Purpose To 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.
Methods Included were 25 healthy subjects (50 lobes) and 75 subjects with DED (cicatrising conjunctivitis (CC, n=27), evaporative dry eyes (EDE, n=25) and Sjogren’s syndrome (SS, n=23)). Analysed parameters included number and location of ductular openings, tear flow rate per gland and per ductule, and the time lag for the initiation of secretion.
Results Ductular openings could be observed in all patients with EDE and healthy subjects whereas only 33% (18/54) glands of CC patients and 67% glands (31/46) patients with SS revealed ductules. The median number of ductules per lobe was 4 in normal (range 3–5), 3 in EDE (3–6), 1 in SS (0–3) and 0 in CC group (0–3) (p<0.000001). The median tear flow rate per lobe in CC (0.00 ) and SS (0.21 ) was significantly lesser than normal lobes (1.05 , and EDE (0.99 eyes. The tear flow rate differed significantly between SS and CC group (p<0.0001). The maximum time lag occurred in the CC group (median, 20 s), followed by the SS group (median, 1.5 s) whereas the EDE group had similar time lag (<1 s) as of normal glands (p<0.0001).
Conclusion Direct assessment of tear secretion from the palpebral lobe demonstrates significant differences between EDE, aqueous deficient dry eye and dry eye in CC.
- lacrimal gland
- ocular surface
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Contributors Concept and design of study or acquisition of data or analysis and interpretation of data: SS and SB. Drafting the article or revising it critically for important intellectual content: SS, SSS and SB. Final approval of the version to be published: SS, SSS and SB. 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 SS was funded through the Initiative for Dry Eye Amelioration (IDEA) project, a corporate social responsibility grant awarded by Sun Pharmaceutical Industries, Mumbai, Maharashtra, India. Grant number: none.
Competing interests None declared.
Patient consent for publication Not required.
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_326). This prospective study adhered to the tenets of the declaration of Helsinki and was approved by the institutional ethics committee.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available on reasonable request. Data are available on request.
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