Radiological measurements of lacrimal gland in thyroid eye disease.

PURPOSE: Lacrimal gland enlargement is a common feature of thyroid eye disease (TED) and has been positively correlated with the clinical activity score. Although lacrimal gland volume is the preferred measure of lacrimal gland size, its calculation is not clinically translatable due to the expertise, time and advanced software required. The aim of our study is to determine whether the lacrimal gland volume in patients with TED undergoing magnetic resonance imaging (MRI) can be estimated using simpler lacrimal gland linear and area measurements. METHODS: A retrospective review of 102 orbits (51 patients) with TED who underwent orbital MRI was conducted. The maximum length, width, and area of the lacrimal gland were measured in axial and coronal sections. Lacrimal gland volume was calculated by using a manual segmentation technique on all consecutive axial slices on commercially available software, OsiriX. All quantitative measurements were correlated with the lacrimal gland volume. RESULTS: Mean age of participants was 59 ± 16 years, and 67% (n = 34) were females. With multivariate analyses, combined lacrimal gland axial and coronal areas strongly correlated with volume (r = 0.843, p < 0.01). Strong univariate predictors of volume included axial area (r = 0.704, p < 0.01) and coronal area (r = 0.722, p < 0.01), while moderate predictors included axial length (r = 0.523, p < 0.01), axial width (r = 0.521, p < 0.01), coronal length (r = 0.450, p < 0.01), and coronal width (r = 0.649, p < 0.01). CONCLUSION: In patients with thyroid eye disease, lacrimal gland volume can be estimated using axial and coronal areas, which is simpler and more time efficient than calculating volumes.

Advances in imaging of the lacrimal gland in Sjögren's syndrome: A narrative review.

Due to lymphocytic infiltration of the salivary and lacrimal glands, Sjogren's syndrome (SS), a systemic autoimmune illness that mostly affects the exocrine glands, causes dry mouth (xerostomia) and dry eyes (xerophthalmia). Additionally, SS is associated with various comorbidities such as cardiovascular diseases, infections, musculoskeletal diseases, and cancers. Among patients with SS, xerophthalmia frequently arises as a complication, leading to insufficient tear production or rapid tear evaporation, thereby causing discomfort, irritation, and a gritty sensation in the eyes. This article aims to examine recent advancements in the imaging of the lacrimal gland in Sjögren's syndrome and briefly discusses the utilization of various imaging examinations for the lacrimal gland in this particular disease.

Diagnostic value of dynamic contrast enhancement combined with conventional MRI in differentiating benign and malignant lacrimal gland epithelial tumours.

AIM: To establish the diagnostic value of the quantitative parameters of dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) combined with conventional MRI in differentiating of benign and malignant lacrimal gland epithelial tumours. MATERIALS AND METHODS: A retrospective analysis of primary lacrimal gland epithelial tumours confirmed by histopathology was conducted. Conventional MRI features and DCE-MRI quantitative parameters were collected and subjected to analysis. The diagnostic value was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS: A total of 53 patients were enrolled of which 29 had malignant, whereas 24 had benign tumours. Conventional MRI revealed statistically significant differences between benign and malignant tumours regarding maximum tumour diameter, posterior margin characteristic, bone destruction, and erosion. The Ktrans and Kep values obtained by DCE-MRI were higher in malignant than in benign tumours, with a statistically significant (p<0.001 and p=0.022). A type I time-signal intensity (TIC) curve was more frequent in benign tumours, whereas a type II TIC curve was prevalent in malignant tumours (p=0.001). ROC analysis showed that Ktrans had the best diagnostic value of the DCE-MRI parameters (area under the ROC curve [AUC] of 0.822, 75.9% sensitivity, and 83.3% specificity, p<0.001). The combination of conventional MRI and DCE-MRI factors had the best diagnostic value and balanced sensitivity and specificity (AUC of 0.948, 93.1% sensitivity, and 91.7% specificity, p<0.001). CONCLUSIONS: The present findings indicate that the combination of quantitative parameters of DCE-MRI and image characteristics of conventional MRI have a high diagnostic value for the diagnosis of benign and malignant lacrimal gland epithelial tumours.

Internal vascular anatomy of the human lacrimal gland: A protocol based on cadaver dissection and three-dimensional micro-computed tomography.

PURPOSE: To evaluate the feasibility of studying the vascular supply of the orbital and palpebral lobes of the human lacrimal gland using micro-computed tomography (micro-CT) and microscopic dissection. METHODS: The lacrimal gland artery of a fresh parasagittalized cadaver head (male, aged 76 years) was infused with a lead oxide-latex mixture near the occipital pole of the gland. The entire lacrimal gland was imaged using micro-CT and 3D cinematic rendering (CR) and then dissected under a surgical microscope. RESULTS: Micro-CT and CR images showed well-demarcated internal vascular branches of the lacrimal artery and their distribution within the orbital and palpebral lobes. The entire course of the artery and its branches could be visualized by CR and microscopic dissection, with the former showing better spatial orientation and finer branching. The main artery runs along the free edge of the aponeurosis of the levator palpebrae superior muscle and lies in the isthmus portion of the gland (between the orbital and palpebral lobes). The branches of the main lacrimal artery include one branch to the orbital adipose tissue just before entering the gland, two branches to the orbital lobe (medial and lateral), and two branches to the palpebral lobe (medial and lateral). The main artery terminates as palpebral and orbital lobe branches in the lateral half of the lacrimal gland. CONCLUSION: Latex and contrast-enhanced micro-CT is very well suited to visualize the vascular anatomy of the lacrimal artery within the gland. A large number of lacrimal gland examinations using the method presented here are required to demonstrate and understand the variability of the vascular anatomy of the human lacrimal gland.

Retrospective radiological analysis to establish anatomical variation in angulation between medial canthus and the middle turbinate, for optimal positioning of Lester Jones Lacrimal bypass tubes in treatment of Epiphora.

PURPOSE: To determine the optimum angle for placement of Lester Jones lacrimal bypass tube using fixed radiological markers on CT scan head with axial and coronal cuts, as well as analysing the anatomical variation and range of angulation between individuals within our local population. METHODS: A retrospective radiological study conducted on a randomly selected sample of 384 adult patients in a UK Teaching Hospital. The angle between the medial canthus and the middle turbinate was measured on CT scans of the head using fixed radiological anatomical landmarks and analysed using the IMPAX software. Patients with orbital or nasal fractures, as well as those with history of surgical procedures involving the facial bones, were excluded. The accuracy of our measurements was validated using three dimensional (3D) CT head reconstruction technology. RESULTS: Analysis of the results showed a range of angulation between 28-45 degrees, with a mean angle of 36.99 ± 4.78 SD. There was no significant correlation found when comparing the different age groups using the One Way ANOVA test. Furthermore, a non-significant correlation was found between males and females when their mean angles were compared using the independent t-test. CONCLUSION: Our study showed that the ideal angle for insertion of Lester Jones tube would be between 30-45 degrees, with a mean of 37 degrees. No significant correlation was found between the age of the patient and the ideal angle of insertion of Lester Jones tube. Moreover, no significant difference was found in the angle measurements between males and females.

An Unusual Case of Lacrimal Gland Dacryops in a 10-Year-Old Child.

Lacrimal gland dacryops are an unusual type of benign epithelial neoplasm. Most of the literature refers to dacryops of the lacrimal palpebral lobe, with orbital lobe involvement less frequent. The authors report a case of dacryops in a 10-year-old child involving the orbital lobe of the lacrimal gland. [J Pediatr Ophthalmol Strabismus. 2023;60(6):e79-e82.].

Punctal Plug Granuloma After Blepharoplasty.

This case report discusses a diagnosis of foreign body granuloma resulting from a punctal plug in a patient aged 66 years with chronic dry eye and a history of blepharoplasty.

Isolated lacrimal gland enlargement as a presenting sign of relapse of B-cell acute lymphoblastic leukemia in an adult.

A 25-year-old woman with a history of acute lymphoblastic leukemia with Philadelphia chromosome (BCR 22q11.2-ABL1 (9q34)) presented with progressively worsening swelling and pain in her left upper eyelid of 3 months' duration. Magnetic resonance imaging showed a heterogeneously enhancing mass lesion in the left lacrimal gland. An incisional biopsy was performed; histopathology showed atypical lymphocytic cells, and flow cytometry revealed a similar immunophenotype to her previously diagnosed cancer. Her presentation was consistent with recurrence of acute lymphoblastic leukemia in the lacrimal gland, which can rarely be involved in relapse of acute lymphoblastic leukemia.

Clinical characteristics, radiologic features, and histopathology of biopsied lacrimal gland tumors.

Herein, we described the clinicopathologic and radiologic features of biopsied lacrimal gland tumors. A retrospective case series of 79 patients treated between 2004 and 2021 was reviewed. The median age was 48.9 years (range 18.3-88.3 years), with 51.9% females. The histopathologic diagnoses were as follows: immunoglobulin G4-related disease (IgG4-RD) = 23, reactive lymphoid hyperplasia = 14, lymphoma = 14, nonspecific inflammation = 10, adenoid cystic carcinoma (ACC) = 9, and pleomorphic adenoma = 9. The proportion of histopathologic diagnoses did not differ significantly over the range of symptom durations (≤ 1 month, > 1-3 months, > 3 months). Patients with ACC had significantly shorter symptom duration and more frequent proptosis than those with pleomorphic adenoma (p = 0.040 and p = 0.009, respectively). Patients with IgG4-RD were older (median 54.3 years) than those with nonspecific inflammation (36.2 years; p = 0.046). Patients with ACC were more likely to present with diplopia than those with lymphoma (p < 0.001). The superior wedge sign increased the likelihood of ACC compared with that of non-epithelial non-malignant lacrimal gland tumors (relative risk ratio = 13.44, p = 0.002). The overall survival of patients with ACC and lymphoma did not differ significantly. Although these patients present with a short symptom duration, urgent orbital imaging, tissue biopsy, and prompt treatment should be performed in patients with lacrimal gland tumors.

New insights into lacrimal gland anatomy using 7T MRI and electron microscopy: Relevance for lacrimal gland targeted therapies and bioengineering.

PURPOSE: To study the tissue architecture, isthmus (connection between two lobes) of the lacrimal gland using preclinical 7T MRI in combination with histology and electron microscopy. METHODS: Ten lacrimal glands from Caucasian body donors (mean age 78.7 years) were studied using 7T-MRI (N = 5; scanned at 75-µm intervals), histology, and electron microscopy (N = 5) and 3D cinematic rendering (CR) techniques. RESULTS: 3D CR images showed uniform-sized lobules (widest lobule diameter, 1.68 ± 0.19 mm in orbital lobe, 1.68 ± 0.17 mm in palpebral lobe) in both lobes, separated by septae (size, 0.29 ± 0.09 mm). The internal framework of the gland resembled a honeycoomb pattern. In CR and histology, the isthmus contained glandular acini, large blood vessels, nerves, and no more than two ducts having a tortuous course towards the conjunctival surface. On assigning a color display to the rendered lacrimal gland, all glands showed a blood vessel originating from the main lacrimal artery just 5 mm beyond the hilum and making it course to the palpebral lobe via isthmus. The distance between the conjunctiva and the central substance of the orbital and palpebral lobe was 9.4 ± 0.2 mm and 2.8 ± 0.7 mm, respectively. Electron microscopy of the palpebral lobe revealed compact subepithelial layer in the overlying conjunctiva, followed by loosely scattered collagen bundles that contained the gland lobules. CONCLUSION: 3D-CR can be used to study the lacrimal gland microstructure, help fabricate a 3D scaffold for lacrimal gland bioprinting, and serve as guide for transconjunctival lacrimal gland targeted therapies i.e., 2.9 & 9 mm long needle to reach the orbital and palpebral lobe center, respectively in normal-size glands.

Normal dimensions of the lacrimal gland on magnetic resonance imaging in Indian adult population: a retrospective study.

Introduction: the lacrimal gland size is affected by a variety of pathologic conditions like inflammatory, infections, neoplastic, autoimmune and granulomatous disorders. Earlier, the dimensions of the gland were estimated by extracting lacrimal glands from cadavers, later ultrasonography and computed tomography studies were used, but had limited soft tissue differentiation. The aim of this study was to retrospectively evaluate Magnetic Resonance Imaging (MRI) data from normal orbits and determine lacrimal gland dimensions. Methods: five hundred and twelve (512) consecutive MRI brain contrast scans (of 240 females, of 272 males; age range 40±20 years) for non-orbital diseases were evaluated retrospectively. The mean axial length (AL), axial width (AW), coronal length (CL), and coronal width (CW) of each lacrimal gland were measured separately. Results: five hundred and twelve (512) MRI brain contrast scans of 272 men and 240 women, with mean age of 40 ± 20 years were included. Right and left LG dimensions were similar, mean AL (13.2±1.35 mm versus 13.11±1.24 mm), mean AW [3.5±0.99 mm versus 3.3±0.82 mm], mean CL [16.3±2.5 mm versus 16.10±2.4 mm], and mean CW (4.15±0.89 mm versus 4.11±0.85 mm). The AL of both lacrimal glands and the CL and CW of right but not left lacrimal glands were significantly lower in women than in men. Age showed significant correlations with the AL and CL of both LGs. Conclusion: in this study, evaluation of normal morphometric parameters of the lacrimal gland in Indian population was established. LG dimensions are smaller in women than men, as well as correlating with side and age.

Morphometric and volumetric analysis of lacrimal glands in patients with thyroid eye disease.

Assessment of morphometric and volumetric changes in lacrimal glands in thyroid eye disease, its clinical manifestations in relation of disease progression. Retrospective volumetric analysis included both genders and was performed on total of 183 patients - 91 patients with diagnosed Grave's disease and thyroid eye disease and 92 patients without Grave's disease and thyroid eye disease who underwent multidetector computed tomography (MDCT) examination in routine daily work according to other medical indications. In the group of females, there was statistical significance between patients with thyroid eye disease and controls who were smoking and had body weight gain. We found statistical significance in volumetric enlargements for both orbits in both genders for the patients group when compared to controls. There was also statistical significance in morphometric characteristics for the lacrimal gland diameters measured. Determination planimetric morphometric parameters of importance were coronary height of lacrimal gland of the right eye, coronary height of lacrimal gland of the left eye and coronary width of lacrimal gland of the left eye for the group of males. In a group of females the established determination parameters of importance were the coronary height of lacrimal gland of the left eye, the axial width of lacrimal gland of the left eye, volume of lacrimal gland of the right eye and the volume of lacrimal gland of the left eye. When we compared the displaced lacrimal gland coming forward (proptosis) in time progressing disease between group of patients and controls, we also found statistical significant connection. Evaluation of lacrimal gland volumetric and morphometric data may increase validity of defining this anatomical substrate and its morphology disruption as liable tool for thyroid eye disease progression follow up and treatment planning and outcome.

Magnetic resonance imaging parameters on lacrimal gland in thyroid eye disease: a systematic review and meta-analysis.

BACKGROUND: Thyroid eye disease is an extrathyroidal manifestation of Graves' disease and is associated with dry eye disease. This is the first systematic review and meta-analysis to evaluate the role of magnetic resonance imaging lacrimal gland parameters in thyroid eye disease diagnosis, activity grading, and therapeutic responses prediction. METHODS: Up to 23 August, 2022, 504 studies from PubMed and Cochrane Library were analyzed. After removing duplicates and imposing selection criteria, nine eligible studies were included. Risk of bias assessment was done. Meta-analyses were performed using random-effect model if heterogeneity was significant. Otherwise, fixed-effect model was used. Main outcome measures include seven structural magnetic resonance imaging parameters (lacrimal gland herniation, maximum axial area, maximum coronal area, maximum axial length, maximum coronal length, maximum axial width, maximum coronal width), and three functional magnetic resonance imaging parameters (diffusion tensor imaging-fractional anisotropy, diffusion tensor imaging-apparent diffusion coefficient or mean diffusivity, diffusion-weighted imaging-apparent diffusion coefficient). RESULTS: Thyroid eye disease showed larger maximum axial area, maximum coronal area, maximum axial length, maximum axial width, maximum coronal width, diffusion tensor imaging-apparent diffusion coefficient/ mean diffusivity, and lower diffusion tensor imaging-fractional anisotropy than controls. Active thyroid eye disease showed larger lacrimal gland herniation, maximum coronal area, diffusion-weighted imaging-apparent diffusion coefficient than inactive. Lacrimal gland dimensional (maximum axial area, maximum coronal area, maximum axial length, maximum axial width, maximum coronal width) and functional parameters (diffusion tensor imaging-apparent diffusion coefficient, diffusion tensor imaging-apparent diffusion coefficient) could be used for diagnosing thyroid eye disease; lacrimal gland herniation, maximum coronal area, and diffusion-weighted imaging-apparent diffusion coefficient for differentiating active from inactive thyroid eye disease; diffusion tensor imaging parameters (diffusion tensor imaging-fractional anisotropy, diffusion tensor imaging-mean diffusivity) and lacrimal gland herniation for helping grading and therapeutic responses prediction respectively. CONCLUSIONS: Magnetic resonance imaging lacrimal gland parameters can detect active thyroid eye disease and differentiate thyroid eye disease from controls. Maximum coronal area is the most effective indicator for thyroid eye disease diagnosis and activity grading. There are inconclusive results showing whether structural or functional lacrimal gland parameters have diagnostic superiority. Future studies are warranted to determine the use of magnetic resonance imaging lacrimal gland parameters in thyroid eye disease.

Assessment of lacrimal gland involvement in primary Sjögren's syndrome using gray-scale ultrasonography and shear wave elastography.

OBJECTIVES: The aim of this study was to assess lacrimal gland involvement in primary Sjögren's syndrome (pSS) using lacrimal gland gray-scale ultrasound (LGUS) and two-dimensional shear wave elastography (2D-SWE). METHODS: Eighty-five pSS patients with a mean age of 51.16 ± 10.61 years and 84 sex- and age-matched healthy subjects with a mean age of 50.94 ± 11.05 years were included in the study. Lacrimal gland parenchymal findings and 2D-SWE values were compared between the two groups and the correlations of LGUS parameters with clinical findings, dry eye tests, and minor salivary gland biopsy (MSGB) were further investigated. RESULTS: LGUS parenchymal grade was 0 in 14 (16.5%), 1 in 45 (52.9%), 2 in 23 (27.1%), and 3 in 3 patients (3.5%) in the pSS group, while in the control group, parenchymal grades were 0 (57.1%) and 1 (42.9%). The mean 2D-SWE value of pSS patients was significantly higher than the control group (p < 0.05) and increased parallel with lacrimal parenchymal grade. The elasticity modulus had a high diagnostic performance in detecting lacrimal gland involvement in pSS patients (AUC 0.901, sensitivity 70.6%, specificity 97.6%), while the diagnostic performance of LGUS was much lower (AUC 0.769, sensitivity 83.5%, specificity 57.1%). LGUS and 2D-SWE values were found to be correlated with dry eye tests and MSGB results (p < 0.05). CONCLUSIONS: LGUS and 2D-SWE are both useful for assessing the lacrimal gland involvement in pSS patients; however, 2D-SWE has a better diagnostic performance than LGUS and found to be correlated with dry eye tests. CLINICAL RELEVANCE STATEMENT: Lacrimal gland US and two-dimensional shear wave elastography (2D-SWE) are imaging modalities that can be used to demonstrate parenchymal involvement of the lacrimal gland in primary Sjögren's syndrome (pSS). KEY POINTS: • Gray-scale US and two-dimensional shear wave elastography (2D-SWE) have been widely used in the recent decade to assess gland involvement in patients with primary Sjögren's syndrome (pSS). • The elasticity modulus had a high diagnostic performance in detecting lacrimal gland involvement in primary Sjögren's syndrome (pSS) patients. • Lacrimal gland US and two-dimensional shear wave elastography (2D-SWE) are both useful for assessing the lacrimal gland in primary Sjögren's syndrome (pSS) patients; however, two-dimensional shear wave elastography (2D-SWE) has a better diagnostic performance than lacrimal gland ultrasound (LGUS).

Localized Recurrence of Multiple Myeloma in the Lacrimal Gland.

The authors report the case of a multiple myeloma recurrence isolated to the lacrimal gland. The patient is a 54-year-old man with a medical history of IgA kappa multiple myeloma status post multiple lines of chemotherapy and stem cell transplantation (×2) who was presumed to be without evidence of disease. Six years following the transplant, he presented with a lacrimal gland tumor with a biopsy consistent with multiple myeloma. Systemic disease evaluation at that time, including positron emission tomography scan, bone marrow biopsy, and serum analysis, were negative. To the best of the authors' knowledge, no prior reports exist describing an isolated lacrimal gland recurrence of multiple myeloma with ultrasound and MRI imaging.

[Disorders of lacrimal drainage: the way from theory to practice]. / Narushenie slezootvedeniya: put' ot teorii k praktike.

The article summarizes the results of research conducted over the past decade concerning the current problems of dacryology, analyzes the improvements made to the methods of diagnostics used in disorders of lacrimal passages on the basis of modern imaging and functional studies, describes the techniques aimed at improving the clinical effectiveness of the intervention, as well as drug and non-drug methods of intraoperative prevention of excessive scarring in the area of the artificial ostium. The article also analyzes the experience of using balloon dacryoplasty in relapses of tear duct obstruction after dacryocystorhinostomy, and presents the modern minimally invasive surgical techniques, including nasolacrimal duct intubation, as well as balloon dacryoplasty and endoscopic plastic surgery of the ostium of the nasolacrimal duct. Additionally, the work lists the fundamental and applied tasks of dacryology and outlines promising directions of its development.

Normative Quantitative Values for Dacryoscintigraphy and the Effect of Lid Massage.

Our objectives were to establish normative quantitative values for dacryoscintigraphy in an older population and to evaluate the effect of lid massage. Methods: We conducted a prospective study of 44 eyes of 22 participants aged between 54-90 y that had no symptoms of epiphora and no clinical tear film instability, lid abnormality, lacrimal system impairment, or patent lacrimal duct on syringing. Dacryoscintigraphy was performed and interpreted by a single nuclear medicine physician. The scan protocol involved instillation of 99mTc-pertechnetate in each eye, with a 45-min scan performed with 1-min frames. Lid massage and a sinus clearing maneuver were then performed, followed by a further 45 min of scanning. Results: The mean age of the 22 participants was 71.9 y. Quantitative analysis by half-clearance time (HCT) demonstrated a median presac HCT of 25.5 ± 15.0 min and a whole-eye HCT of 40.0 ± 19.5 min. There was no association between age or sex and HCT. Qualitatively, 29 of 44 eyes (66%) appeared to have at least 1 region of delayed clearance, with improvement noted in 23 after lid massage (79%). Conclusion: We report the quantitative values for dacryoscintigraphy in an asymptomatic older population who had normal findings on lacrimal examination. A high rate of delay in radiotracer transit on qualitative examination suggesting a low specificity. The false-positive rate was significantly improved with the novel approach of adding lid massage, and the significance of this finding merits further research.