Brachycephalic ocular syndrome: macroblepharon and lagophthalmos
2-year-old Pug with corneal pigmentation in the medial sector of both eyes. It has very large palpebral fissures, does not fully close its eyes when asleep, lower medial canthal entropion and caruncle hairs touching the cornea. Normal Schirmer.
Which treatment best corrects the cause of the problem?
chevron_right Show answer and explanation
A. Superficial keratectomy to remove the pigment
It removes the pigment but not the cause; the pigment returns if exposure and friction persist, and it thins the cornea.
B. Complete resection of the nasal fold as the only measure
It may help if the fold touches the cornea, but it does not correct the macroblepharon, lagophthalmos or medial entropion.
C. Topical ciclosporin or tacrolimus without surgery
They help slow pigmentation and inflammation, but they do not correct the anatomy causing exposure and friction.
D. Medial canthoplasty
Correct. It shortens the palpebral fissure, corrects medial entropion, removes the caruncle hairs and improves eyelid closure, thus reducing corneal exposure.
lightbulb Key takeaway
Brachycephalic ocular syndrome combines shallow orbits, macroblepharon, lagophthalmos, medial entropion, trichiasis and reduced corneal sensitivity. It predisposes to ulcers, pigmentary keratitis and proptosis. Check whether the animal closes its eyes when asleep and consider medial canthoplasty early, before the pigment affects vision.
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Updated: October 31, 2026 · Educational content for veterinary professionals. It does not replace current clinical guidelines or the judgement of the attending veterinarian.