Bacterial meningitis in the mature horse is a rare and typically fatal condition. This report describes a 7-year-old Quarter Horse gelding that initially presented following suspected trauma to the left eye but subsequently developed bacterial meningitis, and a nasal and palpebral abscess, all of which cultured the same isolate of Escherichia coli. The entry site of infection in bacterial meningitis is often related to a breach in the calvarium and extension of bacteria residing in the paranasal sinuses. This case is unique as there were multiple pathways through which bacteria may have entered the central nervous system including haematogenous spread from a nasal abscess, local extension of periocular infection or an undetected skull fracture. Aside from persistent blindness in the left eye, the horse made a full recovery.