Epistaxis or nose bleeds in horses, can be alarming, but many recover without problems if they receive the proper care and attention quickly.


Nasal bleeds, also known as epistaxis, occur in horses of all sizes and forms all the time! That doesn’t mean they can’t look dramatic or worry any horse owner. Our horse health expert recently shared with us more about nosebleeds in horses, how dangerous they can be, and what horse owners should know about them. In this article, we will discuss nose bleeds in horses briefly.


The medical name for nasal bleeding is epistaxis. It could be coming from your horse’s upper or lower respiratory system. Epistaxis is a clinical indicator that can be present in a variety of illnesses. Horse epistaxis has no breed-specific cause, yet it is far more common in some populations than others. Nasal bleeding occurs frequently in racehorses and athletes who engage in intense physical activity.

One or both nostrils may show signs of bleeding, such as a small trickle or a strong flow. Blood can combine with saliva, pus, or mucus. Nosebleeds can occur during or after physical activity.

Epistaxis in Horses: Nosebleed

If your horse only occasionally experiences nosebleeds, veterinary attention may not be necessary, but some horses may suffer from chronic or frequent nosebleeds that require examination.

Blood in one or both nostrils is the most visible indicator of a nosebleed. Depending on where it came from, it could appear as a few droplets, a little stream, or a larger volume of blood. Brown or black blood denotes older bleeding, while bright red or dark blood indicates a recent cut.

Some horses—particularly racehorses—may get frequent nosebleeds associated with strenuous exercise due to Exercise-Induced Pulmonary hemorrhage (EIPH). In some situations, blood flows from the nose following hard exertion.

Recurrent bleeding episodes may indicate an underlying illness if they are not associated with exercise or if additional symptoms accompany them. Horses may also have epistaxis due to blood diseases, respiratory problems, infections, tumors, or severe injuries.

Signs Of Nose Bleeds In Horses

Additional clinical indicators that may be present in horses with severe or recurring nosebleeds include:

  • Shaking one’s head and sniffling
  • Coughing
  • Poor execution
  • laziness
  • Unease
  • Having trouble breathing

Reasons Why Horses Get Nosebleed

Numerous conditions can be the cause of nose bleeds in horses, including:



Kicks, trailer accidents, etc., can result in face bones or skull base fractures. These are the most frequent reasons why young horses that aren’t competitive athletes get nosebleeds. When a horse turns over backwards and smacks its poll, it frequently results in a nosebleed. Significant bleeding may result from rupturing the longus capitis muscle, which joins the guttural pouch.

Developing Ethmoid Hematoma

It is a slowly expanding harmless tumur. Usually, reddish-tinged mucus occasionally appears from one nostril, sometimes following physical activity. Nasal discharge and bilateral bleeding, however, are also possible. Horses may exhibit exercise intolerance or have an unpleasant stench when their faces are touched.

Pulmonary Hemorrhage Induced by Exercise (EIPH)

Most highly exercised horses, if not all, have some effects by EIPH. Risk factors are many lifetime starts and racing in temperatures below 68 degrees Fahrenheit. Mares and older racing animals are more likely to exhibit post-race epistaxis, indicating severe EIPH, following shorter, more intense races. Horse racing increases blood pressure and puts tremendous strain on the respiratory system. A “stress failure” of the capillaries may occur during this extreme hypertension of the small blood vessels in the lungs, allowing blood to enter the lungs.

Rhinitis and sinusitis

The term “sinusitis” refers to inflammation of the sinuses, which can cause breathing noise, reduced airflow, and sporadic bleeding. Since horses have six pairs of sinuses, there is a great deal of opportunity for infection. These can result from cysts, neoplasia, polyps, bacterial, fungal, viral, or parasitic infections. Unless the reason is viral or significant local involvement, this is often a unilateral illness process, so you might only see discharge or blood from one nostril. Equine herpesvirus types 1 and 4 (EHV) and equine influenza virus (EIV) are the most frequent viruses that can cause sinusitis.

GPM, or guttural pouch mycosis

It is a severe infection of the guttural pouches, typically brought on by Aspergillus fumigatus. Fungal plaques proliferate within the pockets and frequently invade a carotid artery. Bright red (arterial) discharge from one or both nostrils is the most typical clinical symptom. Modest initial bleeding usually happens and goes away without any problems, followed over the next few days or weeks by more severe or fatal bleeding.

Diagnosis: Nose Bleeds In Horses


A combination of endoscopy, advanced imaging techniques, and clinical testing serves to diagnose PEH. PEH frequently resembles other respiratory conditions, requiring a variety of diagnoses. 

Your veterinarian can insert the endoscope into the nasal tube through one nostril to examine the interior components of the nose. Looking at both nasal passages is necessary since PEHs typically affect only one side. There may be some minor bleeding throughout this exam.

Hematomas can appear in various colours, such as green, yellow, red, or purple. The nasal cavity may become blocked by these tumors. Occasionally, they are obliviously found during endoscopic examinations for unrelated medical issues.

Additional symptoms indicating underlying causes

Diagnoses of EIPH usually show up by looking at the trachea and lungs with an endoscope. The endoscope is a small camera put into the nose and throat to look for bleeding. This process is done 30 to 90 minutes after working out. 

Bronchoalveolar lavage is another test that checks for blood in the airways by washing the horse’s lungs with a small amount of fluid. This method is more flexible than endoscopy and can help determine what’s wrong with horses that don’t have many signs.  

Veterinarians use respiratory endoscopy to diagnose GPM in horses. Physicians can gain crucial insights by using this nasal endoscopy procedure, which offers a thorough view of the nasal passageways and guttural pouches. 

To access the guttural pouches, your veterinarian will use a tiny, flexible endoscope inserted through the nose. It makes it possible to examine the lining of the bags thoroughly and detect blood clots, mycotic plaques, and inflammation.


How to Treat Nose Bleeds in Horses.


Blood donations and intravenous fluids are essential to assist in replacing lost volume in severe, sudden cases of nosebleeds with significant blood loss. The most common treatment for a growing ethmoid hematoma is a series of Formalin injections into the lesion, followed by a laser treatment. Horses having surgical removal are more likely to experience severe bleeding, which could require a blood transfusion.

Furosemide (Lasix) is a diuretic used to relieve bleeding symptoms in EIPH sufferers. In situations with deep pouch mycosis, antifungals also need to be coated into the cavernous pouches. Systemic antifungals serve in addition as essential. Additional treatments for nosebleeds may include steroids, antibiotics, anti-inflammatories such as flunixin meglumine, nasal sinus flushing, and supportive care.

Recovery and Management of Nosebleed in Horses

Your veterinarian could suggest a disciplined exercise regimen for horses that get recurrent nosebleeds. Monitor for fever, increased breathing difficulty, and coughing following any nosebleed. Horses that experience frequent nosebleeds may be more susceptible to subsequent issues like pneumonia.

Medications to address underlying causes

The most usual therapy for PEH is surgical removal, especially in cases of more prominent or more complicated hematomas. Usually, veterinarians perform a bone flap treatment while the horse is under general anesthesia.

They temporarily remove a portion of the skull to access the deeper structures. 

To remove the hematoma, the veterinarian can access the nasal part of the ethmoidal labyrinth by performing a frontonasal bone flap. The ethmoidal maze is highly complex, making this a complex surgical procedure.

If the hematoma expands to restrict the airway, it can become life-threatening, and the horse’s athletic ability may be impaired if it does not receive treatment.

For horses, an early diagnosis of GPM provides a typically good prognosis.

Antifungal medicine and guttural pouch flushing are the two main treatments for mycosis. Abrupt bleeding is still possible if the mycotic plaque in the throat pouches is active. 

It can take many months to treat GPM successfully, and long-term antifungal therapy is frequently necessary to eradicate the fungus. Surgery could be required to bind the harmful coronary artery and stop the bleeding. However, this is a challenging treatment with a danger of bleeding again.


Epistaxis or nose bleeds in horses, can be alarming, but many recover without problems if they receive the proper care and attention quickly. Whether the nosebleed originates from a little wound or involves a medical condition like EIPH, you can take precautions to lessen the likelihood of more episodes. If your horse is experiencing nosebleeds, speak with your veterinarian. It is particularly crucial if the bleeding is ongoing or occurring with other symptoms.

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