PRESENTING SIGNS

Dacryocystitis, inflammation of the nasolacrimal system, is frequently encountered in rabbits and can be a frustrating condition to manage. Since the aetiology and prognosis are different from dogs (and cats) the condition is being discussed separately. Most rabbits present with unilateral disease but on occasion it can be bilateral. The owners bring the rabbit along because the eye has a nasty discharge. This is usually a thick, whitish, sticky material and can be copious. The medial canthal fur is typically wet and matted and sometimes the rabbit is unable to open the eye as the discharge sticks the lids closed. Sometimes the animal will also show evidence of dental disease, with excessive drooling, anorexia with weight loss and grooming problems (leading to caking of the faeces and so on).

CASE HISTORY

The condition is normally quite gradual in onset – the owners might have been aware that the eye was a bit wet or mucky for several days, or that the rabbit had been off its food for example. There is not normally any specific history suggesting a primary infectious agent (such as the introduction of a new rabbit to the environment). The condition may have occurred previously and if this is the case the owner is more likely to present the rabbit earlier in the course of the disease.

CLINICAL EXAMINATION

Ophthalmic examination will confirm the presence of a copious mucopurulent discharge centred around the medial canthus (Figure 19.1). Samples should be taken for bacterial culture and sensitivity (although samples from nasolacrimal flushings will be more representative – see below). The discharge can then be gently removed, including from the ventral fornix, with damp gauze swabs to facilitate examination. Conjunctival hyperaemia is normally present, often more severe at the medial canthus. Gently pressing the area will result in pus appearing from the single ventral nasolacrimal punctum. The cornea should be evaluated and fluorescein dye used – some patients will have ventromedial corneal ulceration present (presumably related to excoriation by the discharge). Intraocular contents are normally unremarkable although a mild reflex uveitis can be present.

Figure 19.1 Rabbit with copious white purulent discharge and fur matting around the medial canthus.

General clinical examination should pay particular attention to the teeth. Overgrowth of both incisor and molar teeth can be the primary problem, as can generalized hyperparathyroidism due to imbalance in the calcium metabolism – often diet related and resulting in poor skull calcification. The rabbit’s bodily condition should also be assessed.

CASE WORK-UP

The most important diagnostic test, which is also an important part of treatment, is to perform a nasolacrimal flush in exactly the same way as in dogs. Most rabbits tolerate this conscious (Figure 19.2). This will differentiate dacryocystitis from a solely conjunctival disease and samples can be obtained for bacterial culture and sensitivity. Once the discharge has been bathed away, including pressing at the medial canthus a couple of times and removing the extra discharge thus produced, topical anaesthetic is instilled into the conjunctival sac. The ventral punctum is cannulated (rabbits do not have an upper punctum) and sterile saline is gently injected. It is likely that initially there will be marked resistance and backflow of purulent discharge around the cannula. However, with repeated gentle attempts hopefully the discharge will be loosened and milky fluid will drip from the ipsilateral nasal punctum. Further flushing and treatment is described below.

Figure 19.2 Nasolacrimal cannula in place in the sole ventral punctum prior to flushing (the discharge has been bathed away to facilitate localization of the punctum).

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