PROTRUSION OF THE

THIRD EYELID GLAND

 THE THIRD EYELID
Dogs have a third eyelid in the
inner corner of the eye nearest
the nose
"windshield wiper" distributing
the tear film over the eye
Contains a tear-producing gland
which accounts for about 50%
of the tear production in the eye
Break loose from its attachment
in the third eyelid and "pop" up
and appear as a swelling in the
corner of the eye
 INTRODUCTION

A disorder in which a tear gland

that is normally positioned at
the base of the third eyelid
protrudes and swells, appearing
as a lump in the inner corner of
the eye.
Other terms for cherry eye
include prolapse of the gland of
the third eyelid or prolapsed
nictitans gland.
Cherry eye is seen primarily in
dogs, and rarely in cats.
 GENERAL CONSIDERATIONS

May be associated with primary or

secondary adenitis,
Keratoconjunctivitis sicca
occurring after protrusion
(sometimes years later) suggests
involvement of both the lacrimal
and nictitans glands
The hypertrophied, protruding
gland, which extends beyond the
leading edge of the nictitans,
becomes abraded and dry
Protrusion may be unilateral or
bilateral.
 Clinical Presentation
Signalment.
The breeds most often
affected are American
and English cocker
spaniels, English
bulldogs, beagles,

age (usually younger

than 1 year).
History.
Owners notice a mass,
tearing, and/or ocular
irritation.
The condition usually
begins unilaterally, but
may eventually become
bilateral.
PHYSICAL EXAMINATION
FINDINGS
Reddish mass protruding
from behind the third eyelid
near the medial canthus

Conjunctivitis

Epiphora, and local irritation.

DIFFERENTIAL
DIAGNOSIS
Neoplasia, hyperplastic
lymphoid follicles

Malformation of the
nictitating membrane.
MEDICAL MANAGEMENT
Topical antibiotics with or
without corticosteroids can
be used to treat early, mild
cases.

Reducing inflammation and

edema of the conjunctiva
allows the gland to return to
its normal position and size.

However, topical treatment is

often unsuccessful.
 SURGICAL TREATMENT
Preoperative Management
The periocular area is
scrubbed and then rinsed
with saline.
Exudates are removed from
the corneal and conjunctival
surfaces with a sterile
cotton-tipped applicator and
the area is irrigated with a
dilute antiseptic solution
(0.5% povidone-iodine)
ANESTHESIA
Atropine (0.02 to 0.04 mg/kg)
Glycopyrrolate (0.005 to 0.011
mg/kg)
minimizes the oculo cardiac
reflex

Thiopental sodium (8 to 12
mg/kg IV to effect)

Propofol (6 mg/kg IV to effect)

isoflurane or sevoflurane and

oxygen for maintenance of
anesthesia
 SURGICAL TECHNIQUES
Morgan technique
Removal and Replacement techniques
Replacement is recommended to reduce
the incidence of keratoconjunctivitis sicca
later in life.
Place eyelid retractors to maximize
exposure.
1-cm-long parallel incisions through the
bulbar conjunctiva ventral and dorsal to
the free margin of the gland
Separate the mucosa from underlying
submucosa at the incision edge
Return the gland to its normal position by
suturing the two incisions together over
the gland
A simple continuous (5-0 to 7-0) or
interrupted (4-0 to 5-0) suture pattern of
absorbable suture with buried knots