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PubMed · 10150821

Lacrimal disease.

R E Wesley
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Abstract

Several authors have investigated the success of nasolacrimal duct intubation in children as well as the length of time for tubes to remain in place. The treatment of congenital amniocele with potential for life-threatening septicemia has been investigated. Other topics have included the bacteriology of dacryocystitis emphasizing the risk of endophthalmitis after intraocular surgery, balloon treatment for functional nasolacrimal duct obstruction, anatomical measurements of the lacrimal system relative to intracranial space, and new procedures for punctal stenosis. Diagnostic tests for epiphora and methods of punctal occlusion are evaluated.

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DacryocystitisDacryocystorhinostomyHumansIntubationLacrimal Duct ObstructionNasolacrimal DuctTearsJournal ArticleReview

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R E Wesley. 1994. Lacrimal disease.. https://pubmed.ncbi.nlm.nih.gov/10150821/

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BACKGROUND: Dry eyes are a common symptom following LASIK corneal refractive surgery. Treatments include topical lubricants to supplement the tear film, and punctal occlusion to reduce tear outflow. Canaliculitis is a recognised complication of punctal plugs, but has not previously been described following insertion of newer generation semi-permanent intra-canalicular plugs, such as the SmartPLUG. METHODS: Case report. RESULTS: We describe a 60-year-old female who underwent bilateral LASIK surgery leading to aggravation of her dry eye syndrome. She was managed with the insertion of semi-permanent intra-canalicular moldable silicone SmartPLUGs. She subsequently developed bilateral canaliculitis requiring bilateral canaliculotomy. CONCLUSIONS: To the best of our knowledge, this is the first report of bilateral canaliculitis following intra-canalicular SmartPLUG insertion. This case illustrates that punctal occlusion with the newer generation intra-canalicular plugs carries a risk of canaliculitis and that irrigation is not always effective in removing these devices.

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A case of a 56 year old lady presenting clinically with a slow growing painless mass of the left lacrimal gland, the histopathplogical examination of which was consistent with a diagnosis of tubercular dacryoadenitis, is described. Tubercular dacryoadenitis is uncommon, with the diagnosis usually made on histological examination of the lacrimal gland. Other cases of tubercular dacryoadenitis reported in literature are also reviewed.

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Although Stevens-Johnson syndrome has been reported to result in canalicular and nasolacrimal duct obstruction, reports of dacryocystocele formation are lacking. We describe the occurrence and management of bilateral dacryocystoceles related to Stevens-Johnson syndrome. A 45-year-old man, recovered from Stevens-Johnson syndrome, presented with bilateral medial canthal masses and intermittent overlying facial cellulitis. Examination revealed severe keratitis sicca with extensive corneal scarring, cicatricial occlusion of all puncta, and palpable medial canthal masses bilaterally. Computed tomography demonstrated bilateral cystic masses consistent with dacryocystoceles. Bilateral lacrimal sac/cyst excision was attempted, but the left cyst recurred within 6 months after surgery. A dacryocystorhinostomy was then performed, effectively marsupializing the cyst. The puncta were not canalized and stents were not placed. The masses have not recurred with 2 years of follow-up. Dacryocystoceles may arise in the setting of Stevens-Johnson syndrome. Successful management may be achieved with marsupialization to the nasal cavity (dacryocystorhinostomy).

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