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CHERRY EYE

 

   "Cherry Eye" is the common name used to identify a prolapse of the gland of the third eyelid. This third eyelid is located in the inside corner of each eye. The medical term for Cherry Eye is Nictitans Gland Prolapse. Prolapse of the gland means that the gland comes out of its normal position and protrudes from the eye. When this happens, the gland appears as a visible pink/red bulge in the corner of the eye. While unsightly, this occurrence is not an emergency and you shouldn't get overly stressed about getting immediate veterinary care in the middle of the night or over a weekend. It can be annoying to the dog if left untreated for any length of time, but it's not necessarily painful and can wait a day or two for treatment if necessary.

   Keep in mind however, that once exposed to dry air and irritants, the gland can become further irritated, red and swollen, so treatment shouldn't be put off indefinitely. If left untreated for more than a day or two, a mucous discharge and redness of the conjunctiva (lining of the eyelid) may develop and if the animal rubs or scratches at its eye, the gland could be further traumatized, causing increased swelling and irritation. Trauma to the gland from prolonged prolapse or from the dog rubbing or scratching could also injure the eye itself, leading to an ulcer on the surface of the eye.

   While any dog can develop Cherry Eye, this is a condition which is more common in breeds that have large or protruding eyes or eyelid construction that is not tight and tends to droop - Cocker Spaniels, English Bulldogs, Shih Tzus, Lhasa Apsos, Bloodhounds, etc. It is is most common in young dogs, six weeks to two years of age and appears equally in males and females. Cherry Eye can occur in one or both eyes and may occur in each eye at different times.

   A C.E.R.F. certificate or clear ophthalmologist eye exam on a particular dog does not mean that that particular dog does not have or has never had Cherry Eye. Nor does a clear exam mean that puppies from that dog will never develop Cherry Eye. Cherry Eye has not been proven to be a genetic defect and C.E.R.F. will certify a dog that has had one or both glands prolapsed.

   The reason this prolapse occurs is not completely understood.  It can occur secondary to eye inflammation or irritation or for unknown reasons.  Some people suspect that certain occurrences may be due to a genetic weakness of the connective tissue that attaches the gland to the surrounding structures of the eye.   However, there is no known inheritance pattern for Cherry Eye.    While I have seen some familial tendency with Cherry Eye, I have also seen numerous instances that occurred shortly after a particular dog had been in a stressful situation (new home, first dog show, trip to the groomer's, etc.). 

   If you suspect your dog has Cherry Eye, you should contact your veterinarian as soon as possible to avoid further complications. Your vet will visually inspect both eyes and may measure tear production or do a fluorescein staining of the cornea to be sure there is no other problem contributing to or as a result of the Cherry Eye development.  Depending on what your vet finds on examining your dog, there are several courses of action for treating this condition.

   Most vets prefer to start treatment by trying a round of antibiotics and/or topical anti-inflammatory medications to decrease inflammation of the conjunctiva and the prolapsed gland.  If this treatment is ineffective, your vet will most likely suggest a minor surgical procedure be done to correct the problem. There are two different surgical procedures to choose from and each has its pros and cons. The preferred procedure (at this time) involves "tacking" the prolapsed gland back in position with a suture that attaches the gland to the deeper structures of the eye socket. The second procedure is to completely remove the gland.

   The current preference for repositioning the gland stems from the fact that the third eyelid contains a tear duct which is responsible for as much as 35% of watery tears in the eye. It is believed that removal of the gland may contribute to a dog developing a condition known as Dry Eye (Keratoconjunctivitis Sicca or KCS) later in life. When the third eyelid gland is removed, you may be increasing the chances for the development of this condition, especially if the dog should suffer from another condition or injury that impacts the production of tears from the remaining tear glands. Dry Eye can require daily treatment to the eye with artificial tears and lubricants. Signs of dry eye can include thick, pussy discharge, redness of the conjunctiva and cloudiness of the cornea.

   If your dog only has one eye that has prolapsed, you should watch the other eye closely for development of a Cherry Eye as it is likely to prolapse as well. If you choose to have a prolapsed gland repositioned and tacked down, you can ask the vet to suture the other eye's gland at the same time. This could help prevent the need for a second surgery.   The success of surgery to replace a prolapsed gland will be affected by the size of the gland at the time of surgery, the length of time the gland was prolapsed, and the condition of the cartilage of the third eyelid.

   Generally speaking, the success rate is higher if the gland is replaced quickly. Excessive swelling or inflammation or damage to the cartilage can all impact whether surgical replacement is successful. You can generally consider surgical replacement to have been successful if the gland stays in place for 30 days after being tacked back into position. If a repositioned gland should prolapse a second time, a second surgical replacement can be attempted or you and your vet may choose to remove the gland completely.

   Surgical treatment of Cherry Eye is generally very quick, relatively inexpensive and has few complications. The gland is either replaced or is completely absent and causes no further problem. It will be important that you administer all medication and that you return for any follow-up care as directed by your veterinarian. In some dogs, an Elizabethan collar may be needed after surgery to prevent self-induced injury while the surgery site heals. Most dogs will be given an antibiotic ointment for treatment of the eye for a few days after the surgery, but this is generally the only follow-up care necessary.

   The treatment may seem straightforward as described above but, in my experience, there are several additional facts that need to be considered when deciding how to treat a case of Cherry Eye. Remember, the following information is based on my own personal experiences and my viewpoint is offered for informational purposes only! I am not a vet and you should always consult your own veterinarian for diagnosis and treatment of any problem with your dog.

   In my years of dealing with Cockers, here is what I have seen when dealing with this condition and how I deal with this occurrence in my own dogs:

  • In my experience, topical and/or injectable treatments of antibiotics and/or corticosteroids are most often ineffective in reducing the gland and, even if they do work, the gland is likely to prolapse again at a later date.
  • Since a prolapsed gland is at risk for further trauma or infection, I believe prompt surgical treatment is the best choice.
  • Every dog that I have had the gland repositioned and "tacked" down, prolapsed again at a later date and had to have additional surgery to correct the problem. Most vets will tell you there is only a 5 to 20 percent recurrence rate. I have seen much higher percentages in my own and other's dogs.
  • 9 times out of 10, if one eye prolapses, the other will too. The second eye usually prolapses within 1-4 weeks of the first. Or as soon as I do surgery, the second eye will prolapse so that I have to have a second surgery almost immediately following the first!
  • If I have a dog that develops Cherry Eye, I have it surgically removed. I feel that prompt removal without the need for additional surgeries and treatment is safest for the dog.
  • I have had numerous Cherry Eyes completely removed over the years and I have never had a dog develop Dry Eye.
  • I have seen some familial tendency in the occurrence of this problem, but I don't actually believe this is the result of a specific gene that is "defective".   I believe that changes in head structure in American Cockers over the last 70 years (shorter noses, more pronounced "stops", more prominent eyes) have contributed to an eye structure that is now more susceptible and sensitive to irritation and contaminants (dust, dirt, hair) getting in the eye and/or to trauma.  I further believe that these structural changes have resulted in certain head "types" which are more prone to this problem.   
  • In my experience, if you hope to avoid this issue when purchasing a puppy, you should choose a dog with the tightest eye rims possible.   Dogs with droopy lower eyelids (which catch and hold more contaminants in the eye and which do not help support the interior eye structures) tend to be more susceptible to this problem.

If you choose to purchase a Cocker Spaniel, there is some chance that you may eventually have to deal with Cherry Eye. Reputable Cocker breeders as a whole are working to find a way to eliminate this problem, but it is a problem that is prevalent in the breed and can crop up in any bloodline.
 

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Thanks,

Cindy

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