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Research is an important
way to help your furry companions...BUT please consult qualified medical professionals for every case of disease prevention and treatment!  These articles are NOT a replacement for your veterinarian's advice and services!
Eyelid Entropion

An "entropion" is a condition where the eyelid (usually the lower one) curls into the eye...this pushes the eyelashes against the cornea. The discomfort of the lashes rubbing against the eye causes increased tear production, squinting, blinking, refusal to open the eye, and can lead to infections and permanent damage to the cornea. This problems should not be confused with symptoms owing to hairs growing inside the eyelids or from hairs growing upward from facial folds.

This is a condition seen in many breeds, and dogs with the condition should be disqualified from breeding.

The surgery performed to correct this condition involves cutting a small slit of skin from under the eye so that when it is sutured, the eyelid lies flat against the eye globe. Severe cases can require repeat surgery.

An experienced surgeon can perform this so that the eye appears unchanged.

If you have concerns about having this surgery done by a general practicioner, you can ask your vet for a referral to a Veterinary Ophthalmologist.
                    Corneal Abrasions and Ulcers

Dogs that have a lot of facial hair, have hairs that poke backward from the nose or that grow from the inside of the eyelid(s), or have prominent eye globes are prone to scratches and other injuries to the skin of the eyes...this skin is called the Cornea.  Many minor corneal scratches (abrasions) go unnoticed at first:  the eye may tear or squint slightly in the beginning, but will quickly become infected and sore.  Dogs will squeeze the injured eye shut, rub the face and even avoid lying on the affected side of the face. 

If antibiotic intervention does not take place, a corneal abrasion will progress to an ulcerated condition...this is a deeper tearing and erroding of the cornea, accompanied by severe infection.  Medical assistance is urgently required to prevent a corneal ulcer from ripping down through all the corneal layers to the inner eyeball tissue.

A clear sign that a corneal ulcer has gone too far is the presence of a pink/red bulge from inside the eyeball.  Ophthalmologists call this bulged tissue a descemetocele (named for the membrane involved); it must be attended as a medical emergency if the eye and eyesight are to be saved.











Glaucoma/Uveitis/Bleeding Eyes

Glaucoma is a term that is used to generally describe a high-pressure condition in the eye; it does not in itself refer to a specific problem.  Glaucoma can result primarily from a defect in the system that drains the eye of its circulating fluids, or can result from another illness in the body that causes the inner eye tissue to bleed (such as cancer, cardiovascular disease/high blood pressure, immune disorders, infections). 

Medicines used to treat Glaucoma depend entirely on what the original cause of the inflammation is...pain relief is often considered as part of the therapies.

The term Uveitis (say it: "you-vee-ite-iss") describes an inflammation of the middle layer of the eye. This middle layer contains a large number of blood vessels that serve the other structures of vision.

This blood-rich layer can become inflamed (and actively bleed) due to a number of illnesses, both from within (ex: immune dysfunction, Lymphoma, Hypothyroid, Cushing's Disease) or from without (ex: Lyme Disease, Ehrlichia, Blastomycosis).  In other words, this may not be due to an illness of the eye itself in origin.

Occasionally, Uveitis is defined as Idiopathic...this means that no originating cause for the bleeding is found. Treatment is then confined to the eye and aims at preventing further complications, such as Glaucoma (excessive pressure in the eye).  Dogs generally express pain by avoiding sociable activities, avoiding exercise, eating poorly, or protectively guarding one side of the face.
Too Many Tears
Dry Eye/KCS/Sticky Eyelids

Shih Tzus, Pekingese and Lhasas are all breeds (among others) that can develop a variety of conditions related to diseases of the eyes, eyelids, and tear ducts.

They can have excessive runny tear production (epiphora), or thick and ineffective tears. 

Epiphora describes a plentiful liquid tear flow that stains the hair around the eyes, but is easily brushed clean.  This should not be confused with overspill of tears during teething in young dogs, and is different from thick goey tears that accompany other illnesses.   If not attended to regularly, this tear staining can become dark, and even infected.  Keeping hair around the eyes clipped short, brushing several times through the day, and using a wash approved for use around the eyes can all be helpful.  Most people report that products intended to remove eye stains after-the-fact do not bleach the hairs back to their original color, so prevention is best.

There are a number of things that can lead to thickening of tears.  Mild problems, like dehydration due to dry heat in the house or respiratory illness, are short-lived and can be supported with some artificial tears eye drops or ointment.

Long-term problems include:

1) Canine Herpesvirus infection...although gastrointestinal symptoms and fever are more usual upon initial infection (this is a pretty common virus that unfortunately does not have a U.S. vaccine available as yet), ocular and sinus signs are not out of the question in terms of chronic experience.  Herpesvirus can be easily contracted from other dogs (show conditions, boarding, or breeding, for instance)...it can be fatal in young pups (as one of the leading causes of Fading Puppy Syndrome), but is mostly a nuisance to adult dogs.  Some l-lysine can help suppress outbreaks: 100 mg for each 10 pounds of weight daily with food.

2) Blocked or occluded tear ducts--either from dry tears or from conformational problems that keep normal tear drainage to the nose from happening smoothly.  A conformational, or structural, problem would be genetic in origin, so affected dogs should be withheld from breeding.  A Veterinary Ophthalmologist is consulted to confirm a suspected physical defect.  Warm water compresses 2-3 times daily can help dissolve salt plugs and re-open ducts temporarily.

3) Unfortunately, a gentically-carried automimmune illness commonly known as Dry Eye, or KCS (Keratoconjunctivitis Sicca), can run in small breeds.  Although it usually appears in adult dogs, it can be seen in pups.  Basically, the immune system begins to attack the tear glands ability to produce the very liquid part of tears, and the eye discharges are not thinned enough to wash into the sinuses below the eyes.  Early KCS starts out with dry, gunky discharge or crust, then advances to sticky, dull eyeballs that can itch or be painful as they lose protective moisture.  Infections are frequent, and even though they are responsive to antibiotic treatment, will recur when antibiotic therapy is discontinued.  KCS, over time, damages the corneas of the eyes because they are not naturally moisturized and cleaned, but are instead scratched by the eyelids...the degree to which this happens depends in part on how well you can apply treatments reglarly throughout each and every day.  Many advanced cases lead to accumulation of thick eye matter on the eyelids every morning...you can use warm water on a soft cloth like a compress to soften and then remove the discharge. Do not wipe or rub, just let the dried matter dissolve.

4) Tear glands can cease to function when exposed to sulfa drugs (brand names such as Bactrim, Bactrovet, Albon, SMZ-TMP, Tribrissen, Primor, etc., all Trademarks of their respective producers)...this damage is permenant and can mimic KCS.

Your veterinarian can quickly and easily test your dog's tear producing ability.  Although treatment is available for affected dogs, they can still pass on the genes for this condition.  Dogs with KCS should never be treated with sulfa drugs, unless in a life-threatening situation that requires it.

Dogs determined to have less-than-optimal tear production should not be used for breeding.

Dogs can also develop many other forms of conjunctivitis (inflammation of the tissue surrounding the eye) that can become infected...these infections can be viral or bacterial in origin, and may or may not be part of some other illness in the body.  All forms of chronic inflammation can lead to damage of the eyes if not properly addressed in a timely fashion.

Cherry Eye is the common term used for a Prolapsed Nictitans Gland--in other words, the tear duct that lies under the lower eyelid has popped out of its place.  The common name comes from the red appearance: like a small cherry or cranberry lying on the inside edge of the lower eyelid.

Although the appearance is alarming, this is not considered to be painful in and of itself.  Many dogs breeds with small faces or loose facial skin are prone to this condition (among them, pugs, cocker spaniels, lhasa apsos, shih tzu, pekingese, english bulldogs, beagles, or any mix containing pre-disposing genes).  It is not a medical emergency if the tissue is healthy.

Surgical replacement of the tear gland is recommended primarily for two reasons:

1) the tear gland and duct do not work properly when the gland is out of the lid, and this leads to increased susceptibility to and incidence of infection of the eye--a dry eye is not a healthy eye--eyesight can be lost as a result of this condition and its complications;

2) the tear gland itself is meant to stay moist and protected, it can be directly damaged (scratched, infected) when it is not in its normal location.

Non-surgical treatment includes regular use of lubricating drops/ointment on the affected eye(s), antibiotic treatment to the eye when infection is noted, watchfulness for signs of infection (colored discharge from the eye, rubbing, squinting) and prevention of injury to (or immediate treatment of injury to) the gland.  The effectiveness of non-surgical care depends on the ability to maintain a good routine of drops and examination of the eye and the ability of the gland to remain healthy in your individual dog.

Surgical costs can vary widely.  Your regular vet may or may not be familiar with this surgery, and so you may be referred to a Veterinary Ophthalmologist.

If you are unable to find a veterinary opinion in person for several days, you can soothe the eye with some special moisturizing eye drops called Celluvisc by Allergan (found in the eye care section of the regular pharmacy or food store) two or three times daily to prevent drying and irritation...other topical first aid ointments are NOT suited for this purpose.  A heavy, gooey discharge indicates that an infection has taken hold and the eye should be attended immediately.
Eyelid Ectropion

Eyelids that curl outward can cause problems if the inner eyelid surface is significantly exposed to air, dust and bacteria.

While many owners elect to have corrective surgery performed for the sake of appearances, repairing these eyelids is of greater medical significance to veterinary surgeons who are familiar with the problems encountered in the future.
Henry (Lhasa Apsos) was rescued (along with his half-sister who gave birth to their singleton pup a week later!) with BOTH tear glands prolapsed...his overall health prevented a surgical solution.
All About Eyes
Eyelid Bumps/Tumors

The vast majority of eyelid tumors that I have personally seen have been on Labs!  But any dog can develop tiny growths growing from the eyelid tissue.

Most of these growths are benign (not harmful), but some are malignant (bad). Essentially, the only way to tell the difference between these two tumor types is to send the growth to a laboratory for a biopsy (microscopic examination by a specialist).

Some tumors can cause irritation if they grow large enough to rub the cornea of the eye itself, or just tickle in general. Conjunctivitis (generalized inflammation) or infections of the eye are common side effects of growths that grow from the inside edge of the eyelid.

***You should have any growth examined by a veterinarian who can give you specific advice about when to consider removing it.***
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Eye Drift/Eye Rolls Up (Strabismus):
Dogs, like people, can be born with uneven muscles that control the eyes...they can even be cross-eyed.  Pups born with deviated eyeballs, and that do not show any signs of trouble getting around, do not require any treatment.
Sometimes dogs develop problems related to the nerves that control the position and movement of the eyes.
The medical term for an eye/eyes that drifts up is Hypertrophic Strabismus.  This is a problem with the nerves that control the eye's movement.  It can be caused by a number of serious problems, such as infections (like Lyme Disease or Encephalitis).
There is a neurologic condition called Myositis in which certain nerves of the face and head are damaged by an overactive immune response. Ocular Myositis can damage the eyes but not damage other muscles nearby, or muscles controlling the jaw can be affected as well (making it harder to eat than to drink). Treatments may include steroids and/or surgery.
When the eyes move rapidly from side-to-side, we call this Nystagmus.  The most common illness associated with nystagmus is Vestibular Syndrome.  Affected dogs are often nauseated and unable to walk properly due to an extreme experience of vertigo (dizziness).  Steroids and strong antihistamines are used to help these patients.
Quick medical intervention is required to find the root cause of eye drift problems, so do not wait to seek a veterinarian's help if your pet shows any sign of not being able to hold the eyes steady!

Blepharitis
Blepharitis is the general medical term for inflammation of the eyelids, and can include swelling and elevation of the third eyelid.
This condition can be caused by a variety of problems, including infections and autoimmune diseases.  Other problems with the eyelids can develop if this inflammation continues unchecked.

Cataracts
Cataracts can be partial or complete, that is, can allow some light into the eyes or block vision completely. Cataracts can be congenital (they develop because of a genetic predisposition), or can be the result of another medical condition in the eye or body.
There are no medications that can "dissolve" a cataract: surgery is the only treatment, but can only be performed on healthy eyes that have no other problems in them.
On occasion, congenital cataracts have been known to reabsorb to a stage that allows vision to improve. A second opinion is always a good idea when considering this type of expense.

Ophthalmoplegia
Ophthalmoplegia (from the Greek Ophthalmo-EYE + Plegia-PARALYSIS) is a condition caused most often by paralysis of the muscles and/or nerves that control the movement and orientation of the eyeball.
You might see other symptoms such as trouble eating, manipulating the jaws, shrinkage of muscles over the top of the head, and other signs of muscle weakness or paralysis along the head and face, depending on what system is actually involved in your pet's case.
Complete diagnosis would involve neurologic tests.  Deciding to go on with more testing does depend in part on your family's finances, and what you feel this dear Friend can undergo. Brain scans (to look for tumors and scars in the brain tissue) and spinal taps (to look for by-products of nerve degeneration) are performed under general anesthesia in veterinary patients.

Corneal Epithelial Lipid Dystrophy
Epithelial Lipid Dystrophy is a condition in which cholesterol gets trapped between the layers of the cornea.  It is visible as a small, white, fuzzy spot of varying size, and most usually at the center of the eye.
Unlike corneal ulcers (deep infections), this is not a painful condition.  Occasionally, this problem can become more generalized quickly, and reduce your dog’s vision.
Many general veterinarians refer these patients to a Veterinary Ophthalmologist to have this problem examined in detail. 
A dog with any painful symptoms should be examined right away.

Keratitis
There is a group of eye problems seen in German Shepherds and similar breeds collectively called "Keratitis".  These conditions cause the cornea (skin of the eye) to appear bumpy or bubbly.  This is in contrast to problems that cause the cornea to appear pitted inward.  Various other problems can lead to Keratitis, including fungal or viral infective agents, and autoimmune dysfunctions (including allergies).
Keratitis can be painful (you might see tears or squinting), and is progressive.  The Keratin deposits make a dog's corneas more and more cloudy over time.  Blindness can result.
A Veterinary Ophthalmologist is often consulted to completely diagnose this condition and propose the most helpful treatment(s).
After living for many years without treatment for KCS (Dry Eye), this little guy's eyes arrived at rescue permemantly damaged and virtually sightless.  Notice how no light reflects off the thickened/scarred corneas.
A year-old Shih Tzu showing the classic squint indicating eye pain...in this case due to ulcers that developed when stiff eyelashes grew into the insides of his eyelids and began scratching the corneas during normal blinking. Quick veterinary intervention to remove the abnormal hair follicles along with antibiotic treatment is curative.  If your pet squints or keeps an eye closed, please seek qualified veterinary help ASAP!!
photo by D.Bodensieck 2008 all rights reserved
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