04/06/2026
🩺 Let’s work up a case of suspected retrobulbar disease:
A 1 year old cocker spaniel presented with acute onset globe deviation, third eyelid protrusion and conjunctival hyperaemia with mucoid ocular discharge.
He was visual and had a normal intraocular pressure, however there was resistance to globe retropulsion. Mild ipsilateral submandibular lymphadenopathy and pyrexia was noted on physical examination.
Bloods for haematology and biochemistry were taken which revealed leukocytosis, in particular neutrophilia, suggesting inflammation and possible infection.
Under sedation detailed ophthalmic examination was performed along with ocular ultrasonography. This revealed generalised hyperechogenicity of the extraconal retrobulbar tissue with early abscess formation. This was unfortunately too small to obtain a needle aspirate for bacteral culture. Examination of the oral cavity, looking in particular for pterygopalatine fossa swelling, was normal.
A presumptive diagnosis of retrobulbar cellulitis with early abscess formation was made, and intra-venous antibiotics were administered alongside systemic non-steroidal anti-inflammatories. Studies have shown that mixed aerobic and anaerobic bacteria are commonly isolated from retrobulbar abscesses, and amoxicillin-clavulanate is a good first line antibiotic of choice based on sensitivity results.
Thankfully this patient responded very well to treatment and was back to normal after 24 hours! Some patients require hospitalisation for several days, however, and if symptoms recur advanced imaging may be required to assess for foreign body or tooth root involvement. 👀
