February: Bubba’s Bite: From Colic to Retrobulbar Abscess Recovery

February Case of the Month: Bubba’s Bite: From Colic to Retrobulbar Abscess Recovery

Bubba, a retired warmblood showjumper, was originally seen for what was thought was colic on a winter evening.  He had gradually been going off his food and now refused to eat anything but otherwise had no signs of abdominal pain. His sedated dental exam was normal except for a yellow discolouration behind his last molar on the left side.  His teeth were floated without improvement.  Over the next couple of weeks he was seen multiple times without improvement.  He had a waxing/waning fever and would only eat very soft mash.  He wouldn’t go near hay and would try to eat grass but appeared to be unable to chew it and would act like he was choking and drop it all.  Due to the fevers he was put on an oral antibiotic and anti-inflammatories, which he initially improved on and then continued to degrade.  Then a large swelling developed on the left side of his face, right over the temporomandibular joint.  On imaging the swelling appeared to be a soft tissue mass with fluid all through it with associated joint inflammation of the TMJ and enlargement of the mandibular condyle.  It seemed like a retrobulbar abscess, which are fairly common in dogs but not horses.  A prominent equine surgeon was consulted; he had seen a retrobulbar abscess once in a horse with associated TMJ osteoarthritis and he thought that Bubba may indeed have one as well. Bubba received a prolonged course of Excede, and over those 10 days became brighter, the swelling decreased significantly and he started eating his mash well again and then grass.  The TMJ was blocked, a before and after video showed this drastically improved his ability to chew grass and hay.  Just over a week later this joint was injected with a steroid and since then Bubba has gone back to eating grass enthusiastically and eating about 60-70% of his original hay amount and has been bright and happy.  His TMJ will likely always be mildly enlarged and he will need annual repeat injections but his owner was thrilled to have her old horse back and his comfort restored.