Swati Singh, MBBS, MS, Dilip Kumar Mishra, MD, Swapna Shanbhag, MBBS, MS, Geeta Vemuganti, MD, Vivek Singh, PhD, Mohammad Javed Ali, MBBS, MD, Sayan Basu, MBBS, MS
The lacrimal gland, a major contributor to the aqueous component of the tear film, delivers its secretions via ducts opening onto the superotemporal forniceal conjunctiva. Diseases that affect the structure or function of the lacrimal gland result in aqueous tear deficiency. One of the causes of severe aqueous deficiency is Stevens-Johnson syndrome (SJS), an acute self-limiting mucocutaneous blistering disease that often results in chronic ocular sequelae. However, the pathobiological features of aqueous tear deficiency in SJS are not understood fully. A previous report by Singh et al suggests that the aqueous deficiency in SJS could be secondary to fibrosis in the periductal conjunctiva and not the result of primary inflammatory damage to the lacrimal gland itself. Further exploration and confirmation of these initial observations may have significant translational implications because therapeutic approaches can be developed to address the periductal fibrosis, instead of attempting to rejuvenate the entire lacrimal gland.
Teresa H. Chen, Patrick T. Yang, Don O. Kikkawa, Lilangi S. Ediriwickrema, Natalie A. Afshari, Jeffrey E. Lee, Bobby S. Korn
Amniotic membrane (AM), the innermost layer of the placenta, is commonly used as a graft and dressing to promote healing and ocular surface reconstruction. It has been used successfully in the treatment of various ocular surface conditions, such as Stevens-Johnson syndrome (SJS) and toxic epidermolysis necrolysis (TEN) to protect the ocular surface.1, 2 Amniotic membrane application typically takes place in the operating room, unless the patient is too unstable for transport. The technique described by Shammas et al. involves suturing the amniotic membrane over the eyelid margin, then pushing the membrane into the fornix with a muscle hook.3 We report a streamlined technique of amniotic membrane application that can be rapidly performed at the bedside under local anaesthetic.
Masakazu Nishii, Norihiko Yokoi, Aoi Komuro, Jiro Sugita, Yo Nakamura, Kentaro Kojima, Shigeru Kinoshita
Punctal occlusion using a silicone plug is an effective treatment for severe tear-deficient dry eye. At present, plugs from two companies are available in Japan [Eagle plug (EP); Eagle Vision, Punctal plug (PP); FCI]. We compared the extrusion rate between EP and PP in our dry eye clinic.
Subjects and methods
Subjects were 20 eyes of 18 patients for EP [5 eyes from 5 males, 15 eyes from 13 females, age: 58.1±17.5 (mean±standard deviation)] and 76 eyes of 51 patients for PP (6 eyes from 5 males, 70 eyes from 46 females, age: 58.6±13.4), 62 eyes from 44 patients with Sjögren syndrome, 34 eyes from 25 patients with non-Sjögren syndrome with severe tear-deficient dry eye. These patients were treated during the period of November 1996 to February 2002 in our dry eye clinic. We compared the extrusion rate for each plug and the necessity of reinsertion of the plug.
In the examination for EP, 72.2% of the plugs were extruded during the follow-up period. The average period (59 days) until the extrusion was completed was significantly shorter than for PP (P<0.0001). In the examination of PP, 55.9% were extruded, and the average period until the extrusion was 287 days. Significant improvement of corneal epithelial damage was seen with PP after insertion of the plug. For the PP, reinsertion of plugs was sometimes impossible, probably because of the granulation formed inside the canaliculus, while for EP, reinsertion of the plugs was possible for all cases.
EP becomes extruded more easily than PP, and it seems that forms more easily inside PP.