Prolapsed Gland of the Third Eyelid (Cherry Eye)

Basics

Overview

Gland of the third eyelid-normally anchored by a fibrous attachment to the periorbita beneath the third eyelid.
Weak attachment-several breeds of dogs and cats; predisposes animals to unilateral or bilateral prolapse.

Signalment

Dog and cat.
Dog-usually in young dogs (aged 6 months to 2 years); common breeds: cocker spaniel, bulldog, beagle, bloodhound, Lhasa apso, mastiff, Shih Tzu, other brachycephalic breeds.
Cat-rare; occurs in Burmese and Persians.

Signs

Oval, hyperemic mass protruding from behind the leading edge of the third eyelid.
May be unilateral or bilateral.
May see accompanying epiphora, hyperemic conjunctiva, or blepharospasm.
Additional swelling and hyperemia caused by environmental irritation and desiccation of the exposed gland.

Causes & Risk Factors

Congenital weakness of the attachment of the gland of the third eyelid.
Inheritance unknown, but considered complex and multigenic.

Diagnosis ⬆ ⬇

Diagnosis

Differential Diagnosis

Scrolled or everted cartilage of the third eyelid-seen in Wiemaraners, Great Danes, German shorthaired pointers, and other breeds in which the T-shaped cartilage of the third eyelid is rolled away from the surface of the eye instead of conforming to the surface of the cornea.
Neoplasia of the third eyelid-usually seen in older animals; may see squamous cell carcinoma, lymphoma, or fibrosarcoma; may be origin of adenoma or adenocarcinoma; small incisional biopsy is indicated in older patients (>7–9 years) to differentiate.
Orbital fat prolapse-may dissect anteriorly between the conjunctiva and globe; occasionally occurs in the medial canthus and simulates a prolapsed gland of the third eyelid.

CBC/Biochemistry/Urinalysis

N/A

Other Laboratory Tests

N/A

Imaging

N/A

Diagnostic Procedures

N/A

Treatment ⬆ ⬇

Treatment

Surgical replacement of the gland (imbrication technique)-see “Suggested Reading.”
Excision of the gland-avoid; gland produces up to 50% of the aqueous tear film; puts patient at substantial risk for developing KCS as the dog ages.
Elizabethan collar-recommended to prevent self-trauma.

Medications ⬆ ⬇

Medications

Drug(s)

Topical anti-inflammatory medications, such as corticosteroids (if no corneal ulceration) or nonsteroidal anti-inflammatory medications-may be used before and after surgery to lessen swelling.

Contraindications/Possible Interactions

N/A

Follow-Up ⬆ ⬇

Follow-Up

Recurrence-5–20%, depending on the breed, with large-breed dogs such as mastiffs having the highest recurrence rates; re-replacement of the gland is encouraged.
If unilateral, warn client that the other gland may also prolapse and that no preventive procedure or medication exists.

Miscellaneous ⬆

Miscellaneous

Synonym

Cherry eye

Abbreviation

KCS = keratoconjunctivitis sicca

Author Brian C. Gilger

Consulting Editor Paul E. Miller

Suggested Reading

Edelman ML, et al. Investigating the inheritance of prolapsed nictitating membrane glands in a large canine pedigree. Vet Ophthalmol 2013, 16: 416–422.

Hendrix DVH. Diseases and Surgery of the Canine Conjunctiva and Nictitating Membrane. In: Gelatt KN, Gilger BC, Kern T, eds., Veterinary Ophthalmology, 5th ed. Ames, IA: Wiley-Blackwell, 2013, pp. 945–975.

Maggs DJ. Third eyelid. In: Maggs DJ, Miller PE, Ofri R, Slatter's Fundamentals of Veterinary Ophthalmology, 5th ed. St. Louis, MO: Elsevier, 2013, pp. 159–164.

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Basics ⬇

Diagnosis ⬆ ⬇

Treatment ⬆ ⬇

Medications ⬆ ⬇

Follow-Up ⬆ ⬇

Miscellaneous ⬆