Cherry Eye Isn't Just Cosmetic: Protecting Tear Production for the Long Term

The visible swelling is only part of the problem! 

When a dog presents with a prolapsed gland of the third eyelid, owners are often concerned about the conspicuous pink mass in the medial canthus. Many assume it is simply a cosmetic defect and seek treatment to improve appearance. As veterinarians, however, we know that the real concern lies beneath the surface. Cherry eye is a disorder of a tear-producing gland, and inappropriate management can have lifelong consequences for ocular health. 

The gland of the third eyelid contributes approximately 30–50% of the aqueous component of the canine tear film. Losing this gland through excision or prolonged dysfunction can significantly reduce tear production and predispose dogs to keratoconjunctivitis sicca (KCS), chronic keratitis, corneal pigmentation, discomfort, and vision impairment¹. 

Why preserving the gland matters 

Historically, surgical excision of the prolapsed gland was widely performed because it was technically simple and effectively eliminated recurrence. However, long-term follow-up studies demonstrated that removal of the gland compromises tear production and increases the risk of developing KCS. Consequently, gland excision is now reserved only for exceptional situations in which the gland is irreversibly damaged or neoplastic¹. 

Modern surgical management focuses on repositioning rather than removing the gland. Procedures such as Morgan's Pocket Technique preserve both gland anatomy and function, allowing continued tear secretion while restoring a normal cosmetic appearance^1,2. 

For practicing veterinarians, this shift represents an important change in treatment philosophy—the objective is not merely to correct the prolapse but to protect ocular surface health for the remainder of the dog's life. 

Chronic prolapse affects gland function 

Time plays a critical role in determining surgical outcomes. 

A prolapsed gland is continuously exposed to the external environment, making it vulnerable to trauma, desiccation, and chronic inflammation. Over time, persistent inflammation may lead to oedema and fibrosis, making repositioning technically more difficult and potentially compromising secretory function^1,2. 

The clinical evaluation by Deveci and colleagues found that most dogs presented within three weeks of prolapse and achieved excellent outcomes following gland-preserving surgery, with a success rate exceeding 94%². These findings reinforce the importance of recommending early surgical intervention rather than prolonged medical management. 

Tear production should be part of every work-up 

Cherry eye should never be evaluated in isolation. 

A comprehensive ophthalmic examination should include assessment of tear production using the Schirmer Tear Test (STT), particularly in chronic cases or older dogs. Establishing a preoperative baseline allows clinicians to monitor postoperative gland function and identify patients that may require long-term tear supplementation¹. 

Additional assessments should include: 

• Fluorescein staining to detect corneal ulceration 

• Evaluation for conjunctivitis 

• Examination of the contralateral eye 

• Assessment of gland size and tissue viability 

These findings help guide surgical planning and postoperative monitoring. 

Protecting the ocular surface after surgery 

Restoring the gland is only the first step. Maintaining ocular surface health requires careful postoperative management. 

Veterinarians should advise owners to: 

• Prevent self-trauma with an Elizabethan collar. 

• Administer prescribed topical medications as directed. 

• Return for scheduled postoperative examinations. 

• Monitor for excessive discharge, swelling, or recurrent prolapse. 

Follow-up visits provide an opportunity to reassess gland position, repeat the STT when indicated, and identify early signs of ocular surface disease before permanent damage occurs. 

Client education improves long-term outcomes 

One of the most valuable roles of the veterinarian is helping owners understand why surgery is recommended, even when the dog appears comfortable. 

Rather than describing cherry eye as "a gland that has popped out," explain that it is an important tear-producing structure. This simple explanation often improves owner compliance with early surgery and follow-up care. 

Owners of predisposed breeds should also be informed that the opposite eye may become affected in the future, making regular observation worthwhile^3,4. 

Clinical Pearl 

Treat cherry eye as a disease of tear production rather than a cosmetic abnormality. Every effort should be made to preserve a healthy third eyelid gland because protecting tear function today can prevent years of chronic ocular disease tomorrow. 

References (Vancouver) 

1. White C, Brennan ML. An evidence-based rapid review of surgical techniques for correction of prolapsed nictitans glands in dogs. Vet Sci. 2018;5(3):75. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6163435/ 

2. Deveci MZ, İşler CT, Yurtal Z, Altuğ ME, Kırgız Ö. Evaluation of Morgan's pocket technique in the treatment of nictitans gland prolapse in dogs. Turkish Journal of Veterinary & Animal Sciences. 2020;44(3):521–527. Available from: https://journals.tubitak.gov.tr/cgi/viewcontent.cgi?article=1191&context=veterinary 

3. Freyer J, Labadie JD, Huff JT, et al. Association of FGF4L1 Retrogene Insertion with Prolapsed Gland of the Nictitans (Cherry Eye) in Dogs. Genes. 2024;15(2):198. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10887708/ 

4. O'Neill DG, Church DB, McGreevy PD, et al. Investigating the inheritance of prolapsed nictitating membrane glands in a large canine pedigree. Canine Genet Epidemiol. 2015;2:7. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4361898/