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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.'

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.

	A normal cornea has no blood vessels and the tear solution, made of three layers, carries the oxygen and nutrients to the corneal cells. The Composition of Tears The outer layer of the tear film has an oily character produced by numerous tiny glands in the eyelids. This layer helps prevent evaporation of the middle aqueous layer. This aqueous layer is produced by the main tear gland and a the gland in the Third Eyelid. This is the layer that is decreased in dry eye (KCS). The innermost layer in direct contact with the cornea is a mucous layer produced by glands located in the folds of the eyelid. This mucus layer helps the aqueous layer adhere to the surface of the cornea

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 seldom 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.

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.
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.

	Other interesting topics in veterinary ophthalmology
	CERF... eye certification for dog breeding soundness	Corneal ulcers and their treatment	Close up look at a cataract in a dog with Diabetes