Eye infection/drainage

Question
"My house rabbit (Lionshead/female) has had a terrible infection which drains from her right eye. When I press under her eye, towards the corner it just flows out in a large quantity. It started about 4 months ago, I noticed her right eye appeared to be very watery and she didn't seem able to see from that eye. I immediately took her to the vet, but they didn't see anything. Several days later when I was examaning her eye, I pressed around it and to my horror it was like an explosion of this thick pus. It's been like that ever since even though the vet has run her through numerous different antibiotics that I dutifully administer twice a day. Last month she nearly lost this eye because the pus had eaten away a large part of the cornea, leaving an open hole all the way through the cornea. This has healed with an antibiotic ointment, although I doubt she sees very clearly out of it. Anything you can suggest would be most appreciated. I've nearly 1000.00 dollars in this eye infection treatment and don't seem to be any closer to clearing it up. She will finish up this latest round of meds this Friday and it's just as bad, the drainage and smell of the drainage is horrible.  I just don't know what else to do  

Answer
Dear April,

Okay, first question:  was the pus ever sampled and sent off for culture and sensitivity testing?  This is *essential* for choosing the right rabbit-safe antibiotic.  Please read about this here:

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

From your description, I'd say there's about a 99% chance that this is a molar root abscess.  If so, and if the bacteria in the culture are sensitive to the penicillins, then I would *strongly* recommend that you ask your vet about putting your bunny on bicillin injectible (this is Penicillin-G Procaine with Benzathine added, and it has a longer "hang time" in the body than regular penicillin.  This is one reason it tends to be *very* effective against head abscesses.).  You can read more about this here:

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

In this article is a link to an excellent published article on jaw abscess bacteria and antibiotics.  Please print and give it to your vet.  Note that the one antibiotic mentioned as 100% effective against jaw abscesses in rabbits is clindamycin.  However, this can be administered *ONLY* in the form of antibiotic-impregnated resin beads, and not orally.  Clindamycin, like oral penicillins, can be fatal to rabbits because they kill the beneficial intestinal flora, allowing very harmful ones to overgrow.  So if the vet wishes to try clindamycin and is *not* aware of this, be sure s/he knows.

If you feel your present vet is not very experienced with rabbits (and most dog/cat vets merely dabble in rabbits; for something like this, you really need someone who is *very* experienced with rabbit medicine, and particularly with dental problems), you can find another one here:

www.rabbit.org/vets

If the pus is very stinky, it could be Pasteurella, Pseudomonas, or any number of others.  This is why it's very important to have the culture and sensitivity test done.

The corneal problem is another complication that can make this a real mess.  Rabbit corneas heal very slowly, and sometimes there is permanent scarring if the original lesion was severe.  Is the corneal ulceration fine now?  If you're still dealing with this, it might be a job for a veterinary ophthalmologist who can actually anesthetize the eye and debride the dead cells from the surface. This allows the cornea to heal properly, with less scarring.

But the main problem here is almost undoubtedly a very infectetd molar root and the inflammation and pus are blocking her tear duct.  A tear duct flush might help, but only treatment with the appropriate systemic antibiotics are going to permanently solve this problem.

Note that even with bicillin, complete resolution of a head abscess involving the molars can take several weeks, or even months.  The protocol requires one injection every other day of 50,000 - 75,000 IU bicillin per kilogram of bunny.  Expressing the pus (as you have been doing) can help keep things manageable, and warm compresses on the affected eye will help keep her comfortable, and help keep the pus liquid enough to gently express.

I'm sorry you're having such an awful problem, but this *is* treatable, especially with bicillin.  I would definitely give this a try, even if you already have done it, but didn't keep up the shots for a full 8 - 10 weeks.  We have seen utterly miraculous recoveries from horrific jaw abscesses with this treatment, but it requires patience and diligent husbandry.

I hope this helps.  Please write back if you have any other questions.

Dana