Cherry Eye Surgery



Have you ever seen those dogs, usually a small breed, that when you look at their face, it looks like a little red-bulging mass is stuck in the corner of their eye?  That's a prolapsed nictitans membrane, also known as a "cherry eye", as it quite literally looks like a maraschino cherry stuck in the corner of the eye.  But this is no sundae with whipped cream and nuts.  It is most commonly seen in young dogs ages 6 months to 2 years.  The breeds most often affected are cocker spaniels, bulldogs, beagles, lhasa apsos, shih-tzus, bloodhounds, and other brachycephalic breeds (shorter heads/dome shaped heads).  Causes include a weak ligamentous attachment of the gland, reasons secondary to inflammation, and possible genetic/heritable reasons.  That gland is important as it produces up to 50% of the aqueous tear film.  If not replaced surgically, it puts patients at risk for developing keratoconjunctivitis sicca or "dry eye".  I finally did my first "cherry eye" surgery the other day.  I guess I kind of did my surgeries in reverse order.  Typically a new graduate will do this surgery as one of their first surgeries once comfortable with performing ovariohysterectomies (spays) and neuters.  I just hadn't had a case present to me yet.  Instead I''ve been given opportunities to do major orthopedic repairs such as luxating patella repairs, femoral head ostectomies, ruptured acl's, and also mass removals, tooth extractions, etc.  But nonetheless, I LOVE surgery no matter what the procedure.  And learning a new procedure is always challenging but exciting.  Although, I did get a little weirded-out by the fact that during this particular surgery, my scalpel/needle drivers/and forceps were very close to the cornea.  And I felt like my little patient was "watching" me the entire time.  And the size of suture you use is so small that it feels like mircosurgery.  But apart from the that, the surgery is typically extremely successful, the patient is much more comfortable post-op, and the owners are happy.  A win-win situation all around.  Here's an idea of what the surgery entails as followed/modified from the Fossum surgical text.  I'll drum-it-down and recap it at the end.

"Cherry Eye" Surgical Repair:

The area around the right eye was cleaned and surgically prepped. Trithalmic antibiotic ointment was placed in the eye and the eye was draped. The third eyelid was grasped and extended with forceps. A stay suture was placed using 6-0 Vicryl. A small 1 cm parallel incision was made on both sides of the prolapsed Nictitans Gland through the bulbar conjunctiva ventral and dorsal to the free margin of the gland. The gland was tucked between the incisions and returned to its normal position by suturing the two incisions together over the gland in a "tunnel fashion". A simple continuous pattern with 6-0 Vicryl with buried knots on the outside was used. The suture ends were placed in the fornix so that the knots were away from the cornea. Apply neopolydex ophthalmic ointment to the eye twice daily for 2 weeks beginning in 3 days. Keep elizabethan collar on patient for 10-14 days.

Brittany E King, DVM

Recap:

So basically let's pretend there's a small mini cherry stuck in the corner of a dog's eye.  But you can't remove the cherry because the dog needs it.  So you've gotta tuck it back in by sewing it in place.  Now let's pretend the cherry is lodged in a mini banana.  So if the eye is a banana (from the sundae of course), you make a cut on either side of the cherry that's embedded in the banana, take some suture (stitching material), and connect the 2 cuts pulling them together essentially "tucking" the cherry into the banana making a little sandwich.  It stays in place.  Voila.  And the pet goes home with the infamous space collar and eye ointment to decrease the swelling.  Of course, these surgeries aren't possible without a great nursing team and great mentor doctors.  Someday I hope to be the one coaching new graduates through their first surgeries.