Reviewed

SINUS EMPYEMA SECONDARY TO A PLANT FOREIGN BODY IN A HORSE: A case report

Kevin Sherman DVM; Murray Brown DVM, MS; Dan Hawkin.~ DVM, MS

A 13 year old quarterhorse gelding was presented to the University of Florida VMTH with a chief complaint of chronic purulent unilateral left nasal discharge. Four months earlier several thorny twigs had been removed endoscopically from the left nasal passage and he horse treated with antibiotic.s for 1 month, resulting in temporary resolution of the problem.

On clinical examination the horse had a bilateral mucopurulent malodorous nasal discharge. Decreased resonance was noted in percussion ofthe left maxillary sinus. Endoscopieally the left nasal passage had mueopurulent drainage from the middle meatus. The right nasal passage was inflamed and had a plant foreign body lodged extending from the soft palate to a point approximately 20 em. rostraUy. Only a portion of the plant material could be removed endoscopieally. Radiographs of the skull demonstrated fluid in the left eonehal sinus.

The left maxillary sinus was explored under general anesthesia using a technique described by Wheat 1. The sinus contained copious purulent exudate which was partially iuspissated, and several pieces of necrotic bone and mucous membrane. After lavage, a plant foreign body approximately 10x4 mm was removed from the medial wall of the maxillary sinus. The sinus was packed with gauze which exited through a portal at the rostral extent of the flap and the flap dosed in a routine manner. A second attempt was made to remove the

Author's Address: Department of Large Animal Clinical Science, College of Veterinary Medicine, University of Florida, Box 100136, Health Science Center, Gainasville, Florida 32610-0136 Acknowledgement: The au~ors wish to thank Dr. Frank Murphy for referral of this case. Published as Journal series number R-01784 of the University of Flodda. Repdnt requests should be addressed to Dr. Sherman

plant material from the right nasal passage but was unsuccessful due to hemorrhage and poor visualization. The quantity of plant material was insufficient to definitive identification. Two days post operatively the packing was removed under sedation. The nasal discharge persisted at a diminished rate. Unfortunately, further treatment of the problem could not be done because the horse died from an idiopathic cecal impaction and rupture three days after surgery.

Necropy confirmed that all plant material had been removed from the left maxillary sinus. The plant material viewed endoscopically in the right nasal passage was also confirmed.

The incidence of sinus empyema is unknown, but may be fairly common based on a single survey in which 4% (75 of 1776) of reported respiratory tract disease was diagnosed as paranasalsinus empyema2. The most common reported cause of sinus empyema is dental disease 2,3. Less common causes include viral 3, bacteriaD or fungal4 upper respiratory tract infection, skull fi'acture~5, sinus neoplasia2, sinus cystlike lesions6, parasitic granulomas7 and oronasal fistuiasS.

Plant material in the sinus has been reported secondary to patent infundibuium or other dental disorders which allow ingesta to pass through or by the teeth into the maxillary sinus3. There have been no prior reports of plant foreign bodies entering the maxillary sinus via the nasal cavity.

Plant foreign bodies should be considered in cases of septic sinusitis ff plant material is visualized within the nasal passage or if clinical examination and radiographs do not support a diagnosis of other reported causes of sinus empyema.

1. Wheat JD. Sinus Drainage and Tooth Repulsionn in the Horse. Proc Am Assoc Eq Prac 1973;171-176.

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2. Mason BJ. Empyema of the Equine Paranasal Sinuses. JAm Vet MedAssoc 1975;167:727-731.

3. Mansmann R, MeAl,star ES. Eds., Equine Medicine and Surgery third ed., vol 2. Santa Barbara, Califomia: Amedcan Vatednary Publication, 1982;742-743.

4. Schumacher J, Honnas C. Paranasal Sinusitis Complicated by Inspiesated Exudate in the Ventral Conchal Sinus. Vet Surg 1967; 16:373-377.

5. Levine SB. Depression Fractures of the Nasal and

Frontal Bones of the Horse. d Eq Med Surg, 1979;3:186-190. 6. Cannon JH, Grant BD, Sande RD et al. Diagnosis and

Surgical Treatment of Cystlike Lesions of the Equine Paranasal Sinuses. JAm Vet Med Assoc 1976; 169:610-613.

7. Johnson KH, Johnson DW. GranuiomasAssociated with Micronema deletrix in the Maxillae of a Horse JAm Vet MedAssoc 1966;149:155-159.

8. Nihouanneu, J. Oro Sinus Communication in a Filly, Surgical Treatment. Le Pratique Vetet~naire Equine 1976;8:63-67.

Reviewed

CONJUNCTNAL FOREIGN BODY (BURDOCK PAPPUS) INDUCED KERATITIS IN HORSES: 10 CASES

J. Phillip Pickett, DVM1; Mark V. Crisman, DVM, MS2; and Martin O. Furr, DVM 2

S U M M A R Y

Ten cases of ulcerative or non-ulcerative keratitis due to frictional irritation from an eyelid or third eyelid foreign body were documented during a 2-year-period at the Veterinary Teaching Hospital. Cases were referred for corneal ulceration or ocular irritation of four days to three months duration. Following identification of the foreign body, treatment included removal with forceps or scarifying the conjunetival surfaces and supportive care. This report reviews epidemiologie, diagnostic., and therapeutic techniques that will benefit practitioners in the treatment of these cases.

I N T R O D U C T I O N

Ulcerative keratitis due to direct irritation of the corneal surface by foreign material is one of the more common causes of blepharospasm and corneal ulcers in horses. 2,4"e A distinct pattern in non-healing corneal ulcers both in clinical presentation and seasonality, was noted at the Vir~nla- Maryland Regional College of Veterinary Medicine, Veterinary Teaching Hospital. Medical records of equine

Authors' eddms: 1 Department of Small Animal Clinical Sciences, 2Depart- ment of Large Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Polytechnio Institute and State University, 61acksburg, VA 24061. Acknowledgment: The authors thank Tom Wieboldt, Laboratory Specialist, Department of Biology, Virginia Polytechnic Institute and State University for assistance in plant identification and botanical expertise.

referral eases and ambulatory records of local practice equine cases concerning corneal ulcerations refractory to medical therapy, non-ulcerative keratitis, blepharospasm, epiphora, or any other sign of superficial ocular irritation were reviewed f~om July, 1989 through July, 1991. Ten cases of ulcerative or non-ulcerative keratitis due to frictional irritation from an eyelid or third eyelid foreign body were documented during this 2-year-period.

Case histories The distribution of cases by breed, age, and sex was fairly

representative of the equine population from the referral and local practice areas and was felt to be of minimal clinical relevance concerning the history in these cases. All cases occurred in late fall through winter. The seasonal occurrence ranged from late September to early February (see table). All horses were either pastured or were exposed to pasture prior to the onset of ocular disease. Three cases (3, 7, and 8) were referred to the teaching hospital for corneal ulceration or ocular irritation of 4 days to 3 months duration. Seven cases were local practice cases that had ocular irritation or non- healing ulceration of 4 days to one month duration. All animals had been examined at least once by a veterinarian (some as many as 4 times) before the foreign body was found.

C l i n i c a l f i n d i n g s After general physical examination, chemical and/or

manual restraint, topical anesthesia, and palpebral nerve block were utilized for the ophthalmologic examination. All animals were initially examined with focal fight source and magnifying head loupe or direct ophthalmoscope. Only in

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