Whitnall’s barrier: a technique for the management of lacrimal gland prolapse

Background: Whitnall’s barrier procedure, a modified Beer and Kompatscher surgical technique to reposition the lacrimal gland is presented alongside a case series of patients demonstrating excellent aesthetic and functional outcomes. Methods: The Whitnall’s barrier procedure is illustrated procedurally and accompanied by a case series of 20 consecutive patients attending our institution between December 2016 and February 2020. All patients were cared for by a single surgical team. Lid contour and function were assessed post-operatively, as was patient satisfaction. Results: Thirty-seven eyes of 20 patients were included. All patients were female with an average age of 50 years. Fourteen patients underwent surgery for cosmesis; four had inactive thyroid eye disease and two had lacrimal gland enlargement secondary to dacryoadenitis. The degree of lacrimal gland prolapse was described as “mild” in two eyes and “moderate” in 35. All cases had one or more additional surgical procedures. Mean follow up duration was 11 months with complete resolution of lacrimal gland prolapse in 34 eyes. The patient who did not have complete resolution had dacryoadenitis and required ongoing immunosuppressive therapy. Two patients were discharged on topical lubricants, one with thyroid eye disease, and one cosmetic patient who underwent upper and lower lid blepharoplasties at the same time. There were no intra-operative complications and no incidences of infection, dehiscence or damage to the lacrimal gland ductules. Conclusions: The Whitnall’s barrier technique is a safe and effective surgical procedure to restore the anatomical location of the lacrimal gland with excellent aesthetic and functional outcomes.