Nasal fold trichiasis in brachycephalic dogs
4-year-old Pug with chronic epiphora, brown staining at the medial canthus and corneal pigmentation in the nasal quadrant of both eyes. The nasal fold is prominent and its hairs contact the cornea; caruncular hairs also touch the cornea and there is medial lower eyelid entropion. Schirmer normal.
Which treatment best addresses the cause?
chevron_right Show answer and explanation
A. Superficial keratectomy to remove the pigment
If the friction persists, the pigment returns and keratectomy thins the cornea. It is only considered in selected cases, once the cause has been corrected.
B. Regular trimming of nasal fold hair as definitive treatment
Trimming makes the hair stiffer and does not correct the medial entropion or caruncular trichiasis. It may help while surgery is being decided, not as a solution.
C. Lifelong topical ciclosporin as sole treatment
Ciclosporin or tacrolimus help to slow pigmentary keratitis but do not remove the mechanical cause; here they are an adjunct.
D. Medial canthoplasty (with partial nasal fold resection if necessary)
Correct. Medial canthoplasty shortens the palpebral fissure, corrects medial entropion, eliminates caruncular trichiasis and reduces corneal exposure. If the fold still rubs, it is partially resected.
lightbulb Key takeaway
In brachycephalic dogs, medial pigmentary keratitis is usually multifactorial: nasal fold and caruncular trichiasis, medial entropion, lagophthalmos and exposure. Correct the conformation and add a topical immunomodulator if needed.
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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.