eye infection from cat scratch

Question
My rabbit had her upper eyelid scratched by my cat. She became septic within
24 hours, was treated with IM baytril and recovered, only to have the area
around the eye become badly infected, with thick pus. She is on cefazolin and
ciloxin eye drops, Pen G injections, and I'm applying Fucithalmic to the area
around her eye.  I'm also putting in Alcaine eye drops to decrease pain, and
flushing the eye with saline once a day. Because the eyelid can't close fully,
I'm applying a thick,lubricating gel.  She's also receiving Metacam for pain
and I'm giving her s/c fluids. She will occasionally nibble a lettuce leaf but
other than that she's not eating much. She is still pooping, although tiny little
fecals and cecals. The newest problem is that she's doing some mouth-
breathing - I think that's why she doesn't want to eat. I don't think the mouth
breathing is because she's dying, but because of some blockage in her nasal
passages or sinuses, presumably related to the eye infection. Because of this I
can't force-feed her. I've read about rabbits having nasolacrimal flushes done
- would this be an appropriate treatment in her case? If so, is it done under a
general anaesthetic?

Thanks,
Krista and Buttercup

Answer
Dear Krista,

Poor Buttercup!  I'm glad she has such a caring "mom" who's doing so much to make her feel better and heal soon.

The mouth breathing doesn't sound good.  Since she was septic before, there's still a possibility that the infection is in her lungs.  Was a culture done on the pus, or abscess capsule?  It's likely that the causative pathogen is Pasteurella or Bartonella, which should be sensitive to Pen-G, as well as to the fluoroquinolones (e.g., Baytril, ciprofloxacin, marbofloxacin).  

I would get her back to the vet for a listen, and possible chest radiographs to be sure she doesn't have pneumonia, which might necessitate nebulization with oxygen and a "cocktail" of saline, antibiotics (we use amikacin), aminophylline, and Mucomyst.

If the abscess has entered her sinuses, and is blocking her nasal passages, then the vet really needs to know about this and prescribe additional treatments.  If the nasal mucosa are just swollen, then Benadryl pediatric drops might help reduce that and allow air to flow more freely.  But this sounds more serious, and I would worry that the abscess is spreading, perhaps because the resident bacteria are not sensitive to the antibiotics now being used.

If at all possible, I would have a culture done:

www.bio.miami.edu/hare/culture.html

and ask about going back to a fluoroquinolone (perhaps marbofloxacin), since that worked before.

If her poops are getting smaller, her GI tract might also be shutting down from the stress.  Please read:

www.bio.miami.edu/hare/ileus.html

and, if your vet is not familiar with this in rabbits, you might want to share:

www.bio.miami.edu/hare/ileus.pdf

if the vet is amenable to getting information from internet strangers.

A nasolacrimal duct flush should not be done under general anesthesia, since the rabbit needs to be able to sneeze out the liquid that enters her mouth from the flush.  But this is usually done only to ease runny eyes, and doesn't sound as if it's something that would help in Buttercup's severe case.

I hope she will recover soon, and know that her best chance is with your loving nursing care.  I'm sending lots of healing vibes.

Dana