Subconjunctival Prolapse of the Palpebral Lobe of the Lacrimal Gland Occurring in Association with Occult Orbital Fat Herniation

Abstract

Introduction: Sub-conjunctival prolapse of the palpebral lobe of the lacrimal gland can be a disfiguring and sometimes uncomfortable problem, usually caused by lacrimal gland enlargement or associated orbital lobe displacement. However, we present two novel cases associated with occult orbital fat herniation.Method: Retrospective interventional case series of two middle-aged/elderly male patients presenting with unilateral prolapse of the palpebral lobe of the lacrimal gland and no clinically apparent orbital fat prolapse. Neither patient had proptosis, globe displacement or diplopia, but both were aware of a subconjunctival mass in the lateral fornix causing a cosmetic concern.Results: Imaging in both cases revealed a normal sized lacrimal gland with a prominent orbital fat pocket behind this. This fat was excised through an upper-eyelid skin crease approach with temporary detachment of the levator muscle in one case, and through a trans-conjunctival incision in the other. In both cases fat excision resulted in retroplacement of the palpebral lobe of the lacrimal gland such that it was no longer visible. Neither patient experienced any additional dry eye post-operatively.Conclusion: Sub-conjunctival prolapse of the palpebral lobe of the lacrimal gland can be associated with occult orbital fat herniation, revealed on imaging. Localised orbital fat excision is an effective means of treating this condition.