I always recommend tacking first. If it doesn't work, then consider 'wacking' or removing the gland. (makes it easy to remember tack or wack!) You can also remove some of gland, as if to de bulk it, as opposed to removing the entire thing. This will hopefully avoid dry eye issues. I have seen dry eye disease dogs that have to have a lot more than a flush once a week to keep the eyes from becoming extremely painful. This is typically associated with small dogs, not giant breeds that had cherry eye surgery. However, after seeing lots and lots of dogs suffering from dry eye, yes suffering, I would definitely consider tacking before removal.
