Clinical Management of Nasolacrimal Sac Abscessation in a Rabbit.
A Dacryocystitis and obstruction of nasolacrimal duct resulting in abscessation at the medial canthus of eye in a rabbit is reported. The animal was treated and managed successfully.
Keywords: Abscess; dacryocystitis; nasolacrimal duct; rabbit
Dacryocystitis or inflammation of nasolacrimal duct occur due to trauma, blockage of lacrimal duct or secondary to inflammation of lacrimal duct. Infection of duct system can lead to blockage by inflammatory exudates (Slatter, 2003). The condition is often characterized by abscessation of nasolacrimal sac. Here we present, abscessation of nasolacrimal sac and its successful management in a four year old rabbit.
History and Diagnosis
A four year old New Zealand white rabbit was presented with swelling on face, ventral to right medial canthus (Fig. 1). The swelling was soft on palpation and pitting on pressure, suspicious of abscess. Ultrasonographic examination of mass revealed cavity with anechoic-to-hyperechoic contents, further suggestive of an abscess (Fig. 2). Physical and radiographic examination did not reveal any abnormality or infection of maxillary teeth. Nasolacrimal duct patency test, using rose bengal dye was negative, suggestive of associated nasolacrimal duct obstruction. Aspirate from swelling yielded speck of thick pus. Incision and drainage was performed and thick, inspissated milky white pus was squeezed out (Fig. 3). The cavity was cleared off the pus and irrigated with diluted (2.5%) Povidone iodine solution. Meloxicam (a) (@ 0.2mg/kg b.wt.) was given SC, followed by oral antibiotics, Cephalexin (@ 30mg/kg b.wt.), topical antibiotic (Ciprofloxacin, Ciplox (b)) and topical anti-inflammatory, (Flurbiprofen, Flur (c)) eye drops for one week. There was almost complete reduction (Fig. 4) in size of abscess, with mild discharges at incision site, in first post-operative week review. Increased lacrimation, epiphora and purulent discharge from eye at medial canthus (Fig. 5), persisted. Culture of purulent sample, collected at time of incisional drainage, did not reveal any growth. Lacrimal duct patency was not present, as revealed from dye passage test. The condition was thus diagnosed as dacryocystitis with obstruction of naso-lacrimal apparatus.
Treatment and Discussion
Flushing the nasolacrimal duct for regaining patency was the prime requirement for treatment. A 24G IV cannula - after removing the stillete and attached to 5 ml syringe loaded with diluted (2.5%) Povidone iodine was introduced into lower lacrimal puncta of right eye. The nasolacrimal duct was then flushed under moderate pressure. Purulent material, mixed with Povidone iodine, egressed through the incisional opening and also through right nostril, upon flushing. Flushing was continued until egressed solution became clear. Topical antibiotic eye drops were continued for another one month. The animal had excellent recovery with no relapse.
Dacryocystitis is inflammation of lacrimal sac and can occur due to trauma and/or infection, leading to blockage of duct system (Slatter, 2003). Epiphora is the major clinical sign for obstruction in lacrimal drainage system, which was evident in present case also. The two major sites of obstruction of lacrimal drainage system are one near the proximal end of duct at passage through lacrimal foramen and second site is on distal aspect where the duct twists around the upper incisor tooth root (Wagner and Fehr, 2007). Obstruction of nasolacrimal duct can lead to invasion by bacterial and fungal organisms into the sac aggravating the condition. The condition can also occur as an extension of dental infection or inflammation of upper respiratory tract (Slatter, 2003). To conclude, nasolacrimal sac abscess should be considered as one differential diagnosis of any soft swelling near the medial canthus.
Burling, K., Murphy, C.J. and Curiel, J.S. (1991). Anatomy of the rabbit nasolacrimal duct and its clinical implications. Prog. Vet. Comp. Ophthalmol. p. 33-40.
Slatter, D. (2003). In: Textbook of Small Animal Surgery (3rd Ed). Saunders, Philadelphia, p. 1356.
Wagner, F. and Fehr, M. (2007). Common Ophthalmic Problems in Pet Rabbits. J. Exotic Pet Med. p. 158-67.
S. Sooryadas (1), Divya Suresh (2) and P.T. Dinesh (3)
Department of Veterinary Surgery and Radiology College of Veterinary and Animal Sciences Kerala Veterinary and Animal Sciences University (KVASU) Pookode - 673576 (Kerala)
(1.) Assistant Professor and Corresponding author. E-mail: firstname.lastname@example.org
(2.) Post Graduate Scholar
(3.) Assistant Professor
(a) - Brand of Intas Animal Health, Ahmedabad
(b) - Brand of Cipla Ltd., Mumbai
(c) - Brand of Allergan Ltd., Mumbai
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|Title Annotation:||Short Communication|
|Author:||Sooryadas, S.; Suresh, Divya; Dinesh, P.T.|
|Date:||Jul 1, 2016|
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