Name of the Procedure:

Excision of lacrimal gland (dacryoadenectomy), except for tumor; total

Summary

A total dacryoadenectomy is a surgical procedure to remove the entire lacrimal gland, which is responsible for tear production, when the gland is not affected by a tumor.

Purpose

This procedure addresses chronic inflammation, infection, or other non-tumorous conditions of the lacrimal gland that do not respond to other treatments. The goal is to relieve symptoms such as pain, swelling, and excessive tearing.

Indications

• Persistent dacryoadenitis (inflammation of the lacrimal gland)
• Chronic infection of the lacrimal gland
• Obstruction or dysfunction of the tear drainage system causing recurrent issues
• Pain or swelling unresponsive to medical management

Preparation

• The patient may be instructed to fast for a certain period, usually 8-12 hours before the procedure.
• Medication adjustments may be necessary, especially for blood thinners.
• Preoperative diagnostic tests might include imaging studies like an MRI or CT scan to assess the extent of gland involvement.
• General medical clearance and lab tests may be required.

Procedure Description

1. The patient is administered general anesthesia to ensure they are asleep and pain-free.
2. An incision is made near the upper eyelid or above the orbital rim, depending on the approach.
3. The surgeon carefully dissects around the lacrimal gland, separating it from surrounding tissues.
4. The entire lacrimal gland is removed.
5. The incision is then closed with sutures, and a sterile dressing is applied.

Duration

The procedure typically takes 1-2 hours.

Setting

This surgery is performed in a hospital or surgical center operating room.

Personnel

• Ophthalmic surgeon
• Anesthesiologist
• Surgical nurses and technicians

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Scarring or poor wound healing
• Temporary or permanent changes in tear production leading to dry eye
• Injury to surrounding structures, including muscles, nerves, or blood vessels

Benefits

• Relief from chronic pain and swelling
• Resolution of recurrent infections or inflammation
• Improved quality of life and eye comfort
• Most patients will start to notice improvement within a few weeks post-surgery.

Recovery

• Post-operative care involves using prescribed antibiotic and anti-inflammatory medications.
• Patients are advised to avoid strenuous activities and follow specific wound care instructions.
• Follow-up appointments are essential for monitoring healing and managing any complications.
• Full recovery may take several weeks to a few months, with most patients resuming normal activities in about 2-4 weeks.

Alternatives

• Medical management with antibiotics or anti-inflammatory medications
• Minor surgical procedures like dacryocystorhinostomy (DCR) for tear duct obstruction
• Conservative treatments including warm compresses and gland massage
• Each alternative has its own risks and benefits, often weighed against the specific condition severity and patient factors.

Patient Experience

• During the procedure, the patient will be asleep under general anesthesia.
• Post-surgery, the patient may experience discomfort, swelling, and bruising around the eye, managed with pain relievers.
• Vision may be temporarily affected, with improvement as healing progresses.
• Emotional support and reassurance are integral, as the eye area is sensitive and the appearance can temporarily change.