Lacrimal Gland Mistakenly Removed?

Dear Dog
As Dr. Berkowitz points out, an eyelid surgeon should know their anatomy and the lacrimal gland should be left alone. Occasionally the lacrimal gland can hang into the upper eyelid making a bulge. This situation is obvious to an experienced oculoplastic surgeon at the time of the pre-operative assessment. The solution is to tack the lacrimal gland back up under the orbital rim. During surgery the lacrimal gland is often exposed in the upper eyelid. However, it is very clear what is lacrimal gland and what is orbital fat. Routinely, the lacrimal gland should be left alone or tack up if it is prolapsing into the upper eyelid and not resected.
Unless you know specifically that your surgeon removed your lacrimal gland, it is very likely that it is still there. If your question is prompted because of dry eye symptoms, you should know that the bulk of the tears used to maintain the moisture on the surface of the eye is not produced in the lacrimal gland per se but rather the so-called accessory lacrimal glands. These are found in the tissue that lines the eyelids-the conjunctiva.
It is common to have some dry eye after eyelid surgery for a period of a few weeks. Again pre-operative assessment prior to eyelid surgery should include an assessment of the tear production and a series of questions regarding dry eye symptoms. Typically use of ointment at bedtime and artificial tears during the day help these symptoms until the swelling after eyelid surgery is resolved.
If you are having a lot of dry eye symptoms after eyelid surgery, and it has been more than 6-8 weeks after eyelid surgery, you should be assessed by you eyelid surgeon. If your surgeon was not a fellowship trained eye plastic surgeon, you might benefit from a consultation from this type of specialist. Go to ASOPRS.org, the website for the American Society for Ophthalmic Plastic and Reconstructive Surgery, to find one in your area. General ophthalmologists are also trained to address dry eye but it is helpful to be assessed by an individual who is specially trained to manage the eyes and eyelids under these circumstances.

The lacrimal gland can be mistakenly removed from a blepharoplasty. However, it is in such an anatomical position that it is nearly impossible to remove. It is located very lateral in the eyelid nowhere near the orbital fat and has a different consistency than normal fat. If it is removed, dry eyes will ensue. It is a good idea to have a Schirmer test by your ophthalmologist to determine where the functioning tear production is in your eyelids.

The lacrimal gland is tucked up under the rim of the orbital vault laterally and is difficult to access through a standard upper blepharoplasty incision. This complication is rare at best. Only in very elderly patients is ptosis (or drooping ) of the lacrimal gland common. In that scenario an experienced surgeon would need to be aware of the possibility of its anatomic location only, and still this would be an unlikely complication.