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Clinical science
Palpebral lobe of the human lacrimal gland: morphometric analysis in normal versus dry eyes
  1. Swati Singh1,
  2. Swapna S Shanbhag2,
  3. Sayan Basu1,2,3
  1. 1 Centre for Ocular Regeneration, LV Prasad Eye Institute, Hyderabad, Telangana, India
  2. 2 The Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
  3. 3 Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India
  1. Correspondence to Sayan Basu, Director and D Balasubramanian Chair of Eye Research, Brien Holden Eye Research Centre (BHERC), L V Prasad Eye Institute, Road No. 2, Banjara Hills, Hyderabad 500034, India; sayanbasu{at}lvpei.org

Abstract

Aim To study the morphological features of the palpebral lobe of the main lacrimal gland in normal and dry eyes.

Methods This cross-sectional study included 25 healthy subjects and 83 patients with dry eye disease (DED). The aetiological groups of DED were cicatrising conjunctivitis (CC, n=35), evaporative dry eyes (EDE, n=25) and Sjogren’s syndrome (SS, n=23). The palpebral lobes in both eyes were evaluated using slit-lamp biomicroscopy and photography for size (exposed area in mm2), shape (convex or flat), presence of cicatrisation (scarring and/or symblepharon) and appearance of the overlying conjunctival vessels.

Results The palpebral lobes in the normal and EDE group were similar in terms of size (41.5±15.6 mm2 vs 39±12.2 mm2, p=0.203), convex shape (100%) and absence of cicatrisation or vascular engorgement (0%). However, as compared to normal controls, the size of the palpebral lobe was markedly reduced in the SS (27.9±12.3, p<0.0001) and CC (18.1±13.7, p<0.0001) groups. The size of the lobes was asymmetric in the CC group (p<0.0001) and differed significantly from the SS group (p=0.0003). Flat contour (79% vs 50%, p=0.0028), subepithelial scarring with or without symblepharon (52% vs 13%, p<0.0001) and engorged conjunctival vessels (96% vs 63%, p=0.00011) were seen in a significantly higher proportion of lobes in the CC as compared to the SS group.

Conclusion The morphological features of the palpebral lobe of the main lacrimal gland are significantly distorted in aqueous deficient dry eyes due to CC and SS; however, the lobes in patients with EDE are similar to normal eyes.

  • Lacrimal gland
  • Ocular surface
  • Anatomy
  • Conjunctiva
  • Tears

https://doi.org/10.1136/bjophthalmol-2020-316929

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    Footnotes

    • Contributors Concept and design of study or acquisition of data or analysis and interpretation of data ; drafting the article or revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: SS, SSS and SB.

    • Funding Dr Swati Singh was funded through the Initiative for Dry Eye Amelioration (IDEA) project, a corporate social responsibility grant awarded by Sun Pharmaceutical Industries Private Limited, Mumbai, Maharashtra, India. Grant number: none. The Study was funded by the Hyderabad Eye Research Foundation (HERF), Hyderabad, Telangana, India.

    • Competing interests None declared.

    • Ethics approval This prospective cross-sectional observational study was approved by the Institutional Review Board and the Ethics Committee of the L.V. Prasad Eye Institute, Hyderabad, Telangana (approval number: LEC_19_335). Informed consent was obtained from all participants prior to all diagnostic procedures.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article.

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