Lacrimal Caruncle: Continuation to the Lower Eyelid Retractors

Abstract

To examine the relationship between the lacrimal caruncle and the lower eyelid retractors and to study the shape and position of the lacrimal caruncle in relation to the lower eyelid margin. A transcaruncular approach was used to investigate the direction of the lacrimal caruncle shift in 14 medial orbital decompressions (7 patients) and 10 medial orbital wall fracture reductions (10 patients). Eighty lacrimal caruncles in 40 normal volunteers were examined regarding the position of this structure in relation to the lower eyelid retractors and its shape in connection to the lower eyelid margin. Direct investigation of whether the lower eyelid retractors continued to the lacrimal caruncle was performed during 4 lazy-T procedures (2 patients). All the severed lacrimal caruncles moved inferolaterally. The volunteers' lacrimal caruncles were situated adjacent to the lower eyelid retractors, had an ovoid shape, and were positioned obliquely with an inferolateral direction. In the normal eyelid position, the superior border of the lacrimal caruncle was aligned with the lower eyelid margin. During the lazy-T procedures, the lower eyelid retractors were shown to have direct connection to the lacrimal caruncle. The lacrimal caruncle has a direct connection to the lower eyelid retractors that plays an antagonistic role to the medial rectus caspulopalpebral fascia in the movement of the lacrimal caruncle, and it is positioned obliquely, directing inferolaterally with its superior border in level with the lower eyelid margin.