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CONTRIBUTOR(S): Claire Speight, Jennifer Hamlin,

Nystagmus – involuntary rhythmic eye movement

Nystagmus – involuntary rhythmic eye movement

Rabbits move their eyes to scan their environment or to focus on something. Nystagmus is involuntary eye movement where the eye repetitively moves from side to side, up and down, or in a circle.

Nystagmus is often accompanied by other neurological signs such as a head tilt
©Richard Saunders

What is nystagmus?

Nystagmus is a condition that is usually apparent in both eyes. The eyes will rhythmically flick back and forth horizontally, or up and down vertically, depending on the cause of the problem. Sometimes the eyes can rotate in circles. Often nystagmus is accompanied by other neurological signs such as a head tilt, flopping over, rolling around, seizures, hypermetria and loss of co-ordination.

Nystagmus is usually a clinical sign of another disease, most commonly an inner ear infection that has disrupted the vestibular system, upsetting the body’s sense of balance. Less commonly, nystagmus can be a sign of a lesion or tumor on the brain or spinal column, or by an intracellular protozoal parasite called Encephalitozoon cuniculi.

Nystagmus is not painful but may be irritating for the rabbit and very disorientating as vision can be blurred. The underlying cause of the nystagmus may be painful to your rabbit so prompt veterinary attention is important. It can be very distressing to see your rabbit with nystagmus, especially if there are other signs, but it is important to stay calm.

Why does it happen?

If the central nervous system (brain and spinal cord), which may be abbreviated to CNS, is affected the nystagmus can be horizontal, vertical or rotary and the fast phase may be in either direction or can change depending upon the position of the head.

In peripheral disease (stemming further away from the CNS, such as the inner ear), the nystagmus is usually horizontal or rotary and not vertical, with the fast phase away from the affected side, and the direction is not altered by the position of the head.

The most common reason for nystagmus in rabbits is an active E. cuniculi infection stemming from the CNS, or an inner/middle ear infection (otitis media/interna).

What should I do?

You need to take your rabbit to see your veterinarian straight away.

Your rabbit is likely to be disorientated, especially if they also have a head tilt or are rolling, so pad out their carrier with rolled towels so they cannot roll and slip around. Drive carefully so the rabbit is not moved around in their carrier. Do not place water bowls or bottles in or on the carrier. Keep stress low with the radio off and cover the carrier with a loose towel (unless it is very hot). Keep the car at a comfortable temperature for the rabbit, around 16°C/61°F.

Whilst it is always preferable to keep companions together and take both rabbits to the practice even if only one needs to go, if your rabbit is rolling and has a head tilt, it is preferable not to take the other rabbit. If they only have nystagmus and are able to stand without rolling, then taking both rabbits is advised.

How is nystagmus diagnosed and treated?

Your veterinarian will need to ascertain what the underlying cause of the nystagmus is. The direction of the nystagmus can often help to determine if the disease is centrally or peripherally located.

As nystagmus is a clinical sign of another disease, diagnostic processes will be aimed at finding the source of the problem. Your veterinarian will complete a thorough physical and neurological examination and identify any other relevant clinical signs that can help with the diagnosis. They will pay special attention to the ears. Looking down the ears with an otoscope can help to visualize anything within the outer ear, but there may be nothing visible. They are likely to recommend skull x-rays to assess the middle ears, or a CT scan which will give more information than an x-ray. Your rabbit may need to be referred for a CT scan. Bloods will also be taken to send away for E. cuniculi serology.

Supportive care will usually be started, including fluid therapy, assisted feeding, and pain relief. If the rabbit has an inner ear infection, or an infection of E. cuniculi, treatment can begin straight away with injectable or oral antibiotics, anti-inflammatories, and/or anti-parasite medications. Treatment may be required for several weeks to fully treat the infection. Inner ear infections can be challenging to cure so surgery may ultimately be required. With quick treatment and surgery, nystagmus can resolve, but if the middle ear and nerves are damaged, the rabbit may continue to show nystagmus, a head tilt, and will often lose hearing. E. cuniculi infections are treated with a minimum of a 28-day course of Fenbendazole, which is an antiparasitic medication and aims to kill the parasite. All in contact rabbits must be treated and rabbits can reinfect themselves after treatment. Treatment may not 100% resolve the clinical signs, so if the rabbit has other signs, they may be left with these to some degree or always have some nystagmus.

If the cause of the nystagmus originates in the brain and central nervous system, then it’s likely to be difficult to treat and can often be fatal.

Even after treatment some degree of nystagmus may always remain, others may have nystagmus for weeks or months and then it may resolve.

What can I do to help my rabbit?

It can be very upsetting and distressing to see your rabbit with nystagmus. Often the condition is accompanied with other signs such as a head tilt, rolling around and falling over. During treatment, your rabbit may not be able to see well, or steady themselves to eat, so syringe feeding may be required. This must be done under careful instructions by your veterinary care team.

You can help your rabbit by minimizing environmental stimuli and keeping them confined in a quiet darkened place so they can’t injure themselves. A secure carrier can be padded out with rolled up towels to prevent injury. Be sure to inspect the rabbit’s bedding frequently to prevent them soiling themselves.

Can my rabbit be happy afterwards?

Rabbits can adapt and live with mild nystagmus and some degree of head tilt. However, your rabbit must be able to be a rabbit and enjoy their life. Rabbits who roll around and are in pain or are disorientated have a limited quality of life and you should discuss this with your veterinarian.

Others who have some nystagmus but are able to move around, eat normally and are pain free or is under control are likely to have a good quality of life and be happy.

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