Lacrimal gland prolapse is a condition where the tear-producing gland, located in the upper outer part of the eye socket, shifts from its normal position. While discovering a bulge in this area can be unsettling, it is a recognized condition and often treatable.
Understanding Lacrimal Gland Prolapse
The lacrimal gland is an almond-shaped exocrine gland, about 2 cm long, situated in the superotemporal aspect of the orbit, within the lacrimal fossa of the frontal bone. It is divided into two parts: a larger orbital lobe and a smaller palpebral lobe, partially separated by the lateral horn of the levator aponeurosis. The palpebral lobe contains several ducts, which transport tear fluid from the gland to the eye’s surface.
This fluid, commonly known as tears, forms the aqueous layer of the tear film, lubricating the conjunctiva and cornea, providing nourishment, and protecting the ocular surface. Prolapse describes the displacement of this gland from its usual anatomical location, often resulting in it becoming visible or palpable beneath the upper eyelid.
Identifying the Symptoms
Symptoms of lacrimal gland prolapse vary among individuals, with some remaining asymptomatic. Many people experience a visible swelling or bulge in the upper outer eyelid area, which can sometimes give the upper eyelid a full or “S-shaped” appearance. This bulging may be more apparent when looking downward or lifting the eyelid.
Patients might also report discomfort, a feeling of fullness, or a foreign body sensation in the eye. In more pronounced cases, the prolapse can lead to eyelid hooding or even visual disturbances, such as a visual field deficit. These symptoms can range in severity and presentation, sometimes affecting both eyes.
Common Causes of Prolapse
Various factors contribute to the development of lacrimal gland prolapse. One common reason is the weakening of supportive structures around the eye, such as the orbital septum and suspensory ligaments, which often occurs with normal aging. As these tissues thin and lose elasticity, the lacrimal gland can descend from its secure position.
The condition can also arise from increased pressure within the orbit, which might be triggered by trauma to the orbital area, particularly in children due to less developed orbital margins. Inflammation, such as dacryoadenitis, can cause the gland to enlarge and displace anteriorly. Rarely, orbital tumors or lesions, as well as certain congenital conditions like craniofacial deformities or blepharochalasis syndrome, can also lead to lacrimal gland displacement.
Diagnosis and Treatment Approaches
Diagnosing lacrimal gland prolapse typically begins with a thorough eye examination, including careful inspection and palpation of the upper eyelid to identify any bulging or masses. Eversion of the upper eyelid can help visualize the palpebral lobe if it has prolapsed. Imaging techniques, such as computed tomography (CT) scans or magnetic resonance imaging (MRI) of the orbit, are often employed to confirm the diagnosis, assess the extent of the prolapse, and differentiate it from other orbital masses or inflammatory processes.
Treatment for lacrimal gland prolapse usually involves surgical intervention, particularly for symptomatic cases or those with cosmetic concerns. The primary surgical approach is to reposition the gland back into its normal anatomical location within the lacrimal fossa and secure it. This often involves suturing the gland’s capsule to the orbital rim periosteum, using non-absorbable sutures like nylon or prolene.
Another technique involves suturing Whitnall’s ligament over the gland to the superior orbital rim, creating a sling to prevent further displacement. Partial gland excision is generally not recommended due to the risk of dry eye complications. For milder cases, light cautery to the gland capsule may be used, though this carries a higher recurrence rate.
Recovery and Long-Term Outlook
Following surgical intervention for lacrimal gland prolapse, patients can expect some post-operative swelling and bruising around the eyelids, which typically subsides within a few weeks. Post-operative care often includes using lubricating eye drops or antibiotic ointment to manage temporary dry eye symptoms and prevent infection. Patients are advised to avoid strenuous activities and aspirin, which can increase bleeding, during the initial recovery period.
The general prognosis after appropriate surgical treatment is positive, with a low likelihood of recurrence. Studies have shown that recurrence rates can be around 1%. While some patients may experience temporary discomfort or mild dry eye, these issues are generally manageable and resolve with time.