Lateral eyelid bulging is the only recognized sign of lacrimal gland prolapse in the literature which is not sensitive nor specific. The aim of this study is to introduce a new (Supine) test and assess the values of lateral eyelid bulging for diagnosis of lacrimal gland prolapse before upper blepharoplasty

In a prospective case series (2011-2017), lateral eyelid bulging and Supine Test were recorded, preoperatively. Lacrimal gland prolapse was graded as mild (< 4mm), moderate (4-7 mm), and severe (>7mm). A few spots of cautery on lacrimal gland capsule was performed in patients with bilateral mild and suture repositioning in unilateral or bilateral moderate and severe lacrimal gland prolapse. Patients with asymmetric lacrimal gland prolapse was treated based on more severe grade, bilaterally

Included were 1207 patients. Frequency of positive Supine Test (11.8%, 142/1207) increased from almost 10% in patients under age 41 to 15% in more than 60 years. Their mean age was significantly older and 53.2% showed asymmetric lacrimal gland prolapse. Septum was just opened in patients with positive Supine Test and all had lacrimal gland prolapse of ≥3 mm (mean: 5.6 mm, range: 3-14 mm). Mild, moderate and severe lacrimal gland prolapse were observed in 22.5%, 62.6%, and 14.7% of the patients, respectively. Mean follow up time was 22 months (12-60 months). Recurrence was observed in one patient (bilateral) after suture repositioning. Lateral eyelid bulging had a high negative (96.2%) and low positive (30.6%) predictive value as compared to the Supine Test.

Positive Supine Test means lacrimal gland prolapse of ≥3 mm (100% positive predictive value). Negative lateral eyelid bulging was highly predictive of no lacrimal gland prolapse.