Virtual Library | Prolapsed Nictitans Gland and Replacement

If you notice a red or pink mass protruding from behind your pet’s third eyelid, it’s time to have their eyes examined for a prolapsed nictitans gland, also known as “cherry eye.” Once the gland of the third eyelid has prolapsed, surgery is required to replace the gland. Read on to find out more about predispositions, causes and surgical solutions for a prolapsed nictitans gland.

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Prolapsed nictitans gland, also known as “cherry eye,” occurs when the gland of the nictitans comes out of position. It protrudes from behind the third eyelid appearing as a red or pink mass. This appearance is how it gained its common name. This prolapsed gland can occur in one or both eyes. It can also regress then reappear, but more commonly the prolapsed gland remains exposed and out of position.

The third eyelid, also known as the nictitating membrane or nictitans, is a membrane that sits just inside of the lower eyelid in dogs and cats. The nictitans contains a gland that typically sits at the base of this membrane. This gland plays an important role in maintaining normal tear production and is responsible for 40-60% of the tears. Damage to this gland can lead to low-tear production. Normal tear production is important to maintain ocular surface health. The third eyelid also contains cartilage for structural support and immune tissue to provide antibodies in the tear film.

Once the gland of the third eyelid has prolapsed, surgery is required to replace the gland.

Replacement should occur as soon as possible after it is noticed to retain essential production of tears from this gland. If left exposed for long periods of time, the gland can become inflamed, dry, infected and uncomfortable for the pet.  

Before surgery, we may recommend topical therapy to help alleviate any inflammation or infection. Replacement is typically done with “pocketing” or “anchoring” techniques. However, we will recommend and use a technique to ensure the most successful replacement possible. 

Removal of a prolapsed gland can lead to more permanent consequences. The tears produced by this gland are essential for ocular health. Its removal can lead to Keratoconjunctivitis Sicca (dry eye) days or years later in life. If left untreated, dry eye can lead to ulcers, infection and even vision loss. 

Dry eye is uncomfortable for the pet patient, and requires the owner to administer topical medications multiple times a day for the remainder of the pet patient’s life. 

It is recommended that the gland be repositioned so it can continue to function normally. For this reason, replacement, and not the removal of the gland, is recommended.

The cause is most likely due to a combination of overstimulation of the immune tissue present in the third eyelid and weakness in the structures that keep the gland in place. 

Typically “cherry eye” occurs in younger dogs, and occasionally cats, when they are exposed to new environmental allergens for the first time. This, combined with a weak ligament holding the gland in position, increases the chance of gland prolapse.

Some breeds of dogs and cats have a conformational predisposition for a weaker supportive ligament. Brachycephalic breeds (those with prominent eyes and short noses) are more often affected due to their stout facial conformation. Among these, those that are more predisposed to nictitans gland prolapse include: the Shih Tzu, Lhasa Apso, English Bulldog, Boston Terrier and Burmese cats. Other dog breeds that are predisposed to this condition include the Cocker Spaniel, Cavalier King Charles Spaniel, Beagle, Poodle, Bloodhound and Mastiff, although it can be seen in any young pet.

To replace the gland, the surgeon will create a pocket to help position the gland back into its normal location. They will make a curved incision on both sides of the gland where it is prolapsed. The outer edges of these incisions are then brought together to form a pocket using very fine suture material that is ultimately absorbed by the body. This pocket covers, protects and replaces the previously exposed gland.

Following surgery the pet patient will start medical therapy to prevent infection, decrease inflammation and maintain comfort. An Elizabethan collar (plastic cone) is required for the first two weeks to prevent self-trauma to the surgery site. The third eyelid will have mild to moderate redness and swelling immediately following surgery, but this will continue to resolve over the first few weeks. 

At Animal Vision Center, we want the procedure to be a success for your pet just as much as you do. If there is any question as to how he or she is doing at home, please call or bring in your pet for an evaluation.