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  • Nose bleeds – what you need to know!

    Posted on by Abii Dowdy

    Have you ever arrived at the yard to find your horse has had a nose bleed? If so, don’t panic! Our vet Philip has pulled together lots of information to help you understand why this could have happened and what actions to take.

    What is a nose bleed?

    A nose bleed is often referred to as Epistaxis, a Latin term used to describe the clinical presentation of blood leaking from either one of both of your horse’s nostrils.There are many reasons why your horse may have experienced Epistaxis which are listed below:

    Blunt Trauma

    The most common cause of nose bleeds in horses is blunt trauma to the head.This can cause rupture of small blood vessels in the nasal passage, the pharynx, guttural pouches, paranasal sinuses or any structure that drains into the nasal passage; all can result in blood trickling from your horse’s nostrils.

    Cranial Fractures

    Blunt trauma may also result in a fracture to one or more of the facial bones.This will likely cause haemorrhage from the surrounding soft tissue structures leading to a nose bleed. Radiography of the skull is required for definitive diagnosis, though sometimes fractures are easily felt.


    An infection within the sinuses can damage the small capillary network that line the edge of the sinuses, which may present as a nose bleed. Other clinical signs often noted with sinusitis include a malodorous, thick, yellow nasal discharge, which is usually one-sided.

    Ethmoid Haematoma

    An ethmoid haematoma is a progressive mass that occurs in the nasal passages and paranasal sinuses.As the mass grows it causes pressure on the surrounding tissues causing microscopic trauma to the vascular network of this region resulting in Epistaxis. Ethmoid haematomas usually lead to unilateral nose bleeds and diagnosis is made via radiographic imaging and endoscopic exam.

    Guttural Pouch Mycosis

    Guttural pouch mycosis is a rare but possibly fatal reason for your horse to experience a nose bleed.This disease is caused by a fungal infection within the guttural pouches, which are two pouches located just below the horse’s ears on each side of the head. Major blood vessels run through the guttural pouch, including the internal carotid artery; if the integrity of the vessel wall is disrupted, rupture of the vessel can occur and result in severe, acute onset nosebleed which may be fatal.There may be instances of more mild nosebleeds that precede the vessel rupture.The guttural pouches can be examined endoscopically.

    Exercise Induced Pulmonary Haemorrhage (EIPH)

    EIPH is the most common cause of nosebleeds in racehorses and other performance horses post high-intensity exercise; these horses are colloquially known as ‘bleeders’.When horses are pushed to their physical limits, the pressure within the lungs can exceed that which the pulmonary

    capillary walls can withstand, leading to rupture of these pulmonary capillaries.As the bleeding originates within the lungs, Epistaxis is usually noted from both nostrils.

    When to be worried about a Nose Bleed

    In general if the Epistaxis is mild and self-limiting, resolving within a short period of time (less than 5-10 minutes) and the horse otherwise seems well there is likely no need for concern. However, some causes of Epistaxis can be life-threatening and so if there is recurrence of nosebleeds or the bleed is more significant, you should contact your vet for advice.
    Some questions they may ask include:

    • Volume of blood lost
    • Frequency of recurrence
    • Whether there is any mucous or discharge associated with the blood
    • Whether the blood loss is from one or both nostrils.

    If you find your horse has experienced a nose bleed, make a note of the above signs and contact your vet as they will help you to make an informed decision about a treatment plan moving forward.