Morley Ana M S, Malhotra Raman
Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, UK.
Orbit. 2009;28(6):430-2. doi: 10.3109/01676830903177435.
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.
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.
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 retro-placement of the palpebral lobe of the lacrimal gland such that it was no longer visible. Neither patient experienced any additional dry eye post-operatively.
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.
泪腺睑叶结膜下脱垂可能是一个影响美观且有时会带来不适的问题，通常由泪腺肿大或相关的眶叶移位引起。然而，我们报告两例与隐匿性眶脂肪疝相关的新病例。
对两名中老年男性患者进行回顾性介入病例系列研究，这两名患者均出现泪腺睑叶单侧脱垂，且临床上无明显眶脂肪脱垂。两名患者均无眼球突出、眼球移位或复视，但均意识到外侧穹窿结膜下有肿物，这引起了美观方面的担忧。
两例患者的影像学检查均显示泪腺大小正常，其后方有一个明显的眶脂肪袋。其中一例通过上睑皮肤皱襞切口并临时分离提上睑肌切除脂肪，另一例通过结膜切口切除脂肪。两例患者切除脂肪后，泪腺睑叶均向后复位，不再可见。两名患者术后均未出现额外的干眼症状。
泪腺睑叶结膜下脱垂可能与影像学检查发现的隐匿性眶脂肪疝有关。局部眶脂肪切除是治疗这种情况的有效方法。
