Lacrimal Gland Prolapse in Craniosynostosis Syndromes and Poor Function Congenital Ptosis

Abstract

Lacrimal gland prolapse is an important, though uncommon, feature found in craniofacial abnormalities as well as in cases of poor function congenital ptosis. It occurs secondary to a number of conditions, including increased posterior pressure secondary to decreased orbital volume; also, supportive structures of the gland often may be weak in conjunction with a poor function ptosis or as a result of trauma at the time of major reconstruction. Recognition of the prolapsed gland and its replacement into the lacrimal gland fossa in craniosynostosis syndromes, as well as in cases of poor function congenital ptosis in general, allows the temporal eyelid to approach a more normal position, yielding an improved functional and cosmetic result.

The Whitnall Barrier: A Technique for the Management of Lacrimal Gland Prolapse

“…Initial lacrimal gland repositioning techniques used partial excision, which is not recommended as it may cause postoperative dry eye. 10 Since 1978, fixation sutures to secure the lacrimal gland to either the superior lacrimal fossa 2,3,5,6,9 or orbital rim 1,4 have been advocated. A recent survey of American Society of Ophthalmic Plastic and Reconstructive Surgery members 11 reported that, when present during upper lid blepharoplasty, 25% of prolapsed lacrimal glands were left undisturbed, with the remainder undergoing one or more of partial resection (3%) or suture suspension to the lacrimal gland fossa (88%).…”

“…Techniques range from excision of the prolapsed part of the lacrimal gland to suturing the body or capsule directly to the periosteum of the lacrimal gland fossa. [1][2][3][4][5][6][7][8][9] This may cause hematoma, dacryoadenitis, or dry eye secondary to disruption of the lacrimal gland ductules as they pass from the orbital portion of the lacrimal gland through the palpebral lobe before draining into the superior conjunctival fornix. 1,4,10 We describe a simple and effective technique to reposition the lacrimal gland using the Whitnall ligament (also known as the superior transverse ligament) and the inner periorbita, leaving the gland intact.…”