Plus-Hex CLINICAL
It could also be helpful to discuss behaviour with owners. Discussion about the patient ' s normal routine and monitoring for any changes, such as lethargy and anorexia, may lead to early diagnosis of conditions such as gut stasis. Other examples include urine scalding or pododermatitis, which could be indicators of arthritis, with pain preventing the patient from angling the pelvis to urinate normally, meaning they may urinate on themselves.
Another consideration is chewing; while this is a normal behaviour, it can be unwanted, especially in house rabbits as they can damage furniture and other highvalue items. The use of enrichment toys and scatterfeeding can be encouraged.
With ear disease, the patient may show torticollis and ataxia, may have trauma to the face or ear, and in some cases may have a clear or white ocular discharge with alopecia and swelling. These rabbits may also no longer‘ binky’( leap in the air to indicate happiness or excitement) due to torticollis and ataxia. A study in 2023 indicated that some owners noticed their rabbits did not‘ binky’ and showed little response to food being prepared [ 8 ].
If animals have auditory impairment, they are also less likely to react to loud and threatening sounds [ 8 ]. This should be considered in free-roaming rabbits, as they may be less responsive to predators. It may also lead to fear aggression towards people, as rabbits may be more easily startled. These more subtle indicators may be noticed by clients at home and can help the veterinary team reach an early diagnosis of aural pathology in clinical assessments and wellness checks.
Case study
Bumble, an 11-year-old male mini lop-eared rabbit, presented to the practice with recurrent dacryocystitis of the left eye( Figure 1).
Several years previously, he had been seen with ocular discharge affecting the left eye. He was bright and well, with no signs of pain or other illness. Culture and sensitivity testing diagnosed Staphylococcus sciuri infection with sensitivity to gentamicin, enrofloxacin and potentiated sulphonamides.
Topical gentamicin and flushing of the lacrimal gland were successful and the clinical signs fully resolved. There was no evidence of dental disease at any stage during the treatment process.
After a period of no clinical signs, Bumble was re-presented to the surgery with the same complaint; however, stenosis of the lacrimal duct was seen with alopecia around the eye. Diagnostic testing and treatment were resumed, as per the initial diagnosis, but, at this stage, coagulase-negative staphylococci were present with sensitivity only to potentiated sulphonamides and enrofloxacin.
Limited improvement was seen on treatment with potentiated sulphonamides( Sulfatrim 0.3 ml / kg BID) and enrofloxacin( 10 mg / kg SID). This may have been because rabbit abscesses often have a fibrous capsule surrounding the pus, which makes systemic antibiotics ineffective at penetrating the infection without the addition of surgical intervention.
Bumble continued to have ocular discharge and alopecia around the eye, so an NSAID, meloxicam( Metacam, Boehringer Ingelheim), was added at 1.5 mg / ml( dose rate 0.6 mg / kg, increasing to 1 mg / kg later in the course of treatment). An ocular preparation containing dexamethasone was also prescribed to reduce inflammation, plus a lubricating ocular gel.
Bio-lapis( Protexin) was used as a prebiotic / probiotic, due to the use of antimicrobial treatment, which can disrupt the gut flora and increase the risk of dysbiosis. Signs of this could include diarrhoea, abdominal discomfort and gut stasis.
Bumble was still bright and well with no anorexia or grimace. No dental disease was evident. A response to medical management was seen when NSAIDs and ocular treatment were added to the treatment regime.
The patient presented several weeks later with minor torticollis and a large amount of cerumen in the left ear canal. Minor nasal discharge was present on the left side, which corresponded with the affected eye. The tympanic membrane was intact.
Figure 1. Dacryocystitis of the left eye.
Cleaning with Otodine( chlorhexidine digluconate / tris- EDTA) was used off-licence, due to its antibacterial and antifungal properties, alongside NSAIDs and a course of antimicrobials. A VN demonstrated cleaning techniques to the owner, and improvement was noted before a relapse of the clinical signs in the following months.
Volume 40( 5) • October 2025
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