Download Cherry Eye: Prolapse of Third Eyelid Gland in Dog

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Cherry Eye: Prolapse of Third Eyelid Gland in Dog- A Case Report
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* Raza. A, M. A. Naeema, M. Ahmadb, A. Manzoor and M. Ijaz
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Department of Clinical Medicine & Surgery, University of Agriculture, Faisalabad, Pakistan
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a Faculty
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b Livestock
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* Corresponding author: [email protected] :
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Medicine & Surgery, University of Agriculture, Faisalabad, P.O.B.38040, Jail Road Faisalabad,
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Pakistan.
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Abstract Third eyelid covers the medial canthus of the eye and consists of T-shaped flap like
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cartilage and tear gland, both are helpful in protection of eye. Prolapsed gland appeared as a dark pink
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to reddish mass and misdiagnosed as a tumor and treated like a tumor in which gland is excised out.
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The present report describes a case of cherry eye (prolapse of third eyelid) in 18 months old Cocker
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spaniel. The case was treated by adopting massage method to replace the third eyelid back to its place
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followed by administration of eye drops. The treatment method was successful as there was no
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recurrence when the animal was followed-up for 3 months.
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Keywords:
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Introduction
of Veterinary Science, University of Agriculture, Faisalabad, Pakistan
and Dairy Development Department, Government of Punjab
Ph. # +923457697320, Dept. of Clinical
Dog, Cherry eye, Third eyelid prolapse, Treatment, Massage method
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Cherry eye is a common ophthalmic malady of dogs and rarely of cats in which eversion /
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prolapse of third eyelid gland does occur. The prolapsed third eyelid makes it vulnerable to the outer
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environment. Breeds especially Pekingese, Neapolitan Mastiff, Cocker Spaniel, Beagle, Bulldog and
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Basset Hound are more prone to this pathological syndrome [1, 3]. The disease could occur in any age
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but most common in young ones i.e. puppies. This can occur in 2-3 years of age and may be unilateral
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or bilateral [4, 7]. Genetic basis of the disease are not identified and third eyelid is important in
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protection of eyes as well as production of tears [7]. The eversion of nictitating gland is written off as
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glandular hyperplasia, hypertrophy, nictitating gland adenoma, protrusion of gland or cherry eye [9].
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The main cause of prolapse is weakening of supportive ligament that fixes the gland [2]. The present
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manuscript is a maiden attempt to report the cherry eye disease in dogs from Pakistan.
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Case Description
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A 1.5 years old male dog (Cocker Spaniel) was presented to Veterinary Teaching Hospital (VTH),
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Dept. of Clinical Medicine and Surgery, University of Agriculture, Faisalabad, Pakistan, with a
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complaint of pinkish lump like structure protruding out at the base of left eye from the medial canthus.
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The size of the structure was similar to that of cherry with bright pink color. This condition was 15
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days standing and the patient was in great stress from the last 5 days due to severe irritation and
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lacrimation (Plate I).
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Physical examination revealed that temperature of the animal was normal i.e. 101.6 0F with
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severe panting and salivation. Other parameters (Respiration 80 bpm and pulse 90 per minute) were
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also recorded. Regarding previous treatment, patient was treated with eye drops and systemic
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antibiotics.
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The patient was treated by applying the Lignocaine gel on eye (Lidex®, Caraway, Pakistan) and
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gently massaging the protruded mass clockwise and anti-clock wise by closing the eyelids. After
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giving 3 rounds of massage each of 4-5 minutes, the prolapsed gland was replaced back to its original
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position (Plate II). Then patient was medicated topically with eye drops (Mebradex®, MediPak,
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Pakistan) to keep the eye surface wet and reduce the chances of inflammation and infection. The
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animal was monitored for recurrence and there was no recurrence up to 3 months post treatment.
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Discussion
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Third eyelid covers the medial canthus of the eye, consists of T-shaped flap like cartilage and tear
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gland, both are helpful in protection of eye [2]. Prolapsed gland appeared as a dark pink to reddish
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mass and misdiagnosed as a tumor and treated like a tumor in which gland was excised out, but this
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resulted in dryness of the eye because third eyelid gland or nictitating gland is one of the tear
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producing glands that keeps the eye moist. The main complication after its removal was kerato-
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conjunctivitis siccas (KCS) [5]. Third eyelid gland produces 30% of the total tears [7, 10] which are
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important for the intactness of eyelid, eyeball surface and conjunctiva [8]. This prolapse happens
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because of the loss of tensile strength of the peri-orbital supporting ligament that anchors the gland to
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the peri-orbit [9]. So the prolapsed gland becomes exposed to the external environment which leads to
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increase in the glandular size due to abrasion and drying [3, 7].
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Regarding its treatment, two methods are usually adopted; excision of gland and replacement
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of gland. Excision of gland is an old method and not recommended now-a-days because the whole
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gland is nipped at its base which leads to 'dry eye’. This causes further complications. Regarding
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second option, cosmetically correction of prolapsed gland is the most recommended method in which
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'tucking' technique is usually used. Previously single tucking technique was used but if somehow
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suture may adhere, this will cause blepharospasm and visibility of the suture. So this method is
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modified now and a wedge of tissue is removed but how much tissue is removed and tiny sutures will
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tightens the gap or not, are the major points of consideration. Main complications of modified
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techniques are inflammation, chances of recurrence and failure of stitch holding capacity [6]. The
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present case was treated by simple massage method followed by no recurrence. So it is suggested that
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the massage method to replace the prolapsed third eyelid is considered one of the best and safest
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methods to treat the cherry eye condition in dogs if there is no recurrence.
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Plate I. Prolapsed third eyelid in dog (Cockerel Spaniel)
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Plate II. Reduced prolapse of third eyelid after application of massage method
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