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Brachycephalic Syndrome Part 2: Eyes

Posted 04.28.23 by Drew McWatters, DVM

While the respiratory problems are the most well-known problems of brachycephalic dogs, eye problems of brachycephalic dogs may be even more important when it comes to early diagnosis and intervention. The shape of brachycephalic dog faces causes the eye sockets to be shallow which makes the eyeballs especially prominent and vulnerable. There are 5 main problems that can occur with the eyes because of this.

1) Lagophthalmos

Before and after cherry eye
Before and after canthoplasty, cherry eye, and stenotic nares surgery.

Sometimes, the eyes are so prominent that the lids cannot close all the way over them, especially while sleeping when eyelid closure is a passive process. The first symptoms that is usually seen, even as a puppy, is excessive tearing and tear staining of the nasal folds. Eventually it can lead to irritation and drying of the center of the eye which leads to ulceration and ultimately pigmentation of the cornea. Chronic irritation and pigmentation of the cornea decreases vision and can lead to total blindness. If you notice excessive tearing in your dog, watch them when they sleep to see if their eyes are totally closed or if they are cracked open. Even a small opening can cause major problems over time. If this problem is confirmed to be present, I recommend surgical correction (called a canthoplasty), even before problems have occurred. I often do this corrective surgery while puppies are under anesthesia to be spayed or neutered.

2) Entropion (Turned-In Eyelids)

Entropion in a bulldog – skin is rolled in and hairs are scratching the eye.

The shortened face leads to rolling of the eyelids in such a way that the eyelashes or even haired skin can rub the eye. This is not only uncomfortable but will also damage the eye. Some dogs have eyelids that droop or turn out in one area, but turn inward in another area (usually the corner of the eye). Surgical correction is usually needed to protect the eye and restore comfort. Entropion can also be caused by anything that is causing pain in the eye so it is important that your vet determine the cause of the entropion before considering surgery.

3) Tear Problems

Brachycephalic breeds tend to get more than their share of tear problems. They can have Dry Eye (also known as KCS) where their tear glands do not produce enough tear or they can have a tear quality problem where the tears are not viscous enough to work properly. Both conditions cause painful, irritated eyes and both can lead to pigmentation of the cornea and vision loss. Dry Eye will also cause a thick, mucous-like discharge from the affected eye. The earlier these are diagnosed the better chance you have of preserving the eye of your dog’s eyes. A combination of tear stimulating eye drops and artificial lubricants are used to treat both of these conditions.

4) Risk of Proptosis

The shallow eye sockets and poor eyelid coverage make the eyes of brachycephalic breeds at a higher risk of proptosis which is literally where the eyes pop out of their sockets. When this happens, the optic nerve can be stretched and damaged which leads to vision loss. Any trauma to the head or neck can cause this condition. Even pulling hard on a neck collar or firm restraint around the neck can lead to proptosis. Having your pet in a harness instead of a neck collar and leash is recommended to try to protect against this condition.

5) Nasal Fold Irritation

Pigmented area on the eye caused by trichiasis from skin folds.

Many brachycephalic dogs have a fold of skin between the nose and eyes. This skin fold may need regular cleaning as it tends to collect skin oil and moisture but it can also be prominent enough to rub on the actual eyeball (called trichiasis). Chronic irritation will show as a pigmented area on the eye surface, especially on the side nearest the nose. This is hard to see without a bright light but your vet should be able to determine if it is present during an eye exam. If present, surgical correction with a canthoplasty is indicated to stop the irritation and preserve vision. This is the same surgery that corrects lagophthalmos.

So What Do You Do?

While this all sounds very discouraging, the good news is that they are conditions that can be surgically corrected and problems that can be mitigated. The most important thing is to talk to your vet about what problems your dog has and how they can be treated and managed. I meet many owner who just see their dog’s problems as “normal” and don’t speak up to advocate for them. Just because it’s “normal” for a breed doesn’t mean it’s not something that needs to be addressed. Early intervention often means the difference between a long healthy life for your dog and a lifetime of problems.

Brachycephalic breeds can be wonderful dogs with fun, unique personalities but, as you can see, brachycephalic ownership is not for the faint of heart. But by talking to your vet about your dog’s specific problems, together you can formulate a plan to make sure you brachycephalic dog has a long, healthy, happy life.

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