Complications associated with subpalpebral lavage systems in upper and lower equine eyelids: A prospective, randomised study in 73 cases (2015–2024)

Graham, AE ORCID: 0000-0002-2917-1095, Carslake, HB ORCID: 0000-0003-1288-1768 and Malalana, F ORCID: 0000-0002-5773-9725 (2025) Complications associated with subpalpebral lavage systems in upper and lower equine eyelids: A prospective, randomised study in 73 cases (2015–2024) Equine Veterinary Journal. ISSN 0425-1644, 2042-3306

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Abstract

Background: Evidence for optimal location of subpalpebral lavage (SPL) systems is lacking. Objectives: To compare the rate and types of complications with SPL systems located in central upper- compared with medial lower-eyelid in hospitalised patients. Study Design: Prospective, randomised treatment trial. Methods: Horses admitted for ophthalmic treatment using an SPL system from February 2015 to January 2024 were included if ocular pathology did not necessitate SPL system placement in a specific location. Coin toss was used to determine location. SPL systems were monitored at least daily, and complications were defined as major (displacement of footplate from the fornix ± corneal ulceration; loss of footplate; eyelid infection/abscess formation) or minor (loss of suture/tape; palpebral swelling; leakage or tube rupture; loss of injection port; subcutaneous swelling/abscess at suture site). Data were analysed using logistic regression. Results: Seventy-three SPL systems in 68 horses were included, with 38 (52%) located in the upper and 35 (48%) in the lower eyelid, for a median (IQR) duration of 13 (8–16) days. Sixty-nine complications (37 (54%) in upper and 32 (46%) in lower SPL systems) occurred in 44/73 (60%) of all SPL systems. Major complications occurred with 2 lower (2/69; 3%) and 10 upper SPL systems (10/69;14%). The most common major complication was displacement of the lavage footplate from the conjunctival fornix (7/69; 10%). The most common minor complication was loss of suture or butterfly tape (21/69; 30%). Treatment with chloramphenicol (OR = 0.3; 95% CI: 0.09–0.8; p = 0.02) or cross-linked modified hyaluronic acid (OR = 3.9; 95% CI: 1.2–13.3; p = 0.03) was associated with any complication on multivariable analysis. Multivariable analysis showed that upper systems were 5.1 (95% CI: 1.0–25.7; p = 0.05) more likely to have a major complication than lower SPL systems. Main Limitations: Small study size. Conclusions: SPL system location had no effect on all complications, but major complications were more common in those placed in the upper lid.

Item Type:	Article
Uncontrolled Keywords:	SPL, complications, eyelid, horse, subpalpebral lavage
Divisions:	Faculty of Health & Life Sciences Faculty of Health & Life Sciences > Inst. Infection, Vet & Ecological Sciences
Depositing User:	Symplectic Admin
Date Deposited:	30 Jun 2025 09:32
Last Modified:	23 Jan 2026 09:53
DOI:	10.1111/evj.14540
Related Websites:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3193455
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