Dry anophthalmic socket syndrome – morphological alterations in meibomian glands

Abstract

Purpose To evaluate morphological alterations of meibomian glands (MGs) in the dry anophthalmic socket syndrome (DASS). Methods Fifteen unilateral anophthalmic patients wearing cryolite glass prosthetic eyes were enrolled. All patients with clinical blepharitis or other significant eyelid abnormalities were excluded. In vivo laser scanning confocal microscopy (LSCM) of the MGs in the lower eyelids both on the anophthalmic side and the healthy fellow eye was performed to quantify acinar unit density, acinar unit diameter, acinar unit area, meibum secretion reflectivity, the inhomogeneous appearance of the glandular interstice, and inhomogeneous appearance of the acinar walls. Results The lower eyelids of the anophthalmic sockets revealed a significant reduction of the acinar unit density (p = 0.003) as well as a significantly more inhomogeneous appearance of the periglandular interstices (p = 0.018) and the acinar unit walls (p = 0.015) than the healthy fellow eyelid. However, there were no significant differences regarding the acinar unit diameter, acinar unit area, and meibum secretion reflectivity of the MGs on the anophthalmic side compared to the healthy fellow eyelid (p ≥ 0.05, respectively). Conclusions The eyelids of anophthalmic sockets without clinical blepharitis demonstrate a reduced density of MG acinar units and a more inhomogeneous appearance of the periglandular interstices and the acinar unit walls. This can cause meibomian gland dysfunction contributing to DASS and suggests early treatment of these symptomatic patients, even in the clinical absence of any blepharitis signs.

Should we care about the ocular surface in the anophthalmic patient?

“…Continuous mechanical interaction of the prosthesis with the tarsal and posterior conjunctival surface has often been suggested to induce socket inflammation which, over long periods, might lead to a loss of goblet cells, morphologic changes, and loss of meibomian glands, ultimately affecting tear film homeostasis and triggering dry eye symptoms, even in patients without blepharitis. 10,20,21,26 Although it is generally acknowledged that long term prosthesis wearing might induce conjunctival epithelium inflammation, until now only a few reports have analyzed the ocular surface of anophthalmic sockets focusing on superficial cytological alterations induced by long term prosthesis wearing. 3 Kim et al 20 showed that squamous metaplasia with decreased goblet cell density and increased nuclear-to-cytoplasm ratio occurred in the epithelial cells of the anophthalmic conjunctiva.…”

“…29 Evidence of significantly higher conjunctival inflammation and MGD on the anophthalmic side compared to the fellow eye has been demonstrated in several studies. 3,5,10,15,21 Rokohl et al 21 have recently shown with in vivo laser scanning confocal microscopy (LSCM) that cryolite glass prosthetic eye wearers have a reduced density of meibomian glands acinar units and a more inhomogeneous appearance of the periglandular interstices and the acinar unit walls in the lower eyelid. Similar to our study such results were obtained in patients without clinical blepharitis, and although no correlation was found between meibomian gland alteration and conjunctival inflammation, the influence of chronic socket inflammation over long periods was suggested to lead to secondary loss of acinar units.…”

“…7,10,16,19,20 Interestingly, it has been recently reported that subjective dryness is more significant on the anophthalmic side compared to the healthy fellow eye, even in the absence of tear deficiency and clinical blepharitis, thus suggesting the presence of additional underlying factors exacerbating dry eye symptoms in anophthalmic patients. 15,21 Nonetheless, the complex relationship between anophthalmic socket and prosthesis represents a clear challenge for the understanding of the pathophysiological changes leading to the development of dry eye symptoms. Only a few reports have assessed the conjunctival epithelium in prosthetic eye wearers, focusing mainly on the presence of giant papillary conjunctivitis.…”

Anophthalmic Socket Syndrome: Prevalence, Impact and Management Strategies

“… 100 The eyelids of anophthalmic sockets have a reduced density of meibomian glands acinar units and a more inhomogeneous appearance of the periglandular interstices and the acinar unit walls; in these cases, patients benefit from the regular use of lubricants and anti-inflammatory drops. 101 Pain may be due to trochleitis, to supraorbital nerve entrapment or to sensory infraorbital nerve compression. 102–105 …”

“…regular use of lubricants and anti-inflammatory drops. 101 Pain may be due to trochleitis, to supraorbital nerve entrapment or to sensory infraorbital nerve compression. [102][103][104][105] Trochleitis is relatively rare and is caused by supratrochlear nerve compression.…”