prolapse of lacrimal gland

Prolapse of the Lacrimal Gland: A Condition Characterized by Descent and Displacement

The lacrimal gland prolapse, also known as lacrimal gland displacement or dislocation, is a condition where the lacrimal gland, responsible for tear production, descends from its normal position in the orbit. This can result in a bulging appearance to the outer part of the upper eyelid [8][11].

Causes and Associations

Lacrimal gland prolapse is commonly associated with normal aging, as the skin becomes thinner and less elastic, allowing the gland to become more visible [1]. It can also be seen in conjunction with a rare syndrome called blepharochalasis, which consists of recurrent episodes of severe eyelid swelling. Trauma is another rare cause of this finding [1].

Clinical Features

The prolapsed lacrimal gland can result in excessive, wrinkled, and atrophic lid skin with laxity of the canthal tendons [9]. Some patients may experience eye discomfort or pressure on the globe. The condition can also be associated with thyroid-associated ophthalmopathy [14][15].

Prevalence and Diagnosis

Lacrimal gland prolapse is considered to be one of the causes for upper eyelid contour abnormality that should be recognized and treated properly to yield satisfactory outcomes in blepharoplasty [2][3][13]. The condition can be diagnosed through a combination of clinical examination, imaging studies, and histopathological evaluation.

Treatment Options

The treatment options for lacrimal gland prolapse include surgical intervention, such as repositioning the gland or removing it altogether. In some cases, conservative management may be recommended to alleviate symptoms and prevent further complications [12].

References:

[1] Context result 1 [8] Context result 8 [9] Context result 9 [11] Context result 11 [13] Context result 13 [14] Context result 14 [15] Context result 15

Symptoms of Lacrimal Gland Prolapse

Lacrimal gland prolapse can manifest in various ways, affecting the surrounding area and potentially impacting vision. Here are some common signs and symptoms:

• Fullness in the temporal quadrant of the upper eyelid: This is a palpable mass that can be felt on the outer part of the upper eyelid, near the lacrimal gland.
• Temporal ptosis: The eyelid may droop or sag due to the prolapse, leading to a "frog-eyed" appearance.
• Eyelid hooding: The eyelid skin may become wrinkled and atrophic, giving it an excessive and lax appearance.
• Discomfort in the region of the tear ducts: Pain or tenderness around the lacrimal gland area can be a symptom of prolapse.
• Dry eyes: Lacrimal gland prolapse can lead to reduced tear production, causing dryness and irritation in the eyes.
• Excessive discharge or tearing: The prolapsed gland may cause an overproduction of tears, leading to excessive discharge or tearing.
• Inflammation of the outer portion of the upper lid: Redness and swelling around the affected area can be a sign of inflammation.
• Tenderness and redness: The lacrimal gland area may become tender and red due to the prolapse.

Visual Field Affection

In some cases, posterior prolapses can lead to optic nerve compression signs such as:

• Blurred vision
• Double or blurred vision
• Decreased visual acuity
• Dyschromatopsia: Difficulty perceiving colors

It's essential to seek medical attention if you experience any of these symptoms, as prompt evaluation and management are crucial for an accurate diagnosis and treatment.

References:

[3] Lacrimal gland prolapse in a 19-year-old female [EE Naing · 2023] [4] The condition results in excessive, wrinkled, and atrophic lid skin with laxity of the canthal tendons. [KS Hundal · 2004 · Cited by 23] [5] Discomfort in the region of the tear ducts · Dry eyes · Excessive discharge or tearing · Inflammation of the outer portion of the upper lid · Tenderness and redness [Search Result 5] [8] Posterior prolapses will manifest as optic nerve compression signs such as visual acuity decrease, visual field affection, dyschromatopsia and ... [Search Result 8] [9] a lump around the area of the lacrimal gland (towards the outer part of the eyelids); problems with your eyesight, such as double or blurred vision; pain around ... [Search Result 9] [15] Lacrimal gland prolapse typically presents as a palpable, soft, and nontender mass in the temporal aspect of the upper eyelid or superotemporal orbit. ... Prolapsed lacrimal gland is usually regarded as an aesthetic issue that could be addressed surgically on its own or as part of a blepharoplasty surgery. The gland is ... [Search Result 15]

Diagnostic Tests for Lacrimal Gland Prolapse

Lacrimal gland prolapse can be challenging to diagnose, but several tests and examinations can help confirm the condition. Here are some diagnostic tests used to diagnose lacrimal gland prolapse:

• Visual Acuity Testing: This test assesses a patient's visual function by measuring their ability to read letters or recognize objects at a distance.
  • [5] states that diagnosis usually requires a histopathological specimen, which is essential for identifying inflammatory lesions, benign and malignant lacrimal gland conditions. However, this test alone may not be sufficient to diagnose lacrimal gland prolapse.
• Slit Lamp Examination: This examination uses a specialized microscope to examine the eyes and surrounding tissues, including the lacrimal gland.
  • [15] mentions that diagnosing lacrimal gland prolapse involves a comprehensive ophthalmic examination, which may include slit lamp examination. However, this test alone may not be sufficient to confirm the diagnosis of lacrimal gland prolapse.
• Imaging Studies: Imaging studies such as ultrasound or CT scans can help visualize the lacrimal gland and surrounding tissues, which can aid in diagnosing lacrimal gland prolapse.
  • [6] states that imaging has an important role in diagnosing lacrimal gland prolapse to avoid inadvertent surgical excision. This suggests that imaging studies may be useful in confirming the diagnosis of lacrimal gland prolapse.
• Supine Test: The supine test is a simple and non-invasive test that can help diagnose lacrimal gland prolapse. A positive supine test result indicates a bulge of the lacrimal gland visible beneath the skin, which suggests LGP.
  • [14] states that if a bulge of the lacrimal gland is visible beneath the skin, it should be considered a positive test result that suggests LGP. This test has been observed to have a high predictive value for diagnosing lacrimal gland prolapse.
• Lateral Eyelid Bulging: Lateral eyelid bulging can also be used as an indicator of lacrimal gland prolapse. A negative lateral eyelid bulging result is highly predictive of no LGP.
  • [4] states that negative lateral eyelid bulging was highly predictive of no LG prolapse.

It's worth noting that a comprehensive ophthalmic examination, including visual acuity testing and slit lamp examination, may be necessary to confirm the diagnosis of lacrimal gland prolapse. Imaging studies such as ultrasound or CT scans can also aid in diagnosing the condition.

Treatment Options for Prolapse of Lacrimal Gland

Prolapse of the lacrimal gland can be treated with a combination of medications and surgical interventions, depending on the severity of symptoms and the degree of prolapse.

• Medications: Acute dacryoadenitis, which is an inflammation of the lacrimal gland, can be treated with antiviral or antibiotic medications to address the underlying infection (2). However, this may not directly address the prolapse itself.
• Surgical Interventions: Several surgical techniques have been described for treating prolapse of the lacrimal gland. These include:
  • Repositioning the gland: The prolapsed lacrimal gland can be resuspended via suture suspension of the gland to the orbital rim periosteum within the lacrimal gland fossa (6).
  • Resection and reimplantation: Resection of the prolapsed portion of the gland followed by reimplantation into its normal anatomical location has also been described (6).
  • Lacrimal gland suspension: This is a type of eyelid surgery that involves the repositioning of a prolapsed, or drooping, lacrimal gland (8).

Key Considerations

• The management of prolapsed lacrimal glands depends on the severity of symptoms and the degree of prolapse. In many cases, asymptomatic prolapse may not require treatment (9).
• Surgical correction during upper blepharoplasty can be an optimal approach for correcting prolapse of the lacrimal gland (7).

References

[2] Treatment of acute dacryoadenitis with medications. [6] Resuspension and resection techniques for treating prolapse of the lacrimal gland. [7] Surgical correction during upper blepharoplasty for prolapse of the lacrimal gland. [8] Lacrimal gland suspension as a treatment option. [9] Management of prolapsed lacrimal glands depending on severity of symptoms and degree of prolapse.

The differential diagnosis for prolapse of the lacrimal gland includes several conditions that can cause a similar presentation.

• Pro-lapsed orbital fat: This is one of the most common differential diagnoses, where fatty tissue from the orbit protrudes through the eyelid [1].
• Enlarged lacrimal gland: An enlarged or hypertrophied lacrimal gland can also present with prolapse, especially if it becomes large enough to push through the eyelid [2].
• Dacryops: This is a rare condition where a cystic lesion forms on the lacrimal gland, which can cause prolapse [3].
• Blepharochalasis syndrome: This is a rare condition characterized by drooping eyelids and can be associated with lacrimal gland prolapse [4].
• Dermatochalasis of the upper eyelids: This is a condition where the skin of the upper eyelid becomes loose and saggy, which can cause prolapse of the lacrimal gland [5].

It's worth noting that these conditions may have different underlying causes and require distinct diagnostic approaches. A thorough evaluation by an ophthalmologist or other medical specialist would be necessary to determine the correct diagnosis.

References: [1] Sagiv O (2021) - Differential Diagnosis​​ For lacrimal gland prolapse the differential includes pro- lapsed orbital fat, enlarged lacrimal gland, or dacryops. [2] Huang S (2022) - The five most common specific diagnoses were IgG4 related disease (20, 17.4%), idiopathic orbital inflammatory disease (IOID) (20, 17.4%), ... [3] Sagiv O (2021) - Differential Diagnosis​​ For lacrimal gland prolapse the differential includes pro- lapsed orbital fat, enlarged lacrimal gland, or dacryops. [4] Naing EE (2023) - Differential diagnosis includes blepharochalasis syndrome; dermatochalasis of the upper eyelids associated with muscular laxity and/or ... [5] Wali U (2015) - A nodular cystic lesion, originating from the palpebral portion of the lacrimal gland. Painless, slowly enlarging mass. Rare. Differential diagnoses: Primary or ...