References
Immune-mediated disorders of the eye: part two – equine recurrent uveitis
Abstract
Despite the immune-privileged status of the eye, immune-mediated ophthalmic disorders are reasonably common in many species. This article is the second of two articles discussing those most relevant to the horse and focuses on equine recurrent uveitis (the first article covered disorders of the cornea). Equine recurrent uveitis presents in three different forms that vary greatly in their clinical presentation. Importantly, many cases show no overt signs of ocular pain and diagnosis is often delayed until advanced damage has occurred. Several treatment options are available and must be tailored toward each case, with owners made aware of realistic expectations from the outset.
The eye has long been recognised as an immune-privileged organ, whereby immune responses to foreign antigens are suppressed or inhibited. This allows the preservation of normal function within such a highly specialised organ. Immune privilege is maintained by both structural barriers and a complex array of active homeostatic mechanisms. Despite this, immune-mediated diseases of the eye are relatively common and frequently encountered in practice. This is the second of two articles on immune-mediated diseases of the equine eye and will focus on equine recurrent uveitis (ERU). Again, the emphasis will be on the principles and practicalities of treatment and long-term management, with emphasis on a collaborative approach between owner and veterinary surgeon.
There are no treatments licensed for the treatment of uveitis in the horse and clinicians are advised to refer to the cascade when selecting appropriate medications. Proprietary ophthalmic formulations of all of the topical medications discussed are (intermittently) available in the UK, licensed for either human or animal use. These should always be used in place of non-ophthalmic preparations, which can cause severe damage to the eye. Some compounded preparations are now also available. Sustainedrelease ciclosporin A (CsA) implants require a special treatment certificate for importation into the UK. Many preparations are also prohibited in competition horses.
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