When evaluating a horse with nasal discharge or epistaxis, what is the first factor you should determine?

• A. Unilateral or Bilateral
• B. Color of Discharge
• C. Duration of Symptoms
• D. Breed of Horse

Answer: (A)

The first thing you determine is whether the discharge or epistaxis is coming from one nostril (unilateral) or both (bilateral). This laterality quickly narrows the differential and guides the next steps.

Unilateral involvement points to a localized issue within one nasal cavity, the paranasal sinuses, the guttural pouch, or related structures, such as a foreign body, trauma, dental disease, abscess, or a unilateral tumor. Bilateral involvement suggests processes that affect both sides or systemic factors that involve the nasal passages, such as widespread infection or inflammation, bilateral sinus disease, or conditions like a coagulopathy that can cause bleeding from both sides. So starting with unilateral versus bilateral helps you prioritize likely causes and decide how urgently to pursue diagnostics and treatment.