Lacrimal Gland Volume Research Articles

Radiological measurements of lacrimal gland in thyroid eye disease

PurposeLacrimal gland enlargement is a common feature of thyroid eye disease (TED) and has been positively correlated with the clinical activity score. Although lacrimal gland volume is the preferred measure of lacrimal gland size, its calculation is not clinically translatable due to the expertise, time and advanced software required. The aim of our study is to determine whether the lacrimal gland volume in patients with TED undergoing magnetic resonance imaging (MRI) can be estimated using simpler lacrimal gland linear and area measurements.MethodsA retrospective review of 102 orbits (51 patients) with TED who underwent orbital MRI was conducted. The maximum length, width, and area of the lacrimal gland were measured in axial and coronal sections. Lacrimal gland volume was calculated by using a manual segmentation technique on all consecutive axial slices on commercially available software, OsiriX. All quantitative measurements were correlated with the lacrimal gland volume.ResultsMean age of participants was 59 ± 16 years, and 67% (n = 34) were females. With multivariate analyses, combined lacrimal gland axial and coronal areas strongly correlated with volume (r = 0.843, p < 0.01). Strong univariate predictors of volume included axial area (r = 0.704, p < 0.01) and coronal area (r = 0.722, p < 0.01), while moderate predictors included axial length (r = 0.523, p < 0.01), axial width (r = 0.521, p < 0.01), coronal length (r = 0.450, p < 0.01), and coronal width (r = 0.649, p < 0.01).ConclusionIn patients with thyroid eye disease, lacrimal gland volume can be estimated using axial and coronal areas, which is simpler and more time efficient than calculating volumes.

Lacrimal gland enlargement in inactive thyroid eye disease: a case series and literature review.

This study aimed to evaluate the morphometric and volumetric dimensions of the lacrimal gland in patients with inactive thyroid eye disease and compare them with the values reported in the literature. This case series evaluated consecutive patients with inactive thyroid eye disease treated at a tertiary eye hospital from 2015 to 2020. The patients' baseline demographics and clinical characteristics were obtained. The axial and coronal length, width, and volume of the lacrimal gland were measured on computed tomography scan images, and the results were statistically analyzed. A total of 21 patients (42 orbits) with inactive thyroid eye disease were evaluated. Their mean age was 49.0 ± 14.6 years, and 12 (57.1%) of them were men. The main complaint was dryness, and the majority of the patients had good vision and mild proptosis. The mean axial length and width of the lacrimal gland were 19.3 ± 3.9 mm and 7.5 ± 2.1 mm, respectively; coronal length and width, 20.4 ± 4.5 mm and 7.5 ± 2.1 mm, respectively; and lacrimal gland volume, 0.825 ± 0.326 mm3. Age, sex, or laterality were not found to be determinants of lacrimal gland enlargement. Patients with thyroid eye disease have enlarged lacrimal gland even in the nonactive phase of the disease multifactorial aspects influence the lacrimal gland in thyroid eye disease, making it difficult to establish a clear correlation with predisposing factors. Further studies are warranted to better understand the association between thyroid eye disease and the lacrimal gland.

Ultrasound-Guided Transcutaneous Injection in the Lacrimal Gland: A Description of Sonoanatomy and Technique.

Purpose: To develop a method of injecting a volume up to 50% of the lacrimal gland (LG) volume while minimizing patient discomfort and maximizing accurate drug delivery. Herein we describe a series of ultrasound (US)-guided transcutaneous injections in the LG and discuss the safety and feasibility of this technique. Methods: Ultrasonography was performed in 40 patients with aqueous deficient dry eye disease using a GE Logic E10 (Milwaukee, Wisconsin, USA) US machine with a 6-24 MHz transducer. US was performed by 2 medical experts in ultrasonography. We recorded the injection and observed an enlargement of the LG ensuring delivery within the LG before the needle was removed. Assessment of injection-related adverse event was performed immediately after the injection. Results: The position of the injection needle within the LG was documented in all 40 patients. Injection of the stem cells and vehicle (N = 20) or solely vehicle (N = 20) led to an enlargement of the glandular structures in all cases. No serious adverse reactions related to the injections were observed. Conclusion: US-guided injection into the LG enables injection on a closed eye causing minimum patient discomfort and maximum certainty of accurate drug delivery. US can provide real-time images and may be used to safely guide the needle ensuring correct placement and injection within the gland capsule. This reduces the risk of injury to the eye and adjacent structures and makes a precise transcutaneous injection possible. Clinical Trial Registration number: NCT04615455.

Change in lacrimal gland volume and aqueous tear production following treatment with teprotumumab.

Dry eye syndrome occurs in up to 85% of patients with thyroid eye disease (TED). Lacrimal gland enlargement correlates with subjective tearing and a reduction in quality of life in patients with TED. In this prospective longitudinal study, patients presenting for the treatment of TED were considered for eligible. Primary outcomes included a change in the volume of the lacrimal gland and the production of tears following treatment with teprotumumab. The volume of lacrimal glands and proptosis was calculated using 3D volumetric analysis. Tear production was measured by Schirmer's test and associated symptoms were assessed using the VLSQ-8. The orbit with the most proptosis was designated the study orbit and the contralateral orbit was designated the fellow orbit. Twenty patients were included. Mean (SD) age was 61 (18) and mean duration of TED prior to therapy was 48 months (47). Lacrimal gland volume in the study orbit decreased from 768 mm3 (288) to 486 mm3 (173) (p < 0.01) following therapy. For the fellow orbit, volume reduced from 637 mm3 (261) to 379 mm3 (147) (p < 0.01). Schirmer's test reading (STR) in the study orbit increased from 14.5 mm (8.2) to 23 mm (10) (p < 0.01) (59%) following treatment. In the fellow orbit, STR increased from 12.7 mm (7) to 21 mm (9) post therapy (69%) (p < 0.01). There was a significant improvement on all parts of the VLSQ-8. Teprotumumab significantly reduces TED related expansion of the lacrimal gland, increases tear production, and improves dry eye symptoms.

Quantitative analysis of both lacrimal glands in unilateral primary acquired nasolacrimal duct obstruction, based on three-dimensional fast spin echo-Cube-Flex

ObjectiveTo investigate whether unilateral primary acquired nasolacrimal duct obstruction (PANDO) changes the volume and water fraction of both lacrimal glands, using three-dimensional fast spin echo (3D-FSE)-Cube-Flex images, and to identify whether the lacrimal gland is a target organ in this disease. Methods3D-FSE-Cube-Flex images of both lacrimal glands in 25 healthy volunteers and 31 patients with unilateral PANDO were retrospectively reviewed. The differences in volume and water content in the lacrimal glands between the controls, non-PANDO side, and PANDO side groups were examined. Moreover, the associations between magnetic resonance imaging (MRI) parameters and disease duration were assessed with correlation analysis. ResultsThe lacrimal gland volumes were not significantly different between the PANDO and non-PANDO side groups, compared to the control group (P = 0.484). However, the gland volumes tended to be increased bilaterally in patients with PANDO. In contrast, the gland water fractions in the PANDO and non-PANDO side groups were significantly higher than those in the control group (P = 0.009 and P = 0.014, respectively), and similar between the non-PANDO and PANDO side groups (P = 0.897). No correlation was found between the disease duration and the gland MRI parameters (volume and water fraction). ConclusionsBoth lacrimal glands are affected by unilateral PANDO. A change in the water fraction of these glands appears to precede the change in volume and may be a sensitive early indicator.

The value of SPECT/CT imaging of lacrimal glands as a means of assessing the activity of Graves’ orbitopathy

BackgroundGraves’ orbitopathy (GO) is an autoimmune disease with mechanical impairment of orbital muscles and lacrimal gland dysfunction. The frequently used methods of assessing GO activity include Clinical Activity Score (CAS), CT, and MRI. These approaches are mainly associated with orbital muscles; however, there are not many studies that focus on the lacrimal gland inflammation of GO patients.ObjectiveThe aim of this study is to assess the usefulness of 99mTc-DTPA single-photon emission (SPE) CT/CT in evaluating the lacrimal gland inflammation in GO, as compared with other methods.MethodsA retrospective analysis of 48 patients with active GO compared with 33 controls was conducted. All subjects underwent clinical–endocrinological analyses, CAS evaluation, CT scans, and SPECT/CT examination. Lacrimal gland dimensions were determined and analyzed.ResultsThe lacrimal glands in patients with GO were significantly larger in all measured dimensions (P < 0.001) on CT scans relative to those in controls. Increased lacrimal gland diethylene triamine pentaacetic acid (DTPA) uptake ratios (P < 0.001) were displayed in active GO patients compared to controls and were also correlated with thyrotropin receptor antibody levels. The cut-off value for discriminating active and inactive disease was calculated to be 1.735, with specificity of 82.6% and sensitivity of 74.2%. SPECT/CT uptake ratios and CAS values were positively correlated in all GO patients. SPECT/CT uptake ratios were also positively correlated with CT measurements including lacrimal gland volume and coronal width in GO patients.ConclusionsThese data indicated that lacrimal gland SPECT/CT images can serve as a good tool for assessing the inflammation and disease activity of GO.

Relationship Between the Computed Tomographic Volumetry of the Eyeballs and Lacrimal Glands in a Nigerian Population.

Aim:The aim of this article was to obtain measurements of the eyeballs/globes and lacrimal glands in normal subjects using cranial computed tomography (CT) scan. Understanding the normative approximations of these measurements could help in diagnosing and evaluating orbito-ocular pathologies.Materials and Methods:This retrospective study examined 220 globes/eyeballs and 220 lacrimal glands of 110 consecutive participants. The eyeball volume was calculated using both the ellipsoid and spherical formulas, whereas lacrimal gland volume was approximated using the ellipsoid formula only.Results:The mean age of the subjects was 51.18 ± 14.85 years and ranged from 22 to 85 years. The study population was 53.6% male (n = 59) and 46.3% female (n = 51). The mean volumes of all globes in this study were 5.82 ± 0.77 and 5.98 ± 0.75 cm3 using the ellipsoid and spherical formulae, respectively. The mean volume of all lacrimal glands was 0.42 ± 0.14 cm3 using the ellipsoid formula. The mean globe volumes using the ellipsoid and spherical formulae (6.02 ± 0.84 and 6.02 ± 0.84 cm3) in males were significantly larger than the corresponding mean globe volumes in females (5.59 ± 0.62 and 5.80 ± 0.65 cm3) (P < 0.0001 and P = 0.001, respectively). There was no significant difference between the lacrimal gland volumes of males (0.42 ± 0.14 cm3) and females (0.42 ± 0.14 cm3) (P = 0.84).Conclusion:Males have larger eyeball/globe volumes than females. Eyeball and lacrimal gland volumes did not correlate significantly. Eyeball volume showed an inverse relationship with age. Age did not affect lacrimal gland volume.

Lacrimal gland enlargement and tear film changes in acromegaly patients: A controlled study

PurposeEvaluation of the lacrimal gland volume (LGV) and its correlation with tear film functions, serum growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels in acromegaly patients compared to a control group was aimed. MethodsThis prospective case-control study included the eyes of 38 patients with uncontrolled (UA) and 48 patients with controlled acromegaly (CA) and 44 patients with nonfunctioning pituitary adenoma. LGV of the patients was evaluated at the baseline, 3rd, and 6th-month visits with magnetic resonance imaging. Schirmer's test, tear breakup time (TBUT), and ocular surface disease index (OSDI) scores were evaluated at the same visits. Their correlation with serum IGF-1 and GH was investigated. Main outcome measure was the difference in mean LGV. ResultsThe mean LGV of the acromegaly patients at the baseline visit (116.0 ± 33.2 mm3) and the 3rd-month visit (119.5 ± 36.4 mm3) was higher than the control group (65.2 ± 22.3 mm3 and 63.2 ± 22.3 mm3, respectively; p < 0.001) without any significant difference between the UA and CA patients in the LGV in three consecutive visits (p > 0.05). Among all patients, IGF-1 and GH levels showed a positive correlation with the LGV (p < 0.001; r = 0.52; r = 0.6, respectively). However, Schirmer, TBUT, and OSDI scores did not show any difference among the three groups at each visit (p > 0.05). ConclusionAcromegaly patients may have larger lacrimal glands compared to the controls and this increase correlated with the increased IGF-1 and GH levels. Lacrimal gland volume may have no effect on its tear film related functions.

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.

Safety and feasibility of mesenchymal stem cell therapy in patients with aqueous deficient dry eye disease

PurposeTo evaluate the safety and feasibility of injecting allogeneic adipose-derived mesenchymal stem cells (ASCs) into the lacrimal gland (LG) as a treatment of aqueous deficient dry eye disease (ADDE). MethodsIn this open-label, 5-visit clinical trial (baseline, treatment and weeks 1, 4 and 16) seven subjects with ADDE received one transconjunctival injection of allogeneic ASCs into the LG in one eye. The ASC product contained 22 million ASCs/ml and the injected volume was maximally 50% of the LG volume as determined on magnetic resonance imaging (MRI). Treatment related adverse events (AEs) were assessed at each visit (primary endpoint). Ocular Surface Disease Index (OSDI), tear osmolarity, tear film breakup time (TBUT), corneal staining (Oxford grade) and Schirmer's I test were assessed at each timepoint. ResultsNo AEs related to the study treatment were observed. Mean follow-up time was 126 days after treatment. The mean OSDI score decreased from 58.9 ± 20.6 at baseline to 34.1 ± 21.6 (p < 0.002). In the study eye mean tear osmolarity decreased from 312.9 ± 10.4 to 291.6 ± 10.9 mosm/l (p < 0.002), mean TBUT increased from 3.7 ± 1.5 to 7.1 ± 1.9 s (p < 0.002), mean Schirmer's I test increased from 4.6 ± 0.7 to 8.1 ± 3.1 mm/5 min (p < 0.03), while mean Oxford grade showed a trend towards a decrease from 2.4 ± 0.7 to 1.3 ± 1 (p < 0.10). ConclusionOur trial suggests that injection of allogeneic ASCs into the LG is a safe and feasible treatment of severe ADDE. A randomized placebo-controlled trial aimed at elucidating the therapeutic effect of allogeneic ASCs in a larger patient cohort from our research group is currently underway.

Normal Lacrimal Gland Volumes by Magnetic Resonance Imaging and the Relationship of Lacrimal Gland Volume to Orbital Size.

The aim of this study was to measure volumes of normal lacrimal glands (LGs) using magnetic resonance imaging in African-Americans (AAs) and whites and to evaluate relationships of LG volumes to demographic factors. A retrospective chart review was performed searching for "optic neuropathy" and "optic neuritis," cross-referencing patients who had orbital MRI with and without contrast. Cases were excluded with known history of orbital trauma or surgery, previous diagnoses known to affect LG size, and poor image quality. LGs were outlined in consecutive axial and coronal slices, and volumes were generated using OsiriX software; cross-sectional area of the orbit was measured by outlining the bony orbit in largest axial section. One hundred orbits from 50 patients were included (26 AAs, 24 whites). Mean LG volumes as measured in coronal and axial section were 0.714 and 0.671 cm, respectively; mean orbital area was 10.42 cm. Axial orbital size was found to be highly correlated (P < 0.01) with LG volume. No significant correlation was found with LG volume and age, sex, race, or laterality. This article presents normal values for LG volumes by MRI of AAs and whites. LG volumes were highly correlated with orbital size, a relationship which has not been explored in the recent literature. Such an assessment of LG size relative to patients' orbital dimensions may be more clinically useful than comparison to population-based measures of normal LG volume alone. We found no statistically significant relationship between LG volume and race, sex, age, or laterality.

Lacrimal gland abnormalities in blepharophimosis, ptosis and epicanthus inversus syndrome

Abstract: Introduction: Blepharophimosis, ptosis and epicanthus inversus syndrome (BPES) is an uncommon autosomal dominant congenital disease caused by a mutation in the FOXL2 gene. Its major features are blepharophimosis, blepharoptosis, epicanthus inversus and telecanthus, and recently there have been some reports linking this disease to lacrimal gland (LG) agenesis. We studied the LG changes in BPES patients of our institution. Material and methods: Six patients with ages between 1 and 39 years old were studied. Lacrimal film evaluation was performed by slit-lamp biomicroscopy and Schirmer I test. LG volume was measured on computed tomography scans. All patients were screened for FOXL2 mutations. Results and discussion: The lacrimal film was abnormal in 2 patients. Both presented a reduced lacrimal meniscus; in one patient the Schirmer I test was decreased and in the second patient a significative superficial keratopathy was visible. An absence of the LG was disclosed on both CT scans. In 2 other patients LG volume was bilaterally reduced and in 1 it was normal. The remaining 1-year-old child had visible LGs and a normal lacrimal status evaluation. In this group of patients, clinical changes found on the lacrimal film evaluation were greatly associated to LG dysgenesis. A FOXL2 gene mutation was found in all cases, one of them not previously described. Conclusion: This study reinforces the recently described association between BPES and alacrimia and the importance of lacrimal evaluation in these patients, mainly if they are surgical candidates. A new FOXL2 mutation not previously described is also reported.

Understanding of Dry Eye in Subarachnoid Hemorrhage: An Experimental Study on the Role of Facial Nerve Ischemia.

To understand possible mechanisms underlying lacrimal gland degeneration when facial nerve root ischemia induces pterygopalatine ganglion injury and subsequent dry eye in a rabbit model of subarachnoid hemorrhage. Rabbits were divided into four groups: control, sham, moderate subarachnoid hemorrhage, and severe subarachnoid hemorrhage. Autologous blood recovered from the auricular artery was injected into the cisterna magna to induce subarachnoid hemorrhage in the two subarachnoid hemorrhage groups; animals were then monitored for dry eye development over 21 days before removal of their facial nerve roots, pterygopalatine ganglia, and lacrimal glands for immunohistochemical analyses. Neuronal viability in the pterygopalatine ganglia was measured; lacrimal gland vesicles were counted by stereological methods. The mean tear-filled vesicle number and lacrimal gland volumes significantly decreased with an increase in facial nerve root injury severity and damaged neuron numbers in the pterygopalatine ganglion. Increase in injury severity most significantly decreased the tear-filled vesicle numbers in the pterygopalatine ganglion. Subarachnoid hemorrhage degenerates facial nerve parasympathetic branches entering the pterygopalatine ganglion, and neuronal density in this ganglion may be correlated with tear secretion. Our data suggest that pterygopalatine ganglion degeneration following subarachnoid hemorrhage induces dry eye.

Lacrimal Gland Involvement in Blepharophimosis-Ptosis-Epicanthus Inversus Syndrome

To describe the involvement of the lacrimal gland (LG) in blepharophimosis-ptosis-epicanthus inversus syndrome (BPES). Observational, cross-sectional study. Twenty-one patients with BPES (10 female, 11 male) aged on average 15 years (range, 2-39years), from 3 Brazilian medical centers and 1 Portuguese medical center. Patients had their ocular surface evaluated with slit-lamp biomicroscopy, and tear production quantified with the Schirmer test I. The LG volumes were measured on computed tomography (CT) scans in the BPES sample and in a group of age-matched subjects imaged for nonorbital diseases. Sixteen patients were screened for mutations in the FOXL2 gene. Lacrimal meniscus height, Schirmer test I, presence of superficial punctate keratopathy (SPK), LG volume, and molecular analysis of the FOXL2 gene. Absence of LG was detected bilaterally in 9 patients (42.8%) and unilaterally in 2 patients (9.5%). When considering only patients with measurable LG, the median volume was 0.22 cm3 in the right eye (range, 0.06-0.36 cm3) and 0.24 cm3 in the left eye (range, 0.08-0.34 cm3). These values were significantly lower than those for the age-matched controls (median= 0.54 right eye and 0.53 left eye; P < 0.05). There was a significant association between deficiency of tear production and LG volume reduction and agenesis. Molecular analysis of the FOXL2 gene revealed the presence of 8 distinct mutations, 4 of them novel ones. A significant reduction of LG size or agenesis was associated with mutations affecting protein size (due to underlying changes in the stop codon location) or the DNA-binding forkhead domain (Fisher exact test, P= 0.021). In 3 probands, the underlying genetic defect was not found. This is the first study reporting LG volumes in BPES, describing a significant number of patients with LG agenesis. The association between alacrima and BPES is not incidental, and a thorough evaluation of tear production is recommended especially if ptosis surgery is planned.

Quantitative analysis of orbital soft tissues on computed tomography to assess the activity of thyroid-associated orbitopathy.

To evaluate the validity of using quantitative volume and density measurements from orbital computed tomography (CT) images to assess the inflammatory activity of patients with thyroid-associated orbitopathy (TAO). Computed tomography (CT) scans were obtained from 80 TAO patients and 40 controls, and 3D image analysis was conducted to measure the volume and density (in HU units) of intraorbital and extraorbital fat, extraocular muscle (EOM), and the lacrimal gland. Volume and density measurements of the orbital tissues were compared among active TAO, inactive TAO, and control subjects by ANCOVA. To determine the predictive value of each parameter for TAO activity, logistic regression was performed. The mean volume of extraorbital and intraorbital fat was significantly higher in patients with TAO than controls (p = 0.0019, p = 0.0004), with no significant difference between active and inactive TAO subjects. The mean total EOM volume and lacrimal gland volume was greater in active TAO patients than other groups (p < 0.0001, p < 0.0001). The mean density of extraorbital fat and the lacrimal gland was significantly different between active TAO, inactive TAO, and control groups (p = 0.0002, and p = 0.0487, respectively). Regression models incorporating total EOM volume, lacrimal gland volume, intraorbital fat volume, and density of extraorbital fat and the lacrimal gland could predict active inflammation in patients with TAO with accuracy of 84.5%. The measurements of orbital soft tissue volume and density using CT scans can be used as a reliable and feasible technique to establish active inflammation in patients with TAO.

Feasibility of Proton Beam Therapy for Ocular Melanoma Using a Novel 3D Treatment Planning Technique

We evaluated sparing of normal structures using 3-dimensional (3D) treatment planning for proton therapy of ocular melanomas. We evaluated 26 consecutive patients with choroidal melanomas on a prospective registry. Ophthalmologic work-up included fundoscopic photographs, fluorescein angiography, ultrasonographic evaluation of tumor dimensions, and magnetic resonance imaging of orbits. Three tantalum clips were placed as fiducial markers to confirm eye position for treatment. Macula, fovea, optic disc, optic nerve, ciliary body, lacrimal gland, lens, and gross tumor volume were contoured on treatment planning compute tomography scans. 3D treatment planning was performed using noncoplanar field arrangements. Patients were typically treated with 3 fields, with at least 95% of planning target volume receiving 50 GyRBE in 5 fractions. Tumor stage was T1a in 10 patients, T2a in 10 patients, T2b in 1 patient, T3a in 2 patients, T3b in 1 patient, and T4a in 2 patients. Acute toxicity was mild. All patients completed treatment as planned. Mean optic nerve dose was 10.1 Gy relative biological effectiveness (RBE). Ciliary body doses were higher for nasal (mean: 11.4 GyRBE) than temporal tumors (5.8 GyRBE). Median follow-up was 31 months (range: 18-40 months). Six patients developed changes which required intraocular bevacizumab or corticosteroid therapy, but only 1 patient developed neovascular glaucoma. Five patients have since died: 1 from metastatic disease and 4 from other causes. Two patients have since required enucleation: 1 due to tumor and 1 due to neovascular glaucoma. 3D treatment planning can be used to obtain appropriate coverage of choroidal melanomas. This technique is feasible with relatively low doses to anterior structures, and appears to have acceptable rates of local control with low risk of enucleation. Further evaluation and follow-up is needed to determine optimal dose-volume relationships for organs at risk to decrease complications rates.

The Change of Lacrimal Gland Volume in Korean Patients with Thyroid-associated Ophthalmopathy

PurposeTo describe the change of lacrimal gland volumes in Korean patients with thyroid-associated ophthalmopathy (TAO) via computed tomography (CT).MethodsA retrospective review of CT images from 217 TAO patients and 135 control subjects was performed. The TAO patients were diagnosed between May 2005 and May 2014 and had a CT performed on initial presentation (330 orbital CT scans). These images were compared with 270 orbital CT scans from the control group, obtained between May 2013 and May 2014. An open source DICOM viewer was used to calculate the volume of the lacrimal gland.ResultsThe mean volume of the lacrimal gland in TAO patients was 0.816 cm3 in the right orbit (standard deviation [SD], 0.048) and 0.811 cm3 in the left orbit (SD, 0.051), with no significant difference between right and left (p = 0.192). However, significant differences were observed between TAO patients and healthy individuals (p < 0.001). There was no significant difference between mean lacrimal gland volumes of males (0.812 cm3; SD, 0.037) and females (0.816 cm3; SD, 0.029) (p = 0.513). There was a negative correlation between gland volume and age in TAO patients (Pearson r = -0.479, p = 0.00). The subjective tearing (right: r = 0.244, p = 0.018; left: r = 0.226, p = 0.024), corneal superficial punctate keratopathy (right: r = 0.192, p = 0.040; left: r = 0.206, p = 0.036), and exophthalmometry (right: r = 0.182, p = 0.032; left: r = 0.180, p = 0.046) correlated with lacrimal gland volume.ConclusionsThis study is the first to use CT images to calculate the lacrimal gland volume of Korean TAO patients. In TAO patients, the lacrimal gland volume was notably increased compared to control subjects. The lacrimal gland volume decreased with age, but there was no difference between gender and no difference between left and right. The lacrimal gland volume correlated with subjective tearing, corneal superficial punctate keratopathy and exophthalmometry.

Evaluation of Lacrimal Gland Dimensions and Volume in Turkish Population with Computed Tomography.

Computed tomography (CT) is a widespread method for evaluating head and neck pathologies. The lacrimal glands (LGs) are usually visible in routine head and neck CT scans. LG pathologies usually manifests with changes in gland sizes, so it is important to know the normal values of the LG dimensions and volume. The LG sizes may change with age, gender and race. The normal values of LG dimensions and volume in Turkish population was not reported before. The aim of this study was to evaluate the dimensions and volumes of the LGs by CT in a Turkish population. Two hundred seventeen consecutive paranasal CT scans of subjects evaluated retrospectively. Measurements of LG dimensions were performed in axial and coronal paranasal CT images. The LG volume was calculated with Aquarius software by outlining the gland in all consecutive axial images. Four hundred orbits of 200 subjects were included to the study. The mean axial LG length in right and left orbits were 16.2±2.0 mm and 16.0±2.0 mm and the mean axial width of the right and left orbits were 4.1±0.7 mm and 4.0±0.7 mm. The right and left LG mean values for coronal length and width were equal 18.3 ±2.2 mm and 4.1±0.7mm respectively. The mean LG volume was 0.617±0.210 cm(3) in right and 0.597±0.197 cm(3) in the left orbits. There were statistically significant differences in the axial width and volume of the LG according to sides, however there was no significant difference according to gender. Age and LG measurements were negatively correlated. Our study may serve as a guide to determine the average values of the LG measurements in Turkish population and find out the orbital pathologies that involves the LG.

Lacrimal Gland Volume Changes in Unilateral Primary Acquired Nasolacrimal Obstruction.

To investigate whether unilateral primary acquired nasolacrimal duct obstruction (PANDO) causes Schirmer score and lacrimal gland volume changes in the contralateral non-PANDO eye. Sixteen unilateral female PANDO and 16 female controls were enrolled in the study. Exclusion criteria were orbital trauma, inflammation, infection, tumor involvement or infiltrative diseases, history of ocular surgery, ocular surface disorder, systemic drug use that interferes with tear secretion, and chronic use of topical eye drops. Bilateral lacrimal gland volumes were measured in computed tomography (CT) images of the participants. A Schirmer test without anesthesia was also performed on each participant. As there was no significant difference between the right and left eye values for Schirmer and gland size (P > 0.05), both eyes of the control group were enrolled in the study. The groups were age matched and the mean lacrimal gland was 0.479 cm3 in the PANDO as well as the contralateral non-PANDO side, which was statistically smaller compared to the control eyes (0.580 cm3) (P = 0.04). The mean Schirmer scores in the same order were 18.5 ± 7.1 mm, 13.2 ± 8.9 mm, and 21.3 ± 10.5 mm, respectively. Non-PANDO side Schirmer scores were lower compared to the other two groups, but statistical significance was present for the control group (P = 0.04). Compared to the control group, lacrimal gland volumes were bilaterally smaller in unilateral PANDO patients. Schirmer scores were statistically lower in the contralateral non-PANDO side compared to the controls.

Calculated CT Volumes of Lacrimal Glands in Normal Korean Orbits

Purpose: We used computed tomography (CT) scans to describe normal Korean lacrimal gland volume and lacrimal gland size and then examined their correlations with patient age. Methods: CT scans were obtained in 213 orbits of 111 patients who underwent CT from January to August of 2013. Aquarius iNtuition (TeraRecon, Foster City, CA, USA) software was used to outline the lacrimal gland in consecutive axial slices and to calculate the volume. Results: The mean volume of the lacrimal gland was 0.589 cm in right orbits (SD = 0.090), 0.583 cm in left orbits (SD = 0.289), 0.596 cm in males (SD = 0.083), and 0.575 cm in females (SD = 0.094). There was no significant difference in mean lacrimal gland volume according to laterality (p = 0.614) or sex (p = 0.102) (2-sample t-tests). We investigated mean lacrimal gland volume in 3 age groups. Mean lacrimal gland volume was 0.630 cm (SD = 0.080) for the 20 to 40 year old group, 0.553 cm (SD = 0.734) for the 41 to 60 year old group, and 0.544 cm (SD = 0.885) for the older than 60 years old group. There was an inverse relationship between gland volume and age (Pearson r = −0.384, p = 0.00). Conclusions: The mean volume of the lacrimal gland decreased with age and there was no significant difference between right and left orbits or between male and female patients. J Korean Ophthalmol Soc 2015;56(1):1-5