Submitted December 26, 2007

Q.) I have a three-year old female lab that has a runny right eye. The first vet had me apply a dexamethasone solution four times a day for a week. Then for two weeks I did it twice daily and applied gentamicin three times daily. The vet flushed the tear duct and noted that it was difficult to do so, but could not come up with a diagnosis.

Went to a second vet and she also did not know what the problem was. She also flushed the tear duct and also thought it was difficult, but could not come up with a diagnosis. She put her back on another antibiotic and dexamethasone combination to apply twice daily and added in a warm compress 2-3 times a day. Her conjunctiva is quite red and a bit swollen and also the pouch under her eye seems a bit swollen.

Any ideas? She eats well, seems to be in great health and does not rub or bother with that eye.

A.) I was going through some of these older questions today when I stumbled across this question. Ironically, I saw a nearly identical case this week, only it was an eight-year old male lab and had been to three other vets prior to coming to our practice. The dog I saw had been having issues since October and the discharge had gotten thicker, more frequent and green.

One thing that wasn't mentioned in the original question was whether a full eye workup had been performed. If it had not, I would strongly recommend checking the tear production (there are three components for the tear film), a thorough exam of the entire eye, including behind the third eyelid, and a staining of the eye to ensure there are no ulcers on the surface. This staining of the eye will also allow the veterinarian to check if the tears are flowing out. The tear duct empties into the nose, and if the tear duct is working the eye stain will show up there.

If all of the tests come back normal and the tear duct is not flowing, then likely your dog has dacryocystitis, or inflammation of the nasolacrimal duct and lacrimal sac. In dogs, particularly hunting dogs, this is caused by foreign material entering the tear duct opening and causing an infection or irritation. Sometimes the foreign body is still present and can be flushed out. Other times the seed may be gone with the inflammation and irritation still present. If this is the case then other therapy will be needed.

There are typically two ways to treat these cases. The first is with medical management. Often these dogs are placed on eye medications similar to those you had already been given, oral antibiotics and warm compresses. Because of the nature of the problem, this therapy will often need to continue for weeks to months, depending on the dog's progress. The second route is surgical correction where the duct is reopened. This can be a tricky procedure and can also require an extensive post-op recovery. The recovery isn't long because of the invasiveness of the procedure, but rather as a result of the duct being so small and the difficulty in keeping it from closing back down.

If we get to the point of going down the surgical path I will stongly recommend the client visit with an ophthalmologist to have the procedure performed. Their percentage of successful outcomes with this procedure is going to be much higher than those of us in regular practice.

Submitted 8/28/08

Q.) My GSP has entropion which was surgically correccted two years ago. She is a two-time field champion and still young. I was thinking about breeding her, my question is should I? I asked three different vets and they all said it would be no problem breeding her.

A.) I thought this question was a good follow-up to the hernia question from a week or two ago. I'm guessing since you've asked three vets, and now a fourth, that you are a little concerned about this planned breeding and that you want to do what's right for the dog and the breed.

In my answer to the hernia question I relayed that I thought there was some room for interpretation of the problem, how it may have happened and whether it is going to be detrimental. In the case of the eyes I would default to an ophthalmologist, and in particular at the time of the CERF exam. Even though the condition has been corrected, they will offer the best input on whether this is a condition you should be concerned about passing on to future generations. The eyes and the surrounding tissues are their specialty, and of all the vets you've asked, they should have the best answer to your breeding question.

Some conditions of the eye will not result in a failed CERF, but will get noted and are deemed breeder's choice. This means it is an abnormal condition, but up to the breeder in regards to breeding. My Chessie Emma had such a condition with disthichia, or extra eye lashes that rubbed her cornea. They never caused a problem for her and I never bred her so it was a non-issue. In your case, if in the end you get the green light with the CERF exam, and are still hesitant, I would do some looking into the line of dogs yours is out of with emphasis placed on close relatives. If other dogs in the same gene pool have had similar procedures, I'd probably shy away from continuing this trait. If, on the other hand, yours is a fluke you may decide to breed. In situations like this I always caution to look at worse case scenerios. What I mean is how would you handle it if every pup in the litter had entropion? Your answer to that question may give you the most insite in regards to moving forward. Good Luck.

Submitted 2/9/2006:
Q:
I have a four-month old yellow lab female. She is happy and in good health, but has saggy, red, lower eyelids that worsen as she becomes tired. Is this a condition that should be surgically corrected?

A:
At four months of age I would not get too concerned about this eyelid problem, sometimes referred to as ectropion. In many young dogs this will seem to be exaggerated, and as they grow into their body, the condition will resolve on its own. Of more immediate concern are dogs with the opposite problem, the eyelids roll in, called entropion. These dogs have issues with the hair coat rubbing on the cornea and creating issues. Dogs with entropion do need more immediate surgery.

Certainly some dogs with ectropion will require surgery to “tighten up” the eyelids; however, I can say in my experience this has virtually never been the case. I would give her eyes time to mature and make these decisions when she is at adult size. Even if they are slightly droopy later in life and more prone to picking up debris out in the field, you can still manage this with eye flushing and monitoring.

Submitted 1/24/06:
Q:
I have an 18-month old griffon. The whites of his eyes get very red. He has no other symptoms, no discharge or itching. Eyes clear up with cream from the vet, but come right back after I stop using it. Any ideas?

A:
My first recommendation would be to make sure you have had a complete eye work-up (sounds expensive but is rather cheap). This will entail making sure there is no scratch or ulcer present, checking tear production (there are three components to tears), checking pressure in the eye and lastly a thorough exam of the eye and its parts. If all of that comes back normal there are a couple of options. One would be to have the dog evaluated by a veterinary ophthalmologist, or two would be to treat it as an over-reaction on the part of the dog (like an allergic response). I’m going to bet that the cream you are applying has some type of steroid in it to soothe the eye, occasionally these will need to be used periodically in cases like this, but I would strongly recommend talking with your vet about monitoring the eye and potential complications, particularly if the eye becomes scratched.

The other question I would ask is did this occur around hunting season when the dog was out running through various grasses? Some dogs will develop reactions to the irritation and will benefit from having their eyes rinsed after each outing in the field.

Submitted 5/10/05:
Q:
My 14-month old male GSP is currently with the trainer. When I talked to the trainer today he said that he feels that my dog will need to have eye lid surgery because the lids droop too much. He further said that in their current condition they collect dirt, other small items, even plant seed which irritate the eye and need to be removed. My questions are, is there a possibility that this dog will grow into his eye lids and not need the surgery? What is the process of eye lid surgery? Does the surgery need to be performed by a Specialist?

A:
Off the top of my head I can’t think of any dogs with droopy lids (ectropion) that I’ve had to perform a surgery on. Many of these dogs to seem to grow into their eyes (though at 14 months I’d say you probably won’t see much more filling out). A worse condition, in my mind, is entropion, where the eyelid is too tight and rolls in on itself. Many of these are rolled in so much that the eyelashes and hair rub the eye and cause significant irritation and problems. With entropion I recommend surgery sooner rather than later.

With your dogs condition I definitely would recommend the surgery if the droop is to such a degree that he dog is prone to injury or excessive irritation. If it was a mild case though I’m not sure I’d be in too much of a rush. As far as the surgery is concerned, typically they do not need to be performed by a specialist and most general practice vets are pretty competent at eyelid surgeries.

Submitted 3/17/05:
Q:
I have ten-year old GSP that has an eye that tears all the time. The vet treated it with “Tri-Optic S” and that cleared it up for about a month. It came back and he was treated with Prednisolone 1%. That didn’t do much at all. Now we have to go to an ophthalmologist. Do you have any info that might help?

A:
I won’t have anything more than the ophthalmologist gave you, but that being said I like to get pretty aggressive with the eyes when there is a problem.

You didn’t mention what diagnostics had been done by your vet, but my typical approach is to thoroughly examine the eye, including behind the third eyelid (which requires topical anesthetic). I will also stain the eye to look for an ulcer or scratch, measure the tear production and check the pressures. One note on the tears, there are three components to the tear film and occasionally one of those components will be lacking and the other two will be present in excess amounts. So, with some dogs, it will appear that they have excess tears when in actuality they are lacking. Lastly, I will check the tear ducts to make sure they are emptying appropriately. These are little tubes that run from the corners of the eye to the nose and mouth. Occasionally, they will get clogged with debris or close by infection, if this is the case they will need to be addressed.

If all of the above check out then I’ll typically use the steroid medications you mentioned. Usually I will get pretty aggressive for the first couple of days and then taper off once the problem is under control. During certain times of the year some dogs will need medications fairly regularly to keep their eye irritation under control.

Submitted 12/10/2004:
Q:
I have a German Shorthair that is five months old. He has a cherry eye. At what age should I have it removed?

A:
Cherry eye is a term used when the gland of the third eyelid becomes inflamed and prolapses out of the eye, giving the appearance the dog has a cherry coming out of its eye. I typically do not recommend that these be removed, but rather surgically repaired.

Typically I will start with a very thorough exam and diagnostics of the eye. If things check out normally, I attempt to replace the gland and use medications to bring down the swelling. This may have to be done a couple of times over the course of a month in order to see if surgery can be avoided. If the medical management does not work, then I will attempt to replace the gland surgically.

Some dogs, and breeds in particular, are prone to a condition called keratoconjunctivitis sicca, or dry eye. By removing the gland of third eyelid, it is possible to accelerate the development of this problem, or in some cases make it worse.

Even in the field of veterinary ophthalmology there is disagreement over repair versus removal, though most newer schools of thought lean towards repairing.

Submitted 10/2/04:
Q:
My six-month old English Setter recently developed a swollen and bulging eye, really gross looking. I thought maybe a bee sting but the vet operated for an abscess, going in through the mouth. She expected to find pus but didn’t. Said she removed some tissue with the blunt hemostats and put her on antibiotics. This problem developed overnight. She said this was a fairly common problem but I have never seen or heard of it. Have you?

A:
Ironically the last two cases that I’ve had of this condition have been in English Setters, one very old dog and one relatively young dog. I would have to say that in my experience this is an uncommon condition, but one that does occur.

The area just behind the last tooth is somewhat soft and it is thought the dog may have had something (plant awn, stick, etc.) penetrate upward and cause an abscess. We also see this with trauma or from bite wounds. The goal of treatment is exactly what your veterinarian did, and that is establish drainage and start antibiotics. Even though not a lot of pus was found, she likely established a drainage tract for anything that may have been up there.

I would caution to monitor the pup carefully once the antibiotics are stopped, as it is possible that the problem could come back if the inciting cause was not brought out when drainage was attempted. This condition also causes dogs a lot of pain when opening their mouths; for this reason I would caution against doing anything related to hunting that would cause the dog pain. For instance if the dog goes to make a retrieve when it’s painful you may have trouble developing this dog into a retriever. I would pretty much lay off any type of training until the problem is resolved.

Submitted 8/6/2006:
Q:
My five-year old setter has developed an Intraocular Melanoma. One larger one in the left eye and one smaller, possibly mobile, in the left. Any information on this condition, prognosis, treatment, etc would be appreciated?

A:
Conditions of the eyes definitely call for a visit to a veterinary ophthalmologist. I’m going to speculate that you have not been, as they would be able to answer all of these questions. I will say that I routinely find pigmented abnormalities in the eye that are NOT melanomas. There are different cysts that can form in the eye that appear to be floating balls, that while they look very strange are not anything of concern unless they cause a structural problem. Also, some pets will have benign pigment changes to their irises that occur as they age.

My only real suggestion is to have this evaluated by an ophthalmologist. I’m particularly interested in the official diagnosis with the involvement of both eyes. As far as incidence melanomas of the iris are rare, whereas conditions like an iris freckle or melanosis (hyperpigmentation of the iris) are more common. The good news is that the rate of metastasis of primary melanomas of the eye is less than 6%, thus many veterinary ophthalmologists will hold off on surgery until secondary problems develop, like glaucoma.

You definitely will have more answers after visiting a specialist. Good luck.

Submitted 10/25/04:
Q:
Had my 15-month old Small Munsterlander out for the Iowa Youth Pheasant Opener. We went through lots of standing corn and heavy weeds. About an hour after we got home he was rubbing his face with his forepaws. His eyes were all watery, inner eyelids inflamed and swollen, his left pupil did not seem as reactive as his right and both were light sensitive. Put him in the tub and used the hand held shower to gently flush out his eyes. This seemed to help a little. By morning his eyes seemed back to normal as far as pupils and light sensitivity but they were still a little watery and his conjunctiva were still somewhat inflamed. I am guessing plant material, dust, pollen and such. Is there some sort of Dog Visene one can use in these sorts of situations, or is flushing with water enough?

A:
Eye care is one of the biggest reasons I carry a couple of bottles of Saline Rinse. You can purchase this for usually under a buck in the contact lens section of any pharmacy or superstore. The key is to get plain saline, no cleaners, additives, etc. Some dogs seem to have more sensitive eyes than others, and with these dogs I would use the saline to rinse the eyes every time you come out of the field, or at a minimum at the end of the hunt. The key is to not just squirt it directly on the surface of the eye. You will want to aim for the white portion of the eye, or in the sac formed by the bottom eyelid and the eye. Also ask your vet how to examine the dog’s third eyelid, which is a common area for plant matter to get lodged. As far as other products, I would recommend just using plain saline. One other note is your mention of the pupil size. Typically if a dog’s pupils are constricted when they should be dilated, the dog is squinting or the third eyelid is covering some or all of the eye, I begin to worry about a scratch, ulcer or some other problem with the eye that should be addressed by your veterinarian.