DISEASE SUMMARY PAGE

Dacrocystitis in Rabbits

Dacrocystitis. Click here for full page view with caption Dacrocystogram. Click here for full page view with caption Dacrocystitis. Click here for full page view with caption

Summary Information
Diseases / List of Miscellaneous / Metabolic / Multifactorial Diseases / Disease summary
Alternative Names See also:
Disease Agents
  • Pasteurella multocida infection can cause primary bacterial dacrocystitis. (B600.11.w11, B528.14.w14, J3.122.w3)
  • Usually secondary to nasolacrimal duct blockage associated with dental disease. (B600.11.w11, J29.16.w2, J513.4.w2)
    • The rabbit has only a single, ventral, lactrimal punctum and the nasolacrimal duct has a somewhat tortuous route with sudden narrowing at certain points. (B601.12.w12)
    • There is narrowing where the duct passes through the lacrimal foramen, and where the duct curves round to pass between the root of the maxillary incisor and the palatine bone: this second point of narrowing is the most common site for blockage. (B600.11.w11, J29.16.w2)
    • When the duct is inflamed, the consistency of the lacrimal secretion changes and the viscid, gritty secretion can block the duct at the flexure; this is more likely when the tooth root is elongated. (B600.11.w11)
    • The portion of the duct proximal to the obstruction becomes dilated and filled with mucopurulent material. (B600.11.w11)
      • With proximal blockage, the lacrimal sac becomes enlarged and distended with pus. (J29.16.w2, J513.4.w2)
    • There is secondary bacterial infection. (B600.11.w11)
    • Reduced drainage of the conjunctival sac allows accumulation of bacteria and development of inflammation and infection. (B600.11.w11)
    • In advanced disease of the cheek teeth, the elongated maxillary premolar roots may distort and enter the maxillary bones; bony reaction round the roots may impinge on the nasolacrimal duct passing through the nasolacrimal bone. (B600.11.w11)
    • Abscesses around the roots of the elongated upper premolars can block the nasolacrimal duct. (B600.11.w11)
    • When the roots of the upper molars become elongated they may grow into the lacrimal gland at the base of the orbit. (B600.11.w11)
      • Tear production from the gland may decrease at this time. (B600.11.w11)
    • Alteration in eye position associated with elongated molars may interfere with drainage, making infection more likely. (B600.11.w11)
    • Elongated roots of the maxillary incisors commonly impinge on the nasolacrimal duct. (J513.4.w2)
    • Note: the nasolacrimal duct may become obstructed or distorted at several sites due to changes in the roots of several maxillary teeth at the same time. (B600.11.w11)
    • The nasolacrimal duct may become severely dilated and full of mucopurulent material:
      • Dilatation of the maxillary portion of the nasolacrimal duct may result in a lateral bulge in the cribriform side if the mandible. (B600.11.w11)
      • Infection may erode through from the nasolacrimal canal to the nasal cavity; at this point drainage improves and discharge of material into the eye stops. (B600.11.w11, J513.4.w2)
Infectious Agent(s)
Non-infectious Agent(s) --
Physical Agent(s) --
General Description
  • Unilateral or bilateral. (J3.122.w3)
  • Ocular discharge and epiphora: clear to milky, mucoid, mucopurulent or thick purulent. (B600.11.w11, B601.12.w12, B528.14.w14, J3.122.w3, J29.16.w2, J513.4.w2) The discharge:
    • Is particularly seen at the medial canthus. (B600.11.w11,  J29.16.w2)
    • Can be malodorous. (B600.11.w11)
    • May be profuse. (B600.11.w11)
    • Man be longstanding. (J3.122.w3)
  • Associated conjunctivitis, usually ventral. (B600.11.w11, J3.122.w3, J29.16.w2)
  • Sometimes ventral keratitis and corneal oedema, due to the constant discharge of purulent material onto the cornea. (B600.11.w11, J3.122.w3, J29.16.w2)
  • Corneal ulceration in severe cases. (B600.11.w11, J29.16.w2) See: Corneal Ulceration in Lagomorphs
  • Associated facial alopecia and dermatitis due to scalding from epiphora. (B601.12.w12)
Pathological findings

Histopathology

  • Nasolacrimal duct: focal erosions, submuocal inflammatory cell infiltrate (lymphocytes, macrophages and heterophils). (B600.11.w11)
Further Information
Susceptibility
  • Common in dwarf rabbits. (B601.12.w12)
Diagnosis
  • Clinical signs.
  • Presence of mucopurulent material coming from the nasolacrimal punctum or discharging under slight digital pressure on the ventromedial orbit. (B600.11.w11, B601.12.w12, J3.122.w3, J29.16.w2)
  • Lacrimal sac may be visibly/palpably distended with pus. (B600.11.w11, J3.122.w3, J29.16.w2)
  • Flushing of the nasolacrimal duct. Appearance of purulent material around the cannula indicates dacrocystitis, while absence of such material suggests that this condition is not present. (B601.12.w12)
  • Clear discharge and epiphora without signs of infection may occur if the duct is blocked by sterile oil droplets. (B601.12.w12)
  • Gram staining, bacterial culture and sensitivity testing of swabs from the conjunctival sac and of material expressed from the nasolacrimal duct. (J3.122.w3)
  • Radiography: 
    • To assess the teeth, showing any dental abnormalities which may be interfering with the nasolacrimal apparatus. (B600.11.w11)
    • Contrast radiography of the nasolacrimal duct using iodinated contrast medium. (B600.11.w11)
      • A dilute preparation (e.g. sodium/meglumine iothalamate, Conray 280) is cheap and easy to inject into the duct.
      • A concentrated solution is harder to inject but provides a clearer image, and for a longer period of time.
      • A good image of the duct is harder to achieve if the duct is normal since it passes through to the nose where it may be inhaled into the nasal passages, resulting in superimposition on the radiographic film.

      (B600.11.w11)

Treatment
Flush the nasolacrimal duct
  • This removes infected material from the duct, can be curative for primary bacterial infections and assists with treatment of infections secondary to dental disease. (B600.11.w11)
  • Apply a topical ophthalmic anaesthetic solution to the eye if the rabbit is conscious. (B528.14.w14, J34.24.w3)
    • Proparacaine or bupivacaine into the lower conjunctival sac, one minute before cannulation starts. (J29.16.w2)
  • Preferably place the rabbit under general anaesthesia; this procedure can be very stimulating and distressing for the rabbit. (B600.11.w11, J513.4.w2)
  • Use a nasolacrimal cannula or a 18 - 22-g short intravenous catheter (J34.24.w3) 22 gauge (J29.6.w2) or 23 gauge nasolacrimal cannula. (B601.12.w12) A cat catheter can be used in large rabbits. (B600.11.w11) A metal cannula can be used, but increases the risk of iatrogenic damage to the lacrimal sac and nasolacrimal duct. (B600.11.w11) 22 gauge intravenous catheter. (B528.14.w14, J29.6.w2)
  • Insert the cannula into the punctum lacrimale (lacrimal punctum)- the single nasolacrimal ostium which is deep in the craniomedial portion of the lower conjunctival sac. (B528.14.w14, B600.11.w11, J34.24.w3) 
    • Gently evert the lower eyelid to separate the third eyelid from the eyeball, exposing the puncta. (B600.11.w11, B601.12.w12)
    • Use forceps if needed to keep the lid away from the eyeball. (B600.11.w11)
    • Use digital pressure ventrally on the lower eyelid to open the lips of the duct opening. (B601.12.w12)
    • Insert the cannula through the punctum and into the lacrimal sac. 
    • Cannulation may be difficult in cases with severe hyperaemic/hyperplastic conjunctivitis. (B601.12.w12)
  • Gently flush the duct using warm sterile water, saline or dilute antibiotic. (B600.11.w11, B528.14.w14, J34.24.w3) in a 5 mL syringe. (J29.16.w2)
    • Initially there may be resistance from a plug of mucus or pus. (J34.24.w3)
    • Initially, debris comes out of the lacrimal punctum. (J29.16.w2)
    • Gentle pressure on the lacrimal punctum helps force fluid down the nasolacrimal duct. (B600.11.w11)
    • Note: Excessive pressure may rupture the lacrimal sac, with irrigation fluids being forced into the periorbital tissues. (B600.11.w11, J29.16.w2)
      • This fluid is generally absorbed over a few hours. (J29.16.w2)
  • If necessary, to flush the maxillary portion of the duct, pass the cannula through the lacrimal foramen.(B600.11.w11)
    • This cannot be carried out in a conscious rabbit. (B600.11.w11)
    • Always use a plastic catheter. (B600.11.w11)
    • Gently manipulate and direct the catheter through the lacrimal foramen
  • At the end of the procedure, instil antibiotic drops. (J29.16.w2)
  • Repeat every 1 - 7 days as required. (J34.24.w3) Twice a week. (J29.16.w2)
    • Note: Repeated cannulation in the conscious rabbit may be distressing to the rabbit. (B600.11.w11)
  • Retrograde flushing: In severe cases it may be necessary to flush the duct retrograde, from the nose. (B600.11.w11, B601.12.w12)
    • This can be difficult; the narrow aperture is not easy to find. (B600.11.w11)
Medical treatment
  • Following flushing of the nasolacrimal duct, topical antibiotics should be given. (B531.16.w16)
  • Systemic treatment with an appropriate antibiotic for control of Pasteurella multocida infection. (B528.14.w14)
  • Systemic Enrofloxacin 10 mg/kg twice daily intramuscularly or orally. (J29.6.w2)
  • For long-term control of infection, lifelong systemic antibiotic treatment may be given, e.g. enrofloxacin, 5 mg/kg in drinking water. (B601.12.w12)
  • Note: medical treatment may be curative with primary bacterial dacrocystitis, but is usually only palliative where the condition is associated with underlying dental disease. (J29.16.w2, J513.4.w2)
    • In rabbits with primary Pasteurella multocida dacrocystitis, irrigation with saline (repeated weekly for two to four flushes) followed by topical treatment with 1% Oxytetracycline hydrochloride ophthalmic ointment, applied four times daily, was effective in some rabbits. In others, irrigation of the nasolacrimal duct with 1% oxytetracycline in sterile water, weekly, was effective after two or three weeks. (J3.122.w3)
Additional treatment:
  • In chronic disease, repeated use of digital pressure to squeeze purulent material out of the lacrimal sac is useful. (B600.11.w11)
  • The rabbit's owner can massage over the lacrimal sac regularly to encourage movement through the duct; this can be carried out two or three times a day. (B600.11.w11, J513.4.w2)
  • Note: Rabbits which are bonded to one another will groom each other; for a rabbit with chronic dacrocystitis, it is beneficial to have a bonded companion which will clean the face and eyes of the affected rabbit. (B600.11.w11, J513.4.w2)
  • Removal of the incisors has been suggested but can be difficult - the crowns may fracture, and removal of diseased roots is difficult. (J513.4.w2)
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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