Anterior Palpability and Proptosis as Clinical Predictors of Ptosis in Lacrimal Gland Tumors

This study aimed to develop clinical prediction models for pretreatment and posttreatment ptosis in patients with lacrimal gland tumors using readily available examination findings. This retrospective study included 26 patients who underwent surgery for unilateral lacrimal gland tumors. Linear regression models were constructed to predict (1) pretreatment margin reflex distance-1 (MRD-1) difference between the affected and unaffected sides and (2) the change in MRD-1 after treatment (ΔMRD-1), using anterior palpability and pretreatment proptosis difference as candidate predictors. The optimal model for each outcome was selected based on the Akaike information criterion (AIC) and leave-one-out cross-validated R2 (Q2). The optimal model for pretreatment MRD-1 difference included palpability alone (β=-1.36 mm, bootstrap 95% CI: -2.18 to -0.54; Q2=0.156) and that for ΔMRD-1 included both palpability and proptosis difference, with proptosis as the primary predictor (β=-0.21 mm/mm, bootstrap 95% CI: -0.36 to -0.07; Q2=0.195). Among 13 palpable tumors with pretreatment ptosis, posttreatment ptosis persisted in 12 cases (92%), with only partial recovery in 5 cases. The direction of the palpability effect was consistent across all 4 disease categories examined. Two simple clinical findings-palpation and exophthalmometry-can predict pretreatment and posttreatment ptosis patterns in lacrimal gland tumors, providing clinically actionable information for patient counseling and surgical planning.