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Inferomedial Placement of a Single-Entry

Subpalpebral Lavage Tube for


Treatment of Equine Eye Disease

Elizabeth A. Giuliano, DVM, MS,


Diplomate, ACVO

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Treatment of Equine
Ocular Disease
Frequent topical medical
therapy is required

Danger to owner and horse

Poor compliance

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Equine Ocular Lavage Systems
First described: 1967

2 categories:
Indwelling nasolacrimal lavage system
Subpalpebral ocular lavage (SPL)
system

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Equine Ocular Lavage Systems
Advantages
Safety, comfort, less medication
wastage

Disadvantages
Indwelling nasolacrimal system
Subpalpebral lavage (SPL) system

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Placement of ISPL tubes
It’s Easy!
Minimal equipment necessary
Will substantially improve ability to
treat equine ocular disease
May save owner expense and time of
a referral

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Required Equipment

Not shown:
•IV sedation
•Lidocaine
•Tape

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Step 1: Systemic Sedation
Step 2: Lid Block
Step 3: Numb the
inferonasal conjunctival cul
de sac using topical
anesthesia (proparacaine)

Step 4: Regional anesthesia


of the skin and sub-
cutaneous tissues using
Lidocaine (using a 25 gauge
needle and 1-2 ml)

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Step 5: Pass trochar through
the lower, medial eyelid.
(Thimbal, Needle holders)

Step 6: Thread the tube - distal


end of lavage tube through the
trochar first.

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Step 6 continued: once ½
threaded, remove
the trochar from lower
eyelid by pulling ventrally.

Pull the tube through


the lower eyelid until the
footplate is seated.

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Step 7: Ensure proper
placement of footplate between
lower & 3rd eyelid.

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Step 8

Affix onto skin:


Tape & 2-0 Nylon

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Step 8: Seal distal end of tube.
Hint: Check patency PRIOR to
suturing entire tube in place.

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Results
92 ISPL systems were placed in 86 horses
over a 31 month study period

Medications administered:
19 different suspensions and solutions (mydriatic,
antimicrobial, and anti-inflammatory drugs)
Up to 5 different medications administered once per hour
Natamycin – 6 times per day in 15 horses without tube
obstruction

Duration ISPL system remained in place:


Median total: 19 days (1 – 61 days)
83% (71 horses) discharged with tube in place; median
time of removal post discharge: 15 days (1 – 55 days)

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Results
Tube complications:
59% (53 tubes) – no complications reported
Non-ocular complications – 38%
18% (16 tubes) – displacement from the conjunctival
fornix
14% (13 tubes) – resuturing of the tabs to the horse’s
head
6% (5 tubes) – leakage from or loss of the injection
port

Ocular complications – 3%
3% (3 tubes) – minor inferior eyelid swelling

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Benefits of the ISPL tube
Less mobility of the lower eyelid

Cornea protected by the 3rd eyelid

Proper tube placement easier to achieve in the


ventral conjunctival fornix

Normal gravitational forces work “with” the ISPL


tube.

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Conclusions
The ISPL system is economical & easily
and safely placed.

This system is well tolerated for treatment


periods greater than a month.

The ISPL system may be used to


successfully treat a wide variety of medical
and surgical conditions.

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Reference
Giuliano EA, Maggs DJ, Moore CP,
Boland LA, Champagne ES, Galle LE.
Inferomedial placement of a single-
entry subpalpebral lavage tube for
treatment of equine eye diseases. Vet
Ophthal 3: 153-156, 2000.

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Thank you for your attention

Any
Questions?

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