Unilateral LGE was performed under 1.5% to 2% isoflurane anesthesia. The extraorbital lacrimal gland was accessed through a 3-mm incision made anterior and ventral to the ear (Fig. 1A). The intraorbital lacrimal gland, located rostral to the extraorbital gland within the ventral orbit, was approached with a smaller 1-mm incision, taking care to avoid surrounding blood vessels and nerves (Fig. 1B). For the single LGE treatment group, only the larger extraorbital lacrimal gland was excised, whereas both the extraorbital and intraorbital lacrimal glands were excised in the double LGE treatment group. For sham surgeries, two incisions were made and both glands were partially exposed.