Does Epiphora Cause Meibomian Gland Loss and Dry Eye?

Yıl 2023, Cilt: 5 Sayı: 1, 16 - 25, 12.01.2024

Kübra Tinç Sertaç Argun Kıvanç , Berna Akova

Öz

Purpose
To investigate the effects of epiphora due to primary acquired nasolacrimal duct
obstruction (PANDO) and external dacryocystorhinostomy (DCR) for its treatment on meibomian glands and tear film parameters.
Methods
External DCR for unilateral PANDO in the Department of Ophthalmology, Faculty of Medicine, Bursa Uludag University between January 2018-June 2019 were reviewed. The tear film parameters and meibography measurement recorded at the preoperative and follow-up examinations were examined on both the obstructed side and the patent side. SPSS 23 was used for statistical analyzed.
Results
There was a significant difference between Schirmer-1 score before external DCR (13,1±5,0; 6,3±5,0; p=0,01) and this difference disappeared after surgery (12,0±7,3; 7,7±5,0; p=0,06). Postoperative increase in non-invasive average break-up time (niAVG-BUT) on operated side was statistically significant (10,5±4,6; 12,0±5,3; p=0,033). When the healthy and operated sides were compared with each other, no significant difference was observed in niAVG-BUT before and after surgery (p=0,907, p=0,614). Mean meibomian gland losses were decreased in both operated and patent sides postoperatively and these values were statistically significant (33,0±8,2; 27,1±6,8; p<0,001, 37,3±10,4; 31,4±9,6; p=0,01).
Conclusion
Patients with unilateral nasolacrimal duct obstruction (NLDO) had loss of meibomian gland in both NLDO side and patent side. This loss was found to be significantly reduced on both obstructed and patent sides after successful surgical removal of the epiphora.

Anahtar Kelimeler

epiphora, meibomian gland, dacryocystorhinostomy, dry eye, meibography, ophthalmology

Etik Beyan

This study was conducted according to the criteria set by the declaration of Helsinki and was approved by Bursa Uludag University Institutional Review Board.

Kaynakça

• 1. Nuhoglu F, Ozdemir FE, Buyrukcu AT, Eltutar K. Lacrimal Scintigraphy and Dacryocystography in Patients with Epiphora. JAREM 2012;2:68-70.
• 2. Mainville N, Jordan DR. Etiology of tearing: a retrospective analysis of referrals to a tertiary care oculoplastics practice. Ophthalmic Plast Reconstr Surg. 2011 May-Jun;27(3):155-157.
• 3. Pflugfelder SC, Liu Z, Monroy D, Li DQ, Carvajal ME, Price-Schiavi SA, Idris N, Solomon A, Perez A, Carraway KL. Detection of sialomucin complex (MUC4) in human ocular surface epithelium and tear fluid. Invest Ophthalmol Vis Sci. 2000 May;41(6):1316-1326.
• 4. Lang F, Busch GL, Ritter M, Völkl H, Waldegger S, Gulbins E, Häussinger D. Functional significance of cell volume regulatory mechanisms. Physiol Rev. 1998 Jan;78(1):247-306.
• 5. Ngezahayo A, Kolb HA. Gap junctional permeability is affected by cell volume changes and modulates volume regulation. FEBS Lett. 1990 Dec 10;276(1-2):6-8.
• 6. Sachs F. Mechanical transduction by membrane ion channels: a mini review. Mol Cell Biochem. 1991 May 29-Jun 12;104(1-2):57-60.
• 7. Saleh GM, Hussain B, Woodruff SA, Sharma A, Litwin AS. Tear film osmolarity in epiphora. Ophthalmic Plast Reconstr Surg. 2012 Sep-Oct;28(5):338-340.
• 8. Yuksel N, Akcay E, Ayan B, Duru N. Tear-Film Osmolarity Changes Following Dacryocystorhinostomy in Primary Acquired Nasolacrimal Duct Obstruction. Curr Eye Res. 2017 Mar;42(3):348-350.
• 9. Kubo M, Sakuraba T, Arai Y, Nakazawa M. Tear lipid layer interference changes after dacryocystorhinostomy. Jpn J Ophthalmol. 2001 Nov-Dec;45(6):653-656.
• 10. Lee SM, Chung SJ, Lew H. Evaluation of Tear Film Lipid Layer Thickness Measurements Obtained Using an Ocular Surface Interferometer in Nasolacrimal Duct Obstruction Patients. Korean J Ophthalmol. 2018 Dec;32(6):445-450.
• 11. Zengin N. The effect of dacryocystorhinostomy on tear film flow and stability in patients with chronic dacryocystitis. Acta Ophthalmol (Copenh). 1993 Oct;71(5):714-716.
• 12. Yuksel N, Mutlu M, Kilicarslan A, Akcay E. Conjunctival cytologic features in patients with unilateral primary acquired nasolacrimal duct obstruction. Int Ophthalmol. 2018 Feb;38(1):323-326.
• 13. Eshraghi B, Masoomian B, Izadi A, Abedinifar Z, Falavarjani KG. Conjunctival bacterial flora in nasolacrimal duct obstruction and its changes after successful dacryocystorhinostomy surgery. Ophthalmic Plast Reconstr Surg. 2014 Jan-Feb;30(1):44-46.
• 14. Fayers T, Laverde T, Tay E, Olver JM. Lacrimal surgery success after external dacryocystorhinostomy: functional and anatomical results using strict outcome criteria. Ophthalmic Plast Reconstr Surg. 2009 Nov-Dec;25(6):472-475.
• 15. Khurana AK, Moudgil SS, Ahluwalia BK, Parmar IP. Study of tear film flow and stability in chronic dacryocystitis. Acta Ophthalmol (Copenh). 1987 Jun;65(3):300-302.
• 16. Eom Y, Baek S, Kim HM, Song JS. Meibomian Gland Dysfunction in Patients With Chemotherapy-Induced Lacrimal Drainage Obstruction. Cornea. 2017 May;36(5):572-577.
• 17. Wong S, Srinivasan S, Murphy PJ, Jones L. Comparison of meibomian gland dropout using two infrared imaging devices. Cont Lens Anterior Eye. 2019 Jun;42(3):311-317.
• 18. Ngo W, Srinivasan S, Schulze M, Jones L. Repeatability of grading meibomian gland dropout using two infrared systems. Optom Vis Sci. 2014 Jun;91(6):658-667.
• 19. Arita R, Morishige N, Koh S, Shirakawa R, Kawashima M, Sakimoto T, Suzuki T, Tsubota K. Increased Tear Fluid Production as a Compensatory Response to Meibomian Gland Loss: A Multicenter Cross-sectional Study. Ophthalmology. 2015 May;122(5):925-933.
• 20. Miyazaki M, Man WC, Ntambi JM. Targeted disruption of stearoyl-CoA desaturase1 gene in mice causes atrophy of sebaceous and meibomian glands and depletion of wax esters in the eyelid. J Nutr. 2001 Sep;131(9):2260-2268.
• 21. Inaba T, Tanaka Y, Tamaki S, Ito T, Ntambi JM, Tsubota K. Compensatory increases in tear volume and mucin levels associated with meibomian gland dysfunction caused by stearoyl-CoA desaturase-1 deficiency. Sci Rep. 2018 Feb 20;8(1):3358.
• 22. Eshraghi B, Alemzadeh SA, Abedinifar Z. Conjunctival bacterial flora in fellow eyes of patients with unilateral nasolacrimal duct obstruction and its changes after successful dacryocystorhinostomy surgery. J Curr Ophthalmol. 2016 Dec 3;29(1):59-62.
• 23. Jester JV, Nicolaides N, Smith RE. Meibomian gland studies: histologic and ultrastructural investigations. Invest Ophthalmol Vis Sci. 1981 Apr;20(4):537-547.
• 24. Perra MT, Serra A, Sirigu P, Turno F. Histochemical demonstration of acetylcholinesterase activity in human Meibomian glands. Eur J Histochem. 1996;40(1):39-44.
• 25. Luhtala J, Palkama A, Uusitalo H. Calcitonin gene-related peptide immunoreactive nerve fibers in the rat conjunctiva. Invest Ophthalmol Vis Sci. 1991 Mar;32(3):640-645.
• 26. Hartschuh W, Weihe E, Reinecke M. Peptidergic (neurotensin, VIP, substance P) nerve fibres in the skin. Immunohistochemical evidence of an involvement of neuropeptides in nociception, pruritus and inflammation. Br J Dermatol. 1983 Jul;109 Suppl 25:14-7.
• 27. Sullivan DA, Sullivan BD, Ullman MD, Rocha EM, Krenzer KL, Cermak JM, Toda I, Doane MG, Evans JE, Wickham LA. Androgen influence on the meibomian gland. Invest Ophthalmol Vis Sci. 2000 Nov;41(12):3732-3742.
• 28. Wickham LA, Gao J, Toda I, Rocha EM, Ono M, Sullivan DA. Identification of androgen, estrogen and progesterone receptor mRNAs in the eye. Acta Ophthalmol Scand. 2000 Apr;78(2):146-153.
• 29. Stern ME, Gao J, Siemasko KF, Beuerman RW, Pflugfelder SC. The role of the lacrimal functional unit in the pathophysiology of dry eye. Exp Eye Res. 2004 Mar;78(3):409-416.
• 30. Stern ME, Beuerman RW, Fox RI, Gao J, Mircheff AK, Pflugfelder SC. The pathology of dry eye: the interaction between the ocular surface and lacrimal glands. Cornea. 1998 Nov;17(6):584-589.