Entropion in Shar-Pei

posted: by: Linda J.M. Tintle, DVM Tags: "Clinic Specials" "News" 

What is Entropion and Why is it Common in Dogs?
Entropion is an abnormal rolling inward of the eyelid/s and eyelashes. The eyelid has a fibrous band of tissue, the tarsal plate or tarsus, which provides rigidity and support to the eyelid edge just behind the eyelashes. The tarsus is well-developed in humans. In dogs, it is poorly developed and lacks rigidity. You can feel the thick tarsal plate in your own upper eyelid. (See Figure 1).

The weak eyelid edges are supported by the surface of the eyeball. If the dog’s eyes are deep set, support is minimal or lost. Without the surface of the globe to rest upon, the eyelids may roll inward and cause entropion. (See Figure 2).

Entropion can occur because of a combination of conformational and environmental influences and is a common condition in dogs.

Shar-Pei are Wrinkled. The Mutation that causes Wrinkles = Hyaluronosis.

Shar-Pei have abnormally large amounts of hyaluronan (HA or “mucin”) in the spaces around their cells. HA is a gel-like substance that may further reduce tarsal rigidity and make the eyelid edge weaker and the lid heavier.

Spastic Entropion

If an eye is painful or irritated (for example, due to an injury, dust, or allergies), the globe reflexively pulls back, deep into the eye socket. This sudden loss of support causes the eyelids to roll in, leading to acute entropion in a dog that was “fine” for months or even years before the irritating event.

The examining veterinarian may test the eye with a few drops of a topical ophthalmic anesthetic to relieve the underlying eye pain and allow the eyelid and globe conformation to be assessed. If it is a “spastic entropion”, the topical anesthetic will allow the eyeball to resume normal conformation and the eyelids will no longer roll in. Treatment of spastic entropion involves addressing the primary cause of the ocular pain. The use of ophthalmic ointment vs. drops may give greater and longer lasting lubrication. Spastic entropion may sometimes require temporary eyetacking for up to two to three weeks to relieve the entropion until the primary cause is completely resolved.

Shar-Pei are prone to allergies and superficial infections. This can lead to conjunctivitis, blepharospasm (squinting), and secondary spastic entropion. This creates a vicious cycle of pain for conformationally predisposed dogs. (See Figures 3 & 4).

The longer the irritation and reactive entropion goes untreated, the more likely the entropion is to become permanent.

Occasionally, a Shar-Pei suffers a sudden loss of hyaluronan around the eyes and this can lead to acute entropion from loss of support by the receding globe. Underlying causes of “deflated” wrinkling and/or loss of their “meat mouth” include illness or stresses that cause their bodies to release cortisol (which shuts down hyaluronan production), or administration of steroids for a medical condition. This problem will usually correct with supportive care if the underlying cause is resolved.

Do not ignore a squinting, weepy eye. It hurts the dog, can get worse fast and be harder to fix in the long run.

Young Shar-Pei Puppies

Shar-Pei puppies have extreme wrinkling in the first weeks of their lives. This is a result of the breed’s characteristic hyaluronosis. They will out-grow most of these wrinkles. The excess deposition of hyaluronan in the eyelids and about the eye leads to entropion in some puppies.

Eyetacking is the placement of temporary mattress sutures into the eyelids to evert the eyelid margins and relieve entropion. (See Figure 5).

Many, but not all, puppies that need eyetacking will require permanent repair at or after six months of age. Some pups that do not need eyetacking will go on to require surgical correction of entropion as adults. Some puppies that require eyetacking will not need permanent surgical repair of entropion.


Ptosis (pronounced “Toe-sess”) is the inability to elevate the upper eyelid to a normal degree and results in a drooping eyelid. Heavy forehead wrinkles may cause ptosis. Excessive hyaluronan in the upper eyelid may cause ptosis because the weak eyelid muscles are unable to sufficiently lift the heavy upper eyelid. Vertical Lash Syndrome is when the upper eyelashes go straight down and hit the lower conjunctiva, causing much irritation. This is related to ptosis. Lower eyelids do not have eyelashes in dogs. (See Figure 6).

Why are Shar-Pei Particularly Predisposed to Entropion?

From the Chinese Shar-Pei Club of America’s Breeders Standard: “The head is large, slightly, but not overly, proudly carried and covered with profuse wrinkles on the forehead continuing into side wrinkles framing the face. Eyes – dark, small, almond-shaped and sunken, displaying a scowling expression.” The CSPCA standard calls for “sunken” or deep set eyes. Their eyelids may lack sufficient support.

Also, a wide head with “profuse wrinkles on the forehead continuing into side wrinkles framing the face” may lead to ptosis if the brow wrinkles are heavy and excessive.

Great Britain’s Kennel Club recently addressed this by creating an interim standard that altered the standard description of the eyes to: “Dark, medium size, almond-shaped with frowning expression. Amber and lighter colours permissible in paler shades. Function of eyeball or lid in no way disturbed by surrounding skin, folds or hair. Any sign of irritation of eyeball, conjunctiva or eyelids highly undesirable. Free from entropion.”

Treatment of Entropion

Surgical correction is indicated for hereditary entropion in the adult dog. Uncorrected entropion is PAINFUL and puts the dog at risk for blindness and behavioral problems (irritability and aggression).

Neonatal entropion may be treated by the placement of temporary eyetacks in puppies whose eyes fail to open in a timely fashion or who develop blepharospasm. Eyetacks can be left in Shar-Pei pups with entropion until 1) they are no longer needed, 2) they pull through, 3) are no longer holding the lids away sufficiently and have to be replaced, 3) require permanent correction at about six months of age.

Shar-Pei pups may outgrow entropion.

Ophthalmologists generally agree that eyetacking may be successful in Shar-Pei up to 6 months of age and this has been our experience over the past 28 years. After six months of age, permanent correction is indicated. (See Figure 7).

Puppies that do not get needed eyetacking may develop severe corneal damage and even blindness.

Guidelines for Breeders: Keep Good Records!
  • Keep track of who needs eyetacking
  • Avoid keeping a pup that needed eyetacking in your breeding program
  • Keep track of how many pups/litter need eyetacking out of each bitch AND stud (Tell the stud owner!)
  • Remove stock that are producing a lot of pups that need eyetacking from your breeding program
  • Ask pet pup’s new owners to let you know if the dog has eye problems in the future and FOLLOW UP!
  • Move toward ideal goal: NO or RARE EYETACKS.

Why you need to breed away from Entropion

It is painful. It is expensive. Untreated entropion can lead to corneal damage including ulceration and blindness. The eyeball may become perforated and collapse.

Entropion may cause behavioral problems: aggression, irritability, and/or a reluctance to play and interact (dogs with severe entropion tend to sit around with their eyes closed). Correct their eye problem and you often see a “new dog”.

After almost 30 years of treating Shar-Pei, I see fewer cases of primary entropion and fewer dogs with severe eye damage, which I attribute to greater awareness of the potential damage from untreated eye disease. I have seen significant improvement. Nevertheless, I do recommend that breeders avoid exaggerated wrinkling and strongly suggest breeding dogs that do not have sunken, deep set eyes. I would encourage discussion about the current standard in this area. We want all our Shar-Pei to see well and without pain - without the need for surgical intervention and/or constant medication. How do our choices in our breeding programs get us to this end?

Linda J.M. Tintle, DVM
Nov. 2009