What Is Cherry Eye?
Cherry eye is the informal name for prolapse of the gland of the third eyelid (nictitating membrane). Dogs — unlike humans — possess a third eyelid, a semi-transparent membrane that sweeps across the eye from the inner corner to provide additional protection. Nestled at the base of this membrane is a tear-producing gland called the nictitans gland (or gland of the third eyelid), which is responsible for producing roughly 30–40% of the eye's total tear volume.
Normally, this gland sits invisibly at the base of the third eyelid, held in position by a network of connective tissue fibres. In cherry eye, the anchoring fibres weaken or fail, allowing the gland to flip upward and protrude over the edge of the third eyelid. The exposed gland appears as a round, red or pink fleshy mass at the inner corner of the eye — resembling a cherry, which is where the condition gets its memorable name.
Which Breeds Are Predisposed?
Cherry eye has a strong hereditary component, with certain breeds showing a significantly elevated risk. The condition is most commonly seen in:
- English Bulldogs: One of the most frequently affected breeds, often developing cherry eye in both eyes before the age of two
- French Bulldogs: Similarly predisposed, reflecting the brachycephalic facial structure
- Cocker Spaniels: Both English and American varieties are commonly affected
- Beagles: A breed in which cherry eye is a recognised inherited condition
- Shih Tzus: Shallow eye sockets and the prominent eye position contribute to risk
- Lhasa Apsos
- Bloodhounds and Neapolitan Mastiffs: The excessive facial skin folds of these breeds place additional tension on periorbital tissues
- Boston Terriers
The condition occurs most often in young dogs under two years of age, though it can develop at any point in a dog's life. When one eye is affected, there is a substantial risk — estimated at 40–60% in some studies — that the other eye will also prolapse, often within months. Owners of predisposed breeds should monitor both eyes closely after a first prolapse is identified.
Symptoms and What You Will See
The visual presentation of cherry eye is usually unmistakable. You will observe:
- A round, smooth, red or pink mass visible at the inner corner of one or both eyes
- The mass may appear and disappear initially (intermittent prolapse) before becoming permanent
- Increased eye discharge, as the exposed gland becomes irritated and inflamed
- Rubbing at the eye with the paw or against furniture
- Conjunctival redness and mild swelling around the inner corner
- In chronic cases, the surface of the prolapsed gland may become dry, thickened, and discoloured from chronic exposure and self-trauma
Cherry eye is not immediately life-threatening, but it does require prompt veterinary attention. The longer the gland remains prolapsed and exposed, the more damage occurs to the gland tissue, and the more difficult surgical correction becomes.
Why Surgical Repositioning Is Strongly Preferred Over Removal
Historically, the prolapsed gland was simply excised (removed), as this was a straightforward procedure that resolved the cosmetic problem quickly. This practice is now strongly discouraged by veterinary ophthalmologists and should be avoided wherever possible. The reason is simple but critical: the nictitans gland produces a significant proportion — 30–40% — of the eye's aqueous tear film.
Removing the gland dramatically increases the lifetime risk of developing keratoconjunctivitis sicca (KCS, or dry eye). KCS is a chronic, often progressive condition in which insufficient tear production causes the corneal surface to dry out, leading to painful corneal ulcers, scarring, pigmentation that progressively obscures vision, and potentially blindness. Once KCS develops, the affected dog typically requires daily eye medication for life.
Breeds already predisposed to cherry eye — English Bulldogs, Cocker Spaniels — are also predisposed to KCS. Removing the nictitans gland in these breeds compounds an existing risk to a sometimes devastating degree.
Modern surgical techniques successfully reposition and retain the gland in the vast majority of cases, preserving its tear-producing function while correcting the prolapse. Gland removal should be considered only if the gland has become so severely damaged that preservation is no longer viable — a rare situation in cases treated promptly.
Surgical Techniques: Pocket and Morgan Pocket
The Pocket Technique (Enveloping or Imbrication Technique)
In the pocket technique, the surgeon creates a small pocket of conjunctival tissue around the base of the prolapsed gland and sutures it closed, effectively burying the gland back into its correct anatomical position. The stitches are placed so that the gland is enclosed and held in place while the suture line heals. This technique has a reported success rate of 80–95% in experienced hands, though recurrence remains possible, particularly in brachycephalic breeds where the underlying anatomical weakness is more pronounced.
The Morgan Pocket Technique
A variation of the pocket technique, the Morgan pocket involves creating a conjunctival pocket on the bulbar (eyeball-facing) surface of the third eyelid rather than the palpebral surface. The gland is repositioned into this pocket and the edges are sutured. This approach is particularly useful for recurrent cases and in breeds where the standard technique has a higher failure rate. Some veterinary ophthalmologists favour this technique as their primary approach.
General anaesthesia is required for both procedures. Operating time is typically 20–40 minutes per eye. Most dogs recover comfortably and are discharged the same day.
Post-Operative Care
Following surgery, your dog will be sent home with:
- An Elizabethan collar (cone) to prevent pawing at the eye — absolutely essential and must be worn continuously for the first 2–3 weeks
- Topical antibiotic eye drops or ointment to prevent infection
- Anti-inflammatory eye drops or short-term oral non-steroidal anti-inflammatory drugs (NSAIDs)
- Instructions for follow-up examinations — typically at 1 week and 3–4 weeks post-surgery
The operated eye will appear red and swollen for the first few days — this is expected and will resolve. Contact your vet if you notice the mass reappearing (suggesting recurrence), significant worsening of swelling, or any sign of the sutures loosening.
Recurrence Rates and Long-Term Outlook
Recurrence rates after pocket-technique surgery vary from approximately 5–20%, with brachycephalic breeds at the higher end of this range. A second surgical attempt — ideally performed by a veterinary ophthalmologist — can be successful when the first has failed. In a small minority of severely recurrent cases, or where the gland has sustained irreversible damage, removal may ultimately become necessary, with the dog then entering a lifetime monitoring programme for early signs of KCS.
When treated promptly and appropriately, the long-term prognosis for cherry eye is good. Preserving the gland and the tear-producing function it provides remains the guiding principle of modern management.