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Technical report: digital subtraction dacryocystography.

Twenty-one patients presenting clinically with obstructive epiphora were investigated by digital subtraction dacryocystography (DSDCG). This technique is quick and simple to perform, with good patient acceptance. It produces diagnostic images on a single radiographic projection. The proximal lacrimal apparatus is well demonstrated. Patient radiation dose to the orbit is apparently reduced in DSDCG without the use of lead eye shields. The technique of DSDCG was readily acquired by junior radiologists. Reliable and accurate demonstrations of lacrimal duct obstructions were produced in a general radiological department where dacryocystography is an occasional examination. We advocate the use of digital techniques in dacryocystography when the equipment is available.

Adult↗

[Ophthalmomyiasis as a cause of canalicular lesion].

OBJECTIVE: Myiasis is the invasion of human tissues by Diptera larvae. Ocular involvement is uncommon. Trauma is the major cause of lacrimal apparatus lesions. However, it is rarely associated with parasitic infestation. The objective of this paper is to report a case of canalicular laceration caused by Dermatobia hominis larva. DESCRIPTION: An eight-year-old girl presented preseptal cellulitis that was refractive to antibiotics. A Dermatobia hominis larva was observed inside the lacrimal sac. Surgical extraction was performed and laceration of the lacrimal drainage system was noted. COMMENTS: Parasitic infection of the lacrimal apparatus is rare. Surgical extraction is the treatment of choice in such cases. Despite being uncommon, ophthalmomyiasis should be considered as a possible diagnosis when cellulitis is not responsive to antibiotics, especially in endemic areas. This is the first description of lacrimal drainage system injury by Dermatobia hominis larva.

Animals↗

Ocular side effects with 5-fluorouracil.

The concentrations of 5-fluorouracil in tears and plasma were studied in eight patients receiving the drug for carcinoma of the colon. The drug was measured by a gas liquid chromatographic method and found to be present only in the tears of patients with excessive lacrimation. In three patients with watery eyes the peak concentration in tears (16-23.8 micrograms/ml) occurred 15 minutes after IV administration and this corresponded with the end of the distribution (alpha) phase in the plasma when the plasma levels ranged from 18-26 micrograms/ml. In five patients without eye symptoms the drug was undetectable in the lacrimal fluid even though they had similar plasma levels (15-25 micrograms/ml) of 5-fluorouracil. The volumes of distribution and plasma clearance rates were similar in the two groups [being 0.2-0.52 (mean = 0.33) 1/kg and 612-978 (mean = 850) ml/min respectively in patients with excessive lacrimation and 0.13-0.79 (mean = 0.36) 1/kg and 435-1138 (mean = 831) ml/min respectively in the five patients without symptoms.]. It appears that 5-fluorouracil produces irritation of the lacrimal apparatus in about 30% of patients on the drug and in association with this appears in the tears where it may be responsible for the reported irritation and fibrosis of the tear duct.

Chromatography, Gas↗

Tear physiology and dry eyes.

The conditions of tear film formation and stability are governed by the surface chemical characteristics of the tear film system and by the proper functioning of the lacrimal apparatus. The tear film has to remain continuous between blinks in order to fulfill it function. The presence of an abnormal tear film results in dry eye states that can be detrimental to vision. The diagnostic tests presently available are limited mainly to approximately determining tear secretion rate and estimating epithelial damage by staining techniques. The only test that directly measures tear film stability is one which determines tear film breakup time. The treatment modalities depend on the type of irregularity causing the dry eye state and range from the application of artificial tear substitutes or the obstruction of the puncta to surgical alterations of the lacrimal system.

Contact Lenses↗

Normal anatomy and lesions of the lacrimal sac and duct: evaluated by dacryocystography, computed tomography, and MR imaging.

Diseases of the lacrimal system are optimally evaluated by dacryocystography, CT, MR imaging, and nuclear scintigraphy. Dacryocystography is selected to define the lumen of the lacrimal drainage system in inflammatory disease (dacryocystitis), dacryoceles, dacryoliths, and developmental abnormalities. Dacryocystography provides supplemental information in benign and malignant tumors, principally to differentiate an intrinsic lesion from an extrinsic lesion. CT is indicated for delineation of palpable mass lesions such as cysts, benign and malignant tumors, and diseases, especially in the paranasal sinuses, affecting the lacrimal apparatus secondarily. MR imaging has limited application but is useful to differentiate fluid from solid masses within the sac and to define tumor extension from the sac into the duct and anatomic regions outside the sac and duct. MR imaging with gadolinium enhancement should be used in suspected tumors and to separate a cyst from a solid mass. Radiologic methods fail to identify the histopathology of benign and malignant tumors. Nuclear scintigraphy is helpful in patients with epiphora with no demonstrable anatomic abnormality on dacryocystography.

Diagnosis, Differential↗

SURGERY OF EPIPHORA.

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Congenital Abnormalities↗

Cell and molecular biology of human lacrimal gland and nasolacrimal duct mucins.

The old concept that the lacrimal gland is only a serous gland has been superseded by the finding that lacrimal acinar cells are able to produce mucins--high-molecular-weight proteins--the major mass being carbohydrates with the common feature of tandem repeats of amino acids rich in serine, threonine, and proline in the central domain of the mucin core peptide. At the ocular surface, maintenance of the tear film, lubrication, and provision of a pathogen barrier on the epithelia, conjunctiva, and cornea have been shown to be facilitated by mucins that are present in membrane-anchored (lining epithelial cells) or secreted (goblet cells) form. Also in the lacrimal gland, both membrane-anchored (MUCs 1, 4, and 16) and secreted (MUCs 5B and 7) mucins have been identified. The lacrimal gland is the main contributor to the aqueous portion of the tear film. It is part of the lacrimal apparatus that comprises, together with the lacrimal gland, the paired lacrimal canaliculi, the lacrimal sac, and the nasolacrimal duct, which collects the tear fluid and conveys it into the nasal cavity. In this review, the latest information regarding mucin function in the human lacrimal gland and the human efferent tear ducts is summarized with regard to mucous epithelia integrity, rheological and antimicrobial properties of the tear film and tear outflow, age-related changes, and certain disease states such as the pathogenesis of dry eye, dacryostenosis, and dacryolith formation.

Humans↗

Treatment of complete obstruction of the nasolacrimal system by temporary placement of nasolacrimal polyurethane stents: preliminary results.

AIM: To assess the efficacy of the temporary placement of polyurethane nasolacrimal stents as a treatment for complete post-saccal obstruction of the lacrimal apparatus. MATERIALS AND METHODS: Polyurethane nasolacrimal stents were inserted under radiological guidance in nine patients with grade IV epiphora due to complete obstruction of the lacrimal system, at the junction of the lacrimal sac and duct (eight patients) or in the lacrimal duct (one patient). On average, the stents were removed 4 months (range: 3-6 months) after insertion. Dacryocystography was performed immediately before and after each stent was removed. Subsequently, periodic clinical and radiological examinations were performed until recurrence of the epiphora, at which point follow-up concluded. RESULTS: All patients remained free of epiphora and clinical inflammation while the stents were in place, but re-obstruction of the lacrimal system occurred in all patients less than 2 months after the stents were removed. Adhesion of three stents to the lacrimal tract was observed upon removal. In seven cases the dacryocystography results at the end of follow-up revealed changes in the configuration of the lacrimal apparatus. CONCLUSION: Based on our preliminary experience, temporary placement of polyurethane stents would not appear to be an efficacious therapeutic option for treating epiphora caused by post-saccal obstruction.

Adult↗

Nasolacrimal stents in the treatment of epiphora: long-term results.

PURPOSE: Assessment of the long-term results achieved with use of nasolacrimal stents in the treatment of epiphora caused by obstruction of the lacrimal apparatus. The role of stents in treating this condition is evaluated. MATERIALS AND METHODS: From February 1997 to April 1999, a total of 89 procedures to insert nasolacrimal stents were performed in 77 patients (20 men, 57 women; mean age, 53 years). A total of 79 stents were successfully implanted, with 10 failures (11.2%). Postprocedural course was followed for 16-38 months (mean, 27 mo) by means of clinical examinations and/or periodic dacryocystography, with removal of occluded stents. On conclusion of the study in September 2000, dacryocystography was performed in all patients in whom stents were still in place. RESULTS: Of the 79 stents deployed, two were lost, two had to be excluded from the study, 45 (60%) ceased to function, and 30 (40%) remained patent. Median duration of stent patency of these 79 stents was 20 months. Mean time to occlusion was 9.2 months for all obstructed stents; 4.4 months for improperly placed stents (via a trajectory outside the normal lacrimal drainage apparatus) and 12.2 months for stents that appeared to have been inserted properly. Of the 45 occluded stents, 40 were removed and five were left in place. Upon removal, adherence of the stents to the lacrimal apparatus was frequently observed. CONCLUSIONS: The low patency rate and the difficulties encountered in removing nasolacrimal stents during the course of long-term placement calls into question the efficacy of this method as a definitive treatment for epiphora caused by obstruction of the lacrimal drainage system, although studies comparing this and other treatment modalities are needed. Assessment of temporary stent placement may be in order.

Female↗

[Macrodacryocystography--a review of 232 cases].

During the last four years 232 macrodacryocystographies have been performed. The results are compared with the clinical evaluation of these patients. There are two groups of findings, simple stenosis on one side and anatomical abnormalities on the other side. The stenosis is mostly located before the lacrimal sac and most often involves the common canaliculus.--In the second part of the paper examples of alterations of the lacrimal apparatus show the value of the method in evaluating pathological anatomy.

Adolescent↗

Adult nasolacrimal duct obstruction.

Tear production resulting from obstruction of the nasolacrimal duct is a common ophthalmic problem. The diagnosis and treatment of this condition require a thorough understanding of the lacrimal apparatus and its ocular and nasal relationships. Idiopathic or primary acquired nasolacrimal duct obstruction is a syndrome of unknown etiology. Of all nontraumatic forms, it accounts for the vast majority of cases found in adults. The authors discuss a number of potential causes, some of them iatrogenic and discuss the technique of dacryocystorhinostomy, the standard surgical treatment, in detail.

Adult↗

Lacrimo-auriculo-dento-digital syndrome: a literature review and case reports.

Lacrimo-auriculo-dento-digital syndrome, which has an autosomal-dominant pattern of inheritance, typically affects the lacrimal apparatus, ears, teeth, and hands. More recent case reports have uncovered involvement of the kidneys and the respiratory and skeletal systems. Salivary gland malformation may also be a feature of the syndrome, leading to dry mouth. The characteristics of the syndrome vary among individuals, but dental anomalies seem to be prevalent. Microdontia and hypodontia occur, possibly with gray enamel, wear, and caries. This case report introduces a new three-generation family of six individuals affected with lacrimo-auriculo-dento-digital syndrome and concentrates on the dental presentation and management of two of the members.

Abnormalities, Multiple↗