Cherry Eye in Cats – 10 important things you must know

This post include on query Cherry Eye in Cats what are it’s symptoms,treatments by thevetscare.com

Bengal kittens on leather sofa indoors
 Purple Collar Pet Photography / Getty Images

More commonly seen in dogs, and sometimes rabbits, cherry eye is also occasionally a problem for cats. This disease affects the tissues surrounding the eye or eyes of a cat, but it can be more than just a cosmetic issue. Some cats are more prone to developing cherry eye than others, and it is important to know how to recognize it and what to do about it.

What Is Cherry Eye?

Cherry eye” is actually a nickname for a medical condition called prolapsed nictitating membrane, prolapsed third eyelid, or third eyelid gland prolapse. The third eyelid, or nictitating membrane, is the fleshy, pink part next to the eye in the socket. It’s actually a flap of tissue containing a gland that secretes tears. Usually it’s not easily seen, and flattened against the corner of the eye socket. If it gets enlarged, flips over, and protrudes or prolapses, a cherry eye results.

Signs of Cherry Eye in Cats

A pink or red, fleshy protrusion coming from the inner corner of a cats eye is most likely a cherry eye. It is often described as a pink bubble or swelling and may be large enough to block part of a cat’s eye. It can also come and go or be present permanently. Cherry eye in cats is quite obvious if you just know what to look for but the following secondary issues that cherry eye can cause are the real concerns.

Other symptoms include:

  • Dry eye
  • Corneal ulcers
  • Irritation
  • Inflammation of the cornea
  • Inability to close the eyes

When cats develop dry eye, it’s due to a lack of tear production. Since the third eyelid contains a gland that produces tears, this gland may not provide enough lubrication to the eye if it is inflamed and protruding. If an eye is dry it will become inflamed, feel irritated, and itch. An ulcer on the surface of the eye, called the cornea, can result. Dry eye, also known as keratoconjunctivitis sicca or KCS, may need to be treated habitually to avoid corneal ulcers. A corneal ulcer is very painful and can lead to permanent eye damage and even rupture if ignored.

If a cherry eye is large enough, it may also make it difficult or impossible for a cat to completely close its eyes. This is not only stressful and annoying to a cat, but it can also be a contributing factor for dry eye.

Cat with cherry eye
CarlosTheDwarf/Wikimedia Commons

Causes of Cherry Eye

  • Inflammation – Cherry eye is primarily due to the inflammation of the gland in the third eyelid. It swells up, turns inside out, and flips out in front of the eye.
  • Size of the eye socket – Brachycephalic, or smushed face, cats may be born without enough room in their eye sockets to allow an enlarged or inflamed third eyelid gland to fit.
  • Problems with the retinaculum – The retinaculum stabilizes the tendons that help hold the gland that causes cherry eye in place. Sometimes it is too weak to do its job and the gland pops out.
  • Unknown – The reasons why some cats develop or are born with one or two cherry eyes is sometimes unknown.

Treatment

Depending on the severity of the cherry eye, treatment may not even be necessary. But if the cherry eye is chronic and causing problems surgery might be recommended to correct the problem. Some cherry eyes will come and go on their own while others will pop out and stay out. In order to avoid secondary problems of a cherry eye, the gland will have to be put back into the eye socket very carefully. Manual, gentle pressure on the gland may replace it but often times it just comes back out. A special surgical procedure can tack the gland back into place in order to allow the gland to return to normal function and lubricate the eye.

If secondary problems have developed due to a cherry eye, special ointments or eye drops may need to be applied long term. There are also surgeries that may need to be performed. If a cherry eye is ignored for too long, it may not be able to be repaired. Occasionally, the gland will be removed if it is no longer serving its function of providing tears to the eye.

How to Prevent Cherry Eye

Unfortunately there is no real way to prevent cherry eye in cats. If a cat is born with a torn or weak retinaculum or a small eye socket, there is nothing you can do to prevent a cherry eye from happening.

Cherry Eye in Cats

“Cherry eye” is the term used for the prolapse of the gland of the third eyelid. It may occur in one or both eyes. Cherry eye is an uncommon occurrence in the cat.

Causes of Cherry Eye

A weakness of the ligamentous attachment of the gland of the third eyelid is believed to be the most common cause in the cat.Although this weakness may be a heritable condition (Burmese cats predisposed), the inheritance pattern is unknown.Prolapse of the gland may occur secondary to inflammation.Idiopathic (unknown cause) forms also exist.

What to Watch For

Oval pink or red mass protruding from the corner of the eye closest to the noseWatery or thick discharge from the eyeRedness to the conjunctiva (lining of the eyelid)

Diagnosis of Cherry Eye in Cats

Generally, the diagnosis is made by visual inspection of the eye. A complete eye examination is warranted, including measurement of tear production, fluorescein staining of the cornea and examination of the opposite eye.

Treatment of Cherry Eye in Cats

Medical management involves the use of topical anti-inflammatory corticosteroid medications to decrease inflammation of the conjunctiva and the prolapsed gland. Medical management rarely results in return of the gland to a normal position.

Surgical replacement of the gland is the recommended treatment. Complete removal of the gland may be performed, but predisposes the cat to a life of dry eye. The gland of the third eyelid is responsible for the production of around 35 percent of the watery tears, so removal of the gland may result in greatly diminished tear production (dry eye)

Following surgery, an Elizabethan collar may be used to prevent self-induced trauma.

Home Care and Prevention

There is a 5 to 20 percent recurrence rate depending on the surgical procedure used, the size of the gland at the time of surgery, the duration of the prolapse, and the condition of the cartilage of the third eyelid. In general, if the gland is replaced quickly, is not too swollen or inflamed, and if the cartilage of the third eyelid is not bent, then the success rate is higher for surgical replacement. If only one side had prolapsed and was surgically replaced, continue to monitor the other eye for development of a cherry eye.

Administer all medication as directed by your veterinarian and return for follow up as directed by your veterinarian. If the gland stays in place for one month following surgery, then the prognosis is good that it will not reprolapse. If the gland does prolapse again, a second surgical replacement may be attempted, or the gland may be removed.

It is necessary to monitor tear production for sometime after the surgery to determine whether it will remain normal. The onset of dry eye may be delayed for months to years following prolapse of the gland. Signs of dry eye include thick, pussy discharge from the eye, redness to the conjunctiva and cloudiness of the cornea.

To prevent the other gland from prolapsing, the unaffected gland may be prophylactically sutured.

Prolapse of the Tear Gland of the Third Eyelid

Unlike humans (who only have two eyelids), dogs and cats have three. The third eyelid, technically called the nictitans or nictating membrane, arises from the inner corner of the eye and covers the eye diagonally as shown. The eye is lubricated by tear film, which consists of water, oil, and mucus. The oil comes from glands lining the outer eyelids, the mucus comes from glands in the conjunctiva (the pink part inside the eyelids), and the water comes from tear (or lacrimal) glands. Each eye has two glands: one just above the eye and one located in the third eyelid. The gland in the third eyelid is believed to produce a full 30 percent of the total tear film water, so it is important to maintain the function of this gland.

The lacrimal gland of the third eyelid is held in place by tissue fibers but some individuals have weaker fibers than they should so the gland protrudes. This protrusion is called a cherry eye.  In the smaller breeds — especially Boston terriers, cocker spaniels, bulldogs and beagles — the gland of the third eyelid is not strongly held in place for genetic reasons. The gland prolapses (drops down) out to where the owner notices it as a reddened mass. Out of its normal position, the gland does not circulate blood properly, may swell, and may not produce tears normally. 

Treatment: Replacing the Gland in its Proper Location

By far the best treatment for cherry eye is replacing the gland back into its proper location. There are two techniques for doing this. The traditional tucking method (also called tacking) is probably most commonly performed. Here, a single stitch is permanently placed, drawing the gland back where it belongs. Complications are uncommon but be aware of the following possibilities:

  • If the stitch unties, the surface of the eye could become scratched by the suture. If this occurs, the eye will become suddenly painful and the suture thread may be visible. The suture can be removed and the problem solved.
  • The tuck may not be anchored well enough to hold permanently. In fact, this surgery is notorious for this type of failure and frequently a second or even third tuck is needed. If more than a couple of tucks have lead to failure, it may be better to try the imbrication technique as described below. Some cases are repaired using both tuck and imbrication together.
  • Sometimes cherry eye is accompanied by other eyelid problems that make the repair more difficult or less likely to succeed. In these cases, again, if the simple surgery is not adequate, ask your veterinarian if a referral to a veterinary ophthalmologist for the second surgery to maximize the chances of a permanent resolution is in the best interest of you and your pet.

A dog with cherry eye in both eyes. Photo by Dr. Ian Herring

In a newer surgical technique called imbrication, or pocketing, 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:

  • Inflammation or swelling as the stitches dissolve.
  • Inadequate tightening of the tissue gap may lead to recurrence of the cherry eye.
  • Failure of the stitches to hold and associated discomfort. Loose stitches could injure the eye depending on the type of suture used.

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 can happen. If it recurs, it is important to let your veterinarian know so that a second surgery, either with your veterinarian or an ophthalmologist, can be planned.

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, have it rechecked as soon as possible.

Treatment: Removing the Gland

Historically, the prolapsed gland was treated like a small tumor; it was simply removed. This was before the full significance of the gland was realized.

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, 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, its treatment is often frustrating and time-consuming and there is expense involved. If left untreated, the eye can become blind. 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.