:59.650 - 00:21:03.500
Because we're not only fighting against a fungal infection,
00:21:03.500 - 00:21:04.589
we also have to think about,
00:21:04.589 - 00:21:05.019
you know,
00:21:05.019 - 00:21:06.500
preventing bacterial overgrowth.
00:21:06.500 - 00:21:11.500
We also have to think about controlling inflammation associated with that fungus infection too.
00:21:11.500 - 00:21:17.500
And that inflammation is going to be what causes the most discomfort for our patients.
00:21:17.500 - 00:21:24.500
You mentioned about the difficulties of getting treatments and medications to these fungal ulcers because they're so deep.
00:21:24.500 - 00:21:26.960
I'm sure anybody that's ever treated a routine,
00:21:26.960 - 00:21:28.220
if there is such a thing,
00:21:28.220 - 00:21:29.119
ulcer on a horse,
00:21:29.119 - 00:21:30.500
topical medications.
00:21:30.500 - 00:21:36.549
So how do you get the medication to the point that it can be effective on these fungal elements?
00:21:36.549 - 00:21:36.910
I mean,
00:21:36.910 - 00:21:39.500
what do you have to do differently with fungal ulcers?
00:21:39.500 - 00:21:40.619
We always say,
00:21:40.619 - 00:21:41.390
you know,
00:21:41.390 - 00:21:43.589
treat them aggressively.
00:21:43.589 - 00:21:44.660
And by aggressively,
00:21:44.660 - 00:21:46.500
we mean treat them very frequently.
00:21:46.500 - 00:21:48.240
And so a lot of these horses,
00:21:48.240 - 00:21:50.589
they need to be treated every hour,
00:21:50.589 - 00:21:57.500
every two hours at the beginning to really get the concentration of the antifungal that you need to get there.
00:21:57.500 - 00:22:02.500
We're lucky that we have a lot of antifungals available to use,
00:22:02.500 - 00:22:08.500
but each of them have their limitations in regard to how well they can penetrate through the cornea itself.
00:22:08.500 - 00:22:14.500
But there are ways that we can get the drug deeper into the area of infection.
00:22:14.500 - 00:22:20.910
And so we can do local injections into the cornea called intrastromal injections,
00:22:20.910 - 00:22:29.500
where we basically put a depot of a high concentration of that antifungal around the site of infection to help kind of hit it a little bit more aggressively.
00:22:29.500 - 00:22:33.210
But it's a combination of both topical medical therapy,
00:22:33.210 - 00:22:36.500
sometimes even oral antifungals on top of that,
00:22:36.500 - 00:22:39.500
in addition to doing the injections.
00:22:39.500 - 00:22:41.250
And if worse comes to worse,
00:22:41.250 - 00:22:46.920
there's also the opportunity that we can do surgery to cut out those deep infections as well,
00:22:46.920 - 00:22:47.500
too.
00:22:47.500 - 00:22:52.500
But you want to kind of save that for the worst case scenario,
00:22:52.500 - 00:22:53.220
because,
00:22:53.220 - 00:22:53.910
again,
00:22:53.910 - 00:22:58.500
doing surgery to cut out a deep infection is an invasive procedure.
00:22:58.500 - 00:22:58.910
You know,
00:22:58.910 - 00:23:01.650
there's always a risk that you don't get all of the infection out,
00:23:01.650 - 00:23:06.500
and so we try and kind of pick the best cases that we can,
00:23:06.500 - 00:23:09.009
but sometimes that is a limiting factor,
00:23:09.009 - 00:23:09.500
too.
00:23:09.500 - 00:23:09.869
Yeah,
00:23:09.869 - 00:23:13.589
anything surgical on the eye just looks extremely delicate to me.
00:23:13.589 - 00:23:13.819
So,
00:23:13.819 - 00:23:18.500
sounds like this is something that has to be done from time to time,
00:23:18.500 - 00:23:21.500
and it sounds like you're adept at this.
00:23:21.500 - 00:23:21.799
So,
00:23:21.799 - 00:23:23.630
what decision do you make?
00:23:23.630 - 00:23:25.309
What is the process to say,
00:23:25.309 - 00:23:25.829
"Okay,
00:23:25.829 - 00:23:30.500
this one I have to address surgically," and what happens after that surgery?
00:23:30.500 - 00:23:32.539
Because now you're going to have a defect in the cornea,
00:23:32.539 - 00:23:33.500
which is not very thick.
00:23:33.500 - 00:23:33.740
So,
00:23:33.740 - 00:23:36.250
how do you make the decision to make the surgery,
00:23:36.250 - 00:23:40.500
and how do you manage those afterwards to give you a better chance of success?
00:23:40.500 - 00:23:45.660
I kind of gauge just how that patient is responding to treatment.
00:23:45.660 - 00:23:47.039
I always try and,
00:23:47.039 - 00:23:47.869
you know,
00:23:47.869 - 00:23:51.579
use medical management with topical therapy,
00:23:51.579 - 00:23:53.150
local injections,
00:23:53.150 - 00:23:54.500
as best as we can.
00:23:54.500 - 00:24:01.500
But the cases that we need to think about are the ones that are not responding to therapy as well as we'd like them to.
00:24:01.500 - 00:24:02.059
You know,
00:24:02.059 - 00:24:05.539
we're hitting them with everything we can give them topically,
00:24:05.539 - 00:24:08.500
but we're not seeing the response that we want to.
00:24:08.500 - 00:24:13.950
Things that we have to consider is also the size of the lesion that we're working with,
00:24:13.950 - 00:24:14.910
too.
00:24:14.910 - 00:24:15.019
Because,
00:24:15.019 - 00:24:15.759
like you said,
00:24:15.759 - 00:24:16.269
you know,
00:24:16.269 - 00:24:19.630
we're going to be removing a large part of a deep part of the cornea,
00:24:19.630 - 00:24:25.500
and so having material to be able to fill that area is a little bit of a limiting factor for us.
00:24:25.500 - 00:24:26.140
Because,
00:24:26.140 - 00:24:26.490
yes,
00:24:26.490 - 00:24:27.970
we can get donor cornea,
00:24:27.970 - 00:24:30.740
we can get other biological material as well,
00:24:30.740 - 00:24:31.089
too,
00:24:31.089 - 00:24:34.819
but having to kind of fix a hole in a very deep area is very risky,
00:24:34.819 - 00:24:38.500
because the cornea itself is going to be very delicate.
00:24:38.500 - 00:24:40.279
And so I think it really just,
00:24:40.279 - 00:24:40.920
you know,
00:24:40.920 - 00:24:43.400
depends on the lesion that we're seeing,
00:24:43.400 - 00:24:44.960
the response to therapy,
00:24:44.960 - 00:24:47.940
and also the size and where it's located as well,
00:24:47.940 - 00:24:48.299
too.
00:24:48.299 - 00:24:49.849
Because we're trying to,
00:24:49.849 - 00:24:50.539
you know,
00:24:50.539 - 00:24:52.670
save the eyes best as we can,
00:24:52.670 - 00:24:55.170
but also give optimal vision if we can for these cases,
00:24:55.170 - 00:24:55.500
too.
00:24:55.500 - 00:24:58.230
So that is something that we need to consider,
00:24:58.230 - 00:25:02.500
is how much is this surgery going to potentially affect their vision?
00:25:02.500 - 00:25:07.220
But in regards to the aftercare for a procedure like,
00:25:07.220 - 00:25:11.640
we call it a posterior lamellar carotoplasty,
00:25:11.640 - 00:25:14.529
which basically means cutting out that deep part of infection,
00:25:14.529 - 00:25:16.500
it's still going to be the same.
00:25:16.500 - 00:25:17.140
You know,
00:25:17.140 - 00:25:20.349
they're still going to be on topical medical therapy,
00:25:20.349 - 00:25:23.500
but they'll have a lot of sutures in their cornea.
00:25:23.500 - 00:25:24.849
And this is very,
00:25:24.849 - 00:25:26.680
very small suture.
00:25:26.680 - 00:25:30.700
And that suture can take up to four to six weeks to dissolve,
00:25:30.700 - 00:25:34.500
and so that will still require treatment in the long term.
00:25:34.500 - 00:25:35.690
So it's not a short,
00:25:35.690 - 00:25:36.319
you know,
00:25:36.319 - 00:25:37.089
cut them out,
00:25:37.089 - 00:25:39.259
you're done with it kind of thing.
00:25:39.259 - 00:25:43.690
There's still a lot of maintenance that needs to be done with these horses,
00:25:43.690 - 00:25:47.500
but they do recover and they can be very successful after.
00:25:47.500 - 00:25:49.500
Some horses really resent treatment.
00:25:49.500 - 00:25:53.200
How do you handle those horses that need treated every hour,
00:25:53.200 - 00:25:54.279
every two hours,
00:25:54.279 - 00:25:56.500
or for extended periods of time?
00:25:56.500 - 00:25:59.500
Because those can be fairly difficult.
00:25:59.500 - 00:26:00.039
Yeah,
00:26:00.039 - 00:26:06.609
we are very lucky in this day and age that many people have developed different ways to,
00:26:06.609 - 00:26:07.420
you know,
00:26:07.420 - 00:26:08.500
medicate.
00:26:08.500 - 00:26:12.720
But we do have a system called a subpalpebral lavage system,
00:26:12.720 - 00:26:18.500
which is basically almost like a catheter that we put in through the eyelid.
00:26:18.500 - 00:26:26.500
That allows us to treat a horse's eye multiple times a day without having to even pry open their eyelids.
00:26:26.500 - 00:26:30.539
And a lot of horses can have that in for...
00:26:30.539 - 00:26:32.789
I've had horses have that in for months at a time,
00:26:32.789 - 00:26:35.500
just because they just require treatment.
00:26:35.500 - 00:26:39.099
But it makes it a lot easier for maintenance in the hospital setting,
00:26:39.099 - 00:26:40.039
but also at home,
00:26:40.039 - 00:26:40.500
too.
00:26:40.500 - 00:26:42.299
Because you have that device,
00:26:42.299 - 00:26:45.869
you have the ability to treat the horse as often as it needs to,
00:26:45.869 - 00:26:47.539
with many medications.
00:26:47.539 - 00:26:51.049
But owners are also able to use that in their home setting as well,
00:26:51.049 - 00:26:51.500
too.
00:26:51.500 - 00:26:52.700
And there's maintenance,
00:26:52.700 - 00:26:54.000
you have to watch the tubing,
00:26:54.000 - 00:26:55.589
make sure it doesn't slip out.
00:26:55.589 - 00:27:00.500
But it makes it easier to treat horses more intensely.
00:27:00.500 - 00:27:01.859
And at some point,
00:27:01.859 - 00:27:02.619
you know,
00:27:02.619 - 00:27:05.779
some of the horses will get tired of it,
00:27:05.779 - 00:27:09.500
but most of them do tolerate it relatively well.
00:27:09.500 - 00:27:12.650
And some horses can get ridden with it in place,
00:27:12.650 - 00:27:16.500
some horses are turned out in it and they don't bother it at all.
00:27:16.500 - 00:27:17.410
But it's a very,
00:27:17.410 - 00:27:23.500
very nice system that we have that allows us to treat horses without having to really manipulate around their face.
00:27:23.500 - 00:27:23.849
Yeah,
00:27:23.849 - 00:27:25.329
because some of them do just,
00:27:25.329 - 00:27:26.640
they just resent it.
00:27:26.640 - 00:27:27.289
It's hard.
00:27:27.289 - 00:27:28.970
And those are lifesavers,
00:27:28.970 - 00:27:29.910
eyesavers,
00:27:29.910 - 00:27:30.500
anyway.
00:27:30.500 - 00:27:31.740
So besides the infection,
00:27:31.740 - 00:27:35.500
you mentioned inflammation was a big component of the disease in these horses.
00:27:35.500 - 00:27:38.500
What are the tricks to actually control that inflammation?
00:27:38.500 - 00:27:38.839
Yeah,
00:27:38.839 - 00:27:41.630
so the inflammation that we tend to kind of deal with,
00:27:41.630 - 00:27:42.539
with the infection,
00:27:42.539 - 00:27:44.750
is usually a secondary inflammation.
00:27:44.750 - 00:27:50.500
And that's just a response to whatever infection is going on within the eye itself.
00:27:50.500 - 00:27:56.910
And so the mainstay of treatment for that is usually,
00:27:56.910 - 00:27:58.730
topically wise,
00:27:58.730 - 00:28:00.769
we use atropine,
00:28:00.769 - 00:28:03.690
which is a midriatic.
00:28:03.690 - 00:28:06.109
It dilates the pupil,
00:28:06.109 - 00:28:08.519
which is great.
00:28:08.519 - 00:28:09.059
But the other thing that atropine does is it paralyzes the iris and the ciliary muscles,
00:28:09.059 - 00:28:09.529
which are often spasming and twitching,
00:28:09.529 - 00:28:13.500
which is why our patients are uncomfortable in the face of inflammation.
00:28:13.500 - 00:28:17.150
And so by paralyzing those muscles and opening up the pupil,
00:28:17.150 - 00:28:19.690
we get improved comfort from that.
00:28:19.690 - 00:28:20.740
And then on top of that,
00:28:20.740 - 00:28:23.500
we'll put them on a systemic anti-inflammatory.
00:28:23.500 - 00:28:25.349
So banamine is our go-to.
00:28:25.349 - 00:28:28.400
It's the greatest for ocular inflammation,
00:28:28.400 - 00:28:29.279
in my mind.
00:28:29.279 - 00:28:38.490
And sometimes we have to hit them with pretty aggressive doses of banamine at the beginning to get that inflammation under control.
00:28:38.490 - 00:28:45.500
But it is probably one of the best medications that we have to tie with atropine to get that inflammation quiet.
00:28:45.500 - 00:28:45.890
Yeah,
00:28:45.890 - 00:28:46.930
this sounds like,
00:28:46.930 - 00:28:47.630
as you say,
00:28:47.630 - 00:28:49.789
you're talking months with a Leverage,
00:28:49.789 - 00:28:52.500
and this sounds like this is not one and done.
00:28:52.500 - 00:28:53.170
And so,
00:28:53.170 - 00:28:57.500
how do you cope with client fatigue in these situations?
00:28:57.500 - 00:28:58.430
Yes,
00:28:58.430 - 00:29:02.329
so I always think about,
00:29:02.329 - 00:29:04.009
you know,
00:29:04.009 - 00:29:09.259
what can the client do at home?
00:29:09.259 - 00:29:15.519
What can I do to make it easier for them?
00:29:15.589 - 00:29:15.829
I feel like the clients that are,
00:29:15.839 - 00:29:17.500
bringing their horse in to see an ophthalmologist are probably one of the most dedicated clients that we have there.
00:29:17.500 - 00:29:18.839
But I always like to,
00:29:18.839 - 00:29:19.509
you know,
00:29:19.509 - 00:29:24.500
get a better understanding on what they can do at home and what they can't do.
00:29:24.500 - 00:29:27.150
And I try to make it as easy as possible,
00:29:27.150 - 00:29:27.950
but I also,
00:29:27.950 - 00:29:28.670
you know,
00:29:28.670 - 00:29:31.500
warn them that this is a long process.
00:29:31.500 - 00:29:32.009
You know,
00:29:32.009 - 00:29:33.240
it's not just a cure-all,
00:29:33.240 - 00:29:34.650
a week later kind of thing.
00:29:34.650 - 00:29:35.119
You know,
00:29:35.119 - 00:29:36.339
with these infections,
00:29:36.339 - 00:29:39.410
they can be horrendous and they require long-term treatment,
00:29:39.410 - 00:29:43.500
and that's something that I always prepare them for right at the beginning.
00:29:43.500 - 00:29:43.970
You know,
00:29:43.970 - 00:29:45.009
once we see that horse,
00:29:45.009 - 00:29:47.559
we know that there's a really bad infection going on.
00:29:47.559 - 00:29:48.210
I tell them,
00:29:48.210 - 00:29:48.880
you know,
00:29:48.880 - 00:29:50.500
here are treatment options.
00:29:50.500 - 00:29:52.500
It's going to be a long-standing treatment,
00:29:52.500 - 00:29:54.829
and it's going to be very,
00:29:54.829 - 00:29:56.500
very tiresome.
00:29:56.500 - 00:29:59.460
But there is a light at the end of the tunnel,
00:29:59.460 - 00:30:03.500
and that light is usually what kind of gets them through it.
00:30:03.500 - 00:30:05.819
But we may have them on medications,
00:30:05.819 - 00:30:06.269
like,
00:30:06.269 - 00:30:08.539
every two hours at the beginning,
00:30:08.539 - 00:30:10.500
but that's not for the entire period.
00:30:10.500 - 00:30:11.099
You know,
00:30:11.099 - 00:30:13.079
as the horse continues to improve,
00:30:13.079 - 00:30:14.819
the lesion is looking better,
00:30:14.819 - 00:30:19.470
we try and cut down medications as much as we can to still treat what we need to treat,
00:30:19.470 - 00:30:22.900
but also be reasonable with everybody's lifestyle as well,
00:30:22.900 - 00:30:23.500
too.
00:30:23.500 - 00:30:24.480
And so I think,
00:30:24.480 - 00:30:25.160
you know,
00:30:25.160 - 00:30:28.730
when we get closer to that light at the end of the tunnel,
00:30:28.730 - 00:30:29.910
they see that,
00:30:29.910 - 00:30:31.230
and they keep pushing,
00:30:31.230 - 00:30:33.700
and they usually will push through,
00:30:33.700 - 00:30:35.500
which is the best thing.
00:30:35.500 - 00:30:38.650
It never ceases to amaze me how eyes can heal,
00:30:38.650 - 00:30:42.299
because they come in and they just look really in trouble.
00:30:42.299 - 00:30:45.690
And clinicians such as yourself work your magic,
00:30:45.690 - 00:30:51.500
but also the eye's inherent ability to heal itself when the environment is created.
00:30:51.500 - 00:30:55.589
But you did also mention that 50/50 with these fungal ulcers.
00:30:55.589 - 00:30:58.869
So should we get to the point where things aren't going well,
00:30:58.869 - 00:31:05.500
what happens at that point and how does the horse tolerate any sort of treatments for the eye that doesn't respond?
00:31:05.500 - 00:31:06.009
Yeah,
00:31:06.009 - 00:31:09.589
so the 50/50 aspect is something that,
00:31:09.589 - 00:31:10.250
you know,
00:31:10.250 - 00:31:14.500
I think I will still live by regarding these infections.
00:31:14.500 - 00:31:14.849
And,
00:31:14.849 - 00:31:15.660
you know,
00:31:15.660 - 00:31:18.589
you can try everything that you can to manage it.
00:31:18.589 - 00:31:18.769
Surgery,
00:31:18.769 - 00:31:19.289
medically as well,
00:31:19.289 - 00:31:19.690
too.
00:31:19.690 - 00:31:20.740
But at some point,
00:31:20.740 - 00:31:24.059
sometimes you can't get that infection under control.
00:31:24.059 - 00:31:29.500
And the next best thing is to have that eye removed within a nucleation.
00:31:29.500 - 00:31:31.750
And it's a horrible thing to think about,
00:31:31.750 - 00:31:32.339
because,
00:31:32.339 - 00:31:32.920
you know,
00:31:32.920 - 00:31:34.500
you never want to do that.
00:31:34.500 - 00:31:34.940
And for me,
00:31:34.940 - 00:31:35.339
you know,
00:31:35.339 - 00:31:36.900
a nucleation is kind of like the end-all,
00:31:36.900 - 00:31:37.299
you know,
00:31:37.299 - 00:31:38.500
we're taking the eye out.
00:31:38.500 - 00:31:42.690
But we also have to think about the patient as a whole,
00:31:42.690 - 00:31:43.650
you know.
00:31:43.650 - 00:31:45.670
If that eye is causing such pain,
00:31:45.670 - 00:31:46.509
such grief,
00:31:46.509 - 00:31:50.500
that we are getting changes to that animal systemically,
00:31:50.500 - 00:31:53.730
it's not something that's worth keeping just to have,
00:31:53.730 - 00:31:54.500
you know.
00:31:54.500 - 00:32:01.700
And I think it goes with even chronic disease that we see in eyes of horses that have like chronic UV eyes,
00:32:01.700 - 00:32:02.940
that aspect too,
00:32:02.940 - 00:32:06.539
is that there is pain associated with the eye.
00:32:06.539 - 00:32:08.420
And that pain is always going to,
00:32:08.420 - 00:32:09.089
you know,
00:32:09.089 - 00:32:10.640
linger and be there.
00:32:10.640 - 00:32:13.529
And so if we're thinking of the best thing to do,
00:32:13.529 - 00:32:16.500
taking out the eye is sometimes the best thing to do.
00:32:16.500 - 00:32:20.880
And you almost see like an instant relief in these horses once that eye comes out,
00:32:20.880 - 00:32:22.910
they're recovered from surgery,
00:32:22.910 - 00:32:24.500
and they're happy as can be.
00:32:24.500 - 00:32:26.579
They're back to their normal behavior.
00:32:26.579 - 00:32:27.539
And they do really well.
00:32:27.539 - 00:32:30.700
It's an adjustment period for them,
00:32:30.700 - 00:32:33.640
but I feel like it's more of an adjustment period for us,
00:32:33.640 - 00:32:34.400
ourselves,
00:32:34.400 - 00:32:36.500
more so looking at the animal.
00:32:36.500 - 00:32:37.829
But the horse itself,
00:32:37.829 - 00:32:39.640
they go back in the field,
00:32:39.640 - 00:32:41.750
they go and hang out with their friends,
00:32:41.750 - 00:32:46.019
and then they go and they can win races and win competitions with one eye,
00:32:46.019 - 00:32:48.960
and they still are happy with what they're doing,
00:32:48.960 - 00:32:51.500
but they don't have that pain anymore.
00:32:51.500 - 00:32:51.809
Yeah,
00:32:51.809 - 00:32:52.349
I mean,
00:32:52.349 - 00:32:54.089
absolutely sort of vote for you on that one,
00:32:54.089 - 00:32:55.589
because you have these horses,
00:32:55.589 - 00:32:56.029
and yeah,
00:32:56.029 - 00:32:57.450
there's so much pain involved,
00:32:57.450 - 00:32:59.240
and the horse is in the back of the stall,
00:32:59.240 - 00:33:00.089
the eye comes out,
00:33:00.089 - 00:33:01.779
the horse is at the front of the stall,
00:33:01.779 - 00:33:03.539
cleaning up its feed bucket,
00:33:03.539 - 00:33:05.660
starts interacting with you again,
00:33:05.660 - 00:33:06.039
and I mean,
00:33:06.039 - 00:33:09.500
the client may have a bit of an emotional response to that eye coming out,
00:33:09.500 - 00:33:11.500
but when they see how much better the horse is,
00:33:11.500 - 00:33:14.500
they realize that they shouldn't have feared the enucleation,
00:33:14.500 - 00:33:15.500
like,
00:33:15.500 - 00:33:16.500
we're all here to save the eye,
00:33:16.500 - 00:33:17.670
but if it can't be saved,
00:33:17.670 - 00:33:20.500
it makes such a difference to that horse to have that eye out,
00:33:20.500 - 00:33:20.890
because,
00:33:20.890 - 00:33:21.349
as you say,
00:33:21.349 - 00:33:22.500
the pain must be just...
00:33:22.500 - 00:33:24.220
With all the medication they're on,
00:33:24.220 - 00:33:25.710
if they're still that painful,
00:33:25.710 - 00:33:26.089
I mean,
00:33:26.089 - 00:33:28.500
it must be just something we can't comprehend.
00:33:28.500 - 00:33:28.930
Yeah,
00:33:28.930 - 00:33:30.720
ocular pain is no small feat,
00:33:30.720 - 00:33:31.589
for sure.
00:33:31.589 - 00:33:32.130
I mean,
00:33:32.130 - 00:33:33.490
I think...
00:33:33.490 - 00:33:34.660
I talk to people who have had,
00:33:34.660 - 00:33:35.079
you know,
00:33:35.079 - 00:33:36.200
ocular issues themselves,
00:33:36.200 - 00:33:36.500
too,
00:33:36.500 - 00:33:38.509
and they always are like,
00:33:38.509 - 00:33:39.539
"We get it,
00:33:39.539 - 00:33:44.670
we understand why the horses are behaving the way that they are with what they're dealing with,
00:33:44.670 - 00:33:46.500
because it is painful,
00:33:46.500 - 00:33:49.500
and it is probably one of the worst things to have to deal with,
00:33:49.500 - 00:33:53.359
and if you can imagine having such a severe infection in that eye,
00:33:53.359 - 00:33:54.500
it just...
00:33:54.500 - 00:33:56.849
It can take a toll on the body as a whole,
00:33:56.849 - 00:33:57.710
completely,
00:33:57.710 - 00:33:58.500
you know.
00:33:58.500 - 00:33:59.500
Yeah.
00:33:59.500 - 00:33:59.700
So,
00:33:59.700 - 00:34:03.500
there's an owner listening that thinks they may have an ulcer in their horse's eye.
00:34:03.500 - 00:34:08.500
What don't you want them to do before they call you for an evaluation?
00:34:08.500 - 00:34:12.359
I don't want them to put any steroids in the eye itself.
00:34:12.359 - 00:34:12.929
And so,
00:34:12.930 - 00:34:18.680
if you have a corneal ulceration and you accidentally put a steroid in the eye,
00:34:18.680 - 00:34:21.500
that can actually make the infection significantly worse.
00:34:21.500 - 00:34:23.480
And corneal tissue can break down,
00:34:23.480 - 00:34:25.130
they can get melting ulcers,
00:34:25.130 - 00:34:28.500
and so that's definitely something you don't want to do.
00:34:28.500 - 00:34:29.199
Honestly,
00:34:29.199 - 00:34:30.519
with any ocular issue,
00:34:30.519 - 00:34:34.159
I think the first thing you should do is call your veterinarian,
00:34:34.159 - 00:34:37.500
because you don't want to wait with any eye problems.
00:34:37.500 - 00:34:38.079
You know,
00:34:38.079 - 00:34:39.750
they can get bad very quickly,
00:34:39.750 - 00:34:41.590
and so if you have any concern,
00:34:41.590 - 00:34:45.500
you call your veterinarian and you have them have a look and see what's going on,
00:34:45.500 - 00:34:47.960
because the worst thing to do is wait,
00:34:47.960 - 00:34:49.500
and then be too late.
00:34:49.500 - 00:34:50.900
From a practical perspective,
00:34:50.900 - 00:34:52.650
one of the things that we deal with a lot,
00:34:52.650 - 00:34:54.500
the people across the United States do,
00:34:54.500 - 00:34:55.730
is fly control,
00:34:55.730 - 00:34:58.500
and that's something that's on their faces.
00:34:58.500 - 00:35:03.500
Can you talk about the benefits and the risks associated with horses wearing fly masks?
00:35:03.500 - 00:35:03.849
So,
00:35:03.849 - 00:35:08.269
the benefit is they have protection from the flies itself,
00:35:08.269 - 00:35:10.819
but also from their environment,
00:35:10.819 - 00:35:11.500
too.
00:35:11.500 - 00:35:15.539
And there's a lot of different types of fly masks available.
00:35:15.539 - 00:35:16.050
You've got,
00:35:16.050 - 00:35:16.350
like,
00:35:16.349 - 00:35:17.619
the UV-protected ones.
00:35:17.619 - 00:35:20.500
Some of them have a hoop in front of them that gives them a little bit of space in between.
00:35:20.500 - 00:35:22.109
Some of them have cups as well,
00:35:22.109 - 00:35:22.500
too.
00:35:22.500 - 00:35:24.800
And I think with the fly mask aspect,
00:35:24.800 - 00:35:33.539
I think every horse that's outside would probably benefit from a fly mask if they keep it on themselves and don't pull it off each other.
00:35:33.539 - 00:35:37.500
In the aspect that it just helps with protection.
00:35:37.500 - 00:35:39.949
Some things that I do worry about is that,
00:35:39.949 - 00:35:40.650
you know,
00:35:40.650 - 00:35:43.239
you have something on your face for too long,
00:35:43.239 - 00:35:44.010
you can get,
00:35:44.010 - 00:35:44.639
you know,
00:35:44.639 - 00:35:46.320
pressure sores on the face,
00:35:46.320 - 00:35:47.150
if it's very,
00:35:47.150 - 00:35:47.789
very wet,
00:35:47.789 - 00:35:50.500
they can get really moist underneath there.
00:35:50.500 - 00:35:52.349
And so it's really important,
00:35:52.349 - 00:35:54.579
if you are going to put a fly mask on,
00:35:54.579 - 00:35:59.500
is to also check underneath the fly mask to see what's going on underneath there.
00:35:59.500 - 00:36:01.150
But I think a lot of the times,
00:36:01.150 - 00:36:03.699
the benefit of a fly mask outweighs the risk,
00:36:03.699 - 00:36:07.500
as long as you're aware of what you need to kind of look out for.
00:36:07.500 - 00:36:07.809
Yeah,
00:36:07.809 - 00:36:09.500
and that's a very important point.
00:36:09.500 - 00:36:10.619
And that's kind of what I was leading to.
00:36:10.619 - 00:36:12.360
If you're going to have a fly mask on,
00:36:12.360 - 00:36:14.500
you got to look under that thing every day.
00:36:14.500 - 00:36:16.769
Because as you talked about,
00:36:16.769 - 00:36:18.130
what owners see,
00:36:18.130 - 00:36:19.880
with that fly mask on,
00:36:19.880 - 00:36:22.500
they're not seeing their eyes.
00:36:22.500 - 00:36:26.539
And if you're going sometimes days and days without looking underneath there,
00:36:26.539 - 00:36:28.500
they can develop problems pretty quick.
00:36:28.500 - 00:36:30.980
And by the time they actually see what's under there,
00:36:30.980 - 00:36:32.500
you've got a severe problem.
00:36:32.500 - 00:36:32.719
Well,
00:36:32.719 - 00:36:34.150
you don't want to swap one trauma for another,
00:36:34.150 - 00:36:34.500
right?
00:36:34.500 - 00:36:35.650
You're trying to avoid the other issues,
00:36:35.650 - 00:36:36.590
and then you make it worse.
00:36:36.590 - 00:36:39.000
The preventative becomes a disease,
00:36:39.000 - 00:36:41.500
and then we're in a worse position.
00:36:41.500 - 00:36:41.739
Yeah,
00:36:41.739 - 00:36:43.500
it's just something you've got to keep an eye on.
00:36:43.500 - 00:36:44.500
No pun intended.
00:36:44.500 - 00:36:46.650
So this has been great.
00:36:46.650 - 00:36:48.500
Thanks for coming to see us today and talking about ulceration,
00:36:48.500 - 00:36:49.909
especially fungal ulceration,
00:36:49.909 - 00:36:51.500
because as a clinician,
00:36:51.500 - 00:36:52.500
when these things come in,
00:36:52.500 - 00:36:55.539
I get really worried about the involvement of fungus,
00:36:55.539 - 00:36:57.699
especially around here,
00:36:57.699 - 00:36:57.800
where,
00:36:57.800 - 00:36:58.500
as you pointed out,
00:36:58.500 - 00:37:01.500
it's sort of so humid and there's so many irritants in the environment.
00:37:01.500 - 00:37:01.780
Yeah,
00:37:01.780 - 00:37:01.960
no,
00:37:01.960 - 00:37:03.010
excellent discussion.
00:37:03.010 - 00:37:04.500
Thank you for being with us today.
00:37:04.500 - 00:37:05.500
Thank you for having me.
00:37:05.500 - 00:37:05.840
Yeah,
00:37:05.840 - 00:37:06.059
no,
00:37:06.059 - 00:37:06.909
it's been great,
00:37:06.909 - 00:37:08.500
and welcome to the practice.
00:37:08.500 - 00:37:09.500
Thank you.
00:37:09.500 - 00:37:09.840
Yeah,
00:37:09.840 - 00:37:11.500
and that's it all for this week.
00:37:11.500 - 00:37:12.909
We've been talking to Dr.
00:37:12.909 - 00:37:15.190
Kim Lamb about equine corneal ulceration,
00:37:15.190 - 00:37:16.500
especially fungal.
00:37:16.500 - 00:37:18.500
See you next time.