Accessory Lacrimal Glands Research Articles

The lacrimal apparatus as an organ at risk during radionuclide therapy

Within the framework of the article, the authors analyzed the available information about the damage to the lacrimal apparatus during radionuclide therapy. In focus of article lesions of the lacrimal production system, the main and accessory lacrimal glands, as well as lacrimal drainage are considered. It was found that damage to the lacrimal apparatus is characteristic of 131I therapy for thyroid cancer, as well as for radioligand therapy using anti-PSMA antibodies labeled with 177Lu and 225Ac. 177Lu-PSMA and 225Ac-PSMA may damage the lacrimal gland with the formation of a clinically pronounced "dry eye syndrome". The pathogenesis of such lesions is associated with the accumulation of a radioisotope in the tissues of the lacrimal apparatus, while during therapy with 131I, accumulation is realized due to the expression of the sodium-iodine symporter in the nasolacrimal duct, and during therapy with 177Lu-PSMA and 225Ac-PSMA, the radiobiological effect is realized in connection with the expression PSMA by lacrimal tissue. An analysis of the available sources showed that to date there are no results of systematic studies on the problem, there is a lack of knowledge regarding the individual risks of developing these complications, methods for their prevention that have proven effectiveness have not been developed, and the treatment methods used, having relatively low efficiency, are not specialized. The authors concluded that the strengthening of interdisciplinary interaction, as well as the organization verification methodology and correct studies, can contribute to solving problems related to the study of the complications under consideration.

Anatomical and Histological Study of the Upper Tarsus in Asian.

The aim of this study was to observe and analyze the anatomical and histological characteristics of the upper tarsus in Asian. A total of 15 Asians (14 adults, 1 child) were used. The sagittal sections with thickness of 3μm in the middle of the upper eyelid were prepared and stained with hematoxylin-eosin, Masson trichrome and anti-smooth muscle actin antibody staining, and then were observed and photographed under light microscopy. On the sagittal section, the upper end of the tarsus was connected with the Müller muscle and the part of the posterior layer of the levator aponeurosis; the lower end was the inflated part of the palpebral margin; the superficial surface was connected with the pretarsal fascia; and the deep surface was connected with Müller muscle aponeurosis and palpebral conjunctiva. Histologically, the tarsus was similar to the structure between dense fibrous connective tissue and cartilage, and its main structures include meibomian glands and its ducts, accessory lacrimal glands, glands of Moll, glands of Zeis, eyelash hair follicles, Riolan muscle, blood vessels, and collagen fibers. Through the observation of the tarsus of a child, compared with the adult specimen, the meibomian gland tissue was more abundant; the collagen fibers density was significantly lower and arranged orderly; the blood vessel density was significantly higher; α-SMA positive smooth muscle cells could be seen in the upper end of the tarsus and its superficial and deep surfaces. In this study, the internal and adjacent anatomical structures of the upper tarsus in Asians were observed under a microscope, and according to the histological characteristics, the tarsus was divided into 3 parts and 3 types. Through the preliminary analysis, the tarsus was likely to show different histological characteristics in different individuals and age groups of Asians. There was a certain correlation between the degree of meibomian gland atrophy, the degree of collagen fibrosis and the density of blood vessel in the tarsus.

Conjunctival changes following Muller's muscle conjunctival resection.

To analyze the conjunctival changes, especially goblet cell populations, following Muller's muscle conjunctival resection (MMCR) by histologically evaluating pre and post-MMCR specimens. This is a retrospective analysis of conjunctival samples sent for histologic evaluation from two patient populations: those who had previously undergone a MMCR and required repeat surgery and controls who underwent a MMCR surgery in a previously unoperated eyelid. Specimens underwent hematoxylin and eosin (H&E) and periodic acid-Schiff (PAS) staining to accentuate goblet cell identification and were evaluated by two ocular pathologists to quantify goblet cell populations and note other anatomical changes. Statistical analysis of goblet cell populations was then performed. Four samples were identified for each group: (1) post-MMCR and (2) control. The mean age was 67years in the post-MMCR group and 66years in the control group. The mean goblet cell population was 7 ± 5 cells/mm in the post-MMCR conjunctiva and was 39 ± 16 cells/mm in the control group, which was statistically significant (p = 0.01). Samples from both groups demonstrated scarring and inflammatory cell infiltrate. While there was a relative loss of goblet cell populations in the conjunctiva overlying the region of surgery following MMCR, the lack of dry eye symptoms or changes in tear production reported in prior studies suggests that there may be enough goblet cell population reserve in the remaining accessory lacrimal glands and in the unaltered conjunctiva to provide sufficient lubrication and ocular protection.

Altered Prostaglandin E Receptor Subtype 3 Expression in Lacrimal Glands of Patients with Chronic Stevens-Johnson Syndrome

ABSTRACT Purpose To compare the prostaglandin E2 receptor subtype 3 (EP3) distribution in the lacrimal glands of normals, non-specific dacryoadenitis, and chronic Stevens-Johnson syndrome (SJS) patients. Methods Biopsies from lacrimal glands of four chronic SJS patients with severe dry eye disease, four dacryoadenitis patients, and five fresh body donors were assessed for EP3 expression using immunohistochemistry. Results In normal main and accessory lacrimal glands, EP3 is expressed strongly in nuclei and cytoplasm of majority (>75%) of acini with no ductular expression. In dacryoadenitis, EP3 expression was similar to normal glands. However, lacrimal glands from SJS patients (5–20/HPF mononuclear cells) showed a weak and reduced (<10% acini) EP3 expression within acinar cells. The reduction in intensity was more in glands with higher mononuclear cell infiltration (>10/HPF). Conclusion There is downregulation of EP3 expression in the lacrimal glands of SJS patients, whereas EP3 expression is preserved in non-specific lacrimal gland inflammations.

Viral S protein histochemistry reveals few potential SARS-CoV-2 entry sites in human ocular tissues

Despite the reported low expression of the primary SARS-CoV-2 receptor ACE2 in distinct ocular tissues, some clinical evidence suggests that SARS-CoV-2 can infect the eye. In this study, we explored potential entry sites for SARS-CoV-2 by viral S protein histochemistry on various ocular tissues and compared the staining patterns with RNA and protein expression of TMPRSS2 and ACE2. Potential viral entry sites were investigated by histochemistry using tagged recombinant viral S protein on 52 ocular tissue samples including specimens of the cornea, conjunctiva, lid margin, lacrimal gland tissue, retina, choroid, and RPE. In addition, ACE2 and TMPRSS2 immunohistochemistry were performed on the same ocular tissue, each with distinct antibodies binding to different epitopes. Lung tissue samples were used as positive controls. Finally, bulk RNA sequencing (RNA-Seq) was used to determine the expression of ACE2 and its auxiliary factors in the tissues mentioned above. S protein histochemistry revealed a positive staining in lung tissue but absent staining in the cornea, the conjunctiva, eye lid samples, the lacrimal glands, the retina and the optic nerve which was supported by hardly any immunoreactivity for ACE2 and TMPRSS2 and scarce ACE2 and TMPRSS2 RNA expression. Negligible staining with antibodies targeting ACE2 or TMPRSS2 was seen in the main and accessory lacrimal glands. In contrast, ocular staining (S protein, ACE2, TMPRSS2) was distinctly present in pigmented cells of the RPE and choroid, as well as in the ciliary body and the iris stroma. S protein histochemistry revealed hardly any SARS-CoV-2 entry sites in all ocular tissues examined. Similarly, no significant ACE2 or TMPRSS2 expression was found in extra- and intraocular tissue. While this study suggest a rather low risk of ocular infection with SARS-CoV-2, it should be noted, that potential viral entry sites may increase in response to inflammation or in certain disease states.

Dacryops and clinical diagnostic challenges

ObjectiveThe study aims to describe the clinical and histopathologic features of different types of dacryops and their clinical diagnostic challenges. MethodsThis is a retrospective cohort study of all surgically excised cases of dacryops in 2 tertiary eye hospitals in Riyadh, Saudi Arabia. ResultsThe study included 58 dacryops specimens from 55 patients with an average age of 41.2 years (range, 4–78 years). The most common location was the upper lid (60.3%), whereas the least expected location was the caruncle (6.9%). The most common site of dacryops occurrence was in the accessory lacrimal gland (55.2%), the main lacrimal gland (32.8%), and then ectopic dacryops (12%). All patients presented with lid swelling alone except for 3 patients who experienced secondary mechanical ptosis. On physical examination, conjunctival scarring existed in 4 patients (6.9%). Preoperative diagnosis of dacryops was accurate in 44.8% of the cases. Dacryops of the main lacrimal gland was accurately diagnosed clinically in all cases compared with other locations, which was statistically significant (p < 0.001). The causes of inaccurate clinical diagnoses were hidrocystoma (26.9%), inclusion cyst (11.5%), and dermoid cyst (7.7%), whereas the remaining cases were diagnosed as cysts without a specific subtype (53.9%). Recurrence of the lesion was observed in 2 cases (3.5%). No clinical or histopathologic factors were associated with a risk of recurrence. ConclusionDacryops can represent a diagnostic challenge to ophthalmologists. Familiarity with clinical presentations and findings is required to diagnose dacryops outside the main lacrimal gland.

Motilin Receptor Expression Found in the Human Main and Accessory Lacrimal Glands

ABSTRACT Introduction: In this study, we investigated the presence of motilin receptors (MR) in adnexal tissue including the human main lacrimal gland. Method: 17 adnexal human specimens comprising of 11 isolated human main lacrimal gland specimens, four full-thickness human eyelid excisions and two exenterations containing full-thickness eyelid and portions of the main lacrimal gland were immunolabelled with a rabbit polyclonal human MR antibody. Results: Our results demonstrated that all main lacrimal gland specimens (13/13, 100%) were positive for MR expression with a predominance (10/13 (77%) of grade 1+ punctate distribution. Motilin receptors were not found in eccrine glands, cutaneous sebaceous glands, glands of Zeis or glands of Moll (0/6, 0%). We also confirmed MR expression in the accessory lacrimal gland tissue. Conclusion: In summary, we discovered the MR receptor in the lacrimal and accessory lacrimal gland - the significance of which, in the lacrimal gland, remains unclear - but motilin may play a role in the muscarinic control of aqueous tear secretion.

Adenocarcinoma NOS arising from accessory lacrimal glands: A case report and a review of the literature

Primary malignant epithelial tumours arising from accessory lacrimal glands (ALGs) are extremely rare, with only few cases reported in literature. They generally appear as gradually increasing masses of the upper or the lower eyelid. Only one case of primary adenocarcinoma or adenocarcinoma not otherwise specified (ACNOS) from ALGs has been reported in literature. Herein, we describe a case of ACNOS arising from ALGs with an atypical clinical presentation and review prior cases of ALGs epithelial malignancies reported in the literature. A 78-year-old man referred to our Ocular Oncology Unit for adjuvant therapy after the excision of a conjunctival tumour of the left eye with a histological diagnosis of squamous cell carcinoma. He underwent topical chemotherapy with MMC and during follow up he presented a multinodular iris mass in his left eye. The MRI of the orbit showed an ocular mass infiltrating orbital soft tissues of the inferior palpebral region with an involvement of the corresponding zygomatic cutis. We performed orbital exenteration and histological studies revealed an epithelial neoplasm with a solido-glandular growth pattern with lumens containing an eosinophilic material positive for PAS and PAS-D. The immunohistochemical findings confirmed the diagnosis of adenocarcinoma NOS from ALGs. Although ALGs epithelial malignancies are extremely uncommon, they should be considered in the differential diagnosis of ocular tumours. A vigilant approach towards these entities is required, since they can be clinically insidious and locally aggressive.

Immunohistochemical study on the expressions of neuropeptides in the superficial and deep gland of the third eyelid of pigs.

The superficial gland of the third eyelid (SGTE) and deep gland of the third eyelid (DGTE) are classified as accessory lacrimal glands. The aim of the present study was to immunohistochemically investigate the expression of vasoactive intestinal peptide (VIP), dopamine beta-hydroxylase (DβH), substance P (SP), galanin, neuropeptide Y (NPY), pituitary adenylate cyclase-activating peptide (PACAP), somatostatin and calcitonin gene-related peptide (CGRP) in the porcine SGTE and DGTE. We demonstrated the distribution patterns of VIP, DβH, SP, NPY and galanin in the nerve fibres in the SGTE and DGTE. None of somatostatin-, PACAP- and CGRP-immunoreactive (IR) nerve fibres were found in the SGTE and DGTE. The majority of VIP- and DβH-IR nerves fibres were found near to glandular acini, tubules, secretory ducts and blood vessels in the SGTE and DGTE. VIP-IR nerve fibres were found in external connective tissue in SGTE and DGTE and only in interlobular connective tissue in the SGTE. DβH-IR nerve fibres were found in interlobular and external connective tissue in the DGTE but not in the SGTE. Single galanin-, SP- and NPY-IR nerve fibres were observed in close proximity to acini and tubules in the SGTE and DGTE. Single galanin-, SP-, NPY-IR nerve fibres were found in close proximity to the secretory ducts in the DGTE, however only SP-IR nerve fibres were found near to the secretory ducts in SGTE. In conclusion, our research aims to highlight some aspects of SGTE and DGTE innervation in pigs and may also be a source of basic knowledge for further studies.

Understanding the Dual Dilemma of Dry Eye and Glaucoma: An International Review.

Glaucoma-related ocular surface disease (G-OSD) is a significant, yet often underdiagnosed, ocular co-morbidity affecting 40% to 59% of glaucoma patients worldwide. Although the use of topical glaucoma medications represents a proven strategy to control the untoward effects of high intraocular pressure, this treatment can profoundly disrupt the homeostasis of the tear film. The cumulative effect of medications, preservatives, and excipients alter underlying cellular structures which results in tear film abnormalities and instability of the ocular surface. Furthermore, these chronic inflammatory changes have been shown to impact efficacy of glaucoma treatment, patient compliance with therapy and overall quality of life. The pathogenesis of G-OSD is multifactorial and involves a vicious self-perpetuating cycle of inflammatory cytokines and proteins. The diagnosis of such disease is based on similar tests used in assessing traditional dry eye, taking into consideration findings specific to this patient population. The hallmark of treatment for these patients is to minimize the ocular surface inflammatory response by choosing glaucoma therapies that spare the ocular surface such as preservative free formulations and initiating dry eye treatment early in the course of care. In summary, glaucoma affects millions of patients around the world and chronic use of topical glaucoma medications may negatively impact the patient's ocular surface, symptoms, and vision. Understanding the pathogenesis of G-OSD, recognizing its risk factors and incorporating diagnostic and therapeutic strategies that restore and maintain ocular surface homeostasis will result in improved care for our patients.

Conjunctival oncocytic adenocarcinoma of lacrimal gland origin

AbstractPurposeTo present a rare case of a conjunctival tumour, in a patient who presented to the Ophthalmology department at Eastbourne District General Hospital with ocular surface symptoms.MethodsReview of patient case notes and electronic patient record.ResultsAn 83‐year old man presented with a 6‐month history of dry, gritty sensation in the right eye with a recent reduction in vision. He had a history of previously treated squamous cell carcinoma of the scalp. Examination revealed a large lesion extending from the conjunctival surface onto the temporal aspect of the cornea. The visual acuity was 6/12 with pinhole and there was no affect on ocular motility. Systemic evaluation did not suggest any features of metastatic disease and an MRI scan was unremarkable. The patient underwent an incisional biopsy of the lesion and histopathology showed a moderately differentiated adenocarcinoma with oncocytic features. Immunohistochemistry was positive for CK5/6, CK7, EMA and p63. He underwent successful excision of the lesion with adjuvant chemotherapy.ConclusionOncocytic adenocarcinoma (OCA) is a rare epithelial tumour that usually arises from the ductal cell lining of apocrine glandular structures. The oncocytes have a distinctive large size with granular acidophilic cytoplasm secondary to the presence of extensive mitochondria with fragmented cristae. The tumour is more commonly associated with the kidneys, thyroid and salivary glands. Cases within the eye although rare are associated with caruncle, lacrimal sac, accessory lacrimal glands of the conjunctiva and in the lacrimal gland. Cytokeratin (CK) are intermediate filaments found in the cytoskeleton of epithelial tissue and are used in the differential diagnosis of neoplasms as their expression varies with cell origin. CK5/6 found to be expressed in our patient is a marker of stratified squamous epithelium. The patient was also negative for CK 20 expression which would be seen in simple epithelium.

Structural and Molecular Tear Film Changes in Glaucoma.

The Tear Film (TF) is a trilaminar and dynamic fluid covering the entire Ocular Surface (OS), consisting of a mucus, aqueous, and lipid layer deeply interacting between them. Because of its structure and functions, TF plays a pivotal role in the preservation of the OS integrity and the quality of vision. Medical therapy for glaucoma is recognized to profoundly disturb the OS homeostasis by altering all components of the ocular surface unit, including TF. The presence of preservatives, the number of daily eye drops instillations, and the duration of therapy are the main contributors to TF changes. From the physio-pathological side, TF alterations are induced by toxic and allergic mechanisms and result from goblet cell and Meibomian gland loss, dysfunction of accessory lacrimal glands, and epithelial disruption. In detail, TF changes are represented by mucus layer thinning, reduced mucin concentration, aqueous layer volume reduction, and lipid layer thinning with increased tear evaporation. Hyper- osmolarity and instability represent the main hallmarks of these changes and are an expression of a iatrogenic form of dry eye. TF undergoes also molecular modifications that primarily reflect a therapy- or disease-induced inflammatory status of the OS. Over the last years, this field of research aimed a progressively growing interest since molecular variations may be considered as potential candidate biomarkers of glaucoma. The aim of this review is to report the main TF changes occurring during glaucoma, exploring the relationship they may have with the glaucoma-related ocular surface disease and the patient quality of life, and their utility as potential biomarkers of disease.

Lacrimal tissue resection in Fasanella Servat operation and the correlation to dry eye

ABSTRACTPurpose: Fasanella-Servat operation (FSO) was previously reported to be associated with post-operative dry eyes due to accessory lacrimal gland resection during the surgery.We performed a retrospective, cohort study to determine the frequency of lacrimal tissue resection during FSO and its correlation with post-operative eye dryness and keratopathy.Methods: Review of all patients who underwent FSO at New York-Presbyterian Weill Cornell Hospital over a two-year period (2013–2015). Patients were included only if they had adequate histopathological specimens of the resected tissue obtained during surgery. Outcomes included the study of the pathological specimen for the presence of lacrimal tissue; Post-operative dry eye symptoms and pre- and post-operative corneal epitheliopathy.Results: 46 patients with a total of 58 eyelid resections were studied.Eight eyelids (13.7%) were found to have lacrimal tissue present in the pathology specimens.Postoperatively, nine patients reported some symptoms of dry eye and new-onset keratopathy was noted in four eyes (6.8%), only one of which had lacrimal tissue present in histopathology specimen obtained from surgery.Discussion: Previous studies found lacrimal tissue present in up to 43% of specimens resected during FSO. Our data found a lower rate of lacrimal tissue resection during FSO, and did not find an association between lacrimal tissue resection and post-operative dryness or epitheliopathy.Conclusion: Our study is one of few to examine histopathological resections from the FSO.We found that lacrimal tissue is not frequently resected during FSO, and when it is resected, there is no increased incidence of post-operative dryness or keratopathy.

HMG-CoA reductase expression in human eyelid tissue and in a human meibomian gland epithelial cell line.

3-Hydroxy-3-methyl-glutaryl-coenzyme A reductase (HMGCR), the rate-limiting enzyme of cholesterol production, has been found to contribute to lipid secretion from skin sebaceous glands and hair follicles. We assessed for HMGCR expression in human eyelid tissue and in immortalized human meibomian gland epithelial cells (HMGECs) using immunohistochemistry. Full thickness human eyelid specimens in archival paraffin blocks were obtained. A section from each block was stained with hematoxylin and eosin and examined by an ocular pathologist for validation of tissue pathology. Immunohistochemistry was performed using rabbit anti-human HMGCR antibody on serial sections using the Ventana automated staining system. HMGCR expression was examined for in HMEGCs with fluorescence immunocytochemistry and confocal microscopy. Thirteen full thickness eyelid specimens met the inclusion criteria. All specimens contained meibomian glands, and 2 (15%) contained glands of Zeis, 3 (23%) pilosebaceous glands, 2 (15%), accessory lacrimal glands, and 2 (15%), glands of Moll, respectively. Immunohistochemistry showed HMGCR expression in meibocytes of meibomian glands and sebocytes of Zeis and pilosebaceous glands in all specimens. HMGCR expression was also evident in vascular endothelium. Immunofluorescence was positive for HMGCR expression on HMGEC cells. No labeling was seen for the negative Ig control. HMGCR was expressed in all eyelid sebaceous-type glands and in HMGECs, consistent with a role for cholesterol production in the genesis of tear film lipids. The observed expression also provides a rationale for using topical statins, inhibitors of HMGCR, as novel tear film lipid stabilizers in conditions such as blepharitis, where meibum production is aberrant.

This issue of Acta

This issue of Acta

Tear Lactoferrin and Features of Ocular Allergy in Different Severities of Meibomian Gland Dysfunction.

Meibomian gland dysfunction, but not atrophy, was associated with lower tear lactoferrin concentration, greater dry eye, and allergic symptoms, indicating greater inflammation and discomfort in patients with lower meibomian gland expressibility. Meibomian gland dysfunction can potentially damage adjacent palpebral structures, which may induce inflammation in accessory lacrimal glands and affect lactoferrin secretion. This study aimed to examine the relationships between the severity of meibomian gland dysfunction with tear lactoferrin, conjunctival cell morphology, and clinical features of ocular allergy. Forty subjects were divided into two groups based on the severity of meibomian gland plugging and expressibility and secondarily based on its atrophy. Dry eye and allergy questionnaires; slit-lamp examination, including lid telangiectasia; and meibography were performed. Tear lactoferrin concentration was measured using TearScan 270 MicroAssay. Impression cytology was performed on the upper palpebral conjunctiva, and goblet cell density and epithelial squamous metaplasia were quantified. Twenty-two subjects with meibomian gland dysfunction were categorized into severely obstructed group (case), whereas 19 subjects had minimal/no obstruction (comparison). Lower lactoferrin (1.3 ± 0.4 vs. 1.7 ± 0.4 mg/mL, P = .007), greater dry eye (7 [1 to 10] vs. 2 [0 to 5], P = .03), and allergy symptoms (9 [4 to 23] vs. 6 [0 to 9], P = .05) were found in the cases compared with the comparisons. There were no differences in conjunctival cell morphology between groups. The plugging score was correlated with lactoferrin concentration (ρ = -0.43, P = .006), dry eye (ρ = 0.36, P = .02), and allergic symptoms (ρ = 0.33, P = .04). Greater lid margin telangiectasia was associated with meibomian gland obstruction, but not atrophy. Meibomian gland activity/dysfunction, but not atrophy, may be associated with increased inflammation on the ocular surface. The inflammation may be sufficient to reduce tear lactoferrin production from damage to accessory lacrimal glands and/or meibomian gland and result in increased symptoms.

Tear Film Stability in Patients with Pseudexfoliation

Abstract Pseudoexfoliation syndrome is an age related disorder, characterized by abnormal fibrous fiber production and accumulation in different visceral organs as well as in the eye and periocular tissues. Hystological examination recorded the presence of the pseudoexfoliation in the conjunctiva, and they can disturb the accessory lacrimal gland and goblet cell function. This can explain tear film instability in patients with pseudoexfoliations. In our study, we examined the tear film stability in patients with and without pseudoexfoliation, using Schirmer test and tear break up time test. Our results indicated that patients with pseudoexfoliation had lower values of Schirmer and tear break up time tests than patients without it. Pseudoexfoliation is the main reason for the instability of the tear film, because of its negative impact on the conjucntival goblet cells. In conclusion, ophthalmologists must have these data on their mind in the process of the pseudoexfoliation glaucoma treatment and controlling.

Accessory lacrimal gland tumours of the eye region.

Tumours of the accessory lacrimal glands (ALGs) are rare and need to be differentiated from other tumours involving the eyelids and caruncle. We report on a consecutive series of patients with ALG tumours and describe the clinical characteristics. A retrospective case series including all patients who were operated for ALG tumours at two different centres. The study included 27 patients diagnosed with ALG tumours. Mean age at presentation was 55.9years (range, 24-81years; median, 56years). Overall, a slight male preponderance was observed (M:F=1.4:1). Histologically, pleomorphic adenoma was the commonest diagnosis (24 of 27; 88.9%), followed by adenoid cystic carcinoma (2 of 27; 7.4%) and oncocytoma (one of 27; 3.7%). A complete surgical excision was curative in all patients. Accessory lacrimal gland (ALG) tumours are rare and may therefore pose diagnostic difficulties for clinicians. Histopathological examination of these tumours is the cornerstone of the diagnostic evaluation. Complete surgical excision is the treatment of choice in these tumours.

Surgical Treatment of the Semi-Lunar Fold Stromal Cysts in the Bulbar Conjunctiva in Polyclinic “SHOSHI” in Prishtina

Introduction: The conjunctiva is a thin, superficial mucosa that covers the anterior part of the eye lids and the anterior part of the sclera. The semi-lunar fold is located in the interior angle of the eye, and represents the third rudimentary eyelid. In the histological aspect, conjunctiva is composed of the epithelium and stroma. Thestroma is divided into two parts: the superficial adenoid part and the inner fibrotic part. The accessory lacrimal glands are found in the stroma. Materials and methods: A case study of a 14 year-old male patient, who came at our clinic as a result of a 5 - 6 mm tumefaction on the bulbar conjunctiva, on the nasal part of the bulbar conjunctiva, attached to the semi-lunar fold. The patient referred that the cyst appeared 6 - 7 months ago and was constantly growing. In the beginning the patient has been treated with antibiotic and corticosteroid eye drops. However, the cyst grew constantly therefore the best solution was the surgical treatment. The surgery was performed under local anesthesia. The total excision of the cyst was performed. The removed tumefaction was then diagnosed as a cyst of the conjunctival stroma. Purpose: The purpose of this study is to show that the best treatment of the conjunctival epithelium tumefaction, which is not reduced in size by the local treatment with antibiotics and corticosteroids, is the surgical treatment. Conclusion: Every change in the conjunctiva, causing functional and aesthetic problems, is an issue that should be directed to the ophthalmologist. Such changes should be treated with medications or surgically, the patient should be followed up, to see whether or not such changes will reappear.

Pleomorphic Adenoma of an Accessory Lacrimal Gland Masquerading as a Chalazion

Pleomorphic Adenoma of an Accessory Lacrimal Gland Masquerading as a Chalazion