Cherry eye in dogs occurs when the tear gland that is normally under the third eyelid pops out of place and becomes inflamed. This makes it look a bit like the dog has a tiny cherry in the inner corner of the eye, hence the name. To teach dog parents about this common condition, integrative veterinarian Dr. Julie Buzby explains the causes, predisposed breeds, symptoms, diagnosis, and treatment of cherry eye in dogs.
One morning during my ophthalmology rotation in veterinary school, a particular appointment description caught my eye. Right there, in black and white print, it said…
Reason for visit: Cherry in eye
Needless to say, while “cherry in eye” wasn’t completely accurate, it still made the reason for the appointment very clear. This patient most likely had a prolapsed third eyelid gland, which is also called a cherry eye.
What is cherry eye in dogs?
Cherry eye is a condition where the third eyelid gland (a tear gland) pops out of its normal position behind the third eyelid and becomes visible as a red ball of tissue in the inner corner of the eye. The angry tissue of the prolapsed gland looks very much like a tiny cherry, hence the name “cherry eye.”
Anatomy of the third eyelid and tear glands
Before diving into a discussion of cherry eye, let’s take a look at two pieces of relevant eye anatomy and physiology.
- Third eyelid gland (nictitans gland): This tear gland is responsible for producing 30-60% of the aqueous (water) portion of tears. Connective tissue holds the third eyelid gland in place beneath the third eyelid. In a normal dog, the third eyelid gland should not be visible.
- Third eyelid (nictitating membrane): The delicate, crescent-shaped third eyelid sits in the inner corner of the eye and is supported by a T-shaped band of cartilage.
The orientation of the gland of the third eyelid and its important contribution to tear production will come into play when we talk about cherry eye.
What causes cherry eye in dogs?
Dogs often develop cherry eye due to failure of the connective tissues to hold the gland in place beneath the third eyelid. Researchers have also identified a genetic link in certain breeds that are prone to dwarfism (chondrodysplasia). These defective genes may be responsible for the weakened or malformed cartilage that usually supports the third eyelid.
Less commonly, cherry eye can develop as a result of eye trauma, infection (conjunctivitis), or inflammation (lymphoid hyperplasia) secondary to allergies.
Which dogs are most prone to cherry eye?
Cherry eye is a common problem in dogs under a year of age. In fact, dogs less than a year old are diagnosed with cherry eye roughly ten times more frequently than dogs two to four years of age or older. Some research studies also suggest that males may be slightly more susceptible to cherry eye than female dogs. However, this doesn’t seem to be a consistent finding.
Using VetCompass™, the Royal Veterinary College’s database of clinical information from UK veterinary practices, researchers compiled and analyzed breed data for 1,802 dogs with cherry eye. In the study, they discovered that toy and small “smooshed face” (brachycephalic) breed dogs develop cherry eye at almost seven times the incidence of those with longer muzzles, less rounded skulls, and deeper eye sockets (meso- or dolichocephalic).
| Some of the small breeds predisposed to cherry eye include: | However, many medium and large breed dogs are also susceptible to cherry eye, including: |
| Lhasa Apso | English Bulldog |
| Shih Tzu | Cocker Spaniel |
| Maltese | Beagle |
| Havanese | Shar Pei |
| Boston Terrier | Basset Hound |
| Pekingese | Coonhound |
| Brussels Griffon | Chow Chow |
| Pug | Rottweiler |
| French Bulldog | Newfoundland |
| Cane Corso | |
| Great Dane | |
| St. Bernard | |
| Mastiff (Neopolitan and Tibetan) |
Interestingly, that same study showed Puggles (Pug x Beagle) and Jugs (Jack Russell Terrier x Pug) are two of the more commonly affected mixed, or boutique breeds. But, as a general rule, cherry eye occurs in purebred dogs at roughly 1.4 times the rate of mixed-breed dogs.
What are the symptoms of cherry eye in dogs?
Cherry eye is one of those conditions where the main symptom (seeing the protruding gland of the third eyelid) is pretty distinct. But there are other, more non-specific signs to be aware of, too. Some of the symptoms of cherry eye in dogs include:
Visible pink or red fleshy mass in the inner corner of the eye
Normally, when you look at your dog’s eye, you just see a sliver of the third eyelid in the inner corner. But with a cherry eye, there will be a red to pink bump there instead—almost like a strawberry jellybean.
Many dogs just develop a cherry eye in one eye (unilateral cherry eye). But in some dogs, both eyes are affected (bilateral cherry eye). Dogs with unilateral cherry eye can also experience cherry eye in the opposite eye at a later time.
Increase in size of the prolapsed tissue
Sometimes the prolapsed gland may become enlarged (hypertrophied). This can happen if the third eyelid pinches off the gland’s blood supply or the gland is exposed for too long. The more your dog rubs or paws at the eye, the larger and more inflamed the gland will be, too.
Eye redness (conjunctivitis)
The conjunctival tissues (pink tissue inside the eyelids) can become very inflamed and swollen.
Discharge from the eye
Dogs with cherry eye may have a watery eye discharge (epiphora). Or it might be a thicker, mucous-like discharge (goopy eye in dogs) if infection or inflammation is also present.
Corneal opacity
The cornea (clear “windshield” of the eye) may have cloudy white or grey spots. These opacities sometimes develop secondary to physical irritation or edema (swelling).
Corneal ulceration
While cherry eyes are usually not painful, they can occasionally lead to corneal ulcers in dogs, which are very painful. This can cause your dog to rub or scratch more frantically at the eye, causing additional trauma to the exposed third eyelid gland.
Head to the vet if you think your dog has a cherry eye
If some of these symptoms sound like what your dog is experiencing, please make an appointment with your vet. Especially if your dog is rubbing the eye or squinting, the eye is very red, or it has thick discharge coming from it, getting to the vet quickly is important because eyes can worsen rapidly.
How will the vet diagnose cherry eye?
In order to diagnose cherry eye in dogs, the vet will start with a visual examination of the eye and third eyelid tissues. If it is a cherry eye, the tear gland will be visible above the third eyelid cartilage in the inner corner of the eye. The gland may be small or large. Sometimes the tissue looks dry, scabbed, or extremely inflamed if it has been exposed for a long time.
After the initial examination, your veterinarian may recommend other tests to assess the health of your dog’s eye. One is the Schirmer Tear Test (STT). The vet uses the STT to determine whether your dog’s tear production is adequate. This is important since the third eyelid gland makes 30-60% of the watery (aqueous) portion of your dog’s tears.
Your veterinarian may also put fluorescein stain in your dog’s eye if he or she suspects a corneal injury. The fluorescein stain, which is bright green, sticks to any damaged corneal cells. This test looks for corneal ulcers. And it can give your veterinarian a better idea of the size and depth of the ulcer if one is present. That information helps the vet develop an appropriate treatment plan.
What else might look like a cherry eye?
A prolapsed third eyelid gland has a fairly classic appearance. However, the vet will be keeping the following somewhat similar conditions in the back of his or her mind while performing the exam:
Scrolled or everted cartilage
This condition develops in Great Danes and other giant breeds as a result of weakness or malformation of the T-shaped cartilage that supports the third eyelid. Since the cartilage is abnormal, it doesn’t hold the third eyelid tissue against the surface of the cornea as it should. Instead, the eyelid margin rolls outward (everts), allowing the third eyelid gland to wholly or partially prolapse.
Pannus
Pannus is a nonpainful autoimmune condition that causes raised tissue to develop on the dog’s cornea. Plus, it may cause thickening of the third eyelid. Typically, with pannus, both eyes will be affected. There is no definitive cure, although there are management options for recurrent flare-ups.
Plasmoma
This condition causes discoloration and thickening of the margins of the third eyelid. Plasmoma may develop with pannus or occur on its own. This condition is neither painful nor curable.
Follicular conjunctivitis
Follicular conjunctivitis is an allergic condition commonly diagnosed in young, large-breed dogs under two years of age. Allergen exposure can cause the follicles of the conjunctival tissue to become enlarged and inflamed. The larger the follicles become, the more they irritate the surface of the cornea. If the dog begins to paw at his eyes, the irritation worsens, and it starts a vicious cycle of inflammation.
What is the treatment for cherry eye?
After diagnosing your dog with cherry eye, your vet will go over the treatment options with you. Surgery is generally the treatment of choice. However, with very mild cases, sometimes medical management could be an option.
Cherry eye surgery for dogs
Cherry eye surgeries generally fall into two categories—those that remove the gland, and those that tack or tuck it into place again.
Removal of the third eyelid gland
The original technique used to treat cherry eye involved removing the entire third eyelid gland. This prevented the problem from coming back in that eye. But it often caused another serious issue, keratoconjunctivitis sicca (KCS), which is more commonly known as dry eye in dogs.
Remember how the third eyelid gland makes 30-60% of the tears? Removing it may lead to dry eye because the dog may not be able to make sufficient tears to keep the eye lubricated. On average, about 50% of dogs will go on to develop dry eye after cherry eye removal.
Dogs with dry eye have red, irritated eyes and thick eye discharge, which can be very uncomfortable. Over time, brown pigment or blood vessels may cover the surface of the eye, making it harder for the dog to see. Dogs with dry eye usually need daily eye medications for life to keep their eyes comfortable and protect their vision.
Surgeries to put the third eyelid gland back in place
There are multiple variations on the surgeries to replace the gland of the third eyelid in its original location. Let’s discuss two common ones:
Orbital rim anchoring
This cherry eye surgery involves using nonabsorbable suture to tack the third eyelid gland to the tissues around the lower rim of the eye socket. The suture keeps the gland physically attached to the base of the third eyelid and prevents it from popping back out.
Morgan’s pocket technique
In the Morgan’s pocket technique, the vet will create a small pocket in the conjunctival tissue to hold the third eyelid gland in place. First, he or she will make two tiny incisions in the conjunctival tissue in front of and behind the gland to create a pocket. Then the vet will stitch the two incision edges over the tucked gland to hold it in place.
Complications of cherry eye replacement surgery
If the third eyelid gland is extremely swollen, your vet may prescribe steroid eye drops for a few days before surgery. Steroids will help decrease the swelling, so there’s less chance of complications after surgery. That said, complications may develop on occasion, including:
- Suture failure leading to recurrent prolapse of the gland. Suture failure can happen with either technique. But it is more common with orbital rim tacking than the Morgan pocket technique.
- Corneal ulceration due to post-operative irritation from the sutures. Ulcers can be pretty painful, so if your dog becomes acutely uncomfortable after surgery, have your veterinarian recheck the eye as soon as possible.
With newer surgical techniques that allow the dog to keep the gland of the third eyelid, dry eye (KCS) is much less common. However, in some cases, such as when the gland dies or when a tumor makes it necessary to remove part or all of the third eyelid gland, dogs may still need lifelong medication after surgery to keep their eyes healthy.
Is it possible to treat cherry eye without surgery?
If a dog has a mild or intermittent cherry eye, occasionally a course of topical steroids and antibiotics will relieve the inflammation enough that the gland goes back into position under the third eyelid. However, since it already prolapsed once, it is quite possible that the gland will prolapse again.
In the vast majority of cases, surgical replacement of the gland of the third eyelid is the treatment of choice. However, your vet can talk to you about the pros and cons of trying non-surgical management for your dog’s particular situation.
Are there home remedies for cherry eye in dogs?
There aren’t any home remedies that will reliably fix cherry eyes. But there are a few things you can try at home to help keep your dog comfortable while waiting for the surgery.
Applying a warm compress made with plain water or diluted chamomile tea may help reduce redness and swelling. (Chamomile has natural anti-inflammatory properties.) Gently flushing the eye with sterile saline (plain saline with no added medications) can also soothe irritation, especially if allergens are the culprit.
Always check with your veterinarian first to confirm these comfort measures are safe for your dog. And if your dog shows increased pain or resists eye handling, don’t force it.
What is the prognosis for dogs with cherry eye?
Thankfully, dogs with cherry eye usually have a good long-term prognosis, especially when veterinarians can surgically replace the third eyelid gland soon after it prolapses. However, some dogs may experience recurrence. This is especially likely if the prolapse was left untreated for a prolonged period before the dog received veterinary care. Certain dog breeds, like Bulldogs and Mastiffs, also seem to have more challenging cherry eyes to manage.
Without surgical replacement, the prolapsed gland will continue to become inflamed and enlarged, which is uncomfortable for the dog. Plus, a chronic cherry eye puts the dog at a high risk for developing dry eye. As discussed earlier, dry eye requires lifelong management, causes discomfort, and may compromise vision. This is important to take into consideration when deciding what course to take.
Don’t despair…cherry eye is treatable
It can be upsetting when your dog suddenly develops a cherry eye. However, the good news is that thanks to advancements in surgical techniques, genetic studies identifying at-risk dog breeds, and efforts to improve owner education and conscientious breeding practices, cherry eye in dogs remains a very treatable condition.
If you are worried your dog may have a cherry eye (or another eye problem), promptly reach out to your vet for help. Early veterinary intervention ensures that your dog can still experience a good quality of life and little to no risk of permanent visual impairment, despite once having a “cherry in his or her eye.”
Has your dog had a cherry eye?
Please comment below.
