Clinical features and outcomes of horses presenting with presumed equine immune mediated keratitis to two veterinary hospitals in the United Kingdom and Finland: 94 cases (2009-2021).
Authors: Preston Juliette F, Mustikka Minna P, Priestnall Simon L, Dunkel Bettina, Fischer Maria-Christine
Journal: Equine veterinary journal
Summary
# Equine Immune-Mediated Keratitis: European Presentation Differs from North American Descriptions Equine immune-mediated keratitis (IMMK) has been well-characterised in North America as a typically mild condition with minimal blepharospasm, rare corneal ulceration and absent uveitis, yet clinical experience in Europe suggested a different presentation pattern. Preston and colleagues reviewed 94 cases from UK and Finnish referral hospitals (2009–2021) to establish the prevalence of blepharospasm, corneal ulceration and uveitis in European populations and determine whether these features influenced treatment outcomes. Anterior stromal disease was most common (53.2% of cases), but notably, blepharospasm occurred in 37.4% of horses, corneal ulceration in 28.6%, and uveitic signs in 25.3%—substantially higher frequencies than reported in North American literature. The presence of blepharospasm significantly increased the odds of enucleation (OR 5.5, p = 0.008), as did concurrent uveitis (OR 8.9, p < 0.001), whilst corneal ulceration alone did not affect this outcome; importantly, none of these clinical features altered the likelihood of continuing medical management long-term. For practitioners managing IMMK in the UK and Europe, these findings suggest that more severe presentations with inflammation-associated signs are genuinely more common than transatlantic literature implies, warranting awareness that blepharospasm and uveitis are genuine prognostic markers for globe loss rather than atypical features, and that treatment planning should anticipate a longer-term medication requirement regardless of initial clinical severity.
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Practical Takeaways
- •European presentations of IMMK differ markedly from North American literature—expect blepharospasm, ulceration, and uveitis to occur more frequently in UK/Finland populations
- •The presence of blepharospasm or uveitis are strong negative prognostic indicators; communicate these findings to owners when counseling on likelihood of enucleation
- •Corneal ulceration alone does not worsen prognosis, so its presence should not automatically drive discussions toward more aggressive surgical intervention
Key Findings
- •Anterior stromal IMMK was most common (53.2%), followed by unrecorded subtype (17.0%), mid-stromal (14.9%), epithelial (10.6%), and endothelial (4.25%)
- •Blepharospasm occurred in 37.4% of cases and was significantly associated with enucleation (OR 5.5, p=0.008)
- •Corneal ulceration was present in 28.6% of cases but was not significantly associated with increased enucleation risk
- •Uveitis signs were documented in 25.3% of cases and strongly associated with enucleation (OR 8.9, p<0.001)