What Is Cherry Eye?
Cherry eye is the common name for the prolapse of the gland of the third eyelid, also called the nictitating membrane. Every dog has three eyelids: an upper eyelid, a lower eyelid, and a third eyelid — a protective membrane that moves across the eye from the inner corner. Tucked within this third eyelid is a gland that plays a vital role in the tear film. When the connective tissue anchoring this gland to the surrounding structures weakens or fails, the gland pops out of position and becomes visible as a round, fleshy, red or pink mass in the inner corner of the eye. The appearance is striking and unmistakable, resembling a small red cherry — hence the name.
Why the Gland Must Not Be Removed
The gland of the third eyelid is responsible for producing approximately 30 to 40 per cent of the aqueous (watery) component of the dog's tear film. This is a substantial contribution to keeping the eye lubricated, protected from infection, and free of debris. If the gland is surgically removed, rather than repositioned, the dog loses this portion of their tear production permanently. The result, in many cases, is keratoconjunctivitis sicca (KCS), commonly known as dry eye — a painful, chronic, and progressive condition that requires daily medication for the remainder of the dog's life and can ultimately lead to corneal scarring, pigmentation, and significant vision impairment.
Surgical removal of prolapsed third eyelid glands was historically performed, particularly when surgical repositioning techniques were less well established. This practice is now considered negligent by veterinary ophthalmologists and is no longer an acceptable standard of care. If you are advised that your dog's cherry eye should be treated by removal of the gland, seek a second opinion from a veterinary ophthalmologist or a practice with experience in ophthalmic surgery.
The Correct Surgical Treatment
The appropriate treatment for cherry eye is surgical repositioning of the prolapsed gland — returning it to its normal location within the third eyelid and securing it so that it does not prolapse again. Several techniques have been developed, and the choice of procedure will depend on the surgeon's training, the degree of gland prolapse, and whether the gland is inflamed at the time of surgery.
- The pocket technique (also called the conjunctival pocket or envelope technique) is one of the most widely used approaches in the UK. The gland is tucked into a pocket created in the conjunctival tissue overlying the third eyelid and secured with sutures. It has a good success rate and is generally considered the technique of choice for first-time repairs.
- The imbrication technique involves placing sutures around the gland to anchor it more deeply within the third eyelid. It may be used as an alternative or in combination with the pocket technique.
- Anchoring techniques, which involve suturing the gland to deeper orbital structures, may be used in challenging cases or when other techniques have failed.
Early surgical intervention gives the best results. A gland that has been prolapsed for a long time becomes progressively more inflamed, oedematous, and friable, making surgical repositioning technically more difficult and increasing the risk of recurrence. If you notice cherry eye in your dog, prompt veterinary assessment is advised.
Breeds Most Commonly Affected
Cherry eye is far more common in certain breeds than others, and the predisposition is believed to be linked to laxity of the connective tissue that normally anchors the gland in place. Breeds with the highest risk include:
- Cocker Spaniel (English and American)
- English Bulldog
- French Bulldog
- Beagle
- Basset Hound
- Bloodhound
- Shih Tzu
- Lhasa Apso
- Neapolitan Mastiff
Cherry eye can occur in any breed, but these dogs have a significantly higher inherited predisposition. Brachycephalic breeds — those with flat faces — are particularly affected, partly due to the shape of their orbital anatomy.
Age of Onset and Bilateral Risk
Cherry eye most commonly occurs in young dogs, typically under the age of two years, though it can occasionally be seen in older dogs. It is important to be aware that if one eye is affected, there is a meaningful risk that the other eye will prolapse at some point as well — the underlying connective tissue weakness is systemic, not limited to one side. Owners should monitor the second eye carefully after the first prolapse and seek prompt assessment if they notice any change. When the second eye is affected, it should also be surgically repositioned, not managed conservatively.
What to Do If You Notice Cherry Eye
If you notice a red or pink fleshy mass appearing in the inner corner of your dog's eye, cover the eye loosely with a clean, damp cloth to keep the gland moist, and contact your vet as soon as possible. Do not attempt to push the gland back into place yourself — you risk causing further trauma or contaminating the eye. Do not apply any eye drops, ointments, or creams without veterinary advice. The sooner the gland is assessed and surgically repositioned, the better the outcome is likely to be.
Some owners or online sources describe massaging the gland back into place temporarily. While this may achieve a temporary reduction in some very early cases, it does not address the underlying structural weakness and the gland will prolapse again. It is not a substitute for surgical treatment.
Post-Surgical Care
After surgical repositioning, your dog will need careful management during the recovery period to achieve the best outcome:
- An Elizabethan collar (cone) must be worn for the full duration specified by your vet — typically two to three weeks. Rubbing at the eye during healing can disrupt the sutures and lead to recurrence
- Prescribed antibiotic eye drops or ointment and anti-inflammatory drops should be applied exactly as directed for the full course
- Exercise should be restricted to calm lead walks during the healing period to minimise swelling and discomfort
- Keep the eye clean by gently wiping away any discharge with sterile saline on a soft lint-free cloth — do not use cotton wool
- Attend all scheduled post-operative check-ups so the vet can assess healing and suture placement
Recurrence Rate: An Honest Assessment
Surgical repositioning is successful in the majority of cases, but cherry eye does recur in a proportion of patients. Published recurrence rates vary between studies and depend on the technique used, the experience of the surgeon, and how inflamed the gland was at the time of surgery, but figures in the range of 5 to 20 per cent are commonly cited. If cherry eye recurs after surgery, a second surgical attempt is usually recommended and tends to have a good success rate. In rare cases of repeated failure, a veterinary ophthalmologist should be consulted to discuss options.
Long-Term Monitoring After Surgery
Even after a successful surgical repositioning, long-term monitoring of tear production is important. A Schirmer Tear Test (STT) should be performed periodically — at annual health checks or whenever any eye discharge or redness is noticed — to confirm that the repositioned gland is producing adequate tears. Signs of KCS, including thick greenish discharge, dull eye surface, or excessive squinting, should prompt an immediate vet assessment and STT measurement. If tear production is found to be borderline or low, cyclosporine or tacrolimus eye drops may be started prophylactically to preserve and support glandular function before dry eye becomes clinically apparent.
With prompt surgical treatment, appropriate aftercare, and regular monitoring, the vast majority of dogs with cherry eye go on to have comfortable eyes and normal vision for many years.