First view the animal directly.

Make sure both eyes are of

equal size and prominence. Watch for any evidence of
visual impairment. Assess the horse's expression. Look for
any signs of asymmetry or irregularity of the eyelids or the
globe. Also note any abnormalities in the skin around the
eyes and any facial asymmetry. The horse should be
examined for any ocular discharge.

The nasolacrimal duct opening can be seen near the

mucocutaneous junction inside the nostril. It is especially
important to check whether this is present in young animals
presented with a complaint of excessive tearing; congenital
malformation can result in an imperforate duct. In older
animals the duct may become obstructed even if a puncta
is visible.

Color of the conjunctiva and also more detail of the lids can
be examined by carefully everting the eyelid.
 Intraocular pressure can be grossly examined by lightly
palpating the globe through the eyelid. The index and
middle finger are gently applied to the globe and the
fingers are moved back and forth so as to indent and feel
the change in pressure in the eye. Obviously, this will only
detect a gross decrease or increase in intraocular pressure.
The opposite eye should always be compared. Obviously,
this test should never be performed on an eye that is very
painful or in danger of rupturing.

Continue with the ophthalmic exam.....

 If the eye is painful, the eyelids should not be forcibly
opened. One needs to block the motor nerve to the upper
eyelid in order to examine a painful eye. A branch of the
palpebral nerve can be palpated as it passes across the
zygomatic arch and can be gently rolled underneath the
skin.

Following palpation of the nerve, a 25 or 26 gauge needle can be passed through the skin into the subcutaneous tissue
adjacent to the nerve. It is important to rest your hand against the horse's head so that if the horse moves, your hand
will move with him and not inadvertently cause further damage with the needle.

Following placement of the needle, a syringe can be

attached and the local anesthetic (carbocaine, lidocaine,
etc.) can be infused. Usually 1-2 cc directly over the nerve
is sufficient. This blocks only the motor supply to the
upper eyelid. It does not change sensation. If there is any
painful procedure to be done on the surface of the eye, it
is necessary to apply topical tetracaine.

Continue with the ophthalmic exam.....

Usually the eye is initially examined in a darkened area with a bright light. For demonstration purposes, these slides are
taken in an area somewhat lighter than what one would normally use for an ophthalmic examination. A bright light such
as a transilluminator or other halogen light source is shone directly at the eye. This allows one to assess the cornea for
clarity and to look for any abnormalities in the anterior aspect of the eye and the eyelids. Also one can check the direct
pupillary light response. At the same time another observer can view the opposite eye for a consensual light response.
It is important to keep the light source far enough from the eye so that if the horse moves its head, it will not bump
into the light. Alternatively, when one wishes to look closer, one can use a finger or a hand to guard the instrument and
prevent the horse from traumatizing himself on it. Horses' light responses may not be very rapid. A photophobic
response is usual in an eye that is visual.
 The Purkinje light reflections should be noted. When one
moves the bright light horizontally, one sees three light
reflections; one from the cornea, one from the anterior
lens, and one rather dimmer light reflection from the
posterior lens. The dimmer light reflection from the back
of the lens moves in a direction opposite to the other two
light reflections which move in the same direction that the
handler is moving the light. Also, note that one should
stabilize one's hand against the horse's head when
examining the eye with a light at very close range so that
if the horse moves its head very rapidly, the handler will
not traumatize the horse's eye with the light. Also,
different angles can be used when viewing the eye with a
light so as to better assess abnormalities. Shining the light
at different angles is also helpful when a "beginner" is
trying to decide if a lesion is in the cornea or the lens.

The other instrument that can be very helpful in assessing

the horse's cornea is the magnifying lens that is on the
otoscope head. This allows for very close examination of
the cornea and magnifies lesions therein. Then one should
proceed with using the ophthalmoscope.

Continue with the ophthalmic exam.....

When starting the ophthalmic exam holding the ophthalmoscope several inches
from the eye, place the diopter setting on °3 or °4 (red 3 or 4) so as to focus
on the retina. The focus can be refined by rotating the wheel that controls the
diopter lenses. One can change the diopter settings to a more positive reading
and progressively focus on areas between the retina and the cornea.
It is usually necessary to dilate the eye for a full exam, although a
cursory view of the retina can be obtained and it is usually possible to
see the horse's optic nerve clearly, even without mydriasis. Usually
when the eye is first examined at this angle, one will have a view of
the tapetal region. In order to view the optic nerve, it is necessary to
look ventrally just below the tapetal/nontapetal junction. The disk can
be found in this region. Then, look at different angles so as to
evaluate the entire retina. Then move through to the positive diopter
setting to examine the vitreous, lens and anterior segment of the eye.
Remember that the direct ophthalmoscope head does magnify. Note
that one should stabilize one's hand holding the ophthalmoscope so as
to avoid hitting the horse's face if he or she suddenly moves its head.

Continue with the ophthalmic exam. . . . .

If one wishes to dilate the eye for examination, a short acting mydriatic such as tropicamide is used. It is easy to draw
up the required amount of mydriatic into a TB syringe, break off the needle, and then direct a fine stream across the
horses cornea or, if the horse does not like a stream directed across its eye, an alternative is to use the TB syringe to
drop the medication into the medial fornix.. Frequently it is more difficult to administer medication by drops directly
from the bottle, and contamination of the bottle is also likely.

If one needs to stain the cornea, one can use Rose Bengal and/or Fluorescein strips. Fluorescein strips are more
commonly used, and will stain areas where there is loss of epithelium. Rose Bengal will stain areas with devitalized
epithelium, as well as reveal where epithelium is lost. Either strip should be held against the conjunctiva, or
alternatively, the strip can be wetted with sterile saline and then the solution can be dropped across the eye. As the
strip can be somewhat irritating if placed directly on the cornea, direct corneal contact should be avoided. If one
suspects decreased tear production, a Schirmer tear test should be performed. A Schirmer tear test strip is folded and
applied just inside the lower lid so that it hangs vertically. The wetting of the strip (which has mm markings along its
length) by tears can be directly observed and measured for a given time. Both eyes should be compared. Normal horses
and ponies tear at least 15mm/60secs.