Surgical Treatment for Severe Dry Eyes

Dry eyes are one of the most frequent problems in patients over 50 years old and even younger patients can have dry eyes. Indeed: a lot of diseases and drugs can cause dry eyes! Although the possible causes of dry eyes are very numerous, in most cases treatment is limited to a substitution therapy with artificial tears or gels. However: these products only give a partial or temporary solution and that is why sometimes silicone plugs are placed in the tear duct of the patients with dry eyes to prevent the normal outflow of the tears to the nose. Especially in younger patients these plugs can lead to infections because not only the tears but also the micro organisms are kept in the eye instead of being washed away to the nose.

New therapy: A few years ago Prof. Juan Murube from the famous Alcalá University of Madrid in Spain discovered that the secretion product of the salivary glands from de lower lip is very similar to natural tears. He developed a surgical technique to transplant the glands to the inner side of the eyelids. These glands are easily accessible and can be transplanted to the eyelids together with the overlying mucosa. I slightly modified his technique by using radiosurgery and the use of a running suture instead of separate sutures With the patient under general anaesthesia a specimen of labial mucosa of the lower lip and underlying glands is dissected with Radiosurgery and transplanted to the inner, conjunctival side of the eyelid. The patients only have to stay in the hospital for one night and the running sutures can be taken out after already two weeks.

Results: At the time the sutures are removed,most patients already notice an improvement so that they can lower the frequency of instillations of artificial tears. To prove this subjective feeling of the patients after this new surgical technique I asked a pathologist to microscopically examine the transplanted tissue. Biopts of this transplanted tissue, taken after 18 and 36 months confirm the survival of the transplanted glands that maintain their basal secretion.

Conclusions: Up to June 2007 I treated 18 eyes with this technique and although more study has to be done on this type of surgery, the Radiosurgically assisted transplantation of labial salivary glands promises to be an excellent alternative for cases of very dry eyes when conventional treatments fail. Patients’ recovery is very fast with only minimal discomfort in the recovery time. However I would like to stress that this treatment is not the first choice therapy for all cases of dry eyes but has to be considered as a possible solution for severe cases.