The lacrimal gland, often called the tear gland, is an almond-sized structure located in the upper, outer region of the eye socket, nestled within a bony depression of the frontal bone. Its main function is the continuous secretion of the aqueous layer of the tear film, which lubricates, nourishes, and protects the eye surface. Lacrimal gland prolapse is a condition where the gland shifts downward and forward out of its designated fossa, often becoming visible or palpable beneath the upper eyelid. This displacement occurs when the supportive structures that hold the gland in place weaken, allowing it to herniate into the eyelid space.
Recognizing the Symptoms
Patients with a prolapsed lacrimal gland commonly notice a visible fullness or localized swelling in the outer third of the upper eyelid. This swelling can cause the eyelid contour to appear slightly distorted, sometimes presenting with an S-shaped curve. The displaced gland may also be felt as a soft, movable mass when the area is gently touched.
The prolapse can also lead to several uncomfortable symptoms. Some individuals report a persistent foreign body sensation. Because the gland has moved, its ducts may become compromised, potentially affecting the stability of the tear film and leading to symptoms of dryness, grittiness, or excessive watering. These symptoms can be the first indication that the gland has shifted from its protected location.
Causes and Predisposing Factors
The underlying reason for lacrimal gland prolapse is a weakening or laxity in the connective tissues responsible for holding the gland securely within the orbit. The orbital septum and suspensory ligaments, which provide structural support, naturally lose elasticity and strength as a person ages. This age-related atrophy is a common factor, allowing the gland to descend into the eyelid.
Certain conditions can also contribute to displacement by increasing pressure or causing inflammation within the eye socket. Increased intraorbital pressure from conditions such as Thyroid Eye Disease (Graves’ orbitopathy) can physically push the gland out of its fossa. Similarly, the presence of an orbital tumor or severe inflammatory conditions, like dacryoadenitis, can cause swelling and pressure that displace the gland.
Orbital trauma can damage the fascial attachments, leading to prolapse of the gland. Congenital conditions or craniofacial deformities that result in structural weaknesses or shallow orbits may also predispose an individual to this issue.
Diagnosis and Management Approaches
The pathway to confirming lacrimal gland prolapse begins with a detailed physical examination performed by an eye specialist. The clinician visually inspects the upper eyelid for the characteristic bulge and gently palpates the area to assess the texture and mobility of the displaced tissue. The diagnosis is often clinical, relying on the observable signs and the patient’s reported symptoms.
Imaging studies are utilized to confirm the nature of the mass and rule out other orbital conditions, such as tumors or cysts. Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) scans provide detailed images that clearly show the lacrimal gland’s position and confirm the absence of other space-occupying lesions. This step ensures that the patient does not undergo an inappropriate procedure for an undiagnosed underlying mass.
Management is determined by the severity of the prolapse and the extent of the associated symptoms. Mild, asymptomatic cases may only require careful observation and the use of lubricating eye drops to manage any associated dry eye. However, for patients experiencing significant cosmetic concern, chronic discomfort, or functional impairment, surgical intervention is the primary method of correction.
The most common surgical procedure is a lacrimal gland pexy or plication, which aims to reposition the gland and secure it back into its anatomical location. This procedure is typically performed through a small incision made in the natural crease of the upper eyelid. The surgeon lifts the prolapsed gland back into the lacrimal fossa and fixes it to the orbital bone using fine sutures. This restores the eyelid contour and preserves the gland’s function. In rare circumstances where the gland is severely enlarged or chronically inflamed, a partial excision may be considered to reduce bulk while preserving tear production capability.
Recovery and Long-Term Considerations
Following surgical repositioning, the initial recovery involves managing temporary swelling and bruising around the operative site. These effects are expected and generally subside significantly within the first few weeks after the procedure. Patients may experience temporary dryness or a gritty sensation in the eye, which is often managed with lubricating drops until the tissues fully heal and the gland’s function stabilizes.
Suture removal usually occurs within one to two weeks, and most patients can return to normal, non-strenuous activities shortly thereafter. Physical exertion and activities that significantly increase blood pressure are discouraged for a few weeks to minimize the risk of bleeding or delayed healing.
The long-term outlook following a successful pexy procedure is generally favorable, with most patients experiencing a restoration of normal eyelid contour and resolution of discomfort. While the procedure is designed to be permanent, there is a small possibility of recurrence if the underlying tissue weakness progresses or if new trauma occurs. The functional outcome is the preservation of tear production, which is often maintained or improved once the gland is secured in its correct position.