Nursing care of the hospitalised eye case

Nursing care of horses with ocular disease is an integral part of their veterinary treatment. This should include a holistic approach to their care, from pain assessment to nutrition, using subpalpebral lavage catheters and helping manage potential behavioural issues.

Ocular disease, particularly corneal diseases, can result in significant discomfort. While the pain level of the horse with his eye clamped shut who will not allow you anywhere near him is easy to assess, more subtle signs might be missed. These can be important, especially when assessing the response to treatment. As far as possible, the level of ocular pain should be assessed from outside the stall. In animals wearing protective eye masks, these should be removed and the horse left undisturbed in the stall for a short period of time to better assess comfort. The angle of the upper eyelashes is an excellent indicator of ocular pain (assuming that motor function to the lid is normal). Horses with ocular pain will tend to have the eyelashes angled down (Figure 1) (Gilger and Stoppini, 2005). Rather than relying on a descriptive assessment of ocular pain, which can vary between observers (for example, ‘very painful’ versus ‘mild discomfort’), a semiquantitative scale can be developed which includes how open the eye is (for example, 80%, compared to normal) and the angle of the eyelashes (for example, close to 90° would be normal, so 45° would suggest ocular pain). A specific ocular pain score has been investigated in horses, which includes blepharospasm, and this may be useful if further studies validate the initial findings (Ortolani et al, 2021).