title: Subconjunctival prolapse of the palpebral lobe of the lacrimal gland occurring in association with occult orbital fat herniation.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, UK.
authors.forename: Ana M S
authors.initials: AM
authors.lastname: Morley
authors.forename: Raman
authors.initials: R
authors.lastname: Malhotra
mesh_terms: D000273:Adipose Tissue / Q000473:pathology* / Q000601:surgery; D000369:Aged, 80 and over; D003229:Conjunctival Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006547:Hernia / Q000150:complications* / Q000000981:diagnostic imaging; D059685:Herniorrhaphy; D006801:Humans; D007765:Lacrimal Apparatus / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D007766:Lacrimal Apparatus Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009916:Orbital Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D011391:Prolapse; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed