Not such a fungi…

Written By Lynette Jackson and Dr Tias Muurlink

Sometimes, despite our best efforts in veterinary medicine, we encounter cases where achieving the desired outcome is beyond our reach.

Recently, Tias was referred a case involving a gelding with a sudden and severe swelling around one eye, so pronounced that the eye was completely obscured and rendered non-functional. The horse also had a history of discharge from the nostril on the same side, which had been unsuccessfully treated with antibiotics by the referring veterinarians.

Once the horse was admitted to the hospital, our team worked to reduce the swelling, eventually restoring the eye to nearly normal condition. With that under control, we turned our attention to investigating the persistent nasal discharge. This process included passing an endoscope into the gelding’s airway.

During the initial examination, we discovered that the horse’s epiglottis—a flap that closes off the airway during swallowing—was entrapped by a membrane. While this condition can be problematic, especially in performance horses, it was considered incidental in this case. More concerning was the discharge from the sinus drainage angle. Due to the complex anatomy of the equine sinus cavity, we couldn’t fully investigate using the normal methods.

Epiglottic entrapment

To get a clearer picture, we decided to perform a trephination—a procedure that involves drilling a small hole into the sinus. This allowed us to pass the scope directly into the affected area and investigate the source of the persistent infection. What we found were multiple fungal masses within the sinus cavity. A biopsy was taken, and analysis confirmed that the infection was caused by Aspergillus sp., a type of fungus.

Masses seen in the sinus with the endoscope

Collecting a sample to ensure the best course of treatment.

Fungal infections, particularly in the sinus, are notoriously difficult to treat. We began treatment with antifungal medications, administered both orally and directly into the sinus through targeted flushing using the endoscope.

Initially, the treatment appeared to be working, but unfortunately, the sinus infection recurred, and the eye swelling not only returned but spread further. Despite our best efforts, the gelding’s condition deteriorated, and we were faced with the heartbreaking decision to euthanize him due to the secondary effects of the fungal infection. The exact reason for the involvement of the eye remained unclear, but it is suspected that the fungus had invaded the tissue behind the eye, an area that couldn’t be visualized.

Cases like these are always challenging, and the outcome was devastating for both the owner and our veterinary care team. However, it highlights how crucial it is for horses with complex conditions to receive hospitalised care, where we can provide targeted treatments like endoscopy and direct sinus flushing. Without this level of specialized intervention, managing such infections like these is extrememly difficult. At the Sunshine Coast Equine Hospital, we will be equipped to offer this kind of advanced care, ensuring that horses receive the best possible treatment for even the most complicated cases.