Cherry Eye

Description of the Condition
The gland of the third eyelid is located within the base of the third eyelid. The third eyelid (nictating membrane) lies between the lower eyelid and the eyeball at the inside corner of each eye. The third eyelid protects the eye and helps contain and distribute tears over the surface of the eye. The third eyelid gland is a tear-producing gland. This gland is responsible for contributing 30-40 percent of the normal tear volume.

A prolapse of the gland of the third eyelid results in a pink to red mass in the inner corner of the eye (see photo to the right). 
This is commonly referred to as "Cherry Eye." Enlargement (hypertrophy) of the gland is usually associated with the prolapse. The prolapse can occur in one or both of the eyes, yet one eye may precede the other by weeks to months. The cause for the prolapse is believed to be partially due to a weakness of the connective tissue attachment of the gland to the periorbita. Old timers believe "Cherry eye" is often seen as a direct result of puppies after playing on carpet, rubbing their face, or playing in in the dirt. The tear duct becomes blocked, and obstructs tear flow. After a couple of days it begins to swell because now an infection has begun. Once the BLOCKED tear duct swells, there is no room for it in it's present position, and even strong tissue cannot hold it. Thus the result is a cherry eye. This same situation happens a lot in newborn human babies who do not have good tear flow at birth and their tear ducts become blocked with the semi-solid matter that develops in the corners of their eyes. Breeds predisposed to prolapse include Cocker Spaniel, Bulldog, Lhasa Apso, Beagle, Bloodhound, Boston Terrier, Bull Terrier, and St. Bernard, and the Burmese cat.

Restoring the hypertrophied and prolapsed third eyelid gland to its normal position will preserve tear production, enhance appearance, and prevent corneal and conjunctival disease caused by the prolonged exposure. Surgically replacing the gland to its normal position is especially important in breeds (Bulldog) that are also prone to develop tear insufficiency disease (dry eye). Surgical removal of the prolapsed gland could precipitate the development of dry eye syndrome and this is a very serious disease.

Treatment Options for the Condition

Non-Surgical
There are old timers with extensive experience with "Cherry Eye Condition" that recommend an alternative to surgery, especially those breeds that have high surgical risks. The first thing that is done to "treat" this condition is to prescribe an antibiotic ointment, second use warm compresses to the corner of the eye, third is to massage the gland lightly with the index finger applying even gentle pressure in a circular motion. Once the tear duct becomes "unblocked" even if it is out of its normal place it is now of a size that usually can be returned by pulling very gently the outer tissue and "popping" the tear duct back into place. You may have to replace the tear duct several times over a two week period, sometimes I have heard for even a month, but then it does not require surgery, and the dog as a general rule has no more problems with the condition whatsoever. We urge new pet owners to be very careful when attempting to use this technique because you can cause injury to the eyeball if you scratch it when trying to massage the tear duct. Try to find another owner of a bulldog or similar breed to walk you through it the first time to make sure you are doing it correctly. We do urge you to seek veterinarian assistance if the condition worsens or if this technique fails to make an improvement. There are some bulldogs that have an inflamatory disease as well and you may see a worsening of the condition. Inflamatory conditions must be treated with an anti-inflamatory antibiotic drop or ointment.

Surgical
There are several different techniques for replacing the gland, surgically and manually. Surgery requires general inhalation anesthesia, but your pet can go home the same day as surgery once fully recovered. Surgery is performed under strict aseptic conditions.  Please make sure your veterinarian is familiar with the special anesthesia needs of Bulldogs, and is experienced in the surgical procedure of "cherry eye".

The most popular and successful surgical technique is called the Conjunctival Mucosa Pocket Procedure which creates a pocket to place the prolapsed gland inside and then the pocket is closed with very fine absorbable opthalmic sutures. Another method is to merely suture the replaced gland again with very fine absobable opthalmic sutures.  Another procedure, which we do not recommend, is the removal of the gland.  This procedure often leaves your pet with VERY inefficent tear flow which can  lead to the serious problem of dry eye, and can result in permanent corneal damage. 

After Care Recommendations for the surgical procedure
Some swelling and redness of the third eyelid and lower eyelid is normal after surgery.  Keep the eye clean of discharges. Mucoid discharges trap bacteria and inflammatory cells and inactivate medications. We recommend you use Bausch & Lomb Sensative Eyes Saline Solution and white tissues to clean the eye. The saline solution can be directly irrigated into the eye. 

Some coughing for the first postoperative week may be normal if the airway is sore from the tracheal tube used for inhalation anesthesia. If coughing is severe, please call your veterinarian or opthamologist. 

Please restrict your pet's activity for the frist 2 weeks after surgery to enhance retention of the gland. 

A topical antiobiotic and anti-inflammatory eye medication is prescribed to try and prevent infection and to minimize inflammation, but cannot be used if there is a scratch on the surface of the eye. Carefully monitor the cornea for an irregularities. Squinting can also indicate a corneal injusry. If any concerns, stop the medication and call us.

An occasional pet may rub at the eye. Distract your pet with treats or attention when this occurs. Some pets may beed a restraint collar which you can borrow from us or from your referring veterinarian.

A very rare pet will develop a re-prolapse of the gland. Though this is very dissappointing, the surgery can be repeated and is usually successful at this time.

by Stephanie Burr