Salivary gland transplantation provides a revolutionary solution for those suffering from severe dry eye. Our experienced eye doctors are dedicated to restoring ocular lubrication and improving your quality of life.
Transposition or transplantation of the salivary glands for dry eye is an innovative surgical procedure designed to restore ocular surface moisture when natural tear production is severely lacking. This technique takes advantage of the similar structure and secretory properties of salivary glands and lacrimal glands to provide long-term relief for severe dry eye cases. Our eye doctors work closely with patients to determine if this advanced procedure is the right option when conventional treatments have not provided sufficient relief.
Dry eye syndrome can cause constant irritation, a gritty sensation, and even blurred vision because the eye lacks adequate lubrication. In cases when standard treatments such as lubricating eye drops, punctal plugs, or anti-inflammatory medications have failed, the transplantation of salivary glands provides a promising alternative. This procedure aims to rebuild a stable tear film by using the patient’s own functioning gland tissue to continuously provide moisture to the ocular surface.
The two primary approaches under this umbrella are the transposition of salivary duct systems and the complete transplantation of salivary gland tissue. Each technique uses different donor sources based on the severity of dry eye, the condition of the patient’s glands, and expected outcomes.
Submandibular gland transplantation is currently the most widely used and effective technique for patients with severe tear deficiency. In SMGT, the submandibular gland, which sits beneath the jaw and produces a substantial part of resting saliva, is carefully harvested and then relocated near the eye. There are several reasons why the submandibular gland has become the preferred donor tissue:
During the procedure, our eye doctors collaborate with microsurgery and maxillofacial surgery specialists to carefully remove the submandibular gland along with its associated Wharton’s duct and a portion of the vascular network. The recipient site is usually prepared in the temporal region next to the eye, where the gland’s duct is routed into the conjunctival fornix. This setup allows the secretion from the gland to effectively lubricate the ocular surface.
Another option is the transplantation of minor salivary glands harvested from the labial or palatal regions. These glands are smaller and produce a more modest amount of secretion compared to the submandibular gland. MSGT is generally less invasive with fewer surgical risks, and is particularly suitable for patients with less advanced dry eye symptoms or limited alternatives.
Although the increase in tear production can be more modest with MSGT, many patients appreciate the lower risk of complications such as excessive watering or duct obstruction. Both techniques aim to restore a stable tear film by using the natural lubricating properties of saliva, enhancing the overall health of the ocular surface.
If you're struggling with dry eye and traditional treatments haven't worked, reach out today to find a top optometrist near you who can provide personalized guidance.
Let’s break down the surgical procedure into its key steps and explore the thought process behind it. Our eye doctors explain that this method uses the body’s own tissue to create a continuous source of moisture when tears are not produced in sufficient amounts.
The procedure begins in the temporal region near the eye. A curved incision is made along the hairline and the temple, exposing the recipient site where small blood vessels will be connected later. Surgeons are careful to preserve the integrity of these vessels to ensure a robust blood supply to the transplanted gland. By doing this, they create a “pocket” in which the donor tissue can be securely placed and later revascularized.
In SMGT, the donor tissue consists of the submandibular gland along with its duct—the Wharton’s duct—and its blood vessels. An incision is made in the submandibular triangle, where the gland is precisely dissected to preserve its critical structures. During the dissection process, extra attention is given to free up a portion of the facial artery and its accompanying veins. This is essential for the microsurgical reconnection that will occur later.
For minor salivary gland transplantation, a small tissue block containing the labial gland is harvested from inside the mouth. Surgeons make a delicate incision inside the inner lip or palate, carefully preserving the gland along with its minor vascular and neural attachments. The preservation of these structures is crucial for encouraging post-transplant survival and function.
Once the donor tissue has been harvested, it is transferred to the prepared recipient site. In the case of submandibular transplantation, the vascular pedicle is connected to local arteries and veins using microsurgical techniques. Special attention is given to ensure that the blood vessels are neither twisted nor under tension. The Wharton’s duct is then tunneled through a small incision in the upper lateral conjunctival fornix. A nylon tube may be inserted temporarily to keep the duct patent during the early healing period.
This intricate process establishes a new functional unit where the salivary gland, now positioned near the eye, begins to produce secretions that help restore ocular lubrication. The entire operation is carefully planned to minimize the risks associated with vascular reconnection and to prevent duct obstruction.
While the goal is to provide consistent lubrication, managing the rate of salivary secretion is critical to avoid complications. Here’s the thing: too little moisture leaves the eye dry and painful, but too much can lead to bothersome watering or even corneal irritation.
After transplantation, the gland goes through several distinct phases:
To manage these fluctuations, our eye doctors employ several strategies. They may use medications such as carbachol or capsaicin to stimulate the gland’s output when secretion is low. If excessive tearing occurs, topical agents such as atropine gel or Botulinum Toxin A injections might be administered to reduce the hypersecretion. In some cases, a volume-reduction approach during the original surgery is used to lower the risk of postoperative epiphora.
If you're struggling with dry eye and traditional treatments haven't worked, reach out today to find a top optometrist near you who can provide personalized guidance.
Salivary gland transplantation offers innovative relief for dry eye through ocular lubrication, improving quality of life for patients in need.
