The lacrimal glands are paired small sacs of exocrine glands that are normally located just under the edge of the lateral orbital rim in, appropriately called, the lacrimal fossa. They are responsible for secreting the aqueous layer of the tear film. While small, about 1 x 1 cm in size, it has two distinct lobes of which the palpebral lobe may be able to be seen if the upper eyelid is lifted and one looks down.
Aging is the most common reason the lacrimal gland drops out of the fossa and appears as a bulge above the outer corner of the upper eyelid. The thinning of the upper eyelid skin and the loss of fat around it are also contributing factors for its increased show with aging. Lacrimal gland prolapse may also occur for a variety of other reasons such as inflammation and trauma. Tumors of the lacrimal gland may also make it appear like prolapse due to glandular enlargement.
In patients seeking blepharoplasty, lacrimal gland prolapse can be present and can be concurrently treated of properly diagynosed. Techniques for its treatment usually focuses on gland preservation with repositioning up and back into the fossa under the orbital rim. This is done using suture fixation between the capsule of the gland and the periosteum of the bone. While typically effective recurrence of surgically treated lacrimal gland prolapse has been reported.
In the Online First edition of the January 2018 issue of the European Journal of Plastic Surgery an article was published entitled ‘Lacrimoplasty: a new bone fixation technique for recurrent lacrimal gland prolapse.’ They describe a method of true bony fixation of the prolapsed lacrimal gland to the lacrimal fossa. They describe this technique as ‘lacrimoplasty’ and it consists of placing two bone holes through the lateral orbital rim through which a suture is passed so that the tightening and tying of the suture pulls the gland up securely into the fossa. By passing a suture through the bone it offers a very secure fixation method and more assuredly pulls the gland back up into the fossa.
This gland fixation technique is very similar to the double hole lateral canthoplasty and the basis of its use is the same. The placement of the bone holes ensures that the soft tissue structure that needs repositioning is most effectively secured to the bone with a suture whose knot is placed on the outside of the bone.
Dr. Barry Eppley