Lacrimal Dysfunction Research Articles

Evaluation of Greater Petrosal Nerve Function in Patients with Acute Peripheral Facial Paralysis: Comparison of Soft Palate Electrogustometry and Schirmer's Tear Test

We tested sensory and secretomotor function of the greater petrosal nerve (GPN) by means of electrogustometry (EGM) of the soft palate and Schirmer's tear test in 115 patients (59 males, 56 females) with acute peripheral facial paralysis. Facial paralysis was caused by Bell's palsy in 78 cases, Ramsay Hunt syndrome in 27 cases and zoster sine herpetic lesions in 10. All patients had dysfunction of the stapedial nerve. An electrogustometer was used to test taste (GPN sensory function), and elevation of the threshold by > 6 dB on the affected side was considered abnormal. Schirmer's test was used to evaluate lacrimal (GPN secretomotor) function, which was considered abnormal when tear secretion on the affected side was < 50% of secretion on the non-affected side. Of the 78 patients with Bell's palsy, 28.2% had altered taste on the soft palate (sensory dysfunction) and 10.3% had lacrimal dysfunction, indicating that EGM of the soft palate is more sensitive than Schirmer's test for identifying dysfunction of the GPN in patients with facial paralysis due to Bell's palsy. Of the total of 115 patients, 32 (28%) had taste dysfunction and 9 (28.1%) of these 32 patients also had lacrimal dysfunction. This finding indicates that facial paralysis has different effects on the sensory and secretory nerve fibers of the GPN. The results of Schirmer's test were more closely related to the severity of, and prognosis for, facial paralysis than the results of EGM.

Proliferation of Lacrimal Gland Acinar Cells in Primary Culture. Stimulation by Extracellular Matrix, EGF, and DHT

The study of lacrimal dysfunction and insufficiency, a major cause of dry eye, has been hampered by the inability to induce the proliferation of primary lacrimal acinar cells in vitro. Particularly in light of observations that androgens are able to support the overall size and functional status of the lacrimal glands as well as certain specific lacrimal functions, an in vitro culture system that is permissive for cell proliferation would be most beneficial to study the molecular basis for these processes. Here, we report on the successful establishment of such a system. Using a culture system containing Hepato Stim Medium®and Matrigel®, we were able to induce the efficient proliferation of primary rabbit lacrimal gland acinar cells with epidermal growth factor (EGF) and dihydrotestosterone (DHT). The generation of this in vitro cell culture system should greatly facilitate study of the regulation of acinar cell function at the molecular and cellular levels.

The natural history of epiphora in childhood.

To investigate the incidence and aetiology of epiphora in a population of 7-year-old children and determine whether a conservative management policy for congenital nasolacrimal duct obstruction (CNLDO) results in excess lacrimal dysfunction in later childhood. A postal questionnaire was sent to the parents of a large cohort of 7-year-old children previously investigated to determine the incidence and natural progression of CNLDO. They were asked about the presence of epiphora, and its relationship to atopic disease and the presence of upper respiratory tract infections (URTI). Information on epiphora had also been gathered from the same cohort at age 3 1/2 years at a routine examination. Data were compared with those for epiphora in infancy in the same cohort. The incidence of epiphora at 3 1/2 years was 5.5%, and 7 years 7.7%. At age 7 years 70% of cases were related to atopic disease or URTI. CNLDO was not significantly related to epiphora in later childhood (p = 0.000032). A policy of delaying nasolacrimal probing in CNLDO until after the age of 1 year does not result in a detectable excess of lacrimal dysfunction in later childhood, when epiphora is more likely to be related to atopic disease or upper respiratory tract infection.

Acinar cell basal-lateral membrane-endomembrane traffic may mediate interactions with both T cells and B cells.

The lacrimal glands are normally populated by significant numbers of IgA-producing plasma cells and T lymphocytes, with CD8 cells in twofold excess over CD4 cells. The numbers of these cells increase during normal aging, and there has been speculation that they may exacerbate the lacrimal dysfunction of primary lacrimal deficiency. Lymphocytic infiltration increases much more dramatically in Sjögren’s syndrome, an immune system disorder in which CD4 cells dominate the T lymphocyte population, and the antibody-producing population includes large numbers of B cells. The B cell infiltrates are polyclonal and often produce IgG and IgM against intracellular antigens, such as the ribonuclear proteins Ro and La and a variety of Golgi proteins. Because of the severity of the ocular surface disease and the debilitating and potentially life-threatening nature of the systemic manifestations of Sjögren’s syndrome, it is important to identify the mechanisms that lead to CD4 cell and B cell proliferation in the lacrimal glands.KeywordsAcinar CellGolgi ComplexLacrimal GlandOcular Surface DiseaseMembrane RecyclingThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

顔面神経麻痺における大錐体神経機能検査の評価

We coducted electrogustometry (EGM) of the soft palate as a functional test of the greater petrosal nerve (GPN) in patients with acute peripheral facial paralysis and compared these findings with results of the Schirmer's test.One hundred fifteen cases,59 males and 56 females were examined. Seventy-eight cases had Bell's palsy,27 cases Ramsay Hunt syndrome and 10 cases zoster sine herpete. Dysfunction of the stapedial nerve was recognized in all cases.An electrogustometer (TR-5, Rion ) was used for the taste test. The elevation of the threshold more than 6 dB on the affected side was considered abnormal. To evaluate lacrimal function, the Schirmer's test was used. Lacrimal secretion on the affected side was considered abnormal when the secretion was decreased to less than 50% of that on the non-affected side.The following results were obtained.1.28.2% of 78 cases of the B ell's palsy showed taste disturbance of the soft palate, and 10.3%showed lacrimal dysfunction. It was supposed that the EGM of the soft palate was more sensitive than the Schirmer's test for evaluating of dysfunction of the GPN in facial nerve palaysis.2. Only 9 (28.1%) of 32 cases with taste dysfunction also showed lacrimal dysfu nction. It was suspected that the affected nerve fibers differ somewhat in between the sensory and secretory nerve fibers of the GPN.3. Findings of Schirmer's test were more related with the severity of the facial paralysis and with the prognosis of paralysis than those of EGM.

Heerfordt症候群の顔面神経麻痺

In three cases of Heerfordt syndrome, we evaluated the severity of facial paralysis and topographically diagnosed the site of damage to the facial nerve. One patient with severe facial nerve paralysis showed lacrimal dysfunction, absence of stapedial reflex and taste dysfunction on the same side as facial paralysis, and the site of damage to the facial nerve was diagnosed as the geniculate ganglion. Two other cases showed infrastapedial lesion of the facial nerve. The presence of other cranial nerve disorders, i. e. VIIIth, PCt h and X th cranial nerves, was suspected in two patients. All three patients were treated by administration of steroids. One patient with only mild facial weakness showed rapid improvement but the other two patients were unable to achieve complete recovery. We concluded that positive administration of steroids is necessary in the treatment of facial paralysis associated with severe nerve damage or other cranial nerve disorders.

Cholinergic dysfunction in Shy-Drager syndrome: effect of the parasympathomimetic agent, bethanechol.

To determine the frequency, severity and organ distribution of cholinergic dysfunction in the Shy-Drager syndrome, eleven patients were prospectively studied. In addition to documenting adrenergic insufficiency, a battery of twelve tests was employed to assess cholinergic function. Six tests demonstrated pupillary, lacrimal, salivary, urinary bladder, sexual and sudomotor dysfunction in the majority of patients. Cardiac vagal function as studied by the heart rate response to deep breathing, the Valsalva manoeuvre, cold face test, apnoeic facial immersion and atropine test was affected in all patients. Oesophageal motility was abnormal in six patients. Cholinergic dysfunction in patients with the Shy-Drager syndrome was widespread but of variable severity and distribution. Subcutaneous administration of the parasympathomimetic agent bethanechol demonstrated hyperresponsiveness of lacrimal, salivary, oesophageal, bowel, bladder and sudomotor functions. It is suggested that the Shy-Drager syndrome is primarily a preganglionic cholinergic disorder with transsynaptic degeneration accounting for the development of postganglionic cholinergic as well as adrenergic dysfunction.

Lacrimal dysfunction in pediatric acquired immunodeficiency syndrome.

In the United States, the Acquired Immunodeficiency Syndrome (AIDS) is the second leading cause of death among men of 25 to 44 years old. By 1987 AIDS had also become the ninth leading cause of death for children between the ages of 1 and 4. It is estimated that one in 75 men and one in 700 women between the ages of 15 and 49 years are infected with human immunodeficiency virus (HIV). Homosexual/bisexual men still account for most cases, but the groups whose numbers are increasing most rapidly include patients exposed through intravenous drug use or heterosexual contact and children infected by perinatal transmission (CDC, 1991).

Lacrimal dysfunction in hemispheric cerebrovascular disease. A study with periotron

Lacrimal dysfunction in hemispheric cerebrovascular disease. A study with periotron

Tear potassium contributes to maintenance of corneal thickness.

Isolated rabbit corneas were bathed on their endothelial surfaces with normal Krebs bicarbonate Ringer solution, while the epithelial surfaces were bathed in a basic tear solution containing sodium and potassium. When bathed in basic tear solution alone, corneal swelling occurred at an average of 12 microns/h over a 3-hour period. Corneal swelling occurred at a rate of about 21 microns/h when the epithelial solution was switched from normal basic tear solution to an iso-osmotic K(+)-free basic tear solution. Corneal swelling then slowed, and in the final hour of a 3-hour exposure to K(+)-free tear solution, the corneas deswelled at about 10 microns/h. The data indicate that potassium is a necessary solute for the maintenance of normal corneal thickness. The results suggest that a lacrimal dysfunction that would cause a decrease in the potassium content of tears may influence corneal thickness and also suggest that the inclusion of potassium in artificial tears is important.

Standardized echography in the diagnosis of lacrimal drainage dysfunction.

Fifteen patients with symptoms of nasolacrimal duct obstruction were evaluated with B-scan and standardized A-scan ultrasonography. Results were correlated with findings on routine clinical tests of lacrimal drainage function, and echographic findings were confirmed at surgery in all cases. Ten normal lacrimal systems were also examined. In all patients the lacrimal sac and duct were easily visualized as an echolucent defect bounded by the bony lacrimal crests. Abnormal dilatation, diverticuli, and inflammatory exudates were readily detected. Surgically created dacryocystorhinostomy ostia were imaged on both A- and B-scans, as were obstructing membranes seen before surgical revision. Physiologic lacrimal pump failure could not be evaluated, and the exact site of obstruction could not be determined.

Patterns of lacrimal dysfunction in primary biliary cirrhosis.

The lacrimal function has been evaluated in 23 patients suffering from primary biliary cirrhosis by rose bengal test, the Schirmer test 1, and the tear breakup time. Ocular dryness was present in 78% of cases studied. No difference was found with respect to the length or severity of the hepatic involvement between patients with and without lacrimal dysfunction, but in patients with signs of hypolacrimation the changes in the lacrimal tests increased with the duration and histological progression of liver disease.

Naso-orbital Fractures, Complications, and Treatment

Naso-orbital fractures designate a backward displacement of the bones of the nasoskeletal framework into the interorbital space. This anatomical disruption results in deformities, lacrimal dysfunction, medial canthal deformities, ptosis, blow-out fractures, ocular complications, and most severely, penetration of bony fragments into the anterior cranial fossa. Early and late treatment methods are considered. Restoration of the bony contour of the nose and medial canthoplasty procedures are discussed.

Symposium on Surgery of the Orbit and Adnexa

This volume of the Transactions of the New Orleans Academy of Ophthalmology is remarkably comprehensive. Diagnostic procedures, trauma management, cosmetic surgery, and several excellent chapters on tumor pathology and treatment are among the wide range of subjects covered by an outstanding panel of authors. Although the overall quality of the articles is unusually high, several deserve special attention. Blodi and Ellsworth have assembled a detailed survey of orbital tumors and inflammations, including a valuable review of ophthalmic Graves disease. Wadsworth has included two practical and well-illustrated chapters describing techniques of orbital surgery. The rationale of lid reconstruction following tumor excision is reviewed in several articles. Jones has thoughtfully discussed anatomical, physiologic, and therapeutic aspects of lacrimal dysfunction and lower eyelid abnormalities. Theoretical and practical considerations of ptosis, blepharoplasty, and ectropion operations are described by Beard and Callahan. These speakers, together with Keney, participated in a series of panel discussions that