Conditions We Treat – Dry Eyes
Stem cells could help patients with dry eyes (keratoconjunctivitis sicca) due to:
- Sjögren’s syndrome (Autoimmune disorder)
- Age related dry eyes
- Medication affected dry eyes (e.g. post chemotherapy)
- Post dry and painful eyes from LASIK surgery
The role of tears
The production of tears is critical to lubrication of the eyes. Insufficient tears can cause chronic conjunctivitis, photophobia, blepharitis, as well as irritation and ulceration to the cornea.
There is no surgical treatment for low-producing or non-functioning lacrimal and meibomian glands, and the glands have little regenerative capability. Lacrimal and meibomian glands supply the tears that lubricate the eyes. The lacrimal gland is situated in the upper and outer portion of the bony orbit while the meibomian glands are situated in the upper and lower tarsal plates (eyelids).
There are autoimmune diseases such as Sjögren’s syndrome, in which the body attacks its own tear ducts, lacrimal glands and salivary glands producing dry eyes and dry mouth respectively. While there are a variety of ancillary methods to keep the eye moist these are restrictive to a certain extent. As soon as the eye is dry again then you have to use the aids.
There currently is no way to restore lacrimal and meibomian gland function permanently. Artificial tears and lubricants are available, but clinicians generally don’t regard it as an effective long-term solution.
In respect of the condition following LASIK surgery most patients complain of a painful dry eye. It has been reported that up to 25% of patients may have this complaint. It is proposed that the injury is essentially a neuropathic pain affecting the ophthalmic division of the trigeminal nerve which is responsible for supplying the sensory fibres to the cornea and sclera. As a laser is used to reshape the cornea for refractive purposes it initiates a thermal coagulopathy of the sensory receptor cells supplied by the ophthalmic division of the Vth nerve. This then in time produces a reflex sympathetic dystrophy of the cornea not unlike other areas of the body that may suffer the same problem from other mechanisms of injury. The treatment methodology is to block the sympathetic dystrophy by introducing stem cells into the nerve supply of the cornea and sclera via the lacrimal and frontal branches of the opthalmic division of the Vth nerve by injecting stem cells around the lacrimal gland. This is the anatomical area where these 2 nerves traverse the orbit and supply the sensation to the cornea and sclera. Similarly an injection of stem cells is made into the pterygopalatine fossa via the greater palatine canal in the palate. The rationale for this is the greater petrosal nerve supplies parasympathetic preganglionic fibres via the pterygoid canal to the pterygopalatine ganglion and fossa. These synapse and the postganglionic fibres are sent via the zygomatic nerve and zygomaticotemporal nerve to the lacrimal gland. Indeed patients with post LASIK dry eye pain may not have dry eyes at all and a Schirmers test would still be required. Nevertheless the treatment for a dry eye and a post LASIK painful eye is essentially the same.
It has been reported that Mesenchymal Stem Cells injected into or around the remaining lacrimal glands can improve function and flow of tears in animals. This has yet to be proved in humans however there have been anecdotal case reports and some reports from American stem cell companies of offering services in this regard.
Animal Research and its possible relevance to humans
Keratoconjunctivitis sicca (KCS) or dry eye disease (DED) is an immune-mediated multifactorial disease, with a high level of prevalence in humans and dogs. The aim in this study was to investigate the therapeutic effects of allogeneic adipose-derived mesenchymal stromal cells (Ad-MSCs) implanted around the lacrimal glands in 12 dogs (24 eyes) with KCS, which was refractory to currently available treatments. Schirmer tear test (STT) and ocular surface integrity were assessed at 0 (before treatment), 3, 6, and 9 months after treatment. Average STT values and all clinical signs showed a statistically significant change during the follow-up.
Average STT values and all clinical signs showed a statistically significant change during the follow-up with reduction in all ocular parameters scored: ocular discharge, conjunctival hyperaemia, and corneal changes, and there were no signs of regression or worsening. Implanted cells were well tolerated and were effective reducing clinical signs of KCS with a sustained effect during the study period. None of the animals showed systemic or local complications during the study. To our knowledge, this is the first time in literature that implantation of allogeneic Ad-MSCs around lacrimal glands has been found as an effective therapeutic alternative to treat dogs with KCS. These results could reinforce a good effective solution to be extrapolated to future studies in human.
To our knowledge, this is the first time in literature that implantation of allogeneic Ad-MSCs around lacrimal glands has been found as an effective therapeutic alternative to treat dogs with KCS. These results could reinforce a good effective solution to be extrapolated to future studies in human.
Olympus Treatment Planning
We would require you to give a good history of your condition and undergo Schirmers tear tests to ascertain your tear production. Olympus would harvest 20-30cc’s of fat from your abdomen under local anaesthesia and then convert the fat to stem cells and stromal vascular fraction. We would then inject the stem cells and SVF (approximately 1-2 cc’s each eye) into your lacrimal and meibomian glands. We would inject .25-.5cc into the pterygopalatine fossa via the mouth. We would use local anaesthetic prior to the injection of stem cells. Discomfort is minimum and the procedure is done awake. It would be required for you to have a second or ‘top up’ procedure 6 months later and possibly yearly after that.
Dr Peter Vickers, FRCS, FRCSE, FRACDS is a MaxilloFacial Surgeon who has had 40 years of experience in treating patients with orbital and eye trauma, facial deformity and orbital cancer. Dr Vickers has published on Naso-Lacrimal duct cancer and orbital exenteration. Dr Vickers would undertake the fat harvesting and injection of stem cells to the lacrimal and meibomian glands.
Although there has been isolated reports in the literature of this being a successful procedure, NO guarantee is given nor expressed by Olympus as to the effectiveness of this treatment. Olympus Stem Cells Pty Ltd require the patient to fully investigate the proposed treatment and be satisfied that they are fully informed. The FDA (Food and Drug Administration) in the USA and the TGA (Therapeutic Goods Administration) in Australia make no statements that this procedure is effective as not enough clinical trials have been performed.
The Australian Health Practitioner Regulation Agency (AHPRA) also recommend you seek a second medical and surgical opinion to fully appraise yourself of your condition and ascertain alternatives to the proposed treatment provided by Olympus Stem Cells.