DOCSLIB.ORG

Immunohistochemical Detection in the Lacrimal Gland, Optic Nerve, Fat

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Immunohistochemical Detection in the Lacrimal Gland, Optic Nerve, Fat A RQUIVOS B RASILEIROS DE ORIGINAL ARTICLE Orbital lymphatic vessels: immunohistochemical detection in the lacrimal gland, optic nerve, fat tissue, and extrinsic oculomotor muscles Vasos linfáticos orbitários: identificação imunohistoquímica na glândula lacrimal, no nervo óptico, no tecido adiposo e nos músculos extrínsecos oculomotores Renato Wendell Ferreira Damasceno1,2,3 , Juliana Arôxa Pereira Barbosa1,2, Lucas Rafael Costa Cortez2, Rubens Belfort Jr.3 1. Universidade Estadual de Ciências da Saúde de Alagoas, Maceió, AL, Brazil. 2. Hospital Universitário Professor Alberto Antunes, Universidade Federal de Alagoas, Maceió, AL, Brazil. 3. Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil. ABSTRACT | Purpose: To identify the lymphatic vessels in RESUMO | Objetivos: Identificar vasos linfáticos em espécimes orbital specimens from human cadavers using light microscopy orbitários de cadáveres humanos através de microscopia and immunohistochemical analysis. Methods: A postmortem óptica e análise imunohistoquímica. Métodos: Um estudo study included 10 orbital specimens from 10 human cadavers. postmortem incluiu dez espécimes orbitários provenientes de The orbital specimens were obtained no later than 12 hours dez cadáveres humanos. Todos os espécimes orbitários foram after death. The orbital specimens were dissected into lacri- obtidos até 12 horas após a morte com uma técnica cirúrgica mal gland, optic nerve, fat tissue, and oculomotor muscles. de exenteração orbitária e dissecados em glândula lacrimal, The histologic criteria to qualify as a lymphatic vessel were nervo óptico, gordura órbitária e músculos extraoculares. Para thin-walled channels of endothelium without a well-developed classificar como um vaso linfático, os critérios histológicos basal membrane and with an erythrocyte-free, irregular lumen. incluíram vasos endoteliais de parede única sem membrana The immunohistochemical criteria were irregularly shaped, basal bem desenvolvida, irregulares e lúmen sem hemácias, e thin-walled vessels with an erythrocyte-free, irregular lumen and os critérios imunohistoquímicos incluíram vasos endoteliais immunopositivity for podoplanin D2-40. Results: The lacrimal de parede única, com formato irregular e lúmen sem hemácias gland, optic nerve, fat tissue, and extraocular muscle sections e reagentes a podoplanina D2-40. Resultados: As lâminas were positively stained with podoplanin D2-40. Conclusions: histológicas de glândula lacrimal, nervo óptico, tecido adiposo This study demonstrated lymphatic vessels in the human orbit, e músculos extraoculares reagiram positivamente a podoplanina more precisely, in the lacrimal gland, dura mater of the optic D2-40. Conclusão: Este estudo demonstrou vasos linfáticos nerve, adipose tissue, and extrinsic oculomotor muscles via light na órbita humana, mais exatamente, na glândula lacrimal, no microscopy and immunohistochemistry. nervo óptico, na gordura orbitária e nos músculos extrínsecos Keywords: Lymphatic vessels; Orbit; Optic nerve; Lacrimal extraoculares via microscopia óptica e imunohistoquímica. apparatus; Oculomotor muscles; Adipose tissue; Microscopy Descritores: Vasos linfáticos; Órbita; Nervo óptico; Aparelho lacrimal; Músculos oculomotores; Tecido adiposo; Microscopia INTRODUCTION The lymphatic system is essential for maintaining the normal balance of body fluids(1,2). This system con- Submitted for publication: December 9,2019 Accepted for publication: April 2, 2020 tinually transports interstitial macromolecules from Funding: This study received no specific financial support. the extracellular space into the venous circulation(2). Disclosure of potential conflicts of interest: None of the authors have any potential conflicts of interest to disclose. Additionally, the lymphatic system is responsible for fat Corresponding author: Renato Wendell Ferreira Damasceno. E-mail: [email protected] absorption and transports immune cells to the lymph Approved by the following research ethics committee: Universidade Estadual nodes, thus playing a prime role in immunity(2). Although de Ciências da Saúde de Alagoas (CAAE: 43039315.3.0000.5011) e Universidade Federal de São Paulo (CAAE: 43039315.3.3001.5505). the organization of the lymphatic system is parallel to This content is licensed under a Creative Commons Attributions 4.0 International License. http://dx.doi.org/10.5935/0004-2749.20210035 Arq Bras Oftalmol. 2021;84(3):209-13 ■ 209 Orbital lymphatic vessels: immunohistochemical detection in the lacrimal gland, optic nerve, fat tissue, and extrinsic oculomotor muscles that of the blood system, the lymphatic vessels are not Randomization uniformly distributed throughout the body in a similar Random software (random.org) was used to define way(1). Whereas the ocular adnexa (conjunctiva, eyelids, a number between 1 and 100. The selected side was and lacrimal drainage system) are rich in blood and determined as left if the number was odd or as right if lymphatic vessels, some well-vascularized tissues, such the number was even. as the central nervous system, have no lymphatics(1). The human orbit, an ocular adnexa richly vascula- Modified surgical technique of rized with blood vessels, is a space bounded by rigid orbital exenteration bones and fascial sheaths(1,2). The orbital blood capilla- First, the incision line was marked around the orbit ries are unfenestrated and carry proteins into the extra- just inside the orbital rim. The dissection was then vascular space continuously; however, these proteins performed beneath the orbicularis oculi muscle to the are not readily reabsorbed owing to the concentration orbital rim, and the periorbita was dissected from the gradient(1,2). Thus, this protein-rich interstitial fluid must orbital walls with a periosteal elevator. Enucleation scissors leave the orbit and be returned to the vascular compart- were passed around the orbital tissue to the apex, and ment to avoid an increase in the intraorbital pressure. any residual bleeding vessels were cauterized. At the end, Several studies have shown that lymphatic vessels the orbital cavity was packed with gauze sponges. may play an important role in various disorders(3-15). A better understanding of the orbital lymphatic system Demographic data may significantly increase our knowledge of immu ne- Information was collected about the age and gender asso ciated orbital diseases, such as orbital inflammatory of all subjects. diseases and Graves’ ophthalmopathy, and the spread of malignant neoplasms, including carcinoma, lymphoma, Histologic analysis and melanoma. All specimens (lacrimal gland, optic nerve, fat tissue, The purpose of this study was to determine whether and extraocular muscles) were fixed in a buffered 10% lymphatic vessels are present in orbital specimens from formaldehyde solution, embedded in paraffin, and pro- human cadavers, with special regard to the lacrimal gland, cessed for light microscopy at the Pathology Laboratory, optic nerve, fat tissue, and extraocular muscles, using light Universidade Federal de Alagoas, Maceió, Brazil. For microscopy and immunohistochemical analysis. light microscopy, 4-μm-thick paraffin sections were stained with hematoxylin-eosin and periodic acid-Schiff. METHODS General information Immunohistochemical analysis Immunohistochemical analysis was performed on This postmortem study was performed on 10 orbital 4-μm-thick paraffin sections using the peroxidase-la- specimens from 10 human cadavers between January 1 beled streptavidin-biotin method and an LSAB-Plus Kit and December 31, 2016. The orbital specimens were according to the manufacturer’s instructions (Dako, obtained no later than 12 hours after death using a mo- Glostrup, Denmark). The paraffin sections were incu- dified surgical technique of orbital exenteration at the bated with primary antibody dilutions, biotinylated link Autopsy Service, Universidade Estadual de Ciências da antibody, and peroxidase-conjugated streptavidin for 30 Saúde de Alagoas, Maceió, Brazil. The orbital specimens min each. The 3-chromogenic substrate 3-amino-9-ethyl were dissected into lacrimal gland (palpebral and orbi- carbazole was applied, and the samples were stained tal lobes), optic nerve, fat tissue (lower inner quadrant, with Mayer’s hemalum. upper inner quadrant, lower outer quadrant, and upper A monoclonal antibody against the human lymphatic outer quadrant), and extraocular muscles (levator palpe- vascular endothelial-specific glycoprotein podoplanin brae superioris, superior rectus muscle, inferior rectus D2-40 (mouse, 1:40; AbD Serotec) was used. Positive muscle, lateral rectus muscle, medial rectus muscle, controls were performed on amygdala specimens, and superior oblique muscle, and inferior oblique muscle). negative controls were performed with control immu- The exclusion criteria were prior orbital surgery, orbital noglobulin G. Two investigators analyzed all paraffin disease, or head and neck radiation therapy. sections. 210 Arq Bras Oftalmol. 2021;84(3):209-13 Damasceno RWF, et al. Detection of lymphatic vessels fat tissue, and extraocular muscles, using light micros- The histologic criteria for a lymphatic vessel were copy and immunohistochemical analysis with D2-40, a thin-walled channels of endothelium without a well- specific antibody for lymphatic vessels(9). developed basal membrane and with an erythro cyte- free, irregular lumen. The immunohistochemical criteria Lacrimal gland were irregularly shaped, thin-walled
Load more

Recommended publications
  • Treatment of Congenital Ptosis
    13 Review Article Page 1 of 13 Treatment of congenital ptosis Vladimir Kratky1,2^ 1Department of Ophthalmology, Queen’s University, Kingston, Canada; 21st Medical Faculty, Charles University, Prague, Czech Republic Correspondence to: Vladimir Kratky, BSc, MD, FRCSC, DABO. Associate Professor of Ophthalmology, Director of Ophthalmic Plastic and Orbital Surgery, Oculoplastics Fellowship Director, Queen’s University, Kingston, Canada; 1st Medical Faculty, Charles University, Prague, Czech Republic. Email: [email protected]. Abstract: Congenital ptosis is an abnormally low position of the upper eyelid, with respect to the visual axis in the primary gaze. It can be present at birth or manifest itself during the first year of life and can be bilateral or unilateral. Additionally, it may be an isolated finding or part of a constellation of signs of a specific syndrome or systemic associations. Depending on how much it interferes with the visual axis, it may be considered as a functional or a cosmetic condition. In childhood, functional ptosis can lead to deprivation amblyopia and astigmatism and needs to be treated. However, even mild ptosis with normal vision can lead to psychosocial problems and correction is also advised, albeit on a less urgent basis. Although, patching and glasses can be prescribed to treat the amblyopia, the mainstay of management is surgical. There are several types of surgical procedure available depending on the severity and etiology of the droopy eyelid. The first part of this paper will review the different categories of congenital ptosis, including more common associated syndromes. The latter part will briefly cover the different surgical approaches, with emphasis on how to choose the correct condition.
    [Show full text]
  • Nomina Histologica Veterinaria, First Edition
    NOMINA HISTOLOGICA VETERINARIA Submitted by the International Committee on Veterinary Histological Nomenclature (ICVHN) to the World Association of Veterinary Anatomists Published on the website of the World Association of Veterinary Anatomists www.wava-amav.org 2017 CONTENTS Introduction i Principles of term construction in N.H.V. iii Cytologia – Cytology 1 Textus epithelialis – Epithelial tissue 10 Textus connectivus – Connective tissue 13 Sanguis et Lympha – Blood and Lymph 17 Textus muscularis – Muscle tissue 19 Textus nervosus – Nerve tissue 20 Splanchnologia – Viscera 23 Systema digestorium – Digestive system 24 Systema respiratorium – Respiratory system 32 Systema urinarium – Urinary system 35 Organa genitalia masculina – Male genital system 38 Organa genitalia feminina – Female genital system 42 Systema endocrinum – Endocrine system 45 Systema cardiovasculare et lymphaticum [Angiologia] – Cardiovascular and lymphatic system 47 Systema nervosum – Nervous system 52 Receptores sensorii et Organa sensuum – Sensory receptors and Sense organs 58 Integumentum – Integument 64 INTRODUCTION The preparations leading to the publication of the present first edition of the Nomina Histologica Veterinaria has a long history spanning more than 50 years. Under the auspices of the World Association of Veterinary Anatomists (W.A.V.A.), the International Committee on Veterinary Anatomical Nomenclature (I.C.V.A.N.) appointed in Giessen, 1965, a Subcommittee on Histology and Embryology which started a working relation with the Subcommittee on Histology of the former International Anatomical Nomenclature Committee. In Mexico City, 1971, this Subcommittee presented a document entitled Nomina Histologica Veterinaria: A Working Draft as a basis for the continued work of the newly-appointed Subcommittee on Histological Nomenclature. This resulted in the editing of the Nomina Histologica Veterinaria: A Working Draft II (Toulouse, 1974), followed by preparations for publication of a Nomina Histologica Veterinaria.
    [Show full text]
  • Orbital Imaging in Thyroid-Related Orbitopathy
    Orbital imaging in thyroid-related orbitopathy Christopher Lo, MD, Shoaib Ugradar, MD, and Daniel Rootman, MD, MS SUMMARY A broad understanding of the different imaging modalities used to assess the physiologic changes seen in Graves’ orbitopathy complement clinical examination. Subtle applications of radiographic imaging techniques allow for a better understanding of the overall physiology of the orbit, quantify progression of disease, and differentiate it from orbital diseases with overlapping features. A nuanced approach to interpreting imaging features may allow us to delineate inactive from active thyroid eye disease, and advances within this field may arm clinicians with the ability to better predict and prevent dysthyroid optic neuropathy. ( J AAPOS 2018;22:256.e1-256.e9) rbital imaging plays a central role in the diag- mean inferior rectus width, 4.8 mm; medial rectus width, nosis and management of thyroid-related orbit- 4.2 mm; superior rectus width, 4.6 mm; and lateral rectus O opathy (TRO). Diagnostically, it is used to width, 3.3 mm.8,9 These numbers can be used as a guide; compliment a careful ophthalmic examination, laboratory however, they represent population averages, each with values, and ancillary studies to confirm the presence of significant variation. Overlap in populations exist, and TRO and/or dysthyroid optic neuropathy (DON). It can both diseased and nondiseased muscles can have widths also be helpful in surgical planning and understanding close to these values. In the end, there are no strict rules. the progression of thyroid myopathy. Computed tomogra- In terms of muscle involvement, clinical myopathy is phy (CT), magnetic resonance imaging (MRI), ultrasound, thought to most often involve the inferior rectus muscle, and nuclear medicine all have applications in the field.
    [Show full text]
  • Ectopic Intraocular Lacrimal Gland Tissue
    Br J Ophthalmol: first published as 10.1136/bjo.56.9.690 on 1 September 1972. Downloaded from Brit. _. Ophthal. (I972) 56, 690 Ectopic intraocular lacrimal gland tissue GWYN MORGAN AND ALAN MUSHIN Departments of Pathology and Clinical Ophthalmology, Institute of Ophthalmology, University of London Ectopic lacrimal gland tissue is rarely found within the eye. The first report was that of Puech (i 887) who described an adenoma ofthe choroid in an adult female. The lesion had the appearance of lacrimal gland tissue which was adherent to the sclera and the retina. After an interval of 65 years Christensen and Anderson (I 952) described ectopic lacrimal gland tissue within the sclera, ciliary body, limbus, and iris in an infant of 2 weeks. Bruce (I 952) described a case in the iris of a 2-month-old boy who was 2 weeks premature. No other abnormalities were noted in these infants. Hunter (i 960) described a fourth case in which ectopic cystic lacrimal gland tissue was seen in the ciliary body, iris, and sclera. The fifth case was described by Dallachy (i96i) in a 2-month-old female infant; ectopic lacrimal gland tissue was seen in the ciliary body and iris. A search of the literature since I96I revealed only one other case of intraocular lacrimal gland tissue (Green and Zimmerman, I967); their patient was a s-month-old child with ectopic lacrimal gland tissue in the limbal area and a nodule ofsimilar tissue in the chamber angle, on the anterior copyright. surface of the iris, and in the ciliary body.
    [Show full text]
  • Eye External Anatomy of Eye Accessory Structures
    4/22/16 Eye Bio 40B Dr. Kandula External Anatomy of Eye Accessory Structures l Eyebrows l Levator Palpebrae Superioris - opens eye l Eyelashes l Ciliary glands – modified sweat glands l Small sebaceous glands l Sty is inflamed ciliary glands or small sebaceous glands 1 4/22/16 Terms: Lacrimal gland and duct Surface of eye Lacrimal puncta Lacrimal sac Nasolacrimal duct Nasal cavity Tears / Lacrimal fluid l a watery physiologic saline, with a plasma-like consistency, l contains the bactericidal enzyme lysozyme; l it moistens the conjunctiva and cornea, l provides nutrients and dissolved O2 to the cornea. Extrinsic Muscles of the Eye: Lateral/medial rectus Important to know Superior/inferior rectus actions and nerve Superior/inferior oblique supply in table 2 4/22/16 Extrinsic Eye Muscles • Eye movements controlled by six extrinsic eye muscles Four recti muscles § Superior rectus – moves eyeball superiorly supplied by Cranial Nerve III § Inferior rectus - moves eyeball inferiorly supplied by Cranial Nerve III § Lateral rectus - moves eyeball laterally supplied by Cranial Nerve VI § Medial rectus - moves eyeball medially supplied by Cranial Nerve III Extrinsic Eye Muscles Two oblique muscles rotate eyeball on its axis § Superior oblique rotates eyeball inferiorly and laterally and is supplied by Cranial Nerve IV § Inferior oblique rotates superiorly and laterally and is supplied by Cranial Nerve III Convergence of the Eyes l Binocular vision in humans has both eyes looking at the same object l As you look at an object close to your face,
    [Show full text]
  • Anatomy of the Periorbital Region Review Article Anatomia Da Região Periorbital
    RevSurgicalV5N3Inglês_RevistaSurgical&CosmeticDermatol 21/01/14 17:54 Página 245 245 Anatomy of the periorbital region Review article Anatomia da região periorbital Authors: Eliandre Costa Palermo1 ABSTRACT A careful study of the anatomy of the orbit is very important for dermatologists, even for those who do not perform major surgical procedures. This is due to the high complexity of the structures involved in the dermatological procedures performed in this region. A 1 Dermatologist Physician, Lato sensu post- detailed knowledge of facial anatomy is what differentiates a qualified professional— graduate diploma in Dermatologic Surgery from the Faculdade de Medician whether in performing minimally invasive procedures (such as botulinum toxin and der- do ABC - Santo André (SP), Brazil mal fillings) or in conducting excisions of skin lesions—thereby avoiding complications and ensuring the best results, both aesthetically and correctively. The present review article focuses on the anatomy of the orbit and palpebral region and on the important structures related to the execution of dermatological procedures. Keywords: eyelids; anatomy; skin. RESU MO Um estudo cuidadoso da anatomia da órbita é muito importante para os dermatologistas, mesmo para os que não realizam grandes procedimentos cirúrgicos, devido à elevada complexidade de estruturas envolvidas nos procedimentos dermatológicos realizados nesta região. O conhecimento detalhado da anatomia facial é o que diferencia o profissional qualificado, seja na realização de procedimentos mini- mamente invasivos, como toxina botulínica e preenchimentos, seja nas exéreses de lesões dermatoló- Correspondence: Dr. Eliandre Costa Palermo gicas, evitando complicações e assegurando os melhores resultados, tanto estéticos quanto corretivos. Av. São Gualter, 615 Trataremos neste artigo da revisão da anatomia da região órbito-palpebral e das estruturas importan- Cep: 05455 000 Alto de Pinheiros—São tes correlacionadas à realização dos procedimentos dermatológicos.
    [Show full text]
  • Extraocular Muscles. Conjugated Eye Movements. Strabismus
    Extraocular muscles. Conjugated eye movements. Strabismus. Sándor Katz M.D., Ph.D. Conjugated eye movements Requirements: • Extraocular muscles • Innervation: CN. III., IV., VI. Precision and speed of muscle function rely on structural characteristics. Their motor innervation is well developed: 1 motor fiber/6 muscle fibers (in finger: 100-300 muscle fibers, in other muscles: 1500 muscle fibers) • Central pathways for eye movements, ensuring coordination Orbit Eye vs. Orbit • The medial wall runs in paramedian sagittal plane. • The lateral wall deviates laterally: 45°. • The AP (antero- posterior) axis of the eye is parallel with the sagittal axis. • The extraocular muscles run almost parallel with the axis of orbit. Orbit Orbit The eyeball is attached by membranes to the capsule of the orbital fat body, and it can move in all directions in the episcleral space. Movements are achieved by four recti and two oblique muscles. The tendons of the rectus muscles originate form a funnel-shaped ring around the optic canal: common tendinous ring. Orbit medial rectus nasociliary nerve superior rectus superior oblique lateral rectus lacrimal nerve frontal nerve lacrimal gland superior oblique medial rectus inferior rectus inferior oblique pes anserinus minor Possible eye movements Sagittal axis: Internal/medial rotation External/lateral rotation (difficult to see as the pupil is round in humans). Possible eye movements Horisontal axis: Elevation Depression Possible eye movements Vertical axis: Abduction Adduction Lateral rectus muscle – CN VI. Vertical axis: Abduction Origin: common tendinous ring Insertion: sclera, posterior to the limbus corneae Medial rectus muscle – CN III., inferior ramus Vertical axis: Adduction Origin: common tendinous ring Insertion: sclera, posterior to the limbus corneae Superior rectus muscle – CN.
    [Show full text]
  • Double-Bellied Superior Rectus Muscle
    Surgical and Radiologic Anatomy (2019) 41:713–715 https://doi.org/10.1007/s00276-019-02211-0 ANATOMIC VARIATIONS Double-bellied superior rectus muscle Satheesha B. Nayak1 · Surekha D. Shetty1 · Naveen Kumar1 · Ashwini P. Aithal1 Received: 3 September 2018 / Accepted: 23 February 2019 / Published online: 7 March 2019 © Springer-Verlag France SAS, part of Springer Nature 2019 Abstract Congenital variations of extraocular muscles are rare. We report a double-bellied superior rectus muscle, observed in an adult male cadaver aged 70 years. The superior rectus muscle had two equal-sized bellies, which took separate origins from the common tendinous ring and united to form a common belly 1 cm before the insertion. Due to the duplication, the muscle extended laterally beyond the levator palpebrae superioris. Both its bellies were supplied by oculomotor nerve. To the best of our knowledge, this is the first report on doubling of the belly of the superior rectus muscle. Keywords Extraocular · Orbit · Superior rectus muscle · Eye movement · Strabismus Introduction Case report Voluntary movements of the eyeball are performed by six During dissection classes for the first-year medical students, extraocular muscles, namely superior rectus muscle, the we observed a unique variation in the right orbit of an adult inferior rectus muscle, medial rectus muscle, lateral rectus male cadaver aged 70 years. The cadaver was donated to the muscle, superior oblique muscle, and inferior oblique mus- department for teaching and research purpose. No history of cles. Variations of these muscles can result in restrictions of strabismus or visual defects is available. The variation was movements of eyeball, causing strabismus.
    [Show full text]
  • TEAR PRODUCTION and DRAINAGE the Lacrimal Gland Is Located in the Superolateral Aspect of the Eyelid Below the Eyebrow(S)
    Anatomy and Physiology 9 The conjunctiva is a mucous membrane that lines the upper and lower eyelids and extends over the sclera to the corneal margin. It contains lym- phoid tissue, which provides some immunology protection. It is innervated by CN V, the trigeminal nerve. The portion of the conjunctiva that covers the sclera is termed the bulbar conjunctiva; the portion covering the inner surface of the eyelids is termed the palpebral conjunctiva. Figure 1. Eyelid Muscles TEAR PRODUCTION AND DRAINAGE The lacrimal gland is located in the superolateral aspect of the eyelid below the eyebrow(s). It secretes watery (aqueous) tears and produces about 0.2 ml of tears in 24 hours. Aqueous tears flow downward and inward toward the tear drainage system at the inner canthus. In addition to aqueous tears, several glands located in the conjunctiva and eyelid margins secrete oily and sticky (mucous) tears. The meibomian glands are located within the tarsal plate of the eyelid and secrete oily tears. The glands of Zeiss, Moll, Wolfing, and Krause secrete sticky tears. These three types of tears provide moisture and protection to the surface of the eye(s). With each blink, tears are pushed across the eye toward the puncta located at the medial junction of the upper and lower eyelids. From the puncta, tears are pushed into the canaliculi and then into the lacrimal sac. 10 Essentials of Ophthalmic Nursing They are drained from the lacrimal sac and nasolacrimal duct to the inside of the nose and down the throat (see Figure 2). Figure 2. Lacrimal System TEAR FILM The tear film has three distinct layers.
    [Show full text]
  • Related Disease of the Orbit: Imaging Features in 27 Patients
    Published March 13, 2014 as 10.3174/ajnr.A3865 ORIGINAL RESEARCH HEAD & NECK Immunoglobulin G4–Related Disease of the Orbit: Imaging Features in 27 Patients C.A. Tiegs-Heiden, L.J. Eckel, C.H. Hunt, F.E. Diehn, K.M. Schwartz, D.F. Kallmes, D.R. Saloma˜o, T.E. Witzig, and J.A. Garrity ABSTRACT BACKGROUND AND PURPOSE: Immunoglobulin G4–related disease is a systemic fibroinflammatory process of unknown etiology, characterized by tissue infiltration by immunoglobulin G4 plasma cells. The purpose of this study was to retrospectively identify the spectrum of imaging features seen in immunoglobulin G4–related disease of the orbit. MATERIALS AND METHODS: This study included 27 patients with biopsy-proved immunoglobulin G4–related disease of the orbit and either a CT or MR imaging of the orbits. These CT or MR imaging examinations were evaluated for the following: extraocular muscle size, extraocular muscle tendon enlargement, lacrimal gland enlargement, infiltrative process in the orbital fat (increased attenuation on CT or abnormal signal on MR imaging), infraorbital nerve enlargement, mucosal thickening in the paranasal sinuses, and extension of orbital findings intracranially. RESULTS: Extraocular muscles were enlarged in 24 of 27 (89%) patients, 21 (88%) bilaterally. In 32 of 45 (71%) affected orbits, the lateral rectus was the most enlarged muscle. In 26 (96%) patients, the tendons of the extraocular muscles were spared. Nineteen (70%) patients had lacrimal gland enlargement. Twelve (44%) patients had an infiltrative process within the orbital fat. Infraorbital nerve enlargement was seen in 8 (30%) patients. Twenty-four (89%) patients had sinus disease. Cavernous sinus or Meckel cave extension was seen in 3 (11%) patients.
    [Show full text]
  • Excessive Tearing (Epiphora ))
    EExxcceessssiivvee TTeeaarriinngg ((EEppiipphhoorraa)) www.theeyecenter.com A healthy eye is a wet eye, thanks to the workings of the lacrimal (tear duct) system around the eyes. The lacrimal gland is found above the outer edge of the eye under the eyebrow. The lacrimal duct, which forms tears, is found on the inside corner of your eye and down the side of the nose. For various reasons, this system can malfunction and cause the eye(s) to be continuously wet. Symptoms The tear duct is the passage through which the tears drain off the eye. When it becomes blocked or plugged, it may lead to: • Constant tearing • Redness and swelling in and around the eyes • Infection • Pain Alexandria Fairfax Sterling Leesburg 703-931-9100 703-573-8080 703-430-4400 703-858-3170 The blockage may be due to: • Mucous buildup in the lacrimal duct at birth and in infancy • Ingrown eyelashes • Thick or hardened discharge from an eye infection such as conjunctivitis (pink eye) • Continued exposure to allergens that irritate the eyes • Obstruction due to airborne irritants especially in the work environment (i.e. dust, chemicals, smoke or pollution) • Other eye conditions, such as a stye, that cause the eye to have an unusual discharge that can harden and plug the lacrimal duct. Treatment The ophthalmologist will examine the eye and may probe the tear duct to determine if a blockage exists. Initially, antibiotic drops may be prescribed to treat the infection, and possibly corticosteroid drops to treat any swelling. The blockage can often be worked loose by massaging the tear duct along the side of the eye and down the nose.
    [Show full text]
  • The Lacrimal System Terms
    The Lacrimal System Lynn E. Lawrence, CPOT, ABOC, COA, OSC Terms • Etiology – the cause of a disease or abnormal condition • Dacryocystitis – inflammation of the lacrimal sac • Epiphora – watering of eyes due to excess secretion of tears or obstruction of the lacrimal passage Tear Film Layers oil aqueous snot What functions does each layer of the tear perform? Lacrimal System: Tear Film Layers LIPID DEFICIENCY ‐ evaporates TEAR DEFICIENCY – fails to hydrate properly oil aqueous snot What functions does each layer of the tear perform? What are functions of tears? Tear Components • Lipid Layer – prevents evaporation • Aqueous Layer ‐ hydration • Mucus Layer – sticks tear to the eye • Other components Lacrimal Apparatus • Sometimes a person cannot produce natural tears they might need punctal plugs to prevent the tears from draining off the eye. • Faucet • Action • Drain Obstructive – vs‐ non‐obstructive Tear Production – Secretory • Lacrimal gland – Reflex tearing – Too much tearing…epiphora • Gland of Krause – Superior fornix • Gland of Wolfring – Superior tarsal plate Two Primary Forms of Dry Eye 800 nm 8,000 nm 100 nm The two primary forms of dry eye are Evaporative Dry Eye, also known as Meibomian Gland Dysfunction or MGD and Aqueous Dry Eye. The majority of dry eye sufferers have MGD. Oil & Water Remember science class? Oil floats. Oil does not mix with water, but rather sits on top of water. Oil is what keeps water from evaporating. Need three volunteers TEST TIME http://optometrytimes.modernmedicine.com/optometrytimes/news/treating‐dry‐eye‐ lipid‐based‐eye‐drops Lipid Secretion: Meibomian Glands Left: Transillumination of eyelid showing meibomian glands Right: Secretion of lipid at lid margin • The lipid layer restricts evaporation to 5‐10% of tear flow – Also helps lubricate Mucin Secretion: Goblet Cells Superficial layer of bulbar conjunctiva.
    [Show full text]