Retrobulbar Abscesses in Rabbits

Summary Information
Diseases / List of Bacterial Diseases / Disease summary
Alternative Names  
Disease Agents
  • Usually associated with dental disease (infected upper molar tooth roots). (B601.12.w12, B531.16.w16, J15.19.w3, J29.16.w2)
  • Various bacteria - see Facial Abscesses in Rabbits
    • A study published in 2002 found that the bacteria involved in rabbit tooth-associated mandibular and maxillary abscesses included anaerobic gram-negative rods (particularly Fusobacterium nucleatum), anaerobic gram-positive spore-forming rods (especially Actinomyces spp.) and aerobic cocci, particularly from the Streptococcus milleri group. Pasteurella multocida was not isolated in this study. (J93.40.w5)
  • A probable origin in periodontal disease developing to periapical abscessation in a rabbit without any underlying generalized acquired dental disease. (J213.9.w3)
Infectious Agent(s)

In one study of tooth-associated abscesses (J93.40.w5):

  • Achromobacter (Alcaligenes) xylosoxidans subsp. xylosoxidans
  • Actinomyces israelii
  • Arcanobacterium haemolyticum
  • Bacillus sp.
  • Desulfomonas pigra
  • Eubacterium brachy
  • Fusobacterium nucleatum
  • Neisseria weaverii
  • Prevotella heparinolytica
  • Prevotella spp.
  • Peptostreptococcus micros
  • Staphylococcus saccharolyticus
  • Staphylococcus warnerii
  • Streptococcus intermedius
  • Streptococcus anginosus
  • Streptococcus milleri group
Non-infectious Agent(s) --
Physical Agent(s) --
General Description This is the commonest disease of the orbit of rabbits. (B531.16.w16, B601.12.w12)
Clinical signs
  • Inappetance. (J513.1.w1)
  • Exophthalmos (forward displacement of the globe) and lagophthalmos (inability to fully close the eyelids). (B531.16.w16, B601.12.w12, J29.16.w2, J513.1.w1)
  • Usually also prominence of the third eyelid. (B547.4.w4)
  • Epiphora. (J513.1.w1)
  • Purulent discharge. (B531.16.w16)
  • Nasal discharge. (J513.1.w1)
  • Corneal ulceration - this may occur in a central band across the eye where the eyelids can no longer close together. (B601.12.w12, J29.16.w2) See: Corneal Ulceration in Lagomorphs
  • Panuveitis (inflammation of the entire uveal tract) may be present. (J29.16.w2)
  • Note: In one rabbit with a retrobulbar abscess of periapical origin, it was note that the rabbit was bright and eating well; the only clinical signs were unilateral exophthalmos (for seven days) and more recent (two days) development of a soft tissue swelling ventral to the affected eye. (J213.9.w3)
Further Information
  • Oral examination - examination of the teeth.
  • Ultrasonography.
  • Radiography of the skull.
  • Further imaging - CT scan if available.
  • Aspiration of material from the abscess. (B600.8.w8)
  • Example: 
    • In one rabbit, ultrasonography revealed a mass ventromedial to the right eye, with hyperechoic areas which cast acoustic shadow. It was noted that the bony orbit appeared incomplete, the mass projected laterally, and the right globe was mildly indented from pressure of the adjacent mass. Radiography further revealed destruction of normal architecture, and along the zygomatic process of the right maxilla there was reactive proliferation of bone. CT scan further showed the extent of bony destruction and defined the anatomic borders of the abscess. (J213.9.w3)
  • Culture (aerobic and anaerobic) and sensitivity testing.
  • See:

(B600.8.w8, B602.39.w39, J213.9.w3)

Differential diagnoses of unilateral exophthalmos: (J29.16.w2)

Differential diagnoses of bilateral exophthalmos: (J29.16.w2)

  • Transient, associated with fear or stress.
  • Mediastinal masses.
  • Medical treatment Antibiotic treatment is unlikely to be curative without surgery. (J29.16.w2)
    • Antibiotic-impregnated beads may be implanted. (J29.16.w2)
  • Surgical removal.
    • In early cases, a periocular approach to the abscess may allow the eye to be saved. (J29.16.w2)
    • In later cases, with ocular damage (usually ulcerating keratitis and panuveitis), radical surgery, removing all the contents of the orbit (complete orbital exenteration) as well as extracting associated teeth and draining the orbit. (B601.12.w12, J29.16.w2)
      • Note: rabbits have a large venous sinus closely associated with the glands of the orbit, which will haemorrhage if punctured. (B600.11.w11)
      • Haemorrhage should be expected. Control with bipolar radiosurgery, pressure or gel foam or bone wax applied to the orbital wall where vessels are bleeding. (J29.16.w2)
    • Post-surgical treatment:
      • The orbit can be packed with Iodophor-impregnated gauze [later removed]. (J29.16.w2)
      • The abscess may be treated by marsupialization combined with topical treatment. (J29.16.w2)
      • Placement of antibiotic-impregnated beads into the orbit may be useful. (B531.16.w16, B601.12.w12)
      • Use of calcium hydroxide paste (high pH therefore bactericidal) in the orbit may be useful. (B531.16.w16, B601.12.w12)
  • Note: even with radical surgery the prognosis is guarded to poor. (J29.16.w2, J215.11.w2, V.w133)
  • Long-term management, with initial surgery, is possible in some cases: (J213.9.w3) 
    • In one described case, treatment involved removal of involved teeth via an intraoral approach, which drained a large amount of purulent material. Three days later, an external approach was made to the abscess, with curettage of lytic bone of the maxilla and removal of the contents of the abscess, including the remains of one molar, using a small bone curette introduced through the hole in the maxilla; a rigid 2.7 mm endoscope was used to visualise the abscess and facilitate accurate debridement. The area was flushed with sterile saline and Gentamicin-impregnated PMMA beads were introduced (see: Production of Antibiotic-Impregnated Beads) before the facial incision was closed. As well as postoperative analgesia, long-term antibiotic treatment was given (based on culture of Bacteroides). A further operation was carried out seven months later to remove more diseased teeth and a migrating PMMA bead, with the deficit being filled with a polymer gel containing Doxycycline. Ongoing treatment included coronal reduction of the opposing cheek teeth, periodic cleaning out, flushing and refilling of the abscess cavity with doxycycline-containing gel, and long-term antibiotic (procaine Penicillin G, twice weekly) and NSAIDs analgesic (Meloxicam) daily). Note: this treatment was not curative, but had allowed the rabbit to have a good quality of like (bright, with good appetite and normal digestion) for more than 18 months. (J213.9.w3)
Associated Techniques
Host taxa groups /species
Disease Author Debra Bourne MA VetMB PhD MRCVS (V.w5)
Referees Sheila Crispin MA VetMB BSc PhD DipECVO DVA DVOphthal FRCVS (V.w130); Dr David L Williams MA VetMB PhD CertVOphthal FRCVS (V.w133)

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