Autologous submandibular gland (SMG) transplantation has been proved to ameliorate the discomforts in patients with severe keratoconjunctivitis sicca. The transplanted glands underwent a hypofunctional period and then restored secretion spontaneously. This study aims to investigate whether autonomic nerves reinnervate the grafts and contribute to the functional recovery, and further determine the origin of these nerves. Parts of the transplanted SMGs were collected from the epiphora patients, and a rabbit SMG transplantation model was established to fulfill the serial observation on the transplanted glands with time. The results showed that autonomic nerves distributed in the transplanted SMGs and parasympathetic ganglionic cells were observed in the stroma of the glands. Low-dense and unevenly distributed cholinergic axons, severe acinar atrophy and fibrosis were visible in the patients' glands 4-6 months post-transplantation, whereas the cholinergic axon density and acinar area were increased with time. The acinar area or the secretory flow rate of the transplanted glands was statistically correlated with the cholinergic axon density in the rabbit model, respectively. Meanwhile, large cholinergic nerve trunks were found to locate in the temporal fascia lower to the gland, and sympathetic plexus concomitant with the arteries was observed both in the adjacent fascia and in the stroma of the glands. In summary, the transplanted SMGs are reinnervated by autonomic nerves and the cholinergic nerves play a role in the morphological and functional restoration of the glands. Moreover, these autonomic nerves might originate from the auriculotemporal nerve and the sympathetic plexus around the supplying arteries.
Animals ; Autonomic Pathways ; growth & development ; Fascia ; innervation ; Female ; Humans ; Keratoconjunctivitis Sicca ; surgery ; Male ; Models, Animal ; Rabbits ; Recovery of Function ; Secretory Rate ; Submandibular Gland ; innervation ; transplantation ; Transplantation, Autologous

OBJECTIVES: Dry eye disease (DED) is an increasingly important public health problem in Korea. Previous studies conducted in Korea have reported inconsistent results regarding the protective effects of vitamin D on DED, and these discrepancies may be related to the relatively simple questionnaire that has been used. Thus, we evaluated the association of serum vitamin D levels with DED using the ocular surface disease index (OSDI). METHODS: The present study evaluated data from participants in the Study Group for Environmental Eye Disease (2014-2015). This group included data from 752 participants, and data from 740 participants (253 men and 487 women) were analyzed in the present study. DED severity was evaluated using the OSDI. RESULTS: Higher serum vitamin D levels were associated with a non-significantly reduced risk of DED in the crude analysis (odds ratio [OR], 0.991; 95% confidence interval [CI], 0.971 to 1.011) and in the adjusted analysis (OR, 0.988; 95% CI, 0.966 to 1.010). In the crude analysis of no/mild DED vs. moderate/severe DED, men exhibited a decreased risk with increasing serum vitamin D levels (OR, 0.999; 95% CI, 0.950 to 1.051), while women exhibited an increased risk (OR, 1.003; 95% CI, 0.979 to 1.027). In these analyses, we found no significant associations. CONCLUSIONS: The findings of the present study support previous reports that serum vitamin D levels are not associated with DED.
25-Hydroxyvitamin D 2 ; Dry Eye Syndromes ; Eye Diseases* ; Female ; Humans ; Keratoconjunctivitis Sicca ; Korea ; Male ; Public Health ; Vitamin D* ; Vitamins*

Systemic lupus erythematosus (SLE) is a complex connective tissue disease involving multiple organs including various ocular structures including the eyelid, orbit, ocular adnexa, sclera, cornea, retina, uvea, and optic nerve. Keratoconjunctivitis sicca is the most common ocular manifestation resulting in patients that suffer from dry eye symptoms, whereas severe vaso-occlusive lupus retinopathy is the most vision-threatening condition associated with the disease. SLE is a serious systemic disease that may first present with ocular manifestations. In addition, ocular manifestations are often associated with severe systemic inflammation and can be a marker for systemic prognosis. Thus, it is important for ophthalmologists to be aware of the association of visual disorders with SLE to detect and treat the ocular manifestations of SLE.
Connective Tissue Diseases ; Cornea ; Eyelids ; Humans ; Inflammation ; Keratoconjunctivitis Sicca ; Lupus Erythematosus, Systemic* ; Optic Nerve ; Orbit ; Prognosis ; Retina ; Sclera ; Uvea ; Vasculitis ; Vision Disorders

Dry eye disease (also known as keratoconjunctivitis sicca) is a multifactorial disease of the tear film and ocular surface. It results in various symptoms of discomfort such as pain, tearing, fatigue, and headache. Visual function can also deteriorate, and quality of life is negatively affected. Tear film instability which may lead to damage to the ocular surface with an inflammatory reaction is key to the pathogenesis of dry eye disease. This review discussed the classification, pathogenesis, diagnostic approaches, and treatment options of dry eye disease.
Dry Eye Syndromes ; Fatigue ; Headache ; Inflammation ; Keratoconjunctivitis Sicca ; Quality of Life ; Tears

Dry eye syndrome is a relatively common disease of the tears and ocular surfaces that results in discomfort, visual disturbance, and tear film instability with possible damage to the ocular surfaces. Microvascular submandibular gland (SMG) transfer offers a surgical alternative for a permanent autologous substitution of tears using the basal secretion of a transplanted SMG. Long-term follow-up reveals that this technique is a lasting and effective solution for patients with severe dry eye syndrome. The uncomfortable symptoms were relieved, and the frequency of use of pharmaceutical tear substitutes was reduced. Objective examination showed significant improvement in tear film and some features of ocular surface such as breakup time of tear film and corneal staining. Patients may suffer from obstruction of Wharton's duct or epiphora after surgery. Activation of secretion-related receptors could improve the early hypofunction of the denervated SMG and prevent the duct obstruction. Reduction surgery, partial SMG transplantation, uses of atropine gel or Botulinum toxin A could be the choices of treatment for epiphora.
Atropine ; Botulinum Toxins ; Dry Eye Syndromes ; Follow-Up Studies ; Humans ; Keratoconjunctivitis Sicca* ; Lacrimal Apparatus Diseases ; Salivary Ducts ; Submandibular Gland* ; Tears

OBJECTIVE: To determine the prevalence of dry eye disease in an urban community in the Philippines.

METHODS: This was a community-based cross-sectional study. Convenience sampling was conducted on residents of Barangay 733, Sampaloc, Manila, Philippines. One hundred fifty-seven participants, 19 years old and above, underwent investigator-led interview using a dry-eye questionnaire, followed by dry-eye examination consisting fluorescein tear break-up time (TBUT), corneal staining with fluorescein, conjunctival and posterior lid margin staining (PLM) with lissamine green, and Schirmer I test with and without anesthesia.

RESULTS: Of the 157 participants recruited, 148 (94%) fulfilled the inclusion criteria. The mean age was 52.35 years; 95 (64.2%) were females and 53 (35.8%) males. Thirty-four (22.9%) were diagnosed with dry eye disease, and the most common symptom reported was itching (76%). Those with dry eye had significantly higher ocular surface disease index score and subjective grading of ocular discomfort compared with those without the disease. Mean TBUT for those without dry eye was 12.74 seconds compared with 8.84 seconds for the dry eye group. The mean fluorescein corneal staining scores were 2 and 20 for the none and the dry eye groups respectively. The mean lissamine green conjunctival staining scores were 14 and 55 respectively. A positive PLM sign was present in 67.6% with dry eye vs. 5.6% in the none dry eye group. Mean Schirmer I test without anesthesia was 18.53 mm and 17.09 mm in the none and dry eye groups respectively. Mean Schirmer I test with anesthesia was 13.36 mm vs. 11.94 mm respectively.

CONCLUSION: The prevalence rate of dry eye disease in an urban community in Manila was 22.9%. This figure was similar to those reported by neighboring Asian countries.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Fluorescein ; Dry Eye Syndromes ; Tears ; Conjunctiva ; Keratoconjunctivitis Sicca ; Anesthesia ; Pruritus

PURPOSE: To examine histopathological findings of filamentary keratitis due to corneal occlusion. METHODS: We analyzed filamentary keratitis in 11 eyes with corneal occlusion due to blepharospasm, ptosis and paralytic strabismus, 11 eyes with keratoconjunctivitis sicca, and 13 eyes with both corneal occlusion and keratoconjunctivitis sicca. The following protocols were used for filament analyses: slit lamp examination for counting filament numbers, impression cytology for grading mucin content, and histopathology (hematoxylin and eosin staining) and immunohistochemistry (with AE1/AE3, MUC1, 5AC, 16) for histological analysis. RESULTS: Slit lamp biomicrosopy showed a significantly smaller number of filaments in the corneal occlusion group (11 eyes, 2.7 +/- 1.4) than the keratoconjunctivitis sicca group (11 eyes, 5.1 +/- 2.2, p = 0.009). In impression cytology, the standard photograph grade of mucin content was significantly higher in the corneal occlusion group (2.7 +/- 0.9) than the keratoconjunctivitis sicca group (1.9 +/- 0.8, p = 0.034). On pathological exam, filaments showed a central filament with peripheral mucin. The central filaments were composed of core and cortex, and the core contained multiple deformed nuclei. However, the cortex was not stained by AE1/AE3, MUC1, 5AC, 16. CONCLUSIONS: Filamentary keratitis due to corneal occlusion showed a smaller number of filaments and higher mucin content than filamentary keratitis induced by keratoconjunctivitis sicca and should be considered during treatment.
Blepharospasm ; Eosine Yellowish-(YS) ; Immunohistochemistry ; Keratitis ; Keratoconjunctivitis Sicca* ; Keratoconjunctivitis* ; Mucins ; Strabismus

Rheumatic disorders commonly affect the sclera, cornea, retina, and orbit. These disorders range from relatively mild ocular surface problems to a serious threat for the visual sight. The most common ocular manifestations of rheumatic diseases include keratoconjunctivitis sicca, anterior uveitis, and scleritis. The most common entities to causing anterior uveitis and scleritis are seronegative spondyloarthropathies associated with human leukocyte antigen (HLA)-B27 and rheumatoid arthritis, respectively. Patients who developed bilateral or recurrent uveitis, or who have involvement of posterior ocular structures are more likely to have underlying systemic inflammatory diseases. The most significant side effects of the drugs used to treat rheumatic diseases are the maculopathy-associated with anti-malarial agents and cataracts and glaucoma associated with corticosteroid use. Close collaborations between ophthalmologists and rheumatologists are necessary for optimal treatments and the prevention of complications. Understanding the range and patterns of ocular manifestations of rheumatic diseases can provide valuable suggestions for the most suitable diagnosis and optimal management for these patients.
Arthritis, Rheumatoid ; Cataract ; Cooperative Behavior ; Cornea ; Eye ; Glaucoma ; Humans ; Keratoconjunctivitis Sicca ; Leukocytes ; Orbit ; Retina ; Rheumatic Diseases ; Sclera ; Scleritis ; Spondylarthropathies ; Uveitis ; Uveitis, Anterior

PURPOSE: To report the clinical course and results of two cases of anterior segment manifestations associated with systemic lupus erythematosus (SLE). CASE SUMMARY: The first case was a 63-year-old female patient who was diagnosed with corneal ulcer and symblepharon on her left eye and dry eye in both eyes. Although the patient was treated with topical antibiotics, autologous serum and artificial tears, amniotic membrane transplantation and symblepharon removal were subsequently required. At 1 month after medical and surgical treatment, the corneal ulcer improved, but a descemetocele was formed because of persistent corneal thinning. The second case was a 24-year-old female patient diagnosed with filamentary keratitis and recurrent corneal erosion in both eyes and uveitis in her left eye. After treatment with therapeutic contact lenses, topical antibiotics and steroids, her symptoms were slightly improved. After 6 months of treatment, filamentary keratitis and corneal erosion recurred to being intractable. The patient received systemic evaluation and was diagnosed with SLE. After a combined therapy of oral and topical treatments, filamentary keratitis and recurrent corneal erosion improved significantly. CONCLUSIONS: Clinical manifestations of anterior segment associated with SLE rarely respond to topical treatment and are apt to recur easily; therefore, systemic treatment should be applied for better prognosis. Thus, the therapeutic strategy in intractable ocular diseases should be designed with consideration of accompanying systemic diseases.
Amnion ; Anti-Bacterial Agents ; Contact Lenses ; Corneal Ulcer ; Dimaprit ; Eye ; Female ; Humans ; Keratitis ; Keratoconjunctivitis Sicca ; Lupus Erythematosus, Systemic ; Middle Aged ; Ophthalmic Solutions ; Prognosis ; Steroids ; Transplants ; Uveitis ; Young Adult

Sjogren's syndrome is an autoimmune disease that is characterized by keratoconjunctivitis sicca and xerostomia. Small-fiber neuropathy is rare, although neurological manifestations occur in as many as 30% of patients with Sjogren's syndrome. We report herein a patient with Sjogren's syndrome who presented with autonomic neuropathy and painful sensory neuropathy. Primary Sjogren's syndrome should be considered in the differential diagnosis of small-fiber neuropathy.
Autoimmune Diseases ; Diagnosis, Differential ; Humans ; Keratoconjunctivitis Sicca ; Neurologic Manifestations ; Sjogren's Syndrome ; Xerostomia