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Qualitative Hormonal Profiling of the Lacrimal Drainage System: Potential Insights into the Etiopathogenesis of Primary Acquired Nasolacrimal Duct Obstruction

Ali, Mohammad Javed F.R.C.S*†; Schicht, Martin M.D.; Paulsen, Friedrich M.D.

Ophthalmic Plastic and Reconstructive Surgery: September/October 2017 - Volume 33 - Issue 5 - p 381–388
doi: 10.1097/IOP.0000000000000962
Anatomy & Physiology

Purpose: To investigate the presence and distribution patterns of hormone receptors in the lacrimal drainage system in normal and diseased states.

Methods: The study was performed on cadaveric and clinical samples of the lacrimal drainage system. Immunohistochemical labeling was performed for assessing the presence and distribution of receptors of estrogen alpha, estrogen beta, aromatase (CYP19), testosterone, progesterone, oxytocin, prolactin, and somatostatins 1 to 5 (SSTR1, SSTR2, SSTR3, SSTR4, and SSTR5). The immunohistochemistry stains were scored as positive or negative, and the distribution patterns in the canaliculus, lacrimal sac, and nasolacrimal duct were assessed.

Results: There was a strong expression of estrogen alpha, estrogen beta, and oxytocin, but this showed variations in distribution patterns. Testosterone and progesterone expressions were more localized to the basement membrane of the epithelium in postmenopausal females. While SSTR2 and SSTR4 expressed only on the villus surfaces of superficial epithelial cells; oxytocin, aromatase, and prolactin additionally expressed in the subepithelial lamina propria and submucosal glands. Diseased samples from primary acquired nasolacrimal duct obstruction showed dramatic reduction or absence of the receptor expression patterns of all the hormones with the exception of epithelial immunoreactivity with prolactin.

Conclusions: This study provides a proof of principle for the presence of multiple hormone receptors and hypothesizes their possible links in the etiopathogenesis of primary acquired nasolacrimal duct obstructions.

Qualitative hormonal profiling of the lacrimal drainage system reveals some fascinating insights in the presence of receptors for hormones like estrogen, progesterone, testosterone, aromatase, oxytocin, somatostatin, and prolactin.

*Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, Telangana, India, and Institute of Anatomy II, Friedrich Alexander University of Erlangen-Nürnberg, Erlangen, Germany

Accepted for publication May 24, 2017.

Supported by Alexander von Humboldt Foundation (M.J.A.) and Deutsche Forschungsgemeinschaft (PA738/1-1 to 1–5 and PA738/2-1, F.P.).

M.J.A. receives royalties from Springer for the textbook “Principles and Practice of Lacrimal Surgery’; F.P. receives royalties from Elsevier for the anatomy atlas “Sobotta”.

Address correspondence and reprint requests to Mohammad Javed Ali, F.R.C.S., Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Road No 2, Banjara Hills, Hyderabad, Telangana 500002, India. E-mail:

© 2017 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.