Salivary Glands can help Tear Glands in Patients with Very Dry Eyes

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One of the most frequent problems in the daily practise of the ophthalmologist is that of the dry eyes. Especially older patients complain of dry eyes. Indeed: the function of the lacyrmal gland dramatically decreases after the age of 60 but more and more younger patients are seen with dry eyes. This is because also several drugs, surgery (e.g. Refractive Surgery like LASIK, Cosmetic Eyelid surgery,...), diseases (e.g. rheuma,..), trauma and neoplasms can influence the normal function of the lacrymal glands

In a majority of cases treatment is limited to a substitution for the lack of normal tears. A prevention of the outflow of tears to the nose by putting a silicone plug in the tear duct is another possible treatment. We all know the artificial tears, gels and ointments that patients can buy in the pharmacy. Beside, the ophthalmologist can put silicone plugs in the tear ducts to stop evauation of the tears to the nose. These plugs, although helpful in many cases also have disadvantages because they not only stop the evacuation of tears to the nose but also limit the elimination of micro organisms and dust from the eyes.

For patients who respond insufficiently to therapies with artificial teras or punctal plugs we developed a completely new surgical treatment. It is the transplantation of mucosa and salivary glands from the lower lip to the inner, so called conjunctival side of the eyelids. It was Prof. Juan Murube Del Castillo from the famous Alcalá University of Madrid in Spain who discovered that the saliva that is secreted by these specific glands is very similar to natural tears and that the glands continue to function when carefully dissected and transplanted to the eyelids.

It is very easy to dissect the mucosa and underlying glands from the lower lip. With Radiosurgery, using high frequency radio waves, the glands and overlying mucosa are carefully dissected and transplanted to the inner side of both upper and lower eyelid. The transplant is sutured with a running Prolene suture that can already be taken out after 2 weeks. The small wound in the mouth does not need to be sutured at all At the time of the removal of the sutures, patients can in most cases already feel the beneficial effects of the secretion of the salivary glands so that the can diminish the frequency of instillations of artificial tears. The operation is done under general anesthesia and because the treated eye is patched during the first week after surgery, I prefer to treat both eyes separately with an interval of at least one month. However the patients only have to stay in the hospital for one night and all check ups are done on an ambulatory base.

Up to now, I treated 17 eyes with this technique. All patients improved significantly after surgery although some of them still have to put artificial tears, be it at a much lower frequency. And we also have a scientific proof the transplantation is effective. In 2 patients a biopt was taken of the transplanted tissue: one at 18 and one at 36 months. Microscopic examination of the specimen revealed normal functioning glandular structures! This confirmsthe statement that labial salivary glands can maintait their basal secretion after careful dissection.

Although more has to be done, transplantation of labial salivary glands to the conjunctiva already promises to be a reliable new treatment in cases of severe dry eyes that are resistant to other therapies.

Article Source: http://depositarticles.com/

Peter Raus is director of Miró, a centre for Ophthalmology and Oculoplastic Surgery in Belgium. He was not only trained in Belgium but also in Barcelona (Prof. Barraquer), Egypt (Prof. Emarah) and the USA (Dr. Stephen Bosniak).He is internationally known as Radiosurgeon, using high frequency radiowaves for his surgery dry-eyes-therapy.com

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