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Cherry Eye - VVUK and BrAVO position

Recently, Veterinary Voices UK contacted the British Association of Veterinary Ophthalmologists (BrAVO) regarding their stance on excising (removing) the nictitans gland under sedation, after a number of the community raised concerns about cases they were seeing of dogs with long term issues associated with the removal of the gland, typically under sedation.

BrAVO were kind enough to send a comprehensive reply, to support and guide veterinary professionals and owners on making informed decisions around 'cherry eye' treatment options.


Together, Veterinary Voices UK would like to support and thank BrAVO for providing this, in the hope that we can encourage informed choices when it comes to mitigating the risk of procedures to remove the gland. Although these procedures are often done quickly, and at reduced cost, it is often not in the best interest of the animal to do so. We would encourage those currently offering this treatment to reach out to veterinary ophthalmologists for support in how they can offer treatment that will support the best patient outcome, and reduce ongoing risks.


Thank you for your email to BrAVO and the BVA discussing the removal of the nictitans glands in dogs under sedation.


This topic in Bulldogs specifically, was recently discussed in a Vet Times Letter to the editor (see below).

 

The BrAVO committee is very concerned regarding the practice of the removal of the prolapsed tear glands (‘cherry eye’) of the third eyelid, rather than surgical repositioning of the prolapsed tear gland. Whilst there is no published data proving that third eyelid gland excision leads to keratoconjunctivitis sicca (KCS), it seems very likely that by removing up to 50% of the tear producing capability, in a breed of dog already predisposed to KCS, that dry eye will develop. Another point to consider is that anecdotally these iatrogenic KCS cases seem less responsive to standard lacrimogenic treatments.

 

The excision procedure (typically done conscious following the application of topical local anaesthetic solution) is often carried out at breeder-led fertility clinics when the dogs are very young puppies. In our experience, the new owners are not made aware that this has been done to their pet or of the potential future consequences associated with excision of the tear gland i.e. medically refractive keratoconjunctivitis sicca and associated sequelae.

 

There are several surgical repositioning techniques published, with the modified Morgan pocket technique being the most accepted. An article in the Vet Times by James Smith entitled; Cherry eye: a re-emerging problem (Vol 53, Issue 1, p9-10: January 03, 2023), summarises this surgical technique in more detail and includes intraoperative photographs. Whilst this surgery can be associated with post-operative complications it carries a good overall success rate of approximately 90%.

 

In summary, we would strongly advise against excising prolapsed tear glands of the third eyelid, especially in brachycephalic breeds, unless there was absolutely no other option. Surgical repositioning of the gland poses a better solution, albeit is not guaranteed to be successful.

In a situation where the tear gland must be excised, the owner should be made aware of the potential consequences of the procedure and should give fully informed written consent.

 

I hope that the above position statement is useful but please do not hesitate to contact me if I can be of further assistance regarding this very important issue in UK veterinary practice.

 

Kind regards,

 

Mike Rhodes

BVM&S CertVOphthal DipECVO

RCVS Specialist in Veterinary Ophthalmology

EBVS® European Veterinary Specialist in Veterinary Ophthalmology

BrAVO Senior Chair 

On behalf of BrAVO


Vet Times Letter to the Editor:

Surgical excision of prolapsed tear glands of third eyelids in Bulldogs

 

Dear Editor,

 

As a group of UK veterinary ophthalmologists, we are seeing an increasing number of young British Bulldogs with absolute keratoconjunctivitis sicca (KCS) that is refractory to medical management, who have had their third eyelid glands excised,  by veterinary surgeons as puppies, following pressure from Bulldog breeders.

 

Whilst there is no peer reviewed published data currently available proving beyond any doubt that excision of the tear gland of the third eyelid will lead to KCS in this breed, it is our opinion that by removing 35-50% of the tear secreting tissue in a breed of dog that is already at risk of developing KCS later in life, this process significantly increases the risks. In addition, the resultant KCS appears less responsive to standard lacrimogenic treatments.

 

We would ask that all veterinary surgeons refrain from removing the prolapsed tear glands of the third eyelids in these Bulldog puppies unless there is absolutely no other option.

Surgical repositioning of the prolapsed tear gland of the third eyelid is possible and can carry a good success rate (approximately 90%). 

 

As a veterinary profession our first rule of care should be: ‘first do no harm’.

 

Yours faithfully,

 

Mike Rhodes CertVOphthal DipECVO MRCVS 

BrAVO Chair

On behalf of the BrAVO Committee

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