Cherry eye removal

RE: Cherry eye removal

Julie Innes — Wed, 19 Jun 2019 08:36:10 GMT

Thank you Rob, I will stand corrected, as I was only going off the last CPD I did! I do always warn owners about the risks anyway, but some do not want to risk any recurrence, especially in bulldogs with big ones.

RE: Cherry eye removal

Gillian Mostyn — Tue, 18 Jun 2019 12:47:12 GMT

I discuss fully with owners. Most have surgery to retain the gland, but I just think it is important to discuss the options fully and let them decide.

RE: Cherry eye removal

Will McMullan — Tue, 18 Jun 2019 12:43:15 GMT

Robert, is it also the case that the quality of the tear film decreases after gland removal? I think I remember seeing that stated on here before.

RE: Cherry eye removal

Robert Lowe — Mon, 17 Jun 2019 22:35:23 GMT

[quote user="Julie Innes"]

[quote user="David Mills"]Ah some enlightened cpd on removal at last! Who was the lecturer?[/quote]

I'm afraid I don't remember ! It was in the Virtual Congress series of webinars, and he was very good! He argued that most of the breeds that get cherry eye are the same breeds that are predisposed to dry eye, and removing what amounted to 10% or so of the tear producing tissue shouldn't really lead to no tear production! I do still try to preserve the gland as far as possible- it's quite satisfying dissecting out that scrolled cartilage!- but I don't worry about it so much now!

[/quote]

ok. I’ll bite. The nictitans gland is responsible for between 30-57% of aqueous tear production according to 3 of the most commonly quoted papers. I have never seen a reference to it being less than 30% let alone 10%. We know that removal of the nictitans leads to an increase in production from the lacrimal gland to compensate so that there is no initial drop off in tear production.

‘Most of the breeds that get cherry eye get dry eye’. Fantastic causation versus correlation there. If this is the case why on earth would you want to remove a component of a system that is likely to fail. I’d rather be dealing with a KCS case that has as much chance of regaining/retaining tear production because it has as much glandular tissue left as possible.

I really do get that surgery to retain is not possible in a significant number of our patients due to client wishes or finances and I do not set out to castigate those who do so. However from what you read on here it would give the impression that this surgery is suitable for all cases. I remain strongly of the opinion based on the available evidence that removal should not be the treatment of choice where circumstances allow.

I think this is a great summary and overview. As it says in the discussion the evidence of KCS post gland excisions is thin but not because it doesn’t happen. Rather that time to onset is 4-4.5 years and therefore difficult to characterise:

https://www.researchgate.net/publication/327204320_An_Evidence-Based_Rapid_Review_of_Surgical_Techniques_for_Correction_of_Prolapsed_Nictitans_Glands_in_Dogs/fulltext/5b7fff1b92851c1e122f0bd5/327204320_An_Evidence-Based_Rapid_Review_of_Surgical_Techniques_for_Correction_of_Prolapsed_Nictitans_Glands_in_Dogs.pdf?origin=publication_detail

RE: Cherry eye removal

Julie Innes — Mon, 17 Jun 2019 12:21:09 GMT

[quote user="David Mills"]Ah some enlightened cpd on removal at last! Who was the lecturer?[/quote]

RE: Cherry eye removal

David Mills — Mon, 17 Jun 2019 11:17:22 GMT

[quote user="Julie Innes"]

I try to dissect out and remove the cartilage, leaving as much of the actual gland as I can. Although a recent CPD I did said that the tear production from the gland is such a small proportion of the tear production that removal shouldn't really "cause" dry eye. The lecturer seemed to think that most of these dogs were pre-disposed to dry eye anyway, and would develop it regardless.

[/quote]

Ah some enlightened cpd on removal at last! Who was the lecturer?

RE: Cherry eye removal

Julie Innes — Mon, 17 Jun 2019 09:37:39 GMT

RE: Cherry eye removal

serena holmes — Sun, 16 Jun 2019 18:30:03 GMT

Have you thought about trying the pocket technique? Straight forward and there’s a good vet video on YouTube

RE: Cherry eye removal

Clive Ansell — Sun, 16 Jun 2019 14:33:46 GMT

Usually use a bleb of local anaesthetic with adrenaline to help with haemostasis and just dissect out. pinpoint cautery for any bleeders.

RE: Cherry eye removal

Gillian Mostyn — Sun, 16 Jun 2019 12:42:01 GMT

As above, but just cut it off with scissors, put pressure on with a swab for a couple of minutes and voila. Stops bleeding very quickly.

You can't really 'do it wrong'.

RE: Cherry eye removal

David Mills — Sun, 16 Jun 2019 10:46:53 GMT

Grab it with a pair of Allis tissue forceps and cauterise it off at the base. Cauterise fairly slowly to minimise bleeding.