4 year old Rabbit with Corneal Ulcer. What to do?

Question
Hi Doctor Krempels. In September, I noticed my rabbit having an irritated eye. We treated him Polysporin drops (containing polymyxin B and gramicidin) like we did all the three times he's had it before. Except, this time the irritation (tears, redness,discharge) didn't go away so quickly. So we took Chucki to the vet. He gave us Tobrex 0.3% (containing Tobramycin 0.3%). We used this antibiotic during the first time Chucki got congivitis. Before, it had worked really quickly and cured him within 3 days. However, this time, the Tobrex drops didn't work either. So we took him back to the vet. The vet doesn't know what to do anymore.
Right now, it looks like there's a transparent rip on my rabbit's eye surface. When I looked at his eye under the light, the surface isn't smooth. I did some research and think that it's a case of Corneal Ulcer. I read the causes, and they make sense; Chucki has always liked to scratch his eyes when he's cleaning.
I also read that a e-collar might help to prevent "self-trauma for the eye." I made him a cardboard e-collar, but he found a way to get out of it. I really don't know what to do now. I read your post earlier saying that rabbits shouldn't wear e-collars. In that case, how do I keep him from touching his eye so much? And I think another ulcer might be developing in his right eye as well. Please give me some valuable advice. I really want to save my bunny from blindness. Thank you.

Answer
Dear Miranda,

Chucki might have been scratching at his eye to soothe the irritation of the eye, and maybe didn't *cause* the problem that way.  It's very unlikely that he is mutilating himself.  

You need to see a veterinary ophthalmologist, if possible.  But if that's not possible, then please ask your vet about adding the following to the treatment:

1.  continue the tobramycin drops, or switch to gentocin and/or ofloxacin ophthalmic drops
2.  add miconazole (Monistat) cream to contain any fungal pathogens (common)
3.  add EDTA (ethylenediaminetetraacetic acid) to help stimulate corneal tissue repair
4.  add atropine to help stop intra-ocular muscle contractions (atropine will temporarily paralyze these muscles), which will aid in pain relief.  (Note:  many rabbits have an enzyme (atropinase) that inactivates atropine, but this varies.  Many rabbits can get good relief from atropine.)

Also ask about metacam for general pain relief.

We have found that there's never been a corneal lesion that didn't heal with the above regimen.  If this doesn't work (it can take a couple of weeks), then the cornea might need to be gently debrided (with topical anesthetic, of course!), and if THAT doesn't work, then the eye can be very carefully sutured shut (making sure NO sutures come through the eyelid and touch the cornea, which would just make things worse), leaving just a posterior space where you can administer the meds.  The eye can ten be opened up a couple of weeks later once the cornea is fully healed. But you probably won't need to resort to that.

Make sure anything put in the eye is *very* sterile, as the eye is an immunologically "privileged" site with little vascularization.  That's why it's important to hit all possible pathogens, bacterial and fungal, while the cornea repairs (with a little help from EDTA).

Hope this helps!

Dana
P.S. - All these treatments were taught to us by our wonderful veterinary ophthalmologist, Dr. Lorraine Karpinski.  She is AWESOME!