Lacrimal Gland Biopsy
This is Richard Allen at the University of Iowa. This video demonstrates biopsy and repositioning of the lacrimal gland.
A 15 blade is used to make an incision along the eyelid crease which was previously marked.
Dissection is then performed through the orbicularis muscle to expose the orbital septum.
The orbital septum is then opened laterally and the preaponeurotic fat is identified.
The lacrimal gland is positioned lateral to the preaponeurotic fat and identified.
The gland is identified and dissected from the preaponeurotic fat and underlying levator aponeurosis.
A 15 blade is then used to take a biopsy of the gland.
There can often be brisk bleeding from the gland and cautery should be readily available. In this case, there was lacrimal gland prolapse and will be repositioned.
The gland is then repositioned by engaging the inferior aspect of the gland with a double armed 5-0 vicryl suture.
The needle then engages the periosteum of the superior orbital rim inside the rim.
Tying the suture results in repositioning of the gland posterior to the orbital rim.
Usually one or two sutures is enough to reposition the gland appropriately.
The incision is then closed with interrupted 6-0 Prolene sutures.