Labial Salivary Gland Transplantation in cases of Severe Dry Eyes

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. Indeed, a lot of artificial tears, gels and ointments are currently available for the patients with dry eyes and the ophthalmologist can put plugs in the tear duct or surgically close these ducts. 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 use of labial mucosa and salivary glands from the lower lip that can be transplanted to the inner 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.

The glands are easily accessible in 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. To be able to check the patient the day after we ask them to stay overnight but all further 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.

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Peter Raus MD is the head of Miró, a centre for Ophthalmology, Oculoplastic Surgery and Aesthetic Medicine of the face. Peter was trained in Belgium, Spain, Egypt and the USA and is an expert in dry eyes therapy and surgery.