URGENT: suspected retrobulbar abscess and protruded eye

Question
QUESTION: My rabbit, Ball is a domestic breed spayed female who is now 7.5 years old. She developed a swelling at her right eye corner on Monday night and soon become nastily big despite that the vet gave her bicilin ( injection) Metronidazole 0,85 ml （2xday） and Meloxicam 0.11ml (2xday) since Thursday. I  went back to the clinic today and he recommended eye removal followed by putting antibiotics in the orbit for a period of time. To be honest, it sounds like a long term battle with a lot of surgical procedures (weekly, they reckon) and pain.

I am struggling whether I should let her go now or going for the surgery with a lot of risks. How much pain she will have after the operation and what are the chances that she could survive sedated procedure weekly?

All the blood work is normal and she could still eat with supplementary critical care.

I am from Hong Kong and really desperate to hear some expert comments from you, thanks.

ANSWER: Dear Erica,

Our Maggie was 8 years old when a retrobulbar abscess made enucleation of her eye and packing with antibiotics and 50% dextrose (twice a day) necessary.  She survived the surgery and the post-op treatment, which was hairy for two weeks.  But she lived to be 15.

She had been very aggressive--borderline psychotic!--before the surgery, all her life.  Once the abscess was gone, she started to sweeten up.  We often wonder if she'd had something "cooking" back there all her life, making her nuts.  And when it was gone, she finally had a good quality of life.  She was very loving and sweet in her last years, and we never regretted putting her through a couple of weeks of hell, since she lived so long and so happily.

I know not every case will turn out as well as Maggie's.  But if your bunny is a relatively good risk for surgery and you trust the skill of the vets doing this procedure, then it is worth a try if you're willing.

Just my opinion, for what it's worth.

Dana

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

QUESTION: Dear Dana

Thanks so much for your speedy reply, I really appreciated it. In Hong Kong, there are not many vets specialized in rabbit medicine but the one I go to is about the best available. So I have no choice but to put my trust in their hands.

My concerns the post-op care and for how long it will last. I do not want to put Ball through hells of pain. The vet said that he could not say for sure but it could take months! If that is the case, then I think Maggie was very fortunate indeed as 2 weeks were a lot more tolerable than months. Right now Ball is ok with good blood work results and ok appetite and she has been a happy and healthy bunny since we have had her 7.5 years ago.

Do you know the length of time in general for administration of packed antibiotics in the orbit? What would be the kind of antibiotic used for this type of abscess? I researched a fair bit of articles on the net but the results are not conclusive.

Despite the doubts and worries I have, your reply gives me a lot of encouragements and I am a bit more sure that Ball deserves a chance of trying. Thanks so much.
Also, why the use of dextrose?

Answer
Dear Erica,

Actually, Maggie's eye socket was packed with 50% dextrose-soaked gauze wet-packs which were changed twice daily for the first week (under anesthesia, as this can be painful), and then once daily for another week.  We did not implant antibiotic beads.  (In my experience, those beads just form a nidus for further infection.  Maybe the vet who did ours was not competent--and I have plenty of reason to suspect that--but it never worked well for us.)

The 50% dextrose is an extremely hypertonic solution that kills bacteria osmotically.  Unlike antibiotics, dextrose is not something the bacteria are likely to quickly evolve resistance against.  It's sort of a napalm strike.  But it requires aggressive treatment:  if you don't change the dressings, the sugar solution will gradually dry out and dilute, and it can actually be a pretty good bed for bacterial or fungal growth.  Not in a day, but if you leave it too long without changing, you're asking for trouble.

I know this is a big decision.  The good news is that if the eye is removed, the abscess can be sampled for culture and sensitivity.  This will tell the vet which antibiotics will be most effective against it.  So a combination of oral or injected antibiotics plus the dextrose packing (if your vet thinks this is a good idea) might be the way to go.

Obviously, plenty of analgesia.  Metacam is good, but ask about Tramadol, as well.  And if the pain is severe, then buprenorphine, or even morphine, can help him get through the worst part, at the start of the treatment.

I hope all goes well.

Dana