Lacrimal Gland Prolapse Research Articles

Diagnosis and Treatment of Lacrimal Gland Prolapse: A Narrative Review.

Lacrimal gland prolapse (LGP) 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. To describe current findings about the prevalence, pre- and intraoperative diagnosis of LGP and its treatment options. PubMed and Google Scholar were thoroughly searched for articles published describing the diagnosis and treatment of LGP. The reported prevalence of LGP by various authors varies between 10 and 60% based on their preoperative or intraoperative reports. Techniques such as dacryoadenopexy, modified dacryoadenopexy, and dacryoplasty have been described to secure the prolapsed lacrimal gland back into its original position. Additionally, creating a Whitnall's barrier has also been suggested as a method to reposition the gland. While all these surgical procedures have shown promising immediate results, there is a lack of published data on their long-term outcomes. Diagnosis and proper treatment of LGP could enhance the cosmetic results of upper eyelid blepharoplasty. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Aesthetic and Functional Outcomes of Upper Blepharoplasty Combined with Dacryoadenopexy in Lacrimal Gland Prolapse.

Lacrimal gland prolapse (LGP) is a term used to describe a benign, anterior displacement of the lacrimal gland. If this condition is not properly addressed during upper blepharoplasty, the aesthetic and functional results are less than optimal. This study aimed to report the surgical outcomes of upper blepharoplasty combined with dacryoadenopexy in patients with LGP. We reported an unusual case of severe LGP in a young patient. In addition, we performed a systematic review of the English literature on surgical cases of LGP published between 1973 and 2023. Eligible articles were analyzed for individual patient data (IPD) and aggregate patient data (APD). The primary predictor variable was the surgical technique used for lacrimal gland repositioning/suspension. The primary outcome variable was relapse rate. The bibliographic search retrieved 488 surgical cases of LGP: 12 in IPD, and 476 in APD datasets. The relapse rates in the IPD and APD cohorts were 8.3% (1/12) and 1.2% (6/476), respectively. Within the APD dataset, no significant difference in the relapse rates between dacryoadenopexy via suture suspension and Whitnall's ligament suspension (5/409 and 1/20, respectively; P > 0.05) was observed. Light cauterization of the lacrimal gland capsule and surrounding soft tissues was performed in mild LGP cases (< 4mm prolapse), with a relapse rate of 0% (0/47). Upper blepharoplasty combined with dacryoadenopexy proved to be a safe surgical procedure with very satisfactory aesthetic outcome and minimal relapse rate. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Primary Sjögren’s syndrome misdiagnosed as Mikulicz’s disease: a case report

BackgroundSjögren’s Syndrome (SS) is an inflammatory autoimmune disease, and Mikulicz’s disease (MD) is a lymphoproliferative disorder. Both MD and SS are more common in middle-aged female, and the dry eyes could be presented in both of them with different degree. The MD patients are characterized by symmetrical swelling of the lacrimal glands which also can occur in the early stage of SS. And the imaging findings between early stage of SS and MD are lack of specificity. Therefore, SS and MD have similarities in the clinical manifestations, imaging and pathological findings and are confused in diagnosis.Case presentationA 51-year-old female patient presented with bilateral swelling of the upper eyelids for 2 years. She also reported having dry mouth and dry eyes which could be tolerated. The Schirmer’s test result is positive and the laboratory tests indicate serum total IgG increased. In the bilateral lacrimal gland area could palpate soft masses. The orbital magnetic resonance imaging (MRI) examination showed bilateral lacrimal gland prolapse. While the histopathological result was considered as MD. The immunohistochemical (IHC) staining results were positive for IgG and negative for IgG4. To clarify the diagnosis, SS-related laboratory tests were performed: anti-SSA antibody (+++), anti-SSB antibody (+++), anti-Ro-52 antibody (+++). With a comprehensive consideration, the final diagnosis was SS.ConclusionWhen the clinical manifestations are atypical, it is necessary to pay attention to the differential diagnosis of SS and MD.

Modified Lacrimal Gland Suspension Technique in Patients Who Underwent Upper Eyelid Blepharoplasty.

The aim of the present study was to evaluate the efficacy of modified lacrimal gland suspension surgery combined with upper lid blepharoplasty. Between December 2020 and December 2021, 365 patients admitted to our clinic for ptosis were included in the study. The data of 89 patients who underwent upper lid blepharoplasty with lacrimal gland repositioning for dermatochalasis were analyzed. Combined surgery was performed in 24.38% of the patients included in the study; 16 (17.9%) of these patients were males and 73 (82.1%) were females, and the mean age of the patients was 47.34 ± 8.13 years. The mean follow-up period was 16.42 ± 2.63 months. In patients who underwent lacrimal gland suspension, 72 (85%) of the patients complained of swelling on the outer part of the upper lid before surgery. However, 9 (10.11%) of the patients did not have lacrimal gland prolapse, and only fat prolapse was present in these patients. No complication or recurrence was observed in any patient during the follow-up period. With the new modified technique, the lacrimal gland can be suspended close to the anatomical position, and satisfactory results can be obtained for both the patient and the surgeon.

The Whitnall Barrier: A Technique for the Management of Lacrimal Gland Prolapse.

The Whitnall barrier procedure, a modified Beer and Kompatscher surgical technique to reposition the lacrimal gland, is presented alongside a case series of patients demonstrating excellent aesthetic and functional outcomes. The Whitnall barrier procedure is illustrated procedurally and accompanied by a case series of 20 consecutive patients treated in a single institution by a single surgical team between December of 2016 and February of 2020. Lid contour and function were assessed postoperatively, as was patient satisfaction. Thirty-seven eyes of 20 patients were included. All patients were women, with an average age of 50 years. Fourteen patients underwent surgery for cosmesis, four had inactive thyroid eye disease, and two had lacrimal gland enlargement secondary to dacryoadenitis. The degree of lacrimal gland prolapse was described as mild in two eyes and moderate in 35 eyes. All patients had one or more additional surgical procedures. Mean follow-up duration was 11 months, with complete resolution of lacrimal gland prolapse in 34 eyes. The patient who did not have complete resolution had dacryoadenitis and required ongoing immunosuppressive therapy. Two patients were discharged on topical lubricants: one with thyroid eye disease and one cosmetic patient who underwent upper and lower lid blepharoplasties at the same time. There were no intraoperative complications and no incidences of infection, dehiscence, or damage to the lacrimal gland ductules. The Whitnall barrier technique is a safe and effective surgical procedure to restore the anatomic location of the lacrimal gland. It provides excellent aesthetic and functional outcomes.

Lacrimal Gland Prolapse: Case Report

Lacrimal gland prolapse is an important diagnosis to consider in patients with lateral upper eyelid fullness. Prolapse of the lacrimal gland is the descent of the lacrimal gland into the upper eyelid. It can result in blepharoptosis and a bulging “frog-eyed” appearance. This is a case report of lacrimal gland prolapse in a 19-year-old female patient treated by suture repositioning of the glands in an outpatient surgical setting. We report on non-recognition of the prolapse and in the absence of essential surgical correction, in addition to the aesthetic disorders often reported, worsening of functional symptoms such as epiphora with major discomfort. Prolapse in young patients has not been reported in the international literature consulted, E&amp;OE.

Correlation between extent of lacrimal gland prolapse and clinical features of thyroid-associated ophthalmopathy: a retrospective observational study

BackgroundStudies on the factors related to lacrimal gland prolapse (LGP) in patients with thyroid-associated ophthalmopathy (TAO) are limited. This study aimed to assess the factors associated with LGP on magnetic resonance imaging (MRI) and its relation to TAO activity .MethodsThirty-six patients (72 orbits) with inactive TAO (43 orbits, Clinical Activity Score [CAS] < 3) or active TAO (29 orbits, CAS ≥3) were investigated retrospectively. All patients underwent ophthalmic evaluation and orbital magnetic resonance imaging. The severity of LGP and proptosis and the extraocular muscle (EOM) volume were measured. LGP and related factors were assessed by correlational and linear regression analyses. The value of LGP for discriminating the activity of TAO was evaluated by receiver-operating characteristic curve analysis.ResultsThe mean LGP was significantly higher in the active TAO group than in the inactive TAO group (P < 0.001). There were significant positive correlations between LGP severity and the CAS (r = 0.51, P < 0.001), proptosis (r = 0.72, P < 0.001), and EOM volume (superior rectus [r = 0.49, P < 0.001], inferior rectus [r = 0.47, P < 0.001], lateral rectus [r = 0.59, P < 0.001], medial rectus [r = 0.62, P < 0.001], superior oblique [r = 0.48, P < 0.001], and all EOMs [r = 0.59, P < 0.001]). Receiver-operating characteristic curve analysis revealed an LGP of 13.65 mm (area under the curve, 0.824; sensitivity, 79.3%; specificity, 81.4%) to be the cut-off value that differentiated active and inactive TAO.ConclusionsLGP measurements obtained from orbital magnetic resonance images were positively correlated with CAS, proptosis and EOM volume. The extent of LGP appears to be a good indicator of disease activity in patients with TAO.

Blepharochalasis: clinical and epidemiological characteristics, surgical strategy and prognosis-- a retrospective cohort study with 93 cases

BackgroundBlepharochalasis is a rare eyelid disorder but eventually leading to destructive eyelid deformation. Until now the clinical and epidemiological data are unavailable. This study aimed to report the manifestations, epidemiological characteristics and surgical strategy of a large series of blepharochalasis patients with long-term follow-up. The prognosis of different clinical deformities was also investigated.MethodsThis was a retrospective cohort study, including consecutive patients diagnosed with blepharochalasis in a single center. Blepharoplasty and other surgical approaches were performed according to manifestations, after a 2-year quiescent period with no recurrent attacks and exacerbation of lesions. Prognosis after surgery was recorded.ResultsA total of 93 patients, with a mean age of 30.77 ± 14.04 (range: 9.00–70.00) years were included. Of all those 93 patients, 72.04% were females (67, P = 0.02). The mean follow-up was 5.29 ± 2.07 (range: 3–10) years before surgery, and 2.07 (range:1.54–4.22)years follow-up after surgery. The mean age of onset of blepharochalasis symptoms was 10.09 ± 3.32 (range: 5–16) years, and 83.87% patients got symptoms in puberty. With an average of 5 times per year, the mean duration of each acute attack was 28.12 ± 1.01 (rang: 2–192) hours. The mean duration from the onset of acute attack to the quiescent stage lasted for 7.33 ± 2.05 (range: 4–10) years. Most of the cases (88, 94.62%) had more than one manifestation at the end of the last follow-up before surgery. Ptosis (48.39%) was the most common deformity. Followed by lacrimal gland prolapse (44.09%), canthal angle deformity (29.04%), lower eyelid retraction (17.20%). After surgery, the functional and cosmetically acceptable results were achieved in all patients except for overcorrection in 5 (11.90%) patients with ptosis. The lacrimal gland prolapse recurred in two (4.00%) patients at 29 and 36 months after surgery.ConclusionsBlepharochalasis is rare but mostly occurred in adolescent females. The process from the onset to the stable stage usually lasted for about 7 years, which might be associated with the onset of puberty. Surgical management of clinical manifestations after at least 2-year follow-up period of quiescence would be appropriate in order to observe a great plastic effect, low overcorrection and recurrence rate.

A Modified Procedure for Single-eyelid Asian Females with Lacrimal Gland Prolapse: Lacrimal Gland Reposition combined with Fat Transposition in Double-eyelid Operation.

The awareness and treatment of lacrimal gland prolapse (LGP) have been primarily improved with a further understanding of lateral eyelid bulging over the decades. However, for Asian single-eyelid females with LGP, a tailor-made procedure applicable to their comparatively young puffy eyes is needed. This is a retrospective study. From Jan. 2009 to Jan. 2019, two hundred and three Asian single-eyelid females with LGP, who met the inclusion criteria, underwent double-eyelid surgeries and adjunctive lacrimal gland repositions with preaponeurotic fat transposition. Pertinent demographics, complications, pre-and post-operative photography were collected. A total of 167 patients completed the 4-24 months' follow-up (average: 16.3 months). One hundred and thirty-two cases (79.0%) were diagnosed as LGP preoperatively, and the rest (35/167, 21.0%) were diagnosed intraoperatively. All patients (average: 28.4 years old) received modified blepharoplasty. Postoperative symptoms involving local mild pain (2.9%, 5/167), upper eyelid tightness (3.6%, 6/167), and moderate epiphora (9.0%, 15/167) were all recovered spontaneously within one month. Prolapse recurrence and severe complications such as dry eye syndrome were not observed. We proposed a modified procedure to enhance the diagnosis and treatment of LGP during Asian blepharoplasty. The lacrimal gland suspension and fat transposition assured the cosmetic outcome for selected young, puffy Asian eyes. The supratarsal creases were satisfactory, and the complication rate was low. Furthermore, the rearrangement of preaponeurotic fat smoothed the contour transition and preserved the orbital volume. Therefore, this is a safe and effective technique worth recommending.

Clinical histopathologic characteristics of lacrimal glands in lacrimal gland prolapse with blepharochalasis

Objective: To analyze the clinical histopathologic characteristics of lacrimal glands and possible mechanisms of lacrimal gland prolapse in blepharochalasis (BC). Methods: A case-controlled study of 23 consecutive patients with prolapse of lacrimal glands in BC was performed. All samples were obtained during surgery from the Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University between January 2009 and December 2016. The lacrimal tissue included prolapsed lacrimal glands (30 samples) and controls from the donors in the eye bank of Beijing Tongren Hospital, Capital Medical University (8 samples). Hematoxylin-eosin staining, special staining, immunohistochemistry and colloidal gold-labeled pre-embedded indirect immunogold electron microscopy (Gold-IIEM) were performed to analyze the histopathologic characteristics of the samples. The nonparametric Wilcoxon signed-ranks test was carried out for statistical analysis. Results: Among the 23 patients with lacrimal gland prolapse in BC, there were 3 males and 20 females. The mean age of morbidity was 11 years old (7-16 years). In the 8 normal control cases, 3 males and 5 females were included. The mean age was 15 years (10-20 years). In the 30 prolapsed lacrimal gland samples, hematoxylin-eosin staining showed enlargement of glandular lumina accompanied by inflammatory infiltrates of interstitial tissue in 2 samples. Marked loosening of collagen fibers of the obtainable lacrimal fascia was observed. The results on immunohistochemical staining demonstrated an increased level of immunocytes in the 30 prolapsed lacrimal gland samples, including IgA (+++, ++, +, -; 12, 11, 4, 3 vs. 0, 0, 1, 7; Z=-3.892), CD3(+)T cells (+++, ++, +, -; 2, 19, 7, 2 vs. 0, 0, 1, 7; Z=-4.168), matrix metalloproteinase (MMP)-3 (+++, ++, +, -; 0, 0, 11, 19 vs. 0, 0, 0, 8; Z=-2.005) and MMP-9 (+++, ++, +, -; 14, 14, 0, 2 vs. 0, 0, 0, 8; Z=-4.552) (all P<0.05). IgG, IgM, CD20 and C1-inhibitor were either absent or expressed at background level in the 30 prolapsed lacrimal gland samples (all P>0.05). Gold-IIEM showed zymogon granules in lacrimal glands were out of shape. MMP-3 and MMP-9 colloidal gold particles existed on the zymogon granules, and MMP-3 colloidal gold particles also existed on the surface of lacrimal gland epithelial cells. Conclusions: The histopathological changes in the lacrimal glands of lacrimal gland prolapse with BC include inflammatory infiltration, elastic fiber degeneration, marked loosening of the supporting fascia tissue, and an increased level of immunocytes, including IgA, CD3(+)T cells, MMP-3 and MMP-9. The results suggest that lacrimal gland prolapse with BC may result in the immuno-pathogenetic mechanisms with the involvement of cell-mediated immune responses. (Chin J Ophthalmol, 2020, 56: 205-210).

经眉下提眉切口复位泪腺脱垂1例

经眉下提眉切口复位泪腺脱垂1例

Supine Test: A New Test for Detecting Lacrimal Gland Prolapse Before Upper Blepharoplasty.

To introduce a new (Supine) test and assess the values of lateral eyelid bulging for diagnosis of lacrimal gland (LG) prolapse before upper blepharoplasty. In a prospective case series (2011-2017), lateral eyelid bulging and Supine Test were recorded, preoperatively. Lacrimal gland prolapse was graded as mild (<4 mm), moderate (4-7 mm), and severe (>7 mm). A few spots of cautery on LG capsule was performed in patients with bilateral mild and suture repositioning in unilateral or bilateral moderate and severe LG prolapse. Patients with asymmetric LG prolapse were treated based on more severe grade, bilaterally. Included were 1,207 patients. Frequency of positive Supine Test (11.8%, 142/1,207) increased from almost 10% in patients less than 41 years of age to 15% in more than 60 years of age. Their mean age was significantly older, and 53.2% showed asymmetric LG prolapse. Septum was just opened in patients with positive Supine Test, and all had LG prolapse of ≥3 mm (mean: 5.6 mm, range: 3-14 mm). Mild LG prolapse, moderate LG prolapse, and severe LG prolapse were observed in 22.5%, 62.6%, and 14.7% of the patients, respectively. Mean follow-up time was 22 months (12-60 months). Recurrence was observed in 1 patient (bilateral) after suture repositioning. Lateral eyelid bulging had a high negative (96.2%) and low positive (30.6%) predictive value when compared with the Supine Test. Positive Supine Test means LG prolapse of ≥3 mm (100% positive predictive value). Negative lateral eyelid bulging was highly predictive of no LG prolapse.

Lacrimal gland prolapse in upper blepharoplasty

ABSTRACTPurpose: To report the characteristics of lacrimal gland prolapse among the patients who underwent upper blepharoplasty.Materials and Methods: In a retrospective study, consecutive upper blepharoplasty patients with significant lacrimal gland prolapse were included. The degree of prolapse was measured as anterior protrusion of lacrimal gland from the orbital rim. Reposition of the lacrimal gland was performed by using non-absorbable sutures to fixate the gland to the periosteum of lacrimal fossa. In cases with unusually large lacrimal glands, an incisional biopsy of the gland was obtained. The orbital septum was left unsutured.Results: Twenty patients (19 females and one male) out of a total of 198 patients who underwent upper blepharoplasty (10.1%) had clinically significant lacrimal gland prolapse. Mean age was 54.8 ± 9.4 years (range, 31–69). Fourteen patients (70%) were asymptomatic. Anterior protrusion of lacrimal gland was measured to be 6.4 ± 1.2 mm (range, 5–10 mm) from the orbital rim. Incisional biopsy of the lacrimal gland was obtained in 10 patients (50%). Nine biopsies showed mild chronic inflammation and one revealed only normal lacrimal gland tissue. Postoperative course was uncomplicated in 15 patients (75%), with mild symptoms in the others and only one instance of mild unilateral recurrence of lacrimal gland prolapse.Conclusions: Reposition of a prolapsed lacrimal gland is a safe and effective adjunctive procedure in upper blepharoplasty, with minimal complications and acceptable postoperative outcome. Prolapsed lacrimal glands showed mild inflammation which could be due to repetitious movements of a lax gland, although various other etiologies can be involved.

Lacrimoplasty: a new bone fixation technique for recurrent lacrimal gland prolapse

Lacrimal gland prolapse is an often ignored and undiagnosed condition in patients seeking blepharoplasty. Recognition and correct treatment can avoid poor outcomes in such cases. Traditional techniques of treating the prolapsed lacrimal gland include light cautery, partial excision, and periosteal suture fixation. A few series of lacrimal gland prolapse have been published in the literature. But a literature search failed to reveal any reports on the recurrence of surgically treated lacrimal gland prolapse. We report the incidence of lacrimal gland prolapse purely based on the external deformity and also report a case of recurrence following surgical lacrimal gland periosteal hitching, in a patient with blepharochalasis syndrome 4 years post the original correction. A new technique of true bony fixation of the recurrent prolapsed lacrimal gland to the lacrimal fossa is described. We call the new technique ‘lacrimoplasty’. An operative video is also included to demonstrate the technique step by step. Level of Evidence: level V, therapeutic study.

Observation and nursing of modified lacrimal gland injection in the treatment of inflammatory pseudotumor of the lacrimal gland

Objective To observe the effects of face to face for patients with lacrimal gland after injection and nursing measures. Methods We selected 18 patients (21 eyes) with lacrimal gland injection in the treatment room, and they received face to face local injection of lacrimal gland for local injection of triamcinolone acetonide, dexamethasone sodium phosphate and 2% lidocaine lacrimal. Results A total of 18 patients with eyelid swelling disappeared after injection, so the effect was satisfactory. Conclusions Face to face method for lacrimal gland injection is simple, safe, effective, which is worthy of promotion. Key words: Face to face injection; Lacrimal gland prolapse; Injection

Surgical Treatment of Prolapse of the Deep Lacrimal Gland in a Pet Rabbit

A 5-year-old pet rabbit with a history of severe acquired dental disease and rhinitis was presented for unilateral prolapse of the deep lacrimal gland of the third eyelid. The prolapse was believed to be due to abnormalities of the alveolar bullae secondary to severe dental disease and rhinitis. The prolapse was successfully replaced using a combination of techniques used in canine ophthalmology: the creation of a pocket or envelope in adjacent mucosa to cover the gland, and anchoring the nictitans to the periosteum. Correction was successful and the gland remained in place without complications until the rabbit’s death 4.5 years later.

Inhibitory effects of dexamethasone on proliferation of fibroblasts derived by idiopathic orbital inflammatory pseudotumor

Background Idiopathic orbital inflammatory pseudotumor (IOIP) is a common orbital disease, but its etiology is still unclear, so the effect of glucocorticoid treatment is unsatisfied. Objective This study was to investigate the effects of dexamethasone on orbital fibroblasts from IOIP patients and explore the action machanism. Methods Six pieces of IOIP tissues from 6 IOIP patients and 3 pieces of normal orbital connective tissues from lacrimal gland prolapse patients were obtained during the surgery in Beijing Tongren Hospital from November 2011 to January 2012.The orbital fibroblasts were cultured using explant culture method.The morphology of the cells were observed under the optical microscope, and biomarks of the cells were detected by immunochemistry.The growth and proliferation of the cells were assayed using WST-8.The expression of ICAM-1 in the cells in both the control group and the IOIP group was detected by immunochemistry.The fibroblasts were incubated in 96-well plates, and different concentrations of dexamethasone (0, 1×10-3, 1×10-4, 1×10-5 and 1×10-6 mol/L) were respectively added into the medium for 24, 48 and 72 hours, and then the proliferation of the cells was detected by WST-8 assay.The contents of ICAM-1 in different concentrations of dexamethasone groups were assayed by ELISA. Results The characteristics of the cells were similar between the control group and the IOIP group with the spindle shape and long protructions.The cells showed the positive response for vimentin and absent response for desmin, S-100, cytokeratin (CK). Compared with the control group, the growth speed of fibroblasts was fast in the IOIP group.The proliferative values of the cells (absorbancy) were gradually reduced with the increase of dexamethasone concentrations (Fconcentration=36.27, P=0.00) and the lapse of acting time (Ftime=3.69, P=0.00). In cultured cells without dexamethasone for 24, 48 and 72 hours, the mean expression levels of ICAM-1 were 0.298±0.008, 0.312±0.003 and 0.319±0.011, showing a gradually increasing trend.However, the expression of ICAM-1 was gradually reduced with the increases of concentrations and the lapse of acting time of dexamethasone (Fconcentration=75.17, P=0.00; Ftime=3.11, P=0.00). Conclusions Occurrence and development of IOIP is probably associated with the over-expression of ICAM-1 in orbital fibroblasts.Dexamethasone plays anti-inflammation and treating effects on IOIP by down-regulating the expression of ICAM-1 and inhibiting the proliferation of orbital fibroblasts. Key words: Orbital pseudotumor/drug therapy; Fibroblasts/drug effects; Glucocorticoids/pharmacology; Dexamethasone; Intercellular adhesion molecule-1; Down-regulation; Cell culture

Lacrimal gland prolapse in two cases of blepharochalasis syndrome and its treatment

Blepharochalasis is a rare disorder characterized by recurrent non-painful eyelid edema, which leads to atrophy and stretching of the supporting connective tissue around the eye. As a consequence, prolapse of the lacrimal gland can occur which results in fullness in the temporal third of the upper eyelids and may cause visual field restriction or cosmetic blemish for patients. Thus, correct diagnosis is important to plan appropriate surgery and obtain a successful postoperative result. We present two young patients with lacrimal gland prolapse associated with blepharochalasis and report on their treatment.

Clinical features of blepharochalasis and surgical treatment of associated deformities

To describe the clinical features of blepharochalasis and the effect of surgical treatment of associated deformities. A retrospective study reviewed 54 patients (98 eyes) with blepharochalasis. The main features analyzed included sex, age of onset, duration and clinical signs. Surgical treatment for the correction of deformities includes blepharoplasty; resuspension of the prolapsed lacrimal gland, ptosis repair, surgical correction of lower eyelid retraction and lateral canthoplasty. Follow-up ranged from 6 to 60 months. The average age of onset was 9.3 years. The duration in all 54 patients (32 females and 22 males) lasted for 2 - 16 years and different periorbital deformities were presented. After surgical repair, all patients were satisfied with their bilateral symmetrical creases in upper eyelids and the contour of upper eyelids. The appearance of floppy eyelids has been improved distinctly. The lateral canthus moved to the normal position. No patients complained epiphora or dry eye symptoms. Prolapse of the lacrimal gland recurred in two patients (three eyes). They underwent reoperation with no further recurrence. Overcorrection in blepharoptosis surgery of five patients was fixed with suture adjustment of the levator aponeurosis. Blepharochalasis onset often occurs around age 10 years and stabilizes till adolescence. Since it involves bilateral or unilateral, local eye tissues or periorbital tissues, clinical manifestations may vary in blepharochalasis. Ophthalmic plastic surgery to correct blepharochalasis and its associated deformities in the quiescent stage is usually safe and with satisfactory cosmetic effects.

The treatment for prolapse of lacrimal gland by reposition of lacrimal gland and blepharoplasty

Objective To evaluate the clinical effect of the treatment for prolapse of lacrimal gland by reposition of lacrimal gland and blepharoplasty.Methods 36 eyes of 18 patients with prolapse of lacrimal gland were included.To design the operative incision according to blepharoplasty,and acconting to the degree of dermatolysis and satiation of eyelid to decide the removal of the skin and orbital fat.4-0 stitch mattress suture was made at anterior border and aponeurosis d caruncula innominata,prolapsed orbital and palpebral caruncula innominata were fixed on the inside of supraorbital nargin and the periost of lateral orbital wall,respectively.Then the incised orbital septum was tensed and consolidated by interrupted suture.The skin of upper eyelid was sutured by the way of blepharoplasty,and the lateral skin was sutured by interrupted suture.Those cases were followed up for 6 nonths to 3 years.Results The reposition of caruncula innominata were very well after surgery in 34 eyes of 17 cases with no recurrence.2 eyes in 1 case recurrd lightly 2 years after surgery,but the complaint relieved obviously compared with preoperative position.In 18 cases(36 eyes),fissura palpebrae of both eyes were symmetric,the appearance of double eyelid was satisfactory and natural.Conclusion The effect of the treatment for prolapse of lacrimal gland by combined the reposition of dislocated lacrimal gland with strengthening orbital septum and blepharoplasty was safe,with function cure and cosfmeric result. Key words: Prolapse of lacrimal gland; Reposition of lacrimal gland; Blepharoplesty