Undiagnosed Epiphoria in my Mini-Rex

Question
QUESTION: In June, 2015, my rabbit was treated for Coccidia with a course of Albon.Afterwards, he started to tear from his left eye.He was then treated with a double course of Orbax, but only got worse.Then he was given Olfloxacin drops, but got worse after a few days, so I stopped them.He had a thorough check in January, 2016 with Xrays for abscesses and tooth issues, culture of the tears, which was negative for Pasturella and other bacteria that would cause tearing, and was also checked for UTI and kidney stones, which he does have but that are non-obstructive.My vet is clueless.Could it be a clogged duct, even though she saw nothing on the Xrays?If there is no cure,what palliative care can I do?I'm wondering, if the culture was negative, could he still have bacterial overgrowth that might be treated with CombiPen?

ANSWER: Dear Denise,

This is a relatively common problem, especially once a rabbit gets to be 3-4 years old or more.  Please read this:

http://www.bio.miami.edu/hare/weepy.pdf

and regarding the most common cause:

http://www.bio.miami.edu/hare/dental.html

It takes a real expert to interpret a head radiograph on a rabbit; a vet with a lot of experience can spot problems with the tooth bases (rabbit teeth don't actually have true roots) impinging too far into the skull and pinching off the tear duct.  There's no cure, but palliative care can make bunny's eye much more comfortable.  (We have a bunny with epiphora and we were washing her face twice a day until we found her a loving mate who now kisses her eyes clean for us!  Just a thought...)

It would not hurt to have a second opinion from a rabbit-savvy vet, and you might be able to find one near you here:

http://www.rabbit.org/vet

I hope this helps.

Dana

---------- FOLLOW-UP ----------

QUESTION: Thank you for answering my question.I forgot to mention that my bun got Bactrim in January for 10 days after the checkup,again with no help.Both of my vets are Exotic Vets, trained at Univ.of PA,so I'm assuming they ruled out the eye&tooth issues mentioned in the links.My concern is he is now very congested,sneezes,sometimes whimpers when he eats, and is breathing heavily if active.I'm afraid he'll develop pneumonia,a tear duct infection,or conjunctivitis.If he's allergic to something,can I give him an antihistamine?It just came on suddenly,after treatment with antibiotics,so I'm suspecting an infection that isn't responding to the usual treatments.Could I try a course of Combi-Pen.My rabbit rescue lady does 0.1ml/lb/1X/day for 21 days subQ.She says it always works for her buns.

ANSWER: Dear Denise,

Don't assume your vets are aware of the dental/epiphora connection.  Please feel free to share the link I sent previously with them.  You'd be amazed at how many experienced vets attend talks at the various large veterinary conferences about these dental issues and are completely unaware beforehand, as evidenced by the questions at the end of the talk!

Dual-acting penicillin G procaine/benzathine is often an excellent antibiotic to try for head infections, though not all bacteria causing them may be sensitive to it.  You also run the risk of selecting resistant bacteria, but that's a risk you take with just about any antibiotic.  I would not do it for a shorter course than 14 days (50,000-80,000IU/kg once every 48 hours).   And of course in consultation with your veterinarian.

I would not use nasal sprays or antihistamines except as a last resort, if he really cannot breathe through his nose.  If you see him mouth-breathing, it's big trouble.  In such cases, we have instilled a drop of Afrin (regular, not extra strength or anything fancy) into each nostril and have been able to provide relief.  But beware of the possible "kickback" of increased congestion when the drops wear off.  :(

I hope this helps.

Dana

---------- FOLLOW-UP ----------

QUESTION: Thank you,again,for answering.Both vets went for the teeth first and ruled out any issues.I would only use the CombiPen as a last resort.I am a pharmaceutical chemist and would like to give him an antihistamine to lessen the production of mucous and tears, to see if the tear ducts will clear and the issue will resolve.The reduced mucous production would also prevent mucous from going into the lungs and causing pneumonia.Just wondering if a pediatric dose for an 8 pound baby would work. I know that, due to a rabbit's system,you need to give some doses of meds, like aspirin, at a very high dose.I agree, that I'd rather not give a decongestant, due to the rebound effect.Any advice about the use of an antihistamine would be very helpful. Thank you.

Answer
Hi, Denise

I've never used it, but know that some people have good success with pediatric Benadryl.  Unfortunately, because I've never used it, I don't have a dose.  

If you suspect that this problem is due to bacterial overgrowth, then the dual-acting penicillin might be a good thing to try, since an antihistamine is going to treat only the symptoms/signs, and not address the underlying problem.

Just a thought...

I can get a dose of Benadryl for you, if you decide you want to use that.

Dana