Complications associated with subpalpebral lavage systems in upper and lower equine eyelids: A prospective, randomised study in 73 cases (2015-2024).
Authors: Graham Annabelle E, Carslake Harry B, Malalana Fernando
Journal: Equine veterinary journal
Summary
# Editorial Summary: Subpalpebral Lavage System Placement and Complication Rates When treating equine corneal disease requiring frequent topical medication, the choice between upper central or lower medial placement of subpalpebral lavage (SPL) systems remains largely arbitrary in practice, despite widespread use of these devices. Graham and colleagues conducted a nine-year prospective, randomised trial of 73 SPL systems in 68 hospitalised horses, using coin toss to assign 38 systems to the upper lid and 35 to the lower lid, tracking all complications over a median treatment duration of 13 days. Major complications—defined as footplate displacement, corneal ulceration, complete footplate loss, or eyelid infection—occurred significantly more often in upper placements (14% versus 3%), whilst overall complication rates remained high regardless of location (60% of all systems experienced problems), with minor issues such as suture loss (30% of cases) and palpebral swelling predominating. Interestingly, concurrent chloramphenicol treatment was associated with fewer complications, whilst cross-linked hyaluronic acid use correlated with increased complication risk, suggesting that topical medication compatibility warrants further investigation. For practitioners, these findings support preferential use of lower-lid SPL placement when anatomically feasible, particularly for horses at higher risk of major complications, though the high overall complication rate reinforces the importance of meticulous daily monitoring and prompt problem identification regardless of placement choice.
Read the full abstract on PubMed
Practical Takeaways
- •Consider lower eyelid placement for SPL systems when possible, as upper eyelid placement carries significantly higher risk of major complications including footplate displacement
- •Monitor upper eyelid SPL systems more closely given the 5-fold increased major complication rate, particularly for footplate migration
- •Be aware that topical treatments used concurrently with SPL systems may influence complication rates; chloramphenicol appeared protective while hyaluronic acid preparations may increase problems
Key Findings
- •Major complications occurred in 14% (10/73) of upper eyelid SPL systems versus 3% (2/73) of lower eyelid systems, with upper systems 5.1 times more likely to experience major complications
- •Displacement of the lavage footplate from the conjunctival fornix was the most common major complication at 10% (7/69) of all systems
- •Loss of suture or butterfly tape was the most common minor complication at 30% (21/69) of all systems
- •Treatment with chloramphenicol was protective against complications (OR=0.3), while cross-linked modified hyaluronic acid was associated with increased complications (OR=3.9)