A new technique for the treatment of lacrimal gland prolapse in blepharoplasty

Abstract

The lateral temporal fullness of the upper eyelid in patients presenting for a blepharoplasty is sometimes due to a prolapse of the lacrimal gland. The operative procedures that attempt to reposition the migrated lacrimal gland have been either dangerous in that they cause a dry-eye syndrome or unsatisfactory in that they have a high rate of recurrence or other complications. A new and different operative approach to a herniated or prolapsed lacrimal gland deals with an extraglandular concept of repositioning the gland that corresponds to the general principles of hernial surgery.

Blepharoplasty Complications

“…Intraoperatively, the diagnosis of prolapse of the lacrimal gland, noted to be a firm, fibrous gray structure, can be made and corrected by resuspension to the periosteum of the superior orbital rim. 37,38 Another potential complication of upper eyelid blepharoplasty is medial canthal webbing, which results from either an improperly placed incision or excessive skin removal. To decrease the risk of medial canthal webbing, the incision is angled slightly superior at the medial extent of the incision without extending past the level of the superior pomatum.…”

Prevalence of Lacrimal Gland Prolapse in the Functional Blepharoplasty Population

“…1 It has been reported to be clinically present in 15% of patients desiring blepharoplasty. 3,6,7 Surgical repair is indicated to reduce the apparent temporal eyelid bulge with associated mass effect on eyelid structures. 3,6,7 Surgical repair is indicated to reduce the apparent temporal eyelid bulge with associated mass effect on eyelid structures.…”

“…3,6,7 Surgical repair is indicated to reduce the apparent temporal eyelid bulge with associated mass effect on eyelid structures. 3 In 1994, Beer and Kompatscher 3 described lacrimal gland resuspension by suturing Whitnall's ligament over the gland to the superior orbital rim periosteum anterior to the lacrimal gland fossa. They advocated suture suspension of the lacrimal gland parenchyma to the orbital rim periosteum just anterior to the lacrimal gland fossa.…”

Occurrence of lacrimal gland tissue outside the lacrimal fossa: comparison of clinical and histopathological findings

“…Subconjunctival prolapse or herniation of the palpebral lobe of the lacrimal gland is quite frequently observed, but is often misdiagnosed as epibulbar choristoma, lipodermoids or herniated orbital fat (Smith & Petrelli 1977; Beer & Kompatscher 1994) and surgically removed. In our series, nearly half the lesions examined (59; 49%) were prolapsed lacrimal glands (Figs.…”

“…The palpebral portion of the lacrimal gland may prolapse into the subconjunctival space at the upper temporal bulbar conjunctiva and may consequently be misdiagnosed as prolapsed orbital fat, dermolipoma, lacrimal gland tumour or ectopic lacrimal gland tissue (Smith & Petrelli 1978; Beer & Kompatscher 1994). Consequently, prolapsed lacrimal gland tissue may be surgically removed.…”