Salivary Gland Transplantation for Severe Refractory Dry Eye Secondary to Drug-Induced Cicatrising Conjunctivitis from Long-Term Antiglaucoma Therapy

A man in his late sixties with a 30-year history of bilateral glaucoma and prolonged exposure to multiple preserved topical antiglaucoma agents presented with progressive visual decline and chronic bilateral ocular discomfort. Examination revealed lid-margin keratinisation, inferior fornical shortening, and severe ocular surface disease consistent with drug-induced cicatrising conjunctivitis (DICC) — confirmed by conjunctival biopsy with negative direct immunofluorescence, excluding mucous membrane pemphigoid. Owing to refractory aqueous-deficient dry eye unresponsive to maximal lubricant therapy, minor salivary gland transplantation (MSGT) was performed in the left eye. At one-month follow-up, tear meniscus height improved from approximately 0.1 mm to 0.3 mm, tear break-up time increased from under 3 seconds to approximately 7 seconds, and the patient reported meaningful symptomatic relief. This case highlights MSGT as a viable biological tear substitute in end-stage DICC secondary to antiglaucoma therapy, and underscores the importance of early preservative burden reduction.