Surgical Repair of Prolapsed Lacrimal Glands

Smith, Byron; Petrelli, Richard L.

doi:10.1001/archopht.1978.03910050069017

Cited by 48 publications

(15 citation statements)

References 1 publication

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“…The remaining five cases involved posterior prolapse of the orbital lobe. These figures correspond to reports in the literature, where prolapse of the palpebral lobe is much more common than the prolapse of the orbital lobe (Smith & Petrelli 1978).…”

Section: Discussionsupporting

confidence: 89%

“…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.…”

Section: Introductionmentioning

confidence: 99%

“…Herniation of the orbital lobe posterior to the orbital septum is less common (Smith & Petrelli 1978).…”

Section: Introductionmentioning

confidence: 99%

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

Alyahya

Bangsgaard

Prause

et al. 2005

Acta Ophthalmologica Scandinavica

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ABSTRACT.Purpose: To analyse clinical referral diagnoses and the location of lesions with histologically verified lacrimal gland tissue occurring outside the fossa of the lacrimal gland. Methods: Sections of lesions excised from areas outside the fossa of the lacrimal gland containing lacrimal gland tissue on histological examination were collected from the files of the Eye Pathology Institute, Copenhagen, Denmark. Specimens spanned a period of 50 years. Sections were re-examined and referral data on location and clinical diagnosis were compared with histological findings. Results: A total of 120 lesions were collected. Of these, 59 (49%) consisted of prolapsed lacrimal gland. The remaining 61 (51%) lesions contained ectopic lacrimal gland tissue, either as part of a complex choristoma in 38 (32%) cases, or as solitary ectopic lacrimal gland tissue in 23 (19%) cases. The majority (97; 81%) of lesions had been located at the temporal epibulbar conjunctiva and included mainly prolapsed lacrimal gland and complex choristoma. The clinical referral diagnoses covered a wide spectrum of lesions. The most frequent clinical diagnoses were non-specific tumour (35%), non-specific cyst (18%) and dermoid (11%). Of the 61 lesions containing ectopic lacrimal gland tissue, only two had been preoperatively diagnosed as such and only two of the 59 lesions with prolapsed lacrimal gland had been correctly diagnosed. Conclusions: Prolapsed palpebral lobe of the lacrimal gland was the most common lesion and, as expected, the prime location was the temporal conjunctiva. Despite this location, the referring clinical diagnosis was often wrong or non-specific. Surgeons seem to have been unaware of the various clinical manifestations of extrafossal glandular tissue, particularly when excising lesions in the upper temporal region of the conjunctiva. Surgical intervention in this location may jeopardize the excretory ducts of the lacrimal gland and may consequently lead to dry eye and thus should be avoided when the typical clinical appearance of prolapsed lacrimal gland is encountered.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

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

Alyahya

Bangsgaard

Prause

et al. 2005

Acta Ophthalmologica Scandinavica

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“…In this infrequent condition, the patients are generally older, and the bulge is more voluminous. 17 Fullness of the lateral aspect of the upper eyelid may be secondary to brow ptosis or prominent supraorbital rims. The clinical examination will help us to differentiate these conditions from lateral fat pad.…”

Section: Resultsmentioning

confidence: 99%

Adipose Compartments of the Upper Eyelid: Anatomy Applied to Blepharoplasty

Persichetti

Lella

Delfino

et al. 2004

Plastic and Reconstructive Surgery

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Many authors have indicated the presence of ectopic or accessory upper eyelid fat pads, but the effective rate of eyelid fat variations and the corresponding clinical features are still unclear. The purpose of this study was to evaluate the variability of upper lid fat and to define the anatomical landmarks of the adipose pockets of the upper lid. From January of 1998 to January of 2002, the authors investigated the upper eyelid fat compartments of 47 patients who underwent upper blepharoplasty. To support surgical findings, 11 fresh cadavers were also investigated; the anatomy of the intraorbital fat and of the upper eyelid fat compartments was reviewed. Ten patients (21.3 percent) showed an accessory fat pad in the upper lid, which was found on both sides in nine cases. In all patients, the third fat pad was situated lateral to the two classic compartments described by Castanares, behind the orbital septum. Surgical dissections demonstrated that this fat pad derived from the preaponeurotic fat. Anatomical dissections in three cadavers demonstrated an accessory fat compartment protruding under the inferior border of the lacrimal gland. This protruding fat derived from the preaponeurotic fat in all cases and might justify the clinical appearance of a bulge or fullness in the lateral third of the upper eyelid. In the authors' experience, the presence of an accessory upper eyelid fat pad was a frequent finding during blepharoplasty; it could be found and actually resected in about 21 percent of all cases. Surgical and experimental findings put this element as a lateral physiological extension of the preaponeurotic fat that can anteriorly protrude under the inferior border of the lacrimal gland toward the orbital septum. The clinical appearance may be a bulge or fullness in the upper eyelid, and its resection can better define the lateral one third of the supratarsal fold.

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“…1,2,4 In patients with less prolapse, repositioning ensued with light cautery to the tip of the lacrimal gland capsule and surrounding tissue. During this time, the author routinely fully opened the orbital septum to identify whether the lacrimal gland was displaced.…”

Section: Methodsmentioning

confidence: 99%

Prevalence of Lacrimal Gland Prolapse in the Functional Blepharoplasty Population

Massry

2011

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Lacrimal gland prolapse is a common finding during functional upper blepharoplasty surgery and appears to be a normal involutional periorbital aging change. Most cases are moderate in degree (as defined in the article), and not associated with specific preoperative symptoms or complaints, except lateral hooding with concomitant visual field deficit. Repositioning the gland intraoperatively is generally complication free and typically not associated with increased morbidity or healing time. The clinical significance of LGP in the elderly undergoing blepharoplasty surgery is unknown and requires further study.

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Surgical Repair of Prolapsed Lacrimal Glands

Cited by 48 publications

References 1 publication

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

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

Adipose Compartments of the Upper Eyelid: Anatomy Applied to Blepharoplasty

Prevalence of Lacrimal Gland Prolapse in the Functional Blepharoplasty Population

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