The lacrimal caruncle, that reddish-pink, barely noticeable lump sitting quietly in the corner of your eye (inner canthus, to be precise), can go years without being acknowledged. You blink past it, rub your eyes, cry over movies, scroll through phones, and there it sits. Until one morning, it doesn’t look so quiet anymore. It’s puffed. Or red. Maybe even sore. Something feels wrong. Maybe something is wrong.
And this might be more than just a temporary irritation. This could be lacrimal gland insufficiency.
First: That Lacrimal Caruncle Isn’t Just Cosmetic
The lacrimal caruncle, that tiny pinkish blob tucked into the corner where your upper and lower eyelids meet, isn’t some random squishy tissue. It’s a mix of skin-like layers, sweat glands, sebaceous (oil-making) glands, and yeah, even tiny hairs. Wild, right? It’s positioned precisely near the tear drainage spot. On purpose. Not by accident.
And while it rarely asks for attention, it’s not just sitting there looking weird for fun. That little structure plays defense, helping keep the front of your eye clean, slick, and guarded against daily grind, wind, and the chaos of modern life.
But then one morning, maybe after sleep or a long screen session, it looks… bigger. Off. Maybe swollen, red, or with crust forming around it. Or you rub your eye, expecting relief, but get that weird sandpaper feeling instead. Suddenly, it’s gritty. Annoying. Possibly even painful.
At this point, it’s no longer just “oh, maybe I touched my eye too much.” Something’s off. That enlarged lacrimal caruncle could be your early warning, the system’s check-engine light blinking quietly, that something upstream isn’t working right.
Specifically, the lacrimal gland of the eye, the one tasked with keeping the whole tear-production machine running, may be falling behind. Or failing. Or inflamed. Either way, the lacrimal caruncle is speaking up, and if you’re paying attention, you’ll know it’s time to look beyond the surface.
Let’s Talk Glands: Lacrimal, Specifically
The lacrimal gland (main tear-producing gland), perched right above the outer upper part of each eye socket, is about the size of an almond and lives inside a bone depression called the lacrimal fossa (a small hollow in the orbital bone).
It’s primary job is not crying. It’s lubrication. Protection. Comfort. This gland lacrimal sends watery tears through a system of ducts to coat your cornea (the eye’s clear front window), making it easier to blink, see, and avoid getting microscopic scratches every time dust or wind enters your face.
When the lacrimal glands eye begin failing to pump out enough of this watery component, we step into dry territory, medically, that’s aqueous-deficient dry eye (one subtype of dry eye disease). Not caused by evaporation, but by underproduction. Like having a sink with a working drain but a broken tap.
Signs? Symptoms? Clues You Shouldn’t Ignore
The moment you start getting signs like:
- Constant dryness
- Irritation that doesn’t go away with artificial tears
- A swollen lacrimal gland that pushes slightly on the eyelid
- Lacrimal duct swelling (inflammation of the channels that drain tears)
- An enlarged lacrimal caruncle that looks red and puffy
- A visible or palpable lump near the eyebrow (suggesting puffy lacrimal gland or even lacrimal gland prolapse)
… you should pause.
Not panic. Just pause.
Because the lacrimal system isn’t just some random eye feature. It’s a part of a finely tuned balance, tear production, drainage, evaporation, and if that balance tips, symptoms stack. What starts as minor dryness can become corneal damage over time.
Lacrimal Gland Prolapse? What Even Is That?
Sometimes, the lacrimal gland physically shifts downward. This slipping out of its pocket can be due to age, trauma, inflammation, or chronic swelling. It bulges into the upper eyelid, visible when you lift the lid. This is lacrimal gland prolapse.
You might not feel pain, but you’ll see a bulge. Maybe a slight asymmetry between eyes. Maybe a shadow when looking up. Sometimes it causes pressure or heaviness, depending on the size.
That’s when your lacrimal caruncle might also react, looking enlarged, irritated, or caruncula lacrimalis swollen from the upstream dysfunction.
What’s Breaking the System? Causes of Gland Failure
Let’s get one thing clear. This isn’t always just about aging. Surely, people over 50 are more likely to experience tear gland failure, but there are other factors included as well:
- Autoimmune disorders: Especially Sjögren’s syndrome, where the immune system attacks glands that produce moisture.
- Chronic inflammation: Ongoing low-grade swelling quietly destroys gland tissue.
- Hormonal shifts: Menopause, pregnancy, even thyroid conditions can mess with gland output.
- Certain meds: Diuretics, antihistamines, antidepressants, all dry things out.
- Neurological issues: Damage to the facial nerve (cranial nerve VII), which controls tear signals.
And if any of these reduce the gland’s ability to push tears through the ducts? You’ll feel it. Or rather, your corneas will, every time you blink.
On the Cellular Level: AQP5 and Tear Transport
Let’s go microscopic.
Inside your lacrimal gland, there’s a protein called AQP5 (Aquaporin 5). Its job? Move water molecules through glandular cells and out into the tear ducts. Think of AQP5 as the channel that allows fluid to exit cells and become part of your tears.
But in inflammatory conditions, like Sjögren’s, AQP5 doesn’t behave. It gets stuck in the wrong part of the cell (cytoplasm instead of membrane), meaning tears aren’t secreted effectively.
A study showed that in Sjögren’s patients, AQP5 was mislocalized, reducing functional water transport, and leading to dry eye symptoms despite apparently intact glands.
And this failure cascades, leading to a lacrimal gland swelling that isn’t just swelling. It’s a warning flare.
Diagnosis: Getting to the Bottom of It
There’s no single test. Doctors often start with:
- Slit-lamp exam: For tear film break-up time and corneal damage
- Tear osmolarity: High salt concentration = dry tears
- Schirmer’s test: Filter paper strip under eyelid to measure tear volume
- Imaging: MRI or ultrasound for detecting puffy lacrimal gland or lacrimal gland prolapse
- Biopsy: In autoimmune cases or unexplained swelling
They also inspect the lacrimal caruncle for signs; sometimes it’s more inflamed than the eyeball itself. That’s a clue.
Treatment: It’s Not Just About Eye Drops Anymore
Sure, artificial tears are the go-to. But that’s like putting a wet paper towel over a dry sponge. You need more.
What doctors actually use now:
- Anti-inflammatories: Cyclosporine A, Lifitegrast (T-cell inhibitors that reduce inflammation)
- Secretagogues: Like Diquafosol, which stimulates water release from the lacrimal glands eye
- Nano-formulas: Smaller particles = deeper absorption
- Scleral lenses: Trap moisture directly against the cornea
- Punctal plugs: Close tear drainage holes so tears stick around longer
- Autologous serum: Drops made from your own blood, filled with healing growth factors
Another study in 2015 found that stem cell therapy and bioengineered lacrimal tissues might soon offer actual regeneration for damaged tear glands.
In autoimmune cases, treatment shifts upstream, to immune suppression, hormone balancing, or nerve modulation.
And What Can You Do?
Simple habits, real impact:
- Hydrate: Every system in your body, including tear production, runs on water.
- Blink consciously: Especially during screen time.
- Avoid eye fans/heaters: Evaporation is real.
- Eat omega-3s: Fatty acids reduce eye inflammation.
- Use humidifiers: Especially in dry winters or air-conditioned spaces.
Also, don’t rub your eyes. It might feel good, but it triggers histamines that increase swelling, especially in the lacrimal caruncle.
Closing Out: The Caruncle Isn’t Silent, It’s Speaking
This small bump, the lacrimal caruncle, tucked into the edge of your eye, may be trying to tell you something very important. Don’t ignore it.
When it’s red, sore, or enlarged, don’t just chalk it up to bad sleep. It may be reflecting a deeper issue in your lacrimal gland of eye. Especially if you’re also experiencing dryness, irritation, or visible lacrimal duct swelling.
Your tears aren’t just emotional props; they’re frontline defenders of your vision. And when production slows, symptoms follow.
So if the caruncula lacrimalis is swollen, your lacrimal gland might be in distress. And if it is, don’t wait. See a specialist. Get tested. Reboot your tear system before things get gritty.