What should I look for in surgery for lacrimal gland pleomorphic adenoma? Surgery for lacrimal gland pleomorphic adenoma is a very delicate procedure. Due to the active biological behavior of lacrimal gland pleomorphic adenoma, puncture biopsy will destroy the pseudo-envelope on the surface of the tumor, which will easily cause the tumor cells to spread and implant into the surrounding tissues and puncture channels, resulting in postoperative recurrence or even malignancy. Therefore, according to the clinical and imaging manifestations, puncture biopsy should be contraindicated for confirmed or suspected lacrimal gland pleomorphic adenoma. Surgical excision is the primary treatment for lacrimal gland pleomorphic adenoma. The surgical focus is on adequate surgical exposure, removal of the orbital periosteum, and delicate operation to avoid intraoperative rupture of the tumor. The tumor should be removed as a whole as much as possible at one time, and the pseudo-envelope of the tumor should not be destroyed during surgery to prevent postoperative recurrence. For larger tumors or obvious bone destruction, a lateral orbital approach should be adopted to remove part of the bone and fully expose the lacrimal fossa to completely remove the tumor and excise the affected periosteum and orbital bone in order to prevent tumor recurrence. The excised tumor tissue is subjected to histopathological examination. Surgical excision is the mainstay of treatment for lacrimal gland pleomorphic adenoma. The surgical focus is on adequate surgical exposure, excision of the orbital periosteum, and delicate manipulation to avoid intraoperative tumor rupture. As far as possible, the tumor should be removed as a whole at one time, and the pseudo-envelope of the tumor should not be destroyed during surgery to prevent postoperative recurrence. For larger tumors or obvious bone destruction, a lateral orbital approach should be adopted to remove part of the bone and fully expose the lacrimal fossa to completely remove the tumor and excise the affected periosteum and orbital bone in order to prevent tumor recurrence. The excised tumor tissue should be examined histopathologically.