REPUBLIC OF THE PHILIPPINES

Province of Cebu

CEBU TECHNOLOGICAL UNIVERSITY

Barili Campus
Cagay, Barili, Cebu

Disorders of the Eyelids in Dogs

Problems affecting the eyelids may be congenital (present at birth) or may occur as a result of injury, infection,
disease of the surrounding skin, body-wide diseases, or exposure to various types of irritants.

Entropion
Entropion is the turning in of the edges of the eyelid so that the eyelashes and fur rub against the eye surface. It
is the most frequent inherited eyelid defect in many dog breeds. It may also follow scar formation and severe
involuntary winking due to pain in the eye or the surrounding area. The turning in of eyelashes or facial hairs
causes discomfort and irritation of the conjunctiva and cornea. Longterm entropion can cause scarring,
abnormal coloring, and possibly the formation of slow-healing sores on the cornea.

Early spasms of entropion may be reversed if the cause is removed or if pain is lessened. Turning the lid hairs
back away from the eye with stitches in the lid, injections of medication into the lid close to the area where the
lid is turning in, or using anesthetics to block the nerves in the eyelids are some of the methods that have been
used to lessen the pain. Very young puppies with this condition may sometimes be treated with temporary
stitches that are removed in 2 to 3 weeks. Established entropion usually requires surgery to correct the defect.

Commonly affected breeds

Most commonly this condition is seen as rolling-in of the lateral (outer) eyelashes of the lower eyelid of breeds
such as Rottweilers, Mastiff breeds, Malamutes and more commonly Shar Pei. This type of entropion is also seen in
older cats. With Pugs, we see entropion of the medial (inner or near the nose) area of the lower eyelids. In Shar Pei
puppies, we see entropion of the upper eyelids which self corrects as the puppy grows. This can often be managed
with the use of anti-inflammatory/antibiotic eye ointments. Occasionally we place sutures to hold the upper
eyelids away from the cornea for a couple of months as the puppy grows.

Surgical method

The procedure is performed under a general anaesthetic, the surgery can take anywhere between 20 - 45 minutes
depending on if one or both eyes are affected. Incisions are made along the length of the affected eyelid to ensure
the eye is symmetrical given the curvature of the eye. Incisions are made within 2 - 3mm of the eyelid margin, so it
is difficult to see a scar long term. It is not necessary to shave any of the hair away from around the eyelids to
perform this surgery.
 REPUBLIC OF THE PHILIPPINES
Province of Cebu

CEBU TECHNOLOGICAL UNIVERSITY

Barili Campus
Cagay, Barili, Cebu

Ectropion

Ectropion is a slack eyelid edge that is turned out, usually with a large notch or “crack” in the eyelid. It is a
common abnormality affecting both eyelids in a number of dog breeds, including the Bloodhound, Bull Mastiff,
Great Dane, Newfoundland, St. Bernard, and several Spaniel breeds. Scars in the eyelid or facial nerve paralysis
may produce ectropion in one eyelid in any species. Exposure of the conjunctiva to environmental irritants and
secondary bacterial infection can result in longterm or recurrent conjunctivitis (inflammation of the
conjunctiva). Topical antibiotics may temporarily control infections, but surgical lid-shortening procedures are
often necessary to resolve the condition. Repeated, periodic cleansing of the affected eyelid with mild
decongestant solutions can control mild cases.
 REPUBLIC OF THE PHILIPPINES
Province of Cebu

CEBU TECHNOLOGICAL UNIVERSITY

Barili Campus
Cagay, Barili, Cebu

Ectropion exposes the delicate conjunctival tissues that line the inner surface of the eyelids and cover the eyeball,
causing drying of the tissues. This results in conjunctivitis. The surface of the eye or the cornea may also dry out,
resulting in keratitis (corneal inflammation). All of these conditions are painful. Corneal damage can also result in
corneal scarring, that can impair or obstruct vision. In most cases, both eyes are affected. Ectropion is usually
diagnosed in dogs less than one year of age.

Certain breeds have a higher incidence of ectropion than others. Congenital ectropion is the most commonly seen
form of this condition in veterinary practice. These breeds include:

 Cocker Spaniel
 Saint Bernard
 Bloodhound
 Basset Hound
 Mastiff
 Newfoundland
 Bulldog
 Chow Chow

Causes of ectropion:

Acquired ectropion can occur in any dog at any age. Acquired ectropion means that a condition other than an
inherited trait causes the lower eyelid to 'sag' or evert. Some common causes of acquired ectropion include:

 facial nerve paralysis

 hypothyroidism
 scarring secondary to injury
 chronic inflammation and infection of the tissues surrounding the eyes
 surgical overcorrection of ectropion
 neuromuscular disease

Clinical signs of ectropion:

The clinical signs are a 'sagging' or 'rolling outward' lower eyelid. A thick mucoid discharge often accumulates along
the eyelid margin. The eye and conjunctiva may appear reddened or inflamed. The dog may rub or paw at the eye
if it becomes uncomfortable. Tears may run down the face if the medial aspect of the eyelid (the area of the eyelid
toward the nose) is affected. In many cases, pigment contained in the tear fluid will cause a brownish staining of
the fur beneath the eyes.
 REPUBLIC OF THE PHILIPPINES
Province of Cebu

CEBU TECHNOLOGICAL UNIVERSITY

Barili Campus
Cagay, Barili, Cebu

Diagnosis:

Diagnosis is usually made on physical examination. If the dog is older, blood and urine tests may be performed to
search for an underlying cause for the ectropion. Corneal staining will be performed to assess the cornea and to
determine if any corneal ulceration is present. Muscle or nerve biopsies may be recommended if neuromuscular
disease is suspected. Testing for hypothyroidism and for antibodies against certain muscle fibers may be done if
looking for underlying causes.

Treatment:

The treatment for mild ectropion generally consists of medical therapy, such as lubricating eye drops and
ointments to prevent the cornea and conjunctiva from drying out. Ophthalmic antibiotics will be used to combat
any corneal ulcers. If the condition is severe, surgical correction can be performed to shorten the eyelids.

Lagopthalmos

Lagophthalmos is an inability to fully close the eyelids and protect the cornea from drying and trauma. It may
result from extremely shallow orbits, a common condition in breeds with short, broad, flattened heads
(brachycephalic breeds, such as Bulldogs and Pugs, for example). It may also be caused by an abnormal
protrusion of the eyeball due to a mass in the eye socket, or facial nerve paralysis. Scarring, abnormal coloring,
and the formation of slow-healing sores of the cornea are common problems with this condition. Unless the
cause can be corrected, treatment involves frequent use of lubricating ointments and surgical shortening or
closure of the corners of the eye either temporarily or permanently. Excessive nasal skin folds and facial hair
may aggravate the damage caused by lagophthalmos.

Diseases of the eyelids

Eyelashes are important anatomical structures that protect the eye by stopping particulate matter from getting to
the eye and also by diverting water and wind.[1] Lashes also have a strong sensory innervation making them
capable of detecting noxious agents with appropriate protective responses by the eyelids and the periorbital
 REPUBLIC OF THE PHILIPPINES
Province of Cebu

CEBU TECHNOLOGICAL UNIVERSITY

Barili Campus
Cagay, Barili, Cebu

muscles. A large number of congenital and acquired diseases and conditions can affect eyelashes. It is important to
identify the cause where possible and understand how the lashes behave differently from the normal before
corrective measures are undertaken.

Trichiasis

Trichiasis is defined as normal lashes growing inward. In trichiasis, the lash follicle is normal, but the direction of
lash growth is abnormal. In the presence of inflammation, there may be a misdirection of the follicle with the lash
growing inwards towards the cornea, but the cause is not entropion. Some authors have divided trichiasis into
primary where the lash is misdirected by abnormal direction of the shaft of the hair and secondary trichiasis where
there is a misdirection of the follicle. We have found this division less useful in clinical practice. Others have
classified trichiasis as minor (less than five cilia) and major (more than five cilia). Mostly, trichiasis affects the lower
eyelid.

Examination under the biomicroscope should assess the lid margin, the posterior lamella, and fornices (looking for
symblepharon or scarring). An examination will reveal lashes pointing backward rubbing against the conjunctiva or
the cornea. The lashes may be in their normal position may be growing from behind the normal eyelashes. Scarring
of the eyelid margin secondary to inflammation should be looked for. Trichiasis is differentiated from involutional
entropion, where the eyelid margin turns in and causes normal lashes to rub against the cornea. This is often
termed secondary trichiasis or pseudo-trichiasis

Causes:

 Chronic blepharitis
 Vernal keratoconjunctivitis
 Chemical burns
 Thermal injury
 Eczema
 Herpes zoster
 Atopic diseases
 Ocular cicatricial pemphigoid disease
 Cicatrizing conjunctival disease
 Eyelid trauma
 Eyelid surgery
 Meibomitis
 Stevens-Johnson syndrome
 Leprosy
 Eyelid tumors
 Trachoma
 Chalazia: Sometimes one will see trichiasis at a site of a prior chalazion which may or may not have been
surgically drained: the collapsed meibomian gland can cause a local change in the architecture with lashes
turning in.

Mostly, trichiasis affects the lower eyelid, except in chemical burns (where both lids are affected) or trachoma,
where the upper eyelid is more severely affected. Chlamydia trachomatis causes trachoma: the disease is
endemic in sub-Saharan Africa. In trachoma, inflammation of the eyelid margin and conjunctiva will cause a
 REPUBLIC OF THE PHILIPPINES
Province of Cebu

CEBU TECHNOLOGICAL UNIVERSITY

Barili Campus
Cagay, Barili, Cebu

combination of trichiasis as well as cicatricial entropion. Corneal scarring and eventual corneal opacification
can occur.

Treatment:

Short-term relief may be obtained by epilating the lashes or inserting a bandage contact lens. Surgical treatment
should only be undertaken after active inflammation is brought under control. Permanent destruction of the roots
of the offending lashes is achieved using numerous techniques, including argon laser, electrolysis, radiofrequency
epilation, trephination, eyelash bulb extirpation, resection of the lash follicle, cryotherapy, and surgical
repositioning. We use the radiofrequency needle to the depth of the root of the lashes (2.4 mm deep in the upper
lid and 1.4 mm in the lower lid) to kill the offending lash roots. Monopolar electrocautery is used less often now as
it causes more collateral thermal injury to the eyelid margin.

Distichiasis

Distichiasis is defined as a separate row of lashes that are present behind the normal row of lashes. These lashes
are fine with little pigmentation but will cause corneal irritation. Various forms of distichiasis are seen, from a
complete row of lashes to an irregular row. Distichiasis may be congenital, in which case the pilosebaceous units
differentiate into lashes instead of meibomian glands. In the autosomal lymphedema-distichiasis syndrome,
[4] distichiasis is associated with limb lymphedema, and there may be cleft palate and cardiac abnormalities. Other
congenital causes of distichiasis include mandibulofacial dystonia and Setleis syndrome (focal facial dermal
dysplasia with upper eyelid lashes present in multiple rows or eyelashes may be completely absent).

Secondary distichiasis is seen in conditions that cause inflammation which in turn leads to metaplasia of the
Meibomian glands forming lashes within the Meibomian glands. These conditions are similar to those causing
trichiasis, including blepharitis, caustic injuries, meibomian gland dysfunction, meibomitis, ocular cicatricial
pemphigoid, and Stevens-Johnson syndrome.

Management:

This includes epilation, use of cryotherapy, trephination, folliculectomy, lid split and treatment of the abnormal
follicles and radiofrequency treatment of the follicles. In acquired distichiasis, there is eyelid inflammation
(Meibomian gland dysfunction, cicatricial pemphigoid, Stevens-Johnson syndrome). Inflammation induces
metaplasia of the Meibomian glands forming lashes within the Meibomian glands. There may be a need for
application of a mucous membrane graft, particularly if there is mucocutaneous keratinization.

Tristichia/Tetrastichiasis

The presence of a third row of lashes. Tetrastichiasis is the presence of a fourth row of lashes. These are rare
conditions.

Pseudocilium

Sometimes, an eyelash will be seen in a meibomian gland orifice or the punctum. We have termed this
"pseudocilium" because the lash does not have root but is loose in the meibomian gland or the punctum. Such an
 REPUBLIC OF THE PHILIPPINES
Province of Cebu

CEBU TECHNOLOGICAL UNIVERSITY

Barili Campus
Cagay, Barili, Cebu

isolated lash can find its way into a meibomian gland or punctum still and may have the tip of the lash on the
outside or the root on the outside (upside down lash). Either way, the lash can still cause corneal and conjunctival
irritation. Treatment is simply the removal of the lash from the orifice of the meibomian gland or the punctum.

Hypotrichosis

Hypotrichosis, which is defined as reduced hair density anywhere in the body may also affect eyelashes. The only
effective treatment is the use of topical bimatoprost ophthalmic solution 0.03%. It is applied to the lash bases,
resulting in lashes which are thicker, longer and darker. Bimatoprost is thought to prolong the anagen phase of the
lash cycle. Results are seen in 16 weeks. A recent concern is that some patients may show atrophy of orbital fat
after prolonged use of such topical bimatoprost solution. Side effects include increased iris pigmentation, skin
pigmentation, and skin irritation, all of which will reverse with discontinuation of the medication.

Alopecia Adnata has been used to describe under-developed eyelashes. Alopecia areata, which is thought to be an
autoimmune process, can also affect eyelashes.

Madarosis

Madarosis is the loss of lashes (ciliary madarosis) or eyebrows (superciliary madarosis). Milphosis means eyelash
loss. Madarosis and milphosis are often used interchangeably. Trichotillomania is the self-induced pulling of hair
from anywhere in the body but is also applied to eyelash-pulling. In most cases, psychiatric evaluation and
treatment are needed.

Causes:

 Blepharitis
 Meibomian gland dysfunction
 Ocular rosacea
 Seborrheic blepharitis
 Staphylococcal infection
 Demodex infestation
 Trachoma
 Congenital syndromes like Oliver-McFarlane and Cornelia de Lange
 Alopecia Universalis is a type of alopecia which also results in loss of lashes. In this condition,
corticosteroids and topical immunotherapy have been used successfully to achieve hair growth.
 T-cell lymphoma and associated follicular mucinosis
 Allergic contact dermatitis may be caused by many cosmetics and ophthalmic medications with
preservatives and other chemicals.
 Superficial inflammation from any cause can lead to irritation and rubbing of the brows and lashes with
pigmentation, skin laxity and lash loss.
 Psoriasis
 Atopic dermatitis, which may be associated with allergic rhinitis, keratoconjunctivitis, vernal conjunctivitis
causes loss of lashes on the lateral third of the brows (termed Hertoghe’s sign).
 Acne rosacea results in blepharitis, keratitis, and telangiectatic changes on the cheeks and nose
 Alopecia areata may result in a patchy lash loss. The lashes have an “exclamation mark” configuration of
broken hairs: this is pathognomonic of this disease.
 REPUBLIC OF THE PHILIPPINES
Province of Cebu

CEBU TECHNOLOGICAL UNIVERSITY

Barili Campus
Cagay, Barili, Cebu

 Discoid lupus erythematosus and systemic lupus erythematosus: chronic blepharoconjunctivitis and
madarosis may occur.
 Scleroderma en coup de sabre, which is localized scleroderma will show a segmental loss of eyebrows and
lashes
 Hypothyroidism may cause brittle hairs mostly affecting the brows, but also lashes
 Hyperthyroidism may cause ciliary madarosis
 Malignancy: basal cell carcinoma, squamous cell carcinoma, Merkel cell carcinoma, mycosis fungoides
(cutaneous T-cell lymphoma), sebaceous cell carcinoma. Recalcitrant dermatitis and chronic
blepharoconjunctivitis or recurrent chalazia should be indications for biopsy of the eyelid and eyelid
margin.
 Chemotherapy
 Herpes zoster is a common cause of madarosis of the upper or lower eyelid. Secondary syphilis can cause
outer eyebrow loss and eyelash loss. Leprosy as a cause is seen less frequently now. HIV/AIDS may cause
madarosis or trichomegaly.
 Drugs: Systemic drug toxicity and local topical agents may cause madarosis.
 Trauma: Eyelid lacerations, chemical, and thermal injuries and tattooing can all cause madarosis.
 Trichotillomania is a condition in which patients pull hair (scalp being the most common, followed by
eyelashes). As these are episodic, may be confused with alopecia areata. A biomicroscopic examination
will show broken hairs of different lengths with no underlying skin condition. Trichoteiromania is a loss of
hair by repeated rubbing and trichotemnomania is a loss by obsessive shaving.
 Congenital diseases: numerous diseases are associated with hair loss, including ectodermal dysplasias,
Ichthyosis-cheek-eyebrow syndrome, localized autosomal recessive hypotrichosis, ectodermal dysplasias,
Rothmund-Thompson syndrome.

Management

With such a disparate list of causes of eyelash milphosis (madarosis), the underlying condition has to be diagnosed
and treated. Eyebrow transplants may of be used for superciliary madarosis. Eyelash transplants have not gained
popular acceptance because of the risk of trichiasis and lack of lifelike hair on the lid margin. Successful take is not
predictable (depending upon the underlying disease and condition of the eyelid). Composite eyebrow grafts may
be used to reconstruct eyelids with segmental eyelash loss
REPUBLIC OF THE PHILIPPINES
Province of Cebu

CEBU TECHNOLOGICAL UNIVERSITY

Barili Campus
Cagay, Barili, Cebu