Inferomedial placement of a single-entry subpalpebral lavage tube for treatment of equine eye disease

Abstract

The objective of this study was to describe method of placement, and frequency and severity of complications associated with a subpalpebral lavage system placed in the medial aspect of the equine inferior eyelid. The inferomedial subpalpebral lavage (ISPL) tube is positioned deep in the medial aspect of the inferior conjunctival fornix so that the footplate lies flat between the lower eyelid and the anterior surface of the nictitans. Retrospective data from the placement of 92 ISPL systems placed in 86 horses during a 31-month period were examined. Tube placement was performed using sedation and regional anesthesia only in 59% of horses. The median duration of tube placement was 19 days (range: 1-61 days). Seventy-one horses were treated for up to 55 days following discharge from hospital with an ISPL tube in place. No complications were reported with 59% of ISPL systems. Non-ocular complications were found in 38% of ISPL systems and included tube displacement from the conjunctival fornix (18%), suture loss requiring resuturing of the system to the horse's head (14%), and damage necessitating replacement of the injection port (6%). Ocular complications were recorded in 3% of horses and were limited to inferior eyelid swelling. Vision was retained in 88% of horses. The ISPL system is easily and safely placed, and well tolerated for extended periods. It appears to be associated with infrequent and minor complications when compared with placement of subpalpebral lavage tubes in the superior eyelid.

Bacteroides sp. as a cause of anaerobic keratitis in a pony

“…An inferomedial SPL catheter was placed in this pony to avoid placement through the swollen superior lid. Placement of SPL catheters in this site have been reported to result in few complications, and retention of vision in 88% of cases (Guiliano et al 2000). Treatment failure due to inadequate distribution of medications across the cornea from the ventrally located catheter was considered a possible reason for the rapid progression of the ulcer, and thus the catheter was replaced in the superior eyelid.…”

Should I place a subpalpebral lavage system in the upper or lower eyelid?

“…Two papers (Sweeney and Russell 1997;Giuliano et al 2000) and two research abstracts (Hays et al 2013;Cornelissen et al 2015) were evaluated (Tables 2-5). Giuliano et al (2000) included only lower lid SPLs, and had a lower rate and severity of complications than Sweeney and Russell (1997), which included only upper lid SPLs. The studies used different populations of horses, hospitals, categorisation of complications and types of catheter, so it is difficult to draw firm conclusions relating to the PICO question.…”

Inferomedial Subpalpebral Lavage Tube Placement

“…Nonocular complications include leakage or loss of the injection port, need for resuturing of tape tabs, and tearing or breakage of the lavage tube system. 3,5 The most frequently reported complications of inferomedial lavage systems are displacement of the footplate from the conjunctival fornix (18%) and need for resuturing of tape tabs (14%). 3 …”

“…3,5 The most frequently reported complications of inferomedial lavage systems are displacement of the footplate from the conjunctival fornix (18%) and need for resuturing of tape tabs (14%). 3 …”

“…Tape tabs and sutures should be inspected for loosening and should be resutured if necessary. 3,5 Medication: Only 0.1 mL of medication is necessary for injection through the lavage tube. The dose of medication is advanced through the lavage tube by slowly injecting approximately 1 mL of air through the tube using a tuberculin syringe.…”