There were 26 dogs (30 eyes) diagnosed prolapse of the third eyelid gland and treated by using Modified Morgan pocket. The most frequently represented breed was the crossbreed (30.77%), followed by English Pointer (19.23%), Turkish Kangal Dog (7.69%), Beagle (7.69), English Bulldog (3.85%), Rottweiler (3.85%), Cane Corso (3.85%), Presa Canario (3.85%), Boston Terrier (3.85%), American Bulldog (3.85%), Pekingese (3.85%) and Faraze Bulldog (3.85%). The prolapse was unilateral in 22 cases (85%) and, bilateral in 4 cases (15%). The affected eye was on right side in 16 cases (55.17%), left was 13 cases (44.83%). Gender was recorded as 18 (69%) males and 8 (%31) females of cases. Seventy-six percent of the dogs were <1-year-old, 16% were between 1 and 2 years old, and the remaining 8% were over 2 years old.
Etiologically there was no trauma or inflammation history, and the reason of the prolapse was determined as the weakness of the connective tissues which keep the gland in its anatomical position.
In postoperative period, the dogs were controlled 3 times in 7 days interval and no clinical problem was detected. Following period by phone call continued to 1 year. Recurrence was observed in only 1 case at the 3
rd month of the surgery.
Diseases of the third eyelid is commonly encountered in dogs and prolapse of the third eyelid gland, or cherry eye, is the most often one among these diseases
(Plummer et al., 2008; Mazzucchelli et al., 2012; Premont et al., 2012). Etiological factors are not known well, but a weakness of connective tissue attachment of the gland, which can be associated with genetically disorder, is especially emphasized
(Singh et al., 2017; Dehghan et al., 2018). In our study, no underlying reason was detected as a possible reason of cherry eye except connective tissue weakness. According to database, prolapse of the of the third eyelid gland usually occurs at two or three months of age
(Mazzucchelliet et al., 2012). The age distribution of the dogs, with the ratio of younger than 1 years of age of 76%, of this study was consistent with the literature.
Most studies mention that the male dogs were more often suffer from cherry eye than females (
Mazzucchelli et al., 2012;
Sapienza et al., 2014; Multari et al., 2016). The condition was the same in our study. Male dogs (69%) with cherry eye were overrepresented than females (31%). There was a possible explanation in an experimental study which conducted by
Cabral et al., (2005). They found the male mongrel dogs have longer lacrimal glands and their superficial glands of the third eyelid are thicker comparing the females. Larger size of the gland may make male dogs more predisposed than female.
Also, cherry eye usually seen unilaterally, bilateral cases were infrequent. However, in unilateral cases, a prolapse can be occur at contralateral eye with passing time
(Mazzucchelli et al., 2012; Sapienza et al., 2014; Multari et al., 2016). Eighty-five percent of the cases (22 of 26 dogs) included in this study were unilateral and any sign of cherry eye was not seen in contralateral eye of these cases during following period. In bilateral cases (4 of 26 dogs), the 3 were younger than 10 months-old, but one was 7 years-old. One case was female (7 months-old), others were male. The interval between the gland prolapse of opposing eye was 2-5 week.
American Cocker Spaniel, Beagle, Bulldog, Pekingese, Neopolitan Mastiff is suggested as predisposed breeds to cherry eye
(Plummer et al., 2008; Gomez, 2012). Also brachycephalic breeds are predisposed to cherry eye, due to the often formation of conjunctival inflammation because of their head anatomy, has long been agreed. However, there were only 4 brachycephalic dogs (15%) in our study and all of the crossbred dogs were mesocephalic.
Prolapsed gland of the third eye becomes inflamed in time and this inflammation affects the conjunctiva and creates discomfort for the affected animals. These animals usually suffer from reduced altered tear production and chronic conjunctivitis, ocular discharge (
Slatter 2001;
Dehghan et al., 2012; Peiffer 2002). Dogs with cherry eye were presented to our clinic with complain of only mild conjunctivitis and epiphora besides prolapsed gland which looks as dark pink to reddish mass on the third eyelid, as compatible with the literature.
The third eyelid gland contributes approximately 40 percent of the tear production and maintains aqueous tear production
(Saito et al., 2001). For that reason, leaving the animal as untreated, or removing of the third eyelid gland may results in a reduced tear production, keratoconjunctivitis sicca namely. There are a lot of methods described such as suturing the gland to the globe inferiorly (
Slatter, 2001), orbital rim anchorage
(Multari et al., 2016), suture anchor placement technique around the insertion of the ventral rectus muscle
(Sapienza et al., 2014) for repositioning of the gland. However most useful and practical way is the modified Morgan pocket technique (
Zabell, 2007). In our study, all animals were treated by using modified Morgan pocket technique with 96.1% per cent success rate.
There is always recurrence risk for the cherry eye patient following gland-sparing surgeries (Mazzucchelli
et al., 2012;
Multari et al., 2016; Singh et al., 2017). But, this risk can be minimized by presurgical precautions, proper surgical procedure and carefully postoperative care. Topical antibiotics and corticosteroids for initial treatment a couple of days before the surgery and postoperative local antibiotics and non-steroid anti-inflammatory agents may help to reduce the recurrence risk (
Zabell, 2007). In our study, all of these procedures were implemented very sturdily, additionally; an Elizabethan collar was worn by the all dogs. Only in one case recurred and the anamnesis revealed that the dog unfortunately failed to use the elizabethan collar properly.
