Year : 1979 | Volume
: 27 | Issue : 4 | Page : 231-
Stensons duct transplantation in xerophthalmia
TP Ittyerah, ST Fernandez, M George Jacob
Little Flower Hospital, Kerala, India
T P Ittyerah
Little Flower Hospital, Angamally, Kerala
|How to cite this article:|
Ittyerah T P, Fernandez S T, Jacob M G. Stensons duct transplantation in xerophthalmia.Indian J Ophthalmol 1979;27:231-231
|How to cite this URL:|
Ittyerah T P, Fernandez S T, Jacob M G. Stensons duct transplantation in xerophthalmia. Indian J Ophthalmol [serial online] 1979 [cited 2020 Sep 20 ];27:231-231
Available from: http://www.ijo.in/text.asp?1979/27/4/231/32646
Saliva as a moistening agent was tried in dry eyes when other attempts fail to keep the eyes wet'. The purpose of this communication is to share our little experience based on five eyes of 3 patients.
Materials and Methods
3 patients (2 male and one female) were included in the study. Both the male patients had bilateral xerophthalmia with corneal opacity and vascularisation following Steven Johnson syndrome a few years back. The lady had marked xerophthalmia in one eye. Surgery was performed in 5 eyes of the 3 patients.
The procedure was done under general anaesthesia. First the opening of the parotid duct identified and a probe was passed. Buccal mucosa around the opening was dissected in a rectangular shape. A skin incision was made along the line of parotid duct. The duct could be felt because of the probe in the parotid duct. The duct was dissected without injuring the branches of facial nerve and the parotid gland. The opening alongwith the mucosa was brought out. A tunnel was made the lower fornix to the skin opening. If the duct was short the mucosa was used to elongate it by suturing with 6 zero black silk and corneal needle A polythene tube was passed through the duct and 4 zero silk suture was passed at the mucosal edge. The duct and polythene tube were pulled through the tunnel with an artery clamp passed from the lower fornix through the tunnel. The mucous membrane sutured to the lower fornix. The skin incision and mucosal incision closed with 4 zero silk and 4 zero catgut respectively. A drain was put at the lower end of the incision.
During the post operative period they were giver Bacterium tab. 2 bd. The polythene tube and drairr were removed on third day. Swabs were taken foi culture and sensitively from the conjunctival sac. Dressing was done with Genticyn Drops.
In all the 5 cases, the immediate result was excellent. Eyes became wet and two patients had improvement in vision, but later on (after 3 months) the eye started drying up in one patient.
One patient who had bilateral successful parotid duct transplantation had dryness of mouth for few weeks which later subsided.
The parotid fistula developed in one case healed by itself when the obstruction of the duct was relieved by probing from the conjunctival opening of the duct.
In all the cases the obstruction of the duct was around the upper 1/3 of the transplanted duct.
In all the cases swab taken from the conjunctiva for culture showed pseudomonus aerogenosa growth. Dribling of the saliva from the eye was a problem in the successful cases (2 cases) for few days on taking food.
Transplantation of parotid duct is a desperate measure which can be advocated in cases of xerophthalmia. The short term results seem to be good. Retention of a polythene tube and repeated probing was found to be more effective in our cases for keeping the patency of the duct. Usually there is the problem of excessive secretion and crocodile tears which tend to decrease with time.
Five cases of parotid duct transplantation were studied, the procedure and the immediate post operative complications discussed. In three eyes the duct transplantation helped to keep the eyes moist for a period of three months.
We are grateful to Dr. C.K. Eapen, M.D., Medical Superintendent for allowing us to publish this paper.
|1||Duke Elder, S., 1965, System of Ophthalmology vol. VII Part I, P. 510, Henry Kimpton, London.|