bromochloroacetic-acid and Eyelid-Diseases

Meibomian gland dysfunction (MGD) is the major cause of evaporative dry eye disease (EDED) and dysfunction is widely thought to mechanistically involve ductal hyperkeratinization, plugging and obstruction. This review re-evaluates the role of hyperkeratinization in MGD based on more recent findings from mouse models. In these studies, eyelids from normal young and old mice or mice exposed to desiccating stress were evaluated by immunofluorescent tomography and 3-dimensional reconstruction to evaluate gland volume, expression of hyperkeratinization markers and cell proliferation or stimulated Raman scattering (SRS) microscopy to assess lipid quality. Results indicate that aging mice show dropout of meibomian glands with loss of gland volume and a forward migration of the mucocutaneous junction anterior to the gland orifice; similar age-related changes that are detected in human subjects. Atrophic glands also showed evidence of epithelial plugging of the orifice without the presence of hyperkeratinization. Mice exposed to desiccating stress showed hyperproliferation of the meibomian gland and ductal dilation suggesting a marked increase in lipid synthesis. Lipid quality was also affected in EDED mice with an increase in the protein content of lipid within the duct of the gland. Overall, age-related changes in the mouse show similar structural and functional correlates with that observed in clinical MGD without evidence of hyperkeratinization suggesting that gland atrophy may be a major cause of EDED. The response of the meibomian gland to desiccating stress also suggest that environmental conditions may accelerate or potentiate age-related changes.

Topics: Animals; Atrophy; Dry Eye Syndromes; Eye Proteins; Eyelid Diseases; Humans; Keratins; Meibomian Glands; Mice

Phakomatous choristoma is a rare congenital tumour of lenticular origin. The exact location at clinical presentation is controversial, but herein we provide evidence that phakomatous choristoma may be located in the lower eyelid or orbit or both.. Case report of an infant presenting with a mass in the lower eyelid at birth, a systematic review of previous cases of phakomatous choristoma and an outline of the histopathological features in normal mid-facial embryonic development at different gestational ages.. The histopathological features of the present case were consistent with those of a phakomatous choristoma. The preoperative imaging studies and clinical findings at surgery suggested that the tumour occupied parts of both the lower eyelid and anterior orbit. Histopathological sections of a normal human embryo showed that at the 26-mm stage of development the embryonic lens is formed but the bony walls defining the orbit are not yet present.. Phakomatous choristoma arises in a setting of undifferentiated mesenchymal tissue which later may develop into the lower eyelid or orbit depending on the choristomatous elements being deposited superficial or deep to the embryonic surface.

Topics: Avidin; Biomarkers; Biotin; Choristoma; Diagnosis, Differential; Eyelid Diseases; Female; Humans; Infant, Newborn; Keratins; Lens, Crystalline; Ophthalmologic Surgical Procedures; Orbital Diseases; S100 Proteins; Vimentin

To present the differentiating clinical findings between intratarsal keratinous cyst (IKC) and chalazion.. A retrospective review of medical records of all patients who presented between 2010 and 2018 at King Abdulaziz University Hospital with proven histopathological diagnosis of IKC was done. Complete ophthalmologic evaluation at presentation, surgical procedures performed, complications, histopathological findings, response to treatment and follow-up were recorded.. Twelve patients were found to have IKC. All patients presented with an eyelid mass with no signs of local inflammation. All lesions were fixed to the tarsus with freely mobile overlying skin, which was found to be slightly pale compared to the surrounding skin in six patients. On palpation, IKC had well-defined boarders. Isolation with clear surgical plane for cyst excision was achieved in nine patients as they were superficially involving the tarsus. When IKC involved the deep part of the tarsus, bluish/ whitish nodules were seen upon eyelid eversion. Six patients were misdiagnosed and surgically treated as a chalazion elsewhere prior to presentation to us with recurrence.. Differentiating IKC from chalazion can be challenging. Careful clinical evaluation helps reaching the right diagnosis and providing the correct treatment, which involves complete excision of IKC to prevent recurrence.

Topics: Chalazion; Eyelid Diseases; Humans; Keratins; Neoplasm Recurrence, Local; Retrospective Studies

Topics: Epidermal Cyst; Eyelid Diseases; Female; Humans; Keratins; Meibomian Glands; Middle Aged; Ophthalmologic Surgical Procedures

PurposeMeibomian gland ductal cysts (MGDCs) and steatocystomas are epithelial lined, keratin-containing lesions of the eyelids. MDGCs are variably called tarsal keratinous cysts, intratarsal keratinous cysts of the meibomian glands, intratarsal inclusion cysts, epidermal cysts and epidermoid cysts. Both lesions are poorly described in the literature. We report a series of seven MGDC and steatocystomas, and examine their clinical, pathological and immunohistochemistry features and their management and outcomes.Patients and methodsA retrospective review of case notes and histopathology slides of all MGDCs and steatocystomas identified at one major histopathology service in South Australia between 2013 and 2015.ResultsSeven cases were identified, with an average age of 64. The lesions range from 4 to 18 mm diameter and are firm, well-circumscribed and non-tender, and sometimes the keratin-filled cyst protrudes visibly under the tarsal conjunctiva. Two cases were previously misdiagnosed as chalazia but recurred after incision and curettage. Histologically, these lesions are lined by squamous epithelium but lack a well-formed stratum granulosum and can be distinguished by their immunohistochemical staining characteristics. Complete excision, including a wedge of underlying tarsal plate for MDGCs, is curative for with a follow up of 12-36 months.ConclusionsMGDCs and steatocystomas should be included in the differential of benign eyelid lesions. Diagnosing and differentiating these lesions from chalazia is important for determining the optimal management strategy.

Topics: Adult; Aged; Aged, 80 and over; Diagnosis, Differential; Epidermal Cyst; Eyelid Diseases; Eyelids; Female; Follow-Up Studies; Humans; Immunohistochemistry; Keratins; Male; Meibomian Glands; Middle Aged; Retrospective Studies; Sebaceous Gland Diseases

Intratarsal keratinous cysts (IKCs) have been frequently misdiagnosed as chalazia or epidermal cysts. We reviewed a series of cases of IKCs to identify clinical features that distinguish IKCs from other eyelid diseases.. We retrospectively reviewed the medical records of 17 suspected IKC patients between January 2004 and September 2014.. Seventeen patients who were clinically suspected to have IKC were enrolled. All patients presented with non-inflamed eyelid nodules fixed to the tarsus. Among them, 12 biopsy specimens were available and 11 patients (91.7%) were diagnosed with IKC, with a pathological finding of stratified squamous cell lining with keratin material. The mean patient age was 55.1 years (31-71). Six patients had a surgical history of incision or incomplete excision of the lesion, followed by recurrence. On eyelid eversion, five patients showed a white-yellow nodule, and three patients had a bluish cystic lesion. The diameter of the nodules ranged from 4 to 10 mm. The intracystic material was a milky white fluid. Ten patients underwent a complete surgical excision including partial tarsectomy and there was no recurrence.. IKC can be distinguished from other intratarsal lesions by a characteristic tarsal nodule fixed to the tarsus. To prevent recurrence, complete excision with partial tarsectomy is needed.

Topics: Adult; Aged; Biopsy; Cysts; Diagnosis, Differential; Eyelid Diseases; Female; Humans; Keratins; Male; Meibomian Glands; Middle Aged; Retrospective Studies

Topics: Epidermal Cyst; Eye Infections, Bacterial; Eyelid Diseases; Female; Gram-Positive Bacterial Infections; Gram-Positive Cocci; Humans; Keratins; Middle Aged

The histologic features of abnormal spectacles in 60 snakes from the 5 families of Boidae, Colubridae, Elapidae, Pythonidae, and Viperidae are described in a retrospective study conducted on specimens submitted to a private diagnostic service during a period of 15 years. Fifty-two snakes had inflammatory reactions in the spectacle. The stroma and outer epithelium of the spectacle were the layers most often involved in inflammatory disease. Lesions of the outer epithelium included edema, hyperkeratosis, and granulocyte infiltration occasionally with bacterial colonies and fungal elements. The stroma had infectious agents and inflammatory reactions in vessels and between the collagen fibrils. The inner epithelium had varying degrees of hyperplasia and hypertrophy, but no infectious agents were seen. Infectious agents in these cases included mites, bacterial disease, fungal disease, or a combination of bacterial and fungal disease. Special stains identified the bacteria most commonly involved to be Gram-positive cocci. Thirteen snakes had dysecdysis of the spectacle. Of these, 5 displayed a concurrent inflammatory reaction of the spectacle, while the remaining 8 snakes had extra keratin layers on a spectacle with an otherwise normal appearance. These keratin layers were attached to serocellular crusts located on the inner surface of the periocular scales. The cause for dyskeratotic lesions of the spectacle was not always apparent, and concurrent acariasis, other forms of dermatitis, trauma, suboptimal husbandry, and visceral disease were considered possible contributing factors. It was notable that only 4% of the submitted cases were found to have spectaculitis and/or spectacular dysecdysis.

Topics: Animals; Dermatitis; Eyelid Diseases; Eyelids; Keratins; Molting; Retrospective Studies; Snakes

Topics: Biomarkers; Chalazion; Diagnosis, Differential; Epidermal Cyst; Eyelid Diseases; Female; Humans; Keratins; Middle Aged

To explore the clinical and histopathologic features and surgical outcome of intratarsal keratinous cyst (IKC).. The clinical findings, histopathologic evaluations, and immunohistochemical studies in 15 cases of IKC were investigated, retrospectively.. Fifteen patients with an average age of 44.7 years had noninflamed eyelid cysts sized 1-6 mm in diameter. The cysts appeared as solid, whitish opalescent or yellow-white, mildly elevated lesions beneath the palpebral conjunctiva. The cysts embedded in the tarsus were completely excised with a portion of the adjacent tarsus by a surgical procedure through palpebral conjunctival approach. Histopathologic evaluations revealed stratified squamous epithelium linings and keratin contents, which were not identical to the common epidermal or epidermoid cysts. The results were negative for Alcian blue and periodic acid-Schiff staining and showed positive correlation to the immunoreaction for epithelial membrane antigen. No recurrence occurred in all patients who had their lesions removed completely.. Our study revealed the clinical and pathological characteristics of IKC, including the absence of inflammatory sign, lesion partially embedded in the tarsus and protruding beneath the conjunctiva with the intracystic keratinous contents, stratified squamous epithelium linings, string-like keratin contents from the histopathology sections, and strongly immunoreactivity to antibodies against epithelial membrane antigen. A complete excision of cysts with adjacent tarsectomy by transconjunctival approach was proved to be an effective treatment for prevention of recurrence.

Topics: Adult; Alcian Blue; Biomarkers; Coloring Agents; Cysts; Diagnosis, Differential; Eyelid Diseases; Female; Humans; Immunohistochemistry; Keratins; Male; Middle Aged; Mucin-1; Periodic Acid-Schiff Reaction; Predictive Value of Tests; Retrospective Studies; Staining and Labeling; Treatment Outcome; Young Adult

Protein-meibum and terpenoids-meibum lipid interactions could be important in the etiology of meibomian gland dysfunction (MGD) and dry eye symptoms. In the current model studies, attenuated total reflectance (ATR) infrared (IR) spectroscopy was used to determine if the terpenoid β-carotene and the major proteins in tears and meibum affect the hydrocarbon chain conformation and carbonyl environment of wax, an abundant component of meibum. The main finding of these studies is that mucin binding to wax disordered slightly the conformation of the hydrocarbon chains of wax and caused the wax carbonyls to become hydrogen bonded or experience a more hydrophilic environment. Lysozyme and lactoglobulin, two proteins shown to bind to monolayers of meibum, did not have such an effect. Keratin and β-carotene did not affect the fluidity (viscosity) or environment of the carbonyl moieties of wax. Based on these results, tetraterpenoids are not likely to influence the structure of meibum in the meibomian glands. In addition, these findings suggest that it is unlikely that keratin blocks meibomian glands by causing the meibum to become more viscous. Among the tear fluid proteins studied, mucin is the most likely to influence the conformation and carbonyl environment of meibum at the tear film surface.

Topics: beta Carotene; Dry Eye Syndromes; Eye Proteins; Eyelid Diseases; Fatty Acids, Unsaturated; Humans; Keratins; Lactoglobulins; Meibomian Glands; Mucins; Muramidase; Protein Conformation; Spectroscopy, Fourier Transform Infrared; Viscosity

To investigate the morphology of the human eyelid margin and the presence of different cytokeratins, mucins and stem cell markers within the skin epithelium, mucocutaneous junction (MCJ) and palpebral conjunctiva.. Eyelids of body donors were investigated histologically and ultrastructurally as well as by immunohistochemical methods using antibodies to cytokeratins 1, 4, 7, 8, 10, 13, 14, 15, and 19; mucins MUC1, MUC4, and MUC5AC and potential stem cell markers K15, BCRP/ABCG2, integrin β1, and N-cadherin.. The expression pattern of cytokeratins, mucins and stem cell markers varied across the different epithelia of the human eyelid. Within the MCJ, CK7, 15 and 19 were absent, whereas the epithelium reacted positive to antibodies to CK1, 4, 8, 10, 13 and 14. Reactivity was also observed for MUC1 and MUC4, but not for MUC5AC. No reactivity was determined for K15, BCRP/ABCG2 and integrin β1 in the area of the MCJ epithelium but a strong reactivity was present for N-cadherin.. The present immunohistochemical findings lead to a better characterization of the MCJ. Additionally, the knowledge of distribution of biomarkers like cytokeratins, mucins and stem cells can be useful in the investigation of MCJ disturbances which occur in several disorders of the meibomian glands and the lid epithelium in the course of dry eye syndrome and especially meibomian gland dysfunction.

Topics: Aged; Biomarkers; Cadaver; Conjunctiva; Eyelid Diseases; Eyelids; Female; Hair Follicle; Humans; Immunohistochemistry; Keratins; Male; Meibomian Glands; Microscopy, Electron; Middle Aged; Mucins; Mucous Membrane; Skin Physiological Phenomena; Stem Cells; Tissue Fixation

Intratarsal keratinous cyst of the meibomian gland is a recently described entity that recurs if not completely excised. Herein, we report 2 cases and discuss their diagnosis and management: (1) A 57-year-old man with a recurrent mass of the upper eyelid treated with incision and drainage as a chalazion for more than 5 years and (2) An 85-year-old man presented with a slow growing nodule of the upper eyelid. Exploration via the eyelid crease approach revealed cysts fixed to the tarsus that were completely excised with a portion of the anterior tarsus. Histologically, these cysts exhibited a keratinizing squamous epithelium without a granular layer (trichilemmal keratinization), were lined by an eosinophilic undulating cuticle, contain string-like keratin debris, and had a fibrous wall without sebaceous lobules. All epithelial components strongly expressed high-molecular weight keratins, whereas the lining, cuticle, and keratin contents strongly expressed carcinoembryonic antigen. No recurrence has occurred 7 and 12 months postoperatively. The location and clinicopathologic findings of intratarsal keratinous cysts distinguish it from sebaceous tumors, steatocystoma simplex, epidermoid cyst, and dermoid cyst. However, like steatocystomas, intratarsal keratinous cysts exhibit a sebaceous duct phenotype. The anterior lid crease approach with partial tarsectomy seems to be an effective treatment.

Topics: Aged, 80 and over; Epidermal Cyst; Eyelid Diseases; Humans; Keratins; Male; Meibomian Glands; Middle Aged; Sebaceous Gland Diseases; Treatment Outcome

To describe an acquired, smooth white lesion of the caruncle and to underscore the role of subsurface keratinizing squamous epithelium in its formation.. Clinical photographic documentation, histopathologic evaluation, and immunohistochemical staining of an excised specimen from a 25-year-old woman.. A cyst was found that was lined by keratinizing squamous epithelium without a keratohyaline layer (trichilemmal keratinization), typical of lesions of the pilosebaceous unit. A portion of the cyst's lining was replaced by granulomatous inflammation resulting from an earlier spontaneous partial rupture. Ki-67 immunolabeling demonstrated relatively few nuclei in S-phase (DNA synthesis) in comparison with the overlying epithelium, thereby suggesting an obstructive, nonproliferative cause for the cyst.. A white caruncular lesion is a very rare finding according to the literature. It is most likely caused by a cyst lined by squamous epithelium elaborating trichilemmal-type keratin. A sebaceous gland duct was established as the source for the current lesion.

Topics: Adult; Antigens, CD; Antigens, Differentiation, Myelomonocytic; Cysts; Eyelid Diseases; Female; Humans; Keratins; Ki-67 Antigen; Muramidase; Sebaceous Gland Diseases

To report a case of proliferating trichilemmal cyst in a 55-year-old woman.. Observational case report.. A 55-year-old woman sought treatment for a mass in the right upper eyelid. The lesion was excised twice previously, and recurred. The mass was reexcised and examined histopathologically.. Light microscopy showed a cystic lesion lined by stratified squamous epithelium with a compact layer of eosinophilic keratin without granular cell layer. There was no atypia, mitosis, or stromal invasion.. Although proliferating trichilemmal cyst shows benign histopathologic features, clinical manifestations may mimic those of more aggressive tumors with local recurrences or distant metastasis. Wide excision of the lesion and close long-term follow-up is recommended.

Topics: Cell Proliferation; Eosinophils; Epidermal Cyst; Eyelid Diseases; Female; Humans; Keratins; Middle Aged; Mitosis; Skin Diseases

This article describes the first report of phakomatous choristoma of the eyelid in Korea. A six-month-old boy underwent excision of a congenital inferonasal orbital mass arising from the left lower lid. A dermoid cyst was suspected, however a diagnosis of phakomatous choristoma was made following conventional histology. An immunohistochemical study of this rare benign congenital tumor was conducted. The cuboidal epithelial cells comprising this choristoma showed strongly positive cytoplasmic staining with S-100 protein and vimentin. They also showed focally positive staining with a neuron-specific enolase, while they showed no immunoreactivity to cytokeratin or epithelial membrane antigen. The results of the immunohistochemical study support the conclusion that this tumor is of lenticular anlage origin.

Topics: Biomarkers; Choristoma; Diagnosis, Differential; Epithelial Cells; Eyelid Diseases; Humans; Infant; Keratins; Lens, Crystalline; Male; Mucin-1; Phosphopyruvate Hydratase; S100 Proteins; Tomography, X-Ray Computed; Vimentin

Hyperkeratinization of meibomian glands has been postulated to cause gland dysfunction. Recent investigations on rabbits show that keratin proteins are indeed present in the meibomian fluids of these animals. In this report we present our findings on the presence of these water-insoluble proteins in human meibomian secretions. 6 anti-cytokeratin antibodies, CK8, 18, 19, CK7, CK8, CK14, CK19 and AE1/AE3 were used against the keratin proteins expressed from the human meibomian fluids. Using the immunoblotting (dot blot) technique, abnormal waxy meibomian fluids obtained from subjects diagnosed to have meibomian gland dysfunction (MGD) were compared to normal clear meibomian fluids. The results show that keratins are present in a higher concentration (10%) in the abnormal human meibomian excreta as compared to the normals. Even though the presence of protein markers for keratinization in the abnormal meibomian excreta were not shown, the increased presence of keratin proteins in the abnormal meibomian fluids suggests that, in MGD patients, hyperkeratinization of ductal epithelium may have taken place. More keratin proteins (possibly those of higher molecular weights) were produced in addition to the keratin proteins normally produced by the duct epithelium. The increased amount of keratin proteins in the abnormal meibomian fluids may be explained by the susceptibility of duct epithelium to undergo the process of hyperkeratinization as postulated by other researchers.

Topics: Antibodies, Monoclonal; Eyelid Diseases; Humans; Immunoblotting; Immunoenzyme Techniques; Keratins; Meibomian Glands

The expression of keratin proteins from meibomian glands and their correlation with skin epidermal keratins were determined. Keratin proteins were localized in both human and rabbit meibomian glands by indirect immunofluorescence using mouse monoclonal antibodies AE1, AE2 and AE3, which are known to react with human epidermal keratins as well as with keratins from other sources. Keratin proteins from rabbit meibomian glands were further isolated and characterized by SDS-PAGE and immunoblot using mouse monoclonal antibodies AE1 and AE3. Meibomian glands from human and rabbit showed similar immunofluorescent staining with each monoclonal antibody. AE1 antibody, which stains human basal epithelial cells of skin, stains all duct epithelial cells in the human but only the superficial duct epithelial cells in the rabbit meibomian gland. AE2 antibody, which stains human suprabasal epithelial cells of skin and is a marker for fully keratinized epithelia, stains the suprabasal epithelial cells of the central duct and ductules in both the human and rabbit meibomian gland. AE3 antibody, which stains all human epithelial cells of skin, stains all epithelial cells of the duct and ductules, as well as the basal epithelial cells of the acinus in both the human and rabbit meibomian gland. Keratins isolated from whole rabbit meibomian glands contained a 65-67 kD and 58 kD AE3-positive, and a 56.5 kD and 50 kD AE1-positive keratin protein. Expression of 65-67 kD/56.5 kD keratin proteins, and the immunofluorescent staining of the duct epithelium by the AE2 antibody, indicate that the meibomian gland duct epithelium is committed to the process of keratinization.

Topics: Animals; Eyelid Diseases; Eyelids; Fluorescent Antibody Technique; Humans; Immunologic Techniques; Keratins; Meibomian Glands; Proteins; Rabbits; Reference Values; Staining and Labeling

Meibomian gland dysfunction (MGD) was induced in 34 albino rabbits by the twice-daily topical application of 2% epinephrine over a period of 6 months to 1 year. Seven age-matched control rabbits, not receiving epinephrine, were followed up for a similar period. All lids were evaluated pre- and post-treatment by gross clinical examination and by transillumination biomicroscopy and photography. Of the 68 rabbit lids evaluated, 56% developed signs of MGD, which ranged from plugging of the meibomian gland orifice and presence of microcysts (subclinical lesions; 30.9% of the lids) to opacification and enlargement of the glands with increasing severity (clinical lesions; 25.0% of the lids). The remaining lids (44%) remained normal. MGD did not develop in the seven control rabbits. After the development of MGD, lids were evaluated by immunofluorescent microscopy, SDS-PAGE and Western blotting using mouse monoclonal antibodies to keratin proteins. Development and progression of MGD in the rabbit appears to correlate with increasing stratification and keratinization of the meibomian gland duct epithelium. In the early stages of MGD, focal areas of epithelial hyperkeratinization were identified by immunohistochemical staining using AE2 monoclonal antibody, specific for the 56.5 kD and 65-67 kD keratin protein marker for keratinized epidermis. As the severity of MGD progressed there was progressive increase in the AE2 staining of the duct epithelium. SDS-PAGE and immunoblotting of proteins from meibomian gland excreta in chronic MGD showed a progressive increase in both the 56.5 kD and 65-67 kD keratinization protein markers during development of MGD. We conclude that hyperkeratinization of the duct epithelium leading to plugging and dilation of the meibomian gland underlies the development of MGD following topical epinephrine treatment.

Topics: Animals; Biochemistry; Epinephrine; Eye Proteins; Eyelid Diseases; Eyelids; Keratins; Meibomian Glands; Rabbits

Topics: Animals; Epithelium; Eyelid Diseases; Eyelids; Keratins; Meibomian Glands; Microscopy, Electron, Scanning; Rabbits

Topics: Acne Vulgaris; Eyelid Diseases; Female; Humans; Keratins; Middle Aged; Xanthomatosis