Repairing Equine Eyelid Lacerations

Repairing Equine Eyelid Lacerations

Hendrix said most eyelid lacerations can be successfully repaired, like this one's been.

Photo: Courtesy Dr. Diane Hendrix/AAEP Proceedings

Merriam-Webster defines a horse as "a large solid-hoofed herbivorous ungulate mammal domesticated since prehistoric times and used as a beast of burden, a draft animal, or for riding." Many horse owners, however, will agree that the phrase "accident prone" should be included in that definition.

Although eyelid lacerations are common, veterinarians should consider them surgical emergencies, Hendrix stressed.

Photo: Courtesy Dr. Diane Hendrix/AAEP Proceedings

Most owners have a working knowledge of equine first-aid and wound management—thanks to the aforementioned nature of our four-legged charges—and are comfortable managing minor issues. But one area that should always warrant a call to a veterinarian is equine eye injuries, especially eyelid lacerations. A horse's vision might depend on it.

Diane Hendrix, DVM, Dipl. ACVO, a professor of ophthalmology at the University of Tennessee College of Veterinary Medicine, reviewed how to repair eyelid lacerations and special considerations at the 2013 American Association of Equine Practitioners' Convention, held Dec. 7-11 in Nashville, Tenn.

Although eyelid lacerations are common, veterinarians should consider them surgical emergencies, Hendrix stressed at the beginning of her presentation. Repair, she said, is necessary to maintain a horse's ocular health and often can be accomplished in a standing, sedated horse. So owners: If you find your horse with a lacerated eyelid, contact your veterinarian immediately, regardless of how small or innocuous the cut might seem.

Hendrix said that when veterinarians are first presented with a lacerated eyelid, they should first carry out a physical and ocular exam to determine the injury's extent.

"Try to do the initial ocular exam without sedation and nerve blocks to check ocular reflexes,” she said.

Once the initial exams are complete, Hendrix recommended sedating the horse and administering an auriculopalpebral nerve block (which temporarily prevents eyelid movement) to complete a thorough ophthalmic exam.

"It is imperative to make sure the cornea is intact and that the pupillary light response (in which a light shone into the horse's eye induces the pupil to contract) is there," she said. "If there is a corneal injury or the pupillary light responses are abnormal, then there is more to the injury than just an eyelid laceration, and therapy will be more intense."

Also during the eye exam, the veterinarian should evaluate the eyelid margins closely to ensure he or she has identified and fixed all lacerations; stain the cornea with fluorescein dye to check for ulcers or lacerations; and evaluate the eye's anterior chamber (located between the cornea and iris), lens (located behind the iris), and posterior chamber (located between the iris and the lens). The veterinarian should also treat any additional issues identified during the ocular exam.

Once the exam is complete, the veterinarian can prepare to repair the lacerated eyelid. Hendrix stressed that, when disinfecting the area around the eye, veterinarians should use a dilute Betadine solution and saline (both Betadine scrub and alcohol are toxic to the corneal epithelium and can cause ulcers, she cautioned). Then, he or she can numb the eye appropriately and begin surgery.

Hendrix reviewed several surgical repair procedures with the veterinary attendees, making notes of a few special considerations:

Although eyelid lacerations are common, they should be considered surgical emergencies. Repair is necessary to maintain a horse's ocular health.

Photos: Courtesy Dr. Diane Hendrix/AAEP Proceedings

  • Avoid simply excising any potentially viable tissue, she stressed, as serious complications can ensue. "Even if you think it's dead, try to replace it," she said. "It's better to try and fail than to not try at all."
  • Eyelid lacerations can bleed profusely, and hemorrhage can be a nuisance for veterinarians trying to repair defects.
  • Avoid using cautery (burning tissue) when repairing eyelid lacerations to prevent further damage to the lacerated tissue.
  • Use extreme caution when placing sutures, and avoid burying them. The delicate cornea can be damaged if it comes in contact with sutures, Hendrix said, which can lead to complications.

After the repair is complete, Hendrix recommended placing a protective hood with a hard cup over the affected eye, applying a topical broad-spectrum ophthalmic antibiotic ointment, administering flunixin meglumine or phenylbutazone, and, if the laceration is infected, administering systemic antibiotics. She also recommended giving the horse a tetanus booster if he has not been vaccinated in the preceding six months.

"If any other ocular trauma is found, it should be treated appropriately," she added.

"The vast majority of eyelid lacerations can be easily and successfully repaired," Hendrix concluded. "There are no retrospective studies discussing equine eyelid laceration repair in the peer-reviewed literature; however, years of experience have shown that the use of the described techniques produces excellent results."

About the Author

Erica Larson, News Editor

Erica Larson, news editor, holds a degree in journalism with an external specialty in equine science from Michigan State University in East Lansing. A Massachusetts native, she grew up in the saddle and has dabbled in a variety of disciplines including foxhunting, saddle seat, and mounted games. Currently, Erica competes in eventing with her OTTB, Dorado.

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