Cherry eye

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Close-up of a cherry eye Prolapsed gland of the third eyelid.JPG
Close-up of a cherry eye

Cherry eye is a disorder of the nictitating membrane (NM), also called the third eyelid, present in the eyes of dogs and cats. [1] Cherry eye is most often seen in young dogs under the age of two. [2] Common misnomers include adenitis, hyperplasia, adenoma of the gland of the third eyelid; however, cherry eye is not caused by hyperplasia, neoplasia, or primary inflammation. [3] In many species, the third eyelid plays an essential role in vision by supplying oxygen and nutrients to the eye via tear production. [4] Normally, the gland can turn inside-out without detachment. [3] Cherry eye results from a defect in the retinaculum which is responsible for anchoring the gland to the periorbita. This defect causes the gland to prolapse and protrude from the eye as a red fleshy mass. [3] Problems arise as sensitive tissue dries out and is subjected to external trauma [3] Exposure of the tissue often results in secondary inflammation, swelling, or infection. [3] If left untreated, this condition can lead to dry eye syndrome and other complications. [4]

Contents

Description

Cherry eye is most common in young dogs, especially breeds such as Cavalier King Charles Spaniel, English Bulldog, Lhasa Apso, Shih Tzu, West Highland White Terrier, Pug, Bloodhound, American Cocker Spaniel, and Boston Terrier. [1] Cherry eye is rare in felines, but can occur. This defect is most common in the Burmese breed of felines. [5] A similar condition exists in dwarf lop-eared rabbits, which occurs in the harderian gland. Similar surgical treatment is necessary. [3]

There is likely a complicated and multigenic component involving genetic risk factors. [6] Some breeds are considered to be more susceptible to its development than others, including the Bulldog, Boston Terrier, Bull Terrier, Lhasa Apso, Cocker Spaniel, St. Bernard, Shar-pei, Shih Tzu and Poodle [7] The NM contains many glands which merge and appear as a single gland. [8] Typically, glands secrete tears for lubrication of the cornea. [8] Lack of anchoring allows the gland to flip up, causing the gland to prolapse. Symptoms include a visible fleshy mass, abnormal tear production, and a discharge or drainage from the eye. Cherry eye is typically diagnosed by examination of the conjunctiva and nictitating membrane. [2] The most obvious symptom of cherry eye is a round fleshy mass in the medial canthus of the eye, similar in appearance to the fruit it is named for. [8] This mass may be unilateral or ‘’bilateral’’. Both eyes may develop cherry eye at different times in the animal's life. [1] Other symptoms of cherry eye include drainage from the eye and abnormal tear production. Initially, cherry eye results in overproduction of tears, but eventually changes to unsubstantial tear production. [1]

Treatment

Non-surgical

Cherry eye, if caught early, can be resolved with a downward diagonal-toward-snout closed-eye massage of the affected eye or occasionally self-corrects alone or with antibiotics and steroids. [3] Sometimes the prolapse will correct itself with no interference, or with slight physical manual massage manipulation as often as necessary coupled with medication. [3]

Surgical

Surgery is the most common means of repairing a cherry eye. Surgery involves gland replacement, not excision, by anchoring the membrane to the orbital rim or using a pocket technique. [3] In severely infected cases, preoperative antibiotics may be necessary by means of antibiotic eye ointment. [3] Removal of the gland was once an acceptable treatment, and made the eye appear completely normal. [5] Despite cosmetic appeal, removal of the gland reduces tear production by 30 percent. Tear production is essential in maintaining and protecting the eye from the external environment. [5] Reduced tear production is especially problematic in breeds of animals predisposed to Keratoconjunctivitis sicca (KCS), also known as dry eye syndrome. With surgeries performed in this manner, KCS often results later in life. [3]

Close-up of prolapsed gland in small breed dog Cherry Eye in Small Mixed Breed Dog.jpg
Close-up of prolapsed gland in small breed dog

KCS is not common in dogs, affecting one per cent of the dog population. [9] KCS is a chronic degenerative conjunctivitis that can lead to impaired vision and blindness. [2] KCS has a wide array of causes including drug toxicity, cherry eye, previous surgery, trauma, and irradiation. [2] KCS can be treated, but treatment often spans the entirety of the animal's life. [2]

In contrast to this, several replacement surgical procedures exist to remedy cherry eye. [2] Replacement of the gland results in lower instances of dry eye later in life. [10] Surgery types are broken into two groups: anchoring procedures and pocket/envelope procedures. [1] At least 8 surgical techniques currently exist. [1] In anchoring procedures, the prolapsed gland must be sutured to the periorbital fascia, the sclera, or the base of the third eyelid. [5] In contrast, pocket procedures involve suturing healthy tissue around the prolapsed to enclose and secure it. [5] Each of these techniques may be performed with an anterior or superior approach, depending on which direction of suturing will cause the least complications to the eye. [5]

Anchoring method

Originally, the anchoring method involved suturing the gland to the globe. This method was superseded over time due to the risky and difficult nature of the surgery, along with a high rate of recurrence. [3] Anchoring approaches from posterior may disrupt normal fluid excretion. [10] Subsequently, an anterior approach was introduced. [10] Disadvantages of anchoring techniques include restricted mobility of third eyelid, which is essential in the functions of fluid distribution and self-cleaning. [10] New procedures are currently being explored to allow tacking of the NM without restricting movement of the third eyelid. [10] Few studies compare results of surgeries, therefore choosing a procedure is a matter of preference. [10]

Envelope/pocket method

The envelope method, often called the pocket technique, requires suturing of tissue around the prolapse, encasing it in a layer of conjunctiva. [5] Pocket techniques are easiest for doctors to learn. [1] Pocket methods also have anterior and posterior versions. Posterior suturing techniques are the most commonly used because they cause the least complications, with no alterations in tear production. [10] Surgery should only be attempted by experienced surgeons. [3] Inappropriate surgical techniques can result in many complications including cysts on the eye. [10]

Prognosis

Without treatment

Previously, treatment was thought optional until the role of NM was fully understood. [1] The NM gland is responsible for 40–50% of tear production. [11] If exposed for extended periods of time, the gland is at risk for trauma, secondary infection, and reduced tear production. [11] Many complications can arise if left untreated: early closed-eye massage manipulation is recommended to prevent inflammation . [3]

Post treatment

Postoperative treatment includes antibiotic eye ointment three times daily for two weeks. [5] It is possible to have a relapse of the gland after surgery and require multiple surgeries. [3] With treatment, it is possible for animals to live a normal life.

See also

Related Research Articles

<span class="mw-page-title-main">Tears</span> Clear liquid secreted from glands in eyes of mammals

Tears are a clear liquid secreted by the lacrimal glands found in the eyes of all land mammals. Tears are made up of water, electrolytes, proteins, lipids, and mucins that form layers on the surface of eyes. The different types of tears—basal, reflex, and emotional—vary significantly in composition.

<span class="mw-page-title-main">Nictitating membrane</span> "Third eyelid" of some animals that protects and moistens the eye while maintaining vision

The nictitating membrane is a transparent or translucent third eyelid present in some animals that can be drawn across the eye from the medial canthus to protect and moisten it while maintaining vision. All Anura, and some reptiles, birds, and sharks have full nictitating membranes; in many mammals, a small, vestigial portion of the nictitating membrane remains in the corner of the eye. Some mammals, such as cats, beavers, polar bears, seals and aardvarks, have full nictitating membranes. Often called a third eyelid or haw, it may be referred to in scientific terminology as the plica semilunaris, membrana nictitans, or palpebra tertia.

<span class="mw-page-title-main">Photorefractive keratectomy</span> Refractive eye surgery procrdure

Photorefractive keratectomy (PRK) and laser-assisted sub-epithelial keratectomy (LASEK) are laser eye surgery procedures intended to correct a person's vision, reducing dependency on glasses or contact lenses. LASEK and PRK permanently change the shape of the anterior central cornea using an excimer laser to ablate a small amount of tissue from the corneal stroma at the front of the eye, just under the corneal epithelium. The outer layer of the cornea is removed prior to the ablation.

<span class="mw-page-title-main">Eye surgery</span> Surgery performed on the eye or its adnexa

Eye surgery, also known as ophthalmic surgery or ocular surgery, is surgery performed on the eye or its adnexa. Eye surgery is part of ophthalmology and is performed by an ophthalmologist or eye surgeon. The eye is a fragile organ, and requires due care before, during, and after a surgical procedure to minimize or prevent further damage. An eye surgeon is responsible for selecting the appropriate surgical procedure for the patient, and for taking the necessary safety precautions. Mentions of eye surgery can be found in several ancient texts dating back as early as 1800 BC, with cataract treatment starting in the fifth century BC. It continues to be a widely practiced class of surgery, with various techniques having been developed for treating eye problems.

<span class="mw-page-title-main">Blepharitis</span> Medical condition of the eyelid

Blepharitis, sometimes known as "granulated eyelids," is one of the most common ocular conditions characterized by inflammation, scaling, reddening, and crusting of the eyelid. This condition may also cause swelling, burning, itching, or a grainy sensation when introducing foreign objects or substances to the eye. Although blepharitis by itself is not sight-threatening, it can lead to permanent alterations of the eyelid margin. The primary cause is bacteria and inflammation from congested meibomian oil glands at the base of each eyelash. Other conditions may give rise to blepharitis, whether they be infectious or noninfectious, including, but not limited to, bacterial infections or allergies.

<span class="mw-page-title-main">Eyelid</span> Thin fold of skin that covers and protects the eye

An eyelid is a thin fold of skin that covers and protects an eye. The levator palpebrae superioris muscle retracts the eyelid, exposing the cornea to the outside, giving vision. This can be either voluntarily or involuntarily. "Palpebral" means relating to the eyelids. Its key function is to regularly spread the tears and other secretions on the eye surface to keep it moist, since the cornea must be continuously moist. They keep the eyes from drying out when asleep. Moreover, the blink reflex protects the eye from foreign bodies. A set of specialized hairs known as lashes grow from the upper and lower eyelid margins to further protect the eye from dust and debris.

<span class="mw-page-title-main">Dry eye syndrome</span> Medical condition

Dry eye syndrome, also known as keratoconjunctivitis sicca, is the condition of having dry eyes. Symptoms include dryness in the eye, irritation, redness, discharge, blurred vision, and easily fatigued eyes. Symptoms range from mild and occasional to severe and continuous. Dry eye syndrome can lead to blurred vision, instability of the tear film, increased risk of damage to the ocular surface such as scarring of the cornea, and changes in the eye including the neurosensory system.

<span class="mw-page-title-main">Chalazion</span> Medical condition

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Trichiasis is a medical term for abnormally positioned eyelashes that grow back toward the eye, touching the cornea or conjunctiva. This can be caused by infection, inflammation, autoimmune conditions, congenital defects, eyelid agenesis and trauma such as burns or eyelid injury.

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<span class="mw-page-title-main">Entropion</span> Medical condition

Entropion is a medical condition in which the eyelid folds inward. It is very uncomfortable, as the eyelashes continuously rub against the cornea causing irritation. Entropion is usually caused by genetic factors. This is different from when an extra fold of skin on the lower eyelid causes lashes to turn in towards the eye (epiblepharon). In epiblepharons, the eyelid margin itself is in the correct position, but the extra fold of skin causes the lashes to be misdirected. Entropion can also create secondary pain of the eye. The upper or lower eyelid can be involved, and one or both eyes may be affected. When entropion occurs in both eyes, this is known as "bilateral entropion". Repeated cases of trachoma infection may cause scarring of the inner eyelid, which may cause entropion. In human cases, this condition is most common to people over 60 years of age.

<span class="mw-page-title-main">Blepharoplasty</span> Surgical modification of the eyelids

Blepharoplasty is the plastic surgery operation for correcting defects, deformities, and disfigurations of the eyelids; and for aesthetically modifying the eye region of the face. With the excision and the removal, or the repositioning of excess tissues, such as skin and adipocyte fat, and the reinforcement of the corresponding muscle and tendon tissues, the blepharoplasty procedure resolves functional and cosmetic problems of the periorbita, which is the area from the eyebrow to the upper portion of the cheek. The procedure is more common among women, who accounted for approximately 85% of blepharoplasty procedures in 2014 in the US and 88% of such procedures in the UK.

<span class="mw-page-title-main">Distichia</span> Medical condition

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<span class="mw-page-title-main">Ectopia lentis</span> Medical condition

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A corneal ulcer, or ulcerative keratitis, is an inflammatory condition of the cornea involving loss of its outer layer. It is very common in dogs and is sometimes seen in cats. In veterinary medicine, the term corneal ulcer is a generic name for any condition involving the loss of the outer layer of the cornea, and as such is used to describe conditions with both inflammatory and traumatic causes.

Retinal dysplasia is an eye disease affecting the retina of animals and, less commonly, humans. It is usually a nonprogressive disease and can be caused by viral infections, drugs, vitamin A deficiency, or genetic defects. Retinal dysplasia is characterized by folds or rosettes of the retinal tissue.

Oculoplastics, or oculoplastic surgery, includes a wide variety of surgical procedures that deal with the orbit, eyelids, tear ducts, and the face. It also deals with the reconstruction of the eye and associated structures.

<span class="mw-page-title-main">Canine glaucoma</span>

Canine glaucoma refers to a group of diseases in dogs that affect the optic nerve and involve a loss of retinal ganglion cells in a characteristic pattern. An intraocular pressure greater than 22 mmHg (2.9 kPa) is a significant risk factor for the development of glaucoma. Untreated glaucoma in dogs leads to permanent damage of the optic nerve and resultant visual field loss, which can progress to blindness.

References

  1. 1 2 3 4 5 6 7 8 Gelatt, K. N. (2000). Essentials of Veterinary Ophthalmology. Baltimore: Lippincott Williams & Wilkins.
  2. 1 2 3 4 5 6 Gelatt, K. N. (2001). Color Atlas of Veterinary Ophthalmology. Baltimore: Lippincott Williams & Wilkins.
  3. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Slatter, D. (2001). Fundamentals of Veterinary Ophthalmology: Third Edition. Philadelphia: W.B. Saunders Company.
  4. 1 2 Robledo, E. P., Serrano, R. D., Sanches, N. Q., & Ramirez, A. M. (n.d.). "Effect of Pet Vision in a Canine with Keratoconjunctivitis Sicca (Dry Eye) Archived 2012-12-18 at the Wayback Machine ". Retrieved 1 December 2012.
  5. 1 2 3 4 5 6 7 8 Griffin, C., & Glaze, M. B. (2008). "Eyes and Ears". St John U.S.V.I. November 3–6. International Veterinary Seminars.
  6. ↑ Edelmann, M. L., Miyadera, K., Iwabe, S., & Komáromy, A. M. (2013). Investigating the inheritance of prolapsed nictitating membrane glands in a large canine pedigree. Veterinary ophthalmology, 16(6), 416–422. https://doi.org/10.1111/vop.12015
  7. ↑ "Common Ocular Problems of Shih Tzu Dogs". Canadian Veterinary Journal , Volume 33, 392.
  8. 1 2 3 Sarma, B. (2010). "Cherry Eye in Dogs. Intas Polivet, 11, pp. 80–81.
  9. ↑ Blount, W. (n.d.). "Dry Eye: More formally known as Keratoconjuntivis Sicca or KCS". Retrieved 1 December 2012.
  10. 1 2 3 4 5 6 7 8 Plummer, C., Kallberg, M., Gelatt, K., Gelatt, J., & Barrie, K. P. (2008). "Intranictitans tacking for replacement of prolapsed gland of the third eyelid in dogs". Veterinary Ophthalmology, pp. 228–233.
  11. 1 2 "Prolapsed gland of the third eyelid". American College of Veterinary Ophthalmologists. Archived from the original on 2017-08-04. Retrieved 2017-08-03.
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