Prolapse of the Tear Gland of the Third Eyelid
The normal canine eye receives its tear film from two lacrimal (tear-producing) glands. One gland is located above the eye, and the other is found within the animal's third eyelid. The gland of the third eyelid contributes a significant portion of secretion to the tear film.
In the smaller breeds -- especially Boston terriers, Cocker spaniels, bulldogs and beagles -- the gland of the third eyelid is not strongly held in place. The gland prolapses (slips out) to where the owner notices it as a reddened mass. Out of its normal position, the gland does not circulate blood properly and may swell.
Treatment - Removal of the Gland
Historically, the prolapsed gland was treated like a small tumor and was simply removed. That was before the full significance of the gland was realized.
If the third eyelid's tear gland is removed, it cannot be put back in place. If the other tear gland (the one above the eye) cannot supply adequate tears, which is not an uncommon phenomenon in older small breed dogs, then the eye becomes dry and uncomfortable. A thick yellow discharge results and the eye develops a blinding pigment covering for protection. This condition is called simply dry eye, or more scientifically keratoconjunctivitis sicca, and daily medical treatment is required to keep the eye both comfortable and visual. Not only is dry eye uncomfortable for the pet, its treatment is often frustrating and time-consuming and there is expense involved. We would like the dog to maintain the greatest amount of tear producing tissue possible, thus removing the gland for cosmetic reasons is not an acceptable treatment method.
Treatment - Replacing the Gland
The only acceptable treatment of cherry eye is replacement of the gland in its proper location. There are two techniques for doing this. The traditional tucking method is probably most commonly performed. Here, a single stitch is permanently placed that draws the gland back where it belongs. Complications are uncommon but be aware of the following possibilities:
- If the stitch unties, the surface of the eye could become scratched by the suture. If this occurs, the eye will become suddenly painful and the suture thread may be visible. The suture can be removed and the problem solved.
- The tuck may not be anchored well enough to hold permanently. In fact, this surgery is notorious for this type of failure and frequently a second tuck is needed. If this occurs, we recommend that a board certified ophthalmologist perform the second surgery to maximize the chances of permanent resolution.
- Sometimes cherry eye is accompanied by other eyelid problems that make the repair more difficult or less likely to succeed. In these cases, again, if the simple surgery is not adequate, we recommend that a veterinary ophthalmologist perform the second surgery to maximize the chances of a permanent resolution.
In a newer surgical technique, a wedge of tissue is removed from directly over the actual gland. This technique is more challenging as it is not easy to determine how much tissue to remove. Tiny stitches that will eventually dissolve are used to close the gap so that the tightening of the incision margins pushes the gland back in place. Complications may include:
- Inflammation or swelling as the stitches dissolve.
- Inadequate tightening of the tissue gap may lead to recurrence of the cherry eye. As mentioned, if the surgery fails, a veterinary ophthalmologist should perform the second surgery.
- Failure of the stitches to hold and associated discomfort. Loose stitches could injure the eye depending on the type of suture used.
Sometimes both surgical techniques are used in the same eye to achieve a good replacement. Harmful complications from cherry eye surgery are unusual but recurrence of the cherry eye is common. If a cherry eye recurs, it is important to let your veterinarian know so that a second surgery either with your normal veterinarian or with an ophthalmology specialist can be planned. An owner should expect some postoperative swelling after cherry eye repair but this should resolve and the eye should be comfortable and normal in appearance after about a week. If the eye appears suddenly painful or unusual in appearance, it is important that it be rechecked as soon as possible.