Submandibular Gland Transfer in the Treatment of Refractory Xerophthalmia

Abstract

Objectives: Dry eye syndrome is a very common condition characterized by ocular irritation due to a deficient tear film. In mild cases, patients present with an annoying foreign-body sensation in the eyes. In its most severe form, it can cause ulceration of the cornea with spontaneous perforation and loss of the eye. There exists a small subpopulation of patients who suffer from extremely dry eyes. In these patients, routine surgical measures or medical management do not suffice to prevent complications. Submandibular gland transfer as a treatment for xerophthalmia has been studied and shown to be effective in other countries; however, the procedure is rarely used in the United States. Methods: We describe the procedure of microvascular submandibular gland transfer and discuss the outcomes in cases of submandibular gland transfer that have been performed at our institution to date. Results: In the series of patients reported from our institution, four procedures in three of the patients were successful, with improvement in epithelial defect on slit-lamp examination and/or improvement in tear production. Two procedures in the fourth patient were unsuccessful; the first was complicated by scarring of the submandibular duct, which was unsalvageable with revision surgery. The gland was removed and replaced with the opposite submandibular gland, but the transplanted gland proved non-viable. Conclusions: The technical expertise required for the transfer is readily available in almost all academic centers. The microvascular reconstructive surgeon has expertise in the harvesting of the flap, as well as in the transfer. When used, this technique provides an effective way to treat patients with refractory xerophthalmia.