Pug eye problems can be a worrisome issue for pug owners.
There are several pug eye problems. If your pug rubs its eyes, that's one indication of a serious matter. If left neglected, many pugs go
blind, or at best, near-blind from this condition.
DOES YOUR PUG RUB his/her eyes often? Does s/he lick a paw, then rub the
same paw against one or both eyes? Does your pug mush his/her face into the
carpet or couch? Or does your pug have some brown, pigment-like spots that
show on the white of the eye in the inside corner(s)?
If your answer is yes to any of these questions, then there’s a good chance
your pug has, or is developing, a common pug eye problem known as pigmentary keratitis, which can quickly lead to limited vision, progressing to total blindnes in just a few short years.
What does pigmentary keratitis look like? In the beginning, it looks like a
small black or dark-brown glob of pigment that begins on the white of the eye in
the inside corners and spreads, or starts directly on the center-top of the eye, andgets thicker with time. Gradually it grows, and spreads across the eye until, often, it completely covers it, looking very similar to a very dark brown contact lens placed on top of the eye. Although the pug’s eye is perfectly healthy beneath this pigment growth, the brown pigment blocks the vision and eventually the pug cannot see through it—effectively rendering it blind.
There appears to be several causes which can lead to this pug eye condition. Some veterinarians believe that Kerotoconjunctivitis sicca (dry eye), or entropion is the precursor, while a new theory is that the pug’s eyelid does not completely cover the bulged or protruding eyeball, during sleep, thereby causing dryness.
According to Dr. Brian Golden, of the Lake Murray Village Veterinary Clinic
in the San Diego area, dry eye is a common culprit, due to lack of proper tear
production. This means the eye is not getting bathed properly with the natural
tear, which is antibacterial and a lubricant. Imagine how your eyes would feel
with no fluids bathing them regularly. Every time you blinked, it would be painful.
“Once there isn’t adequate tear production then we start to get all kinds of
different eye diseases, and mucousy discharges (which can turn into crusts)
building up in the pug's eye,” Dr. Golden says. “Then, secondary to that, the cornea starts to dry out, starts to get irritated, and we start to get this pigment infiltration, and all this black coloration, which is called pigmentary keratitis, which is getting deposited on the surface of the cornea.”
|Entropion can also contribute to pigmentary keratitis. Entropion is a slight rolling of the eyelids to the point where the little hairs and lashes, which are like little brushes, are rubbing against the cornea and irritating it. Even a p u s h e d - i n wrinkle may rub against the eye, and again is
uncomfortable or painful.
Causes of entropion can include birth defects, injuries, or other pug eye problems, and can occur at any age, beginning when the pug’s eyes open at 2 weeks of age. (Most veterinarians who are knowledgeable about eye disorders like to operate on puppies as early as 4-8 weeks of age if they exhibit entropion right away.)
Pug eye problem
Dr. Alan MacMillan, of the Animal Eye Clinic of San Diego, is a veterinary
ophthalmologist. This means he specializes in eye disorders, and although he
agrees that Kerotoconjunctivitis sicca (also known as KCS or dry eye) and/or
entropion can be contributing causes, they are not always the culprit. “Veterinarians are taught to look for a cause of the abnormal pigmentation. While entropion may be a cause of this pigmentation, it is usually not the cause . . . I recently saw a dog who had no entropion, but it [the pigment] covered the entire eye. So where is it coming from?”
So there doesn’t have to be a cause? we asked. “There’s a cause, but it’s not always a mechanical kind of a cause. It is just from being a pug.” Dr. MacMillan says Collies and Miniature Schnauzers don’t get this.
Perhaps because a pug’s eyes are so prominent, they are vulnerable to the
elements and irritants around them such as dust particles blown into them from
air conditioners or heaters. Or just the wind. Who knows? Nevertheless, the fact
is, Dr. MacMillan says Pugs, Bulldogs, Bostons, Chihuahuas, Pekingese, Lhasas, Shih Tzus, and other breeds with “bulged” eyes are all vulnerable to pigmentary keratitis and other eye problems.
So how can it be treated?
First, if there is an underlying cause such as entropion or dry eye, the cause
should be treated before tackling the keratitis problem. However, if no obvious
cause exists, the severeness of the pigmentary keratitis will determine the appropriate treatment for this pug eye problem.
Dr. Golden says that pigmentary keratitis is an inflammation on the cornea,
“So what we want to do is use an anti-inflammation product like Pred Forte drops (which range in strength from mild to very strong).” If your vet doesn’t carry these drops s/he can call in a prescription for them from any pharmacy since it’s a “people” medicine, too. Your veterinarian will prescribe the dosage, but often it is suggested the owner put the drops in the pug’s eye(s) twice a day. Hopefully, the drops will arrest the spread of this black pigment, and in some cases, even push it back a little.
In addition to the Pred Forte, pugs who do not have adequate tear production
should be treated with Cyclosporine drops, which can stimulate tear production,
says Dr. Golden. “The nice thing about cyclosporine is you only need to give the
pug one drop in the morning (in each eye) and one drop at night for a week or so. If the drops work and we’re getting good tear production, then you can drop to once a day for a few weeks, and if all is going well, you can then go to once every other day (probably for the rest of the pug’s life).” Pred Forte drops are usually for life also. (Cost averages about $10-$15 a month.)
Now, what happens to the poor pug whose eye is completely covered with this
creeping brown crud? Dr. Golden uses the following analogy: “The cornea is like
16 pieces of clear Saran Wrap all stacked on top of each other, so theoretically you could peel that Saran Wrap off one piece at a time or in this case, you could peel the first layer off, which would have the black pigment tissue on it.”
If surgery is ever suggested, this is when you must go to a veterinary ophthalmologist such as Dr. MacMillan, who will be the first to tell you he tries to
avoid surgery if at all possible. However, once the eye clouds over completely
with pigment, then surgery is usually called for if you want to restore your pug’s
eyesight. The corneal procedure is called a Keratectomy, and usually runs anywhere from $500-$750 per eye, depending on the severeness of the problem.
Dr. MacMillan has an entire scrapbook devoted to pictures of his K9 clients
with various degrees of pigmentary keratitis, ulcers, cataracts, and you-name-it.
He also has before and after photos once he’s performed the operation. One photo shows him literally peeling a layer of tissue right off the cornea. Not a gory
photograph, it basically looks like he’s lifting a soft, brown contact lens off the
Recovery involves your pug wearing an Elizabethan collar so s/he cannot
scratch the stitches that are temporarily keeping the eye closed while it heals. In a few weeks the collar comes off, the stitches are taken out, and you will have the joy of watching your pug look around the room and into your eyes, absolutely astounded that he or she can actually see once again.
How successful will the operation be for the eye problem? Every dog is different; some have complete recovery of eyesight, some eyes get cloudy and take months to clear up, and some eyes will have scar tissue buildup and only gain partial vision.
|Nevertheless, any improvement on this pug eye problem is better than complete blindness. After the surgery, the pug will have to wear an Elizabethan collar as shown in the photo, for a few weeks. The eye that is operated on is sewn shut during the recovery process, and the stitches removed once the eye is healed. The pug shown, Benny, was a pug fostered for Pug Rescue of San Diego many yearsago. He was a very sweet, 6-year-old beautiful little guy who was almost completely blind. He had one eye operated on by Dr. MacMillan and regained partial vision in it. His new pug-parent promised to get his other eye done as well.
Some owners who cannot afford the eye operation have wondered if they should put their blind pug down because of this pug eye problem. The answer, of course, is never. Pugs are very clever, and have their living quarters fairly well memorized whether their eyes work or not. Some of you have blind pugs and don’t know it. But you’d find out in a hurry if you moved to a new house and they suddenly began bumping into things.
Having fostered many pugs with severe pigmentary keratitis, I have had
newcomers walk into me, walk into walls, not be able to navigate stairs—particularly a flight of stairs—and walk into the cats. Within days their seeming clumsiness miraculously disappears. Did they regain their sight suddenly? No. I have also had this happen with pugs who have just lost one eye due to an injury. Remember, pugs are adaptable little survivors, and as long as their quality of life is good there is no reason to put them down prematurely. If they are suffering from dry eye, however (and your vet can test them for this quite easily), it is only humane to give them lubricant eye drops such as cyclosporine to ease their discomfort with this pug eye problem.
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Why Do Pugs Rub Their Eyes? This is the most common problem reported. If left neglected, many pugs go
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I cannot stress the importance of going to a veterinarian who is knowledgeable
about pigmentary keratitis. I have had unknowledgeable veterinarians tell me
to use an over-the-counter eye lubricant such as Tears 4-5 times a day, instead of Cyclosporine 1 or 2 times a day. I know people who came home from work
during the day to make sure their pug got Tears every four hours before they heard of Cyclosporine. I have had veterinarians tell me they don’t believe in prescribing Pred Forte or Cyclosporine for pug eye problems because they are human drugs. I have even had a veterinarian look at a pug who was almost completely blind from pigmentary keratitis and tell me the pug’s eyes were fine.
If you do not have a veterinarian knowledgeable about eye problems in pugs,
run to your nearest veterinary ophthalmologist. You can find one in your area at
the American College of Veterinary Ophthalmologists, www.acvo.com - click on
the link that says “Diplomates’ Profiles by State/Province.” If you do not have
Internet access, you can go to your public library and ask for their assistance in
getting to this website, as there is not a general information phone number listed
for this organization.
This website also has brief articles on many animal eye problems, including
cataracts, glaucoma, dry eye syndrome, corneal ulcers, genetic eye testing, and
much more. This is under the “Public Arena” link.
Always take your Pug to the veterinarian appropriate to your pug’s problem
at the first sign of a symptom. If you have doubts, get a second or even third
For veterinarians unfamiliar with the products in this article, Dr. Golden has
supplied the following information:
“In order to stop or reverse pigment migration [in pigmentary keratitis], the
use of Pred-Forte eye drops can be used for the life of the pug. Pred-Forte is a 1% solution of prednisolone, sodium phosphate, and can be called in to a local pharmacy since it is a human ophthalmic preparation.
“Also for Keratoconjunctivitis sicca (dry eye), the instillation of cyclosporine
in the eyes has been very effective. Cyclosporine is mixed with virgin olive oil at
the ratio of 2cc cyclosporine to 8cc olive oil for a 2% solution. This is used twice
a day to initiate a response and then the frequency of administration is reduced toevery other day.” Optimune is also often prescribed. it also contains cyclosporine but is weaker. Optimune is currently off the market but will hopefully return in the near future. In the meantime, many veterinarians are mixing it up themselves, or getting a pharmacy to do so. IMPORTANT NOTE: DO NOT USE CORN OIL INSTEAD OF VIRGIN OLIVE OIL. Some veterinarians are substituting corn oil for virgin olive oil. Corn oil is very irritating to a pug’s eye and should never be used. Before purchasing cyclosporin from any veterinarian, be sure it has not been mixed with corn oil!!!
Eye Tucks for Pug Eye Problems
More recently, many veterinarians are discovering that a major contributing cause to PK is the fact that a pug’s eyelids do not always close completely on the “blink” cycle, causing exposure to air when it should be getting coated with tear film.
Fortunately, there is a simple surgical procedure that can often correct this
problem, yet maintain cosmetic appearances. Dr. Paul D. Weeks, of Providence
Vet Association in Charlotte, NC, has advised us on this surgery, saying, basically, the eyelid opening is “closed” down slightly–just enough to stop the facial fold irritation and complete the closure during the blinking cycle. The change in eye size is usually not noticeable to most owners. Dr. Weeks says elective surgery of this type is best performed early in the course of the disease to prevent permanent discoloration and opacity. A pug-patient of his named Lucky, fully recovered from his surgery and the pigmentation stopped and even reversed itself to some degree.
There are no outwardly visible signs of surgery due to the small incisions and
sutures that are used.
Dr. Weeks feels this is a basic procedure most veterinarians can perform
without the pug owner having to see a specialist, but to be sure, ask your veterinarian if he commonly performs this operation successfully before committing your pug to it, and know that the surgery is not always successful.
My own pug, Coco, recently had entropion surgery and her wrinkle greatly
reduced to try and stop the progression of pigment across her eyes. Apparently her large nose wrinkle was pushing the eyelashes on her bottom lids into her eyeball, causing pigment to form. Although she had been seen by an ophthalmologist many years previous for pug eye problems, either this was not noticed at the time, or it happened somewhere down the line as she aged. Unfortunately, although a very large section of her wrinkle was removed (not noticeable after surgery), the surgery was only partially successful in that once her incision healed it was found that removal of the extra folds pulled the lashes back from only one of her eyes. I declined a second surgery for her as the eye that wasn’t helped was already so covered with pigment she could hardly see through it. We are using the cyclosporin drops on her good eye and hoping for the best.
If your pug has pigment covering one or both eyes and you would like to
determine how much vision is left, give him or her the following simple eye test:
Eye Blindness Test
1. Put your pug up on a table level with you, or get down on the floor and sit
level with him or her. Have an assistant hold him or her firmly, either in a sitting
or standing position.
2. Cup one hand over your pug’s eye (not hard, just enough that s/he can’t
see through your hand).
3. Take your other hand, palm facing your pug, and shove it suddenly forward
in his face (being extremely careful not to misjudge the distance).
If your pug blinks or pulls back, s/he has vision out of that eye. If not, time to
see the ophthalmologist nearest you.
4. Repeat the test for the other eye.
Following is a simple eye test you can do yourself to see whether
or not your pug has the pug eye problem pigmentary keratitis.