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Eye Surgery - Cherry Eye Surgery - Entropion Repair - Meibomian Gland (Eyelid Tumour) Removal Cherry Eye (Prolapse of the Tear Gland of the Third Eyelid)  The normal canine eye receives its tear film from two lacrimal (tear-producing) glands. One gland is located above the eye, and the other is found within the animal's third eyelid. The gland of the third eyelid contributes a significant portion of secretion to the tear film. In the smaller breeds -- especially Boston terriers, Cocker spaniels, bulldogs and beagles -- the gland of the third eyelid is not strongly held in place. The gland prolapses (slips out) to where the owner notices it as a reddened mass. Out of its normal position, the gland does not circulate blood properly and may swell. If the third eyelid's tear gland is removed, it cannot be put back in place. If the other tear gland (the one above the eye) cannot supply adequate tears, which is not an uncommon phenomenon in older small breed dogs, then the eye becomes dry and uncomfortable. A thick yellow discharge results and the eye develops a blinding pigment covering for protection. This condition is called simply dry eye, or more scientifically keratoconjunctivitis sicca, and daily medical treatment is required to keep the eye both comfortable and visual. Not only is dry eye uncomfortable for the pet, its treatment is often frustrating and time-consuming and there is expense involved. We would like the dog to maintain the greatest amount of tear producing tissue possible, thus removing the gland for cosmetic reasons is not an acceptable treatment method. Treatment - Replacing the Gland
In a newer surgical technique, a wedge of tissue is removed from directly over the actual gland. This technique is more challenging as it is not easy to determine how much tissue to remove. Tiny stitches that will eventually dissolve are used to close the gap so that the tightening of the incision margins pushes the gland back in place. Complications may include:
Sometimes both surgical techniques are used in the same eye to achieve a good replacement. Harmful complications from cherry eye surgery are unusual but recurrence of the cherry eye is common. If a cherry eye recurs, it is important to let your veterinarian know so that a second surgery either with your normal veterinarian or with an ophthalmology specialist can be planned. An owner should expect some postoperative swelling after cherry eye repair but this should resolve and the eye should be comfortable and normal in appearance after about a week. If the eye appears suddenly painful or unusual in appearance, it is important that it be rechecked as soon as possible. Entropion (in-folding of the eyelid(s))  Entropion is an uncomfortable or painful condition in which the animal’s eyelids roll inward, allowing the eyelashes (or other hair) to rub against the cornea and irritate it. The upper and/or lower eyelids can be involved, and the condition can occur in either one eye or both.Signs
An animal with entropion will squint and have an excessive amount of tears coming from the affected eye. Some animals will be sensitive to light and will rub at their eyes, particularly when they’re outside. Some animals will produce a mucous-like discharge from the eyes. Flat-faced dog/cat breeds, with entropion that involves the inside corner of the eyes, may not show any discomfort -- simply because of their facial structure. In some animals, entropion is never more than a minor annoyance, but in others it can cause painful ulcers and erosions that cause scarring and affect vision. That level of entropion needs surgical correction.
Causes
While any dog can have entropion, there is often a genetic factor. When caused by genetics, entropion can be seen well before a dog’s first birthday. Predisposed dog breeds include the Boxer, Bull Mastiff, Cavalier King Charles Spaniel, Chesapeake Bay Retriever, Chow Chow, Cocker Spaniel, English bulldog, Golden Retriever, Great Dane, Irish Setter, Irish Setter, Labrador Retriever, Poodle, Pug, Shar Pei, Springer Spaniel, and St. Bernard. Selective breeding for specific traits (e.g., skull formation, skin folds on the face, and prominent eyes) are thought to be contributing factors to genetic causes, but are most likely not the only genetic base. Selective breeding may have simply exaggerated entropion in breeds that were already prone to it. Entropion can also occur as a secondary condition resulting from scarring of the eyelid, infection, corneal spasms and pain, trauma, or nerve damage. Sometimes it happens after the eyelids lose their normal neurologic function.
Diagnosis
Your veterinarian can diagnosis entropion through an ocular exam. A local anesthetic is usually used, to make the examination easier on the animal. Because it’s important to determine whether or not there is a corneal ulcer secondary to the entropion, a fluorescein dye may also be used. The fluorescein will stick to damaged parts of the cornea, and show as a bright green area.
Treatment
Medical treatment with antibiotic ointments can decrease damage to the cornea, but it can not resolve the entropion itself. To fix the eyelid, surgery is needed. If the entropion is significant enough to warrant treatment, the excess skin of the outer lids can be removed in a simple surgery called blepharoplasty. (Essentially, this is plastic surgery, so you can tell everyone your pet is having “his lids done.”). Excess skin that causes skin folds is also removed, and the eyelids are tightened. Typically the entropion does not return after surgery, unless the case is quite severe.
(Recurrence is more common in Shar Peis, due to the breed’s excessive facial skin folds.) The sutures should be removed in about 10 to 14 days. Some dogs will need to wear an Elizabethan collar to prevent them from rubbing at their sutures.
Young puppies generally only have a minor procedure called lid tacking, rather than the full blepharoplasty. Permanent surgery like the blepharoplasty isn’t typically done in puppies who are less than 6 months old, because it’s not possible to predict what the (adult) head conformation will be, and the full surgery may not be needed. In lid tacking, temporary sutures are used to roll out the eyelids, and keep the puppies’ eyes healthy until these puppies mature and grow into their adult facial features. Entropion can be seen in Shar Peis as young as two or three weeks old, and these Shar Pei puppies do very well with the temporary eyelid tacking. If the animal has corneal ulcers, those will need to be treated too. Untreated corneal ulcers may scar excessively, impairing vision. Treatment will reduce the incidence of scarring. Treatment usually involves the use of antibiotic ophthalmic ointment. (To administer ophthalmic ointment, place your thumb directly below the eyelid and very gently push, which will cause the lower eyelid to pull away from the eye. Put the ointment in the opened lower lid.)
The sutures should be removed in about 10 to 14 days. Some dogs need to wear an Elizabethan collar to prevent them from rubbing at their sutures.
Dogs with the inherited form of entropion should not be used for breeding. See the recommendations from the Canine Eye Registration Foundation (CERF) for dogs with entropion.
Dogs with surgically corrected entropion cannot be shown in conformation classes at dog shows.
Prognosis
Prognosis is excellent, if surgery is performed before the cornea is damaged. If the cornea is damaged, then the prognosis depends on the type and severity of damage. Meibomian Gland Tumors
Meibomian gland tumors can protrude outward or can extend into the eyelid. Some of these tumors will become ulcerated. Some will cause keratoconjunctivitis (an inflammation of the cornea and conjunctiva). Benign tumors generally do not spread, but they can become inflamed, irritated, and painful. If the tumor becomes large enough, it can cause problems during blinking (resulting in extra tearing and tear staining). Most meibomian gland tumors grow slowly. A veterinarian can detect them easily because of where the tumors are located. Treating the Tumor with Surgery and Cryosurgery After the tumor is removed, you may see a bit of blood in the dog’s tears for a couple of days. The surgical site will be swollen for a week or so. Within two weeks, the surgery site will probably turn pink, and the hairs around the site may become white. Generally speaking, the skin will become repigmented within a few months, but the white hair will remain permanently. Less than 10 percent of these eyelid tumors recur. If they do come back, they will usually be seen within six months or so. Check the eyelids often to find new and recurring tumors. |
Meibomian gland tumors are tiny, slow-growing tumors that form in the meibomian glands of the eyelids. (Meibomian glands are sebaceous glands that provide an oily secretion to stabilize the tear film over the cornea.) Common in older dogs, meibomian gland tumors are usually benign, but a small percentage of them are carcinomas that can metastasize into lymph nodes.