Did you know that your dog, and many other mammals, have a third eyelid? The third eyelid, also known more formally as the nictitating membrane, is essential for production of the tear film and protection of the eye. This small triangular structure can be seen in the inner corner of your dog’s eyelid, especially if they’re falling asleep. Sometimes medical conditions can affect the third eyelid, especially one commonly known as “cherry eye.”1 Read on to discover how to treat cherry eye in your dog.
Image courtesy of: https://www.pdsa.org.uk/pet-help-and-advice/pet-health-hub/conditions/cherry-eye-in-dogs
Understand Why Cherry Eye Occurs
Now that you understand the importance of the third eyelid, let’s talk about why cherry eye occurs. The third eyelid has an associated gland that is responsible for creating approximately 30-40% of the tears for the eye.2 Maintaining a normal tear film is essential for keeping your dog’s eyes comfortable and healthy. The gland of the third eyelid is attached to the lower rim of the eye by a ligament. In young dogs and certain breeds, this attachment may become weakened, which allows the gland to prolapse or herniate out of its normal position. Breeds commonly affected by cherry eye are Cocker Spaniels, Beagles, Lhasa Apsos, and brachycephalic breeds (which includes “smush” face dogs like Bulldogs, Boston Terriers, Pekingese, Shih Tzus, etc.). Aside from genetic predisposition, occasionally physical trauma to the eye can cause the third eyelid gland to prolapse.3
Recognize the Symptoms of Cherry Eye
Cherry eye will appear as a pink or red swollen mass in the inner corner of your dog’s eye. The mass may be small and may seemingly disappear on its own. Other times, the cherry eye can be quite large and cover a significant portion of your dog’s eye. You may notice the cherry eye only affects one eye, while other times it can affect both eyes.4 Cherry eye is generally not a painful condition, but you should watch for signs of discomfort, such as squinting, pawing at the face, excessive tearing, or conjunctivitis (redness and inflammation in the tissues surrounding the eye).
Image courtesy of: https://animalvisioncare.com/eye-conditions/canine/third-eyelid-gland-prolapse-cherry-eye/
Consult With Your Veterinarian
Once you notice the symptoms of cherry eye, you should always consult with your family veterinarian about treatment options. Your veterinarian will conduct a thorough eye examination to determine the severity of the condition and to rule out any other eye conditions that may be present. This is particularly important in brachycephalic breeds, which are genetically predisposed to other conditions that can affect the eyelids.5 Your veterinarian will thoroughly examine the cornea (the outermost layer of the eye), the conjunctiva (the tissues surrounding the eye), the eyelids, and the fundus (the back surface of the eye that contains the retina). Based on this examination, your veterinarian will recommend a treatment plan appropriate for your dog.
Discuss Your Treatment Options
While your veterinarian may prescribe an eye medication to temporarily help decrease inflammation and discomfort, surgical treatment is the best option to treat cherry eye in dogs. Your veterinarian might be able to perform this surgery, however, be prepared that they may also refer you to a veterinary ophthalmologist (a veterinarian who specializes in eye conditions) for the best possible outcome. Check out this link to find board-certified veterinary ophthalmologists in your area. The veterinarian will put your dog under general anesthesia to replace the prolapsed gland. Usually, two small incisions are made around the cherry eye to create a “pocket.” The prolapsed gland is tucked away into this pocket and stitched closed. Your veterinarian may prescribe an antibiotic eye drop or ointment and oral pain medications to help your dog recover from surgery.67 If your dog seems uncomfortable or is rubbing at the eye, an Elizabethan collar will be recommended so they don’t disrupt healing of the surgical site. The stitches will be absorbable and will not need to be removed, and the incision is typically healed within 2 weeks.
Weigh the Pros and Cons of Surgery
While any kind of surgery can sound intimidating, it is considered the only definitive way to treat cherry eye in dogs. The biggest pro of surgery is that once the incision is healed, your dog has a great chance for the third eyelid gland to return to its normal function and appearance within a few weeks. For many dogs, the surgery is considered curative. Great news, right? Not so fast. This brings us to one of the biggest cons of surgery, which is recurrence of the cherry eye. It is estimated that between 5-20% of dogs who undergo surgery for cherry eye experience a recurrence of the prolapse, which could require repeated surgical intervention.8 Another thing to be aware of is that even in some dogs who undergo surgical correction for cherry eye, there is still some risk for development of dry eye at some point in their life. Finally, you should know that if your dog has cherry eye in only one eye, they can develop it in the other eye at any time.9 Check out this article written by a veterinary ophthalmologist about treatment options for cherry eye.
Know the Risks of Non-Surgical Treatment
Despite the risks of surgery, the benefits of attempting surgical correction are far greater. If you decide not to pursue surgical correction of your dog’s cherry eye, there are some important risks to know about. Since the gland of the third eyelid produces such a large portion of your dog’s tear film, untreated cherry eyes can lead to a condition called keratoconjunctivitis sicca (KCS), more commonly known as dry eye.10 Symptoms of dry eye include eye discomfort, redness, squinting, and excessive eye discharge. Once your dog develops dry eye, it is considered a lifelong condition that requires treatment with one or multiple medications you will put in your dog’s eyes to ease the discomfort. To make things worse, dogs that develop dry eye are at greater risk for developing painful corneal ulcers and eye infections. In addition, untreated cherry eye also predisposes your dog to developing conjunctivitis and abnormal eye discharge. Without surgical treatment, the only thing you can safely try at home is to try to keep the eye lubricated with artificial tears.11
If you have a puppy who has cherry eye, know that sometimes the condition can resolve on its own without surgery as your pup grows.12 Your veterinarian may possibly recommend surgical correction of the cherry eye at the same time as their spay or neuter. Remember that even with surgery, recurrence of the cherry can certainly happen. Eye conditions can be frustrating but understand that there is not necessarily a one-size-fits-all approach to treating cherry eye in dogs. Always bring up any concerns with your veterinarian so you can discuss how to keep your dog’s eyes healthy and keep your furry family members happy!
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- Brooks W. Cherry eye in dogs and cats. Veterinarypartner.vin.com. Published January 1, 2001. Updated January 2, 2021. Accessed March 2, 2022.
- Rankin AJ. Skills laboratory: prolapsed third eyelid gland replacement. Dvm360.com. Published October 1, 2013. Accessed March 2, 2022.
- O’Neill DG, Yin Y, Tetas Pont R, et al. Breed and conformational predispositions for prolapsed nictitating membrane gland (PNMG) in dogs in the UK: a VetCompass study. PLoS One. 2022;17(1):e0260538. doi:10.1371/journal.pone.0260538
- Ward E. Cherry eye in dogs. Vcahospitals.com. Accessed March 2, 2022.
- Costa J, Steinmetz A, Delgado E. Clinical signs of brachycephalic ocular syndrome in 93 dogs. Ir Vet J. 2021;74:3. doi:10.1186/s13620-021-00183-5
- Stanley RG. Surgical management of third eyelid problems in dogs. Vin.com. Accessed March 2, 2022.
- Houston K, Blacklock B. A cherry on top: a look at prolapsed glands of the third eyelid. Veterinary-practice.com. Published November 26, 2021. Accessed March 2, 2022.
- Ward E. Cherry eye in dogs. Vcahospitals.com. Accessed March 2, 2022.
- PDSA. Cherry eye in dogs. Pdsa.org.uk. Published April 2021. Accessed March 2, 2022.
- Brooks W. Dry eye (keratoconjunctivitis sicca) in dogs and cats. Veterinarypartner.vin.com. Published December 2, 2002. Updated September 1, 2020. Accessed March 2. 2022.
- Hunter T, Ward E. Keratoconjunctivitis sicca (KCS) or dry eye in dogs. Vcahospitals.com. Accessed March 2, 2022.
- Blue Cross. Cherry eye in dogs. Bluecross.org.uk. Updated September 10, 2019. Accessed March 2, 2022.