Reducing Cherry Eye Recurrence: Practical Surgical Tips Every Veterinarian Should Know

One of the most frustrating situations in veterinary ophthalmology is seeing a dog return weeks or months after cherry eye surgery with another prolapsed gland. While recurrence is often attributed to the surgical technique itself, current evidence suggests that the outcome depends on a combination of timely intervention, meticulous tissue handling, appropriate case selection, and diligent postoperative management. Even the most established procedures, including Morgan's Pocket Technique, can fail if these factors are overlooked^1,2. 

The encouraging news is that many causes of recurrence are preventable. 

Success starts with the preoperative assessment 

Before entering the operating room, veterinarians should determine whether the gland is still healthy enough to be repositioned successfully. 

A complete ophthalmic examination should include: 

• Duration of gland prolapse 

• Degree of conjunctival inflammation or oedema 

• Presence of corneal ulceration using fluorescein staining 

• Baseline tear production using the Schirmer Tear Test (STT) 

• Examination of the contralateral eye for early prolapse 

Dogs presented shortly after prolapse generally have healthier gland tissue and experience better surgical outcomes than those with chronic, inflamed glands. Prolonged exposure leads to oedema, fibrosis, and enlargement of the gland, making repositioning more difficult and increasing the risk of recurrence^1,2. 

Veterinarians should therefore encourage owners to seek treatment promptly rather than waiting to see if the gland "goes back on its own." 

Small surgical details make a big difference 

Morgan's Pocket Technique has become the preferred procedure because it preserves the tear-producing gland while restoring it to its physiological position. However, successful outcomes rely on precise execution rather than simply following the surgical steps¹. 

Several practical surgical principles consistently reduce recurrence: 

• Create conjunctival incisions large enough to accommodate the gland comfortably. 

• Handle gland tissue gently to minimise trauma and preserve vascular supply. 

• Avoid excessive tension while closing the conjunctival pocket. 

• Ensure the gland is completely buried without residual exposure. 

• Position suture knots away from the corneal surface to minimise postoperative irritation. 

• Maintain meticulous haemostasis to improve tissue healing^1,2. 

A prospective study evaluating Morgan's Pocket Technique reported a 94.1% success rate, with recurrence occurring in only one of twenty operated eyes. These findings demonstrate that careful surgical technique can achieve consistently favourable outcomes in routine clinical practice². 

Don't underestimate postoperative care 

A technically perfect surgery can still fail if postoperative management is inadequate. 

An effective postoperative protocol should include: 

• Elizabethan collar for 10–14 days 

• Topical lubricants to improve ocular comfort 

• Topical antibiotic therapy when conjunctivitis or surgical contamination is present 

• Systemic anti-inflammatory medication where clinically indicated 

• Restriction of vigorous activity during the early healing period 

• Scheduled re-examinations at one and three weeks 

Owners should also be informed that mild conjunctival swelling or temporary epiphora may occur during the first few postoperative days and does not necessarily indicate recurrence². 

Equally important is educating owners to prevent self-trauma. Persistent rubbing of the eye remains an avoidable cause of surgical failure. 

When recurrence isn't your fault 

Although surgical technique plays a major role, recurrence should not automatically be interpreted as technical failure. 

Recent genetic research has identified the FGF4L1 retrogene insertion as a significant risk factor for cherry eye, providing evidence that inherited connective tissue weakness contributes to gland instability³. Earlier pedigree studies similarly demonstrated that the disease has a complex hereditary basis rather than simple inheritance⁴. 

This explains why certain breeds—including Bulldogs, Cocker Spaniels, Beagles, Shih Tzus and Lhasa Apsos—may remain predisposed to recurrence despite technically successful surgery. 

For dogs with recurrent prolapse or severe connective tissue laxity, alternative gland-preserving approaches such as anchoring procedures or combined pocket-and-anchoring techniques may provide additional support. Importantly, gland excision should remain a last resort because of its association with reduced tear production and subsequent keratoconjunctivitis sicca (1). 

Follow-up is part of the treatment 

The final assessment of surgical success should extend beyond the immediate postoperative period. 

At follow-up visits, clinicians should evaluate: 

• Stability of gland position 

• Conjunctival healing 

• Corneal integrity 

• Tear production using repeat STT when indicated 

• Development of prolapse in the opposite eye 

Monitoring predisposed breeds over the long term allows early detection of contralateral disease and provides an opportunity to reinforce owner education. 

Clinical Pearl 

The best way to reduce cherry eye recurrence is not necessarily to change the surgical technique—it is to optimise every stage of case management. Early intervention, thorough preoperative assessment, meticulous tissue handling, structured postoperative care, and realistic owner counselling collectively have a greater influence on long-term success than the procedure itself. 

References (Vancouver) 

1. White C, Brennan ML. An evidence-based rapid review of surgical techniques for correction of prolapsed nictitans glands in dogs. Vet Sci. 2018;5(3):75. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6163435/ 

2. Deveci MZ, İşler CT, Yurtal Z, Altuğ ME, Kırgız Ö. Evaluation of Morgan's pocket technique in the treatment of nictitans gland prolapse in dogs. Turkish Journal of Veterinary & Animal Sciences. 2020;44(3):521–527. Available from: https://journals.tubitak.gov.tr/cgi/viewcontent.cgi?article=1191&context=veterinary 

3. Freyer J, Labadie JD, Huff JT, et al. Association of FGF4L1 Retrogene Insertion with Prolapsed Gland of the Nictitans (Cherry Eye) in Dogs. Genes. 2024;15(2):198. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10887708/ 

4. O'Neill DG, Church DB, McGreevy PD, et al. Investigating the inheritance of prolapsed nictitating membrane glands in a large canine pedigree. Canine Genet Epidemiol. 2015;2:7. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4361898/