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Experimental Eye Research Aug 2020Tears have a vital function to protect and lubricate the ocular surface. Tear production, distribution and clearance is tightly regulated by the lacrimal functional unit... (Review)
Review
Tears have a vital function to protect and lubricate the ocular surface. Tear production, distribution and clearance is tightly regulated by the lacrimal functional unit (LFU) to meet ocular surface demands. The tear film consists of an aqueous-mucin layer, containing fluid and soluble factors produced by the lacrimal glands and mucin secreted by the goblet cells, that is covered by a lipid layer. The array of proteins, glycoproteins and lipids in tears function to maintain a stable, well-lubricated and smooth optical surface. Tear factors also promote wound healing, suppress inflammation, scavenge free radicals, and defend against microbial infection. Disease and dysfunction of the LFU leads to tear instability, increased evaporation, inflammation, and blurred and fluctuating vision. The function of tear components and the consequences of tear deficiency on the ocular surface are reviewed.
Topics: Dry Eye Syndromes; Glycoproteins; Humans; Lacrimal Apparatus; Mucins; Tears
PubMed: 32561483
DOI: 10.1016/j.exer.2020.108115 -
Current Opinion in Ophthalmology Jul 2021Dry eye disease (DED) is a multifactorial disease affecting approximately 5-50% of individuals in various populations. Contributors to DED include, but are not limited... (Review)
Review
PURPOSE OF REVIEW
Dry eye disease (DED) is a multifactorial disease affecting approximately 5-50% of individuals in various populations. Contributors to DED include, but are not limited to, lacrimal gland hypofunction, meibomian gland dysfunction (MGD), ocular surface inflammation, and corneal nerve dysfunction. Current DED treatments target some facets of the disease, such as ocular surface inflammation, but not all individuals experience adequate symptom relief. As such, this review focuses on alternative and adjunct approaches that are being explored to target underlying contributors to DED.
RECENT FINDINGS
Neuromodulation, stem cell treatments, and oral royal jelly have all been studied in individuals with DED and lacrimal gland hypofunction, with promising results. In individuals with MGD, devices that provide eyelid warming or intense pulsed light therapy may reduce DED symptoms and signs, as may topical Manuka honey. For those with ocular surface inflammation, naturally derived anti-inflammatory agents may be helpful, with the compound trehalose being farthest along in the process of investigation. Nerve growth factor, blood-derived products, corneal neurotization, and to a lesser degree, fatty acids have been studied in individuals with DED and neurotrophic keratitis (i.e. corneal nerve hyposensitivity). Various adjuvant therapies have been investigated in individuals with DED with neuropathic pain (i.e. corneal nerve hypersensitivity) including nerve blocks, neurostimulation, botulinum toxin, and acupuncture, although study numbers and design are generally weaker than for the other DED sub-types.
SUMMARY
Several alternatives and adjunct DED therapies are being investigated that target various aspects of disease. For many, more robust studies are required to assess their sustainability and applicability.
Topics: Complementary Therapies; Dry Eye Syndromes; Humans; Lacrimal Apparatus
PubMed: 34010229
DOI: 10.1097/ICU.0000000000000768 -
Clinical Autonomic Research : Official... Feb 2019The production of emotional tears appears to be uniquely present in Homo sapiens. Despite the ubiquity of this human behavior, research is only just beginning to uncover... (Review)
Review
The production of emotional tears appears to be uniquely present in Homo sapiens. Despite the ubiquity of this human behavior, research is only just beginning to uncover the neurobiologic underpinnings of human emotional crying. In this article, we review the current state of the literature investigating the neurobiologic aspects of this uniquely human behavior, including the neuroanatomical, neurochemical, and psychophysiologic findings. To set the context for this review, we first provide a brief overview of the evolutionary background and functions of tearful crying. Despite an accumulating understanding of the neurobiology of human emotional crying, the primary sources of information are currently from animal studies and observations in neurologic patients suffering from pathologic crying. Currently, most of the research on the neurobiology of crying in humans has focused on autonomic physiologic processes underlying tearful crying, which may yield essential clues regarding the neural substrates of the production of crying behavior and its effects on the crier. Further challenges in elucidating the neurobiology of crying involve the complexity of crying behavior, which includes vocalizations, tear production, the involvement of facial musculature, subjective emotional experience, emotion regulatory behaviors, and social behaviors. Future research is needed to comprehensively characterize the neurobiology of this intriguing and complex human behavior.
Topics: Animals; Brain; Crying; Emotions; Facial Muscles; Humans; Lacrimal Apparatus; Neural Pathways; Tears
PubMed: 29687400
DOI: 10.1007/s10286-018-0526-y -
International Journal of Molecular... Jun 2017Dry eye can damage the ocular surface and result in mild corneal epithelial defect to blinding corneal pannus formation and squamous metaplasia. Significant progress in... (Review)
Review
Dry eye can damage the ocular surface and result in mild corneal epithelial defect to blinding corneal pannus formation and squamous metaplasia. Significant progress in the treatment of dry eye has been made in the last two decades; progressing from lubricating and hydrating the ocular surface with artificial tear to stimulating tear secretion; anti-inflammation and immune regulation. With the increase in knowledge regarding the pathophysiology of dry eye, we propose in this review the concept of ocular surface microenvironment. Various components of the microenvironment contribute to the homeostasis of ocular surface. Compromise in one or more components can result in homeostasis disruption of ocular surface leading to dry eye disease. Complete evaluation of the microenvironment component changes in dry eye patients will not only lead to appropriate diagnosis, but also guide in timely and effective clinical management. Successful treatment of dry eye should be aimed to restore the homeostasis of the ocular surface microenvironment.
Topics: Cellular Microenvironment; Conjunctiva; Cornea; Dry Eye Syndromes; Eye; Eyelids; Homeostasis; Hormones; Humans; Lacrimal Apparatus; Lubricant Eye Drops; Meibomian Glands; Microbiota; Tears
PubMed: 28661456
DOI: 10.3390/ijms18071398 -
Arquivos Brasileiros de Oftalmologia 2021The purpose of this article was to report a case of intraconal lacrimal gland tissue and to review the literature on lacrimal gland choristoma. The magnetic resonance... (Review)
Review
The purpose of this article was to report a case of intraconal lacrimal gland tissue and to review the literature on lacrimal gland choristoma. The magnetic resonance imaging findings of a biopsy-proven orbital case are also presented. A PubMed database search was performed using the key terms heterotopic, ectopic, aberrant, choristoma, and lacrimal gland to identify all the previously documented studies on lacrimal gland choristoma, in English, Spanish, and French. We classified the lacrimal gland choristoma cases classified according to the location of the lesions, clinical appearance, management, and outcome. The search targeting the period between 1887 and 2019 returned 79 articles, which were reviewed. We found a total of 113 cases of choristomas with normal lacrimal gland tissue. Only two of them were not associated with the eye or its adnexa while the remaining 111 lesions were found either on the ocular surface (n=46) or in the orbit (n=34). Intraocular choristomas were found in 18 patients, and the rest of the lesions were noted either on the eyelids (n=10) or in the lacrimal drainage system (n=3). Orbital and intraocular choristomas are the most harmful lesions as orbital choristomas are frequently associated with permanent diplopia while intraocular lacrimal gland choristomas have a poor visual prognosis and are a common cause of enucleation of the eye. In one of the reported cases, a corneal lacrimal gland choristoma had been experimentally induced by activating the FGF10 signaling pathway. Lacrimal gland choristomas are not uncommon. This peculiar type of lesion has been experimentally induced and may appear in a variety of locations associated with the globe and its adnexa.
Topics: Choristoma; Cornea; Humans; Lacrimal Apparatus; Orbit
PubMed: 35416898
DOI: 10.5935/0004-2749.20220029 -
Korean Journal of Ophthalmology : KJO Oct 2021This study aimed to analyze the common causes of epiphora in Korean patients and their response to subsequent management.
PURPOSE
This study aimed to analyze the common causes of epiphora in Korean patients and their response to subsequent management.
METHODS
We retrospectively analyzed the medical records of 180 patients who visited Kim's Eye Hospital for epiphora between December 2017 and January 2019. This study included 320 eyes of 180 patients.
RESULTS
In the 320 eyes of 180 patients, the most common etiology of epiphora was reflex tearing due to dry eye syndrome, which occurred in 167 eyes (52.19%). The other etiologies of epiphora included anatomical abnormality (68 eyes, 21.25%), multifactorial (60 eyes, 18.75%), functional epiphora (14 eyes, 4.38%), ocular surface disease (seven eyes, 2.19%), and eyelid abnormality (four eyes, 1.25%).
CONCLUSIONS
The most common etiology of epiphora in Korean patients was reflex tearing due to dry eye syndrome, followed by lacrimal passage abnormality, multifactorial, functional epiphora, anterior segment disease, and eyelid malposition. Most patients with reflex tearing reported improvement in their symptoms after lubrication.
Topics: Dry Eye Syndromes; Eyelid Diseases; Humans; Lacrimal Apparatus; Lacrimal Apparatus Diseases; Retrospective Studies
PubMed: 34237206
DOI: 10.3341/kjo.2021.0069 -
Asia-Pacific Journal of Ophthalmology... 2017Tumors of the lacrimal sac are rare but their recognition and early management are imperative, as they are locally invasive and potentially life-threatening. Because of... (Review)
Review
Tumors of the lacrimal sac are rare but their recognition and early management are imperative, as they are locally invasive and potentially life-threatening. Because of their rarity, large clinical studies with statistically significant data on the natural course, management, and prognosis of these neoplasms are unavailable. Current practices are therefore based on a few case series and a small number of isolated case reports. Most tumors are primary and of epithelial origin (60-94%), of which 55% are malignant. Lacrimal sac tumors typically present with epiphora and a palpable mass over the medial canthus and are thus often erroneously diagnosed as chronic dacryocystitis. A full history with clinical and diagnostic workup is essential to plan treatment, which is often multi-disciplinary. Statistically significant associations have been shown with higher tumor staging and size with increased metastatic risk and lower survival rates. Management usually involves complete surgical resection with adjuvant radiotherapy and/or chemotherapy for malignant lesions. Long-term follow-up is required, as recurrences and metastases can occur many years after initial treatment.
Topics: Combined Modality Therapy; Disease Management; Eye Neoplasms; Humans; Lacrimal Apparatus; Lacrimal Apparatus Diseases
PubMed: 28399337
DOI: 10.22608/APO.201713 -
Ophthalmic Plastic and Reconstructive...This study aimed to report the performance of the large language model ChatGPT (OpenAI, San Francisco, CA, U.S.A.) in the context of lacrimal drainage disorders.
PURPOSE
This study aimed to report the performance of the large language model ChatGPT (OpenAI, San Francisco, CA, U.S.A.) in the context of lacrimal drainage disorders.
METHODS
A set of prompts was constructed through questions and statements spanning common and uncommon aspects of lacrimal drainage disorders. Care was taken to avoid constructing prompts that had significant or new knowledge beyond the year 2020. Each of the prompts was presented thrice to ChatGPT. The questions covered common disorders such as primary acquired nasolacrimal duct obstruction and congenital nasolacrimal duct obstruction and their cause and management. The prompts also tested ChatGPT on certain specifics, such as the history of dacryocystorhinostomy (DCR) surgery, lacrimal pump anatomy, and human canalicular surfactants. ChatGPT was also quizzed on controversial topics such as silicone intubation and the use of mitomycin C in DCR surgery. The responses of ChatGPT were carefully analyzed for evidence-based content, specificity of the response, presence of generic text, disclaimers, factual inaccuracies, and its abilities to admit mistakes and challenge incorrect premises. Three lacrimal surgeons graded the responses into three categories: correct, partially correct, and factually incorrect.
RESULTS
A total of 21 prompts were presented to the ChatGPT. The responses were detailed and were based according to the prompt structure. In response to most questions, ChatGPT provided a generic disclaimer that it could not give medical advice or professional opinion but then provided an answer to the question in detail. Specific prompts such as "how can I perform an external DCR?" were responded by a sequential listing of all the surgical steps. However, several factual inaccuracies were noted across many ChatGPT replies. Several responses on controversial topics such as silicone intubation and mitomycin C were generic and not precisely evidence-based. ChatGPT's response to specific questions such as canalicular surfactants and idiopathic canalicular inflammatory disease was poor. The presentation of variable prompts on a single topic led to responses with either repetition or recycling of the phrases. Citations were uniformly missing across all responses. Agreement among the three observers was high (95%) in grading the responses. The responses of ChatGPT were graded as correct for only 40% of the prompts, partially correct in 35%, and outright factually incorrect in 25%. Hence, some degree of factual inaccuracy was present in 60% of the responses, if we consider the partially correct responses. The exciting aspect was that ChatGPT was able to admit mistakes and correct them when presented with counterarguments. It was also capable of challenging incorrect prompts and premises.
CONCLUSION
The performance of ChatGPT in the context of lacrimal drainage disorders, at best, can be termed average. However, the potential of this AI chatbot to influence medicine is enormous. There is a need for it to be specifically trained and retrained for individual medical subspecialties.
Topics: Humans; Dacryocystorhinostomy; Lacrimal Duct Obstruction; Nasolacrimal Duct; Mitomycin; Intubation; Silicones
PubMed: 37166289
DOI: 10.1097/IOP.0000000000002418 -
Acta Ophthalmologica Nov 2021The aims of the review are to summarize the aethiopathogenesis, management and outcomes of different treatments of proximal lacrimal obstructions. (Review)
Review
PURPOSE
The aims of the review are to summarize the aethiopathogenesis, management and outcomes of different treatments of proximal lacrimal obstructions.
METHODS
An electronic database (PubMed, MEDLINE and Google Scholar) search of all articles written in English and non-English language with abstract translated to English on proximal lacrimal obstructions was performed. The articles were reviewed along with their relevant cross references. Data reviewed included demographics, presentations, investigations, management, complications and outcomes.
RESULTS
Punctoplasty is as effective as punctal dilatation with monocanalicular or bicanalicular stent in case of punctal stenosis. Dacryocystorhinostomy with retrograde intubation is more effective in case of proximal canalicular obstructions than in case of mid-canalicular obstructions. Trephination and intubation is effective in both mid and distal canalicular obstructions in patients with no associated nasolacrimal duct obstruction. Canaliculodacryocystorhinostomy has a specific indication in case of proximal common canalicular obstruction. Bypass surgery is the preferred treatment if there is no residual patency, however surgical success may not match patient satisfaction.
CONCLUSION
Optimal choice of surgical method depends on identification of the site of obstruction. Mini-invasive techniques should be avoided in cases that would only benefit from standard surgical treatment.
Topics: Dacryocystorhinostomy; Disease Progression; Humans; Lacrimal Duct Obstruction; Nasolacrimal Duct; Stents
PubMed: 33455087
DOI: 10.1111/aos.14762 -
Indian Journal of Ophthalmology Oct 2017
Review
Topics: Child; Dacryocystorhinostomy; Endoscopy; Humans; Lacrimal Duct Obstruction; Nasolacrimal Duct
PubMed: 29044070
DOI: 10.4103/ijo.IJO_696_17