Palpebral Pleomorphic Adenomas of the Lacrimal Gland

To report the characteristics and management for patients with palpebral pleomorphic adenoma of the lacrimal gland.

The records for patients with palpebral pleomorphic adenoma seen at Moorfields Eye Hospital between 1978 and 2019 were reviewed for demographics, presentation, imaging, histopathology, management, and outcome.

Forty-three patients (25 male; 58%) with palpebral pleomorphic adenoma were identified, presenting at a mean age of 46 years (median 46.4 years; range 24-81 years) with symptoms for an average of 31 months (median 18.0 months; range 1 month to 17 years). The commonest symptom was a painless upper lid lump (37 patients; 86%), although 4 patients (9%) had a localized ache, and 1 (2%) had episodic epiphora. A moderately-mobile, firm round mass (like a "chick-pea") was readily palpable in 39/43 (91%) patients, and significant ptosis and upper lid swelling was noted in 6 cases (14%). Imaging was reviewed in 35 patients, 28 (80%) having a well-defined homogeneous mass in front of the orbital rim, on the anterior pole of the lacrimal gland. With the exception of 8 tumors removed from the actual palpebral lobe using a conjunctival incision, all others were excised intact through an upper eyelid skin-crease incision. Histopathology confirmed an intact pseudocapsule in 39/43 (91%) and 10 (23%) had a mild chronic lymphocytic inflammation within the tumor and/or neighboring lacrimal gland. There were no tumor recurrences at an average follow-up of 40 months (median 9.1; range 2 weeks to 230 years).

Most palpebral pleomorphic adenomas are discovered as an upper lid lump and a few first become manifest as upper lid swelling with ptosis. To avoid inadvertent incisional biopsy, they should be recognized preoperatively-especially as most are readily palpable as a hard lump superotemporally, often freely mobile in the suborbicularis plane (anterior to the tarsus and main lacrimal gland). Excision, generally easiest through a transcutaneous route, was judged intact in all cases and confirmed in 91% of histological reports, with no recurrent tumors.