Purpose: To analyse clinical referral diagnoses and the location of lesions wi th histologically verified lacrimal gland tissue occurring outside the fossa of the lacrimal gland. Methods: Sections of lesions excised from areas outside the fossa of the lacrimal gland containing lacrimal gland tissue on histological exa mination were collected from the files of the Eye Pathology Institute, Copenhage n, Denmark. Specimens spanned a period of 50 years. Sections were re-examined a nd referral data on location and clinical diagnosis were compared with histologi cal findings. Results: A total of 120 lesions were collected. Of these, 59 (49% ) consisted of prolapsed lacrimal gland. The remaining 61 (51%) lesions contain ed ectopic lacrimal gland tissue, either as part of a complex choristoma in 38 ( 32%) cases, or as solitary ectopic lacrimal gland tissue in 23 (19%) cases. Th e majority (97; 81%) of lesions had been located at the temporal epibulbar conj unctiva and included mainly prolapsed lacrimal gland and complex choristoma. The clinical referral diagnoses covered a wide spectrum of lesions. The most freque nt clinical diagnoses were non-specific tumour (35%), non-specific cyst (18% ) and dermoid (11%). Of the 61 lesions containing ectopic lacrimal gland tissue , only two had been preoperatively diagnosed as such and only two of the 59 lesi ons with prolapsed lacrimal gland had been correctly diagnosed. Conclusions: Pro lapsed palpebral lobe of the lacrimal gland was the most common lesion and, as e xpected, the prime location was the temporal conjunctiva. Despite this location, the referring clinical diagnosis was often wrong or non-specific. Surgeons see m to have been unaware of the various clinical manifestations of extrafossal gla ndular tissue, particularly when excising lesions in the upper temporal region o f the conjunctiva. Surgical intervention in this location may jeopardizethe excr etory ducts of the lacrimal gland and may consequently lead to dry eye and thus should be avoided when the typical clinical appearance of prolapsed lacrimal gla nd is encountered.
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