Due to different causes of treatment of lacrimal gland prolapse

     【Abstract】 Objective: To explore the different causes of lacrimal gland prolapse treatment. Methods: According to the cause of the patients were divided into trauma type, eyelids

    relaxation type, loose eyelid skin type 3 types. The lacrimal gland prolapse in patients with a total of 54 patients (88), with the exception of traumatic lacrimal gland prolapse reduction methods can be used, the remaining cases were used reposition or resection of the lacrimal gland, and was carried out before and after surgery tear secretion test and tear film break-up Determination of the time. Results: In three groups of cases, whether surgery or manual reduction were maintained lacrimal gland tear secretion and tear film function and lacrimal surgery patients had dry eye, foreign body sensation and other symptoms significantly. Conclusion: The different causes of lacrimal gland prolapse should take a positive approach and surgical reduction for the treatment, not only

    guarantees the integrity of lacrimal gland function and prevent the occurrence of dry eye, while also exposes patients to look to improve.

     Key words dry eye appearance of lacrimal gland prolapse in

     Therapy of lacrimal glands prolapse with different causes

     Xiao-Xia Ren, Xiao-Fen Zheng

     Department of Ocular Plastics, Eye Hospital of Shanxi Province, Taiyuan 030002, Shanxi Province, China

     Abstract AIM: To discuss the treatment of lacrimal glands prolapse with different causes. METHODS: Fifty-four

    cases (88 eyes) with lacrimal glands prolapse were divided into three groups: ocular trauma group, blephsrochalasis group and dermatochalasis group. Except lacrimal glands were relocated by hand in some traumatic cases, lacrimal glands

    reposition or resection were performed. Schirmer's test and BUT test were done before and after operation in all the patients. RESULTS: The results of Schirmer's test and BUT test were normal in the group of lacrimal glands repositione , but

    declined in the group of lacrimal glands resection in which dry eye and foreign body sensation occured. CONCLUSION: The reposition therapy, through opration or by hand. is effected to treat lacrimal glands prolapse with different causes.

     * KEYWORDS: lacrimal glands prolapse; dry eye; appearance

     0 Introduction

     The lacrimal gland is located outside the top of the orbital lacrimal fossa was extension of the levator muscle of the orbital septum into larger and smaller eyelid Department

    of the lacrimal gland, both in the rear is continuous, under normal circumstances the lacrimal gland is not palpable [1], when the lacrimal gland prolapse occurs due to different reasons, the clinical department commonly eyelid lacrimal gland, in the upper eyelid may reach outside the texture on the hard flat oval mass, and can be also satisfied to the orbit to the eye especially when the more obvious the next turn. Now our hospital out-patient at the 1999/2005 collection of the lacrimal gland prolapse in patients with a total of 54 patients (88) in retrospective study, reported as follows.

     An object and method

     1.1 The objects were 54 cases of lacrimal gland prolapse in patients (88 eyes). Trauma type in 6 cases (6 eyes), age 20 to 46 (mean 33) years old, 5 males and 1 female; eyelid lax-

    type 37 cases (60), age 36 to 67 (mean 47) years old, male 15 cases of and 22 females; eyelid skin and slow-type, 11 cases

    (22), age 12 to 23 (mean 17) years old, 2 males and 9 females.

     1.2 Methods All patients were in operation before the Schirmer tear secretion test: The use of 35mm × 5mm filter

    paper, the first foreign-side folding 5mm into the lower

    eyelid 1 / 3 within the conjunctival sac, 5min after the

remove, filter paper was wet tear length of 10 ~ 30mm were

    normal; less than 5mm were as abnormal. Determination of tear film break-up time (BUT): fluorescein eye drops, in the slit lamp inspection, using cobalt blue light inspection, when the tear film surface of the black hole (often for the spot,

    linear or irregular dry patches) that the tear film break-up .

    Blink from one spot start to appear dry time for the tear film break-up time, the normal for the 15 ~ 45s, is less than 15s, said the tear film instability. After 1mo, again for the above

    examinations. Surgical methods for the reduction of lacrimal gland surgery: local orbital deep superciliary arch and its surrounding tissue and the orbicularis muscle of subcutaneous infiltration anesthesia. Incision double eyelid operation in accordance with the design surgical incision, skin incision through the skin, cut off before a tarsus orbicularis oris muscle, open the orbital septum, removal of fat prolapse, prolapse of the lacrimal gland found (Chenganhongse, and adipose tissue different). Does not need to absorb 6-0 nylon

    suture line of the Ministry of the lacrimal gland in the eyelid deep orbital periosteum, the view eyelid know the situation of the lacrimal gland reset situation; close to the orbital margin of orbital overlap reinforced stitching,

    removal of loose skin, fascia interrupted suture through the tarsal plate the skin to form a satisfactory form of double eyelid. Postoperative pressure bandage, dressing was changed every other day, 1wk remove the skin stitches. Part of the lacrimal gland excision: ibid method prolapsed lacrimal gland after exposure to its removal, reinforced stitching orbital septum, removal of loose skin, fascia interrupted by the tarsal plate suture the skin, so that double eyelid appearance. Postoperative pressure bandage, dressing was

    changed every other day, 1wk remove the skin stitches. The lacrimal gland manual reduction surgery: the forthcoming prolapse of the lacrimal gland to the orbit is also satisfied that the organization after the pressure bandage, 0.5 ~ 1mo,

    some cases can be permanently reset.

     2 Results

     2.1 Preoperative Schirmer tear secretion test and determination of tear film break-up time (BUT) in patients

    with post-traumatic trauma group because of local tissue edema, inflammation heavier, determined that there were

    difficulties with the contralateral eye as a reference, the

    basic normal; eyelids relaxation type group in patients with long-term result of lacrimal gland prolapse, Schirmer test and BUT values decreased slightly, but basically within normal

    limits; eyelid skin type relaxation in patients with older age groups, Schirmer test and BUT values decreased slightly, but basically within normal limits; 3 Groups of patients were near normal.

     2.2 after 1mo Schirmer tear secretion test and

    determination of tear film break-up time (BUT) to the lacrimal

    gland resection was classified as a group, I combined a group. The experimental data with mean ? standard deviation, said,

    using single-factor t test statistical analysis (Table 1).

    Reposted elsewhere in the paper for free download http://

     2.3 The shape of eyelid surgery in patients with upper eyelid edema status were significantly improved, the lacrimal gland reset, blepharophimosis highly satisfactory results.

     3 Discussion

     Lacrimal gland prolapse more common in clinical practice, especially in eye plastic and orbital disease, when examined by a doctor to get a clear diagnosis, because some doctors for their attention and awareness is not enough, and often unknown

    or delayed diagnosis treatment, or even wrong treatment.

     Traumatic lacrimal gland prolapse is common in mechanical trauma, or accidents causing serious injury fighting the Department of orbital eyelid trauma, leading to the Ministry of the lacrimal gland of the eyelid prolapse, clinical manifestations of the lacrimal gland prolapse in the lateral upper eyelid, upper eyelid can be seen clearly outside of the Department of uplift. As prolapse of the lacrimal gland organizations, mostly in normal tissues, they have a normal

    secretory function, it will be reset to retain the normal lacrimal gland lacrimal gland organizations, to ensure the normal tear secretion, thereby maintaining the stability of tear film function, thus avoiding a series of complications.

    Previous clinical or because of lack of understanding of the lacrimal gland prolapse treatment of skin wounds and only ignores the lacrimal gland of the reset, or more to take the lacrimal gland surgery, but there is the lacrimal gland excretory duct of about 10 ~ 20, the opening on the outside on

    the dome conjunctiva, orbital lacrimal gland the Department of the catheter through the eyelid or the eyelid close to the Department of [2], when the lacrimal gland prolapse when the tear secretion function and quality of tears has not been

    seriously affected, and when the eyelid after excision of the Department of the lacrimal gland, as catheter was cut off, it means that all of the lacrimal gland was removed, and then tear caused by the lack of, leading to a variety of

    postoperative complications occurred, such as the eyes dry eye, patients often have sensitivity to light, flu, foreign body sensation, Suanzhang flu does not apply. The experimental results in this group has been confirmed, so traumatic lacrimal gland prolapse surgery should take an active reset. As the manual reduction may occur in the lacrimal gland prolapse again, repeated prolapse can affect the secretion of the lacrimal gland function, and therefore still have to reset the preferred method of operation.

     Lax eyelid syndrome is a cause of uncertainty eyelid disease mostly occurs in later adolescence. May be related to heredity, autonomic disorders, or endocrine disorders. Morbidity due to orbital septum and the lacrimal gland Lockwood ligament relaxation, causing the lacrimal gland and orbital fat prolapse, eyelid skin, causing the blood and lymph circulation disorder, and degenerative changes occur. Most patients showed recurrent episodes of eyelid skin angioedema, mainly involving the upper eyelid, eye disease. Both men and women the disease more common in young women. The beginning of this disease is characterized by upper eyelid skin edema, mild hyperemia, heavy early morning, after 2 ~ 3d can be self-

    limiting, issued a few days later, followed by thinning of the

    eyelid skin was purple, elastic disappear, wrinkles increase, often accompanied by There lacrimal gland prolapse and pseudo-

    ptosis, with lacrimal gland prolapse except for the skin on the bottom of the orbital margin slightly bulging at the

    orbital margin of the reach of a sliding mass block, turning on the dome exposed to the Ministry of upper eyelid may be out on the dome to see the subconjunctival prolapse of the lacrimal gland. Relaxation eyelid syndrome is divided into two

    types of proliferative and atrophic [3-5], the above described

    as proliferative, atrophic type showed orbital fat absorption, on the orbital area depression, and the tarsal levator tendon membrane on the separation of Authenticity ptosis in clinical practice in order to proliferative more common, the line

    surgical treatment must be attention to protecting the levator to avoid iatrogenic ptosis at the same time period as far as possible to avoid surgery edema, or severe postoperative reaction, affect the outcome.

     Eyelid skin disorder is an age-relaxation changes, more

    common in the elderly, occasionally seen in middle-aged, due

    to lax eyelid skin, orbital septum is weak, with the fat and lacrimal gland prolapse. Due to age of onset is too large, tear secretion function started to decline, while the lacrimal gland prolapse is bound to increase the patient's condition and should be timely surgery, at the same time due to the correction of the appearance of the eyelids to achieve cosmetic results [6]. The water layer of the tear film and

    vice lacrimal gland secretion by the lacrimal gland, which is the main component of the formation of the tear film. In some diseases, can cause partial or total lack of tears, the tear film can not form normally [7]. For example: lacrimal gland

    inflammation and cancer, due to extensive damage Erzhi lacrimal gland atrophy; lacrimal trauma, surgery and so on. This shows that organizations in the lacrimal gland tear secretion and tear film stability plays an important role and

    can not be removed while the eyelids due to morphological changes induced by the lacrimal gland prolapse, affecting appearance, surgical treatment should be promptly reset the lacrimal gland organization, cut loose skin, to achieve Functional treatment and cosmetic results of a dual purpose.

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