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Cherry Eye - Issue Description

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Issue Name

Cherry Eye

Other Names
Canine Nictitans Gland Prolapse

Issue Description

Cherry eye is the term used to refer to canine nictitans gland prolapse, a common eye condition in various dog breeds where the gland of the third eyelid known as the nictitating membrane prolapses and becomes visible.


It appears as a red mass in the inner corner of the eye, and is sometimes mistaken for a tumor. After gland prolapse, the eye becomes chronically inflamed and there is often a discharge. Because the gland is responsible for about 30% of the eye's tear production, the eye can eventually suffer from dryness (keratoconjunctivitis sicca). Dry eye may eventually occur in 30 to 40 percent of dogs that have the gland removed, yet it may affect about 20 percent of dogs that have the gland surgically replaced.

Breeds Affected

Any dog can develop cherry eye, but there are several breeds that appear to have a higher incidence of developing it in both eyes. They are: the Basset Hound, Beagle, Bloodhound, Boston Terrier, Bulldog, Bull Terrier, Chihuahua, Cocker Spaniel, Lhasa Apso, Neapolitan Mastiff, Saint Bernard, and Shar-Pei. Dogs can acquire this condition at any age and it affects males and females equally.


Cherry eye may be caused by a hereditary weakness in the connective tissue surrounding the gland. It is most common in puppies.


Cherry eye, if caught early, can be resolved with a downward diagonal-toward-snout closed-eye massage of the affected eye or occasionally self-corrects alone or with antibiotics and steroids. Sometimes the prolapse will correct itself with no interference, or with slight physical manual massage manipulation as often as necessary coupled with medication.

Surgery is the most common means of repairing a cherry eye. Surgery involves gland replacement, not excision, by anchoring the membrane to the orbital rim or using a pocket technique. In severely infected cases, preoperative antibiotics may be necessary by means of antibiotic eye ointment. Removal of the gland was once an acceptable treatment, and made the eye appear completely normal. Despite cosmetic appeal, removal of the gland reduces tear production by 30 percent. Tear production is essential in maintaining and protecting the eye from the external environment. Reduced tear production is especially problematic in breeds of animals predisposed to Keratoconjunctivitis sicca (KCS), also known as dry eye syndrome. With surgeries performed in this manner, KCS often results later in life.

Close-up of prolapsed gland in small breed dog
KCS is not common in dogs, affecting one per cent of the dog population. KCS is a chronic degenerative conjunctivitis that can lead to impaired vision and blindness. KCS has a wide array of causes including drug toxicity, cherry eye, previous surgery, trauma, and irradiation. KCS can be treated, but treatment often spans the entirety of the animal's life.

In contrast to this, several replacement surgical procedures exist to remedy cherry eye. Replacement of the gland results in lower instances of dry eye later in life. Surgery types are broken into two groups: anchoring procedures and pocket/envelope procedures. At least 8 surgical techniques currently exist. In anchoring procedures, the prolapsed gland must be sutured to the periorbital fascia, the sclera, or the base of the third eyelid. In contrast, pocket procedures involve suturing healthy tissue around the prolapsed to enclose and secure it. Each of these techniques may be performed with an anterior or superior approach, depending on which direction of suturing will cause the least complications to the eye.

Anchoring method
Originally, the anchoring method involved suturing the gland to the globe. This method was superseded over time due to the risky and difficult nature of the surgery, along with a high rate of recurrence. Anchoring approaches from posterior may disrupt normal fluid excretion. Subsequently, an anterior approach was introduced. Disadvantages of anchoring techniques include restricted mobility of third eyelid, which is essential in the functions of fluid distribution and self-cleaning.[10] New procedures are currently being explored to allow tacking of the NM without restricting movement of the third eyelid.[10] Few studies compare results of surgeries, therefore choosing a procedure is a matter of preference.

Envelope/pocket method
The envelope method, often called the pocket technique, requires suturing of tissue around the prolapse, encasing it in a layer of conjunctiva. Pocket techniques are easiest for doctors to learn. Pocket methods also have anterior and posterior versions. Posterior suturing techniques are the most commonly used because they cause the least complications, with no alterations in tear production. Surgery should only be attempted by experienced surgeons. Inappropriate surgical techniques can result in many complications including cysts on the eye.


Without treatment
Previously, treatment was thought optional until the role of NM was fully understood. The NM gland is responsible for 40–50% of tear production. If exposed for extended periods of time, the gland is at risk for trauma, secondary infection, and reduced tear production. Many complications can arise if left untreated: early closed-eye massage manipulation is recommended to prevent inflammation.

Post treatment
Postoperative treatment includes antibiotic eye ointment three times daily for two weeks. It is possible to have a relapse of the gland after surgery and require multiple surgeries. With treatment, it is possible for animals to live a normal life.

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