Shar Pei Entropion Management Guide

Comprehensive, practical guide to recognizing and managing entropion in Shar Pei — from puppy tacking to adult surgical correction, post-op care, and long-term monitoring.

Quick Overview

• What it is: Entropion is inward rolling of the eyelid margin so eyelashes and skin rub the cornea and conjunctiva. In Shar Pei it is typically conformational (related to facial fold and eyelid anatomy).
• Who’s at risk: Shar Pei are one of the brachycephalic/loosely-skinned breeds at highest risk because of deep facial folds, excessive eyelid skin and eyelid laxity.
• Prognosis: With timely treatment (medical stabilization and surgical correction when indicated) most dogs regain comfortable eyes and good vision. Chronic or severe corneal ulceration can cause scarring and permanent vision loss if untreated.

Pathophysiology (Explained Simply)

Entropion occurs when the eyelid margin rolls inward. That inward-turning brings hairs and skin into constant contact with the corneal surface, causing irritation, inflammation, tearing and, frequently, corneal ulceration. Two main forces are involved in Shar Pei:

• Conformational skin excess: deep facial folds and excessive lower eyelid skin pull the lid inward.
• Eyelid laxity and short palpebral fissure: structural eyelid weakness increases rolling.

Breed-specific Risk Factors and Prevalence

• Shar Pei have heavy facial folds, thick eyelid skin and a shortened eyelid opening; these traits promote medial and lower eyelid entropion.
• Entropion can be congenital or develop as puppies grow; juvenile entropion is common in Shar Pei puppies.
• Exact prevalence varies between lines and populations; Shar Pei are widely recognized by veterinary ophthalmologists as among the breeds with the highest risk.

Symptoms and Staging

Common clinical signs:

• Squinting, excessive blinking (blepharospasm)
• Tearing (epiphora) and mucopurulent ocular discharge
• Conjunctival redness and swelling
• Visible inward-turned eyelid margin or skin folds touching the eye
• Corneal cloudiness, ulceration or pigment formation
• Rubbing at the face, pawing at the eye

• Mild: Intermittent rubbing, increased tearing, minimal corneal change.
• Moderate: Persistent epiphora, conjunctivitis, superficial corneal erosions or early ulcers.
• Severe: Deep/complicated corneal ulcers, corneal stromal loss, pigmentary keratitis or vision impairment.

Diagnostic Approach

Referral: early referral to a boarded veterinary ophthalmologist (DACVO) is recommended if corneal ulceration, vision loss, or recurrent/persistent disease is present.

Treatment Options — Overview

Management has three goals:

Treatment falls into medical (urgent stabilization) and surgical (definitive) approaches.

Medical (initial/emergency) Management

• Corneal protection and lubrication: preservative-free artificial tears (e.g., carmellose-based drops) applied 4–6+ times daily; ointment at night.
• Topical antibiotics for epithelial defects/ulcers: ofloxacin 0.3% or ciprofloxacin 0.3% eye drops q6–8h, or tobramycin 0.3% ointment q6–8h. Choice guided by culture if available.
• Pain control and anti-inflammatories: systemic NSAIDs (e.g., carprofen 2.2 mg/kg PO every 12 hours) if appropriate; avoid topical/ systemic steroids if corneal ulceration is suspected.
• Mydriatics for uveitis: atropine 1% topical q24h–q72h if there is anterior uveitis (use under veterinary guidance).
• Elizabethan collar (E-collar): prevent self-trauma and rubbing.

Puppy Tacking (Temporary/Early Surgical Approach)

Puppy tacking (also called temporary eyelid tacking or mattress sutures) is widely used in Shar Pei puppies.

• Purpose: temporarily evert the eyelid margin while the puppy grows and facial conformation changes. It reduces corneal contact and risk of ulceration until definitive surgery can be performed (or until puppy outgrows the problem).
• Typical timing: often performed between 6–12 weeks of age, though older puppies may also benefit. If corneal ulcers are present, tacking can be used urgently to protect the cornea.
• Technique: multiple transcutaneous everting mattress sutures (usually 4–8 nylon or polypropylene sutures) placed under sedation or brief anesthesia. Sutures are left in for several weeks and then removed.
• Pros: quick, relatively low morbidity, preserves options for later definitive surgery; effective short-term at protecting cornea.
• Cons: temporary (many dogs still need adult surgery); risk of infection, suture-related irritation; recurrence possible. Reported clinical experience shows good short-term protection, but re-operation at maturity is common.

Definitive Adult Surgical Correction

When the dog is mature (often around 6 months or older, sometimes later depending on growth), permanent surgical correction is recommended if entropion persists.

Common techniques:

• Hotz-Celsus (excisional blepharoplasty): the most commonly used procedure. A crescent or elliptical strip of skin and orbicularis muscle is excised just outside the eyelid margin; closure advances the lid margin outward. Well-suited for many Shar Pei cases.

• Wedge resection (full-thickness eyelid wedge): useful for focal margin rotation or short segments of entropion. Removes a small triangular (full-thickness) wedge to rotate the lid margin.

• Lateral canthoplasty/canthopexy: tightens the lateral canthus; useful when palpebral fissure shortening or lateral laxity contributes.

• Combined procedures: Shar Pei often need a combination — Hotz-Celsus with excision of redundant facial-fold skin (blepharoplasty and facial fold excision) to address deep medial folds and prevent recurrence.

Success rates: surgical correction using Hotz-Celsus and appropriately tailored procedures has high rates of clinical improvement; many practices report >80–90% primary success, but some dogs (10–20%) may require revision for recurrent entropion or over-correction.

Post-operative Care

• E-collar: strongly recommended until sutures are removed and healing is complete (typically 10–14 days).
• Topical antibiotics: commonly prescribed — e.g., ofloxacin 0.3% drops or tobramycin ointment q6–8h for 7–14 days depending on the surgery and corneal status.
• Topical lubricants: continued for weeks as corneal epithelium heals (artificial tears q4–6h).
• Systemic pain control: NSAIDs such as carprofen (2.2 mg/kg PO q12h) or meloxicam per label and under vet guidance; short opioid courses may be used in painful cases.
• Activity restriction: short leash-only exercise for 7–14 days to avoid wound tension.
• Suture removal: typically at 10–14 days post-op unless absorbable sutures used.
• Monitoring: watch for swelling, discharge, wound dehiscence, or changes in vision. Return to your surgeon if concerns arise.

Corneal Damage Prevention and Management

Prevention is as important as surgery.

• Early recognition and treatment of blepharospasm, tearing or conjunctivitis prevents progression to ulcers.
• Use lubricants liberally in dogs with chronic irritation to protect the corneal surface.
• For any corneal ulcer: immediate veterinary attention, topical antibiotics, E-collar, and close follow-up until healed.
• Adjuncts for non-healing ulcers: grid keratotomy, conjunctival grafts (pedicle grafts), or amniotic membrane grafts may be necessary in complicated cases; these are specialist procedures.

Long-term Management and Monitoring

• Regular eye checks: owners should inspect eyes daily for tearing, redness or discharge; formal veterinary eye exams every 6–12 months or sooner if signs recur.
• Manage facial folds: keep medial canthal folds clean and dry. Some dogs benefit from permanent excision of redundant fold skin at the time of entropion surgery.
• Address secondary problems: pigmentary keratitis and chronic conjunctivitis may need medical therapy (lubricants, tear stimulants like cyclosporine 0.2% ophthalmic where appropriate) and long-term monitoring.
• Recheck after surgery: typically at 10–14 days (suture removal), 6 weeks and 6–12 months. Additional rechecks if signs recur.

Prognosis and Quality of Life Considerations

• If entropion is corrected before severe corneal damage develops, prognosis for comfort and vision is excellent.
• Dogs with extensive corneal scarring or perforation may suffer permanent visual deficits despite intervention.
• Most Shar Pei that undergo timely surgical correction have good long-term quality of life and tolerate procedures well.

Living With Entropion — Daily Practical Tips

• Inspect the eyes daily for tearing, discharge, redness or squinting.
• Keep facial folds clean and dry; use a soft damp cloth and pat dry to reduce irritation and bacterial overgrowth.
• Use prescribed lubricating drops or ointment regularly, especially in windy or dusty conditions.
• Avoid dogs rubbing their faces on rough surfaces; use an E-collar when healing or if your dog persistently rubs its eyes.
• Prefer harnesses to choke/prong collars to reduce facial pressure and rubbing during walks.
• Schedule veterinary/ophthalmology rechecks as recommended.

When to See Your Vet Urgently

Seek immediate veterinary attention if your Shar Pei shows any of the following:

• Sudden onset of intense eye pain or severe squinting
• New green or yellow ocular discharge
• Corneal cloudiness, white spot, or obvious ulcer
• Sudden change in vision (bumping into objects) or severe swelling of the eye
• Self-trauma causing bleeding or exposed sutures post-surgery

This guide is for educational purposes. Always consult your veterinarian for diagnosis and treatment.

Primary references and further reading

• American College of Veterinary Ophthalmologists (ACVO) — client education and clinical resources: https://www.acvo.org
• Gelatt KN, Gilger BC, Kern TJ. Veterinary Ophthalmology (Textbook). 6th ed. (comprehensive surgical techniques and disease overviews)
• Peer-reviewed clinical reviews on canine entropion and surgical outcomes (see veterinary ophthalmology journals and ACVO resources for study specifics).

Frequently Asked Questions