Cherry Eye in Dogs: Are You Treating Too Late?

A pink mass protruding from the medial corner of a dog's eye is one of the most recognizable ocular conditions in small animal practice. While many pet owners view it as a cosmetic issue, veterinarians know that prolapse of the gland of the third eyelid—or cherry eye—is a functional disorder that can compromise tear production and predispose dogs to chronic ocular disease if not managed appropriately. The challenge lies not only in diagnosing the condition but also in determining when intervention should occur. 

Early intervention matters 

The gland of the third eyelid contributes approximately 30–50% of the aqueous component of the tear film. Once prolapsed, the gland becomes exposed to the environment, making it susceptible to trauma, desiccation, inflammation, and secondary infection. Prolonged prolapse can lead to fibrosis of the gland, making surgical repositioning more difficult and potentially reducing long-term gland function^1,2. 

In practice, dogs presented within days or weeks of prolapse generally have healthier gland tissue and better surgical outcomes than those with chronic, inflamed prolapses. Delaying treatment often results in repeated episodes of swelling, making tissue manipulation more challenging during surgery². 

Which patients deserve immediate attention? 

Cherry eye is most commonly diagnosed in young dogs, often before two years of age. Breeds such as Bulldogs, Beagles, Cocker Spaniels, Lhasa Apsos, Shih Tzus, and Cane Corsos appear predisposed due to inherited weakness of the connective tissue supporting the gland^1,3. 

Although some prolapses may temporarily reduce in size after topical anti-inflammatory therapy, spontaneous long-term resolution is uncommon. Medical therapy should therefore be viewed as supportive rather than curative. 

A practical approach in the clinic 

Once a prolapsed gland is identified, assess: 

• Duration of prolapse

• Degree of gland inflammation

• Corneal health

• Tear production if chronic disease is suspected

• Presence of unilateral versus bilateral disease

Fluorescein staining is recommended whenever corneal irritation is present. Schirmer Tear Test (STT) values provide a useful baseline before surgery, particularly in chronic cases where gland function may already be compromised². 

Why gland excision is no longer recommended 

Historically, gland removal was commonly performed because it was technically simple and eliminated recurrence. However, evidence now consistently demonstrates that excision significantly increases the risk of keratoconjunctivitis sicca (KCS) later in life due to permanent loss of tear-producing tissue². 

Current recommendations strongly favour gland preservation whenever feasible. Even glands that appear chronically enlarged often regain satisfactory function after successful repositioning. 

Client communication improves compliance 

Owners frequently ask whether surgery is "really necessary" because the dog appears comfortable. This conversation is an opportunity to explain that the visible swelling represents a tear-producing gland rather than an isolated piece of tissue. Delayed intervention increases the likelihood of chronic inflammation and recurrence while potentially compromising lifelong ocular health. 

Clinical Pearl 

Think of cherry eye as a functional tear gland disorder—not simply a prolapsed tissue mass. Early surgical replacement offers the best opportunity to preserve tear production and reduce future complications. 

References 

1. 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. https://pmc.ncbi.nlm.nih.gov/articles/PMC10887708/

2. 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. https://pmc.ncbi.nlm.nih.gov/articles/PMC6163435/

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