Practical Ophthalmology for “Equine Road Warriors”

Take Home Message  

Equine practitioners can develop solid expertise in field ophthalmology with practice and effort.  Some problems will always have to be referred to specialists, but the average practitioner can  examine, diagnose, and treat 85% of the eye problems that are seen in the field. This presentation  provides many tips for success in diagnosing and treating ophthalmic problems of horses in the  ambulatory setting.  

Medications, Diagnostic Tools, and Supplies  

Items to carry in the ambulatory vehicle for diagnosis and treatment of eye problems:

• Direct ophthalmoscope (www.hillrom.com)  
• Penlight, Finoff transilluminator (www.hillrom.com) and/or Mini Mag Lite (K Mart) 
• 14 D Magnifying lens (www.hillrom.com)  
• Digital Camera (4.0 megapixel camera or higher resolution, good autofocus system, large  LED viewing screen advised)  
• (Optional) Hand held slit lamp (KOWA-SL-15, www.danscottandassociates.com, about  $4500.  
• (Optional) Tonopen applanation tonometer (www.danscottandassociates.com) or Tonovet  rebound tonometer, (http://www.icaretonometer.com/index.php?page=tonovet-for animals, available through Jorgenson, Inc, http://www.jorvet.com/ $3000-$4000.  
• Fluorescein and Rose Bengal dye strips (carry in ophthalmoscope case)  
• Schirmer tear test strips (carry in ophthalmoscope case)  
• Tropicamide (Mydriacil)—topical agent to dilate pupils  
• Proparicaine (topical anesthetic); Carbocaine (injectible local anesthetic)  
• 30 ml bottles of 1part Betadine to 50 parts Saline. Larger pour bottle of same. 
• Sterile wooden handled Cotton Swabs bundled 6 swabs to a pack  
• Sterile individual Dacron polyester swabs (Puritan Medical Products, 1-800-321-2313) 
• Sterile 4 x 4 gauze, Non sterile 4 x 4 gauze, Sterile gloves, exam gloves  
• Scalpel blades, packed in sterile sleeves (any size other than #22 as blunt end is used) 
• 2 mm biopsy punches (for occasional “scooping” of foreign bodies)  
• Slide boxes with 4 microscope slides to a box (for cytology specimens)  
• Formalin in small jars (for preserving biopsy specimens)  
• “Write on” Plastic bags—4x6” (to dispense meds and clarify tx schedules)  
• Thioglycollate culture broth or agar plates, Porta-cult transport media  
• Serum separator tubes (to prepare autologous serum)
• Fine suture material: 1-0 through at least 4-0, some use up to 6-0 PDS polygalactin or  vicryl  
• Sedatives (Xylazine, Butorphanol tartrate, Detomidine) 
• Subpalpebral lavage systems (www.mila.com—the longer 60 inch “Florida” tubes are  good for large patients; 36 inch tubes will suffice for smaller horses and foals)  
• Adhesive tape (to make butterfly holding wings for lavage systems)  
• 20 G catheters and IV Catheter caps (to use with SPL lavage system)  
• Tongue Depressors (to use with SPL lavage systems)  
• Braidette rubber bands (to braid mane for SPL systems)  
• TB and 3 cc syringes as well as larger sizes  
• Prescription Pad  
• Halogen light on tripod or hook (Home Depot). Headlamp—Pella or other brand LCD  with at least 4 diodes (buy at outdoor stores)  

Medications readily available through veterinary distributors for ophthalmic problems

• Antibiotic Ointments: Triple Antibiotic, Chloramphenicol, Gentamycin-Most others need  to be prescribed through pharmacies.  
• Antibiotic solutions: Triple antibiotic, ciprofloxacin, moxifloxacin  
• Corticosteroid Ointments: Triple antibiotic with 1% Hydrocortisone, Triple antibiotic  with 0.1% Dexamethasone  
• Corticosteroid solutions: Prednisolone acetate  
• 1% Atropine ointment  
• Injectable antibiotics to make fortified solutions for SPL or subconjunctival use:  Cefazolin (1 gram vials of powder), Gentamycin (100mg/ml injectable), Amikacin (50 or  250 mg/ml injectable)  
• Artificial Tears  
• Timolol maleate (0.5% drops)  
• NSAIDS: Injectable and oral flunixin meglumine and phenylbutazone  
• Systemic corticosteroids: injectable and oral dexamethasone  
• Fluconazole tablets (200mg)  

Drugs that will take more effort to obtain 

• Be ready to prescribe many drugs at local pharmacies such as Muro 128 solution or  ointment (5% NaCl), CoSopt solution (Timolol maleate combined with Dorzolamide),  Voltaren solution (0.1% diclofenac), Ocufen solution (flurbiprofen), Tobrex ointment  (0.3% tobramycin), Vigamox (moxifloxacin), oxacillen, silver sulfadiazine crème and  Ciloxan (ciprofloxacin ointment). Some practitioners use over the counter anti-fungal  products in the eye such as Monistat (1-2% miconazole), or Gyno lotrimin (1-2%  clotrimozole) but caution is advised here.  
• Other products must be ordered through compounding pharmacies in order to obtain the  desired concentration or vehicle of a drug for ophthalmic use when it is not available  commercially. Common items include: 2% cyclosporine solution or ointment  (commercial product is 0.2% cyclosporine, but this is ineffective for most problems), 1%  5-fluorocytourasil (5 FU ophthalmic ointment), 1% miconazole solution, 1%  itraconazole/30% DMSO ointment, oral itraconazole, sterile sesame oil (for mixing with cisplatin). CAUTION: Practitioners should be aware of the FDA guidelines on the use  of compounded pharmaceuticals, and prescribe from reputable compounding pharmacies  licensed in their state of practice.  
• Some hard to find medications (Natamycin, Voriconazole, sequestersol EDTA prep) may  be available through the pharmacy at the nearest veterinary school. Chemotherapeutic  agents, antifungal products and other specialty items may be ordered from specialty  human pharmaceutical distribution companies. A useful source is Florida  Infusion/Nations Drugs (www.floridainfusion.com, 1-800-624-0152). Another useful  source for veterinary distribution of human products is Amatheon, Inc. (http://www.amatheon.com/) 

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