Reposition of prolapsed lacrimal gland

Table 70.1

Indications for surgery

Discomfort over lateral orbit

Cosmetically displeasing lateral fullness

Rule out lacrimal gland malignancy/pathology

Table 70.2

Preoperative evaluation

History of pain and/or paresthesia over lateral orbit suggestive of lacrimal gland malignancy

History of autoimmune disease and dry eye

Presence of upper eyelid dermatochalasis, ptosis or blepharochalasis syndrome

History of trauma

History of prior facial surgery

Consider orbital imaging

Introduction

Prolapse of the lacrimal gland is generally considered a benign, senescent change. The presentation may vary from lateral fullness of the upper eyelids on physical examination or an incidental finding during upper blepharoplasty. Patients will often present with cosmetically displeasing lacrimal gland prolapse noted on external examination. Palpation along the superolateral orbital rim may disclose a palpable nodule that spontaneously prolapses despite manual retroplacement.

A history of pain and paresthesias over the lateral orbit should prompt consideration of malignant lacrimal pathology such as adenoid cystic carcinoma, particularly for unilateral cases. A history of autoimmune disease and dry eye may also be associated with lacrimal gland prolapse as is trauma or prior facial surgery. Pain, redness, and mucoid discharge may suggest infectious dacryoadenitis.

The upper eyelid should be everted whilst looking for prolapse of lacrimal gland tissue. Exophthalmometry and globe position should be measured to rule out an orbital mass lesion. Ductions should be measured and slit lamp examination and tear function studies should be performed to rule out dry eye. If there is any suspicion of a neoplasm, orbital imaging should be obtained prior to surgery.

Lacrimal gland prolapse is generally treated by repositing the gland into the orbit through placement of several non-absorbable sutures. An incisional biopsy of the lacrimal gland should be considered in all cases to rule out occult neoplasm. Commonly, non-specific inflammation will be noted in the lacrimal gland. A concurrent blepharoplasty may be performed to address dermatochalasis at the time of lacrimal gland repositioning. Care should be taken to minimize removal of tissue to prevent dry eye.