What Is A Retrobulbar Abscess?

Bling’s official diagnosis was a right-sided retrobulbar abscess.  She’s been on antibiotics now for a week, and is completely back to normal.  So what is a retrobulbar abscess?  After much research and study, let me explain…

A retrobulbar abscess is a fancy term for an infection that has formed a fluid collection (ie: pus) behind the eyeball.  The eyeball, of a dog or human, sits within a bony socket (ie: the orbit).  When an infection forms in this enclosed space, it causes pressure on the eye, and pushes the eyeball itself outward.  This causes one of the main signs of the condition – a bulging eye.

In dogs, the posterior aspect of the jaw has virtually direct communication with the floor of the orbit, making retrobulbar abscesses not uncommon.  As the veterinary ophthalmologist explained to us, Bling was a “classic case.”  The origin of her abscess came from her jaw.  As dogs chew on sticks and twigs (like Bling once did, but will not do again), splinters can pierce through the soft tissues of the mouth and enter the orbit seeding the infection.

canine skull anatomy highlighting where a retrobulbar abscess forms

Notice how the back of the jaw bone communicates with the orbit.

So the big question is, if dogs chew on sticks and can get retrobulbar abscesses, what signs and symptoms do you look for to spot them?  In retrospect, Bling was showing us so many signs that logically made sense, but we didn’t pick up on.

The first thing we noticed was Bling wasn’t acting right.  She didn’t seem happy, and she didn’t seem as active and this is probably because she was fighting an infection.  Perhaps the oddest thing was that she didn’t like to play her usual game of fetch.  In hindsight, this makes sense as well.  Bling’s retrobulbar abscess originated from her mouth (though others can originate from the sinuses or eye itself).  She didn’t eat as vigorously and she certainly didn’t want to open her mouth to grab the balls we threw.  Her jaw hurt too much.  She would also occasionally yelp after barking, again because her mouth hurt.  Later, we also started to notice droopiness and discharge from her eye – like the “sleepers” people get when they wake up in the morning.  Her eye finally started bulging a bit and we knew something was wrong.

To summarize in a list, signs and symptoms of a retrobulbar abscess include (with reasoning in parentheses):

1.  Not acting right, lethargic (fighting an infection).

2.  Eye discharge, droopiness, bulging, redness (because of an infection in and possibly behind the eye).

3.  Swollen third eyelid (infection around eye).

4.  Slow or poor feeding, yelping with barking, not opening mouth (oral cause of abscess).

5.  Bad breath (oral infection seeding eye socket).

So, how is a retrobulbar abscess diagnosed and treated?  Well, clinically the veterinarian had a strong suspicion before any labs or testing was done.  She started Bling on a strong broad spectrum IV antibiotic immediately.  The diagnosis was formally made via CT (or CAT) scan which can visualize the fluid collection behind the eyeball.  An ultrasound could also possibly be used.  Bling received 48 hours of IV antibiotics and is currently on oral antibiotics for the next 2-3 weeks.  Her abscess was also surgically drained through the mouth.  Surgical drainage is necessary because if the abscess gets big enough, antibiotics cannot adequately penetrate and attack it.  The combination of surgery and antibiotics had Bling back on her feet (actually paws) in no time.

To recap Bling’s story, check out the posts about her initial trip to the Doggie ERher ICU stay, and subsequent outpatient treatment.

Moral of the story, Bling isn’t allowed to chew on as many sticks as before, and be sure to watch out for your dog!

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