Eye Diseases

Eye diseases are a fairly common health issue in rabbits.

Many eye conditions are treated similarly to those in humans or other animals, but some are specific to rabbits, such as choroid inflammation caused by E. cuniculi.

The tricky aspect of these diseases is that they are often misjudged in rabbits. Anyone who has experienced eye inflammation or other eye conditions knows how painful they can be. However, rabbits usually display normal behavior, making it difficult to recognize their discomfort. Proper pain management is therefore crucial in treatment. Additionally, some conditions, such as eye discharge, may be mistakenly considered harmless but require urgent attention to prevent them from becoming chronic.

Early diagnosis and treatment by a veterinarian experienced with rabbits are essential for addressing these conditions effectively.

We recommend consulting an eye specialist (veterinary ophthalmologist) for eye diseases.

For eye discharge or a protruding/bulging eye, a dental veterinarian specializing in rabbits is more suitable. In the case of uveitis, it is particularly important to ensure the veterinarian is knowledgeable about rabbits.

Care
Creating the right environment can positively impact the healing of eye conditions. Avoid any drafts or wind, direct sunlight or bright light, smoky, dry, or cold air, as these are unsuitable for recovery.

Preliminary Examination

The eye can be inspected before the vet visit. Are any injuries visible? Is the issue affecting the eye itself or just the eye rim? Can foreign objects, such as hay strands, be detected in the eye? To check, gently pull the lower eyelid downward with light pressure to see behind it.

However, removing foreign objects is not simple for non-professionals, as using tweezers can injure the eye. Rabbits rarely remain completely still, and their movement can increase the risk of injury. A veterinarian, skilled in such procedures, can safely remove the foreign object.

Caution: A first impression is not enough to make an accurate assessment. Most corneal injuries are not visible to the naked eye, and foreign objects can easily be overlooked.

Administering Medications
The veterinarian will explain how to administer the prescribed medications. Typically, eye ointments and drops are required. Drops are more comfortable for the rabbit and easier to apply, while ointments last longer and therefore need to be applied less frequently.

The least stressful method is to administer the medication while the rabbit is secured on the floor. For this, kneel down and position the rabbit gently between your thighs, keeping it steady. Avoid lifting the rabbit, as this can cause unnecessary stress. Apply the medication as quickly and gently as possible to minimize discomfort.

Eye Flushing
To flush the eye, you can use artificial tears, lukewarm boiled water, or saline solution. Always wipe from the outer corner of the eye toward the inner corner using a cotton pad soaked in the solution. Each cotton pad should only be used for a single wipe—replace it before wiping again to avoid contamination.

When to Visit the Veterinarian?

Eye diseases in rabbits are typically extremely painful, and delays in treatment can worsen the condition, sometimes causing permanent damage to the eye. Therefore, it is generally recommended to consult an emergency veterinarian promptly for any eye-related issues.

The only exceptions might be mild eye discharge (without blinking, squinting, or excessive closing of the eye, and without changes in behavior) or known, recurring eye conditions.

Since eye diseases often require consultation with an emergency veterinarian, who may not always be knowledgeable about rabbits, it is essential to ensure that the prescribed medications are not cortisone-based (e.g., dexamethasone, prednisolone). The only exception to this rule is the use of cortisone for treating a diagnosed uveitis.

Since eye diseases often require consultation with an emergency veterinarian, who may not always be knowledgeable about rabbits, it is essential to ensure that the prescribed medications are not cortisone-based (e.g., dexamethasone, prednisolone). The only exception to this rule is the use of cortisone for treating a diagnosed uveitis.

Blind Rabbits?

It is not uncommon for rabbits to go blind in one or both eyes. Unlike humans, rabbits do not rely primarily on their vision; they place more importance on their other senses.

Rabbits that are blind in one eye still have a reduced field of vision but otherwise behave normally in their daily activities.

Even rabbits that are blind in both eyes adapt surprisingly well. However, it is important to avoid moving them, placing sharp or dangerous objects in their environment, or rearranging their living space, as these changes can cause stress or confusion.

If a rabbit becomes blind, it is crucial to have it examined by a veterinarian. The underlying causes of blindness can be very painful, such as increased intraocular pressure (glaucoma), and need prompt treatment.

Pigment Flecks

Some rabbits have differently colored pigment spots in their eyes (heterochromia), which may be congenital or genetically determined. However, they are more commonly acquired, for example, due to a delayed or untreated keratitis (corneal inflammation) or injuries.

Affected rabbits often have a speckled pattern around their eyes.

It is important to note that there is a risk of confusing this with other conditions, such as acute keratitis.

Inflammation/discharge of the nasolacrimal duct (Dacryocystitis)

Eye Discharge
Dacryocystitis is an inflammation or blockage of the tear drainage system (tear ducts, nasolacrimal duct, and/or tear sac). This leads to a watery or whitish-milky discharge from the eye, which often results in crusting around the fur and a damp eye area. If the fluid is clear, it usually indicates a non-infectious cause. In later stages, thick, white pus may emerge. This pus can also originate from abscesses on the tooth roots that extend into the nasolacrimal duct.

In this condition, other parts of the eye are often also inflamed, such as the cornea, eyelids, and conjunctiva, as they can become infected.

The causes of discharge or inflammation of the nasolacrimal duct are almost always dental issues (the first two molars or incisors) or bacterial infections. The tooth roots in rabbits are located very close to the nasolacrimal duct, so if the teeth are too long (due to insufficient tooth wear or due to retrograde growth) or if the teeth are misaligned, the tooth roots can swell and obstruct the nasolacrimal duct. In many cases, inflamed tooth roots lead to an infection and pus in the nasolacrimal duct, or vice versa. More information can be found under Jaw Abscesses.

Rabbits with very round heads, such as dwarfs and lop breeds, often suffer from hereditary dental issues that can affect the tear duct. This is related to brachycephaly (shortened skull shape).

Eye discharge is often not noticed until the partner rabbit passes away. Many owners then describe it as the rabbit „crying.“ This can be explained by the fact that the companion rabbit used to clean the discharge several times a day. After the death of the partner, the discharge becomes visible. Sometimes, after pairing the rabbit with a new companion, the discharge may disappear because the new partner cleans it away, making it less noticeable.

The tear duct is usually flushed first by the veterinarian (although it is not always passable). If it is blocked, dental diseases are typically the cause. The tooth roots may grow into the tear duct or compress it due to swelling or inflammation. If the condition is left untreated for a long time, the tear duct may become blocked or widened due to chronic inflammation, or secretions may clog it. By using contrast agents in the tear duct followed by head X-rays (oblique views), the cause of the obstruction can be more accurately determined. A CT scan is also a useful diagnostic tool.

It is essential to investigate whether the issue is related to dental problems (using X-rays or a CT scan), as dental diseases are the most common cause. Retrograde growth can only be detected through an X-ray. In this case, the dental issues must be treated accordingly. Additionally, the rabbit’s diet should be switched to a purely hay-based diet.

Depending on the identified cause, it may be treatable (e.g., dental treatments). If the underlying issue is not addressed, the discharge will likely return. Antibiotic treatment is crucial. Drops are preferable to ointments because ointments can further block the tear duct. Additionally, the tear duct can be flushed with antibiotics. If eye drops are ineffective, a swab may be taken for an antibiogram to identify the most suitable antibiotic. In cases of chronic widening of the tear duct, a long-term, intensive treatment with eye drops may be successful, often in combination with a systemic antibiotic. Mucolytics can also be used. It’s important to ensure good ventilation and frequent bedding changes (to avoid ammonia build-up) and use dust-free bedding.

Please consult a rabbit dental specialist from this list for eye discharge issues. Other veterinarians may not be familiar with the specialized anatomy of the tear duct and its relationship to dental diseases.

Eye Infections in Rabbits

Conjunctivitis (Inflammation of the Conjunctiva) in Rabbits

Conjunctivitis is an inflammation of the conjunctiva, the mucous membrane surrounding the eye, and is common in rabbits. It typically presents as redness of the conjunctiva. Clear tear discharge is often present, and in cases caused by bacterial infections, the discharge may become pus-like.

Causes of Conjunctivitis:

1. Irritation:
   • Air drafts, high dust exposure, or harmful substances in the air (such as ammonia from poor hygiene in the rabbit’s enclosure or smoke in smoky rooms) can irritate the eyes and lead to conjunctivitis.
   • Foreign bodies (e.g., hay or bedding) entering the eye are another common cause.
   • Allergies can also contribute to conjunctivitis.
2. Injuries:
   • Bites or scratches often lead to conjunctivitis as a secondary condition. This form of conjunctivitis is usually unilateral (affecting one eye) and is non-contagious.
3. Infections:
   • Conjunctivitis can also be caused by bacterial infections (e.g., Pasteurella or rabbit snuffles), viruses (e.g., Myxomatosis), or rarely, fungi. When caused by infections, conjunctivitis is usually contagious and may affect both eyes.
4. Secondary Conditions:
   • An inflamed tear duct (dacryocystitis) often leads to conjunctivitis as a secondary condition.

Treatment:

• Conjunctivitis is typically treated with eye drops or eye ointments. In cases of bacterial infection, antibiotic eye drops are often required.
• For mild cases that are not caused by injuries, Bepanthen eye ointment can be used.
• The underlying causes should be addressed, and any related health conditions should be treated.
• Corticosteroid medications should only be used if the cornea is intact, but they are generally not recommended for rabbits. Rabbits have poor tolerance to corticosteroids, which can cause liver damage, weaken the immune system, and potentially shorten their lifespan.

It’s essential to identify and treat both the symptoms and the root causes of conjunctivitis to ensure proper recovery and prevent further complications.

Hypertrophy of the Meibomian Glands, Blockage of the Meibomian Glands, Meibomitis, Chalazion, Adenomas of the Meibomian Glands

The Meibomian glands are located on the inner side of the eyelid, and an enlargement of these glands manifests as white to yellowish spots and swelling. Several conditions can be associated with these glands. Most commonly, it is an inflammation of the glands (meibomitis). When these glands become significantly thickened, a Meibomian cyst (chalazion or stye) may form. In older rabbits, flower-like, often pigmented growths may indicate adenomas of the Meibomian glands. Pustules from the cilial and sebaceous glands (styes) can also be involved.

The exact cause is not fully understood, but factors such as bacterial infections, genetic components, and other eye diseases are under discussion.

Hypertrophy of the Meibomian glands is usually asymptomatic, though it can occasionally contribute to inflammation around the eye or cause irritation if it rubs against the cornea. Regular warm compresses can help empty the glands, promoting drainage. If necessary, the glands can be punctured under local anesthesia to drain the secretions. Following this procedure, antibiotic eye ointments are typically applied immediately and for several days thereafter to prevent infection.

Eyelid Inflammation and Injury (Blepharitis):

Injuries to the eyelids can occur due to rank fights between rabbits, and these injuries often require veterinary treatment. Since the eye is very sensitive, such injuries typically happen quickly and without malicious intent from the attacking rabbit, for example, through a scratch from a claw.

The veterinarian will assess the injury, and depending on the severity, surgical intervention may be necessary. It should also be checked whether the eye itself is injured, which can be done by using a special dye to assess any damage. Additionally, the veterinarian will prescribe antibiotic medications. Ointments are particularly useful because they adhere well to the eyelid. Corticosteroid eye drops or ointments should never be used in these cases!

If left untreated, the cornea could be injured or irritated by the eyelid.

Corneal Inflammation (Keratitis)

Keratitis is an inflammation of one or more layers of the cornea (the cornea is the transparent layer covering the eye). In cases of corneal inflammation, rabbits often become sensitive to light. Due to this sensitivity and associated pain, they may squint or close their eyes more frequently than usual (pain behavior).

As an owner, you might not notice any visible changes in the eye, but in some cases, you may observe slightly cloudy to white spots, or the entire eye might appear covered with a white layer. The eye often waters, and in some cases, there might be pus. Keratitis is often accompanied by other eye conditions that can cause additional symptoms.

There are various causes of corneal inflammation. Viruses (e.g., myxomatosis), fungi, and bacteria (e.g., rabbit snuffles) can trigger keratitis in rabbits. If a rabbit has suffered from untreated conjunctivitis or dacryocystitis for an extended period, it may also lead to keratitis.

Treatment typically involves the use of eye drops or ointments to manage the keratitis. Often, cornea-regenerating ointments and drops are also prescribed. Keratitis is extremely painful (even if affected rabbits may not show it outwardly) and, if left untreated, can lead to blindness. Pain relief medication must be prescribed as part of the treatment.

Corneal Injuries, Erosions, and Ulcerations (Ulcers)

Eye injuries or foreign bodies (e.g., hay stalks, dirt, thorns, twigs, hair – especially long hair around the eyes) are common causes of corneal injuries. These injuries and foreign bodies are often not visible to the naked eye. Another cause can be entropion (inward rolling of the eyelid). Additionally, dacryocystitis can lead to corneal erosions. Drying of the eye caused by protruding eyes (exophthalmos) or incomplete eyelid closure due to Horner’s syndrome (ear infections or other neurological causes) may also result in ulceration. For this reason, eyelid closure should always be tested.

To determine whether the cornea is intact or injured, a fluorescing dye is applied to the eye, and the results are examined using a slit lamp. Corneal injuries are classified as abrasions (superficial erosions), perforating injuries (penetrating ulcers), or non-perforating injuries.

Whitish, cloudy changes in the eye should always be sent for bacteriological testing using a swab sample before starting treatment.

In rabbits, eye injuries heal more slowly than in dogs or cats, so patience is required. During the healing process, blood vessels grow into the injured area before complete healing occurs. Treatment involves administering a broad-spectrum antibiotic directly into the eye and using re-epithelializing eye medications. For deeper ulcerations, proteinase-inhibiting eye drops (e.g., Stromease) are often used. In some cases, an artificial lens can help support the healing process.

Treatment Process for Eye Injuries

Treatment by a Veterinary Ophthalmologist with Artelac and Corneregel (2-3 Times Daily)

Entropion (Rolled Eyelid)

A lid deformity, such as entropion (rolled eyelid), causes the eyelashes to rub against the surface of the eye. This leads to irritation and injury to the eye. Entropion is a congenital condition and is extremely painful, as every blink causes discomfort. It is usually identified in young rabbits, and often, multiple rabbits in the same litter are affected. Affected parent animals must be excluded from breeding programs.

Treatment:

• Surgical Correction:
  • Removal of part of the eyelid margin to prevent the eyelashes from rubbing against the eye.
  • Alternatively, fixation of the eyelid margin upwards to allow the rolled eyelid to heal in the correct position.
• Non-Surgical Correction:
  • In some cases, simply taping the eyelid upwards during the growth phase can be effective, provided it is securely fixed.

Prompt treatment is essential to relieve pain and prevent further damage to the eye.

Choroiditis (Uveitis)

Uveitis is a very painful inflammation of the inner eye, specifically the choroid (uvea). In rabbits, it is usually caused by an infection with E. Cuniculi (phacoclastic uveitis), Pasteurella, or Staphylococcus (unilateral or bilateral uveitis), and sometimes by blunt trauma or a tumor (usually unilateral uveitis). Uveitis manifests as milky-colored or cloudy areas in the iris or lens. Due to bleeding in the eye, even reddish areas may appear. While the first form is characterized by a yellow-white filling of the eye, the latter form is recognized by a more defined, often vascularized white mass in the iris, which is often associated with cataract formation. Rabbits may blink more frequently than usual and squint the affected eye. The conjunctiva may be red, and the pupils are sometimes constricted (miosis). The aqueous humor (fluid behind the cornea) may appear cloudy, and the veterinarian may detect elevated intraocular pressure (which is painful!). Many affected rabbits appear unusually calm or withdrawn due to the pain.

Treatment in rabbits differs from that in dogs and cats, as rabbits typically have a different underlying cause.

Conservative Treatment
(prevents the progression of uveitis and addresses the underlying cause):

• Cortisone as eye drops or eye ointment
• Liver protection (!) since rabbits tolerate cortisone very poorly (usually milk thistle capsules or Rodicare hepar)
• The E. Cuniculi titer should be checked in the blood. In EC-positive rabbits, it is assumed that this pathogen has triggered the uveitis. In this case, the following medications are important:
  • Fenbendazole (Panacur, 20 mg/kg, once daily for 28 days) to help contain the pathogen
  • Tetracycline-based eye ointment, a systemic antibiotic (oxytetracycline), since the pathogen is sensitive to this antibiotic
• If the intraocular pressure is too high (glaucoma), eye drops that lower the pressure will be prescribed (see glaucoma).
• On the eye: atropine-containing eye drops can locally alleviate pain and prevent adhesions (synechiae). Not for elevated intraocular pressure!
• On the eye: non-steroidal anti-inflammatory eye drops (e.g., Nepafenac (NEVANAC®), Flurbiprofen (Ocufen), Diclofenac (Voltaren), Ketorolac (Acular), Bromfenac (Yellox)).
• Indirectly: anti-inflammatory painkillers to administer (Meloxicam). Pain relief is required, as uveitis is extremely painful!
• If these measures are not sufficient, surgical treatment must be chosen, as the elevated intraocular pressure is very painful.

Surgical Treatment

• Phacoemulsification (as soon as possible, this can cure uveitis!)
• Eye removal (enucleation) if the disease is advanced and/or conservative treatment does not stop it.
  A uveitis can lead to glaucoma, cataract, or retinal detachment.

Abscess in the Eye

Abscesses in the eye are not that uncommon in rabbits, but they are often mistaken for uveitis and incorrectly treated. Therefore, we would like to highlight this point.

Case Reports
Rabbits with abscess in the eye

Conservative Therapy with Eye Preservation:

„My veterinarian had also mentioned the possible removal of the eye and assumed a lens dislocation, but she referred us to Dr. Kindler in Wiesbaden (specialist in veterinary ophthalmology). There, they performed a fluorescein test and slit lamp examination. Elvis had a pin-sized corneal injury, so the diagnosis was a corneal abscess. The area became whiter as pus formed. We treated it daily with two different medications: Polyspectran and serum (derived from dog blood, prepared directly in a centrifuge there), one drop in the morning, at noon, and in the evening, at 15-minute intervals. The veterinarian also anesthetized the eye and touched the cornea (abrasio cornea) to stimulate the formation of new blood vessels. Later, he also received VitA POS ointment in the eye once daily.“

4o mini

Case Study:
This rabbit was initially treated for uveitis. The photos show that the abscess grew larger and significantly altered the eyeball. By the time the abscess was diagnosed, the condition had worsened so much that the eye had to be removed. Afterward, the rabbit recovered very well and was finally pain-free.

Maja, 8 years old, had an abscess on the cornea after an eye injury, which developed into an intraocular abscess. The eye was removed, and she is doing great. Even at an advanced age, there are good chances for rabbits!

Pseudopterygium or Precorneal Membranous Corneal Occlusion/Pterygium

This refers to a growth of the conjunctiva, which is believed to be inherited. As long as the conjunctiva is not fused with the eye and does not cause problems, no treatment is necessary (Pseudopterygium). If it fuses with the cornea (Pterygium), it should be treated surgically.

Cataract (Cataract, Lens Opacity)

Cataracts are an opacity of the lens. They can be hereditary or develop as a slow age-related condition, but they are most commonly caused by E. Cuniculi. Diabetes can also trigger cataracts (though this is extremely rare in rabbits).

The symptom of cataracts can only be treated through a specific and prompt surgical procedure. Additionally, treating the underlying condition can stop or delay the progression of the disease. Therefore, it is important to diagnose and treat the underlying illness.

Case Report
Maple developed cataracts due to E. Cuniculi, and his eyes developed glaucoma, so they had to be removed one after another with about a year between the surgeries. He manages wonderfully without sight and is completely happy and pain-free!

Glaucoma (Increased Intraocular Pressure)

Glaucoma is a condition where the eyeball becomes more bulging (enlarged eye), which can manifest in various ways and is associated with increased intraocular pressure. Often, the eye is squinted or blinked more frequently, and the rabbit may show sensitivity to light. The eye may appear reddish due to strong blood circulation, and the pupil is often quite large. Due to the enlarged eyeball, it might not always be possible to fully close the eye, leading to areas of the eye that are not covered by the eyelids developing a gray-white layer. Glaucoma is very painful, but rabbits rarely show obvious signs of pain. They often become quieter and more withdrawn.

In rabbits, glaucoma is usually caused by pre-existing conditions, such as uveitis. Hereditary glaucoma has been described in the White New Zealand rabbit, but it can also occur in other white rabbits (autosomal recessive inherited goniodysplasia). The pressure in the eye rises significantly, but the lens cannot expand. The cause is an imbalance in the circulation of the aqueous humor. Normally, the aqueous humor circulates through the angle of the anterior chamber between the front and back parts of the eye. If the canal in the chamber angle is blocked, more aqueous humor is produced in the posterior chamber, but it cannot drain into the anterior chamber, causing a high intraocular pressure. Elevated intraocular pressure can also occur if too much aqueous humor is produced.

Treatment

In the early stages, the intraocular pressure should be reduced with medications. In later stages, this may no longer be easily possible, and the eye may need to be removed to alleviate the pain. Glaucoma is very painful, and if left untreated, it will lead to blindness in the rabbit. However, even after blindness occurs, the glaucoma must still be treated, as the blind rabbit continues to suffer from severe pain. Pain is rarely indicated by squinting but is more often shown through behavioral changes, such as withdrawal and apathetic behavior. EC-positive rabbits should be treated with Panacur concurrently to reduce the pathogen load.

A veterinary ophthalmologist will carefully examine the glaucoma and prescribe the appropriate medications.

Pharmacological Therapy:

• Treating the cause: The E. Cuniculi titer should be determined, as E. Cuniculi could be the cause. In EC-positive rabbits, Panacur should be administered in addition.
• Inhibition of aqueous humor production:
  • Dorzolamide (Trusopt)
  • Brinzolamide (Azopt)
  • Dorzolamide/Timolol (Cosopt)
  • Brinzolamide/Timolol (Azarga)
  • Beta-blockers are generally not used in rabbits (Timolol maleate, Levobunolol, Betaxolol)
• Improvement of aqueous humor drainage:
  • Miotics (pupil constriction to improve drainage): These cause contraction of the ciliary muscle and increase vascular permeability. Depending on the type of glaucoma, they may not always be suitable.
  • Direct-acting miotics (Acetylcholine effect, parasympathomimetic (Pilocarpine)), indirect-acting miotics (Cholinesterase inhibitors (Demecarium bromide, Echothiophate iodide))
• Improvement of uveoscleral aqueous humor drainage:
  • Latanoprost (Xalatan)
  • Travaprost (Travatan)
  • Tafluprost (Taflotan)
  • Unoprostone (Rescula)
• Amlodipine (Calcium channel blockers increase blood flow and reduce vascular resistance)
• Reduction of intraocular volume:
  The use of mannitol is now considered outdated.
• Anti-inflammatory painkillers:
  • Meloxicam

Surgical Therapy:

Depending on how advanced the glaucoma is, there are various surgical treatment options. A veterinary ophthalmologist can provide advice on the best approach.

Exophthalmos (Protruding Eye)

In this condition, the eye protrudes from the eye socket.

There are two types: one eye protruding (unilateral) or both eyes protruding (bilateral).

A protruding eye, in most cases, is caused by dental diseases that create a granuloma or abscess at the tooth roots behind the eye, or (extremely rarely) by a tumor (e.g., lymphoma of the Harderian glands) behind the eye. Other potential causes include injuries (e.g., blunt trauma), hematomas, tear duct diseases, fat prolapse, foreign bodies, or a salivary gland cyst. In one case, an eye protruded due to a cyst with a tapeworm larva (Taenia serialis).

Bilateral exophthalmos is usually caused by increased blood pressure, which leads to swelling of the vessels behind the eye, pushing the eye forward. This can occur with heart diseases or pre-cardiac masses (such as thymoma, lymphoma, or abscesses) in front of the heart, with thymoma being particularly notable. A thrombosis of both jugular veins can also cause the eyes to protrude. Additionally, excessive fat deposits in the orbit in overweight rabbits can contribute to this condition.

Protruding eyes are often associated with poor food intake and behavioral changes, including withdrawal. The eye may also become partially dried out due to difficulty in fully closing the eyelids.

4o mini

The treatment depends on the underlying cause.

Unilateral Protruding Eye

If only one eye is protruding, a computed tomography (CT) scan should be performed, if possible, to identify the cause and treat it specifically.

The most common cause is dental diseases, which can also be diagnosed through a CT scan or X-rays (in four planes) and a thorough examination of the oral cavity. Typically, the upper molars (usually from the third molar (P3-M3)) are the problematic teeth. If a jaw abscess is located behind the eye, the affected tooth must be removed by a veterinary dentist, and the abscess should be surgically drained. In most cases, the eye can be preserved, and the rabbit will receive an effective antibiotic (see here) and pain relief. Some, less specialized veterinarians may remove the entire eye, but this approach is now considered outdated.

Tumors are extremely rare, but if present, they must be surgically removed. Often, the eye also needs to be removed during surgery, but this is generally not a significant problem for the affected rabbit. It can continue to live comfortably within the group, even with multiple levels.

Bilateral Protruding Eyes

To rule out heart diseases, especially in cases of bilateral exophthalmos, it is advisable to perform an echocardiogram, ECG, and blood pressure measurement. This will help detect heart diseases as well as abscesses, lymphomas, and thymomas around the heart. Sometimes, such conditions can even be identified through X-rays. Depending on the underlying condition, appropriate treatment can then be initiated (see links to relevant conditions).

The protruding eye is extremely painful, and the condition can lead to eye drying (due to impaired eyelid closure) and circulatory failure, so it must be treated as soon as possible! Strong pain relief is necessary until surgery.

Eyeball Removals and Eye-Saving Surgeries

Case Reports
Schnee (4 years old)

The eye was protruding, and the rabbit could no longer close it. The triggering tooth was removed, and the eye was preserved. In the second-to-last photo, you can see him the day after surgery; he can now close his eye again.

Ernie was operated on at over 8 years old. After the surgery, he immediately felt much better because the severe pain was gone.

Third Eyelid Prolapse (Haw’s Gland Hyperplasia)

The third eyelid (nictitating membrane or nictitating gland) in rabbits is normally not visible, except in some large meat rabbit breeds where it is often seen.

If it becomes visible (temporarily or permanently), it indicates a health issue. It is often seen in cases of stress, heat, or when the head is lowered. Common causes include injury or trauma to the third eyelid, enlargement near the heart (e.g., thymoma, lymphoma), associated high blood pressure, heart diseases, infections (such as rabbit snuffles), eye diseases, abscesses/tumors behind the eye, and various other conditions. Therefore, diagnosing the underlying cause can be tricky. A thorough examination, including an echocardiogram and a detailed eye exam, should be conducted. In some cases, a dental check-up may also be recommended.

Fat Eye (Fatty Eye)

Fat eye is a condition affecting the eye, characterized by a sagging eyelid and a protruding conjunctival sac beneath the eye. This condition is hereditary and is particularly pronounced in certain rabbit breeds (such as the German Giants and German Giant Spotted). Unfortunately, it is often unintentionally bred into these rabbits, as it typically develops after several months of life, around puberty. Rabbits with fat eyes should be removed from breeding programs. In most cases, treatment for fat eye is not necessary.

Commonly Used Medications

Antibiotic Ointments/Drops (e.g., Cephenicol CA, Floxal, Chibroxin, Refobacin, Posifenicol, Gent Ophtal, Oxytetracycline…)
These are used for eye or periocular infections caused by bacteria. The most effective antibiotic for eye infections is Chloramphenicol (e.g., Cephenicol CA). Infections of the nasolacrimal duct are treated with antibiotic eye drops (not ointments). Eye drops and ointments can be swallowed through the nasolacrimal duct, so they must be safe for ingestion (follow the PLACE rule!).
Ointments stay in the eye longer and don’t need to be applied as frequently, but drops are usually easier to administer and do not clog the nasolacrimal duct. Some rabbits may be sensitive to eye ointments, and in these cases, drops are preferred.

Corticosteroid Ointments/Drops (e.g., Cephenidex CA/DEX, Ultracortenol, Isopto-Max, etc.)
These are generally unsuitable for most rabbit diseases (except for uveitis). They can shorten the rabbit’s lifespan, harm the immune system, and negatively impact the liver. Some rabbits react more strongly than others, while some tolerate them well. They are used for non-infectious eye inflammations or periocular inflammations. They should never be used in cases of corneal injury, as they can hinder healing.

Pain-relieving Eye Drops (e.g., non-steroidal anti-inflammatory eye drops like Nepafenac (NEVANAC®))
These are used to relieve pain and inflammation in the eye.

Regenerative Ointments/Drops (e.g., Corneregel, Regepithel, etc.)
These are typically used for corneal defects.

Moisturizing Drops
These are used when the eye lacks sufficient tear production, such as when the eye cannot close completely.

Vitamin A-containing Eye Ointments/Drops (e.g., Vitagel)
These are used to promote healing and regeneration of the eye’s surface.

Atropine-containing Eye Drops
These have a wide range of uses, including pupil dilation, pain reduction, and preventing adhesions.

Eye Drops to Lower Intraocular Pressure (e.g., Azopt, Travatan, Xalatan, Azarga…)
These drops are used to lower intraocular pressure, such as in the case of glaucoma.

Bepanthen Eye and Nose Ointment
Used for skin/mucosal disorders.

Homeopathic Eye Drops
Common options include Echinacea and Euphrasia eye drops. Euphrasia is used for inflammation, while Echinacea helps regulate fluid balance in the eye.

Sources include:

Böhmer, E. (2011): Zahnheilkunde bei Kaninchen und Nagern: Lehrbuch und Atlas; mit 27 Tabellen. Schattauer.
Butler, K., DeGeorge, B., Dunn, G., VanGyzen, J., Gruaz, M., van Praag, A., & van Praag, E. (2016): Heterochromia of the iris in rabbits belonging to the Dutch breed.
Eckert, Y., Ferkau, A., & Thöle, M. (2022): Augenerkrankungen beim Kaninchen. Der praktische Tierarzt, 103(4), 352-372.
Ewringmann, A. (2016): Leitsymptome beim Kaninchen: diagnostischer Leitfaden und Therapie; Georg Thieme Verlag.
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