At ten years of age, Ted is beginning to show some signs of ageing. His muzzle has greyed, and he doesn’t have quite as much energy has he used to have. And a few months ago, Kevin noticed something else linked to his advancing age: he developed a couple of growths.
The first one is a tiny pink wart-like growth that sprouted from the right side of his muzzle. It looks like something that could be called a “skin tag”. It’s tiny – around 3mm wide, and 8mm long – and it doesn’t bother Ted at all. It would be easy to remove; a small injection of local anaesthetic at the base of it would allow it to be snipped off with scissors. But it doesn’t bother Ted in any way at all, and it hasn’t grown any bigger since it appeared, so there’s no real need to do anything.
The other growth is more complicated; it’s on the upper eyelid of his right eye. When Kevin first noticed it, it seemed like no more than a mark on the eyelid, but it gradually grew bigger, forming into an oval shape, like a tiny rugby ball measuring 5mm by 8mm. It isn’t much bigger than the small growth on his muzzle, but its location has been causing a problem. As the growth has enlarged, it has begun to rub on the surface of the eye. A few days ago, Ted started to rub the right side of his face along the ground, and Kevin realised that the growth was now causing an irritation that had to be tackled. He brought Ted in to see me.
When I examined Ted, I did a few checks to try to work out if the growth needed to be removed. First, I compared the whites of his eyes, looking at the left eye and then the right eye. When I did this, it was obvious that the white part of the right eyeball was red and sore-looking compared to the white part of the left eyeball. This confirmed that the growth was causing a physical irritation by pressing on the surface of the eye. This irritation had allowed bacteria to move in to the slightly damaged part of the surface of the eye, and Ted was suffering from conjunctivitis. Eye drops would be sufficient to clear this up for a short while, but it would rapidly recur because of the ongoing irritation caused by the growth pressing against the sensitive surface of the eyeball.
The second part of the decision making process was to closely examine the growth itself. While the skin tag on his muzzle resembles a small piece of healthy skin, the growth on the eyelid has an irregular, ulcerated surface, oozing a bloody discharge. So even if it was not rubbing on the surface of the eyeball, this was a growth that was likely to be itchy and uncomfortable in any case.
The growth is almost certainly a type known as a Meibomian cyst. This is a cystic growth of a type of gland that’s located on the edge of the eyelid. Healthy Meibomian glands produce sebum, or oil, which is an important component of tears, ensuring that they don’t dry out too quickly, and creating a tear film that keeps the surface of the eye continually moist. Also known as a chalazion, a Meibomian cyst is a benign type of tumour that develops from Meobomian glands. It’s one of the most common types of tumours found in older dogs.
This type of small growth can often be left alone, as long as it is not bothering the dog, or pressing on the surface of the eye. Some dogs have small cysts that remain unchanging for years, not causing any problem. But when they start to get bigger, and when they start to cause a problem for the animal, they need to be surgically removed.
As long as this type of growth is reasonably small, it’s a type of simple surgery that can be done by most vets. If, however, the cyst is bigger (e.g. more than a third of the width of the eyelid), then the surgery may involve complex procedures like skin flaps and grafts. Such cases are best referred to vets with a particular interest and advanced skills in this type of intricate surgery.
When the cyst is removed, it can be sent off to the laboratory for full analysis. This is the ideal option, as it is the only way to confirm, for sure, that it’s definitely a Meibomian cyst. There are some other, rarer, more malignant tumours that could theoretically have a similar appearance and the only way they can be identified is via histopathology of this type. However, given that even for such cases, surgical excision is the most effective treatment, many people choose not to pay the extra cost to have the analysis carried out. This is one of the biggest differences between human and animal cancer treatments: humans always have analysis carried out, so that people know exactly what is wrong with them. With animals, because owners are paying the costs from their own pockets, it’s often enough for people just to know that the problem has almost certainly been solved, without getting into the extra costs of detailed analysis. Vets normally guide owners to let them know if detailed analysis is likely to change the type of treatment. In such cases, obviously it makes sense to pay the extra money. In Ted’s case, it’s unlikely to make any difference, so there’s no urgent need for laboratory analysis to be done.
Ted’s operation is scheduled for later this week: we’ll snip off the muzzle growth at the same time as removing the cyst. He will soon have a blemish-free snout and a comfortable, cyst-free eyelid.