Refractory Dry Eye Syndrome after Transconjunctival Excision of the Palpebral Lobe of the Lacrimal Gland

The aim of the present study was to report two cases of refractory dry eye syndrome (DES) after transconjunctival excision of the palpebral lobe of the lacrimal gland. A 25-year-old female patient with a chief complaint of a palpable mass in both upper eyelids visited our medical center. Preoperative orbital computer tomography showed high-attenuation lesions in both lacrimal glands. Incisional biopsy of the lacrimal gland palpebral lobe via transconjunctival incision was performed in January 2019. At 1 month after the biopsy, a lack of tears and persistent corneal erosions were found in both eyes. Artificial tears, punctal occlusion, autologous serum eye drops, and therapeutic contact lenses were applied in an attempt to control the dry eye symptoms. The patient continues to suffer from intractable DES at 2.5 years after the procedure. The second case involved a 52-year-old female patient who visited our medical center with a chief complaint of a palpable mass in both upper eyelids. Bilateral orbital tumors were diagnosed with preoperative magnetic resonance imaging. An incisional biopsy of the lacrimal gland was performed. Immunoglobulin G4-related dacryoadenitis was confirmed through lacrimal palpebral lobe incisional biopsy. Intractable DES and corneal erosion of her left eye persisted thereafter. A transconjunctival incision is an effective approach for minimizing postoperative scars and is suitable for the biopsy of tumors that are visible through the conjunctiva. After a biopsy of the palpebral lobe of the main lacrimal glands, the secretion of reflex tears decreases due to damage to the secreting ducts of the main lacrimal glands. However, total tear secretion can be maintained by basal tear secretion from the accessory lacrimal glands. In this report, we describe two cases of refractory DES due to decreased total tear secretion, although only the palpebral lobes of the main lacrimal glands were biopsied.

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Tear secretion from the lacrimal gland: variations in normal versus dry eyes

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-318159 ◽

2021 ◽

pp. bjophthalmol-2020-318159

Author(s):

Swati Singh ◽

Swapna S Shanbhag ◽

Sayan Basu

Keyword(s):

Dry Eye ◽

Flow Rate ◽

Lacrimal Gland ◽

Healthy Subjects ◽

Time Lag ◽

Similar Time ◽

Dry Eyes ◽

Tear Secretion ◽

Direct Assessment ◽

Tear Flow

PurposeTo investigate the secretory status of the main lacrimal gland in healthy and dry eye disease (DED) via fluorescein-assisted direct assessment of tear secretion from the palpebral lobes.MethodsIncluded were 25 healthy subjects (50 lobes) and 75 subjects with DED (cicatrising conjunctivitis (CC, n=27), evaporative dry eyes (EDE, n=25) and Sjogren’s syndrome (SS, n=23)). Analysed parameters included number and location of ductular openings, tear flow rate per gland and per ductule, and the time lag for the initiation of secretion.ResultsDuctular openings could be observed in all patients with EDE and healthy subjects whereas only 33% (18/54) glands of CC patients and 67% glands (31/46) patients with SS revealed ductules. The median number of ductules per lobe was 4 in normal (range 3–5), 3 in EDE (3–6), 1 in SS (0–3) and 0 in CC group (0–3) (p<0.000001). The median tear flow rate per lobe in CC (0.00 μL/min) and SS (0.21 μL/min) was significantly lesser than normal lobes (1.05 μL/min, and EDE (0.99 μL/min eyes. The tear flow rate differed significantly between SS and CC group (p<0.0001). The maximum time lag occurred in the CC group (median, 20 s), followed by the SS group (median, 1.5 s) whereas the EDE group had similar time lag (<1 s) as of normal glands (p<0.0001).ConclusionDirect assessment of tear secretion from the palpebral lobe demonstrates significant differences between EDE, aqueous deficient dry eye and dry eye in CC.

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Ultrasonic Predictors of Dry Eye Syndrome in Sarcoidosis

Journal of radiology and nuclear medicine ◽

10.20862/0042-4676-2019-100-4-186-191 ◽

2019 ◽

Vol 100 (4) ◽

pp. 186-191

Author(s):

T. N. Safonova ◽

S. I. Kharlap ◽

O. V. Eksarenko

Keyword(s):

Dry Eye ◽

Lacrimal Gland ◽

Structural Changes ◽

Dry Eye Syndrome ◽

Tubular Structures ◽

Lacrimal Glands ◽

Acoustic Structure ◽

Different Types ◽

Systemic Sarcoidosis ◽

Vascularization Index

Objective. To identify clinical and morphofunctional changes in the lacrimal gland in sarcoidosis.Material and methods. Ultrasonography was conducted in 53 patients (106 eyes) with a verified diagnosis of systemic sarcoidosis (7 men and 46 women) whose age was 31 to 72 years.Results. Different types of lacrimal gland structural changes in sarcoidosis were detected. Comparing the acoustic and functional findings revealed a high correlation (r > 0.7) between these parameters as vascularization index, a reflex component of tear secretion, and the presence of tubular structures. Types of changes in the acoustic structure of the lacrimal glands were identified, which were designated as edematous and polymorphic changes, as well as atrophic changes with a necrotic component.Conclusion. The findings can be used to diagnose lacrimal gland changes in patients suffering from sarcoidosis.

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Oral Administration of Royal Jelly Restores Tear Secretion Capacity in Rat Blink-Suppressed Dry Eye Model by Modulating Lacrimal Gland Function

PLoS ONE ◽

10.1371/journal.pone.0106338 ◽

2014 ◽

Vol 9 (9) ◽

pp. e106338 ◽

Cited By ~ 5

Author(s):

Toshihiro Imada ◽

Shigeru Nakamura ◽

Naoki Kitamura ◽

Izumi Shibuya ◽

Kazuo Tsubota

Keyword(s):

Oral Administration ◽

Dry Eye ◽

Lacrimal Gland ◽

Royal Jelly ◽

Tear Secretion ◽

Eye Model ◽

Gland Function

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The Effect of Buddleja officinalis Maxim Eye Drops on Morphology and Apoptosis in Lacrimal Gland of Experimental Dry Eye Rabbit Model

Journal of Ophthalmology ◽

10.1155/2019/5916243 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7

Author(s):

Genyan Qin ◽

Yasha Zhou ◽

Jun Peng ◽

Youwei Zhang ◽

Xiaofang Peng ◽

...

Keyword(s):

Dry Eye ◽

Lacrimal Gland ◽

Rabbit Model ◽

Morphological Structure ◽

Study Groups ◽

Control Group ◽

Eye Drops ◽

Model Group ◽

Lacrimal Glands ◽

Eye Model

The purpose of this study was to investigate the effects of Buddleja officinalis Maxim eye drops on morphology and apoptosis in lacrimal glands of the experimental dry eye rabbit model. A total of thirty-six male rabbits were divided into six study groups, consisting of the control group and the dry eye rabbit model group (without any treatment), the dry eye rabbit model group treated with testosterone, and the dry eye rabbit model group treated with different concentrations of Buddleja officinalis Maxim eye drops (1.0 mg/ml, 1.5 mg/ml and 3.0 mg/ml). The lacrimal glands were evaluated by hematoxylin-eosin staining and immunohistochemistry. Buddleja officinalis Maxim eye drops can improve the morphological structure of the lacrimal gland in the dry eye model of castrated rabbits. The average optical density values of PI3K, Akt, and caspase-9 protein in the lacrimal gland tissue of the 3 mg/ml Buddleja officinalis Maxim eye drops group were significantly different from those in the model group (P<0.01) and similar to the testosterone control group and the control group (P>0.05). Buddleja officinalis Maxim eye drops can improve the morphological structure of the lacrimal gland in the dry eye model of castrated rabbits.

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