Lacrimal Gland Duct Research Articles

Six surgical principles for safe excision of superotemporal dermolipoma

Purpose The aim of this study was to describe six surgical principles that were applied for safe excision of superotemporal dermolipomas. Patients and methods This retrospective interventional clinical study included 32 dermolipomas (in 29 patients) that presented to the Orbit Clinic of Assiut University Hospital, Assiut, Egypt and were subjected to surgical excision. The six surgical principles applied for safe dermolipoma excision were: conjunctival incision at the junction between normal and abnormal conjunctiva sparing as much bulbar conjunctiva as possible, hooking the lateral rectus muscle and dissecting the lesion free from the muscle and the covering Tenon’s capsule, eversion of the upper lid using Descemar’s retractor, incision at the upper bulbar conjunctiva, and dissection of the superior surface of the lesion away from the levator muscle, dissection of the lateral surface of the lesion from its attachment to the lateral canthus sparing a stump of the conjunctiva, dissection of the deep part of the lesion from the underlying normal orbital tissue, and suturing the bulbar conjunctiva to the preserved conjunctival stump at the lateral canthus. The follow up ranged from 3 to 35 months (mean=21±3.2 months) during which the patients were assessed for improvement in the presenting manifestations as well as for the presence of complications such as ptosis, dry eye, strabismus, limitation of ocular motility, or symblepharon. Results The surgery was successful in all patients without permanent dry eye, blepharoptosis, or permanent strabismus. Temporary limitation of adduction was observed in two patients that resolved spontaneously within 1 month. Conclusion Adherence to the six surgical principles outlined in the study allowed the authors to safely excise the dermolipomas without damaging the lateral rectus, levator complex, and lacrimal gland ductules. Thus, postoperative squint, ptosis, and dry eye were avoided. In addition, preserving the forniceal conjunctiva and suturing the bulbar conjunctiva prevented symblepharon formation and restricted mobility.

The Whitnall Barrier: A Technique for the Management of Lacrimal Gland Prolapse.

The Whitnall barrier procedure, a modified Beer and Kompatscher surgical technique to reposition the lacrimal gland, is presented alongside a case series of patients demonstrating excellent aesthetic and functional outcomes. The Whitnall barrier procedure is illustrated procedurally and accompanied by a case series of 20 consecutive patients treated in a single institution by a single surgical team between December of 2016 and February of 2020. Lid contour and function were assessed postoperatively, as was patient satisfaction. Thirty-seven eyes of 20 patients were included. All patients were women, with an average age of 50 years. Fourteen patients underwent surgery for cosmesis, four had inactive thyroid eye disease, and two had lacrimal gland enlargement secondary to dacryoadenitis. The degree of lacrimal gland prolapse was described as mild in two eyes and moderate in 35 eyes. All patients had one or more additional surgical procedures. Mean follow-up duration was 11 months, with complete resolution of lacrimal gland prolapse in 34 eyes. The patient who did not have complete resolution had dacryoadenitis and required ongoing immunosuppressive therapy. Two patients were discharged on topical lubricants: one with thyroid eye disease and one cosmetic patient who underwent upper and lower lid blepharoplasties at the same time. There were no intraoperative complications and no incidences of infection, dehiscence, or damage to the lacrimal gland ductules. The Whitnall barrier technique is a safe and effective surgical procedure to restore the anatomic location of the lacrimal gland. It provides excellent aesthetic and functional outcomes.

Features of water-electrolyte component of the tear fluid

Tear production is a complex multi-step process that can be arbitrarily divided into three stages: «primary» secretion by the acinar cells of the main lacrimal glands, formation of «secondary» lacrimal fluid in the ducts of the main lacrimal glands, and «tertiary» modification of the tear composition in the conjunctival sac. This article highlights mechanisms of water and electrolytes secretion in the process of tear fluid production and describes the particularities of distribution of the membrane transport proteins in the lacrimal gland and the ocular surface.

The ocular graft-versus-host disease: the path from current knowledge to future managements.

Graft-versus-host disease (GVHD) is one of the major complications of allogenic haematopoietic stem cell transplantation (HSCT). The manifestation of ocular GVHD (oGVHD) is variable and may involve cornea, lacrimal gland, conjunctiva, eyelid, and/or nasolacrimal duct. We reviewed and summarized the current managements of oGVHD with specific focus on the emerging therapeutic advances. PubMed, Web of Science, and Google Scholar were searched for relevant literatures published within 20 years. Keywords used included "Graft-Versus-Host Disease", "GVHD", "ocular", "ocular surface", "ocular GVHD", "oGVHD", "dry eye", "keratitis", etc. RESULTS: Current managements of oGVHD can be classified into topical immunosuppressants, local tear-preservatory treatments, local non-pharmacological/surgical interventions, and systemic treatments. Additionally, some innovative therapies with promising treatment effects have been proposed, including topical target therapies, epitheliotrophic and neurotrophic treatments, recombinant DNase eye drops, mesenchymal stromal cell injection, and more. Clinical managements of oGVHD are administered in a symptom-based, stepwise manner. The advances in innovative therapies may help improve clinical outcomes, and it is essential that physicians stay updated with these novel treatment options.

Lacrimal Gland Microenvironment Changes After Obstruction of Lacrimal Gland Ducts.

PurposeTo investigate microenvironment changes of the lacrimal gland after obstruction of lacrimal gland ducts.MethodsThe ducts of rat exorbital lacrimal gland were ligated by sutures for different durations. After that, the sutures in some animals were released, and they were observed for 21 days to evaluate the recovery of the lacrimal gland. Slit lamp and tear secretion test was performed to evaluate ocular surface and lacrimal gland function. The lacrimal gland and cornea were harvested and processed for hematoxylin and eosin staining, oil red O staining, LipidTOX staining, Masson staining, quantitative real time polymerase chain reaction, and immunofluorescence staining.ResultsAfter the lacrimal gland ducts were blocked, tear secretion and the weight of the lacrimal gland were reduced. Incidence of corneal neovascularization increased after seven days. Intraglandular ducts dilated and acini destroyed. Long-term ligation induced fibrosis and lipid accumulation of the lacrimal glands. Inflammatory cell infiltrated and inflammatory factors upregulated. Proliferative and apoptotic cells increased. Structure of myoepithelial cells and basement membrane was destroyed. The p63 expression increased whereas Pax6 expression decreased. After suture release, tear secretion and structure of acini could recover in less than seven days after ligation, with a decrease in inflammatory cell infiltration and fibrosis relief. Apoptotic cells and proliferative cells increased at five days thereafter. The structure of the myoepithelial cells and basement membrane could not recover three days after ligation, and the number of mesenchymal cells increased in ligation after five to 14 days.ConclusionsBlockage of the lacrimal gland ducts results in dystrophy of lacrimal gland acini cells, inflammation, and lipid accumulation of the lacrimal gland microenvironment. Long-term duct blockage will cause irreversible lacrimal gland failure.

COVID-19–Related Chronic Bilateral Dacryoadenitis

Pathological features of ophthalmic aftereffects of COVID-19 are important for new insight in treating patients. To examine the expression of SARS-CoV-2 nucleocapsid protein and angiotensin-converting enzyme 2 (ACE2) in lacrimal gland tissues of a patient with COVID-19 and a patient without COVID-19. In this retrospective case-control study, the case of a 35-year-old woman with positive test results for SARS-CoV-2 who had had lacrimal gland enlargements for 6 months was analyzed. A 43-year-old woman without COVID-19 who had idiopathic chronic bilateral dacryoadenitis served as a negative control. Histopathology and immunohistochemistry with anti-SARS-CoV-2 nucleocapsid protein and ACE2 in the lacrimal glands. Both patients were Japanese women aged 35 years (case) and 43 years (control). Histopathologic findings in the patient with COVID-19 demonstrated marked inflammatory cell infiltration, lymphoid follicles, and germinal center formation in the lacrimal gland. The inflammation was mainly made up of lymphocytes and plasma cells with several polymorphonuclear leukocytes, where the lacrimal glands were atrophic. Of note, a number of lacrimal gland ducts markedly contained eosinophilic materials in the lumens, which indicated glandular damage. Immunoreactivity for SARS-CoV-2 nucleocapsid protein was noted in the inflammatory cells around the lacrimal gland ductal epithelia. In addition, strong ACE2 expression was noted in the lacrimal gland. In the patient without COVID-19, marked inflammation was noted in the lacrimal gland; however, there were no eosinophilic material deposits in the ductal lumens. SARS-CoV-2 nucleocapsid protein immunoreactivity was not observed, whereas ACE2 was expressed in the lacrimal glands. In this case-control study, expression of ACE2 indicated that the lacrimal gland could be a target organ for SARS-CoV-2 to adhere to. Chronic bilateral dacryoadenitis in the patient with COVID-19 showed SARS-CoV-2-positive inflammatory cells with glandular damage, which might be a COVID-19-associated ophthalmic aftereffect.

STRUCTURE OF EXCRETORY DUCTS OF EXTRAAND INFRAORBITAL GLAND OF LABORATORY RATS

The aim of the study. To find out and compare the structure of the excretory ducts of the extraand infraorbital lacrimal gland of the laboratory rat. Object and methods. Five male laboratory rats were examined by dissecting the lacrimal glands, from which a series of thin paraffin sections were obtained for histological examination. Micropreparations were stained with hematoxylin and eosin and examined under a light microscope. Results. It was found that the tubular-alveolar epithelial components of the extraorbital gland of rats inside the lobe are even denser than in the infraorbital gland, as evidenced by very narrow interstitial fissures. The lacrimal glands of laboratory rats have an individual well-defined connective tissue capsule. Inside and between the lobes there are slit-like interpithelial interstitial spaces, in which we do not detect an accumulation of lipocytes, as occurs in the lacrimal glands of man. In the volume of lobes such as the extraorbital and infraorbital glands, the interpithelial interstitial spaces contain vessels of the hemicrocirculatory tract, mainly capillaries, precapillary arterioles and postcapillary venules. Arterioles and venules are usually visualized outside the lobes in more pronounced interstitial spaces. Conclusions. 1. The epithelial tubular structures of the lacrimal gland of the laboratory rat form a complex-branched system of excretory ducts, in which there are no typical intercalated ducts, which would be the connecting component between the terminal section and the excretory duct system. 2. The absence of intercalated ducts leads to a change in the appearance on histological specimens of tubulo-acinar aggregates of the lacrimal glands of rats in favor of tubuloalveolar assemblages. 3. Among the excretory ducts of the lacrimal glands of the laboratory rat, the following can be distinguished: intra-lobular, lobular and common excretory ducts, through which the secret is produced. The common ducts of the extraand infraorbital lacrimal glands, as a rule, combine to form their common duct.

Could Extension Into the Lacrimal Gland and Sac Thwart Topical Chemotherapy for Intraepithelial Sebaceous Carcinoma?

To identify the frequency of intraepithelial (Pagetoid) spread beyond the ocular surface-namely beyond conjunctiva and cornea-in patients undergoing orbital exenteration for advanced periocular Sebaceous carcinoma (SC). A retrospective, noncomparative observational case series. Patients undergoing orbital exenteration for biopsy-proven SC, at Moorfields Eye Hospital between 1997 and 2013. Review of clinical records and histological specimens, with particularly reference to involvement of conjunctiva and the extent of Pagetoid infiltration beyond the examinable ocular surface-here termed "hidden" disease. Histological evidence of intraepithelial SC within the lacrimal sac or lacrimal gland. Twenty-nine patients had clinical data and histological specimens adequate for review. Seventeen (59%) did not have a discrete mass (clinically or histologically) and, on clinical examination, were thought to only have extensive intraepithelial carcinoma; foci of microscopic invasion were, however, detected histologically in 11/17 (65%) of these specimens. Moreover, the in situ carcinoma was found to have invaded far in lacrimal gland ductules in 1/17 patients, in the lacrimal sac (in 2 patients; 12%) or in both the gland and sac (in 2 patients); these 5/17 (29%) cases all showed extensive poorly differentiated intraepithelial SC. Of the 12 other patients who had both Pagetoid spread and a clinically evident nodule, 3 had histological evidence of "hidden" disease. Although-due to their being operated in the era prior to the accepted usage of topical therapy for this condition-some of these exenterations might have had particularly advanced in situ SC, over a quarter of patients with periocular SC warranting orbital exenteration show "hidden" intraepithelial tumor within the lacrimal gland and sac. This important finding might significantly reduce the efficacy (particularly in the lacrimal gland) of the various topical therapies used for in situ SC of the ocular surface, and it also emphasizes the importance of excising both the lacrimal gland and sac in all orbital exenterations for this particular tumor.

Detection of radiotherapy-related damage in head and neck cancer patients by evaluating volumetric changes in lacrimal gland, nasolacrimal duct and computed tomography attenuation changes in lens

In our study, we aimed to evaluate the change in attenuation of lens in CT images, volumetric changes, in lacrimal gland (LG) and nasolacrimal duct (NLD) of the patients receiving radiotherapy for brain or head & neck tumor. Additionally, the correlation between these changes and radiation dose data were investigated. Patient simulation CT images and control CT images were used to evaluate the volume and attenuation changes. Pre- and post-treatment MR and CT images were used to evaluate radiation-induced volumetric alterations in NLD and LG, respectively. Radiation therapy was given to a total dose of 54-70Gy with conventional fractionated scheme using intensity-modulated radiotherapy technique (IMRT). Dose volume parameters were evaluated via dose volume histograms (DVHs). Dose volume parameters, volume and densities of 59 lenses (L), 60 LG and 60 NLD of 30 patients were retrospectively assessed. The median LG volume was significantly lower in the post-treatment images (p < 0.001), whereas the median volumes of NLD in pre- and post-RT images were similar. The Hounsfield unit (HU) numbers of lenses were significantly lower on post-RT CT images (p < 0.001). No statistically significant correlation was found between dose parameters and volume or HU changes (p = 0.054-0.817). It was observed that the attenuation of lenses and lacrimal gland volume significantly lowers following radiation. However, these alterations were not found to be correlated with dose.

Alpha-Adrenergic Agonists Stimulate Fluid Secretion in Lacrimal Gland Ducts.

PurposeThe role of adrenergic innervation in the regulation of lacrimal gland (LG) ductal fluid secretion is unknown. The Aim of the present study was to investigate the effect of adrenergic stimulation on fluid secretion in isolated LG duct segments and to study the underlying intracellular mechanisms.MethodsFluid secretion of isolated mouse LG ducts was measured using video-microscopy. Effect of various adrenergic agonists (norepinephrine, phenylephrine, and isoproterenol) on fluid secretion as well as inhibitory effects of specific antagonists on adrenergic agonist-stimulated secretory response were analyzed. Changes in intracellular Ca2+ level [Ca2+i] were investigated with microfluorometry.ResultsBoth norepinephrine and phenylephrine initiated a rapid and robust fluid secretory response, whereas isoproterenol did not cause any secretion. Phenylephrine-induced secretion was completely blocked by α1D-adrenergic receptor blocker BMY-7378. The endothelial nitric oxide synthase (eNOS) inhibitor L-NAME or guanylyl cyclase inhibitor ODQ reduced but not completely abolished the phenylephrine-induced fluid secretion, whereas co-administration of Ca2+-chelator BAPTA-AM resulted in a complete blockade. Phenylephrine stimulation induced a small, but statistically significant elevation in [].ConclusionsOur results prove the direct role of α1-adrenergic stimulation on LG ductal fluid secretion. Lack of isoproterenol-induced fluid secretory response suggests the absence of β-receptor mediated pathway in mouse LG ducts. Complete blockade of phenylephrine-induced fluid secretion by BMY-7378 and predominant inhibition of the secretory response either by L-NAME or ODQ suggest that α-adrenergic agonists use the NO/cGMP pathway through α1D receptor. Ca2+ signaling independent from NO/cGMP pathway may also play an at least partial role in α-adrenergic induced ductal fluid secretion.

The Presentation and Surgical Treatment of Peribulbar Dermolipomas.

To evaluate the presentation, treatment, and outcome for patients with peribulbar dermolipomas and describe a reliable technique for excision of large lesions. Retrospective chart review for patients seen at Moorfields Eye Hospital between 1976 and 2019. Patient demographics, clinical features, imaging (CT or MRI, where available), histopathology, and surgical outcomes were reviewed. One hundred and ninety-six eyes of 187 patients (117 females; 63%) were identified as having dermolipoma, the patients presenting at an average age of 21.5 years and-where recorded in 163 patients-had first symptoms at an average age of 12.9 years. Although 8/187 (4%) patients were asymptomatic, the commonest symptom was increasing size of a longstanding peribulbar lump (136 patients; 73%); other symptoms included ocular irritation (24%), episodic localized conjunctival injection (12%), and mucoid discharge (12%). One-third of dermolipomas had visible hairs (some with localized giant papillary conjunctivitis), lateral canthal widening was present in 44 patients, aberrant lacrimal gland ductules opening onto skin in 8, and a complex lateral canthal anomaly-with both an external dermoid and an internal dermolipoma-was present in 9 patients. Complete management details were available for 120 patients (those treated after 1990) and 40 (33%) electing for observation, 71 (59%) had excision for long-term irritation and discharge and 9 (8%) for cosmesis: together with the integral subdermal fat lobule, in all cases the abnormal, nonwetting squamous epithelium was delineated and excised under microscopic control, and the conjunctival defect closed directly (59/80 eyes) or with a "V-to-Y" closure (21 eyes; 26%). The presenting symptoms were cured in all except 1 patient, who required excision of residual abnormal epithelium causing persistent symptoms. Two patients developed symblepharon to the lateral canthus after direct conjunctival closure, this having no functional effect, and 2 other patients had slight restriction of extreme horizontal gaze. Dermolipomas may require surgery when they become more prominent with age, or start causing ocular irritation and discharge. Complications are few with meticulous removal of the nonwetting squamous epithelium and direct conjunctival closure, or when using a "V-to-Y" conjunctivoplasty for larger defects.

Inflammatory choroidal neovascularization associated with immunoglobulin G4-related disease: a case report

BackgroundImmunoglobulin G4-related disease is a recently recognized condition with pathologic features that are consistent across a wide range of organ systems. Orbital manifestations of this disease entity typically involve the lacrimal gland and lacrimal duct, extraocular muscles, orbital soft tissue, and sclera. Here, the authors report the first known case of inflammatory choroidal neovascular membrane associated with immunoglobulin G4-related disease and offer suggestions for clinical management of this enigmatic condition.Case presentationA 38-year-old Caucasian man with a history of recurrent tonsillitis presented with blurry vision in his left eye of 1-week duration and was diagnosed as having inflammatory choroidal neovascular membrane. An infectious workup was negative, but his serum immunoglobulin G4 level was elevated at 248 mg/dL (reference 4–86), and a subsequent tonsillectomy for a repeat episode of tonsillitis revealed increased immunoglobulin G4 staining on histopathology, thus confirming the diagnosis of immunoglobulin G4-related disease. The inflammatory choroidal neovascular membrane was treated with intravitreal bevacizumab injections and orally administered prednisone resulting in improved visual acuity and choroidal neovascular membrane regression. He later received rituximab infusions for immunoglobulin G4-related disease.ConclusionsWe report a case of choroidal neovascularization associated with immunoglobulin G4-related disease, a chronic inflammatory condition whose ophthalmic manifestations typically include dacryoadenitis, orbital myositis, or scleritis. This is the first reported instance of inflammatory choroidal neovascular membrane associated with immunoglobulin G4-related disease. Early detection of this disease is important to avoid organ damage and potential complications, so clinicians should maintain an index of suspicion for this condition when inflammatory choroidal neovascular membrane is observed.

A clinicopathological classification analysis of ocular mass lesions in 7 910 cases

Objective: To investigate the anatomical region, histopathological classification and histogensis distribution of ocular mass lesions in South China. Methods: Retrospective cases study. The clinical and pathological data of 7 910 samples with ocular (adnexal) tumors or proliferative lesions which were examined from January 2000 to May 2018 were retrospectively retrieved. The constituent ratios of ocular mass lesions in different anatomical regions and histogenesis have been analyzed. Results: There were 3 445 males and 4 465 females aged from 3 months to 106 years. Classification by anatomical region. Eyelid 4 976 cases (62.9%): benign-pigmented nevus (31.7%, 1 342/4 235), squamous cell papilloma (12.3%, 519/4 235), seborrheic keratosis (9.4%, 396/4 235); malignant-basal cell carcinoma (48.5%, 359/741), sebaceous gland carcinoma (34.4%, 255/741), squamous cell carcinoma (12.3%, 91/741). Ocular surface 1 449 cases (18.3%): benign-pigmented nevus (26.6%, 359/1 348), squamous cell papilloma (12.8%, 173/1 348); malignant-lymphoma (34.7%, 35/101), squamous cell carcinoma (30.7%, 31/101).Orbit 1 485 cases (18.8%): benign-hemangioma (28.5%, 332/1 167), lacrimal gland (duct) cyst(13.2%, 154/1 167); malignant-lymphoma (44.7%, 142/318), adenoid cystic carcinoma (10.1%, 32/318). Classification by histogenesis: epithelial 2 145 cases (27.1%), cutaneous appendages 378 cases (4.8%), cystoid 1 068 cases (13.5%), mesenchymal 748 cases (9.5%), lymph-hematopoietic 225 cases (2.8%), neurogenic 31 cases (0.4%), melanocytic 1 765 cases (22.3%), others 1 550 cases (19.6%). Conclusions: Over the past 18 years, the ocular tumors identified at the Second Affiliated Hospital, Zhejiang University School of Medicine most frequently occur in eyelid and originate from epithelium. The most common types are as followings. Benign lesions: pigmented nevus, squamous cell papilloma are the most common types for eyelid and ocular surface, whereas hemangioma, lacrimal gland (duct) cyst and epidermoid cyst are the most common types for orbit. Malignant cancers: basal cell carcinoma is the most prevalent disease in eyelid, whereas lymphoma occurs more frequently in ocular surface and orbit. (Chin J Ophthalmol, 2019, 55: 847-853).

Repeated Transfusion of Granulocytes to Control Multidrug-Resistant Pseudomonas Aeruginosa Sepsis in Haploidentical Hematopoietic Stem Cell Transplant Patients during Pre-Engraftment Stage

Background and Objectives: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative therapy for treating pediatric hematological malignancies that are refractory to other therapies. However, severe infections in neutropenic patients remain the major cause of morbidity and mortality, as well as influence the engraftment during HSCT. Multidrug-resistance (MDR) pseudomonas aeruginosa sepsis during the pre-engraftment stage has a highly prevalence of mortality, especially in patients with the primary infection site at the facial dangerous triangle. Without the efficient and time treatment, the bacterium may readily spread into the brain, causing severe intracranial infection and even death. There is an urgent need to effectively control MDR-pseudomonas aeruginosa infection and reduce the mortality of patients undergoing allo-HSCT.Method: We report herein a 5-year-old boy with acquired severe aplastic anemia (SAA) who experienced a secondary engraftment failure eight months after receiving haploidentical HSCT from his father. Owing to recurrent fever and severe pneumonia during persistent neutropenia, the patient received second transplant using bone marrow cells from his farther. Two days after the secondary transplant bloodstream identified an infection of MDR-pseudomonas aeruginosa accompanied with symptoms of chills and high fever, and deteriorating pneumonia. On day +4 he had a cellulitis at facial dangerous triangle with lacrimal gland and nasolacrimal duct involved, and secretion culture also confirmed the same bacteria. He was given antibiotics of Tetracycline, Levofloxacin, and Cefoperazone schubatam. However, the involved skin became worse and high fever peak became more frequent, suggesting the progression of sepsis. To facilitate the reconstitution of granulocytes in the patient, we performed six doses of granulocyte transfusion (GTX) from father once every over a period of six days. Granulocyte counts were performed every 12 hours after transfusion in order to maintain a level of granulocyte more than 0.5×109/L. Blood typing showed that the patient was type A and the farther was type AB. To avoid a possible hemolysis due to ABO-mismatched, we treated granulocytes with hydroxyethyl starch before transfusion.Results: During GTXs (from day +6 to +11 after transfusion), the patient's body temperature fluctuated between 37.0℃-38.2℃. There were no signs and symptoms of exacerbated pneumonia, such as cough, hemoptysis and moist rale. We didn't observe transfusion related acute lung injury (TRALI) and respiratory failure. The urine was clear without hematuria. The area of skin involved became under control. Notably, the patient had granulocyte engrafted on day +15 after transfusion, decrease of body temperature on day +16 and normal temperature on day +20. Concurrently, the facial cellulitis was gradually narrowing and moist rale of the lung disappeared. A repeat chest CT scan confirmed disappearance of the infection site in the lung. The bloodstream culture was negative on day +9 and secretion culture was negative on day +15. We maintained the treatment with antibiotics until the negative blood culture was confirmed twice. Eleven months after the treatment, the patient is alive with full donor chimaerism. His blood type becomes AB type. Other tests, including peripheral blood cell counts, liver and renal functions as well as pulmonary function, are all normal.Conclusion: Multidrug-resistant bacteria infection is a common and yet fatal complication in SAA patients. These patients usually experience a prolonged period of neutropenia when undergoing HSCT. We demonstrate here that when being combined with the utilization of broad spectrum antibiotics, repeated GTXs from donor source prove to be an effective therapy for controlling these infections, thereby reducing early death and improving successful rate of allo-HSCT. Therefore, GTXs are recommended as, at best, a “bridge” procedure, that may protect the patient from fatal infections until myeloid recovery ensues DisclosuresNo relevant conflicts of interest to declare.

A huge lacrimal gland ductule dacryolith with a hairy nucleus: a case report

BackgroundDacryoliths in lacrimal gland ductule are a rare condition and an unusual cause of conjunctivitis. Here we report a case with a large lacrimal gland ductule stone with an unique hairy nucleus.Case presentationA 38-year-old female presented with a red left eye for one month. Physical examination revealed an inflammatory granuloma in the lateral canthus and a fistula with purulent secretion. Antibiotics did not ameliorate the symptoms. After we incised the fistula, a huge dacryolith (10 mm × 5 mm × 3 mm) was identified at the end of the dilated lacrimal gland ductule and was removed surgically. Histopathologic examination showed a hairy nucleus surrounded by lamellar structure. The symptoms were resolved in 2 weeks after dacryolith extraction. The formation of the hair-centered dacryolith might be associated with the patient’s personal history of being a rabbit raiser for years.ConclusionWe should be aware of lacrimal gland ductule dacryolith as a rare cause of conjunctivitis. The relationship between dacryolithiasis and fur-bearing animal raising warrants further investigation.

Diagnosis and genetics of alacrima.

Alacrima, the lack of tears, is a rare clinical finding that has been reported as a feature of multiple genetic disorders and can serve as a diagnostic clue to some rare conditions. Causes of alacrima range from absence/hyposecretion of tears to agenesis or improper development of lacrimal gland ducts and associated structures. There are 13 known heritable disorders featuring varying degrees and causes of alacrima. Some manifest only the congenital absence of tears, while others affect multiple organ systems and may involve severe developmental delay, intellectual disability, and potentially life-threatening autonomic dysregulation. To aid in the diagnosis for patients manifesting alacrima, we review the major causes and the various genetic disorders associated with alacrima and provide a differential template for diagnosis.

Novel Insight Into the Role of CFTR in Lacrimal Gland Duct Function in Mice

PurposeThe role of cystic fibrosis transmembrane conductance regulator (CFTR) in lacrimal gland (LG) function has only recently received some attention, mainly from our group. In the present study, we investigated the potential changes of LG pathology, tear secretion, ocular surface integrity, and fluid secretion in isolated LG ducts from CFTR knockout (KO) mice.MethodsTear production and ocular surface integrity were investigated in anesthetized wild-type (WT) and KO mice using cotton threads and fluorescein staining, respectively. Immunofluorescence was used to localize CFTR protein in the LGs. Ductal fluid secretions evoked by forskolin (10 μM); cell-permeable cAMP analogue (8-bromo cAMP, 100 μM); or carbachol (100 μM) were measured in isolated LG ducts using video-microscopy. Intracellular Ca2+ homeostasis underlying carbachol stimulation was investigated with microfluorometry.ResultsSignificant decrease in tear secretion and impaired ocular surface integrity were observed in KO mice. Immunofluorescence demonstrated the predominant presence of CFTR protein in the apical membranes of the duct cells from WT mice. Continuous fluid secretion was evoked by forskolin and 8-bromo cAMP in LG ducts from WT mice, while no secretory response was observed in ducts from KO mice. Carbachol caused similar secretory responses in ducts from WT and KO animals without significant differences in cytosolic Ca2+ signaling.ConclusionsOur results suggest the important role of CFTR in LG ductal secretion and in the maintenance of ocular surface integrity, suggesting that CFTR may be a promising target of novel therapeutic approaches in the treatment of dry eye.

Characterization of Na+-K+-2Cl- Cotransporter Activity in Rabbit Lacrimal Gland Duct Cells.

PurposeWe recently reported that isolated duct segments from rabbit lacrimal gland (LG) were able to secrete fluid in response to secretagogues, which were blocked completely by bumetanide. This suggests the functional involvement of Na+-K+-2Cl− cotransporter (NKCC1) in ductal fluid secretion. Therefore, the aim of this study was to investigate the activity profile of NKCC1 in isolated rabbit LG duct segments.MethodsInterlobular ducts were isolated from fresh rabbit LG tissue. Microfluorometry with the ammonium (NH4+)–pulse technique was used to elicit pH changes in duct cells, and the rate of bumetanide-sensitive cytosolic acidification after addition of NH4+ was used to quantify the activity of NKCC1.ResultsWhile basal activity of NKCC1 was undetectable, low cytosolic chloride (Cl−) level and hyperosmotic challenge (390 mOsm) were able to increase the activity of NKCC1. Carbachol (100 μM) had no significant effect on NKCC1 activity. Elevation of cytosolic calcium (Ca2+) level with Ca2+-ionophore (A 23187, 1 μM) did not cause any alteration in the activity of the cotransporter while direct activation of protein kinase C (phorbol myristate acetate, 100 nM) increased its activity slightly but in a significant manner. Addition of either forskolin (10 μM), cell-permeable cAMP analogue (8-bromo cAMP, 100 μM) or vasoactive intestinal peptide (200 nM) resulted in a significant increase in the activity of NKCC1.ConclusionsThese results highlight the functional involvement of NKCC1 in LG duct secretion. These findings may facilitate our understanding of LG function and may contribute to the development of targeted pharmacologic interventions in case of dry eye disease.

Histology, histochemistry and fine structure of the Harderian gland, lacrimal gland and superficial gland of the third eyelid of the European bison, Bison bonasus bonasus (Artiodactyla: Bovidae)

The macroscopic anatomy and the microscopic and ultrastructural features of the Harderian gland (HG), lacrimal gland (LG) and superficial gland of the third eyelid (SGTE) of the adult European bison are described. In addition, morphometric studies were conducted and were followed by statistical analysis of the results. Tissue sections were stained with hematoxylin and eosin, methyl green-pyronin Y, periodic acid-Schiff, Alcian blue pH 2.5, aldehyde fuchsin and Hale's dialysed iron. Analysis of the staining showed that the HG has a multilobular tubuloalveolar structure with mixed secretion. The LG and the SGTE have a multilobar tubuloacinar structure with serous secretion in the LG and mucoserous in the SGTE. The TEM study demonstrates that the secretory cells of the HG, LG and SGTE have similar ultrastructural appearance, with two types of secretory vesicles in the cytoplasm of all studied glands. The histochemical staining methods and the TEM study revealed the secretory activity in the HG, LG and SGTE ducts. The structural studies can be important for establishing relations between morphological structure and functions of these glands. It can have clinical implications especially when taking into consideration the protective mechanisms of the eye.

Accessory lacrimal gland duct cyst: 23 years of experience in the Saudi population.

BACKGROUND AND OBJECTIVESAccessory lacrimal gland ductal cyst is a rare clinical entity that has been reported after trauma, infection, or conjunctival inflammation. Trachoma has been postulated as an etiologic factor for this dacryops in Saudis. We studied the prevalence, demographics, clinicopathological features and surgical approach for these lesions.DESIGN AND SETTINGRetrospective study of 23 consecutive ductal cysts diagnosed clinically and proved histopathologically at King Khaled Eye Specialist Hospital (KKESH) over 23 years (1991–2014).PATIENTS AND METHODSData on patient demographics, clinical features, surgery, and outcome were collected by chart review. The histopathologic slides were reviewed by a single pathologist.RESULTSOf 23 cases of accessory lacrimal gland ductal cysts confirmed histopathologically, 14 were males and 9 females with a median age of 38.8 years. Cysts were located in the upper eyelid in 73.9%. The commonest presentation was a painless eyelid mass in 91.3%. Excision by conjunctival incision was performed in 14 and intra-operative perforation occurred in 9. Trachomatous scarring was evident in 39.1% but did not have significance in relation to this rupture. No recurrences have been observed with a mean follow up of 34.6 months.CONCLUSIONThe approximate prevalence of accessory lacrimal gland dacryops in the Saudi population is 1/6800. Trachoma does not seem to be a major predisposing factor. They are more frequent in males. Their histopathological appearance is identical regardless of origin. The presence of conjunctival scarring, dacryops size, and the surgical incision type did not seem to have significant correlation with the iatrogenic rupture of the cyst. We recommend careful dissection for complete cyst excision through conjunctival approach with no expected recurrence.