The impact of lacrimal gland characteristics on the clinical presentation of lacrimal gland prolapse in candidates for upper eyelid blepharoplasty

Abstract

Background lacrimal gland prolapse (LGP) is a rare yet significant condition in oculoplastic surgery, characterized by the downward displacement of the lacrimal gland leading to upper eyelid bulging. This study aimed to understand LGP's defining characteristics and clinical implications for accurate diagnosis and tailored treatment planning. Methods The research, enrolled 496 candidates for upper eyelid blepharoplasty. Initially, all patients underwent an examination in an upright position to identify lateral eyelid bulging, the "supine test" was then performed. Surgical exploration was carried out for those with a positive supine test. Measurements of gland prolapse length and thickness were recorded, with glands classified based on thickness (thin < 2 mm vs. thick >= 2.5 mm). Dacryoadenopexy was performed to secure prolapsed glands using non-absorbable sutures, followed by skin closure. Results The average age of 48.39 years predominantly comprising females. Findings revealed an incidence of LGP around 22. Patients with LGP were significantly younger than those without, suggesting evolving aesthetic demands. The supine test demonstrated a 90 positive predictive value for LGP. Analysis of the prolapsed lacrimal gland characteristics indicated that the average length in patients with upright prolapse was significantly larger (8.33 +/- 3.12 mm) than in those without (6.03 +/- 2.91 mm, p = 0.001). The odds ratio analysis revealed that each millimeter increase in gland length correlates with a 29 increased likelihood of upright eyelid bulging (OR: 1.29, 95 CI: 1.106-1.509, p = 0.001). However, the thickness of the gland and the presence of superotemporal pre-aponeurotic fat did not significantly influence the clinical manifestation of LGP. Conclusion This study challenges existing assumptions about LGP by revealing a higher incidence, particularly among younger individuals, indicative of evolving aesthetic demands possibly influenced by social media. The supine test proves valuable for LGP assessment. Gland characteristics, especially length, significantly impact clinical manifestation, underscoring the need for tailored approaches. Surgeons should navigate LGP diagnosis and treatment with precision, considering both gland and fat prolapse for comprehensive care and aesthetic results.