Supine Test: A New Test for Detecting Lacrimal Gland Prolapse before Upper Blepharoplasty
Amir Tabrizi1 *, Mohsen Bahmani Kashkouli1
- Eye Department, Eye Research Center, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
Abstract: Purpose: To introduce a new (Supine) test and assess the
values of lateral eyelid bulging for diagnosis of lacrimal gland
(LG) prolapse before upper blepharoplasty.
Methods: Methods: 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
(4–7mm), and severe (>7mm). A few spots of cautery on LG
capsule was performed in patients with bilateral mild and suture
repositioning in unilateral or bilateral moderate and severe LG
prolapse. Patients with asymmetric LG prolapse were treated
based on more severe grade, bilaterally.
Results: Results: Included were 1,207 patients. Frequency of positive
Supine Test (11.8%, 142/1,207) increased from almost 10% in
patients less than 41 years of age to 15% in more than 60 years of
age. Their mean age was significantly older, and 53.2% showed
asymmetric LG prolapse. Septum was just opened in patients
with positive Supine Test, and all had LG prolapse of ≥3mm
(mean: 5.6mm, range: 3–14mm). Mild LG prolapse, moderate
LG prolapse, and severe LG 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 1 patient (bilateral) after suture repositioning. Lateral eyelid
bulging had a high negative (96.2%) and low positive (30.6%)
predictive value when compared with the Supine Test.
Conclusion: Conclusions: Positive Supine Test means LG prolapse of
≥3mm (100% positive predictive value). Negative lateral eyelid
bulging was highly predictive of no LG prolapse.
