A Better Way to Treat Equine Eyes: Subpalpebral Lavage

Anyone who's ever managed an equine eye issue knows how challenging it can be to administer treatment. Horses have an uncanny ability to morph into giraffes when they'd rather not have their eyes touched, and an owner's inability to provide appropriate treatment can hinder a horse's recovery. Fortunately, there's an easier way: the subpalpebral lavage system.

During a presentation at the 2013 American Association of Equine Practitioners' Convention, held Dec. 7-11 in Nashville, Tenn., Ann Dwyer, DVM, owner of the Genesee Valley Equine Clinic in Scottsville, N.Y., reviewed with veterinarians how to insert and manage a subpalpebral lavage (SPL) system.

A subpalpebral lavage system consists of flexible tubing passed through either the upper or lower eyelid and stitched into place, with medication administered via the other end of the tube. Dwyer said SPLs can be used on any patient, "from babies to big drafts," and can be left in place for as long as 12-15 weeks. She also noted that horses generally adapt quickly to having an SPL in place.

An SPL system allows a handler to administer eye medication without touching the horse's face or ocular region.

Photo: Courtesy Dr. Ann Dwyer

"An SPL is an essential tool for treating serious equine ocular conditions," Dwyer explained. "Management of serious ocular problems requires multiple treatments per day and may extend for several weeks. SPL medication is delivered without the handler touching the face or periocular (the area around the eye) region; therefore, the treatment of fractious horses or painful eyes is simplified."

When a veterinarian inserts the SPL, the horse must be heavily sedated and the eyelid and eye surface numbed. This also allows the practitioner to gather additional samples from the eye for tests, she said. Whether the lavage is placed through the top or bottom lid is the clinician's preference, Dwyer said, and either route is effective.

Once the SPL is in place, the veterinarian and horse owner often work as a team to both administer the required medication to the eye and maintain the system. She offered the following tips for individuals managing horses with SPLs in place:

  • Wipe the catheter port—where the medication is administered—daily with an antiseptic solution and use a plastic baggie to keep the port clean and debris-free.
  • Change the catheter port once a week to ensure bacteria doesn't build up.
  • Always ensure you're administering the correct medication at the correct time. Owners, get a detailed administration schedule from your veterinarian. Practitioners, ensure the medications you leave are clearly labeled and the owner knows how and when to administer them.
  • Follow each medication injection by injecting about 1.5 mL of air to ensure the medication reaches the eye and does not remain trapped in the tubing.
  • When using multiple medications, wait a few minutes between administrations to ensure the drugs don't wash out of the eye.
  • Consider using a hood or flymask to help protect the SPL insertion site.

Ultimately, though, Dwyer said well-secured SPLs are easy to manage.

The footplate can occasionally cause corneal ulceration.

Photo: Courtesy Dr. Ann Dwyer

Potential complications include corneal ulcers from the lavage's footplate (the part of the system located under the eyelid, closest to the eye) and the lavage tubing breaking. Dwyer said the latter can usually be easily fixed by splicing the remaining tubing together.

In closing, Dwyer stressed that SPLs are only devices, and they rely on veterinary expertise to be effective. Practitioners should make a correct diagnosis, prescribe appropriate treatments, and ensure sufficient help is available to deliver medications.

"Horse owners should also understand that some very serious eye problems will require evaluation and surgical or medical management by a specialist in addition medication delivery through an SPL," she noted.

Disclaimer: Seek the advice of a qualified veterinarian before proceeding with any diagnosis, treatment, or therapy.