DISEASE SUMMARY PAGE

Keratitis and Corneal Ulceration in Lagomorphs

Click here for full page view with caption. Plasmalymphocytic keratitis in a rabbit.

Summary Information
Diseases / List of Miscellaneous / Metabolic / Multifactorial Diseases / Disease summary
Alternative Names Ulcerative keratitis

See also:

Disease Agents
Infectious Agent(s) --
Non-infectious Agent(s)
Physical Agent(s)
General Description
  • Keratitis may occur secondary to chronic bacterial conjunctivitis (Conjunctivitis in Lagomorphs). (J4.189.w15, J83.13.w2)
  • Significant keratitis may occur with Dacrocystitis in Rabbits; ulceration in the medioventral quarter of the cornea is also common in association with dacrocystitis. (J29.16.w2)
  • Simple corneal ulcer may be seen following trauma. (B601.12.w12)
  • Deeper ulceration with stromal abscessation usually is associated with trauma such as partial penetration of the cornea by a shaft of hay or straw. (B601.12.w12)
  • Persistent superficial erosion of the corneal epithelium may occur. (B601.12.w12)
Clinical signs
  • Epiphora, blepharospasm, hyperaemia of the conjunctiva. (B602.39.w39, J29.16.w2, J213.5.w2)
  • A defect may be visible in the corneal stroma. (J213.5.w2)
  • May be purulent secretion from the eye. (J29.16.w2)
  • Internal ocular signs such as uveitis may be present. (J29.16.w2)
  • With an infected ulcer:
    • Corneal ulcer which may be large, yellow and necrotic. (B600.11.w11)
    • Surrounding cornea inflamed and opaque. (B600.11.w11)
    • Conjunctiva inflamed and bright red. (B600.11.w11)
    • Pain, blepharospasm, lacrimation. (B600.11.w11)
  • With indolent (non-healing) ulcer:
    • Epiphora, blepharospasm, hyperaemia of the conjunctiva. (B602.39.w39)
    • Undermined edges of epithelium and lack of vessels growing in from the limbus towards the ulcer. (J29.16.w2)
  • Corneal lesions similar to those seen in cats with eosinophilic keratoconjunctivitis may be present. (B531.16.w16)
Diagnosis
  • Clinical signs.
  • Ophthalmological examination. (J29.16.w2, J213.5.w2)
    • Topical application of fluorescein and slit lamp examination to show the depth and extent of the lesion. (J29.16.w2, J213.5.w2)
      • Non-healing ulcers are usually paracentral, shallow and have non-adherent epithelial edges. (B602.39.w39)
    • Sometimes miosis and aqueous flare may be seen due to associated uveitis. (J213.5.w2)
    • Note: Examination should involve diagnosis of the underlying cause (e.g. examination for aberrant hairs, tonometry to diagnose glaucoma, ocular ultrasound for detection of orbital abscess, flushing of the nasolachrymal duct for dacrocystitis). (B602.39.w39, J213.5.w2)
Further Information
Treatment
  • Treatment of the underlying cause. (J213.5.w2)
For a simple superficial post-traumatic ulcer:
  • Topical antibiotic application to avoid secondary bacterial infection; e.g. 0.5% Chloramphenicol, or neomycin-polymyxin B-gramicidin, 2 - 4 times daily. (B601.12.w12, J29.6.w2, J213.5.w2)
  • Atropine Sulphate, topically, as a mydriatic and cycloplegic (1%, four times daily). (J29.6.w2, J213.5.w2)
  • Autologous serum, 3 - 4 times daily; this contains beneficial growth factors.
  • Note: check healing after 24 - 48 hours to confirm appropriate progress. (J213.5.w2)
For deeper ulceration with infection or stromal abscessation: 
  • Under general or local anaesthesia, remove as much suppurative material as possible. (B531.16.w16, B601.12.w12)
    • Cytology, culture and sensitivity testing of suppurative material/ulcer bed. (B531.16.w16, B601.12.w12, J29.16.w2)
  • Repeated frequent topical application of an appropriate antibiotic (based on culture and sensitivity testing) for two to three weeks. (B531.16.w16, B601.12.w12)
    • Start treatment while waiting for results of culture and sensitivity testing. (J29.16.w2)
    • Apply topical antibiotic every 1 - 2 hours. (J213.5.w2)
    • Choose the antibiotic based on a Gram stain of a corneal scrape. (J213.5.w2)
    • Ciprofloxacin 0.3% is an appropriate initial antibiotic choice since it is active against Pseudomonas. (J213.5.w2)
  • Apply autologous serum frequently. (J213.5.w2)
  • Appropriate medical treatment is usually effective. (B600.11.w11) e.g.
    • Combination of systemic Cephalexin and topical cephalonium. (B600.11.w11)
    • Topical Fucidic Acid - Fucithalmin Vet (Leo Laboratories Limited). (B600.11.w11) Licensed for use in rabbits in the UK.
    • Gentamicin ophthalmic solution (Tiacil, Virbac). (B600.11.w11) Licensed for use in rabbits in the UK.
  • Consider use of an Elizabethan collar to reduce the risk of self-trauma to the eye. (J213.5.w2)
  • A conjunctival pedicle graft can be used if medical treatment fails. (J213.5.w2)
    • This is preferred to a third eyelid flap for deep and infected corneal ulcers. It provides better mechanical support to the cornea; a ready source of fibrovascular tissue for filling stromal defects; does not impede topical application of drugs; is thought to offer better anticollagenase and antibacterial activity; and allows frequent inspection of the ulcer. (J15.17.w4)
      • This is the treatment of choice. (V.w133)
    • A third eyelid flap has previously been recommended (B528.14.w14); this is an easier procedure to perform than a conjunctival pedicle graft. (J15.17.w4)
For persistent superficial erosion (superficial nonhealing ulcer):
  • Apply topical anaesthetic to the eye and remove the loosely-attached areas of epithelium (corneal debridement) using dry cotton-tipped applicators. (B531.16.w16, B601.12.w12, B602.39.w39, J29.16.w2, J213.5.w2) Following debridement:
    • Topical broad-spectrum antibiotic to prevent secondary bacterial infection. (J29.16.w2, J213.5.w2)
    • Topical atropine, every 12 hours for two days then every 24 hours. (J29.16.w2)
    • Topical autologous serum etc. may be useful. (J213.5.w2)
    • Tear replacement (e.g. Viscotears) may be a useful ancillary treatment. (B601.12.w12)
  • Further treatment if required:
    • Topical application of serum. (B602.39.w39)
    • Grid keratotomy. (B531.16.w16, B601.12.w12, B602.39.w39)
      • Note: The rabbit has a thin cornea. (B531.16.w16, B601.12.w12) [Great care is required in carrying out this procedure]
      • Preferable to punctate keratopathy due to the danger of puncturing the cornea; gauging depth is easier with grid keratopathy. (V.w133)
    • Multiple punctate keratotomy. (J213.5.w2)
      • Note: The rabbit has a thin cornea. (B531.16.w16, B601.12.w12) [Great care is required in carrying out this procedure]
    • Use of corneal glue. (B602.39.w39)
    • Tarsorrhaphy. (B602.39.w39)
    • Superficial keratectomy if other treatments have not been effective. (B531.16.w16, B601.12.w12, B602.39.w39)
      • Note: Care is required because the rabbit has a thin cornea. It is recommended that an appropriately-shaped instrument such as a crescent knife or a Martinez corneal dissector should be used. (B531.16.w16)

For corneal lesions similar to those seen in cats with eosinophilic keratoconjunctivitis. (B531.16.w16)

  • Topical Prednisolone acetate two to three times daily, tapering off once the condition resolves. (B531.16.w16)
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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