Vet Guide 2025: Equine Nosebleeds Explained by Dr Duncan Houston 🩺🐴

Welcome, I’m **Dr Duncan Houston**, BVSc, founder of Ask A Vet. In this in-depth guide, I’ll walk you through everything you need to know about horse nosebleeds—medical term epistaxis—including causes, when to worry, first aid, diagnosis, treatment, and preventive care. Let’s dive in! 🌟

1. What Is Equine Epistaxis?

Nosebleeds in horses—known as epistaxis—can range from light drips to heavy flows. They may originate from the upper airway (nasal passages, sinuses, guttural pouches) or lower respiratory tract (lungs) :contentReference[oaicite:3]{index=3}.

2. Why Do Horses Have Nosebleeds?

2.1 Minor Trauma

Commonly, nosebleeds are due to knocks during turnout, collisions, or falls. These usually resolve quickly—within 10–15 minutes :contentReference[oaicite:4]{index=4}.

2.2 Exercise-Induced Pulmonary Hemorrhage (EIPH)

Athletic horses, especially racehorses, often experience EIPH—tiny lung vessels rupture under intense exercise, causing bleeding from both nostrils :contentReference[oaicite:5]{index=5}.

2.3 Progressive Ethmoid Hematoma

A benign but locally destructive sinus mass causing intermittent, often one-sided, darker-red bleeding :contentReference[oaicite:6]{index=6}.

2.4 Guttural Pouch Mycosis

A life-threatening fungal infection in guttural pouches that can erode arteries and cause massive bleeding—the worst-case scenario :contentReference[oaicite:7]{index=7}.

2.5 Other Causes

• Sinus infections, abscesses—with pus and blood :contentReference[oaicite:8]{index=8}
• Tumors in nasal passages or sinuses :contentReference[oaicite:9]{index=9}
• Clotting disorders (e.g., thrombocytopenia, Von Willebrand’s) :contentReference[oaicite:10]{index=10}
• Nasal foreign bodies, allergies, fungal infections (e.g., Aspergillus) :contentReference[oaicite:11]{index=11}
• High blood pressure increasing vessel fragility :contentReference[oaicite:12]{index=12}

3. Recognizing Warning Signs

Minor bleeds that stop within 10–15 minutes and occur once are usually benign :contentReference[oaicite:13]{index=13}. But seek veterinary care if:

• Bleeding lasts over 15 minutes or recurs frequently :contentReference[oaicite:14]{index=14}
• Blood loss is heavy—enough to fill a bucket over minutes :contentReference[oaicite:15]{index=15}
• Bleeding from one nostril at rest suggests upper airway lesion :contentReference[oaicite:16]{index=16}
• Bleeding from both nostrils immediately after exercise suggests EIPH :contentReference[oaicite:17]{index=17}
• Accompanying signs: nasal discharge, coughing, head shaking, poor performance, lethargy, breathing difficulty :contentReference[oaicite:18]{index=18}

4. First Aid Protocol

• Stay calm to avoid spooking the horse.
• Isolate the horse quietly; keep head slightly elevated—but not too high.
• Do **not** pack the nostrils—horses are obligate nasal breathers :contentReference[oaicite:19]{index=19}.
• Apply gentle pressure with clean gauze for minor external bleeds.
• If bleeding continues >15 minutes or is severe, contact your veterinarian immediately :contentReference[oaicite:20]{index=20}.

5. Veterinary Diagnosis

When you call, your vet will likely perform:

• Full physical exam and history
• Bloodwork to check clotting and infection
• Endoscopy of nasal passages, sinuses, guttural pouches
• Imaging: X‑rays, ultrasound, CT/MRI
• Fluid sampling (sinus aspiration, BAL, TTW)
• Biopsy of masses if present :contentReference[oaicite:21]{index=21}

6. Treatment Options

6.1 Minor Trauma

Rest and optional antibiotics to prevent sinusitis from clotted blood :contentReference[oaicite:22]{index=22}.

6.2 EIPH

No cure. Management includes furosemide (Lasix), diet/environment adjustments, gradual training, and ongoing monitoring :contentReference[oaicite:23]{index=23}.

6.3 Ethmoid Hematoma

Treatment via surgical removal, laser ablation, or formalin injections. Good prognosis, though recurrence possible :contentReference[oaicite:24]{index=24}.

6.4 Guttural Pouch Mycosis

Surgical artery ligation and antifungal flushing. High risk—requires immediate referral :contentReference[oaicite:25]{index=25}.

6.5 Sinusitis, Abscess, Tumors

Appropriate antibiotics, surgical drainage or removal, possibly radiation/chemotherapy :contentReference[oaicite:26]{index=26}.

6.6 Clotting Disorders

Treat underlying condition; may require transfusion in severe cases :contentReference[oaicite:27]{index=27}.

7. Prevention & Management

• Minimize trauma in paddocks, stalls, during handling.
• Improve stable ventilation and reduce dust/allergens :contentReference[oaicite:28]{index=28}.
• Keep horses well hydrated to maintain nasal integrity :contentReference[oaicite:29]{index=29}.
• Monitor training intensity; introduce exercise gradually.
• Perform routine vet checks and dental care.
• Consider routine endoscopy for high-risk performance horses.

8. Red Flags: When to Call Your Vet Immediately

Contact your veterinarian without delay if your horse has:

• Bleeding >15 minutes
• Heavy blood flow or multiple episodes
• One-sided bleeding at rest
• Signs of EIPH post-exercise
• Coughing, poor condition, lethargy, or breathing difficulty

9. Why Vet Care Matters

Many serious causes of nosebleeds—like mycosis or tumors—can be life-threatening. Prompt vet intervention saves lives. Even EIPH impacts performance and welfare.

10. Ask A Vet Support

Need advice or urgent help? Reach out via the Ask A Vet app. I’m always ready to assist with first aid instructions, connect you with specialists, and support ongoing care. Visit AskAVet.com and download the app today 🐴📱

— **Dr Duncan Houston**, BVSc & founder of Ask A Vet