Cherry Eye & Entropion

April 20, 2019

What is “cherry eye”?

“Cherry eye” is a common term for prolapse of the gland of the third eyelid, or nictitans membrane. Many mammals, including dogs, have an “extra” or third eyelid located inside the lower eyelid. This serves as an additional protective layer for the eye, especially during hunting or fighting. The third eyelid contains a gland that produces a significant portion of the tear film. When this gland prolapses or “pops out”, the condition is known as “cherry eye”.

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What are the clinical signs of “cherry eye”?

Prolapse of the third eyelid gland appears as a red swollen mass (named by its resemblance to a cherry) on the lower eyelid near the nose or muzzle. The “cherry eye” may be large and cover a significant portion of the cornea or it may be small and appear only periodically. Any sign of “cherry eye’ should be brought to your veterinarian’s attention immediately.

What causes “cherry eye”?

The gland of the third eyelid is normally anchored to the lower inner rim of the eye by a fibrous attachment. In certain breeds, it is thought that this attachment is weak, which allows the gland to prolapse easily. The breeds most commonly affected include cocker spaniels, bulldogs, beagles, bloodhounds, Lhasa apsos, Shih tzus, and other brachycephalic breeds (dogs with “squished” faces and short limbs). Burmese and Persian cats are also reported to have “cherry eye”.

What is the treatment of “cherry eye”?

Treatment involves surgical replacement of the third eyelid gland. It is important to treat the condition as soon as possible in order to minimize damage. This is critical because the third eyelid gland produces up to fifty percent of the watery (aqueous) portion of the tear film. Without adequate tear production, your dog is much more likely to develop “dry eye”, which can seriously impair vision. Your veterinarian will discuss the appropriate surgical technique that will best suit your pet’s condition.

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What is the prognosis?

In most cases, the gland returns to normal function within a few weeks of surgery. Approximately five to twenty percent of cases may experience a re-prolapse of the third eyelid gland and require additional surgery. Many pets that have a prolapse in one eye will eventually experience a prolapse in the opposite eye. Surgical replacement of the third eyelid gland is always the first choice of treatment due to the risk of developing “dry eye” if the gland is lost. In severe or chronic cases, there may be no option other than removal of the gland, especially if the function is severely diminished or absent.

Eyelid Entropion in Dogs

What is entropion?

Entropion is an abnormality of the eyelids in which the eyelid “rolls” inward. This inward rolling often causes the hair on the surface of the eyelid to rub against the cornea (outer part of the eyeball) resulting in pain, corneal ulcers or corneal erosions. This corneal damage can also result in corneal scarring, that can interfere with vision.

Most dogs will squint, hold the eye shut and tear excessively (epiphora). Interestingly, many flat-faced dogs with medial entropion (involving the corner of the eyes near the nose) exhibit no obvious signs of discomfort. In most cases, both eyes are affected. Cats can also be affected by entropion and are treated similarly.

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Are certain breeds more likely to have entropion?

Entropion is considered a hereditary disorder. While the exact genetics are unknown, many breeds are identified as having this problem. These breeds include:

  • Akita
  • American Staffordshire terrier
  • Pekingese
  • Bulldog
  • Pomeranian
  • Pug
  • Japanese chin
  • Shih tzu
  • Yorkshire terrier
  • Staffordshire bull terrier
  • Dalmatian
  • Old English sheepdog
  • Rottweiler
  • Siberian husky
  • Vizsla
  • Weimaraner
  • Toy and miniature poodle
  • Basset hound
  • Bloodhound
  • Clumber spaniel
  • English and American cocker spaniel
  • English springer spaniel, English toy spaniel
  • Tibetan spaniel
  • Chesapeake Bay retriever
  • Flat-coated retriever
  • Golden retriever
  • Gordon setter
  • Irish setter
  • Labrador retriever
  • Great Dane
  • Bernese Mountain dog
  • Mastiff
  • Saint Bernard
  • Newfoundland
  • Great Pyrenees
  • Shar pei

How is entropion treated?

The treatment for entropion is surgical correction. A section of skin is removed from the affected eyelid to reverse its inward rolling. In many cases, a primary, major surgical correction will be performed, and will be followed by a second, minor corrective surgery later. Two surgeries are often performed to reduce the risk of over-correcting the entropion, resulting in an outward-rolling eyelid known as ectropion. Most dogs will not undergo surgery until they have reached their adult size at six to twelve months of age.

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What is the prognosis for entropion?

The prognosis for the surgical correction of entropion is generally good. While several surgeries may be required, most dogs enjoy a pain-free normal life. If the condition is treated later and corneal scarring has occurred, there may be permanent irreversible visual deficits. Your veterinarian will discuss a diagnostic and treatment plan for your dog to help you successfully treat this condition.

Ernest Ward, DVM

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