Palpebral Lobe Research Articles

In vivo lacrimal gland imaging artefact assessment based on swept-source optical coherence tomography for dry eye disease.

This study aimed to characterise imaging artefacts in the lacrimal gland using swept-source optical coherence tomography (SS-OCT) in patients with dry eye disease (DED) and healthy participants and identify risk factors for these artefacts. In total, 151 eyes, including 104 from patients with DED and 47 from non-DED participants, were analysed. Demographic data collection, comprehensive ocular examinations and SS-OCT imaging of the palpebral lobe of the lacrimal gland were performed. Artefacts were classified into distinct categories with different severities. Univariate and multivariate logistic regression analyses were performed to evaluate the association of age, gender, best-corrected visual acuity, intraocular pressure (IOP) and the presence of DED with the presence of artefacts. Eight artefact types and severity grading were defined by analysing 1208 lacrimal SS-OCT images. The three most prevalent artefacts were defocus (75.83%), cliff (67.47%) and Z-off (58.44%). The presence of artefacts was significantly associated with the presence of DED (OR=9.13; 95% CI, 2.39 to 34.88; p=0.001) and higher IOP (OR=1.34; 95% CI, 1.14 to 1.58; p<0.001). Furthermore, multivariate logistic analyses showed that lower tear film breakup time (OR=0.71; 95% CI, 0.55 to 0.92; p=0.009) and higher meibum quality score (OR=2.86; 95% CI, 1.49 to 5.48; p=0.002) were significantly associated with higher odds for the presence of artefacts. DED eyes had more SS-OCT image artefacts than normal eyes. Stringent standardised image quality control should be implemented before further image analysis when using SS-OCT to assess lacrimal gland image.

Comparison of the efficacy and safety of lacrimal gland botulinum toxin injection in functional versus non-functional epiphora

Objective To determine whether botulinum toxin is effective and safe for the treatment of epiphora, and to compare its utility in functional versus non-functional epiphora using both qualitative and quantitative methods. Materials and Methods Patients were divided into two groups (functional and non-functional epiphora) according to the presence of lacrimal drainage obstruction. All patients were injected with 2.5 units of botulinum toxin into the palpebral lobe of the lacrimal gland, and improvement in epiphora and quality of life were assessed both objectively and subjectively using Schirmer’s I test, indoor and outdoor Munk scores, TEARS score, watery eye quality of life score, and tear meniscus measurements at pre-injection, and 1, 3, and 6 months post-injection. Functional and non-functional epiphora groups were compared. Results Botulinum toxin was injected into 72 lacrimal glands of 65 patients with functional and non-functional epiphora. In both the functional and non-functional epiphora groups, the mean Schirmer’s I test value, indoor and outdoor Munk scores, TEARS score, watery eye quality of life score, tear meniscus height, depth, and area values improved significantly at 1, 3, and 6 months after injection compared with pre-injection values (p < 0.05). There were statistically significant differences in mean Schirmer’s I test, tear meniscus height, depth, and area values between the functional and non-functional epiphora groups at 1, 3, and 6 months after botulinum toxin injection (p < 0.05). In the functional epiphora group, a greater proportion of patients reported improvement than in the non-functional group. All complications were minor and resolved within 2 weeks after the injection. Conclusion Botulinum toxin injection into the lacrimal glands of patients with functional and non-functional epiphora was a simple, effective, and safe treatment. In addition to qualitative methods, quantitative methods, such as tear meniscus measurement, provided direct evidence that symptomatic improvement occurred more in those with functional versus non-functional epiphora after botulinum toxin injection.

Anterior Segment Optical Coherence Tomography Imaging of the Lacrimal Gland in Patients With Chronic Ocular Graft-Vs-Host Disease.

The purpose of this study was to explore the image characteristics of the palpebral lobe of the lacrimal gland in patients with chronic ocular graft-vs-host disease (coGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) using anterior segment optical coherence tomography (AS-OCT). This comparative cross-sectional study included 32 patients with coGVHD, 21 patients with severe aqueous tear deficiency dry eye, and 20 healthy control subjects. All subjects underwent an AS-OCT examination on the palpebral lobe of the lacrimal gland. The main outcomes are the number of visible gland lobules, ducts, and blood vessels and the proportions of mille crêpe-like structures in the AS-OCT images. Compared with the other 2 groups, patients with coGVHD had significantly more blood vessels and slightly less visible lobules and ducts (all P <0.05) in the palpebral lacrimal gland. Mille crêpe-like structures were observed only in the coGVHD group. Number of blood vessels was positively correlated with time after allo-HSCT (β: 0.14, 95% confidence interval [CI], 0.01-0.26). Mille crêpe-like structure was positively correlated with coGVHD severity (odds ratio: 9.07, 95% CI, 1.75-16.38) and time after allo-HSCT (odds ratio: 0.13, 95% CI, 0.03-0.23). We reported the AS-OCT characteristics of the palpebral lacrimal gland in coGVHD and found an increased number of blood vessels and mille crêpe-like structures. AS-OCT has the potential in the disease monitoring of coGVHD.

The lateral fornix orbitotomy: a novel surgical corridor to lacrimal gland lesions.

Current practice for diagnostic biopsy of lacrimal gland lesions entails an orbitotomy procedure via an upper eyelid crease or lateral canthotomy skin incision. We describe a novel surgical technique to address these lesions via the lateral conjunctival fornix. Retrospective case series of all patients who underwent a lateral fornix orbitotomy procedure for incisional or excisional diagnostic biopsy of lacrimal gland lesions. The procedure involves a conjunctival incision in the lateral fornix remote from the openings of the lacrimal ductules, and an intraperiosteal surgical corridor to access the lacrimal gland. The study cohort included 16 patients (3 male, 13 female) with a mean age of 48.3 years (range, 24.0-78,9 years). The sampled lesions involved the orbital lobe in 14 patients, the palpebral lobe in 1 patient, and the entire gland in 1 patient. A histopathological diagnosis was obtained in all cases. Postoperatively, new moderate adduction deficit developed in one patient (6.3%) that recovered after adhesiolysis of the conjunctival scar. 3 patients (18.8%) experienced transient mild limitation of adduction or abduction. There was no new or worse ptosis or dry eye disease related to the surgery. The mean length of postoperative follow-up was 1.3 years (median 1.0 years, range, 0.6-4.7 years). The lateral fornix orbitotomy approach was successful in obtaining biopsy specimens of histopathological diagnostic value. It provides transconjunctival access to the lacrimal gland without damage to the excretory lacrimal ductules or displacement of the eyelid support system.

The Cambrian (Paibian–Jiangshanian; Steptoean) dokimocephalid trilobite Deckera Frederickson, 1949 in Laurentian North America

Abstract The Cambrian dokimocephalid trilobite genus Deckera Frederickson, 1949 is a minor component of Steptoean (Jiangshanian) faunas of Laurentian North America. The original diagnosis emphasized strongly inflated palpebral areas of fixed cheeks and elevated palpebral lobes as important and novel characters. An appraisal of archival and new specimens from Oklahoma, Missouri, Pennsylvania, Nevada, Utah, and Newfoundland show that the genus is geographically widespread and likely represented by as many as nine species, although only two of them are named formally. Deckera cf. D. aldenensis Frederickson, 1949 from Nevada extends the stratigraphic range of Deckera down to the base of the Jiangshanian Stage, and new species from Nevada and Newfoundland take the genus down farther, into upper Paibian strata. Paibian species show that some basal members of the genus have weakly inflated, nearly flat palpebral areas with palpebral lobes that sit well below the crest of the glabella. A revised diagnosis of Deckera focuses on the broad cranidium with width across the palpebral lobes much greater than the sagittal length. Pygidia are known for a few species and all of them have an unusual flexure of the posterior margin and border. Lectotype and paralectotype specimens are designated for Deckera completa.

In Vivo Human Lacrimal Gland Imaging Using an Ultrasound Biomicroscopy.

In the present study, we introduce human lacrimal gland imaging using an ultrasound biomicroscopy (UBM) with a soft cover and show their findings. The representative UBM findings of palpebral lobes in seven subjects (four with non-Sjögren dry eye syndrome, one with Sjögren syndrome, and two healthy subjects) were described in this study. To prolapse the palpebral lobe, the examiner pulled the temporal part of the upper eyelid in the superotemporal direction and directed the subject to look in the inferonasal direction. We scanned the palpebral lobes longitudinally and transversely using UBM. We used an Aviso UBM with a 50 MHz linear probe and ClearScan. In UBM of two healthy subjects, the echogenicity of the lacrimal gland was lower than that of the sclera and homogeneous. But the parenchyma of a patient with Sjögren dry eye syndrome was quite inhomogeneous compared to the healthy subjects. In two patients with dry eye syndrome, we were able to observe some lobules in the parenchyma. We could find excretory ducts running parallel at the surface of the longitudinal section in some subjects. In the longitudinal UBM scan of a subject, we observed a tubular structure at a depth of 1,500 μm that was considered a blood vessel. It ran from the superonasal to the inferotemporal direction. In a subject, we observed a large cyst beneath the conjunctiva. Lacrimal gland imaging using UBM has both advantages of optical coherence tomography and sonography, and could be useful for evaluating dry eye syndrome.

Internal vascular anatomy of the human lacrimal gland: A protocol based on cadaver dissection and three-dimensional micro-computed tomography

PurposeTo evaluate the feasibility of studying the vascular supply of the orbital and palpebral lobes of the human lacrimal gland using micro-computed tomography (micro-CT) and microscopic dissection. MethodsThe lacrimal gland artery of a fresh parasagittalized cadaver head (male, aged 76 years) was infused with a lead oxide-latex mixture near the occipital pole of the gland. The entire lacrimal gland was imaged using micro-CT and 3D cinematic rendering (CR) and then dissected under a surgical microscope. ResultsMicro-CT and CR images showed well-demarcated internal vascular branches of the lacrimal artery and their distribution within the orbital and palpebral lobes. The entire course of the artery and its branches could be visualized by CR and microscopic dissection, with the former showing better spatial orientation and finer branching. The main artery runs along the free edge of the aponeurosis of the levator palpebrae superior muscle and lies in the isthmus portion of the gland (between the orbital and palpebral lobes). The branches of the main lacrimal artery include one branch to the orbital adipose tissue just before entering the gland, two branches to the orbital lobe (medial and lateral), and two branches to the palpebral lobe (medial and lateral). The main artery terminates as palpebral and orbital lobe branches in the lateral half of the lacrimal gland. ConclusionLatex and contrast-enhanced micro-CT is very well suited to visualize the vascular anatomy of the lacrimal artery within the gland. A large number of lacrimal gland examinations using the method presented here are required to demonstrate and understand the variability of the vascular anatomy of the human lacrimal gland.

New insights into lacrimal gland anatomy using 7T MRI and electron microscopy: Relevance for lacrimal gland targeted therapies and bioengineering

PurposeTo study the tissue architecture, isthmus (connection between two lobes) of the lacrimal gland using preclinical 7T MRI in combination with histology and electron microscopy. MethodsTen lacrimal glands from Caucasian body donors (mean age 78.7 years) were studied using 7T-MRI (N = 5; scanned at 75-μm intervals), histology, and electron microscopy (N = 5) and 3D cinematic rendering (CR) techniques. Results3D CR images showed uniform-sized lobules (widest lobule diameter, 1.68 ± 0.19 mm in orbital lobe, 1.68 ± 0.17 mm in palpebral lobe) in both lobes, separated by septae (size, 0.29 ± 0.09 mm). The internal framework of the gland resembled a honeycoomb pattern. In CR and histology, the isthmus contained glandular acini, large blood vessels, nerves, and no more than two ducts having a tortuous course towards the conjunctival surface. On assigning a color display to the rendered lacrimal gland, all glands showed a blood vessel originating from the main lacrimal artery just 5 mm beyond the hilum and making it course to the palpebral lobe via isthmus. The distance between the conjunctiva and the central substance of the orbital and palpebral lobe was 9.4 ± 0.2 mm and 2.8 ± 0.7 mm, respectively. Electron microscopy of the palpebral lobe revealed compact subepithelial layer in the overlying conjunctiva, followed by loosely scattered collagen bundles that contained the gland lobules. Conclusion3D-CR can be used to study the lacrimal gland microstructure, help fabricate a 3D scaffold for lacrimal gland bioprinting, and serve as guide for transconjunctival lacrimal gland targeted therapies i.e., 2.9 & 9 mm long needle to reach the orbital and palpebral lobe center, respectively in normal-size glands.

Morphology, variation, and systematics of the late Cambrian Laurentian dikelocephalid trilobiteWalcottaspis vanhornei(Walcott, 1914)

AbstractWalcottaspis vanhornei(Walcott, 1914) is a large, late Cambrian trilobite with a unique pygidial morphology known only from a narrow outcrop belt of the St. Lawrence Formation in the Upper Mississippi Valley. Found in carbonate-rich layers within heterolithic facies that represent the toesets of a prograding shoreface, it is restricted to a single or small number of parasequences. Only four specimens of any of its sclerites have been illustrated previously. Here holaspid examples of all its biomineralized sclerites are described and illustrated, along with a morphometric analysis of cranidial landmarks and landmarks plus semilandmarks for the pygidium. Ontogenetic allometry accounts for 29% of the variance among holaspid cranidia and includes a relative shortening and narrowing of the palpebral lobe and a reduction in the relative length and width of the frontal area. Notable pygidial phenotypic variation occurs in the extent of the postaxial region and in the proportion of the structure occupied by the axis. Phylogenetic analysis suggests thatW. vanhorneiis sister taxon toDikelocephalus minnesotensisOwen, 1852, which also occurs in the St. Lawrence Formation and has a broadly similar cephalon but distinctive trunk. The holaspid pygidium ofW. vanhorneiis uniquely characterized by the interpleural furrows of the first two segments becoming abruptly obsolete on approaching the axial furrow. Some pygidia show narrow, shallow, flat-bottomed grooves etched into the internal sides of the dorsal surface or doublure that apparently represent infestation of the live trilobite.

Lacrimal gland activity in lacrimal drainage obstruction: exploring the potential cross-talk between the tear secretion and outflow

PurposeTo investigate the effects of lacrimal drainage obstructions on the lacrimal gland activity and if there exists a potential link between the two.MethodsDirect assessment of the lacrimal gland activity from...

Lacrimal gland targeted therapies for refractory epiphora: quantitative changes in the gland activity

ABSTRACT Purpose To investigate the effect of botulinum toxin (BTX) and partial orbital lobe dacryoadenectomy (POLD) on the main lacrimal gland functions using the direct assessment of its secretory activity. Methods A pilot study involving 14 subjects (mean age, 42.16 years) with proximal bicanalicular block (n = 9) or complete punctal effacement (n = 5) received either intraglandular 2.5 units of BTX (n = 7) or underwent the POLD procedure (n = 7). Dynamic assessment of tear secretion from the palpebral lobes was performed as per standard protocols. The parameters studied included Schirmer I, changes in the glandular outflow, and the neurosensory secretory lag. Results Schirmer I values showed a mean reduction of 5.25 mm (range, 2–8 mm) following BTX injection, and mean tear flow decreased from 1.46 to 1.11 (P = 0.15). The POLD group showed a significant mean reduction of 0.45 in mean tear flow at 1 month (P = 0.03) and 0.32 at 3 months of follow-up (P = 0.20). However, there was no statistically significant change of the Schirmer values in the POLD group at 3 months. Conclusion Direct assessment of lacrimal gland function can be used to monitor changes following the gland therapies. Although POLD shows a significant reduction in short term, significant surgical improvisation would be needed for it to be effective in long term. A larger study is ongoing to further our understanding.

5-Fluorouracil as a targeted lacrimal gland therapy for chronic Stevens-Johnson syndrome: A pilot study.

The surgical technique of periglandular 5-fluorouracil (5-FU) injection and its effects on the morphology and function of the main lacrimal gland of patients with severe dry eye disease due to Stevens-Johnson syndrome (SJS) are reported. 5-FU, as a potential antifibrotic agent, is given in the dose of 0.1 ml (50 mg/ml), subconjunctivally into the periglandular fibrosed area of the palpebral lobe of the main lacrimal gland. The injection is given using 30G needle into the subconjunctival plane and not into the substance of palpebral lobe. Eight eyes (eight lobes) of seven chronic SJS patients (mean age, 32.5 years, <5 mm Schirmer) received the injection. All eight lobes demonstrated a visible reduction in the conjunctival congestion and scarring over the lobar area. The mean OSDI scoring improved from 65.3 to 51.1. Three patients with mean pre-injection Schirmer I values of 4 mm showed a mean change of 1 mm at four weeks following a single injection. The tear flow rate per lobe for the above three patients improved from 0.22, 0.12, and 0.16 μl/min to 0.31, 0.12, and 0.21 μl/min, respectively. Another patient with pre-injection Schirmer of 4 mm showed no change in tear flow. Three eyes with zero baseline Schirmer values (no visible secretory opening) had no improvement in tearing or ocular surface staining. Local 5-FU injection alters morphology of the conjunctiva overlying the palpebral lobe in SJS patients, but fails to show any significant effect on tear secretion.

Lacrimal and meibomian gland evaluation in dry eye disease: A mini-review.

Lacrimal and meibomian glands contribute to the aqueous and lipid components of tear film, respectively. Their evaluation remains central to diagnosing and managing dry eye disease (DED). The review discusses the differences and reliability of various diagnostic tests and commercially available devices used for DED diagnosis. Slit-lamp-based techniques are direct palpebral lobe and tear flow assessment, Schirmer test, meibum quality and expressibility, and evaluation of tear meniscus height. Non-invasive tear meniscus height (TMH), tear break-up time (TBUT), lipid layer thickness (LLT), and meibography are machine-based diagnostic tests. The structure-function correlation of the tear-producing glands gives more comprehensive details than either information alone. Many devices are available in the market, which make DED diagnosis an easy feat, but the tests should be interpreted keeping in mind the intra-observer and inter-observer repeatability. Also, the tear film displays a huge variability as per the environmental conditions and impact of blinking. Hence, the examiner should be well versed with the techniques and repeat the test two to three times to obtain an average reading, which is more reliable. The recommended sequence of tests for diagnosing DED is a dry eye questionnaire, TMH, LLT, NIBUT (FBUT if non-invasive test is unavailable but should be performed after osmolarity), tear osmolarity, meibography, and ocular surface staining. Invasive tests such as Schirmer should be performed after the non-invasive tear film diagnostic testing.

Silent tears and the loud mimic.

A 57-year-old gentleman presented with a bilateral (OU) upper eyelid swelling since a month along with gritty sensation in the eyes. There was no history of systemic manifestations or similar family history. On examination, best corrected visual acuity (BCVA) in OU was 20/20 and N6 with Schirmer’s of 5 mm in the right eye (OD) and 3 mm in the left eye (OS), and ocular surface staining OU indicating aqueous deficiency dry eyes. Bilaterally, upper eyelid fullness was seen temporally along with S-shaped drooping of the eyelids [Fig. 1]. The superior orbital margin was palpable in OU along with mild tenderness. The palpebral lobe of the lacrimal gland was prolapsed and congested with surrounding chemosis. There was mild restriction of ocular motility on abduction. There was no evidence of proptosis. Intraocular pressure was 16 mmHg in OU. Posterior segment examination was within normal limits.Figure 1: (a) Shows bilateral upper eyelid fullness laterally and S-shaped lateral droop; (b) shows bilaterally prolapsed and congested palpebral lobes of the lacrimal gland, Figure 1c shows axial cut of the CT orbit showing a diffusely enlarged isodense lacrimal gland bilaterally, with no additional bony changesWhat is the next step? Radiological investigations Multilevel incisional biopsy with histopathologic confirmation Collagen vascular profile All of the above Correct Answer D. All of the above Diagnosis and Management Table 1 shows the clinical characteristics of common lacrimal gland disorders. Considering the possibility of subacute dacryoadenitis involving the orbital and palpebral lobes of the lacrimal gland, radiological investigation was done in the form of computed tomography (CT), which showed bilaterally bulky lacrimal glands abutting the lateral rectus on both the sides along with slightly bulky appearance of the lateral recti. A multilevel incisional biopsy was performed for the patient, and histopathology and immunohistochemistry confirmed the diagnosis of IgG4-related dacryoadenitis. A detailed collagen vascular profile was done to evaluate all underlying collagen vascular diseases. Out of the panel, serum IgG4 was found to be raised, therefore correlating with the histopathology. The patient was treated with intravenous methyl prednisolone 500 mg pulse therapy for six pulses along with topical lubricants. He started responding by the fourth cycle and at the latest follow-up of 2 years and 8 months, he is doing extremely well with normalized serum IgG4 levels and resolution of ocular symptoms with Schirmer’s improved to 10 mm in OU.Table 1: Clinical characteristics of lacrimal gland disordersDiagnosis OU IgG4-related dacryoadenitis with severe dry eyes. Discussion Over the last two decades, the unidentified zone of IgG4-related disease has been duly explored. The disease mimics a broad spectrum of clinical entities, ranging from neoplastic to inflammatory and even infectious conditions, which makes it mandatory for the clinicians to understand the clinical presentation, possible differentials, management, and prognosis of IgG4-related disease. Ophthalmologically, the patients present with diplopia, ptosis, visual acuity, disturbance, ocular motility restriction, dry eyes, corneal ulcer, or epiphora.[1] Baseline radiological imaging followed by surgical biopsy would be appropriate.[2] Systemic correlation rules out its presentation as sialadenitis, pancreatitis, and lymphadenopathy as well.[1] Serum IgG4 levels are confirmatory as well as prognostic. The disease responds well to treatment with steroids, but has follows a chronic course with systemic morbidity if left undiagnosed and untreated as it causes end-stage organ failure.[3] Therefore, this possible differential diagnoses and the low remission rate of 23.8% must be kept in mind in a patient with dacryoadenitis presenting with dry eyes.[4] Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his names and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

A phylogenetic approach to the study of the evolution of Hypermecaspididae (Olenida, Trilobita)

AbstractHypermecaspidinae (Trilobita; Olenidae) constitutes a monophyletic clade but its internal relationships are unknown and its phylogenetic position with respect to the rest of Olenida has recently been questioned. In order to propose a phylogenetic hypothesis, and to resolve the status of the group, a cladistic analysis of the hypermecaspidinids was performed. One hundred characters (28 quantitative and 72 qualitative) of holaspid morphology were coded for 30 taxa (18 Hypermecaspidinae). Two groups of analyses were performed considering the percentage of missing data. For each group of analyses, discrete partition was treated as totally unordered or as with some characters (describing intensity, position or shape of certain structures) ordered. The analyses were performed with TNT using maximum parsimony and implied weighting as optimality criteria. Hypermecaspididae constitutes a monophyletic family within Olenida, and is the sister group of pterocephaliids. In light of the present analysis, an emended diagnosis of the family is provided. The results suggest that ‘Tropidopyge’ broeggeri should be reassigned to Hypermecaspis. Hypermecaspidids would have originated in the late Furongian and rapidly diversified across different parts of the world in the Early Ordovician. With the exception of H. armata and H. chamarrensis, the species of Hypermecaspis have a proportionately large pygidium with a wide doublure and a distinct postaxial field. An evolutionary trend toward an increase in the size of these characters is observed in the genus. The cranidium shows a tendency toward enlargement of the glabella and the palpebral lobes, together with a narrowing of the interocular genae.

Pleomorphic adenomas of palpebral lobe of the lacrimal gland.

Pleomorphic adenomas of palpebral lobe of the lacrimal gland.

Lacrimal Gland Lesions Biopsied in a Tertiary Eye Center in Saudi Arabia: A Clinical, Radiological, Surgical, and Histological Review.

PurposeTo study the demographics and clinical presentation of biopsied lacrimal gland lesions in a tertiary eye center and determine the accuracy of radiological imaging and blood investigations in reaching the diagnosis. We also studied the histopathological outcome of different lacrimal gland biopsy approaches.Materials and MethodsA retrospective review of patients’ charts from 2014 to 2021 who underwent lacrimal gland biopsy. The data collected included demographics, clinical presentations, surgical approaches used, blood workup done, and histopathological and radiological diagnoses. The accuracy of radiological imaging in diagnosing lacrimal gland pathologies was evaluated by comparing radiological interpretation to the final pathological report.ResultsIn a total of 48 cases, the most common lacrimal gland lesion was nonspecific inflammation of the lacrimal gland (34%, n=17) followed by lymphoproliferative lesions (25%, n=12). Females (62.5%, n=30) were more affected than males (37.5%, n=18). Other lesions included pleomorphic adenoma, angiolymphoid hyperplasia with eosinophilia, and IgG4 disease. Complete blood investigations were performed in 45.8% of patients and a systemic disease was found in only 18.2%. The initial assumptive diagnosis based on MRI and CT scan images was congruous with the histopathological diagnosis in 42% and 12%, respectively. Three surgical approaches were used for incisional biopsy in this study, including sub-periosteal, trans-septal, and palpebral lobe biopsy. Lateral orbitotomy was done in all excisional biopsy cases. We found no statistical difference in the histopathological outcome between the different surgical approaches used.ConclusionNonspecific inflammation and lymphoproliferative disorders are the most common causes of lacrimal gland lesions. Blood work-up should not be used to waive off the need for lacrimal gland biopsy, and the diagnosis should preferably be based on histopathology results. The MRI is a useful tool to diagnose lacrimal gland lesions; however, histopathology remains the gold standard method.

Intact Removal of Orbital Lobe Tumors of the Lacrimal Gland, With or Without Lateral Wall Osteotomy.

To examine the necessity for lateral osteotomy for intact removal of tumors within the orbital lobe of the lacrimal gland. Patients who, between 1992 and 2020, were scheduled for intact excision of well-defined masses within the orbital lobe of the lacrimal gland were identified from an orbital database. A retrospective review of the clinical records was performed and details of the tumor size obtained from histopathological reports. The first patients in the series had lateral osteotomy, whereas later, there was a shift toward osteotomy-free tumor excision through a skin-crease incision. The latter approach required isolation of the gland's orbital lobe on an intact sheet of periosteum, an anterior "flip" of the mass (out of the orbit, past the orbital rim) "hinged" at the isthmus between the orbital and palpebral lobes, and finally a division of the isthmus to release the intact mass. Clinical details were available for 100 patients (50 male), with 56 tumors removed using lateral osteotomy and 44 without. The mean age at surgery was 50.3 years with osteotomy (median, 51.8; range, 19-85 years) and 51.1 years without (median, 50.3; range, 11-81 years; P = 0.81). There were no postoperative complications in either group. Although the range of tumor volumes was similar in the two groups (1.6-15.0 ml with osteotomy; 0.9-15.1 ml without), the average volume was somewhat greater in those having osteotomy (mean, 6.4 ml) as compared with those without (mean, 4.6 ml; P = 0.0016). Inadvertent rupture of the tumor occurred once in each group, with tumors of similar small size. In many cases, large masses within the orbital lobe of the lacrimal gland can be safely removed intact, using the described flip technique without the need for lateral wall osteotomy.

Comparison of external dacryocystorhinostomy versus injection botulinum toxin in the management of functional epiphora

To compare the efficacy of external dacryocystorhinostomy (DCR) and botulinum toxin-A in the management of functional epiphora.A prospective, comparative, interventional study included 45 patients with functional epiphora out of which 20 patients had undergone external dacryocystorhinostomy and 25 patients received 5 units of injection botulinum toxin in the palpebral lobe of lacrimal gland as per the patient’s preference. All patients underwent syringing and fluorescein dye disappearance testing before the procedure. Epiphora was graded subjectively with Munk scores obtained before and after intervention. Duration of side effects and severity were also noted.This study showed functional epiphora common in elderly age group. Female constitued of 71.11% and male 28.89 % with female: male ratio of 2.4:1. Left eye (42.22%) predominantly involved. The overall success rate at 6 months after surgery for external DCR was 95% and that of injection botulinum was 91.17%. The overall success rate in both the group was not statistically significant(p&amp;#62;0.05%). Improvement in epiphora graded by Munk score was statistically significant after intervention in both the groups(p&amp;#60;0.05%). This study showed injection Botulinum toxin can be considered as an alternative management in case of functional epiphora for patient who do not want to undergo surgical intervention and for those with co-morbid conditions with high risk for surgical intervention like DCR.

Tear secretion from the lacrimal gland: variations in normal versus dry eyes

PurposeTo investigate the secretory status of the main lacrimal gland in healthy and dry eye disease (DED) via fluorescein-assisted direct assessment of tear secretion from the palpebral lobes.MethodsIncluded were 25...