The presence of a local immune system in the upper blind and lower part of the human nasolacrimal duct

The nasolacrimal duct is exposed to exogenous agents, including potentially harmful microorganisms, coming from the eye surface by the lacrimal sac, and from the nasal cavity by the inferior meatus of the nose. The upper blind and lower part of the human nasolacrimal duct were examined immunohistochemically to ascertain the presence and localization of immunoglobulin-producing cells and the epithelial expression of IgA, IgM, and IgG in order to verify the possible antimicrobial properties of this duct. IgA-, IgM-, and IgG-positive immunocompetent cells were recognizable in the lamina propria of the upper blind and lower part of the human nasolacrimal duct, while an evident immunoreactivity for sIgA, IgM, and IgG was demonstrated in the cytoplasm of the apical epithelial cells. The results suggest that all the effector components of the mucosal immune system are present in that area of the human nasal mucosa next to the opening of the nasolacrimal duct as well as in the human lacrimal sac.     

The lacrimal fascia redefined.

It has been commonly accepted that the lacrimal fascia is an intact septum, composed of connective tissue, that separates the orbital cavity into a large compartment, which contains the eyeball, and a small compartment, which contains the lacrimal sac and nasolacrimal duct. the septum, however, is not necessarily always intact. We found a circular or oval opening in the lacrimal fascia in 37 of 52 specimens (71.2%) examined. The opening, which we shall refer to as the lacrimal fascial foramen, was located at variable levels in the lacrimal fossa. The lacrimal fascial foramen was buried in fatty tissue through which passed a branch of either the inferior palpebral artery or the infraorbital artery and a vein of the nasolacrimal duct. The clinical implications of the lacrimal fascial foramen in obstruction of the nasolacrimal duct are discussed.     

Anatomical features of the opening of the nasolacrimal duct and the lacrimal fold (Hasner's valve) for intranasal surgery: A cadaveric study

The location and size of the opening of the nasolacrimal duct and the lacrimal fold (Hasner's valve) are variable. These features have clinical importance in nasal surgery because of the difficulty in determining their location. The aim of this study was to demonstrate the anatomical features of the opening of the nasolacrimal duct and the lacrimal fold and to discuss the importance of such knowledge in minimizing the risk of injury at surgery. Twenty sagittal head sections from formalin‐fixed cadavers were examined. The sections showed no evidence of pathology or trauma. The type of opening of the nasolacrimal duct was a vertical sulcus in 14 of 20 (70%), an oblique sulcus in 2 of 20 (10%), an oblique fissure in 2 of 20 (10%), a vertical fissure in 1 of 20 (5%), and an anteroposterior fissure in 1 of 20 specimens (5%). The lacrimal fold was present in 16 of 20 specimens (80%). Five different forms of this fold were observed. Some morphological features were evaluated quantitatively. We believe that detailed anatomical knowledge of the opening of nasolacrimal duct will be useful in surgical approaches to this area. Clin. Anat. 22:925–931, 2009. © 2009 Wiley‐Liss, Inc.     

Functional anatomy of human lacrimal duct epithelium

 Resorption of tear fluid in the lacrimal ducts has hitherto been controversial; one reason for this has been insufficient knowledge of the anatomical structure and function of the lacrimal duct epithelium. The present study analyzes the structure of lacrimal duct epithelium by means of histological, histochemical, immunohistochemical and electronmicroscopical methods and draws a conclusion about its physiological function regarding its role in immunodeficiency. Investigations were performed on 31 lacrimal systems of 17 male and 14 female individuals (aged 54–88 years). Lacrimal ducts are surrounded by a wide-ranging cavernous system, which is embedded in an osseous canal between the maxilla and the lacrimal bone. The internal wall of the lacrimal canaliculi is lined by a stratified epithelium. The lacrimal sac and nasolacrimal duct contain a double-layered epithelium, which rests on a broad basement membrane. In their apical part epithelial cells contain large lipid droplets and secretory vacuoles. Epithelial cells are faced by microvilli and some tufts of kinociliae are also visible. Goblet cells are integrated in the epithelium as solitary cells or in a characteristical arrangement of several cells. The secretory product of these cells contains carbohydrates including fucose and sialic acid. Inside the surrounding cavernous system serous glands are found that open their excretory ducts into the lacrimal sac and nasolacrimal duct. Some T- and B-lymphocytes and macrophages may be demonstrated immunohistochemically in the submucosa partly penetrating the epithelium. Synthesized mucins of goblet cells form a specialized protective layer on the epithelium of the lacrimal ducts, which functionally serves for a simplified drainage of tear fluid into the inferior meatus of the nose. Together with immunocompetent cells, the protective layer plays a role in antigen defense and prevents invasion of pathogenic agents. The facing of epithelial cells by microvilli gives hints of reabsorption of lacrimal fluid inside the lacrimal ducts. Accepted: 13 January 1998     

CT-anatomy of the nasolacrimal sac and duct

Summary Recent developments in ophthalmology such as balloon dilatation, stent implantation, laser therapy and endoscopy of the lacrimal drainage system raise the need for a detailed anatomical knowledge of this system. In this study morphometric measurements of the lacrimal drainage system were performed with thin-section axial computed tomography (CT) examinations in 147 patients with no signs of pathology related to the lacrimal drainage system. The mean length of the nasolacrimal duct measured 11.2±2.6mm (range: 6–21 mm), the narrowest diameter was 3.7±0.7 mm (range: 2–7 mm). The mean length of the nasolacrimal sac was 11.8±2.5 mm (range: 6–18 mm). The width of the nasolacrimal sac did not exceed 4 mm unless filled with air. In 43 (29.3%) of the subjects air was visible within the nasolacrimal sac or duct. The knowledge of the morphometry of the lacrimal drainage system enables the ophthalmologist to plan intervention on the lacrimal drainage system precisely and avoid unnecessary manipulations.

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Anatomie du sac et du conduit lacrymo-nasaux en tomodensitométrie

Résumé Les récents progrès en ophtalmologie tels que la dilatation par ballonnet, la pose de sondes, les traitements au laser, l'endoscopie du système lacrymal accroissent la nécessité d'une connaissance anatomique précise de ce système ; dans cette étude morphométrique, les mesures du système de drainage lacrymal ont été réalisées par tomodensitométrie en coupes fines (CT); l'étude portait sur 147 patients indemnes de toute pathologie du système de drainage lacrymal. La longueur moyenne du conduit lacrymal était de 11,2±2,6 mm (limites : 6–21 mm) ; le diamètre le plus réduit était de 3,7±0,7 mm (limites : 2–7 mm). La longueur moyenne du sac lacrymo-nasal était de 11,8 mm±2,5 mm (limites 6–18 mm) ; la largeur du sac n'excédait pas 4 mm, en dehors d'un remplissage par l'air. La présence d'air a été décelée dans le sac ou le conduit chez 43 sujets (29,3 %). La connaissance de la morphométrie du système de drainage lacrymal permet à l'ophtalmologiste de planifier avec précision une intervention sur le système en évitant des manuvres intempestives.

     

The nasolacrimal duct of anuran amphibians: suggestions on its functional role in vomeronasal perception

Tear secretions discharged by the Harderian gland are suggested to function as a solvent for molecules sensed by the vomeronasal organ (VNO) in anurans. It has been assumed that chemical stimuli are absorbed at the surface of the eye to be carried – together with the lacrimal fluid – into the nasal cavity via the nasolacrimal duct. In the study presented herein, we examined the intranasal anatomy of 10 different anuran species to analyse the opening region of the nasolacrimal duct and its functional relationship with the VNO and the external naris. In addition, vital staining of the nasal cavities was conducted. Our results indicate that stimuli reaching the VNO are more likely to be ingested through the nostril than via the eye. In many cases the intranasal orifice of the nasolacrimal duct shows a close proximity to the external naris and simultaneously we observed a noticeable distance to the VNO. We suggest that the secretions of the Harderian gland are carried to the external naris by the nasolacrimal duct, where they bind chemical stimuli that are subsequently actively transported into the VNO. In some of the investigated species the opening region of the tear duct was situated in a more caudal part of the nasal cavity and closer to the VNO. In these cases a conspicuous system of channels can be found, which is suspected to carry the intruding medium of smell from the nostril to the nasolacrimal aperture.     

泪道逆行置管术联合下鼻甲骨折内移术的观察

目的：观察泪道逆行置管联合下鼻甲骨折内移术治疗鼻泪管阻塞伴下鼻道狭窄的疗效。方法：60例72眼慢性泪囊炎伴下鼻道狭窄患者按区组随机将病员分成两组,A（30例35眼）组为试验组,行泪道逆行置管联合下鼻甲骨折内移术;B组（30例37眼）为对照组,只行泪道逆行置管术;C（512例702眼）组亦为慢性泪囊炎不伴下鼻道狭窄患者,只行泪道逆行置管术。结果：一年后追踪观察,A组治愈率84．86％,有效率93．93％,B组治愈率29．41％,有效率61．76％。C组治愈率85．60％,有效率95．09％。AB两组比较有显著差异（P〈0．005）。A组和C组相比无明显差异。结论：泪道逆行置管联合下鼻甲骨折内移术治疗鼻泪管阻塞伴下鼻道狭窄的疗效比单纯行泪道逆行置管术效果好。     

On the A. malaris of the common squirrel monkey (Saimiri sciureus)

Detailed observations were made of the a. malaris in 11 adult common squirrel monkeys (Saimiri sciureus) utilizing the plastic injection method. The malar artery was well-developed in all 21 examples observed and arose medially from the infraorbital artery proximal to the entrance of the infraorbital canal and lateral to the obliquus inferior muscle. The a. malaris passed superomedially outside the periorbita on the orbital surface of the maxilla and curved medially in front of the muscle, where it gave rise to the infraorbital nerve, the periosteal, the inferior oblique muscular and the infraorbital marginal branches. However, these branches arose directly from the infraorbital artery in many cases. The malar artery ascended in the lower eyelid up to the bottom of the lacrimal sac, where it gave rise to the third palpebral branch and the medial inferior palpebral artery. This artery did not anastomose with peripheral branches of the supraorbital artery. The malar artery continued to pass superomedially behind the lacrimal sac and gave off the nasolacrimal canal and the lacrimal sac branches. However, the former arose in common with the latter in many cases. The malar artery finally ascended behind the medial palpebral ligament after giving off the dorsal nasal branch and the medial superior palpebral artery at the superior end of the lacrimal sac. Its main stream formed a strong communication with the dorsal nasal artery of the supraorbital artery. This communication in an arc was characteristic in the common squirrel monkey. The medial inferior and superior palpebral arteries were well-developed in all examples and formed distinct, inferior and superior palpebral arterial arches by anastomosing with the lateral fellows of the lacrimal, respectively. A large arterial ring surrounding the upper tarsus was constructed from the superior palpebral arterial arch, branches of the lateral superior palpebral artery and the palpebral branch of the supraorbital artery.     

耳内窥镜经鼻观察泪囊前泪道阻塞鼻泪管下口的形态

目的　应用30o斜耳内窥镜镜头经鼻观察泪囊前泪道阻塞患者鼻泪管下口的形态,总结内窥镜下泪囊前泪道阻塞患者鼻泪管下口的影像解剖形态特征,为临床开展经鼻泪管下口逆行插管造影检查打下基础。  方法　选取患有泪囊前泪道阻塞性疾病患者54例（75眼）,上下泪点闭锁3例（5眼）、上下泪小管阻塞15例（24眼）、泪总管阻塞18例（28眼）、陈旧性上下泪小管断裂18例（18眼）,均应用30°斜耳内窥镜镜头观察鼻泪管下口,总结活体泪囊前泪道阻塞患者鼻泪管下口的形态特点。  结果　54例（75眼）,66眼鼻泪管下口开放,开放率88%,其中1例鼻泪管下口开放者,受刺激后,Hanser瓣膜完全遮盖鼻泪管下口,导致其呈线形关闭;9眼鼻泪管下口闭锁,占12%。根据鼻泪管下口开放的形态将其分为椭圆形宽大状（30眼,45.45%）、三角形裂隙状（12眼,18.18%）、条形裂隙状（24眼,36.36%）三种类型。21例（42眼）双眼患病的患者,双侧鼻泪管开口形态不同者15例（30眼,71.42%）,双侧鼻泪管开口形态相同者6例（12眼,28.57%）。  结论　应用30°斜耳内窥镜镜头经鼻观察泪囊前泪道阻塞患者的鼻泪管下口的可行性好,对于鼻泪管下口开放的患者有进行内窥镜引导下的逆行插管造影检查的解剖基础。     

Nd：YAG激光泪道成形术和鼻泪管支架术治疗慢性泪囊炎的疗效对比

目的比较Nd：YAG激光泪道成形术和鼻泪管支架术治疗慢性泪囊炎的临床效果。方法 93例（102眼）慢性泪囊炎患者随机分成两组,一组应用Nd：YAG激光泪道成形术治疗,另一组应用鼻泪管支架术治疗,比较两组的治疗效果。结果应用Nd：YAG激光泪道成形术治疗57眼,有效39眼（68.42%）;鼻泪管支架术治疗45眼,有效40眼（88.89%）,两组疗效差异有统计学意义（χ2=6.03,P〈0.01）。结论鼻泪管支架术相对于同样微创的Nd：YAG激光泪道成形术治疗慢性泪囊炎疗效更加稳定,手术成功率更高,不失为微创治疗慢性泪囊炎的首选术式。     

Morphometric characteristics and correlation interdependence of the lacrimal sac fossa and nasolacrimal canal in cerebral and facial parts of the skull of various shape

Morphometric characteristics of lacrimal sac fossa (LSF) and nasolacrimal canal (NLC) were studied in 105 macerated skulls of humans of mature age. Extreme shape variants were detected for LSF and NLC inferior foramen. The peculiarities of topographic-anatomical relations of NLC with the neighboring structures of nasal cavity were established. Morphometric characteristics of LSF and NLC were found to be largely determined by the shapes of facial part of the skull, nasal cavity and orbit, and to a lesser extent by the shape of cerebral part of the skull. Some variants of LSF and NLC topographic-anatomical localization were found to exist that could predispose to spreading of an inflammatory process from the adjoining areas. Correlation analysis of morphogenetic relations of LSF and NLC has demonstrated significant dependence of only some dimensions in each of the skull shape variants.     

Ontogeny of the Orbital Glands and Their Environs in the Pantropical Spotted Dolphin (Stenella attenuata: Delphinidae)

The nasolacrimal duct (NLD) connects the orbital (often associated with the Deep Anterior Orbital gland: DAOG, a.k.a. Harderian gland) and nasal regions in many tetrapods. Adult cetaceans are usually said to lack an NLD, and there is little agreement in the literature concerning the identity of their orbital glands, which may reflect conflicting definitions rather than taxonomic variation. In this study, we examined an embryological series of the pantropical spotted dolphin (Stenella attenuata), and report numerous divergences from other tetrapods. Underdeveloped eyelids and a few ventral orbital glands are present by late Stage (S) 17. By S 19, circumorbital conjunctival glands are present. In S 20, these conjunctival glands have proliferated, eyelids (and scattered palpebral glands) have formed, and a duct similar to the NLD has appeared. Subsequently, both the palpebral glands and the NLD are progressively reduced by S 22, even as the conjunctival glands exhibit regional growth. In most tetrapods examined, the ontogeny of the NLD follows a series of three stages: Inception of NLD, Connection of orbit and nasal cavity by the NLD and Ossification (i.e., formation of the bony canal surrounding the NLD, emerging into the orbit via the lacrimal foramen in the lacrimal bone). In contrast, the dolphin NLD originates at the same time as the lacrimal bone, and a lacrimal foramen fails to develop. The cetacean fossil record shows that a lacrimal foramen was present in the earliest ancestral amphibious, freshwater forms, but was soon lost as the lineage invaded the oceans. Anat Rec, 2017. © 2017 Wiley Periodicals, Inc. Anat Rec, 301:77–87, 2018. © 2017 Wiley Periodicals, Inc.     

Morphological Study of Fossa For Lacrimal Sac: Contributions by Lacrimal and Maxilla

Fossa foclacrimal sac, houses lacrimal sac and its lower end (orbital opening) continues through nasolacrimal canal to open into the inferior meatus of nose. Surgical procedures like dacryocystostomy and dacryocystorhinostomy are performed extranasally and endoscopic endonasal dacryocystostomy is done intranasally.Lacrimal bone and frontal process of maxilla, contributing to the formation of fossa, were observed for their morphological features. (based on examination of 734 orbits from 528 skulls)Shapes of maximum number of fossae observed were found to be oval, and contribution by maxilla and lacrimal bone was in variable proportions. The two extremes were also observed where the fossae were entirely formed by maxilla, orlacrimal bone and remaining fossae have been contributed in variable proportions.Anterior bauhdary yeas observed, to be formed by maxilla in 99% of cases and by lacrimal in 0.81 % cases. Posterior boundary was observed to be`formed by lacrimal in 98% of cases and by maxilla in 0.01 % fossae, in which the lacrimal bone was either present behind the boundary of the fossa or absent.From this study it is concluded that one should scan the contribution of the fossa for lacrimal sac by maxilla and lacrimal, as it is essential for endoscopic endonasal dacryocystorhinostomy. Presence of perilacrimal ossicles which are perhaps the detached segments of lacrimal bone and lacrimal bone being rudimentary and absent in some of the cases, are suggestive of the frontal process of maxilla increasing in size and the lacrimal bone gradually vanishing in the process of evolution.     

复发性泪囊炎鼻腔泪囊解剖学特点及其在内镜下鼻腔泪囊吻合联合支架植入术中的应用

目的 内镜下观察鼻腔泪囊的解剖结构，采用鼻腔泪囊吻合术联合支架植入方式治疗慢性复发性泪囊炎，并观察其疗效。 方法 收集2010年1月至2019年1月期间就诊于甘肃省人民医院耳鼻咽喉头颈外科的已行传统内镜下鼻腔泪囊吻合术后再次复发的慢性泪囊炎患者30例，共计30只眼，予以再次行内镜下鼻腔泪囊吻合术，术中联合支架植入术，术后3个月拔出泪道支架，观察患者术后流泪症状，冲洗泪道判断泪道阻塞情况，随访期为12个月。 结果 随访至12个月时，30例患者14只眼无诉流泪，溢泪，冲洗泪道通畅，鼻内镜下观察见造瘘口通畅，造瘘口无明显缩小；30例12只眼无诉流泪，溢泪，冲洗泪道通畅，但可见造瘘口缩小；4只眼可见造瘘口旁肉芽增生，再次堵塞造瘘口，治疗整体有效率为87%。 结论 内镜下鼻腔泪囊吻合术联合支架植入是治疗慢性复发性泪囊炎一种有效方法，临床效果良好。     

Distribution of cytochrome P-450 monoxygenase enzymes in the nasal mucosa of hamster and rat

Deposition of inhaled particulates onto the respiratory mucosa is relatively great in that portion of the nasal cavity unprotected by ciliated, goblet, or keratinized superficial cells. The cytochrome P-450 system is an important enzyme system involved in the biotransformation of xenobiotics into metabolites that are more readily absorbed. To examine the transitional region caudal to the nasal vestibule, nasal tissues of hamster and rat were prepared for immunocytochemistry. Blocks of tissue representing four levels along the axis of the nasal cavity were examined. Paraffin sections were processed through the avidin-biotin peroxidase procedure, with diaminobenzidine tetrahydrochloride as the chromagen. Enzyme localization was accomplished through the use of antibodies for three rabbit cytochrome P-450 isozymes; 2, 5, and 6 (subfamilies IIB, IVB, and IA, respectively); and for rabbit NADPH-cytochrome P-450 reductase. Enzyme distribution was similar in both hamster and rat nasal tissues except in cells of striated and intercalated ducts of nasal glands and in cells of the nasolacrimal duct where immunoreactivity for reductase and isozyme 2 was intense in nonciliated cells lining the nonolfactory epithelium, in sustentacular cells of the olfactory epithelium, and acinar cells of olfactory glands. Distribution of reaction products to isozyme 5 and 6 were similar to but not so intense as those of reductase an isozyme 2. Reaction products for reductase and isozyme 2 occurred generally in the same cellular and intracellular regions with the following exceptions: isozyme 2 was more concentrated in cells of striated ducts and of the nasolacrimal duct, and reductase was more abundant in intercalated ducts of nasal glands. Ciliated and goblet cells in epithelia lining much of the nasal cavity evidenced little reactivity; those ciliated cells adjacent to olfactory mucosa contained reaction product. It is concluded that the nonciliated epithelium adjacent to the internal ostium of the nose contains enzymes essential for biotransforming extrinsic particles that impinge on it from inhaled air currents.     

Morphological and morphometric evaluation of lacrimal groove

The nasolacrimal canal is placed at the anterior part of the inferior lateral wall of the orbit and opens to the inferior nasal meatus. The canal can be obstructed by acquired diseases such as dacryocystitis and posttraumatic epiphora due to nasoorbitoethmoidal fractures. Furthermore in nasolacrimal canal obstructions, dacryocystorhinostomy with balloon dilatation is used frequently. In evaluation of the nasolacrimal canal's acquired diseases, obstruction etiologies and during the reopening of the canal with balloon dilatation, knowing the lacrimal groove's morphology and morphometry play an important role. The aim of the present study was to evaluate not only the morphological features and types but also the morphometric measurements of lacrimal groove. A total of 60 (30 right, 30 left) adult human dry bone maxillae (both male and female samples) from the collection of the Department of Anatomy of Dokuz Eylül University Medical School were used. Digital compass with 0.01 mm sensitivity was used for measurements. Average length of lacrimal groove was 9.62 +/- 2.10 mm. Average width of lacrimal groove was 5.88 +/- 1.53 mm at upper one-third, 8.04 +/- 2.05 mm at middle one-third, and 5.94 +/- 1.28 mm at lower one-third. In 87.7% of cases a crista was observed at the end of the lacrimal groove. Among them, 34.0% were directed to inferior, 54.0% were directed to posterior and 12.0% were horizontal. The present results on the width, length, shape and direction of the lacrimal groove could mediate the etiology of nasolacrimal canal obstructions and could be helpful in surgical approaches and clinical treatment.     

Lacrimal Duct Occlusion Is Associated with Infectious Keratitis

Background: To explore the prevalence of lacrimal duct obstruction in patients with infectious keratitis, and the necessity of lacrimal duct dredge in the treatment of human infectious keratitis.Methodology/Principle Findings: The design is prospective, non-control case series. Thirty-one eyes from twenty-eight continuous patients with infectious keratitis were included in this study. The presence/absence of lacrimal duct obstruction was determined by the lacrimal duct irrigation test. The diagnosis of infectious keratitis was made based on clinical manifestations, cornea scraping microscopic examination and bacterial/fungus culture. Diagnosis of viral keratitis was set up based on the recurrent history, deep neovascularization and typical outlook of the cornea scar. The treatment of keratitis included drugs, eye drops or surgery, while treatment of chronic dacryocystitis was lacrimal duct dredging with supporting tube implantation surgery. In the thirty-one eyes with infectious keratitis, fifteen suffered from fungal keratitis (48%), two bacterial keratitis (6%), and fourteen viral keratitis (45%). Eleven eyes (35%) from ten patients with infectious keratitis also suffered from lacrimal duct obstruction. In those cases, six eyes also suffered from lower canalicular obstruction, three nasolacrimal duct obstruction and chronic dacryocystitis, one a combination of upper and lower canalicular obstruction, one upper canalicular obstruction. After local and systemic applications of anti-bacterial, anti-viral, anti-fungal and anti-inflammatory drugs, twenty-eight eyes (90%) recovered within three weeks, while the ulceration of three patients required the lacrimal duct dredging and supporting tube implantation surgery for the healing.Conclusions: Herein, we first report that the prevalence of infectious keratitis is closely correlated to the occurrence of lacrimal duct obstruction. When both confirmed, simultaneous treatment of keratitis and lacrimal duct obstruction promptly is required. Further evaluation of mechanism, prevention and control of the diseases are warranted.     

泪前隐窝入路的解剖与手术学意义

本文就泪前隐窝入路相关的应用解剖以及该入路的临床应用进行概述,重点介绍泪前隐窝、齿槽隐窝、鼻泪管、筛前动脉鼻外侧支、中鼻甲动脉、下鼻甲动脉、下鼻道动脉、翼腭窝及其内容物、颞下窝及其内容物以及蝶窦外侧隐窝等的临床应用解剖结构,并对泪前隐窝入路在真菌性上颌窦炎、上颌窦囊肿、眼眶眶底骨折、翼腭窝肿瘤、颞下窝肿瘤以及蝶窦外侧隐窝病变中的应用,以及相应解剖结构对手术的影响加以分析,为耳鼻咽喉头颈外科临床医师开展此类手术提供参考。     

Innervation of the cavernous body of the human efferent tear ducts and function in tear outflow mechanism

The lacrimal sac and nasolacrimal duct are surrounded by a wide cavernous system of veins and arteries comparable to a cavernous body. The present study aimed to demonstrate the ultrastructure of the nervous tissue and the localisation of neuropeptides involved in the innervation of the cavernous body, a topic not previously investigated. Different S‐100 protein antisera, neuronal markers (neuron‐specific enolase, anti‐200 kDa neurofilament), neuropeptides (substance P, neuropeptide Y, calcitonin gene‐related peptide, vasoactive intestinal polypeptide) and the neuronal enzyme tyrosine hydroxylase were used to demonstrate the distribution pattern of the nervous tissue. The ultrastructure of the innervating nerve fibres was also examined by means of standard transmission electron microscopy. The cavernous body contained specialised arteries and veins known as barrier arteries, capacitance veins, and throttle veins. Perivascularly, the tissue was rich in myelinated and unmyelinated nerve fibres in a plexus‐like network. Small seromucous glands found in the region of the fundus of the lacrimal sac were contacted by nerve fibres forming a plexus around their alveoli. Many nerve fibres were positive for S‐100 protein (S 100), neuron‐specific enolase (NSE), anti‐200 kDa neurofilament (RT 97), calcitonin gene‐related peptide (CGRP), substance P (SP), tyrosine hydroxylase (TH), and neuropeptide Y (NPY). Vasoactive intestinal polypeptide (VIP) immunoreactivity was only demonstrated adjacent to the seromucous glands. Both the density of nerve fibres as well as the presence of various neuropeptides emphasises the neural control of the cavernous body of the human efferent tear ducts. By means of this innervation, the specialised blood vessels permit regulation of blood flow by opening and closing the lumen of the lacrimal passage as effected by the engorgement and subsidence of the cavernous body, at the same time regulating tear outflow. Related functions such as a role in the occurrence of epiphora related to emotional responses are relevant. Moreover, malfunction in the innervation of the cavernous body may lead to disturbances in the tear outflow cycle, ocular congestion or total occlusion of the lacrimal passages.     

Agenesis or hypoplasia of major salivary and lacrimal glands

We described a young man with almost total absence of the parotid glands, hypoplasia of both lacrimal glands, marked hypofunction of both submandibular glands, and left nasolacrimal duct atresia. Lack of tearing, severe dental caries, and conjunctival scarring following chronic xerophthalmia and conjunctivitis serve to alert pediatricians to this autosomal dominant disorder with considerable variation in expressivity.