Treatment
Our approach to managing cherry eye is always surgical, with the primary goals of repositioning the prolapsed third eyelid gland, restoring normal ocular function, and alleviating discomfort or irritation. The gland within the nictitating membrane plays a crucial role in maintaining tear production, contributing approximately 30% of the aqueous tear film, which is essential for long-term ocular health.
In a healthy eye, the gland is securely anchored by connective tissue. When this support fails, the gland prolapses, producing the characteristic red swelling at the medial canthus that gives the condition its common name, “cherry eye.”
Without surgical correction, affected patients are at risk of reduced tear production, which can lead to chronic keratoconjunctivitis sicca (dry eye) and associated complications. Surgical intervention not only restores normal anatomy and function but also helps prevent long-term ocular morbidity.
Surgical options for Cherry Eye
All procedures have their advantages and disadvantages, but the most commonly used technique to treat cherry eye is the ‘Morgan pocketing procedure’. This method allows the third eyelid to remain mobile but results in a reduced ability to secrete.
Alternative approaches involve permanently suturing the gland into position to allow continued secretion, but immobilisation of the third eyelid means that it is unable to perform a ‘windscreen wiper’ action.
Suggestions to amputate the third eyelid should be resisted as it produces approximately one third of the liquid phase of the tear film and increases the likelihood of kerato-conjunctivitis sicca (KCS). One study showed only 10% of re-positioned glands went onto get KCS whereas 85% of amputated third eyelid cases developed KCS.
You can read more about the procedure and its aftercare in our resource section here.
