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The Ocular Surface Oct 2020Tear secretion is a complex process with the involvement of the main and accessory lacrimal glands, corneal and conjunctival epithelial cells and the Meibomian glands.... (Review)
Review
Tear secretion is a complex process with the involvement of the main and accessory lacrimal glands, corneal and conjunctival epithelial cells and the Meibomian glands. The lacrimal gland is the main source of fluid, electrolytes and proteins in tear fluid. Deficient ion and water secretion results in aqueous deficient dry eye with serious consequences on the integrity of the ocular surface. Functions of acinar cells are widely studied, whereas less information is available about the duct system of the lacrimal gland. Secretory mechanisms of duct epithelium may play an important role in tear production, but only limited studies have tried to elucidate the role of the duct system in tear secretion. Significant progress has been made in the past few years, resulting in new insight into lacrimal gland duct function. New experimental techniques were introduced, which contributed to the exploration of the role of lacrimal gland ducts in more detail. Therefore, the aim of this review is to summarize our present knowledge about the role of ducts in lacrimal gland function and tear secretion, which appears to be the first review with a focus on this topic. Short outline of pancreatic and salivary gland duct functions is also given for the purposes of comparison.
Topics: Cornea; Dry Eye Syndromes; Epithelium; Humans; Lacrimal Apparatus; Tears
PubMed: 32707335
DOI: 10.1016/j.jtos.2020.07.002 -
In Vivo (Athens, Greece) 2023Lacrimal sac tumors are rare tumor types, with a long time interval from disease onset to diagnosis. We aimed to investigate the characteristics and outcomes of patients...
BACKGROUND/AIM
Lacrimal sac tumors are rare tumor types, with a long time interval from disease onset to diagnosis. We aimed to investigate the characteristics and outcomes of patients with lacrimal sac tumors.
PATIENTS AND METHODS
The medical records of 25 patients with lacrimal sac tumors initially treated at the Kyushu university hospital from January 1996 to July 2020 were reviewed.
RESULTS
Our analysis included 3 epithelial benign tumors (12.0%) and 22 malignant (88.0%) tumors (squamous cell carcinoma, n=6; adenoid cystic carcinoma, n=2; sebaceous adenocarcinoma, n=2; mucoepidermoid carcinoma, n=1; malignant lymphoma, n=10). The average time from symptom onset to diagnosis was 14.7 months (median=8 months; range=1-96 months). The analysis of patients revealed that lacrimal sac mass (22/25, 88.0%) was the most frequent symptom and a possible tumor marker. Most epithelial benign (n=3) and malignant epithelial (n=12) tumors were treated surgically (14/15, 93.3%). One malignant case was treated with heavy ion beam therapy. Eight patients were treated with postoperative (chemo)radiation therapy because of positive surgical margins (including one unanalyzed case). Local control was ultimately achieved in all but one case. The patient survived for 24 months with immune checkpoint inhibitors and subsequent chemotherapy for local and metastatic recurrence.
CONCLUSION
We report our experience in the diagnosis and treatment of lacrimal sac tumors and analyze the clinical trends in cases involving these tumors. Postoperative radiotherapy and pharmacotherapy, including immune checkpoint inhibitors, may be useful for recurrent cases.
Topics: Humans; Nasolacrimal Duct; Lacrimal Apparatus Diseases; Immune Checkpoint Inhibitors; Eye Neoplasms; Carcinoma, Squamous Cell; Retrospective Studies
PubMed: 37103086
DOI: 10.21873/invivo.13198 -
BMJ Case Reports May 2021A 35-year-old woman underwent left external dacryocystorhinostomy (DCR) following a recent bout of left acute dacryocystitis. She had a right DCR 14 years earlier. Her...
A 35-year-old woman underwent left external dacryocystorhinostomy (DCR) following a recent bout of left acute dacryocystitis. She had a right DCR 14 years earlier. Her relatively young age of presentation prompted suspicion of secondary nasolacrimal duct obstruction and, although the left lacrimal sac appeared macroscopically normal peroperatively, a lacrimal sac biopsy was taken. Histopathology revealed florid chronic inflammation, with abundant granular brown pigment and polarisable crystals suggestive of an exogenous material in the lacrimal sac mucosa compatible with mascara. After initial improvement, her epiphora has recurred 1-year postoperatively, but her ocular discharge has resolved. Mascara-induced conjunctival pigmentation is well established. However, there are very few published reports of nasolacrimal duct obstruction due to mascara. Since cosmetic application of mascara and kohl eyeliner is widespread, patients and practitioners should be aware of their potential to migrate into the lacrimal apparatus and cause chronic inflammation with secondary nasolacrimal duct obstruction.
Topics: Adult; Dacryocystitis; Dacryocystorhinostomy; Female; Humans; Lacrimal Duct Obstruction; Nasolacrimal Duct; Neoplasm Recurrence, Local
PubMed: 33962923
DOI: 10.1136/bcr-2020-240942 -
International Journal of Medical... 2021The anatomical parameters of normal lacrimal puncta and vertical canaliculus using optical coherence tomography (OCT) and the OCT imaging features of punctal lesions... (Observational Study)
Observational Study
The anatomical parameters of normal lacrimal puncta and vertical canaliculus using optical coherence tomography (OCT) and the OCT imaging features of punctal lesions were analyzed to provide a basis for clinical diagnosis and treatment. From June to September 2019, 40 volunteers (80 eyes) from Tongji Hospital were enrolled. The external punctal diameter (ELP) was measured using slit-lamp microscopy and OCT. The internal lacrimal punctal diameter (ILP) at 100 μm, vertical canalicular length (VCL), and tear meniscus depth were measured by OCT with open eyes. Twenty-eight volunteers (56 eyes) underwent the same examinations with their eyes closed. The OCT imaging features of 26 patients (27 eyes) with lacrimal lesions were examined. The ELP of the right and left healthy eyes under slit-lamp microscopy were 564.40 and 555.40 µm respectively. Under OCT, the ELP, ILP, and VCL of the right and left eyes were 628.20 um and 616.85 µm, 343.40 µm and 346.95 µm, 731.95 um and 709.20 µm respectively. The ELP was larger when measured by OCT than slit-lamp microscopy (p<0.05). Twenty-eight volunteers (56 eyes) had measurements taken under different conditions. The ELP, ILP, and VCL of the open and closed right eyes were 667.54 and 567.21 µm, 369.18 and 303.18 µm, 715.00 and 417.14 µm, respectively. The ELP, ILP, and VCL of the open and closed left eyes were 655.86 um and 551.68 µm, 369.25 um and 313.54 µm, 719.96 um and 433.89 µm respectively. The anatomical parameters of the open eyes were greater than those of the closed eyes (p<0.05). Thus, we identified the imaging features of lacrimal stenosis, punctal obstruction, punctal tear, lacrimal atresia, and lacrimal mass using OCT. OCT can be used to measure the anatomical parameters of lacrimal puncta and vertical canaliculus . In addition, OCT can detect punctal lesions and provide an objective basis for the clinical diagnosis and treatment of punctal lesions.
Topics: Adult; Aged; Feasibility Studies; Female; Healthy Volunteers; Humans; Lacrimal Apparatus; Male; Middle Aged; Prospective Studies; Slit Lamp Microscopy; Tomography, Optical Coherence; Young Adult
PubMed: 34104080
DOI: 10.7150/ijms.58291 -
PloS One 2017The study of human lacrimal gland biology and development is limited. Lacrimal gland tissue is damaged or poorly functional in a number of disease states including dry... (Clinical Trial)
Clinical Trial
BACKGROUND
The study of human lacrimal gland biology and development is limited. Lacrimal gland tissue is damaged or poorly functional in a number of disease states including dry eye disease. Development of cell based therapies for lacrimal gland diseases requires a better understanding of the gene expression and signaling pathways in lacrimal gland. Differential gene expression analysis between lacrimal gland and other embryologically similar tissues may be helpful in furthering our understanding of lacrimal gland development.
METHODS
We performed global gene expression analysis of human lacrimal gland tissue using Affymetrix ® gene expression arrays. Primary data from our laboratory was compared with datasets available in the NLM GEO database for other surface ectodermal tissues including salivary gland, skin, conjunctiva and corneal epithelium.
RESULTS
The analysis revealed statistically significant difference in the gene expression of lacrimal gland tissue compared to other ectodermal tissues. The lacrimal gland specific, cell surface secretory protein encoding genes and critical signaling pathways which distinguish lacrimal gland from other ectodermal tissues are described.
CONCLUSIONS
Differential gene expression in human lacrimal gland compared with other ectodermal tissue types revealed interesting patterns which may serve as the basis for future studies in directed differentiation among other areas.
Topics: Databases, Genetic; Dry Eye Syndromes; Eye Proteins; Female; Gene Expression Regulation; Humans; Lacrimal Apparatus; Male
PubMed: 28081151
DOI: 10.1371/journal.pone.0169346 -
BMC Ophthalmology Jan 2022Acquired nasolacrimal duct obstruction is a blockage of the lacrimal outflow system usually caused by local nonspecific inflammation of the lacrimal sac and the...
BACKGROUND
Acquired nasolacrimal duct obstruction is a blockage of the lacrimal outflow system usually caused by local nonspecific inflammation of the lacrimal sac and the nasolacrimal duct. However, cases exist where the primary nasolacrimal system obstruction is caused by malignancies. Our aim was to investigate lacrimal sac pathologies in patients with acquired nasolacrimal duct obstruction and compare their clinical manifestations.
METHODS
This retrospective clinical study included 275 patients with acquired nasolacrimal duct obstruction who underwent external dacryocystorhinostomy and lacrimal sac biopsy. Cases were classified into tumor or nonspecific pathology groups and subdivided according to the level of inflammation. Histological and clinical data were analyzed.
RESULTS
Three tumors (1.1%) (an adenoid cystic carcinoma, an eccrine spiradenoma and small B cell lymphoma) were diagnosed. Chronic nongranulomatous inflammation was the most common histological finding, corresponding to 194 cases (70.5%). The other 81 (29.5%) were subacute, acute forms of nongranulomatous inflammation, tumors and fibrosis cases. Epiphora with continuous purulent discharge was the most common clinical sign reported by 144 (52.4%) patients, and two (0.7%) patients had a palpable mass near the medial canthal tendon, which was identified as an eccrine spiradenoma and small B cell lymphoma. There was no significant difference in the clinical symptoms, duration or case history between the nonspecific pathology and tumor groups (p = 0.292).
CONCLUSIONS
Chronic nongranulomatous inflammation of the lacrimal sac was the most common finding among acquired nasolacrimal duct obstruction cases. There were no associations between the histological findings and clinical presentation. The authors recommend a lacrimal sac biopsy only in cases when a tumor is clinically suspected.
Topics: Dacryocystorhinostomy; Humans; Lacrimal Apparatus; Lacrimal Duct Obstruction; Nasolacrimal Duct; Retrospective Studies
PubMed: 34986808
DOI: 10.1186/s12886-021-02185-x -
Developmental Dynamics : An Official... Dec 2017The lacrimal gland plays a pivotal role in keeping the ocular surface lubricated, and protecting it from environmental exposure and insult. Dysfunction of the lacrimal... (Review)
Review
The lacrimal gland plays a pivotal role in keeping the ocular surface lubricated, and protecting it from environmental exposure and insult. Dysfunction of the lacrimal gland results in deficiency of the aqueous component of the tear film, which can cause dryness of the ocular surface, also known as the aqueous-deficient dry eye disease. Left untreated, this disease can lead to significant morbidity, including frequent eye infections, corneal ulcerations, and vision loss. Current therapies do not treat the underlying deficiency of the lacrimal gland, but merely provide symptomatic relief. To develop more sustainable and physiological therapies, such as in vivo lacrimal gland regeneration or bioengineered lacrimal gland implants, a thorough understanding of lacrimal gland development at the molecular level is of paramount importance. Based on the structural and functional similarities between rodent and human eye development, extensive studies have been undertaken to investigate the signaling and transcriptional mechanisms of lacrimal gland development using mouse as a model system. In this review, we describe the current understanding of the extrinsic signaling interactions and the intrinsic transcriptional network governing lacrimal gland morphogenesis, as well as recent advances in the field of regenerative medicine aimed at treating dry eye disease. Developmental Dynamics 246:970-980, 2017. © 2017 Wiley Periodicals, Inc.
Topics: Animals; Bioengineering; Eye Diseases; Humans; Lacrimal Apparatus; Regenerative Medicine; Signal Transduction
PubMed: 28710815
DOI: 10.1002/dvdy.24551 -
Investigative Ophthalmology & Visual... Jul 2023Orbital glands and drainage conduits are two distinct entities that constitute the lacrimal apparatus system, the malfunction of which leads to a range of ocular surface...
PURPOSE
Orbital glands and drainage conduits are two distinct entities that constitute the lacrimal apparatus system, the malfunction of which leads to a range of ocular surface disorders. Despite the close functional relationship, how the two parts interact under pathophysiological conditions has not been directly tested. The study aims to investigate the lacrimal gland (LG) structural and functional changes upon the drainage system obstruction, thus, testing their function link.
METHODS
Dacryocystectomy was performed in C57BL/6 mice to create a surgical model for tear duct (TD) obstruction (STDOB). Prickle1 mutant line with congenital nasolacrimal duct dysplasia serves as a genetic model for TD obstruction (GTDOB). Alterations of the LG and the ocular surface in tear duct obstruction mice were examined.
RESULTS
STDOB and GTDOB mice showed similar ocular surface phenotypes, including epiphora, corneal epithelial defects, and conjunctival goblet cell abnormalities. At the molecular and cellular levels, aberrant secretory vesicle fusion of the LG acinar cells was observed with altered expression and localization of Rab3d, Vamp8, and Snap23, which function in membrane fusion. LG secretion was also altered in that lactoferrin, lipocalin2, and lysozyme expression were increased in both LG and tears. Furthermore, STDOB and GTDOB mice exhibited similar LG transcription profiles.
CONCLUSIONS
Physical obstruction of tear drainage in STDOB or GTDOB mice leads to LG dysfunction, suggesting a long-distance interaction between the tear drainage conduits and the LG. We propose that various components of the lacrimal apparatus should be considered an integral unit in diagnosing and treating ocular surface diseases.
Topics: Mice; Animals; Lacrimal Apparatus; Mice, Inbred C57BL; Tears; Lacrimal Apparatus Diseases; Nasolacrimal Duct; Adaptor Proteins, Signal Transducing; LIM Domain Proteins
PubMed: 37440262
DOI: 10.1167/iovs.64.10.13 -
BMJ Case Reports Dec 2016
Topics: Cysts; Diagnosis, Differential; Humans; Infant, Newborn; Lacrimal Apparatus Diseases; Magnetic Resonance Imaging; Nasolacrimal Duct
PubMed: 27941115
DOI: 10.1136/bcr-2016-218029 -
Digital Journal of Ophthalmology : DJO 2017To describe a surgical technique in which a suture, instead of forceps, is used to improve access for the introduction of scissors and more easily achieve an...
PURPOSE
To describe a surgical technique in which a suture, instead of forceps, is used to improve access for the introduction of scissors and more easily achieve an appropriately-sized punctoplasty.
MATERIALS AND METHODS
In this technique, a new modification of the 2-snip punctoplasty, a 6-0 polyglactin 910 suture is passed through the posterior wall of the punctum to apply traction. A video of the technique is provided.
RESULTS
This technique improves the surgical field of view and eases access for introduction of Vannas scissors into the punctum to perform the punctoplasty.
CONCLUSIONS
This simple and practical modification of the 2-snip punctoplasty improves instrument access so that an appropriately-sized punctoplasty can be performed with ease.
Topics: Aged; Dacryocystorhinostomy; Female; Humans; Lacrimal Apparatus; Lacrimal Apparatus Diseases; Suture Techniques; Sutures
PubMed: 29162988
DOI: 10.5693/djo.01.2017.01.001