Abscess after eye removal - marsupialization?

[DemiS]

Elmo my 9 year old boy had his eye enucleated early June, unfortunately he went on to develop an infection in the surgical site and yesterday we noticed a large amount of puss escaping the area. The vet has suggested the best option other than PTS would be to open the wound up, giving it a good clean and performing a marsupialization where they essentially stitch the wound so that the cavity stays open whilst the edges heal. But that it could be a very long healing process and will need a lot of cleaning which he may not tolerate and could trigger stasis.

We are waiting for some more information on the procedure/aftercare from the head exotic vet, the vet we spoke to today had never personally performed this surgery on the eye area. Has anyone here got experience with this and the aftercare? He doesn't enjoy being handled at all but once I catch him he's fairly docile. He's generally a pretty tough bunny and will still be quite active and happy to eat despite the fact the abscess (and us encouraging it to drain) must have been extremely painful so unless the marsupialization procedure is much more painful than the enucleation then I'm not too concerned about stasis. But I don't want to put an elderly rabbit through a second surgery and a lot of aftercare if it's going to be really traumatic for him or there's a good chance it won't work

 

[Shimmer]

It's the usual option for treating abscesses. I've had 2 rabbits with marsupialisation their faces (cheek / jaw areas) for abscess treatment, after surgical removal of the capsule(s). It can look quite horrific, so you need to be prepared for that - but it isn't an issue for the rabbit - and probably looks no worse than enucleation. The lack of fur (as it's shaved for the operation) and a hole in the face isn't something most people are prepared for - you get used to it and the fur grows back.

It was some years ago, so I can't remember all the details. There were some anaesthetic drops to put in the hole before flushing and cleaning it out. Give the drops time to work (10 mins?), then flush with a 1ml syringe of (water / saline / dilute hibiscrub?). Pat dry and pack the wound with medical grade manuka honey. This was daily or twice a day. It does work. The rabbit does need to be handleable to allow you to do this, but they get used to it and you get better at doing it. If they are not going to sit still on your lap / worktop, etc, you could try an open top carrier - the eye area should be reasonably accessible.

Warm honey is easier to use. You don't need much. It does tend to run out of the hole as it warms up in the wound, but it's not a disaster if bunny grooms some off. I tended to use a 1ml syringe warmed in a cup of hot water, dried on some kitchen roll and then draw up the honey - so the syringe was warmed, rather than the bulk of the honey. Or warm the syringe with honey in your hand prior to use. (I was using a jar of standard high UMF manuka honey - the tubes of medical grade honey were not as readily available).

Abscesses are usually treated with injectable penicillin-based meds - which you can be shown how to do at home. It could be daily or less frequently. You would probably get some additional pain relief / anti-inflammatory as well (eg Metacam).

I do remember that one of the main issues was keeping the hole open to allow it to heal from the inside. It tended to scab over quite quickly, which then prevents drainage / flushing. Softening the scab makes it easier to remove, and it's easier to keep up to if you are diligent in stopping the external hole scabbing over.

It's easier if you are well prepared. Get everything laid out before you start, then get bunny.

 

[bunny momma]

I just want to send you and Elmo lots of positive vibes for a full recovery.

 

[DemiS]

It's the usual option for treating abscesses. I've had 2 rabbits with marsupialisation their faces (cheek / jaw areas) for abscess treatment, after surgical removal of the capsule(s). It can look quite horrific, so you need to be prepared for that - but it isn't an issue for the rabbit - and probably looks no worse than enucleation. The lack of fur (as it's shaved for the operation) and a hole in the face isn't something most people are prepared for - you get used to it and the fur grows back.

It was some years ago, so I can't remember all the details. There were some anaesthetic drops to put in the hole before flushing and cleaning it out. Give the drops time to work (10 mins?), then flush with a 1ml syringe of (water / saline / dilute hibiscrub?). Pat dry and pack the wound with medical grade manuka honey. This was daily or twice a day. It does work. The rabbit does need to be handleable to allow you to do this, but they get used to it and you get better at doing it. If they are not going to sit still on your lap / worktop, etc, you could try an open top carrier - the eye area should be reasonably accessible.

Warm honey is easier to use. You don't need much. It does tend to run out of the hole as it warms up in the wound, but it's not a disaster if bunny grooms some off. I tended to use a 1ml syringe warmed in a cup of hot water, dried on some kitchen roll and then draw up the honey - so the syringe was warmed, rather than the bulk of the honey. Or warm the syringe with honey in your hand prior to use. (I was using a jar of standard high UMF manuka honey - the tubes of medical grade honey were not as readily available).

Abscesses are usually treated with injectable penicillin-based meds - which you can be shown how to do at home. It could be daily or less frequently. You would probably get some additional pain relief / anti-inflammatory as well (eg Metacam).

I do remember that one of the main issues was keeping the hole open to allow it to heal from the inside. It tended to scab over quite quickly, which then prevents drainage / flushing. Softening the scab makes it easier to remove, and it's easier to keep up to if you are diligent in stopping the external hole scabbing over.

It's easier if you are well prepared. Get everything laid out before you start, then get bunny.

Thank you so much for the detailed response and advice. I've had a response from the head vet and I think we are leaning towards going ahead with surgery.

I've seen a few pictures so I'm expecting it to look pretty gnarly, although I've not seen any pictures of what it may look like once it's healed and fur grown back, do they end up with fur around the edge then just a furless hole in the middle? It's good to hear anaesthetic drops are an option, I'll definitely discuss this with the vet and it'll make me feel better if I know the flushing isn't causing pain. If he's tired he will sometimes just let me pick him up and not even attempt to run away but other times he will run and thump and hide, although once I get him he's quite calm. Maybe a small nip if I spend too long grooming him. When I tried to clean and express the abscess he got quite aggressive and tried to attack the towels/cotton pads so I'll probably get some thick gloves to protect myself, but despite being quite sore and upset he carried on munching banana so he obviously wasn't too traumatised.

They've suggested flushing twice daily and packing with manuka, I'll definitely ask about the anaesthetic drops and antibiotic injections. Do you remember how long you had to clean the wound until it healed?

 

[DemiS]

I just want to send you and Elmo lots of positive vibes for a full recovery.

Thank you I appreciate it

 

[tulsi]

Best of luck. Sounds like you are prepared. Really hope it all goes smoothly.

 

[Shimmer]

Full wound healing - I can't really remember - weeks rather than days, though, and it will depend on the size of the wound.
Once fully healed, you probably won't know it was there. The loss of an eye will surely be the most noticable thing.

Penicillin based injections may be long term. Abscesses are difficult to sort out, although this one has a distinct cause after the enucleation. Often they just randomly occur and then seed elsewhere - hence antibiotics may be very long term / for life in some circumstances. If that's the case, ask for a bottle to keep at home, get a box of sterile syringes and needles, and a disposal bin. If it's short term, your vet might send you home with some pre-filled syringes with the right dose.

My rabbits were treated by FHB. I don't know if she still offers advice to other vets on specialist procedures, but it might worth asking.

 

[DemiS]

Elmo had his surgery yesterday, the enucleation site had actually healed up quite nicely, the abscess seems to have formed a bit further down in his nasolacrimal sac(?) which we didn't expect. I was warned that bone may be visible but I can't see any and the wound isn't quite as gruesome as I expected, not as large or deep as I thought it would be, I imagine when his fur grows back it will cover the tissue under it.

He's been given metacam, tramadol and some gut stimulants. Then Tris-Nac to flush the wound and remove any biofilm, and F10 ointment to pack the wound with afterwards

I asked about something to numb the area but apparently regular local anaesthetic may affect wound healing. In terms of the penicillin injections, I was told this used to be quite common but resistance has increased now, so we're continuing with oral doxycycline until the culture results are back

 

[joey&boo]

Oh bless him, I hope he recovers well. My Noodle had this & once healed it looks like a stuffed toy whose eye/button has fallen off

 

[Zoobec]

Sending lots of vibes for him xx

 

[joey&boo]

not the best photo but this was Noodles eye post healing


I remember when Noodle had hers done my vet called to check I'm not squeamish & what I thought she said, was that the sight of Noodles wound had caused a vet nurse to pass out & need blue lighting to hospital! It turned out I'd misheard, a recent client had the same procedure & the owner fainted at the sight of her own bunny, hit her head on the radiator, sustained injury & did need ambulance

 

[Pets mum]

Sorry to hear that Elmo had to have further surgery, sending him every vibe for a successful healing x

 

[DemiS]

Thanks everyone. This morning the area was full of puss again, just two days after surgery to clear the infection out I feel awful that I've put him through all this and it may not even work. All we can do is wait for the cultures to come back but I don't have a good feeling

 

[keletkezes]

Aw man I'd've done the same, the surgery was worth it because not doing it would've just left you at square one anyway, this at least has a chance of doing something. I hope its just some runoff of leftovers or something and not a full-on reinfection or whatever.

 

[DemiS]

Just a little update, Elmo is still with us. As the marsupualisation healed the puss never disappeared, probably because it was tucked away in his nasolacrimal duct

At first we could suck it out with a syringe. As it started to heal we had to use an electric baby snot sucker and micro swabs and to try flush it with trasnac and chloramphenicol. It healed so quickly, we got to the point we were having to use plastic catheters and blunt needles to try clean and flush it and keep it open as long as possible. Eventually the poor thing fought so much that even using numbing cream for him and bite proof Gloves for us werent working, it felt like we were torturing him.

We took him to the vets on a Friday, in tears thinking he would need putting down but the vet didn't think it was needed just yet. We asked for different antibiotics because even though cultures showed the infection was susceptible to doxycycline, the dose was 0.05ml (essentially a drop) and we were convinced that some of that was being spit out or left in the syringe. We were given co-trimoxazole instead and it's a bigger volume so we knew he was getting the dose. By Sunday we gave in trying to open and clean the wound and said no more, it's not fair to him. Monday the wound reopened itself and loads of puss came out, so we thought maybe it will drain on its own this way. Then it closed again and nothing has come out since, if you poke the area it feels hollow and empty and we are now 3 weeks on. To go from a significant amount of puss built up each day to nothing in three weeks, I can only think that the switch in antibiotics kicked in just in time as the wound closed

Oddly he had dropped from 2kg to 1.6kg but I think his brother had been eating the majority of his food as Elmo is still a bit traumatised and runs away from me at feeding time. So as his teeth are absolutely fine for an old bun, I've been feeding him a lot of extra pellets separate to his brother, in a week he has gone back up to 2.2! Scales aren't wrong because his brother was weighed on the same day on the same vet scales and he hasn't changed at all when I use my scales

I'm cautiously optimistic, although he is due to finish the bottle of antibiotics over the next few days which makes me nervous.

 

[joey&boo]

Oh my! Such a nice update. I'm glad things are finally looking more positive. That is some recovery period & it sounds like a lot of hands on care. Thank god you suggested other antibiotics - they were clearly a life saver since he was getting so fed up with the cleaning. You've all done a really great job & to think I was worried about opening this thread

 

[Zoobec]

Fingers crossed that he will continue to stay well