Repositioning the Lacrimal Gland
Transcript
Repositioning the lacrimal gland
Lacrimal gland prolapse is often a finding in patients undergoing blepharoplasty. It is usually bilateral, and patients complain of bumps above the lateral eyelid. This is usually a benign condition. Of course, if it were unilateral and associated with orbital signs, imaging should be performed to ensure there is not a tumor. In addition, if there were any history of associated inflammation, imaging should be performed. If benign lacrimal gland prolapse is suspected, repositioning can be performed through the blepharoplasty/lid crease incision. Some physicians will biopsy the gland at the time of repositioning, and it is not common to find evidence of chronic inflammation. This chronic inflammation is thought to bear minimal clinical consequence. (https://pubmed.ncbi.nlm.nih.gov/36801834/)
This is Richard Allen at oculosurg.com. This video demonstrates repositioning of the lacrimal gland in a patient who has bilateral lacrimal gland prolapse and was undergoing an upper eyelid blepharoplasty. The orbital septum is opened laterally with the needle tip cautery and the underlying preaponeurotic fat is identified. Dissection is then carried out between the lateral edge of the preaponeurotic fat and the medial edge of the lacrimal gland. The lacrimal gland is then mobilized. This the orbital lobe of the lacrimal gland. Repositioning is then performed using a double-armed 5-0 Nylon suture. The needle engages the inferior aspect of the lacrimal gland, laterally. The other arm of the suture then engages the inferior aspect of the lacrimal gland, medially. The needle then engages the periosteum on the inside of the superior lateral orbital rim. The other arm of the suture is then placed similarly. Tightening shows the tuck of the gland. The needle holder is used to tuck the gland inside the orbital rim completely. The suture is then tied. The upper blepharoplasty incision is closed in the standard manner. Antibiotic ointment is placed over the incision and the patient will follow up in approximately one week.
