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Objectives: This study examined the impact of injectable plateletrich fibrin (iPRF) and concentrated growth factor on postoperative pain, edema, trismus, and quality of life in impacted mandibular third molar surgery. The primary aim of this study was to minimize common sequelae following third molar surgery by using iPRF and concentrated growth factor. The secondary objective was to compare the postoperative effects of these products. Method and materials: This study represents a single-center, randomized prospective clinical trial conducted at the Ordu University Faculty of Dentistry. It involved patients who underwent third molar surgery for various reasons between July and October 2022. The predictor variables were the use of concentrated growth factor and i-PRF. They were categorized as concentrated growth factor, i-PRF, and control groups. The outcome variables include pain levels and analgesic consumption measured on a visual analog scale, distances between predetermined anatomical points, maximum mouth opening capacity, and data from the postoperative symptom severity (PoSSe) scale. Some statistical tests were performed with a 95% confidence interval, which was considered significant. Results: Total analgesic use was notably lower in the concentrated growth factor group (P = .044). Concentrated growth factor and iPRF outperformed the control group in all edema measurements by postoperative day 7 (tragus–pogonion, lateral canthus–angulus, tragus–commissura; P < .05). Concentrated growth factor significantly reduced trismus on days 2 and 7. Quality of life was notably higher in the concentrated growth factor group than in the control group (P = .026), although iPRF group differences were not significant. Conclusion: The results indicate that concentrated growth factor has a limited impact on postoperative pain, but significantly reduces edema, trismus, and enhances quality of life. The iPRF group experienced positive effects on pain, edema, and trismus, although the statistically significant differences observed with concentrated growth factor highlight its potential for use instead of iPRF after third molar surgery. An increased sample size is essential for more comprehensive results [ABSTRACT FROM AUTHOR]

Purpose: To critically appraise the evidence on the ability of the lacrimal gland ultrasonography (USG) or magnetic resonance imaging (MRI) to differentiate between Sjogren's syndrome and non-Sjogren's syndrome/healthy controls. Methods: A systematic review and meta-analysis (based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines) of online literature search was performed using PubMed, Scopus, and Cochrane databases. Cohort studies comparing the imaging features of the lacrimal glands of Sjogren's syndrome with a control group were included. Quantitative synthesis was performed using the RevMan (Version 5.4.1). Results: Six studies used USG as an imaging technique, and three used MRI for the lacrimal gland imaging. The lacrimal gland affected with Sjogren's syndrome shows glandular heterogeneity on USG and MRI. Heterogeneity on USG had 6.18 times higher odds of the lacrimal gland being involved with Sjogren's syndrome (95% CI, 3.31–11.55). Gland hyperechogenicity cannot reliably differentiate the glandular involvement in Sjogren's syndrome. There is insufficient data for analysis on the gland size, hypoechoic areas, fibrous bands, and increased lacrimal artery resistance in Sjogren's syndrome patients. Of the three MRI-based studies, reduced apparent diffusion coefficient and heterogeneity were the characteristics of Sjogren's syndrome. Clinical parameters such as dry eye symptomatology and Schirmer values had variable associations with USG or MRI parameters. Ultrasonography parameters were no different between dry eye versus no dry eye in Sjogren's syndrome patients, whereas small-sized glands had low Schirmer on MRI-based studies. Conclusion: Glandular heterogeneity on USG is significantly associated with lacrimal gland involvement in Sjogren's syndrome patients. However, the role of radiology in predicting lacrimal gland involvement is unclear as the evidence is insufficient and heterogeneous. [ABSTRACT FROM AUTHOR]

To review the efficacy and safety of the use of intraoperative image guidance (IIG) in orbital and lacrimal surgery. A literature search of the PubMed database was last conducted in November 2023 for English-language original research that assessed the use of any image guidance system in orbital and lacrimal surgery that included at least 5 patients. The search identified 524 articles; 94 were selected for full-text analysis by the panel. A total of 32 studies met inclusion criteria. The panel methodologist assigned a level II rating to 2 studies and a level III rating to 30 studies. No study met the criteria for level I evidence. Procedures reported on were as follows: fracture repair (n = 14), neoplasm and infiltrate biopsy or excision (n = 6), orbital decompression for Graves ophthalmopathy (n = 3), dacryocystorhinostomy (n = 1), and mixed etiology and procedures (n = 8). Four studies used more than one IIG system. One study that met level II evidence criteria compared the outcomes of orbital fracture repair with IIG (n = 29) and without IIG (n = 29). Borderline better outcomes were reported in the IIG group: 2% versus 10% with diplopia (P = 0.039) and 3% versus 10% with enophthalmos (P = 0.065). The other level II study compared the repair of fractures with navigation (n = 20) and without (n = 20). The group in which navigation was used had a measured mean volume reduction of 3.82 cm3 compared with 3.33 cm3 (P = 0.02), and there was a greater measured reduction in enophthalmos in the navigation group of 0.72 mm (P = 0.001). Although the remaining 30 assessed articles failed to meet level II criteria, all alleged a benefit from IIG. No complications were reported. A small number of comparative studies suggest that there are improved outcomes when IIG is used in orbital fracture repair, but each study suffers from various limitations. No high-quality comparative studies exist for the management of lacrimal surgery, neoplastic disease, or decompression. Complications attributable to the use of IIG have not been identified, and IIG has not been analyzed for cost savings. Proprietary or commercial disclosure may be found after the references. [ABSTRACT FROM AUTHOR]

The document explores the life and work of Sir Percivall Pott (1714-1788) and his lacrimal treatise from 1758, focusing on lacrimal drainage disorders. Pott, a renowned English surgeon, made significant contributions to the field of ophthalmology. The treatise discusses various aspects of lacrimal disorders, including etiologies, clinical presentations, and management strategies, providing valuable insights into the historical understanding of these conditions. The text also includes criticisms and assessments of Pott's work, highlighting the importance of his observations in advancing the science of lacrimal drainage disorders. [Extracted from the article]

Lacrimal adenoid cystic carcinoma (LACC) is one of the most common malignant epithelial tumors of the lacrimal gland, characterized by high rates of local recurrence, distant metastases, and tumor-related mortality. This malignancy impairs the lacrimal gland's ability to secret tears, thereby disrupting the normal function of the ocular surface. Due to ineffective diagnostic approaches and the complex anatomical location of the lacrimal gland within the orbit, many LACC patients are often diagnosed at the later stages. Therefore, it is urgent to develop a simple and convenient method for early detection of LACC through biomarker analysis by liquid biopsies, such as blood or tears. Various microRNAs (miRNAs) derived from liquid biopsies have been shown to serve as biomarkers for early diagnosis of tumors. In the present study, we screened LACC-specific miRNAs using miRNA microarray analysis in both primary and recurrent patient groups. We then validate their expression by qPCR experiments conducted in tissues, cell lines, tear fluid and serum to explore the association between these miRNAs and LACC development and prognosis. Our findings reveal that hsa-miR-200b-3p, hsa-miR-200c-3p and hsa-miR-141-3p are significantly upregulated in LACC, and the microarray data showed that these three miRNAs were significantly elevated in the recurrence group compared to the primary group. In conclusion, detecting miRNA expression in tear fluid and serum provides non-invasive biomarkers for the early diagnosis of LACC and may facilitate monitoring outcomes related to lacrimal gland diseases. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess whether the involvement of major salivary and lacrimal glands in primary Sjögren's syndrome (pSS) affected the psychological resilience of patients. This cross‐sectional study included 116 patients with pSS. Data were collected through clinical examinations, measurement of salivary flow rates (SFRs), and from Schirmer's test, as well as from patient‐reported outcome measures (PROMs), such as the European League Against Rheumatism (EULAR) Sjögren's Syndrome Patient Reported Index (ESSPRI), Brief Resilience Scale (BRS), Work Productivity and Activity Impairment (WPAI), Oral Health Impact Profile‐14 (OHIP‐14), and the Hospital Anxiety and Depression Scale (HADS). Hyposalivation was defined as an unstimulated SFR of ≤0.1 mL/min. The BRS score (mean ± SD = 2.60 ± 0.69) was lower in patients with recurrent parotitis (2.11 ± 0.37) than in those without recurrent parotitis (2.67 ± 0.86), in the whole group. In patients with an unacceptable symptom state (ESSPRI score ≥ 5 points), a lower BRS score was observed in patients with both hyposalivation and ocular dryness (2.59 ± 0.69) than in patients with isolated hyposalivation (2.84 ± 0.84). The BRS score was also negatively associated with the WPAI‐Daily Impairment and OHIP‐14 scores in patients with hyposalivation as well as with HADS‐A (the seven items of HADS relating to the anxiety dimension) and HADS‐D (the seven items of HADS relating to the depression dimension) in the whole group. The results suggest that psychological resilience in pSS may be affected by recurrent parotitis, the levels of anxiety and depression, as well as hyposalivation with ocular dryness. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effectiveness and safety of a crosslinked hyaluronate (HA) canalicular filler (Lacrifill Canalicular Gel) compared with a commercially available hydrogel canalicular plug (Form Fit). Setting: 5 sites in the United States. Design: Prospective, multicenter, controlled, double-masked, randomized 2:1 (filler:plug). Methods: Adults (=22 years) with the Schirmer test (with anesthesia) =10 mm/5 minutes, presence of corneal staining, ocular surface disease index (OSDI) of =23 with =3 responses of "not applicable," patent lacrimal drainage system, and bilateral corrected distance visual acuity of 20/40 or better. Filler or plugs were instilled bilaterally in the inferior canaliculi. Primary effectiveness endpoint was noninferiority of the mean within subject change from baseline to month 3 in Schirmer score for patients receiving filler compared with plugs. The key secondary effectiveness endpoint was noninferiority of the proportion of patients with filler achieving improvement from baseline to month 3 in OSDI by a minimal clinically important difference. Additional endpoints included the mean change from baseline to 3 and 6 months in tear meniscus height, OSDI, corneal staining, tear breakup time, and safety. Results: 157 patients were randomized; 99 patients with crosslinked HA filler and 52 patients with hydrogel plugs completed the study. Filler was noninferior to plugs in the mean Schirmer score change from baseline and in the proportion of patients achieving a clinically important improvement in OSDI. Conclusions: Crosslinked HA filler is a safe, well-tolerated, and effective method to treat dry eye. Clinically and statistically significant improvements in signs and symptoms of dry eye were sustained through 6 months. [ABSTRACT FROM AUTHOR]

Background: The aim of our study was to determine the success of endoscopic endonasal dacryocystorhinostomy using powered instrument (microdebrider) and removing the nasal mucosal and posterior saccal flaps. Methodology: A prospective hospital based case study was conducted in patients attending ENT, Head & neck surgery department of Government Medical college hospital between April 2023 to April 2024 with complaint of epiphora including nasolacrimal duct obstruction. A total of 30 cases of epiphora secondary to nasolacrimal duct obstruction were operated using endoscopic endonasal DCR technique. Result: Complete resolution of epiphora was reported in 28 patients of the 30 procedures, (93.3% success rate) with patent ostia on syringing. None of the patients developed recurrence, 2 patients developed synechiae and mucosal overgrowth over the canalicular sight post operatively. There were no intra-operative or post-operative complications. Conclusion: The technique of endoscopic dacryocystorhinostomy with creation of wide bony ostium around the medial aspect of the lacrimal sac by drilling out the bony borders and removing mucosal and posterior saccal flaps with the help of powered instrument (microdebrider and drill) has shown good longterm results comparable with other studies. It also has the additional advantage of less granulation tissue formation, less chance of redundant flap obstructing the ostia and practically no synechiae formation. The technique is relatively easy with favourable outcome. [ABSTRACT FROM AUTHOR]

This literature review looks at Sjogren's Syndrome (SS), a chronic autoimmune disorder affecting exocrine glands, particularly the lacrimal and salivary glands. SS manifests as ocular and oral dryness, with severe complications like visual dysfunction and corneal perforation, as well as systemic implications, such as interstitial lung disease and lymphoma. This review explores the use of tear film biomarkers to diagnose SS, emphasizing the significance of their identification in aiding clinical diagnosis and differentiation from other diseases. This study identified and analyzed 15 papers, encompassing 1142 patients and employing various tear sample collection methods. Tear biomarkers were categorized by function and explored in-depth. Categories include (1) antimicrobials, antivirals, and antifungals; (2) components of immune regulation; (3) components that regulate metabolic processes; and (4) inflammatory markers. Noteworthy findings include the potential diagnostic values of tear lysozyme, lactoferrin, dinucleoside polyphosphates, cathepsin, defensin, antibodies, epidermal fatty acid-binding protein, HLA-DR, ADAM10, aquaporin 5, and various miRNAs and mRNAs. Overall, our understanding of SS tear film composition is enhanced, providing valuable insights into the pathogenesis of SS and offering a foundation for future diagnostic and therapeutic advancements in autoimmune conditions affecting the ocular surface. [ABSTRACT FROM AUTHOR]

Dacryocystorhinostomy (DCR) stands as an essential surgical procedure for addressing the persistent challenge of dacryocystitis—a condition marked by inflammation of the lacrimal sac due to nasolacrimal duct obstruction. A hospital-based retrospective study was conducted in a tertiary care hospital, spanning the years 2018 to 2023, involving 34 patients who underwent Endoscopic Dacryocystorhinostomy. The study involved the examination of their clinical presentations, surgical techniques employed, and resulting outcomes along with causes of failure. Our study included 34 patients who had presented with persistent watering of eyes. The maximum number of cases was in the age group of 46–60 years (38%), with a minimum age of 7 years and a maximum age of 68 years. Among those 34 patients, 5 underwent a revision DCR. Fifteen patients underwent stenting. Thirteen of the fifteen patients, who underwent stenting came for regular postoperative follow up and stent removal was done 6 to 8 weeks later. The two patients who were lost to follow-up presented after 4 years of their initial surgery with persistent symptoms. The success rate of endoscopic DCR was 94% in our study. Endoscopic Dacryocystorhinostomy has emerged as a practical solution for addressing nasolacrimal duct obstruction. Despite numerous surgical modifications documented over time, the endoscopic DCR technique consistently demonstrates excellent outcomes with minimal patient morbidity. This study underscores the significance of thorough preoperative assessment, making informed decisions regarding stenting during both the preoperative and intraoperative period, employing proper surgical techniques, and recognizing the importance of regular post-operative follow-up. [ABSTRACT FROM AUTHOR]

A bibliometric analysis concluded that the evaluation of post-operative outcomes of endoscopic dacryocystorhinostomy in Indonesia had yet to be done. Hence, this study aims to assess the postoperative outcomes of endoscopic dacryocystorhinostomy, focusing on ostium granulation, intranasal synechiae, membranous obstruction, and ostium stenosis after a three-month follow-up in our Indonesian center. A longitudinal study (2017–2023) at our Indonesian center included cases with a minimum of three-month follow-up. Nasal endoscopy assessed ostium granulation, intranasal synechiae, membranous obstruction, and ostium stenosis. 28 cases were successfully followed up for three months. At three months, ostium granulation was present in 42.9% of cases, membranous obstruction in 14.3% of cases, with no intranasal synechiae or ostium stenosis observed. Out of 28 cases, 13 were successfully followed for six months, revealing ostium granulation in 7.7%, membranous obstruction in 38.5%, and ostium stenosis in 23.1%. Ostium granulation predominates, followed by membranous obstruction at three-month follow-up. Ostium stenosis, a minimal occurrence, manifests after six months. [ABSTRACT FROM AUTHOR]

This article provides an overview of the historical contributions made by the Babylonians, Ancient Egyptians, Medieval Arabs, and Persians to the understanding and treatment of lacrimal drainage disorders. It highlights the Code of Hammurabi, which contains laws related to lacrimal sac abscesses, and the Ebers Papyrus, which documents treatments for lacrimal sac inflammations. The text also discusses the works of physicians like Al-Razi and Ibn-Sina, who made significant contributions to ophthalmology in the Middle Ages. It emphasizes the importance of understanding these ancient descriptions in their historical context and acknowledges that our understanding of lacrimal diseases has evolved over time. The author concludes by stating that there is still much to learn in this field. [Extracted from the article]

Introduction: Primary Sjögren's syndrome (pSS) is a chronic autoimmune disorder affecting salivary and lacrimal glands, while endometriosis involves uterine‐like tissue growth outside the uterus, causing pelvic pain and infertility. Investigating their intricate relationship using real‐world data is crucial due to limited research on their connection. Material and Methods: This population‐based cohort study included patients with endometriosis and controls without endometriosis. Propensity score matching was used to balance baseline differences in demographic and clinic characteristics between the two groups. Cox proportional hazards model were used to estimate the effect of endometriosis on the risk of new‐onset pSS over time. A symmetrical cohort study, including patients with pSS and propensity score‐matched controls without pSS, was conducted to investigate the effect of pSS on the risk of endometriosis over time. To elaborate on the mechanisms linking endometriosis and pSS, Ingenuity Pathway Analysis was performed to identify activated pathways in eutopic endometrium from patients with endometriosis and parotid tissues from patients with pSS. Results: A total of 15 947 patients with endometriosis and 15 947 propensity score‐matched controls without endometriosis were included. Patients with endometriosis presented a significantly greater risk of pSS compared to non‐endometriosis controls (adjusted hazard ratio, aHR = 1.57, 95% CI = 1.29–1.91, p < 0.001). In the symmetrical cohort study, which included 4906 pSS patients and 4,906 propensity score‐matched controls without pSS, patients with pSS were found to be at a significantly higher risk of endometriosis compared to non‐pSS controls (aHR = 1.51, 95% CI = 1.12–2.04, p = 0.012). Ingenuity Pathway Analysis showed that the underlying cellular mechanisms involved autoimmune‐related pathways, including activation of dendritic cell maturation, and chronic inflammatory pathways, including the fibrosis signaling pathway. Conclusions: These findings support a bidirectional association between endometriosis and pSS, which may be driven by dendritic cell maturation and fibrosis signaling pathways. [ABSTRACT FROM AUTHOR]

Purpose: Data supporting treatment recommendations for congenital nasolacrimal duct obstruction (CNLDO) in patients with craniofacial abnormalities is scarce. This study reports the incidence, clinical features, and outcomes of patients with concomitant craniofacial abnormalities and CNLDO. Methods: This multi-center, retrospective, population-based cohort study included all patients diagnosed with CNLDO before age 6 during a 10-year period in a single US county. Results: Of the 17,713 live births during the study period, 1998 infants were diagnosed with CNLDO, among whom 41 (2.05%) had associated congenital craniofacial abnormalities, yielding a birth prevalence of 23.1 (95% CI 16.6–31.4) per 10,000 live births. Craniofacial patients were significantly older at time of diagnosis (6.2 months) compared to uncomplicated CNLDO (3.7 months; p = 0.035). There was no significant difference in mean age at spontaneous CNLDO resolution, but 31.7% of craniofacial patients required probing for CNLDO resolution, compared to 14.5% in the CNLDO group (OR 2.76 [95%CI 1.41–5.39] p = 0.003). All but two patients with craniofacial abnormalities had resolution of symptoms after initial probing. Intraoperative probing findings indicated that 8 of 13 craniofacial patients had complex obstructions. Conclusions: The similar age at spontaneous resolution indicates that watchful waiting until approximately one year of age is a reasonable approach even in patients with craniofacial abnormalities, though more of these patients may require surgical intervention. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to determine the public's perception of the scope of practice for oculofacial plastic and reconstructive surgeons (OFPRS). Methods: A 49-question survey was distributed by QualtricsⓇ to a panel similar to the US demographic composition. Responses collected underwent bivariate statistical analysis. Result: A total of 530 responses were obtained, with most respondents being white, female, over the age of 35, from the Midwest, and with at least a college education or above. Most respondents did not think ophthalmologists or optometrists were surgeons, and only 158 people (29.8%) knew the primary specialty of OFPRS was ophthalmology. Board certification was preferred by 98.87% of respondents, and 95.28% preferred ASOPRS-trained OFPRS. Conclusions: Our study highlights the gap in knowledge about OFPRS as a field, the qualifications and training required, and the scope of practice. Notably, even for OFPRS-specific procedures, PRS remained the leading subspecialist chosen for interventions such as orbital decompression (58.5% vs. 71.5%), orbital reconstruction (57.9% vs. 74.2%), enucleation/evisceration (48.1% vs. 53.4%), optic nerve-related surgery (39.8% vs. 43.4%), orbital cancer resection (42.8% vs. 46.8%), and tear duct surgery (41.9% vs. 52.5%). Additionally, most respondents did not feel that facial fillers, laser skin resurfacing, eyelid cancer removal, or cataract surgery were within the OFPRS scope of practice. [ABSTRACT FROM AUTHOR]

We describe a case of primary ductal adenocarcinoma of the lacrimal gland with novel histopathological characteristics corresponding to a biphasic growth course and provide a comprehensive genomic profile of this malignancy. A 39-year-old male with a history of slowly progressive unilateral proptosis and hypoglobus presented after 1 month of hyperacute exacerbation. Orbital imaging revealed a superior mass with osseous erosion. The patient underwent orbital exploration and excisional biopsy via lateral orbitotomy. Histopathology demonstrated high-grade adenocarcinoma with a well-differentiated glandular component alongside a poorly differentiated sarcomatoid region. The glandular section was immunopositive for Her-2, CK7, GATA3, and androgen receptor. Tumor recurrence necessitated en-bloc exenteration with dural resection alongside adjuvant radiotherapy and chemotherapy. This represents the first report of sarcomatoid differentiation in primary ductal adenocarcinoma of the lacrimal gland, which may incite hyperacute progression. Conversely, GATA3 immunopositivity may correlate with indolent growth. Genomic variants such as SEMA3C represent potential therapeutic targets for this condition. [ABSTRACT FROM AUTHOR]

A 7-year-old male child presented with complaints of lagophthalmos and lid retraction of the right eye since birth. Magnetic resonance imaging (MRI) showed diffuse thickening of right superior rectus and levator-palpebrae complex along with a hypointense, irregular, and ill-defined lesion in the adjoining fat abutting the lacrimal gland. Biopsy from the lesion showed diffuse orbital fibrosis. Another 3-year-old female child presented with complaints of her right eye appearing smaller and inability to move the right eye freely since birth. MRI showed thickening of right superior and medial recti with diffuse retrobulbar hypointense fibrotic strands. The findings were suggestive of orbital fibrosis. Congenital orbital fibrosis is an extremely rare orbital pathology with very few cases described in the literature. The most common clinical features are motility restriction, restrictive strabismus, upper lid retraction, enophthalmos, and proptosis. The diagnosis can be made on imaging but requires biopsy for confirmation. Management is mostly conservative in the form of refractive and amblyopia therapy. [ABSTRACT FROM AUTHOR]

Purpose: Dry eye syndrome is a common ocular disease that causes morbidity, high healthcare burden, and decreased quality of life. In this study, we evaluated the beneficial effects of a standardized extract of small black soybean (EYESOY®) in a benzalkonium chloride (BAC)-induced murine model of dry eye. Methods: Experimental dry eye was induced by instillation of 0.02% BAC on the right eye of the Sprague-Dawley rats. Saline solution or EYESOY were administered orally every day for 8 weeks. Results: EYESOY significantly improved tear volume in the cornea compared with that in the BAC group. Moreover, EYESOY inhibited damage to the corneal epithelial cells and lacrimal glands by suppressing the oxidative and inflammatory responses in a mouse dry eye model. It also increased the goblet cell density and mucin integrity in the conjunctiva. Conclusions: Our results suggest that EYESOY has the potential to alleviate dry eye syndrome. [ABSTRACT FROM AUTHOR]

Sjӧgren's syndrome (SS), also known as Sjögren's disease, is a chronic autoimmune condition predominantly affecting the salivary and lacrimal glands. The disease is driven by autoimmune responses involving the activation and actions of major innate- and adaptive immune cell subsets. However, the specific characteristics and roles of regulatory T cells (Tregs) in SS remain elusive. This study seeks to clarify the main phenotypic and functional attributes of Tregs in the salivary glands and their draining lymph nodes in murine models of SS. Our flow cytometric analysis revealed that Tregs in the salivary gland-draining lymph nodes of female non-obese diabetic (NOD) mice, a spontaneous model of SS, exhibited a greater proportion of activated Tregs and fewer resting Tregs compared to Balb/c mice. Furthermore, Tregs from the salivary gland-draining lymph nodes of female C57BL/6.NOD-Aec1Aec2 (B6.NOD-Aec) mice, a model for primary SS, demonstrated significantly lower IL-10 production but markedly higher IFNγ- and IL-17 production than their C57BL/6 counterparts. Additionally, treatment of C57BL/6 Tregs with IL-7, a cytokine critical for SS pathogenesis, resulted in diminished IL-10 production and enhanced IFNγ and IL-17 production in these cells. Notably, the alterations in B6.NOD-Aec Tregs also included an increased expression of the immune-inhibitory molecule CTLA-4 compared to the C57BL/6 Tregs. Intriguingly, in vitro co-cultures of Tregs with conventional CD4 T cells and other key immune populations from lymph nodes indicated that Tregs from salivary gland-draining lymph nodes of both B6.NOD-Aec and C57BL/6 strains exhibited comparable and limited immunosuppressive effects on the proliferation and function of conventional CD4 T cells. The ability of B6.NOD-Aec Tregs to directly inflict damages to salivary gland epithelial tissues and contribute to SS pathologies through IFNγ and IL-17 that they produce warrants further investigations. In addition, enhancing the relatively weak immunosuppressive capacities of these Tregs may also serve as a viable strategy to alleviate the SS phenotype in the mouse models and potentially in patients. 1. Tregs in SS murine models exhibit distinct features compared to those in control mice 2. Tregs in target tissues of B6.NOD-Aec model of SS display aberrant cytokine profiles 3. IL-7 treatment increases IFNγ and IL-17 production and reduces IL-10 output in Tregs 4. B6.NOD-Aec Tregs and C57BL/6 Tregs show similarly weak suppressive functions in vitro [ABSTRACT FROM AUTHOR]

The anteromedial temporal region and the lateral wall of the sphenoid can be the site of an array of pathology including trigeminal schwannoma, encephalocele, cholesterol granuloma of the petrous apex, malignancy, infection, and sellar pathology extending to the lateral cavernous sinus. Approaches to this region are technically challenging and the existing approach requires sacrifice of all of the turbinates including the nasolacrimal duct, which can cause postoperative complications. We describe a novel anatomical landmark between the periorbita and the periosteum of the pterygopalatine fossa (which is located at the inferolateral periorbital periosteal line [ILPPL]). The posterior one-third of the incision line lies between the foramen rotundum and the superior orbital fissure, which is proximal to the maxillary strut. A 1.5-cm incision can divide the orbital and pterygoid contents and lead us to the posterior inferolateral orbital region, anteromedial temporal region, lateral wall of the sphenoid sinus, and lateral wall of the cavernous sinus. A combined multiangled approach to the ILPPL will enable us to preserve all of the turbinates and the septum, and the nasolacrimal duct, allowing for the preservation of the physiological function and pedicled flaps, such as the middle turbinate, inferior turbinate, and septal membrane flap. The ILPPL is a simple, effective, and novel landmark for the minimally invasive approach to the anteromedial temporal fossa. [ABSTRACT FROM AUTHOR]

Objective: This study aims to evaluate the visual prognosis in craniosynostosis patients in order to identify ophthalmologic manifestations in craniosynostosis patients and strabismus surgery outcomes in these patients. Materials and Methods: The medical records craniosynostosis patients were reviewed retrospectively from January 2000 to June 2023. All the relevant patient data, such as age, sex, visual acuity, ophthalmologic examinations, and strabismus surgery outcomes were recorded. Results: In total, 123 patients were included in the study, among whom 65 (52.84%) were male. Overall, there were 70 cases (56.91%) of non-syndromic craniosynostosis, and 53 cases of syndromic craniosynostosis, comprising Crouzon syndrome (15 cases), Apert syndrome (8 cases), Pfeiffer syndrome (2 cases), and other syndromes (28 cases). The mean age at first examination was 3.11 years old. Out of 107 cases with visual impairment at the first visit, 92 (85.98%) showed no visual impairment at the last visit. Among the 87 patients with strabismus, 28 (32.18%) had strabismus at the primary position, with exotropia being the most common type (18 cases). Eight cases underwent strabismus surgery, and 4 cases achieved success (deviation < 10 prism diopters). Other ophthalmologic manifestations were lagophthalmos (17 cases, 13.82%), exposure keratopathy (15 cases, 12.2%), ptosis (11 cases, 8.94%), proptosis (10 cases, 8.13%), and nasolacrimal duction obstruction (10 cases, 8.13%). The syndromic group exhibited higher rates of visual impairment, strabismus, lagophthalmos, exposure keratopathy, proptosis and nasolacrimal duct obstruction compared to the non-syndromic group. Conclusion: Among the craniosynostosis cases, 85.98% had no visual impairment, with the common ophthalmologic manifestations being refractive errors, strabismus, lagophthalmos, and exposure keratopathy. The syndromic craniosynostosis cases showed worse visual outcomes and a higher incidence of ocular diseases than non-syndromic cases. The success rate for strabismus surgery in craniosynostosis patients was 50%. [ABSTRACT FROM AUTHOR]

Introduction: Primary Sjögren's syndrome (pSS) is an autoimmune disorder primarily affecting salivary and lacrimal glands, although about 40% of patients experience systemic complications. In this setting, the identification of patient phenotypes characterized by increased risk of extra-glandular involvement still represents an unmet need. Areas covered: The aim of this paper is to review the scientific evidence on the utility of salivary gland biopsies in pSS, emphasizing their role in defining prognosis. In latest years, research focused on disease-specific clinical, serological, or histological features able to categorize patient prognosis. Among histopathological features, focus score and ectopic germinal centers exhibit associations with glandular and extraglandular manifestations, including higher rates of lymphomagenesis. Expert Opinion: Pathological characterization of salivary glands provides information that go beyond a mere diagnostic or classification utility, providing insights for a stratification of disease severity and for predicting systemic manifestations. Thus, a salivary gland biopsy should be offered to all patients and included in routine practice, even when not strictly required for diagnostic purposes. More advanced analysis techniques of the tissue, including immunohistochemistry and 'omics' should be further explored in longitudinal studies to boost the ability to further stratify and predict disease evolution. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionThis study aims to investigate the role of Interleukin-37 (IL-37) in mouse models of dry eye.Two murine models of dry eye were employed in this investigation.   The evaluation of the anti-inflammatory impact of IL-37 (200 μl, 10 μg/ml) on dry eye mice involved intraperitoneal injections administered once daily for 7 days. Additionally, intraperitoneal injection of VO-Ohpic trihydrate (VO, 0.25 mg/kg) in dry eye mice was performed to investigate the role of PTEN in the IL-37 anti-inflammatory signaling pathway. Tear production was assessed using phenol red cotton thread, while corneal damage was examined through sodium fluorescein staining using a slit lamp. Histological alterations in the lacrimal gland were observed through H&E staining. PAS staining was used to assess conjunctival goblet cells. The levels of NFκB-P65, p-NFκB-P65, IL-1β, IL-6, TNF-α, CD3, AQP5, α-SMA and PTEN proteins were determined via Western blotting or immunofluorescence.Following IL-37 treatment, both dry eye models exhibited reduced corneal fluorescence staining scores and enhanced tear production. In lacrimal gland, the expression of p-NFκB-P65, IL-1β, IL-6, CD3 and TNF-α was diminished, while PTEN, AQP5, α-SMA expression increased after IL-37 treatment in both dry eye mice. However, the intraperitoneal injection of VO significantly attenuated the anti-inflammatory effect of IL-37 on dry eye mice.IL-37 emerges as an anti-inflammatory mediator within the lacrimal gland of dry eye mice, exerting its effects through the IL-37-PTEN-NFκB signaling pathway. [ABSTRACT FROM AUTHOR]

Objective Animals Studied Procedures Results Conclusions To determine the impact of chronic dental disease on the nasolacrimal duct of chinchillas using contrast CT dacryocystorhinography.Two 12‐year‐old female chinchillas with uni‐ or bilateral ocular discharge and a history of chronic, moderate (Chinchilla 1, one‐year) or severe (Chinchilla 2, three‐years) dental disease.Contrast CT dacryocystorhinography was performed to identify abnormalities in the nasolacrimal duct and dentition, and to correlate those changes.Chinchilla 1 had a focal soft tissue attenuating expansion of the maxillary bone rostral to the first left premolar interpreted as possible abscessation causing deviation of the nasolacrimal duct over its dorsomedial margin. The right nasolacrimal duct appeared normal. Chinchilla 2 had periapical abscessation of a retained subgingival left maxillary incisor fragment which extended into the nasal cavity causing focal narrowing and distal dilation of the left nasolacrimal duct. Complete contrast infusion of the right nasolacrimal duct could not be completed on Chinchilla 2. A focal area of superficial corneal fibrosis ipsilateral to the obstructed nasolacrimal duct was also identified in Chinchilla 2. Treatment consisted of occlusal adjustments to correct the coronal elongation, systemic antibiotics (metronidazole and either marbofloxacin or azithromycin), and topical tear replacement therapy and diclofenac as needed. Ocular discharge decreased in both chinchillas but did not resolve long‐term in either animal.Chronic dental disease including periapical abscessation in chinchillas can obstruct the nasolacrimal duct, leading to impaired tear drainage. Management of dental disease is crucial to maintain patency of the nasolacrimal duct. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionsThis study aimed to quantify the proportion of patients with bilateral epiphora and suspected nasolacrimal obstruction who self-reported improved epiphora bilaterally following unilateral dacryocystorhinostomy and investigate predictive factors.A retrospective cohort study of patients from an Australian lacrimal clinic was performed. Eligible patients were at least 18 years of age, complained of bilateral epiphora, underwent unilateral dacryocystorhinostomy between 2012 and 2022 and followed-up. Outcome groups were created by grouping self-reported epiphora improvement levels for each eye. Two-sided confidence intervals were calculated for the proportion of participants in each outcome group. Ordinal elastic net regression identified clinical features associated with outcome groups and estimated their effect sizes.Of 243 patients, the median post-operative follow-up duration was 3 months. Fifty-eight percent (95% CI 52–64%, n = 141) reported significant improvement (≥50% ipsilateral and any contralateral improvement), 5% (95% CI 3–9%, n = 13) reported small improvement (<50% ipsilateral and any contralateral improvement) and 26% (95% CI 20–31%, n = 62) reported ipsilateral improvement only. Eleven percent had functional or anatomical failure. Older age (OR 1.01), contralateral nasolacrimal duct narrowing (OR 1.37), contralateral nasolacrimal duct obstruction (OR 0.93) and longer follow-up time (OR 0.85) predicted outcome groups.After unilateral DCR, many patients with bilateral epiphora and suspected nasolacrimal obstruction report an improvement of their symptoms bilaterally in the early postoperative period. Contralateral nasolacrimal system diagnosis, patient age and follow-up duration were associated with outcomes. Further study using validated epiphora assessment tools may quantify this observation, and we suggest a potential underlying mechanism of contralateral effects after unilateral treatment. [ABSTRACT FROM AUTHOR]

This editorial explores the life and work of Lorenz Heister, a renowned German surgeon and anatomist known as the father of Surgical Anatomy in Germany. It focuses on Heister's three influential treatises on surgery and anatomy, with a specific emphasis on his observations and treatments of lacrimal disorders. Heister was a proponent of Dominique Anel's methods for managing fistula lacrymalis and provided detailed descriptions of Anel's probes and syringes. He also discussed the technique of St Yves, a famous oculist from Paris, and added his own steps to the procedure. Heister's work on lacrimal drainage disorders and other contributions to ophthalmology solidified his reputation as a pioneer in surgical anatomy and orthopedics in Germany. [Extracted from the article]

Dry eye disease (DED) is a very common disease in dogs, especially that of immune‐mediated origin, with Shih Tzu dogs being some of the most affected. In this study, ultrasound changes of the orbital lacrimal gland (LG) were described in healthy Shih Tzu dogs and those diagnosed with different intensities of DED. For training purposes, a macroscopic and ultrasonographic study of the orbits of brachycephalic dog cadavers (n = 6) was conducted. Subsequently, thirty‐five eyes from 23 male and female dogs aged between two and eight years, distributed into four groups according to the Schirmer tear test (STT‐1), including a control group (CG, n = 10) (STT‐1 ≥15 mm/min), early DED group (DED1, n = 8) (STT‐1 between 14 and 11 mm/min), moderate DED group (DED2, n = 7) (STT‐1 between 10 and 6 mm/min), and severe DED group (DED3, n = 10) (STT‐1 ≤5 mm/min), were used. Ultrasound evaluation of LG showed a higher occurrence of glandular tissue heterogeneity (p = 0.755) and the presence of hyperechoic areas (p = 0.027) in dogs with DED3. The variables measuring the major axis were lower in dogs with DED3 (p = 0.002). The area and perimeter were smaller in dogs with DED3 than in CG and DED1 groups (p < 0.001) and the perimeter of the LG of dogs in the DED2 group was smaller than that of CG (p < 0.001). The LG major axis (r = 0.56), area (r = 0.66), and perimeter (r = 0.66) decreased as the STT‐1 of the different groups decreased. LG ultrasound of Shih Tzu dogs is a feasible technique that allows the evaluation of characteristics of the glandular tissue. The ultrasound could identify changes in texture, echogenicity, and size in LG of Shih Tzu dogs with immune‐mediated DED. [ABSTRACT FROM AUTHOR]

Background: Epithelial tumors of lacrimal glands are rare and primary ductal adenocarcinoma of the lacrimal gland accounts for only 2% of all epithelial lacrimal gland tumors. Considering its rarity and lack of uniform diagnostic criteria, treatment protocols are not well defined. In this study, we describe a Her‐2 positive case and review previously reported cases. Methods: In 2012, a 42‐year‐old woman affected by primary ductal adenocarcinoma of the lacrimal gland was treated with transpalpebral anterior orbitotomy and adjuvant radiotherapy. In July 2013, she presented local relapse and she underwent orbital exenteration. In November 2013, for neck nodal progression, seven cycles of chemotherapy (cisplatin and epirubicin) associated with a humanized monoclonal antibody–targeting HER 2 therapy (trastuzumab and pertuzumab) were performed, with a marked response rate. Then, she underwent total parotidectomy with right neck lymphadenectomy and adjuvant hadrontherapy. Results: Nine years later (113 months) after treatment completion, the patient was alive without disease and with acceptable toxicity. Conclusions: In primary ductal adenocarcinoma of the lacrimal gland, early diagnosis and multimodal treatments could be crucial, considering its often aggressive tendency. Considering the lack of treatment guidelines, case report recording can be useful in patient management. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionsTo emphasise the importance of “soft” observations during lacrimal irrigation in diagnosing lacrimal outflow dysfunction and reporting outcomes of soft factors post-DCR.A retrospective study of patients with ≤ 20% of regurgitation on lacrimal irrigation who underwent DCR surgery. A comparative analysis of percentage reflux of saline (RFX), initial mucus in reflux (IMR), patient-reported transit time of saline (PR-TTS), and resistance encountered (RES) during LS was performed. Validated TEARS score was used. Subjective success was defined as ≥ 2-point improvement in T subscale of TEARS score. Objective success, as a decrease in RFX, RES, PR-TTS and absence of IMR, post-operatively.From a total of 253 patients who underwent DCR surgery, 8 patients met the inclusion criteria. All patients were T4 (wiping >10× daily) indoors and outdoors. TEARS score improved after surgery with a mean reduction of T = 2.62, E = 1.63 and A = 1.35 (p < .05) with no significant change in R scores (p = .10). A mean reduction in RFX of 11.75 ± 6.74% and a median improvement of 1 point in PR-TTS and 2 point in RES was observed (p < .05). No significant changes of these parameters occurred in the contralateral side during this period. Subjective and objective success of DCR was 75% and 100%, respectively.This study is the first to attempt to combine qualitative “soft” observations during lacrimal irrigation such as IMR, RES and PR-TTS for identifying nasolacrimal outflow dysfunction and reporting outcomes using these parameters of DCR in patients with epiphora and ≤ 20% of fluid regurgitation. These parameters were greater in the more symptomatic side and successfully improved after DCR, making them a valuable tool to reach a provisional diagnosis. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionsTo compare the long-term outcomes of mucosal-sparing mechanical endoscopic dacryocystorhinostomy (MMED) for primary acquired nasolacrimal duct obstruction (PANDO) with or without silicone intubation.An 11-year follow-up study of the Silicone intubation in Endoscopic Dacryocystorhinostomy (SEND) randomized controlled trial (RCT) was conducted at a university-affiliated dacryology clinic from December 2019 to March 2023. Questionnaires on symptoms, anterior segment examination, endoscopic examination with functional endoscopic dye test (FEDT) and FICI grading, and ostial size measurements using Image J software were performed by a masked ophthalmologist. The primary outcome was surgical success, defined by Munk’s score ≤1 and a positive fluorescein endoscopic dye test. Secondary outcomes included risk factors for failure and outcomes of revision surgeries.Fifty-three of the original 118 patients were evaluated at 155 ± 21 (136–218) months postoperatively. Seventy-seven percent (46/60) ostia remained successful, including 70% (19/27) of unstented and 82% (27/33) of stented ostia (p = .3). Stented ostia had larger size (p = .003), but this did not confer higher success (p = .14). Successful ostia had higher FICI scores and better ostial dynamicity (p < .05). Ostium movement was the only parameter associated with surgical success on multivariate analysis (OR 13.1, p = .01). Four (1 stented) underwent revision MMED, intraoperative mitomycin-C, and 12-week intubation. All revision ostia were functional after 141 ± 43 months.Surgical success of MMED after 11-years was 77%, a notable reduction compared to 96% success at 1-year. Statistical advantage of silicone intubation for primary MMED was not demonstrated, though clinically, stented ostia had a higher success (82% vs 70%). The presence of a dynamic internal common opening was highly associated with long-term surgical success. [ABSTRACT FROM AUTHOR]

To compare the success rates of probing with or without monocanalicular intubation, and/or inferior turbinate fracture in resolving simple congenital nasolacrimal duct obstruction (CNLDO). A randomized, double-blind clinical trial was conducted on children aged 12–36 months exhibiting symptoms of epiphora and/or mucous discharge along with a positive fluorescein dye disappearance test (DDT). Patients were randomly assigned to one of the following interventions: (1) probing; (2) probing and monocanalicular intubation; (3) probing and inferior turbinate fracture; (4) probing, inferior turbinate fracture, and monocanalicular intubation. Participants were categorized into two age groups (12–24 months and 24–36 months) and assessed for resolution of CNLDO three months post-surgery. Success was defined as the absence of epiphora or mucopurulent discharge and a negative DDT. Among the 201 participants, 51 underwent probing alone, 53 underwent probing with intubation, 47 underwent probing with turbinate fracture, and 50 underwent probing with turbinate fracture and intubation. No significant differences were observed in age, gender, or laterality of the disease between the groups (Ps > 0.05). While there was no significant difference in success rates among interventions in both age groups (Ps > 0.05), patients aged 24–36 months who underwent interventions involving intubation exhibited a significantly higher success rate compared to those without intubation (93.0% vs. 76.2%; P = 0.018). However, this difference was not observed in patients aged 12–24 months (95.7% vs. 92.9%; P = 0.551). Incorporating interventions such as intubation and/or turbinate fracture alongside conventional probing does not significantly alter the success rate of simple CNLDO resolution in children aged 12–24 months. However, older patients (24–36 months) may derive greater benefits from interventions involving intubation. [ABSTRACT FROM AUTHOR]

Background: Spheno-orbital meningioma (SOM) represents a unique variant of sphenoid wing meningiomas, distinguished by its propensity for bone infiltration and cranio-orbital involvement. SOM exhibits a considerable incidence of misdiagnosis and recurrence. Purposes: To elucidate the clinical, radiological, and pathological characteristics of SOM. Methods: Review of electronic medical records, histopathology, radiological images and follow-up information of 100 SOM patients. Results: Of the 100 patients (28 males, 72 females) with SOM, mean age was 46.8 ± 12.6 years and prevalent symptoms were proptosis (99%). All the CT scans showed hyperostosis with 89.3% of the hyperostosis having an irregular edge. In MRI scans, dural tail sign was observed across all patients and the cranio-orbital tumors often penetrated temporal muscle (74.1%), extraocular muscle (74.1%) and lacrimal gland (63%). All the 100 patients underwent surgical intervention, and among them, 62 individuals received postoperative radiotherapy. Grade I resections had a lower recurrence rate(16.7%), which further decreased with the addition of radiotherapy(13.9%). In contrast, all patients with grade II or higher grade resections without radiotherapy experienced recurrence, indicating a higher risk associated with less complete tumor removal. The pathological examination revealed that intraorbital sections exhibited comparable tumor density to intraorbital SOM tumors, along with increased fibrous density but decreased vascular distribution. Conclusions: Radiological characteristics of SOM included cranio-orbital tumors, hyperostosis of the sphenoid wing with an irregular edge, and dural tail sign. Combination of gross total resection and adjuvant radiotherapy was recommended to minimize recurrence rate. Intracranial SOM tumors tended to be softer and more bleed-prone than intraorbital sections, necessitating surgical precision. Highlights: Imaging shows sphenoid wing hyperostosis and the dural tail sign. Complete tumor removal, followed by radiotherapy, reduces recurrence risk. The intracranial part exhibits a lower fibrous and higher bleeding intention. [ABSTRACT FROM AUTHOR]

Kimura's disease (KD) is a rare, chronic inflammatory disorder characterized by angiolymphoid hyperplasia, peripheral eosinophilia, and elevated serum immunoglobulin E levels. It primarily affects young Asian males and typically involves the head and neck region, especially near the mandible and postauricular regions. Orbital involvement is unusual and extraocular muscle (EOM) involvement is exceedingly rare, with only a few cases reported in the literature. The present report describes a case of surgically confirmed KD in a 16-yearold male, involving the bilateral EOM, lacrimal gland, and left parotid gland. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Allergic rhinitis (AR) is a chronic noninfectious inflammation of the nasal mucosa mediated primarily by allergen‐specific immunoglobulin E (IgE) in atopic individuals after exposure to allergens, with the involvement of non‐IgE‐mediated mechanisms and neuroimmune dysregulation. Conservative treatment of AR is ineffective in children who lack compliance, and traditional surgical procedures are risky, making treatment of this community challenging. The sphenopalatine ganglion (SPG), aka pterygopalatine ganglion, is the largest of the four parasympathetic ganglia located within the head region, existing as a bilateral pair. The fibers that arise from the SPG regulate secretomotor functions and provide sensation from various structures, including the lacrimal glands, the mucous membranes of the oropharynx, nasopharynx, nasal cavity, and upper portion of the oral cavity. Previous studies suggest that SPG plays a much crucial role in the neuro‐related pathophysiological mechanisms of AR. Pulsed radiofrequency (PRF) is a commonly used technique in pain management to produce neuromodulatory effects without damaging nerve tissue. Previous research suggests that SPG dysfunction is one of the important pathophysiological mechanisms of trigeminal autonomic cephalalgia, and PRF targeting SPG can effectively exert neuromodulatory effects to improve its symptoms. We thus predicted that the application of PRF for neuromodulation of SPG would be beneficial for symptom remission in AR. We report the first case of AR successfully treated with PRF targeting the SPG, symptoms did ameliorate during the 24‐week follow‐up period, as manifested by the disappearance of nocturnal open‐mouth breathing and its murmur and a significant reduction in the frequency and severity of daily episodes of nasal congestion, tearing, and conjunctival congestion, which diversifies clinical interventions for AR. [ABSTRACT FROM AUTHOR]

Objective: This study aims to investigate the effect of NADPH oxidase 4 (NOX4)-mediated inflammation on concanavalin A (ConA)-induced dry eye syndrome (DES) in mice. Methods: Thirty-six mice were randomly divided into Control, Model, no-load Control, and NOX4 interference group. Adenovirus was injected (10 μL) into the lacrimal glands of both eyes of mice in no-load Control group and NOX4 interference group. Four days after adenovirus injection, the Control group was injected with phosphate-buffered saline, and the other groups were injected with ConA (200 μg) in the lacrimal glands of mice to establish DES models. The tear secretion rate was estimated by phenol red thread test. Lissamine green eye staining was used to evaluate conjunctival damage. The corneal surface was observed by hematoxylin–eosin (HE) staining and scanning electron microscopy (SEM). The morphology and quantity of conjunctival epithelial cells and goblet cells were observed by Periodic acid-Schiff staining. The expression of NOX4, NOD-like receptor thermal protein domain-associated protein 3 (NLRP3), interleukin-1β (IL-1β), and mucin 5 subtype AC (MUC5AC) was detected by immunohistochemistry. Results: Compared with the Control group, the Model group showed a significant decrease in tear secretion and an upregulation in microscopic image score. The HE staining and SEM showed corneal and conjunctiva damage in the Model group. The protein expression of NOX4, NLRP3, and IL-1β was upregulated, but MUC5AC was downregulated in the Model group. After interfering with NOX4, all these indicators were reversed. Conclusion: The pathological process of concanavalin A-induced DES appears to be related to NOX4. [ABSTRACT FROM AUTHOR]

Laser dacryocystorhinostomy (LDCR) is a surgical procedure designed to treat obstructions in the lacrimal duct system, which can cause excessive tearing, infections, and discomfort. This technique involves creating a new passage for tear drainage, thereby restoring normal tear flow and alleviating symptoms associated with duct obstruction. A retrospective study was conducted on 48 patients who underwent the LDCR procedure, amounting to 56 eyes. The primary outcome measured was the anatomical success rate, defined as the restoration of duct patency. Patients were examined postoperatively from 6 months to 3.5 years. The LDCR method demonstrated a 95% success rate, encompassing both anatomical and functional outcomes. The procedure's effectiveness was determined by achieving a patent osteotomy and resolving symptoms. Anatomical success was measured by the creation of a viable drainage pathway, while functional success pertained to the resolution of symptoms such as epiphora. The efficacy of the procedure was found to be independent of both age and gender. Among patients with successful anatomical outcomes, there was a statistically significant improvement in their Munk scores. The LDCR method is highly effective in treating lacrimal duct obstruction. These findings highlight the importance of the Munk score as a predictive indicator of procedural success in LDCR. [ABSTRACT FROM AUTHOR]

Background: The uncinate process is very relevant with respect to the ventilation and drainage of the frontal, maxillary and anterior ethmoid sinuses in the osteomeatal complex. Aims and Objectives: The study was conducted with the aim to examine and assess various patterns of upper attachment of the ethmoidal uncinate process. The secondary objective of the study was to study the incidence of pneumatization of the uncinate process. Materials and Methods: With the objective to study the various patterns of upper attachment of the uncinate process, the study was conducted at the Department of Ear, Nose, and Throat (ENT) Head and Neck Surgery, at Government Medical College, Doda, J and K, India. The period of study was from November 2020 up to November 2021. The study involved 100 patients who had presented to the ENT outpatient with nasal and or sinus-related complaints. Results: The study included 58 males and 42 females. Among the various patterns, it was the type-2 pattern of the uncinate attachment that was the most prevalent (42%). This was followed by a type-1 pattern (attached to the lamina papyracea) (16%) and then a type-6 pattern (14%). Type-3 in 4%, type-4 in 3%, and type-5 in 7%. In 14% of the cases, there was no upper attachment of the uncinate process. The pneumatization of the uncinate process was noted among 42 of the uncinate processes that we studied. The pneumatization was unilateral in 41% and bilateral in 59% of the uncinate process. The patients with a pneumatized uncinate process had more severe clinical presentation. Conclusions: A thorough computerized tomography scan assessment of the attachments of the uncinate process and its variations aids in minimizing damage to the related landmarks during the surgery and helps minimizing the chances of iatrogenic trauma to the nasolacrimal duct, medial orbital wall, and other surrounding structures. It can also assist in figuring out the likely cause of refractory sinusitis. [ABSTRACT FROM AUTHOR]

Objective: To determine the relative frequency of orbital lesions based on the site of origin and histopathology at a Tertiary care hospital (Mayo Hospital, Lahore Pakistan) from 1996 till 2022 (27 years). Methods: This descriptive case series included 2651 patients of all age groups presenting with orbital lesions who initially got enrolled at Institute of Ophthalmology Mayo Hospital, Lahore from 1996 till 2022. Of these, 583 patients left against medical advice. So, clinical data of 2068 patients were completely analyzed. Lesions were managed medically and/ or surgically. Final clinical diagnosis, with the help of histopathology, was used to classify the lesions. Results: There were 1258 (60.9%) adults and 810 (39.1%) children, 1358 (65.66%) were neoplastic while 710 (34.33%) non-neoplastic lesions. Amongst the neoplastic lesions, 405 (29.8 %) were benign and 953 (70.2%) malignant. Primary orbital lesions were 1676 (81.04%), Secondary orbital lesions were 300 (14.51%), Endocrine/ hematopoietic reticuloendothelial system lesions were 84 (4.06%) and Metastatic lesions from distant organs were 08 (0.39%). Conclusion: Retinoblastoma, rhabdomyosarcoma, optic nerve gliomata were common in children. Pleomorphic adenoma & adenocystic carcinoma of lacrimal gland, cavernous hemangioma, optic nerve meningioma, neurofibroma, schwannoma, squamous cell carcinoma of eyelid, carcinoma of maxillary antrum and lymphomas were more common in adults. [ABSTRACT FROM AUTHOR]

To establish and characterize a dry eye model in New Zealand rabbits by subcutaneous injections of scopolamine hydrobromide (SCOP). Twenty New Zealand male rabbits were injected subcutaneously SCOP for 14 consecutive days; subcutaneous saline was used as a negative control. The correlated clinical parameters of ocular surface dryness were detected in vivo using tear secretion and corneal fluorescein staining. The expression of IL-1β and TNF-α on the ocular surface and in lacrimal glands were analyzed by real-time PCR and western blot on the 14th day. The expression of Mucin-5 subtype AC (MUC5AC) was detected by Immunofluorescence staining in conjunctival tissue. The SCOP-treated rabbits exhibited significantly decreased aqueous tear secretion and increased corneal fluorescein staining scores over time. Both the mRNA expression levels and the protein expression levels of IL-1β and TNF-α were significantly increased after SCOP treatment compared with those after saline treatment. The loss of conjunctival MUC5AC was found in the SCOP-injected rabbits. Some infiltrated inflammatory cells and atrophic acinar cells were observed in the lacrimal gland after SCOP treatment. The disordered structures of the ocular surface and lacrimal glands were also observed. This study showed that repeated subcutaneous SCOP injections successfully elicited some of the typical dry eye symptoms commonly seen in humans. [ABSTRACT FROM AUTHOR]

Sjӧgren's syndrome is a systemic autoimmune disease primarily targeting the salivary and lacrimal glands. Our previous investigations have shown that administration of interleukin-22 (IL-22), an IL-10 family cytokine known for its complex and context-dependent effects on tissues, either protective- or detrimental, to salivary glands leads to hypofunction and pathological changes of salivary glands in C57BL/6 mice and in non-obese diabetic (NOD) mice, the latter being a commonly used model of Sjӧgren's syndrome. This study aims to delineate the pathophysiological roles of endogenously produced IL-22 in the development of salivary gland pathologies and dysfunction associated with Sjӧgren's disease in the NOD mouse model. Our results reveal that neutralizing IL-22 offered a protective effect on salivary gland function without significantly affecting the immune cell infiltration of salivary glands or the autoantibody production. Blockade of IL-22 reduced the levels of phosphorylated STAT3 in salivary gland tissues of NOD mice, while its administration to salivary glands had the opposite effect. Correspondingly, the detrimental impact of exogenously applied IL-22 on salivary glands was almost completely abrogated by a specific STAT3 inhibitor. Moreover, IL-22 blockade led to a downregulation of protein amounts of Ten-Eleven-Translocation 2, a methylcytosine dioxygenase critical for mediating interferon-induced responses, in salivary gland epithelial cells. IL-22 neutralization also exerted a protective effect on the salivary gland epithelial cells that express high levels of surface EpCAM and bear the stem cell potential, and IL-22 treatment in vitro hampered the survival/expansion of these salivary gland stem cells, indicating a direct negative impact of IL-22 on these cells. In summary, this study has uncovered a critical pathogenic role of the endogenous IL-22 in the pathogenesis of Sjögren's disease-characteristic salivary gland dysfunction and provided initial evidence that this effect is dependent on STAT3 activation and potentially achieved through fostering Tet2-mediated interferon responses in salivary gland epithelial cells and negatively affecting the EpCAMhigh salivary gland stem cells. • IL-22 neutralization protects salivary glands in a murine model of Sjögren's syndrome. • STAT3 activity is required for the detrimental impact of IL-22 on salivary glands. • IL-22 upregulates Ten-Eleven-Translocation 2 expression in salivary epithelial cells. • IL-22 negatively impacts the size of the salivary gland stem cell compartment. [ABSTRACT FROM AUTHOR]

Primary Sjögren's syndrome (pSS) is a systemic autoimmune disease that affects exocrine glands, mainly the salivary and lacrimal glands, leading to the development of sicca symptoms. Patients with pSS may also present with extraglandular manifestations, including lung involvement, estimated to occur in 9–24% of cases. Shrinking lung syndrome (SLS) is an uncommon respiratory complication primarily associated with systemic lupus erythematosus, with a prevalence of approximately 1% in these patients. It typically manifests as dyspnea, pleuritic chest pain, lung volume reduction, and a restrictive pattern on respiratory function tests. Cases reporting SLS with other connective tissue diseases, including pSS, are even rarer. Herein, we describe a case of a 57-year-old woman with a 10-year history of pSS who presented with dyspnea and pleuritic chest pain. After evaluation, the patient was diagnosed with SLS based on clinical, radiologic, laboratorial, and electrophysiologic characteristics. In addition, we identified and analyzed previously published cases of SLS in pSS. Treatment includes corticosteroids, immunosuppressants, and respiratory muscle training. This study highlights the importance of considering SLS in the differential diagnosis of patients with pSS and respiratory symptoms. [ABSTRACT FROM AUTHOR]

Background: Nasal and paranasal sinus abnormalities may be related to nasolacrimal duct obstructive disease but are strongly debated. Data of acute disease stage are lacking. Objective: The purpose of this study was to determine if there are correlations between radiologic signs of sinus inflammation and acute dacryocystitis (AD). Methods: This cross-sectional controlled study was conducted at Wenzhou, Zhejiang Province, China from February 2021 to November 2023. Forty-four consecutive patients with AD and 50 consecutive patients with orbital tumors (the control group), who completed preoperative computed tomography scans, were enrolled to evaluate the extent of their inflammatory sinonasal disease by the modified Lund-Mackay score system. Results: The inflammation signs of the paranasal sinuses (total mean sinus scores, 95% CI [0.00, 2.00]; P < 0.001), namely the anterior ethmoid sinus(95% CI [0.00, 1.00]; P < 0.001), the posterior ethmoid sinus(95% CI [0.00, 0.00]; P = 0.003), the frontal sinus (95% CI [0.00, 0.00]; P = 0.02), and the ostiomeatal complex (P < 0.001) were more extensive in patients with AD when compared with the controls. The disease course was negatively correlated with the anterior ethmoid (P = 0.03) and frontal scores (P = 0.01). The symptom of eyelid swelling was positively correlated with the anterior ethmoid (P = 0.03), ostiomeatal complex (P = 0.004), and total sinus scores (P = 0.005). Conclusion: Inflammatory sinus disease was found to be more frequent in patients with AD, which was gradually alleviated with the prolongation of the disease course. The mutual spread of inflammation particularly in the acute course may play an important role in lacrimal duct obstructive disease. [ABSTRACT FROM AUTHOR]

Background: Utilizing expanded endoscopic approaches to the maxillary sinus for the endonasal management of a variety of tumors is increasing in popularity. The nasolacrimal duct (NLD) may be injured inadvertantly or need to be removed during tumor resection or to augment visualization. Management of the NLD can take the form of transection alone, transection with stenting, or performing a formal dacryocystorhinostomy to avoid postoperative sequelae of injury. The purpose of this study was to review the literature and determine the optimal management of the NLD during expanded maxillary sinus approaches. Methods: A systematic review of Ovid, Embase, Medline, and Cochrane databases was performed to identify studies involving expanded approaches to the maxillary sinus and that explicitly reported the status of the NLD and postoperative outcomes. Results: Nineteen studies were included in the analysis and divided into two groups: NLD-preserving (n = 9 studies; n = 191 patients in aggregate) and NLD-involving (n = 10 studies; n = 296 patients in aggregate). In the NLD-preserving subgroup, one patient out of a subgroup aggregate of 191 patients (0.5%) developed epiphora. In the NLD-involving subgroup, sharp transection alone was the most common method of NLD removal and was associated with a low rate of epiphora (study rates: 0 to 18.2%; aggregated subgroup rate: 7.0%, 21 / 296). Spontaneous resolution of symptoms was common (60%-100% cases). Conclusions: The NLD should be preserved when feasible from an exposure and tumor-control perspective. When pathology or approach requires the removal of the NLD, rates of persistent epiphora are very low, regardless of surgical technique. When expanded maxillary approaches are employed, particularly for benign tumors, and require removal of the NLD, sharp transection is the simplest method of removal, provides a low rate of postoperative epiphora, and is supported by the available literature. [ABSTRACT FROM AUTHOR]

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Leprosy, also known as Hansen disease, is an airborne spread disease caused by Mycobacterium leprae (M. leprae) which commonly presents with skin lesions, peripheral neuropathy, and ocular involvement. This report describes a patient who presented with epiphora secondary to chronic nasolacrimal duct obstruction four years after completing antimicrobial treatment for tuberculoid leprosy. At the time of endoscopic dacryocystorhinostomy (DCR), the lacrimal sac demonstrated chronic dacryocystitis with granulomatous inflammation and a Fite positive staining bacterial rod-like structure. Pathological examination of the surgical specimen demonstrated numerous non-necrotizing granulomas in a perivascular and neural distribution, compatible with sequelae of previously treated M. leprae infection. The patient has remained symptom free six months after surgery. [ABSTRACT FROM AUTHOR]

Purpose: To report a rare non-endemic case of Leishmania aethiopica in Washington DC. Case report: A 68-year-old female presented for a routine examination with a complaint of right upper eyelid lesions for the past 5 months. On examination, a cluster of elevated and erythematous lesions extending from the medial canthus to the brow area of the right eye were seen. Initial treatment with Valtrex based on a suspected viral etiology failed. Although a biopsy was recommended at this time, the patient declined, and subsequent workup included nasolacrimal duct irrigation, blood work to rule out autoimmune etiology, a course of doxycycline, and an MRI, which yielded no improvement. Upon progression of the lesions into persistent plaques on the eyelids, a punch biopsy was performed, confirming leishmaniasis. The patient was then started on a 28-day course of oral miltefosine which led to complete resolution of her symptoms. Conclusion: This case underlines the importance of a broad differential including non-endemic diseases, particularly in urban areas with frequent patient travel. Furthermore, the delayed punch biopsy in this case highlights the importance of patient counseling to ensure prompt diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Background: To determine the paranasal changes and inflammatory markers that may cause primary acquired nasolacrimal duct obstruction (PANDO) and to determine their relationship with success rates on different types of surgeries. Main body: We retrospectively reviewed the blood sample and computed tomography (CT) results on 92 patients who underwent dacryocystorhinostomy (DCR) surgery for PANDO and 82 healthy controls. Age, gender, paranasal abnormalities, hemogram values, International Normalized Ratio (INR) values, type of surgery, and recurrence rate were recorded; systemic Immune-inflammation Index (SII), neutrophil-to-lymphocyte ratio (NLR), monocytes-to- lymphocyte ratio (MLR) and platelet-to-lymphocyte ratio (PLR) were calculated in both groups. In the case group, total white blood cells, monocytes, and INR values were significantly lower (p < 0.05). Platelet, lymphocyte, neutrophil, PLR, MLR, NLR, and SII values did not differ significantly between the control and case groups (p > 0.05). There was no significant difference in the CT results between the groups (p > 0.05). No correlation was found between CT findings and inflammatory markers. Dacryocystitis (DC) was seen in 20% of patients and they were all in the case group. No correlation was found between recurrence rate and age, gender, type of surgery, CT findings, and blood results (p > 0.05). The recurrence rate was significantly higher in patients with bilateral PANDO and with DC (p < 0.05). Short conclusion: The incidence of PANDO may not be directly related to paranasal abnormalities and systemic inflammation. Low INR values may cause obstruction in the nasolacrimal duct. Age, gender, type of surgery, CT findings, and inflammation level do not affect the success of the surgery. [ABSTRACT FROM AUTHOR]

Immune checkpoints refer to mechanisms entrusted with the modulation of immune responses in peripheral tissues and are required for minimising collateral damage. Immune checkpoint inhibitors (ICPi) work through numerous pathways, including the anti-CTLA-4 (cytotoxic T-lymphocyte-associated protein 4), anti-PD-1 (programmed cell death protein 1) and the PD-L1 (protein cell death protein-ligand-1) pathways. They are proving to be an exciting therapeutic avenue in the attempt to activate anti-tumour activity. Ipilimumab is a fully human monoclonal antibody working on the anti-CTLA-4 pathway, while nivolumab and pembrolizumab are humanised monoclonal IgG4 antibodies that work on the PD-1 pathway. Despite a growing body of research pertinent to these novel therapies, early indications show that they are limited by their side effect profile. Furthermore, their efficacy appears to be greater in cancers with a high mutational burden. We present two female patients with bilateral reactive dacryoadenitis secondary to ICPi therapy, a finding that to the best of our knowledge was not previously described in the literature. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionsTo determine the incidence and clinical characteristics of ocular adnexaltumors in Olmsted County, Minnesota.Retrospective population-based cohort study of all patients residing in Olmsted County, Minnesota diagnosed with any ocular tumor from January 1, 2006, to December 31, 2015. The medical records of all patients with an incident diagnosis of any ocular adnexal tumor were reviewed using the Rochester Epidemiology Project medical record linkage system for patient demographics, tumor type, and histopathologic confirmation. Incidence rates were calculated per 100,000 person-years. Poisson regression analysis was used to analyze changes in incidence over time.There were 717 patients diagnosed with ocular adnexal tumors during the 10-year study period, yielding an age- and sex-adjusted incidence rate of 59.7 per 100,000 (95% CI 55.4 to 64.0, p < 0.05) per year. In total, 764 tumors were diagnosed. Most tumors were eyelid lesions (N = 756, 99.0%), which were mostly benign (N = 512, 67.8%) with epidermal inclusion cysts (N = 275, 36.0%), hidrocystoma (N = 70, 9.2%), and eyelid sebaceous cysts (N = 46, 6.1%) accounting for the majority. Malignant eyelid lesions (N = 244, 31.9%) were relatively common with basal cell carcinoma (N = 184, 24.1%) and squamous cell carcinoma (N = 49, 6.4%) having the highest frequencies. Orbital tumors (N = 8, 1.0%) were infrequent. Of the orbital tumors, the most common was lacrimal gland adenoidcystic carcinoma (N = 2, 25.0%).In a population-based setting, most ocular adnexal tumors were benign eyelid lesions. Understanding the epidemiology of ocular adnexal tumors is important to aid providers in diagnosing and facilitating appropriate referrals of potentially vision- and life-threatening malignancies. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to evaluate the impact of treatment on psychological well-being by looking at changes in anxiety and depression levels in patients receiving treatment for tear duct obstruction. Materials and Methods: Forty patients who had been diagnosed with tear duct obstruction and receiving dacryocystorhinostomy (DSR) were included in our prospective cohort study. The Beck Anxiety and Depression Inventory, two standardized psychometric measures, were used to measure the individuals' levels of anxiety and depression both before and after DSR treatment. Results: The study comprised 40 patients in total, 16 (40%) of whom were male and 24 (60%) of whom were female. The number of patients in the "minimal anxiety" class climbed to 37 (92.5%) after DSR, compared to 22 (55%) patients in the class prior to DSR, based on the patients' anxiety levels. There was a significant change (p<0.001) in the median Beck anxiety scores before and after DSR. The median was 0 after it was 6.5 previously. There was a significant change (p<0.001) between the median Beck depression ratings before and after DSR. The median after was 13, compared to the prior median of 14. The results indicate that the scores for anxiety and depression decreased in a way that was statistically significant. Conclusion: In summary, this study represented a significant advancement in our understanding of the anxiety and sadness experienced by patients having DSR for tear duct obstruction. The study's noteworthy reduction in the levels of depression and anxiety implies that DSR might be beneficial for psychological as well as physical health. [ABSTRACT FROM AUTHOR]