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Cherry Eye... Third Eyelid Eversion In The Dog
Cherry Eye in the dog is a picturesque term
for Everted Third Eyelid. The Third Eyelid is also known as the
Nictitating Membrane. It serves as added protection for the eye through an
interesting ability to close upward and
over the dog's eyeball. The canine
is able to retract the entire eyeball backward
into the eye socket, and coupled
with this retraction is the Third Eyelid's ability to slide up and over the
retracted globe.
On the underside of the Third Eyelid is a small gland. It secretes about 30 percent of the eye's tear production. Some surgeons prefer to preserve this gland at the time of surgery to correct Cherry Eye, with the thought in mind that if the other tear producing apparatus ever fail due to infection, trauma, or autoimmune disorders, the gland of the Third Eyelid will be of benefit to the eye.
Once the tear production of an eye fails, a chronic dryness ensues and adversely impacts the health of the eye surfaces. This "dry eye" is called Keratoconjunctivitis sicca (KCS).
Keratoconjunctivitis sicca (KCS) or "dry eye" describes the changes in the eye which result from lack of tear production. To understand "dry eye" it is helpful to know how tears help keep the cornea healthy. The cornea is the optically clear portion of the eye that allows entry of light into the eye. Like all living tissue, the cornea requires a supply of oxygen and energy to remain healthy. Oxygen and nutrients are supplied to most tissues by the blood that moves through the area in blood vessels. The healthy cornea has no blood vessels, if it did it wouldn't be clear, so the oxygen and nutrients are supplied through the three-layered 'tear film.'
Another Technique To Correct CHERRY EYE SURGERY
The “pocket technique” has been recognized as one of the more successful
techniques to correct this condition. Since originally described, several
additional steps have been suggested to improve surgical success. The basic
steps of the surgery involve creating two parallel incisions on either side of
the gland. These two incisions are then sutured together with 6-0 vicryl as the
prolapsed gland is positioned ventrally. Care is taken to either bury the knots
or suture them on the palpebral surface of the nictitans. Several surgeons have
suggested adding a second layer of suture material over first to decrease
tension on the incision. In addition, knots are suggested to be tied on the
palpebral surface (pass the needle through the nictitans) of the nictitans to
avoid corneal frictional irritation.
The images below of CHERRY
EYE can be clicked on for a close-up look in a new window.
They are fairly large sized images and will take a moment to display.
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SURGERY TO REPAIR AN EVERTED THIRD EYELID
The thumbnail images below should be clicked on to reveal full sized images of one surgical method of correcting an everted Third Eyelid. In this case the surgeon has elected to remove the thin strip of cartilage that has weakened and bent backward along with the gland of the Third Eyelid. Generally there is little bleeding and care is taken not to cut through the entire eyelid. It is not a good idea to remove the entire Third Eyelid. By removing the weakened and bent strip of cartilage and the gland the eyelid is able to retract into its normal position in the nasal corner of the eye.... allowing less irritation and decreased potential damage to the cornea.
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Click on an image to enlarge... click on ZOOM for a close up |
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| This view displays an everted Third Eyelid and adjacent structures. ZOOM | Alligator forceps are used to stabilize the Third Eyelid so the surgeon can have a good look at the underside of the lid. | Just below the inside edge of the lid the scissors begins to incise parallel to the lid margin. ZOOM | The thin cartilage strip is cut through and the gland is undermined and pulled away from its attachment to the inner surface of the lid. |
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| The deep attachment of the gland and the cartilage strip are incised. This view is looking from beneath the separated gland of the Third Eyelid. ZOOM | This view shows the surface of the gland of the Third Eyelid as the scissors completes the removal of the offending tissue. ZOOM | Immediate post op view of the relaxed Third Eyelid after the gland and bent cartilage have been removed. Healing is complete in just a few days. | A close-up of the excised gland of the Third Eyelid. The thin strip of cartilage is barely visible in the center of the specimen. |
Most veterinarians can perform this simple surgical procedure. It is generally advisable to consider the procedure due to the irritation and potential damage that can result from the dog pawing or scratching at the affected eye. Take a look at what can happen when a dog rubs the cornea and creates a corneal ulcer. For more information about veterinary ophthalmology, a good place top start would be to visit with a Board Certified Specialist in Veterinary Ophthalmology... click here to view.
References for your information:
http://www.vetmed.wisc.edu/Data/CourseMaterial/Miller/Thirdeyelid.pdf
Therapy - Many practitioners excise the gland
because it is technically simpler, because they are uncomfortable with
replacement procedures, and because they feel that they do not see KCS as a
sequelae. I would encourage you to replace the gland as KCS really does
occur in many of these dogs following excision (but usually several years
later) and life-long medication is a lot more complicated than the
replacement procedures.
a. In one study, of 160 dogs presented for dry eye, 38 had the gland of the
third eyelid resected (this percentage is obviously much greater than the
frequency of gland excision in the general population).
b. In another study of 89 cases of "cherry eye" by Rhea Morgan: 48% of dogs
treated by excision of the gland developed KCS but did so an average of 3
years later (the earliest was 6 months). Possibly the remaining lacrimal
gland "burns itself out" from chronic overproduction over time.
If the gland was left prolapsed, 43% developed KCS. If the gland was replaced, 14% developed KCS; and 5% of the "normal" eyes (those without a prolapsed gland), developed KCS. Dogs with a tendency for "cherry eye" are at a higher risk for KCS than the general population.
http://www.ivis.org/proceedings/wsava/2005/105.pdf
Many dogs with KCS associate dry eye with seborrhea or atopy and rheumatoid factor was positive in some dogs with KCS. Based on these findings, the majority of canine KCS cases are considered as an autoimmune disease.
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http://www.ivis.org/proceedings/wsava/2005/106.pdf
Proceedings of the World Small Animal Veterinary Association, Mexico City, Mexico – 2005
The first treatment to try is the replacement of the gland by using different techniques. A recurrence of the prolapse may occur and the removal of the gland could be performed, although there is not agreement about the effects of this technique on tear production. |
Other interesting topics in veterinary ophthalmology |
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