EQUINE OPHTHALMOLOGY
(2)The foal and congenital abnormalities
An ophthalmic survey of the neonatal horse
CLAIRE A. LATIMER, M . WYMAN and J. HAMILTON
Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Ohio State University, Co/umbus, Ohio
43270, USA
Introduction
THIS study was undertaken to define variations of the normal
eye and adnexa in foals of three breeds: Thoroughbred,
Standardbred and Saddlebred. In the ocular examination of
horses of all ages, the ability to distinguish a lesion from a
normal eye rests on one's knowledge of normal variants. The
objective here was to describe these variants and to document
their incidence in the three breeds studied.
Materials and methods
One hundred and forty-four foals of three breeds were
examined: 41 Saddlebreds, 50 Standardbreds and 53
Thoroughbreds. The average age of these foals was 9.4 weeks
with a range of five days to 19.5 weeks. There were 61 fillies
and 81 colts among those foals in which sex was recorded.
All animals were first evaluated for menace and pupillary
light responses. A rapid hand gesture toward the tested eye was
used to elicit a menace response. Care was taken not to touch
the vibrissae or to create air currents. The pupillary light reflex
was elicited by directing a bright focal beam from a direct
ophthalmoscope (Welch Allyn, Skaneateles Falls, New York)
toward the temporal fundus. Level of excitement following
manual restraint was recorded to determine correlations with
pupillary light response. A mydriatic (1 per cent tropicamide)
(Mydriacyl; Alcon Laboratories, Fort Worth, Texas) was then
instilled into each eye twice at 5 min intervals. The degree of
pupil dilation at 5, 10 and 15 mins after the first instillation of
tropicamide was recorded in 52 foals. Examinations occurred
15 to 60 mins after the mydriatic was instilled.
The anterior segment (lids, nictitans, conjunctiva, cornea,
aqueous and lens) was examined using a hand held
biomicroscope (Kowa SL-2; Keeler, Broomall, Philadelphia).
Horizontal and vertical corneal diameters were measured in 43
foals using a Jameson caliper (Stortz Instrument Co, St.
Louis, Missouri). Both indirect (American Optical, Buffalo,
New York) and direct (Welch Allyn) ophthalmoscopy were
used to evaluate the posterior segment (vitreous and fundus).
Variations of normal were documented by photography using
a Kowa RC-2 (Keeler) fundus camera.
Results
Menace response
All foals responded to a menacing gesture by withdrawal of
the head, blinking, or both. Five foals had a very subtle or
"depressed" menace response. Four were Standardbred, one
was Thoroughbred and their ages ranged from 12 days to nine
weeks. These five were also "quiet" foals, minimally disturbed
by the restraint required for examination.
Direct and consensual pupillary light reflexes were present in
all foals and the pupils were oval in shape before dilation. The
pupil was wider nasally by 0.3 to 1 mm and its width, following
stimulation of the temporal fundus with a focal beam, varied
from 2 to 7 mm nasally and 2 to 6 mm temporally. The average
width of the pupil following light stimulation was 4.15 mm
nasally and 3.8 mm temporally. The two youngest foals (five
days and 12 days of age) had pupillary apertures of 7 mm
nasally/6mm temporally and 3.5 mm nasally/3.5 mm
temporally, respectively.
The degree of pupillary light reflex response (ie, the width of
the pupil following focal light stimulation) did not correlate
with the level of excitement at the time of examination. The
average pupil width for the most excited foals was 4.15 mm
nasaU3.8 mm temporal compared to an average pupil width
for the calmest foals of 4.04 m m nasaV3.8 mm temporal.
The onset of pupillary dilation was recorded in 52 foals. Five
minutes following instillation of the mydriatic, no dilation had
occurred. At 10 mins, the majority of foals were mid-dilated
and not responsive to Light. At 15 mins the majority were mid
to fully dilated and not responsive to light. Accurate dilation
records were not kept past the 15 min time interval.
Following dilation, the pupil shape varied from round to
oval. There did not appear to be a correlation between age and
the pupil shape following dilation. The two youngest foals had
oval pupils at the time of examination, and the age range of
foals having round pupils at the time of examination was 3.5 to
17.5 weeks. It was our impression that those foals with a
longer time lapse before examination had rounder pupils,
although dilation records beyond 15 mins were not kept.
Eyelids
Vibrissae were present below the eyes in all foals and above
the eyes in most foals. Cilia were usually long on the superior
lids and sparse on the inferior lids. Some foals lacked
demonstrable inferior cilia.
Ocular discharge was noted on the lid margins in 11 foals.
The discharge noted was mucoid in seven foals, all
Standardbred. Two foals with unilateral purulent discharge
had conjunctivitis ipsilaterally .
Seven foals had alopecia, excoriation and depigmentation of
their lids primarily at the canthi. This occurred unilaterally or
bilaterally and was considered,to represent fly-bite blepharitis.
No foals had entropion, but one Thoroughbred had a
healing corneal ulcer associated with a previously diagnosed
and treated unilateral entropion.
Nictitans
The margin of the nictitans was pigmented in 138 foals.
Non-pigmented margins occurred in six foals with only one
being bilateral. Three of the foals were chestnut Saddlebreds
and three were bay Thoroughbreds which also lacked
conjunctival and limbal pigment.

6/16/82 9/20/82
FOAL 1 ( 3 (I>a
FOAL 4
Fig I . Distribution of superficial corneal opacities in five
Thoroughbred foals
Cornea
The cornea in all normal foals was clear, oval and broader
nasally (similar to pupil shape). Biomicroscopy confirmed that
the cornea was thinnest axially and thickest peripherally. The
scleral shelf or overhang, which was more prominent dorsally
and ventrally, prevented visualisation of the iridocorneal angle
structures in these areas. These structures were often visible at
the nasal and temporal limbus as a "grey line" representing
the insertions of the pectinate ligaments into the cornea at the
termination of Descemets membrane. These lines were
apparent around the entire limbal circumference in 17 foals
and were least obvious when conjunctival pigment was absent.
The conjunctiva was usually irregularly pigmented with the
greatest density of pigment at the limbus.
The average corneal dimension was 26.1 mm in the
horizontal plane and 19.8 mm in the vertical plane. The
averages for the three breeds were similar. Sixteen
Saddlebreds, 15 Standardbreds and 12 Thoroughbreds had
respective average corneal dimensions of 26.6 x 20.4 mm,
26.1 x 19.6 mm and 25.7 x 19.5 mm.
Five of nine Thoroughbred foals examined on one farm had
irregular punctate corneal opacities located primarily in the
epithelial layer of the cornea. The opacities were unilateral in
three foals and bilateral in two foals. The pattern of distribu-
tion on the cornea was a varied axial eliptical shape in six eyes
and diffuse in one eye (Fig 1). One animal exhibited photo-
phobia. None of the foals had conjunctivitis or any history of
ocular or systemic disease.
The five affected foals were re-examined after three months.
Two foals were still affected. The shape of the opacified area
had changed in one and, in the other, the area of affected
cornea had diminished. One of these foals had a bilateral mild
seromucoid discharge accumulated at the medial canthi. A
third foal from the initial affected group had a small linear
epithelial opacity thought to be a scar.
The two foals affected at the second examination were re-
examined after a two month interval. Their corneas were clear
and of normal curvature and thickness. All nine of the
weanlings on this farm had a slight mucopurulent discharge in
both eyes at the time of this examination. There was no
conjunctival vascular injection or sign of upper respiratory or
other systemic disease.
EQUINE VETERINARY JOURNAL SUPPLEMENT 2
Other corneal lesions were limited to three foals with super-
ficial corneal nebulae and one foal with a healing corneal ulcer
associated with previous entropion.
Aqueous
The aqueous was clear in all foals examined.
Iris
The majority of foals had a brown iris with tan mottling or
splotching in the periphery. This did not vary with coat colour.
A few individuals had irides of a homogenous brown colour,
and in some, the mottling appeared to be grey rather than tan.
Persistent pupillary membrane tags arising from the iris
collarette were noted unilaterally or bilaterally in 47 foals.
These iris strands extended freely into the aqueous or spanned
a short circumference of the iris colarette. In none did they
contact the corneal endothelium or lens capsule. The entire iris
colarette was prominent in two individuals. Persistent
pupillary membrane tags were noted in foals ranging from five
days to 17 weeks in age.
Corpora nigra (granulosa iridica) were present in all
individuals, but their prominence along the dorsal and ventral
pupillary margins was variable. They were prominent dorsally
in all individuals but in only 23 individuals were they
prominent ventrally. Eleven foals had no ventral corpora nigra
and 13 had a homogenous exaggeration of the pupillary ruff.
The remainder had moderate to slightly prominent ventral
corpora nigra.
Lens
Marked variations in lens suture patterns were noted among
the foals. In only seven foals were the sutures inapparent by
biomicroscopic examination. The anterior suture almost
invariably had a Y configuration while the posterior suture
shape varied from Y to sawhorse to stellate with feathering.
The suture patterns of the two eyes in the same animal were
not always symmetrical. The only breed specific trend noted
was an inability to visualise the anterior suture in the majority
of Thoroughbred foals. In contrast, the anterior surface was
visualised in the majority of Standardbred and Saddlebred
foals. The peripheral tips of the sutures had a sparkling
appearance in 17 foals. These prominent suture tips occurred
in eight Standardbreds, eight Thoroughbreds and one
Saddlebred. The anterior sutures were involved in only three
foals, all Standardbred.
A focal opacity less than 2 mm in diameter was noted in the
posterior cortex of one Thoroughbred foal. This was the only
observed cataract in the foals examined. Two foals had an
observable zone of demarcation between cortex and nucleus
but this was not considered to represent a true opacification of
the lens.
Vitreous
Persistent hyaloid structures were present in 20 foals. The
anterior extent of the hyaloid system (Mittendorf's dot) was
visualised unilaterally in four foals: two Saddlebreds, one
Standardbred and one Thoroughbred in this group. The ages
of these four foals ranged from 3.5 to 16 weeks with an
average age of 9.9 weeks.
More extensive remnants than the anterior hyaloid
(Mittendorf's dot) were demonstrable in 16 foals. Twelve of
these foals were Thoroughbred and four were Standardbred.
Their ages ranged from five days to 16 weeks with an average
age of six weeks. Thirteen of these foals had bilateral remnants
EQUINE OPHTHALMOLOGY

and three were unilateral. Only two foals had remnants span-
ning the entire distance from optic nerve to the anterior
hyaloid remnant and these foals were five days and 3.5 weeks
old respectively.
The anterior hyaloid membrane or "face" was prominent
and easily visualised in 22 foals: seven Thoroughbreds and 15
Standardbreds. Their average age was 8.7 weeks with a range
of 3.5 to 19.5 weeks.
Optic nerve
The optic discs were located in the non-tapetal fundus and
were generally oval in shape (Fig 2). Variations included round
(five foals), nasally blunted (four foals) and football shaped
(one foal) discs. All optic discs were a pink to salmon pink
colour and their surface appeared fasciculated. A white rim
was commonly present along the mid ventral aspect of the disc
and one foal had white margins both dorsally and ventraliy.
Another foal's disc was characterised by concentric rings of
varying pink density and a similar but less pronounced pattern
was observed in several other foals (Figs 3, 9, 10 and 14). The
margins of the disc appeared to be pigmented in four foals,
two dorsal and two ventral. The pigment appeared to be distri-
buted in multiple triangular shapes when lining the ventral disc
margin. The physiological cup was inapparent or shallow in
most foals but accentuated in one foal (Fig 4). Retinal vessels
extended 1 to 2 mm on to the surface of the optic disc.
Retinal vasculature
Retinal vessels radiated from the optic disc in all directions
with fewest vessels present in the mid ventral aspect. The
vessels extended 1 to 2.5 disc diameters (paurangiotic pattern)
and their course was essentially linear with slight tortuosity.
All vessels were small in calibre and arterioles were not
distinguishable from venules.
Tapetal fundus
The tapetum was predominantly green in all three breeds.
Variations in tapetal colour included primarily yellow, nasal
yellow/temporal green, green with a yellow periphery, yellow-
green, and yellow with green islands (Figs 5, 7 and 12). In
Saddlebreds, the colour of the tapetal fundus often varied
from one area to another with a relatively well defined
junction between areas. Stars of Winslow, visible as reddish
brown specks or short streaks, were present throughout the
tapetal fundus. These end-on capillaries were especially
prominent in individuals with a yellow tapetum (Fig 5).
Pigment mottling occurred most consistently in the nasal
quadrant of the tapetal fundus but also occurred dorsally and
peripherally (Figs 6 and 11).
Choroidal vessels extending dorsally from the disc were
commonly observed in all three breeds as a pink or red streak
(Figs 7, 8 and 9). Visualisation of choroidal vasculature
resulted from a relative lack of tapetum and pigment within
the choroid and retinal pigment epithelium in these areas.
Discrete choroidal vessels were infrequently seen within the
hypopigmented region adjacent to the optic disc (Fig 10).
Choroidal patterns extended as far as five disc diameters into
the tapetal fundus and varied in width from narrow bands to
the full breadth of the optic disc. Choroidal vessels or
"streaks" were observed to slant nasally or temporally and
were not always contiguous with the optic disc. Choroidal

Fig 6. Transition from tapetal to non-
tapetal fundus is abrupt in this
Thoroughbred foal. Pigment mottling b
seen in the d o r s a l p e r i p h e r y
Fig 13. Oval pigmented structure
overlying the tapetal fundus present in a
Thoroughbred filly. This structure was
presumed to be a cyst probably of
neuroepithelial origin
Fig 15. Focal white spot temporal to the
optic disc in a Thoroughbred foal. It may
represent absence of pigment, an atypical
coloboma cellular infiltration or a focal
degeneration (scar)

Fig 17 (left). Grey streaks following the retinal vascular

course temporally and nasally from the disc margin in a
Saddlebred foal. A tortuous retinal vessel is seen at 4
o'clock

Fig 18 (right). Grey streaks similar to Fig 17. Note the

absence of retinal vessels and grey sheen in the mid
ventral quadrant
EQUINE VETERINARY J O U R N A L S U P P L E M E N T 2
EQUINE OPHTHALMOLOGY
Captionsfor Figs on opposite page
Fig 2. Fundus of a Standardbred foal demonstrates an oval optic disc
located in the non-tapetal region. The tapetum extends irregularly
toward the dorsal margin of the disc. The pink spots at the 7 o'clock
position probably represent myelin extension into the nerve fibre layer
Fig 3. Optic disc of a Standardbred foal with concentric rings of
varying pink colour. This was a common variant
Fig 4. Physiologic cup accentuated in this Standardbred foal. Note the
relative paucity of retinal vessels emanating from the mid-ventral disc
margin
Fig 5. Stars of Winslow easily seen in the yellow tapetal fundus of a
Saddlebred foal
Fig 7. Choroidal vascular pattern (streak) extending 4 disc diameters
into the tapetalfundus present in a Saddlebred foal. The linearpattern
within the "streak"probab1y reflects the pattern of large choroidal
vessels
Fig 8. Wide choroidal "streak" extending just to the fapetal fundus,
giving a reddish brown appearance to the fundus just dorsal ro the
disc. Focal atapetal areas appear as red spots in the tapetal fundus of
this Saddlebred foal
vessels also took halo or irregular shapes and in a few foals
extended ventrally into the non-tapetal fundus (Fig 9).
The demarcation between tapetal and non-tapetal areas was
prominent in certain individuals of all three breeds. In the
majority of foals the ventral extent of the tapetum was
approximately one quarter disc diameter dorsal to the optic
disc. However in 15 foals the tapetum dipped ventrally toward
or to the dorsal margin of the optic disc (Fig 1). The junctional
area between tapetal and non-tapetal fundus, dorsal to the
optic disc, was variable. The tapetum was observed to drop
ventrally nasal and temporal to the disc in five foals. This
ventral tapetal aspect did not have the distinct colouring of the
major aspect of the tapetum. These variations in tapetal extent
were not related to breed.
Focal atapetal areas were present in three foals (Figs 5 , 8 and
11). Tapetal "islands", seen as dense green circumscribed
areas, were observed in four foals (Fig 12). A pigmented oval
structure one quarter the size of the optic disc and one-and-a-
half disc diameters dorsal to it was present in one Thorough-
bred foal. The rounded shape of this structure and its location
on the vitreal surface of the retina suggested a cyst-like
structure.
A swirling pattern reminiscent of a vortex pattern was
present approximately two disc diameters dorsal to the optic
disc in one foal.
The non-tapetal fundus was a dark brown or chocolate
colour in the majority of foals. A few individuals had a reddish
brown colour to the non-tapetal fundus. A focal reddish area
ventral to the optic disc was observed in two foals (Fig 14).
Focal areas devoid of pigment or vessels were observed ventral
or temporal to the disc in three foals (Fig 15) and a tapetal
island adjacent to the disc was also observed in one individual
(Fig 16).
A commonly observed feature of the non-tapetal fundus
which was difficult to document photographically was light
grey streaks arcing nasally and temporally away from the
ventral disc margin. This grey reflection followed the course
of the retinal vessels in these areas and was not observed
adjacent to the mid-ventral disc margin where retinal vessels
were few (Figs 17 and 18).
13
Fig 9. Right fundus of a Standardbred filly with choroidal streaks
angled temporally both dorsal and ventral to the disc
Fig 10. Single choroidal vessel dorsal to the disc and a white ventral
disc margin in a Saddlebred filly
Fig I I . Focal atapetaf spot and peripheral pigment mottling present in
a Saddlebred colt
Fig 12. Tapetal islands visible as focal green spots in the fundus of a
Standardbred filly
Fig 14. Focal spot lacking choroidal and retinal pigment epithelial
pigmentation present in a Standardbred foal. The non-tapetal fundus
is reddish brown and the optic disc has a fasciculated appearance
Fig 16. Two tapetal islands present dorsal to the optic disc in a
Thoroughbred foal
Sclera
The sclera was prominent in two Saddlebred foals, both
chestnut. Corneal measurements in these animals were 27 x
19 mm and 28 x 22 mm, thus microcornea was not present.
The sclera also appeared prominent when there was a
paucity of conjunctival pigment.
Systemic disease
No correlations between systemic and ocular disease were
made. Foals with pneumonia, joint-ill, strangles and scours
were not those with conjunctivitis, ocular discharge or other
ocular abnormalities.
Discussion
The results of this study are in general agreement with
previous ocular descriptions of the neonatal horse (Barnett
1975; Koch et a1 1978; Peiffer 1979).
We did not examine foals less than five days old and were
unable to confirm the round pupil and sluggish pupillary light
reflex reported in the newborn (Koch et a1 1978; Peiffer 1979).
Excitement does not inhibit the pupillary light reflex, provided
a bright light source is directed toward the temporal fundus.
The full mydriasis necessary for complete ophthalmic
examination occurs at least 15 mins after topical administra-
tion of 1 per cent tropicamide. Entropion (historical) and
cataract (Huston, Saperstein and Leipold 1977; Koch et a1
1978) were the only previously reported congenital ocular
defects observed in our study groups.
Few ocular variations were breed specific. The paucity of
observable anterior lens sutures in the Thoroughbred was
notable compared to the other two breeds. In the Saddlebred,
junctions between areas of varied tapetal colouring were well
delineated. Scleral prominence was also observed only in the
Saddlebred.
Variations in the appearance of the fundus were related
primarily to tapetal colour and optic disc configuration.
Tapetal colour tended toward yellow/green compared to the
greedblue commonly observed in the adult. The irregular
delineation between tapetal and non-tapetal fundus dorsal to
the optic disc observed in many foals may be caused by the
varied pigmentation of the retinal pigment epithelium, in this

area, precluding visualisation of the underlying tapetum. Focal
or diffuse variations in tapetal colour may reflect variations in
relative thickness of the tapetum fibrosum.
The white margin commonly observed at the inferior edge of
the optic disc may represent myelin (Rubin 1974) or a local
variation in the vascularity. This area of the optic disc has
fewest retinal vessels emanating from it. Similarly, the arcate
grey streaks radiating nasally and temporally from the ventral
disc margin follow the retinal vascular pattern. These striae
may represent altered reflectivity of the nerve fibre layer in this
area of concentrated retinal vasculature or subtle extension of
myelin into the nerve fibre layer.
Focal non-pigmented spots in the non-tapetal fundus have
been previously reported (Koch et a1 1978). These spots may
represent focal absence of choroidal and retinal pigment
epithelial pigmentation. Focal gliosis, cellular infiltration or
chorioretinal degeneration would also be possible, but less
likely, in the neonate. Histopathology would be required to
confirm the nature of these spots and the pigmented "cystic"
structure observed in the tapetal fundus of one foal. The
varied depigmented patterns commonly observed in the non-
tapetal fundus of horses (Rubin 1974; Riis 1981) were absent in
examined foals.
Superficial corneal opacities observed in five Thoroughbred
foals were the most frequent ocular abnormalities noted in this
study. The lesions were self-limiting and unassociated with
observed systemic disease. An environmental or infectious
aetiology is suspected because affected foals were from one
farm. Multiple whitish punctate corneal epithelial lesions
associated with photophobia and tearing have been reported
(Riis 1981). Equine herpesvirus 1 was isolated from the surface
epithelium of affected horses, and aqueous and serum
neutralising antibody titres were demonstrated. The signifi-
cance of titres and isolations was uncertain. Therapy with
topical antibiotic-corticosteroid solutions appeared to be
effective.
EQUINE VETERINARY JOURNAL SUPPLEMENT 2
Ocular manifestations of systemic disease were not observed
in this group of foals. Corynebacterium equi and
Streptococcus equi infections were present in several studied
foals without the previously reported ocular lesions (Rubin
1974; Whitley and Gelatt 1981).
This study confirms the low incidence of congenital ocular
disease in the horse. We intend our report of normal variants
to clarify distinctions between normal, acquired or congenital
lesions.
Acknowledgements
The authors wish to thank J . Fred Arnold, James F. Sautter
and Jerry Snyder of Lexington, Kentucky for their assistance
in organising and performing this study. We are also indebted
to the owners, managers and staff members of the several
Lexington farms who made their horses available for study.
References
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