"What to do with the open wound? One stitch had come off," the owner pointed to the medial canthus (see picture). The correct method would be to re-stitch under anaesthesia. But that would mean another risk to be taken. Eye drops again? It would not help. I noted a 4th eyelid swelling on the upper eyelid to the right of the previous one. "There is a 4th eyelid growth," I said. "It is best to remove it as it may be the cause of eye rubbing." 

This time, I just gave isoflurane gas and excised the big granuloma. Stitching should be from muscle to upper eyelid edge rather than lower eyelid edge to upper eyelid edge to prevent ectropion. The puppy went home with no complaints for the next 10 days. I hope all would be well.

Through my 30 years of small animal practice, I had not encountered this problem in such a young puppy. So, was it Divine play? It is hard to say. I doubt other vets all over the world encounter such a problem. The eyelid granulomas appear some days after purchase, as if by magic.