February: A Real Eye Sore

February Case of the Month: A Real Eye Sore

Eddie’s owner noticed a wound on his forehead one morning at breakfast.  Dr. McDonald was called out and found a fresh laceration associated with a fracture of the frontal bone penetrating into the frontal sinus.  She lavaged the wound and open sinus, sutured the wound and started antibiotics.  The cut appeared to heal fairly quickly and the horse never developed nasal discharge indicating infection of the sinus which was a concern.  Dr. McDonald returned a couple of weeks later to examine Eddie again for a swollen eye.  An ophthalmic exam was normal except for swelling of the eyelid.  An ultrasound of the orbit showed a bony irregularity but no obvious fragments.  Dr. Fennell did the next recheck of the swelling and found swelling was reduced significantly and the horse was doing well.  Ten days later however, swelling suddenly reappeared and an abscess burst from the corner of the eye.  Dr. Fennell found a large draining tract.  X-rays showed a complete orbital fracture with several associated fragments and possible osteitis.  Eddie was placed on another antibiotic with good bone penetration and surgical debridement of potentially infected bone as well as fragment removal was discussed.   The swelling, pain and discharge around the eye resolved quickly on the new antibiotic however. On a follow-up visit two weeks later, Dr Fennell found a completely normal eye. Follow-up radiographs still showed a large orbital fracture but with cleaner margins.  The surgical referral wasn’t likely going to be necessary given how well Eddie was doing.  Eddie is back into his regular work routine with no apparent bother about his orbit being incomplete, oblivious of his close call with the surgical table.