Study links upper-eyelid SPL placement to more major complications

A prospective, randomized study from the University of Liverpool compared complications in 73 subpalpebral lavage (SPL) systems placed in 68 hospitalized horses between February 2015 and January 2024, asking a practical question equine clinicians face every day: should the system go in the upper or lower eyelid? The researchers found that overall complication rates were similar between central upper- and medial lower-eyelid placements, but major complications were significantly more common when the SPL was placed in the upper eyelid, at 14% versus 3% for lower-eyelid systems. The paper was published in Equine Veterinary Journal and adds prospective, randomized evidence to a question that had previously been guided mostly by retrospective studies and expert opinion. (pmc.ncbi.nlm.nih.gov)

Why it matters: For veterinary professionals, the study suggests lower-eyelid placement may offer a safety advantage when either site is clinically acceptable, especially if the main concern is avoiding major events such as footplate displacement, corneal ulceration, loss of the footplate, or eyelid infection and abscess formation. At the same time, the authors reported that overall complication risk was also influenced by treatment-related factors, and earlier Liverpool evidence reviews had concluded that the literature was too limited to clearly favor one site. This new trial helps move the discussion from preference to stronger comparative data. (pmc.ncbi.nlm.nih.gov)

What to watch: Whether equine hospitals and referral ophthalmology services begin shifting routine SPL placement toward the lower eyelid when anatomy and disease location don't require an upper-lid approach. (pmc.ncbi.nlm.nih.gov)