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Lacrimal gland activity in lacrimal drainage obstruction: exploring the potential cross-talk between the tear secretion and outflow
  1. Swati Singh1,
  2. Saumya Srivastav2,
  3. Nandini Bothra3,
  4. Friedrich Paulsen4,
  5. Mohammad Javed Ali3
  1. 1 Ophthalmic Plastics Surgery Service, LV Prasad Eye Institute, Hyderabad, Telangana, India
  2. 2 Centre for Ocular Regeneration, LV Prasad Eye Institute, Hyderabad, Telangana, India
  3. 3 Govindram Seksaria Institute of Dacryology, LV Prasad Eye Institute, Hyderabad, Telangana, India
  4. 4 Institute for Clinical and Functional Anatomy, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany
  1. Correspondence to Dr Swati Singh, Oculoplastics, LV Prasad Eye Institute, Hyderabad, Telangana, India; dr.swati888{at}


Purpose To investigate the effects of lacrimal drainage obstructions on the lacrimal gland activity and if there exists a potential link between the two.

Methods Direct assessment of the lacrimal gland activity from the palpebral lobe was performed in consecutive patients diagnosed with unilateral primary acquired nasolacrimal duct obstruction (PANDO), along with Ocular Surface Disease Index (OSDI), non-invasive tear break up time (NIBUT; Oculus K5M), tear meniscus height and Schirmer I. The primary outcome measure was the difference in the tear flow rate between the eye with PANDO and the contralateral uninvolved eye.

Results Thirty patients (median age, 45.5 years; 25 females) with unilateral PANDO had epiphora for a mean duration of 20 months. The mean OSDI score was 6.3. NIBUT (mean 11.56 vs 11.58 s; p=0.49) and Schirmer I values (mean 18.83 vs 19.4 mm; p=0.313) were not significantly different between PANDO and non-PANDO eyes. The morphology of the palpebral lobe (size 29.3 vs 28.6 mm2, p=0.41) and the number of lacrimal ductular openings (median 2 vs 2.5) were similar between the two eyes. The mean tear flow from the lacrimal glands of the PANDO side was significantly reduced compared with the contralateral uninvolved side (0.8 vs 0.99 µL/min; p=0.014)).

Conclusion Tear flow rate from palpebral lobes of patients with unilateral lacrimal outflow obstruction shows a significant reduction compared with the contralateral side. The potential ways of communications between the tear drainage and the tear production mechanisms need to be explored further.

  • Lacrimal gland
  • Lacrimal drainage
  • Tears

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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  • SS and SS are joint first authors.

  • Contributors Concept and design of study or acquisition of data or analysis and interpretation of data: SwS and SaS. Drafting the article or revising it critically for important intellectual content: SwS, NB, FP and MJA. Final approval of the version to be published: SwS, SaS, NB, FP and MJA. 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: SwS, SaS, NB, FP and MJA. SwS acts as a guarantor.

  • Funding The authors have no proprietary or commercial interest in any materials discussed in this manuscript. FP receives royalties from Elsevier for the 24th and 25th Ed. of the anatomy atlas “Sobotta” and for the “Sobotta Textbook of Anatomy”. FP was also supported by Deutsche Forschungsgemeinschaft (DFG) grant PA738/15-1. Dr Swati Singh is funded by Alexander von Humboldt Foundation (AvH), Germany as part of her experienced researcher fellowship award. The Funding organization had no role in the design or conduct of this research.

  • Competing interests None declared.

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