Mass or tumor removals are not uncommon in dogs and cats. These masses grow in or around a major organs, under skin (subcanteously) or apart of the skin. These masses or tumors can be benign or malignant. Malignant tumors have a higher chance for recurrence, spread to other parts of the body, or have impaired healing and need a wider margin of excision than benign tumors. Therefore; the incision may be much larger then the mass itself. Unfortunately, sometimes it is impossible to get a definitive diagnosis without removal and histopathology. Even with aggressive surgery, these tumors occasionally re-grow and need further surgery. Rarely, the tumor can be so invasive that complete excision is not possible without damaging the organs, nerves or blood vessels that lie near the mass.

Histopathology reveals the types of cells present in abnormal tissue, permitting accurate diagnosis of the disease and helping determine appropriate treatment(s). Where cancer is involved, histopathology helps determine the aggressiveness of the cancer, which assists in coming to a decision how to proceed.

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 nictitating 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 tear 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 tear 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 Options 

• 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 the 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 anchor 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 led 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.

• Imbrication

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.

We do not Imbrication. If you are interested in this option we recommend you contact an Ophthomologist. 

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.

• Removing the Gland

Historically, the prolapsed gland was treated like a small tumor; it was simply removed. 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 then the eye becomes dry and uncomfortable. Studies have shown that dogs treated with excision of the gland or those that remain untreated are more likely to develop dry eye or more scientifically keratoconjunctivitis sicca KCS. 

Dry Eye - keratoconjunctivitis sicca (KCS)

When the tear glands can not supply adequate tears, 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, but its treatment is often frustrating and time-consuming and there is expense involved. If left untreated, the eye can become blind. 

It is important to note that May breeds predisposed to to prolapse of the third eyelid gland are also predisposed to KCS. There is no Guarantee that your pet will not develop KCS in the future if you choose Gland replacement surgery.