Rabbit eye injury: first response and the do-not list

Quick answer

Almost nothing in a home first aid kit belongs near a rabbit's eye. The useful things you can do are keep it eating, keep it calm, and get it seen.

A rabbit's eyes are large, prominent and set on the sides of the head. That gives an enormous field of view and leaves a great deal of corneal surface exposed, with a blind spot directly in front of the nose, which is where the hay is.

The result is that eye injuries in rabbits are common, painful and easily made worse. The most damaging thing an owner can do is put the wrong drops in, and the most common wrong drops are the ones already in the bathroom cabinet.

• Do not use human eye drops, dog or cat eye drops, or anything containing a steroid. A steroid on an ulcerated cornea can lead to the eye rupturing.
• Do not try to remove an embedded object, and never push a protruding eye back in.
• A watery or milky eye in a rabbit is a dental problem until proven otherwise, because the tear duct runs alongside the tooth roots.
• Squinting is pain. A rabbit that is holding one eye shut needs to be seen the same day.
• Keep the rabbit eating. A rabbit that stops eating because its eye hurts develops a second, faster emergency.

:::danger
Never put steroid-containing eye drops or ointment in a rabbit's eye.

Most rabbit eye emergencies involve a damaged cornea. Steroids suppress the healing response and the local immune defence, and on an ulcerated cornea they can allow the ulcer to deepen through the layers until the eye perforates.

Many human and veterinary combination eye products contain a steroid, and the packaging does not always make it obvious. Some also contain atropine or anaesthetic, neither of which should be used without direction.

The only fluid it is reasonable to use before you reach a vet is sterile saline, gently, and only to flush visible debris. Everything else waits for the examination, because the correct treatment depends on whether the cornea is intact, and that is determined with a fluorescein stain rather than by eye.
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Decide in 60 seconds

Why rabbit eyes get injured, and why they get worse quickly

The eye is large relative to the head and sits laterally, which gives a rabbit close to panoramic vision and lets it see a predator approaching from behind. The trade-off is a big exposed cornea with limited protection from the eyelids, and a blind area immediately in front of the face.

Hay is the commonest culprit. A rabbit pushes its face into a rack or a pile it cannot see, and a stem enters the eye. Overhead hay racks are worse than ground-level hay for exactly this reason, because material falls into the eye from above.

Corneal injuries then behave badly for two reasons. Rabbits rub, which converts a scratch into an ulcer. And rabbits are prey animals that continue to behave almost normally, so a painful eye is often not reported until the rabbit stops eating.

There is a further anatomical point that changes how these cases are handled. The tear duct that drains the eye into the nose runs immediately alongside the roots of the upper incisors and the cheek teeth. Rabbit teeth grow continuously and, when they grow abnormally, the roots elongate into the space the duct occupies. That is why a rabbit with a chronically wet eye is investigated as a dental case, and why the same tooth roots can form an abscess behind the globe and push the eye forward.

What each sign points to

Squinting or holding the eye closed.
Pain. The usual cause is a corneal ulcer or a foreign body. It is not a sign to monitor for a few days.

Cloudiness or a blue haze.
Fluid in the cornea, usually from an ulcer. It can also indicate glaucoma or inflammation inside the eye.

A white mass inside the eye.
In rabbits, a distinctive cause is inflammation triggered by the parasite Encephalitozoon cuniculi damaging the lens, producing a white deposit within the eye rather than on its surface. This is a specific rabbit condition and it needs a proper diagnosis rather than treatment aimed at the surface.

Watery eye with wet fur down the cheek.
Blocked or overwhelmed tear drainage. The commonest underlying reason is dental disease, followed by conjunctivitis, irritation from dust or ammonia, and eyelid conformation problems.

Thick white or creamy discharge.
Often material accumulating in a blocked duct. It can look dramatic and is not necessarily an infection of the eye surface itself, which is why flushing the duct is often part of the treatment.

Redness.
Conjunctivitis, inflammation inside the eye, glaucoma or trauma. Redness with pain and cloudiness is more serious than redness alone.

Third eyelid coming across the eye.
Pain, dehydration, or something behind the eye pushing it forward.

Bulging eye.
A retrobulbar abscess from tooth roots is the classic rabbit cause. A mass behind the eye, or glaucoma, are the others. When both eyes bulge together, particularly with any change in breathing, that combination points to a mass in the chest interfering with venous return from the head and is an emergency.

Swollen eyelids with discharge, along with swelling of the face, ears or genitals.
Myxomatosis. It is spread by biting insects and by direct contact, it is usually fatal in unvaccinated pet rabbits, and it is preventable by vaccination. Isolate the rabbit and contact a vet immediately.

Fur or hay visible on the surface.
Common and treatable, but do not attempt removal of anything that is not lying loose.

The useful kit is sterile saline, a soft towel and a carrier. Not drops, not ointment, not cotton buds.

The first response

Look at the whole rabbit before the eye.
Breathing, posture, whether it is eating, and whether droppings are being produced. A rabbit with an eye injury that has also stopped eating has two problems, and the gut is the one that kills faster.

Keep the rabbit calm and handle minimally.
Rabbits injure themselves struggling. Their skeleton is light relative to their muscle mass and a kicking rabbit can fracture its own spine. Support the hindquarters at all times and keep sessions short.

Do not trance the rabbit.
Placing a rabbit on its back until it goes still is not relaxation. It is tonic immobility, a fear response, and it is stressful and potentially harmful. It has no place in examining an injured rabbit.

Flush only if there is loose debris, and only with sterile saline.
A gentle stream from a sterile saline pod or an unopened sterile eyewash. Do not use tap water, contact lens solution, boric acid eyewash, salt water made at home, or anything medicated.

Do not remove anything embedded.
An object penetrating the cornea may be the only thing preventing the eye's contents from escaping. Removal at home can cost the eye.

If the eye is out of its socket, keep it moist and go.
Sterile saline on the surface, no pressure, no attempt to replace it. Transport immediately.

Stop the rubbing if you safely can, but think before using a collar.
A protective collar prevents self-trauma but also prevents the rabbit from eating caecotrophs, which are an essential part of its nutrition, and many rabbits stop eating altogether while wearing one. If a collar is needed, that is a decision to make with the vet along with a plan for feeding and for caecotroph provision.

Keep it eating.
Offer favourite greens, fresh hay at ground level and anything the rabbit will take. If it will not eat, tell the vet when you call, because that changes the urgency.

Travel with a companion if the rabbit is bonded.
Taking the bonded partner along reduces stress for both and avoids the bond breaking during separation.

Support the head with both hands rather than restraining the body. Short, calm, well-supported handling is safer than a firm grip.

The do-not list

Do not use human eye drops of any kind, including lubricating drops, allergy drops and anything for redness.

Do not use eye products prescribed for a dog, a cat or another rabbit. Steroid combinations are common and dangerous here.

Do not use antibiotic ointment left over from a previous course without asking. The correct product depends on whether the cornea is ulcerated.

Do not attempt to remove an embedded object.

Do not press on, push back or bandage an eye.

Do not use cotton buds on the eye surface.

Do not use tap water, homemade saline, boric acid eyewash, or contact lens solution.

Do not put a collar on a rabbit without a plan for feeding and caecotrophs.

Do not trance the rabbit to get a better look.

Do not scruff a rabbit or lift it by the ears or the skin.

Do not delay because the rabbit is still eating. Rabbits mask pain and the cornea can deteriorate over hours.

Do not treat a wet eye as a cosmetic problem. It usually means the teeth.

Preventing the next one

What changes by breed and age

Lop breeds.
Over-represented for dental disease, blocked tear ducts and ear problems, because of skull shape. A wet eye in a lop should raise the dental question immediately.

Brachycephalic and dwarf breeds.
Shortened faces crowd the tooth roots and the tear duct, and prominent eyes are more exposed. Netherland dwarfs and similar types have more eye problems than long-faced breeds.

Rex-coated rabbits.
Short protective guard hairs around the face, and eyelashes that may be less protective.

Young rabbits.
Trauma from play, from cage mates and from wire is the usual cause. Congenital duct problems also present early.

Older rabbits.
Dental disease accumulates, cataracts and glaucoma appear, and arthritis makes grooming and facial cleaning harder.

Outdoor rabbits.
Higher exposure to insects that transmit myxomatosis, to plant material and to grass seeds.

Bonded pairs.
Mutual grooming around the face is normal, but a partner over-grooming one eye area can be a sign that something is wrong with it.

What the vet will ask for

• When you first noticed it, and whether it appeared suddenly.
• Whether the rabbit has been rubbing at the eye.
• Whether it is eating, and how the droppings look.
• Whether either eye has ever been wet or discharging before, and what was used.
• Dental history, including the date of the last dental check.
• Hay type and how it is presented, particularly whether the rack is overhead.
• Bedding and litter type, and how often the enclosure is cleaned.
• Vaccination status.
• Anything already put in the eye, with the packaging if you have it.
• Whether any other rabbit in the household is affected.

Expect a fluorescein stain to check for a corneal ulcer, and expect a discussion about the teeth if there is any discharge. Skull radiographs or a scan are often needed to see tooth roots and to identify an abscess behind the eye.

A calm rabbit that is eating is a rabbit you have time to treat properly. Keeping it eating is the most useful thing you can do at home.

When to get help

Go immediately for an eye that is out of its socket, bleeding, penetrated by an object, or for both eyes bulging with any change in breathing, and for facial swelling with discharge that could be myxomatosis.

Go the same day for squinting, a cloudy or blue eye, obvious pain, a rabbit rubbing at its face, a bulging eye, or an eye problem in a rabbit that has stopped eating.

Book within a few days for a persistently watery eye, thick discharge, mild redness without pain, or wet fur down the cheek in an otherwise well rabbit, and expect the teeth to be part of that appointment.

Bring the packaging of anything already used, your photographs of both eyes, the dental history and the vaccination record. In rabbit ophthalmology the eye is often the last part of the problem, and the history is what points at the rest of it.