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What causes blockage or inflammation in the tear duct?

Dr Mohammad Javed Ali, Consultant Ophthalmologist and Head of Govindram Seksaria Institute of Dacryology, L V Prasad Eye Institute (LVPEI), Hyderabad, has conducted a research on ‘What causes blockage or inflammation in the tear duct?’

Blockage or inflammation in the tear duct can cause watering, discomfort and compromised vision. This disorder is known as ‘Primary acquired nasolacrimal duct obstruction (PANDO)’ and is more common in 40+ age group women. Currently, it is treated through surgery, but in most cases it reoccurs. The actual cause of this very common problem is still relatively unknown.

The LVPEI research team led by Dr Javed Ali and Dr Inderjeet Kaur studied the tear samples of patients and compared them with tear samples collected from healthy eyes.

The findings have indicated that abnormal secretion of  ‘Cytokines’ (a large group of proteins, peptides or glycoproteins) by specific cells or hormones that regulate defence from injury or infection or wound healing and blood vessel formation in the eyes are responsible for this disease.

This research paper titled ‘Alteration of Tear Cytokine Expressions in Primary Acquired Nasolacrimal Duct Obstruction – Potential Insights into the Etiopathogenesis’, a detailed assessment of these cytokines would further help to define better treatment methods for the management of this disorder. 

Dr Javed Ali is a globally known name in the field of Dacryology, the science that deals with the tear ducts and tears drainage. He is well-trained in ophthalmic plastic surgery and rhinology, a much desirable combination for a Dacryologist. He is a prolific researcher with more than 200 papers to his credit.

Dr Ali currently heads the Govindram Seksaria Institute of Dacryology at LV Prasad Eye Institute (LVPEI) and is a senior Humboldt scientist at Friedrich-Alexander University, Nuremberg, Germany.

He has received The Experienced Researcher – Senior Alexander Von Humboldt Fellowship Award. He has also won the coveted ‘Shanti Swarup Bhatnagar Award’ in the ‘Medical Sciences’ category for his outstanding contributions to science and technology in 2019.

Dr Mohammad Javed Ali shares details about the research in an interview with India Medical Times.

How prevalent is the PANDO (Primary acquired nasolacrimal duct obstruction) disorder in India?

The exact prevalence of PANDO is not known but it accounted for approximately 50% of all the tear duct disorders that were seen at LV Prasad Eye Institute.

How was the treatment being done so far? What were the bottlenecks of existing line of treatments?

The most common modality of treating PANDO is a surgical bypass procedure into the nasal cavity – termed as dacryocystorhinostomy. While this is a surgery with a good success rates, the major issue is the very fundamental nature of it – the bypass. One bypasses the nasolacrimal duct obstruction, the seat of the disease, without actually treating it.

What was the objective of this research? What were the key findings?

Well, we all now know that PANDO is a multifactorial disorder and its etiopathogenesis has been elusive for centuries now. As a part of this major project, we were keen to explore the possible role of tear proteomics in the disease causation. We found that there was a significant elevation of 10 pro-inflammatory and 4 anti-inflammatory proteins. Analysis of these showed that there was an interaction between the inflammatory proteins with the prominent tear duct vasculature and hormonal microenvironments.

How would this study lead to better treatment methods for the management of this disorder?

The current study has taken the first step of integrating the three different pathogenic mechanisms, which were individually assessed for their role, earlier by our own group. This signifies that the so thought diverging roads are communicating and now converging to a single point. Once we get to know this point, it would be even possible to device preventive strategies against PANDO.

When and where was the study conducted? What was the sample size? What challenges did you face while doing this research?

The study was conducted at the LV Prasad Eye Institute on 40 eyes of patients and 20 eyes from the normal and healthy population. The challenges include not much literature to use as our base, chartering of unknown territories and time-consuming interpretations in the disease context.

How long will it take for the research findings to reach from the lab to clinics and start benefitting patients?

Well, that is something that every clinician-scientist would wish to answer right away. However, what can be said now is that we have come a long way, our foot is on the accelerator and the destination can be spotted on the horizon.

What else are you working on? What’s next on your research agenda?

The team from the Dacryology services at LV Prasad Eye institute is very focussed on the tear duct disorders. The spectrum of our ongoing work is large, audacious and futuristic. We are revisiting not only the anatomy and physiology of the tear duct but every possible basic science that could be of help in furthering our understanding of this system. The team believes that better understanding of the structures in health paves way for translational work in the disease stages.

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