Study suggests bilateral enucleation can improve welfare in horses
Bottom line
A new retrospective case series in Equine Veterinary Journal suggests bilateral enucleation may be a more acceptable welfare option than many pet parents and clinicians assume for horses with chronic, untreatable ocular pain. The study reviewed 21 horses that underwent bilateral enucleation between 2016 and 2024, with owners later surveyed about pain, activity, tactile sensitivity, overall well-being, and satisfaction. Most horses in the series had equine recurrent uveitis, the mean age at the second or bilateral procedure was 20.6 years, and Appaloosas made up 62% of cases. Owners reported improvement across all welfare-related measures after surgery, with a median satisfaction score of 5 out of 5, and all horses were reported to have better quality of life afterward. (madbarn.com)
Why it matters: For equine veterinarians, the paper adds practical evidence for a difficult conversation that often ends with euthanasia because of concern about how a blind horse will cope. That concern is understandable, especially since equine recurrent uveitis is the most common cause of blindness in horses, can affect both eyes, has no cure, and may ultimately leave horses blind and painful despite medical or surgical management. Existing guidance from UC Davis and the American College of Veterinary Surgeons already positions enucleation as an appropriate option for blind, painful eyes, and ACVS notes that horses with chronic ocular pain often show marked improvement in comfort after surgery. (ceh.vetmed.ucdavis.edu)
What to watch: Expect this study to be cited in referral ophthalmology and end-stage ERU decision-making, but its small size and reliance on owner-reported outcomes mean prospective, objective follow-up data would strengthen the case. (madbarn.com)
A newly published case series in Equine Veterinary Journal reports high owner satisfaction and owner-perceived welfare gains after bilateral enucleation in horses, a finding that could reshape how clinicians frame end-stage ocular pain cases. In 21 horses that underwent bilateral enucleation between 2016 and 2024, owners reported improvement in every welfare-related parameter assessed after surgery, and all said their horse’s quality of life improved. Median satisfaction with the procedure was 5 out of 5. (madbarn.com)
The paper addresses a particularly difficult clinical and emotional crossroads. Bilateral enucleation is usually considered only when ocular disease is chronic, painful, and no longer responsive to treatment, yet the idea of leaving a horse completely blind can push pet parents toward euthanasia instead. That tension is reflected in the study’s stated rationale: uncertainty about postoperative welfare and the emotional burden of the decision can make surgery feel less acceptable, even when pain relief is the primary goal. (madbarn.com)
Most horses in the series were older adults, with a mean age of 20.6 years, and the case mix was dominated by Appaloosas, which accounted for 62% of patients. Equine recurrent uveitis was the underlying diagnosis in 95% of cases. That fits the broader epidemiology: UC Davis notes that Appaloosas are particularly susceptible to ERU, especially bilateral disease, and that the condition has no cure. The same resource says ERU-affected horses with complications such as glaucoma or cataracts are more likely to become blind and require enucleation. (madbarn.com)
The study’s main takeaway is straightforward: owners perceived less pain and better day-to-day function after surgery. According to the abstract, most horses returned to previous activity levels, and owners also gave a high median score for recommending the procedure to others. Those findings align with current surgical guidance. The American College of Veterinary Surgeons says enucleation is used to improve comfort in horses with severe trauma or chronic painful ocular disease, and notes that for horses with chronic ocular pain, the procedure can significantly improve quality of life. (madbarn.com)
There wasn’t much direct outside commentary on this specific paper available at publication, but the broader specialist view appears consistent with its conclusions. ACVS describes enucleation as typically well tolerated in horses, while UC Davis notes that some horses ultimately require removal of one or both eyes for humane and medical reasons when advanced treatment can’t preserve comfort. In other words, the new study doesn’t overturn practice, but it does add owner-reported outcome data to support what many referral clinicians likely see in practice. (acvs.org)
Why it matters: For veterinary professionals, especially equine practitioners and ophthalmology referral teams, this paper may help reframe bilateral enucleation from a last-resort failure to a legitimate welfare intervention. In advanced ERU, the clinical question often shifts from vision preservation to pain relief. Having published data showing uniformly improved owner-perceived quality of life may make those conversations clearer, particularly for Appaloosa cases and other horses at risk of bilateral progression. It also reinforces the value of early referral, because UC Davis notes that early diagnosis and intervention are associated with the best prognosis, even though long-term prognosis remains guarded. (ceh.vetmed.ucdavis.edu)
The study also has important limits. It was retrospective, included only 21 horses, and depended on owner recall and subjective reporting rather than objective postoperative welfare measures. That means the results are encouraging, not definitive. Still, for a procedure that can be emotionally hard to discuss and easy to delay, even small datasets can be clinically useful if they help veterinarians and pet parents weigh pain, function, adaptation, and alternatives more realistically. (madbarn.com)
What to watch: The next step will be whether follow-up studies add prospective welfare assessments, behavioral metrics, or larger multicenter cohorts, which could help define which horses are the best candidates and how to counsel pet parents before vision is completely lost. (madbarn.com)