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.

It would be quite difficult for a qualified surgeon to remove the lacrimal gland during blepharoplasty. The gland sits in the lateral aspect of the orbit and the fat is in the middle and medial areas. Dry eyes after blepharoplasty is more likely due to a change in the tear film due to swelling and inflammation and a change in the muscular contraction of the upper lid. The effects if mild are usually temporary, but it should certainly be followed by an ophthalmologist to ensure that the eyes do not get to dry. Good luck.

Upper eyelid blepharoplasty or eyelid lift usually consists of removal of excess skin and contouring of upper eyelid fat pads. The upper eyelid has two main pads while the lower eyelid has three. The upper lid pads are medial (closer to the nose) and central (in the center of the eyelid). The third upper lid pad is not fat but the lacrimal gland. The lacrimal gland has a different consistency that fat. An ocular plastic surgeon who specializes in eyelid surgery would definitively know this anatomy well. It would be highly unusual to remove this gland. Dryness after blepharoplasty is usually related to the eye being more open and more air then being able to hit against the eye. Usually there is a pre existing condition called Sicca. Your Ocular plastic Surgeon would normally examine your eye for this condition prior to any surgical under taking.
If this was not checked for prior, it can be noted after by an excellent Ocular plastic Surgeon or ophthalmologist. They will examine your eye with a microscope called a slit lamp and perform a tearing test.

The lacrimal gland is located at the far end of the blepharoplasty incision and is usually tucked under the eye socket. As such it is difficult to reach even if you tried to remove it which makes its removal unlikely. Drier eyes can be common after blepharoplasty so do use humidifying agents like dura tears until the situation improves.

It is possible that the lacrimal glad was removed, but very unusual and very unlikely. However, if there is any question, then you should see an ophthalmologist. In the mean time, it is very important the you keep your eyes well-lubricated with liquid tears or some other lubricating product to prevent further problems. Good luck.

Anatomically, the lacrimal gland is in such a distinct location that it would be difficult for a surgeon to remove it by mistake. My bold assumption is that you experience dry eye complaints after an upper blepharoplasty. These dry eye issues are relatively common and usually temporary. Occurence of dry eyes do not mean that your surgeon did something wrong. It is rather your eyes' response to the eyelid lift.

The modern upper blepharoplasty relies on removal of excess skin, occasionally obicularis muscle, and rarely fat. Below the upper eyelid muscle and orbital septum, there are 3 compartments - lateral, middle, and medial (closest to the nose). The lateral compartment contains the lacrimal gland, the middle contains a yellowish colored fat pad, and the medial contains a whiter colored fat pad. In the past, many eyelid surgeons removed too much orbital fat. I've seen hundreds of these patients who have that "sunken-in" deep upper orbital sulcus or the so called "A-frame deformity" - which is not aesthetic. This deformity can be corrected with fat grafting or a safe filler.
If I remove upper orbital fat, it is usually a small amount from the compartment closest to the nose. I rarely remove fat from the middle compartment and never disturb the lacrimal gland. The lacrimal glands provide tear lubrication for the eyes, thus removal or partial removal can cause a dry eye.
Your Plastic Surgeon should ask you before eyelid surgery if you have a history of dry eyes. If your Plastic Surgeon suspects you have dry eyes, he can perform a simple test on both eyes called a Schirmer's Test. This test involves placing a small strip of filter paper under your lower lid and measuring the length of the wetness. A normal test is greater than 10 mm of moisture on the filter paper after 5 minutes.

The lacrimal gland is located in the lateral part of the orbit. Part of the eye muscle used to lift the eyelid sits between two lobes of the lacrimal gland. To remove it during blepharoplasty is an almost unheard of complication. It is technically possible and I am sure somewhere in the history of eyelid surgery, someone has done it. The consequences can be disasterous in that the production of tears would be gone from the eye and the eye. More commonly, I have seen a few patients who had their lacrimal gland damaged  during blepharoplasty. Sometimes patients' lacrimal glands can prolapse or drop down from the recess in the eye socket into a more visible area. During surgery the lacrimal gland does not have the same consistency  as fat and so usually the surgeon doesn't remove it completely but realizes halfway through that this is not fat. When the gland is damaged like that sometimes it is still functional, other times the patient needs to lubricate their eyes to compensate. Overall though it is a very rare thing to happen.

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.