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PubMed2000

Management and complications of congenital dacryocele with concurrent intranasal mucocele.

INTRODUCTION: The association of dacryocele and intranasal mucocele has been previously reported. Its incidence and optimal treatment are unknown. PATIENTS AND METHODS: A retrospective review of 22 patients with 30 dacryoceles was performed to determine the mean age at presentation, sex distribution, and prevalence of associated intranasal mucocele, associated dacryocystitis, and respiratory distress. The components of the examination, ancillary tests, treatment modalities, and treatment outcomes were then summarized. RESULTS: Unilateral dacryoceles were seen in 16 (73%) of the infants, and bilateral dacryoceles were seen in 6 (27%) of the infants. Four (25%) of the 16 patients who initially had unilateral dacryoceles later developed bilateral dacryoceles. Dacryocystitis, preseptal cellulitis, or both were present on presentation or developed in 18 (60%) of 30 dacryoceles. Nasal endoscopy was performed on 13 (59%) of 22 patients. Nasal examination with nasal speculum and headlight was performed on 7 patients (32%). A concurrent intranasal mucocele was diagnosed in 23 (77%) of 30 dacryoceles. Respiratory distress arose in 5 (71%) of 7 patients with bilateral intranasal mucoceles and in 2 (22%) of 9 patients with a unilateral intranasal mucocele. Thirty-four procedures were performed. Seven dacryoceles (21%) were treated with nasolacrimal duct probing under topical anesthesia. Another one (3%) was treated with needle aspiration with later definitive therapy. All other procedures were managed under general anesthesia. These included 2 nasolacrimal duct probings (6%), 2 probings with silicone tube placement (6%), 10 probings with intranasal mucocele marsupialization and silicone tube placement (29%), and 12 probings with marsupialization alone (35%). Two (29%) of the 7 probings performed under topical anesthesia failed, whereas all other procedures were successful. One dacryocele spontaneously resolved. CONCLUSIONS: Congenital dacryoceles are commonly associated with intranasal mucoceles, dacryocystitis, and preseptal cellulitis. Respiratory distress is common in bilateral cases. Bilateral nasolacrimal duct probing should be considered in unilateral cases because of the high incidence of occult contralateral involvement.

Endoscopy↗

PubMed2001

Complications associated with silicone intracanalicular plugs.

PURPOSE: To assess American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) member physicians' experiences with complications associated with silicone intracanalicular plugs and publicize risks associated with this device. METHODS: Two case reports are presented. A survey was sent to 420 ASOPRS member physicians, questioning them on their experiences with complications associated with silicone intracanalicular plugs. RESULTS: We present two case reports of complications associated with migration of intracanalicular plugs. In the first case, a 41-year-old man underwent serial insertion of seven intracanalicular plugs in one eye over several years, he had a 3-month relapsing course of Nocardia asteroides canaliculitis, dacryocystitis, and cellulitis requiring systemic antibiotics and multiple surgeries. In the second case, a 72-year-old woman had acute dacryocystitis, eventually necessitating dacryocystorhinostomy; at surgery, an intracanalicular plug was discovered in the lacrimal sac. One hundred fifty-nine usable survey responses were obtained. Sixty-one percent of respondents reported various complications including tearing, canaliculitis, and dacryocystitis. Fifty-one percent of respondents performed surgery to treat complications associated with silicone intracanalicular plugs. CONCLUSIONS: Silicone intracanalicular plugs may be difficult to remove and may be associated with significant lacrimal complications.

Adult↗

PubMed2003

[The effect of treating obstructive disease of lacrimal passage by lacrimal plastic operation with Nd:YAG laser].

OBJECTIVE: To study the therapeutic effects of Nd:YAG laser on obstructive diseases of the lacrimal passage. METHODS: 693 eyes in 603 cases with obstructive diseases of lacrimal passage, including obstruction of lacrimal puncta (23 eyes), lacrimal duct (192 eyes), nasolacrimal duct (227 eyes), chronic dacryocystitis (231 eyes), and traumatic laceration of lacrimal canaliculus (20 eyes), were treated by lacrimal plastic operation with Nd:YAG laser and the therapeutic effects were compared among the groups. RESULTS: The cure rates and effective rates of the five diseases were 86.9% and 95.7%, 89.1% and 93.8%, 93.0% and 96.0%, 78.4% and 82.7%, 40.0% and 65.0%, respectively. By Ridit analysis, R +/- S(R) values for each group were 0.921 +/- 0.023, 0.914 +/- 0.009, 0.927 +/- 0.007, 0.856 +/- 0.013, 0.749 +/- 0.055. CONCLUSIONS: The therapeutic effect on chronic dacryocystitis is less than those of obstruction of nasolacrimal duct and lacrimal duct (P < 0.05). The therapeutic effect on traumatic laceration of lacrimal canaliculus is less than that of the other four groups (P < 0.05). Therefore, it should be restricted on indication for the cases of chronic dacryocystitis and traumatic laceration of lacrimal canaliculus.

Adolescent↗

PubMed1987

Nasal obstruction in the neonate secondary to nasolacrimal duct cysts.

The neonate is an obligate nasal breather and any form of nasal obstruction causes respiratory distress during feeding and sleeping. We report two patients with unusual causes of respiratory distress secondary to nasolacrimal duct cysts. The failure of the lacrimal duct to perforate at the distal end results in dacryocystitis and cyst formation. Removal of the nasal wall of the cyst resolves the obstruction and the dacryocystitis. The nasolacrimal duct cyst is an unusual, but readily treated, cause of neonatal respiratory distress.

Airway Obstruction↗

PubMedDate not supplied

Recurrent bilateral dacryocystoceles in Wegener's granulomatosis: a rhinologic perspective.

Wegener's granulomatosis (WG) is a rare, idiopathic, systemic vasculitis of small vessels that manifests in multiple organ systems. Otorhinolaryngic manifestations of this disease include recurrent sinusitis and relapsing polychondritis. Periocular involvement is also a well-documented location of Wegener's disease. We present the case of a 13-year-old girl with severe WG who developed multiple recurrent orbital infections. She underwent multiple incision and drainage surgeries of each orbit and multiple courses of intravenous antibiotics. The patient persistently reaccumulated purulence in her nasolacrimal duct system and was referred to an oculoplastic surgeon for evaluation of these recurrent infections. The diagnosis of dacryocystitis as a complication of WG was made. This unique case represents a patient with severe WG developing bilateral dacryocystitis requiring bilateral dacryocystorhinostomies.

Adolescent↗

PubMed2005

Early CT-scan for chronic lacrimal duct symptoms - case report of a malignant melanoma of the lacrimal sac and review of the literature.

Malignant melanoma of the lacrimal sac is rare, and only 21 cases have been reported in the world literature. They have an insidious onset and may look like chronic dacryocystitis. In only 6 of these cases were there no recurrences. In most of the survivors, the diagnosis was made early which appears to be the most important prognostic factor. Hence a CT-scan in cases of persistent dacryocystitis is important. Melanoma of the lacrimal duct system is a good example of a condition requiring a multidisciplinary approach between ophthalmologist and maxillofacial surgeon. Any persistently symptomatic lacrimal duct system may need a maxillofacial consultation.

Chronic Disease↗

PubMed2006

Ocular infections caused by Providencia rettgeri.

PURPOSE: To report a series of patients with ocular infections caused by the rarely described gram-negative bacterium, Providencia rettgeri. DESIGN: Retrospective case series. PARTICIPANTS: Five patients with ocular infections who grew P. rettgeri after culture (2 keratitis, 1 dacryocystitis, 1 conjunctivitis, 1 conjunctivitis/endophthalmitis). METHODS: Microbiology culture results positive for P. rettgeri were cross-referenced to identify the patients with ocular infections. Medical records of these patients were carefully reviewed. MAIN OUTCOME MEASURES: Descriptive analysis of each patient's history, potential risk factors, and clinical outcome. RESULTS: Five eyes in 2 institutions were found to be culture positive for the gram-negative bacterium P. rettgeri. The organism may cause keratitis, dacryocystitis, conjunctivitis, and endophthalmitis. Possible risk factors include a compromised ocular surface and coexisting medical morbidity, including urinary tract infections, recent hospitalizations, and an immunocompromised state. Culture and sensitivity profiles should guide treatment; resistant strains are being identified. CONCLUSIONS: Infections caused by P. rettgeri, although rare, are responsible for ocular morbidity. This report describes patient attributes, risk factors, and outcomes that will be helpful to ophthalmologists treating ocular infections. P. rettgeri should be acknowledged as a source of ocular infection.

Conjunctivitis↗

PubMed2000

Bacteriology and antibiotic therapy in congenital nasolacrimal duct obstruction.

AIMS: To determine the current bacteriology of mucopurulent discharge in congenital nasolacrimal duct obstruction (CNDO), the in vitro response to different antibiotics and clinical effectiveness of the antibiotics used to relieve babies from mucopurulent discharge. METHODS: A clinical study evaluated the effectiveness of local antibiotic agents clinically and in vitro. 50 samples were obtained from the lacrimal sac in 47 young children with CNDO. The patients' mean age was 21.45 +/- 17.09 months. The cultures were incubated and the infectious agents isolated. Sensitivity testing was performed in each case, testing 10 different local antibiotics. A control group of 10 babies expected for cataract surgery was constituted. RESULTS: Cultures were positive for bacteria from 72.64% of the samples. 73 isolates were recovered from the 50 samples. The bacterial species most frequently cultured was Streptococcus pneumoniae, representing 35.4% of the isolates, followed by Haemophilus influencae (19.6%). The sensitivity testing revealed ofloxacin and tetracycline to be the most effective drugs as monotherapy. Clinically the combination of bacitracin and neomycin, primarily used in half of the patients as initial therapy, was successful in curing the dacryocystitis in 82.5% of all patients. CONCLUSION: Chronic dacryocystitis due to CNDO is associated with an equal proportion of Gram positive and negative bacteria, which can be treated with a high effectiveness by a combination drug of bacitracin and neomycin.

Anti-Bacterial Agents↗

PubMed2002

Combined coliform and anaerobic infection of the lacrimal sac.

A case is reported of combined coliform and anaerobic bacterial infection of the lacrimal sac, a condition of which there is only one other published case report. In addition, a literature review is presented of the bacteriology of acute dacryocystitis as it applies to this case. Recommendations for the microbiological investigation and management of acute dacryocystitis are made.

Acute Disease↗

PubMed1992

Clinicopathologic study of lacrimal sac and nasal mucosa in 44 patients with complete acquired nasolacrimal duct obstruction.

We studied 44 patients who had dacryocystorhinostomy for primary acquired complete nasolacrimal duct obstruction. The lacrimal sac and nasal mucosa adjacent to the osteotomy were examined histologically. The lacrimal sac had chronic inflammatory changes in 33 of 37 patients with varying degrees of fibrosis in 34 of 37. Focal ulceration of the lacrimal sac epithelium was present in 15 cases. Goblet cells, present in 11 specimens, were not identified in 26 specimens. Moderate or severe chronic inflammation was found in 14 of 44 nasal mucosal specimens and marked fibrosis in 22. The pathology of the lacrimal sac and nasal mucosa is similar to that of the nasolacrimal duct in complete nasolacrimal duct obstruction. The nasal inflammation may have resulted from dacryocystitis or alternatively contributed to the dacryocystitis.

Adolescent↗

PubMed1993

Lacrimal sac, conjunctival, and nasal culture results in dacryocystorhinostomy patients.

Chronic dacryocystitis is commonly seen in patients requiring a dacryocystorhinostomy (DCR). The infection may be primary, or may be secondary to an anatomical abnormality that has led to tear flow stasis. It is possible that many cases of primary acquired nasolacrimal duct obstruction are in fact secondary to unrecognized low-grade dacryocystitis. The intent of this study was to determine what organisms grow in the lacrimal sac of patients requiring DCR. It also investigated whether or not there was a correlation between organisms cultured from the sac and from the conjunctiva and/or the nose. The results of the study indicate that there is not a clinically significant correlation. The level of obstruction does not affect whether similar organisms were cultured from the three sites.

Bacteria↗

PubMed1995

Pseudodacryocystitis arising from anterior ethmoiditis.

The contiguous spread of inflammation from infected ethmoid sinuses to the surrounding tissues of the lacrimal drainage system can produce symptoms easily confused with acute dacryocystitis. We report the cases of two patients with presumed dacryocystitis whose patency of the lacrimal apparatus was established by probing, irrigation, and dacryocystography. Computerized tomography and magnetic resonance imaging demonstrated opacification of anterior ethmoid air cells adjacent to the region of the lacrimal sac. A greater awareness of this diagnostic possibility of pseudodacryocystitis arising from anterior ethmoiditis, together with improved noninvasive imaging techniques, will likely increase the observed incidence of this disease. This distinction is important since anterior ethmoidectomy, rather than dacryocystorhinostomy, is the treatment of choice when such pseudodacryocystitis proves unresponsive to antibiotic therapy. In misdiagnosed patients who undergo dacryocystorhinostomy, it is the coincidental limited anterior ethmoidectomy and not the lacrimal-nasal fistula that provides the cure.

Acute Disease↗

PubMed1999

Oral and topical antibiotic therapy of complete, primary acquired nasolacrimal duct obstruction in adults.

PURPOSE: To determine whether patients with complete, acquired nasolacrimal duct obstruction may be treated with broad spectrum oral antibiotics and office lacrimal irrigation. METHODS: In a retrospective review, patients with complete, primary acquired nasolacrimal duct obstruction (NLDO) were divided by predominant symptoms and signs into two main groups: (a) those with tearing and/or mucous discharge and (b) those with previous acute dacryocystitis and/or lacrimal sac mucocele. All patients received a therapeutic trial of oral and topical antibiotics followed by lacrimal irrigation. RESULTS: Five of 55 patients with tearing and/or mucous discharge showed significant improvement after treatment with a mean follow-up of 16.5 months. A sixth patient with mucous and tearing had resolution of the mucous discharge but persistent tearing and blockage of the nasolacrimal system to irrigation. Two of 20 patients with lacrimal sac mucocele or history of acute dacryocystitis avoided surgery while 18 opted for early lacrimal surgical intervention. CONCLUSIONS: Conservative management of complete acquired NLDO consisting of oral and topical antibiotics and appropriately timed office lacrimal drainage system irrigation may be considered in selected patients.

Administration, Oral↗

PubMed1994

False-positive radioiodine whole-body scan in thyroid cancer patients due to unrelated pathology.

Radioiodine whole-body scanning is the imaging modality of the highest accuracy in diagnosing metastases from differentiated thyroid cancer. However, unrelated pathology in one of several nonthyroidal tissues that normally take-up/secrete radioiodine may result in a false positive scan. The authors report cases of an ectopic kidney, chronic sinusitis, dacryocystitis, and an artificial eye, complicating differentiated thyroid cancer, that on radioiodine scanning mimicked lumbar, frontal, and left and right orbital bone metastases, respectively. The nature of the radioiodine uptake was suspected from the results of a bone scan and proven by ultrasound (ectopic kidney), by reimaging after specific treatment (chronic sinusitis, and dacryocystitis), or by postwashing reimaging (artificial eye). To our knowledge, this is the first report of such cases. Nonthyroidal pathology should be excluded before exposing patients with apparent thyroid cancer metastases that have atypical characteristics on radioiodine whole body imaging.

Adult↗

PubMed1997

Bacteriology of lacrimal duct obstruction in adults.

AIMS: To determine the current bacteriology of lacrimal duct obstruction (LDO) and to relate the bacteriological findings to the type of symptoms. METHODS: 127 samples were obtained from the lacrimal sac in 118 consecutive adult patients with LDO, including nine bilateral cases. RESULTS: Altogether, 156 isolates were recovered from the 127 samples cultured. Cultures were positive from 84% of the samples. Gram positive bacteria were isolated in 79 (62%) samples. The most frequently cultured bacterial species was Staphylococcus epidermidis, representing 27% of the isolates. Gram negative bacteria were recovered from 26 (20%) samples, and these bacteria were statistically significantly more common in cases with copious discharge than in cases with minor discharge (p = 0.000). Cases with simple stenosis of the lacrimal duct (SSLD) showed significantly less Streptococcus sp (p = 0.004) and Gram negative organisms (p = 0.004) than those with chronic dacryocystitis. CONCLUSION: The bacteriology of SSLD resembles that of normal conjunctival flora. Chronic dacryocystitis in adults is associated with an increased proportion of Gram negative bacteria which may be a reservoir for postoperative intraocular infection. They should also be taken into account in selecting antimicrobial prophylaxis in lacrimal drainage surgery.

Adult↗

PubMedDate not supplied

Endoscopic transnasal dacryocystorhinostomy and bicanalicular silicone tube intubation.

PURPOSE: To evaluate the results of endoscopic transnasal dacryocystorhinostomy (ETDCR) combined with bicanalicular silicone tube intubation (BSTI) performed in 49 patients with nasolacrimal canal obstructions secondary to chronic dacryocystitis. MATERIAL AND METHODS: ETDCR combined with BSTI was applied as a primary procedure in 47 cases, and as a secondary procedure in 2 cases. All patients underwent dacryocystography, and 41 patients underwent radionuclide dacryoscintigraphy before the surgery. Silicone tubes were left in place for about 6.2 months. The patency of the lacrimal passages was controlled with a clinical examination, nasolacrimal canal lavage, and dacryoscintigraphy. RESULTS: Patients were followed up for a mean period of 25.1 months after the removal of the tubes. The epiphora symptom disappeared and a successful drainage could be maintained in 43 out of 49 cases (87.7%). The obstruction rate found in the dacryoscintigraphy performed 15 days after extubation was 22.9%, while it was found to be 14.2% in the nasolacrimal canal lavage. CONCLUSION: ETDCR combined with BSTI proved to be an effective surgical method in chronic dacryocystitis. The sensitivity and specificity of the postoperative dacryoscintigraphy in determining the surgical success were lower than those of the nasolacrimal canal lavage.

Adult↗

PubMed2001

Detection of natural peptide antibiotics in human nasolacrimal ducts.

PURPOSE: To determine the expression and production of antimicrobial peptides by mucosal cells of the lacrimal passage in healthy and pathologic states. METHODS: Detection of bactericidal-permeability-increasing protein (BPI), heparin-binding protein (CAP37), human cationic antimicrobial protein (LL-37), human alpha-defensin 5 (HD5), human alpha-defensin 6 (HD6), human beta-defensin 1 (HBD-1), and human beta-defensin 2 (HBD-2) was performed by reverse transcription-polymerase chain reaction (RT-PCR). Intracellular deposition of lysozyme, lactoferrin, secretory phospholipase A(2), human neutrophil defensins (HNP-1, -2, and -3), human beta-defensin 1 (HBD-1), and human beta-defensin 2 (HBD-2) was analyzed immunohistochemically. Samples were obtained from 15 patients by surgery and from 10 cadavers. RESULTS: RT-PCR revealed BPI, CAP37, and HBD-1 mRNA in samples of healthy nasolacrimal duct epithelium. Additionally, HBD-2 mRNA was detected in epithelial samples from patients with dacryocystitis. Messenger RNAs for LL-37 and alpha-defensin 5 and 6 were absent in all samples investigated. Immunohistochemistry revealed lysozyme, lactoferrin, secretory phospholipase A(2), and HNP-1, -2, and -3 to be present in all samples, whereas HBD-1 was present only in some of the healthy and inflamed samples. Immunoreactive HBD-2 peptide was visible only in some of the inflamed samples. CONCLUSIONS: The data suggest that the human efferent tear ducts produce a broad spectrum of antimicrobial peptides. Under inflammatory conditions, changes in the expression pattern occurred, revealing induction of the human inducible defensin HBD-2 and in some cases downregulation of HBD-1 and CAP37. Antimicrobial peptides have a therapeutic potential in dacryocystitis, in that they have a broad spectrum of antimicrobial activity and accelerate epithelial healing. However, caution is appropriate, because defensins also promote fibrin formation and cell proliferation, which are key elements in scarring processes, such as dacryostenosis.

Adolescent↗

PubMed2005

[Modified dacryocystorhinostomy].

OBJECTIVE: To introduce a novelty-modified dacryocystorhinostomy. METHODS: With the innovated scalpels, 11 patients (13 eyes) suffering from chronic dacryocystitis were performed with the newly modified surgical procedures derived from traditional dacryocystorhinostomy. The efficacy, efficiency, and complications were observed. RESULTS: Thirteen operations for 11 patients were performed successfully and efficiently. The wound was during operation neat and with a slight hemorrhage which could be stanched easily. No serious complications were observed intra-operatively. The average time of follow-up was 7.8 months (6-12 months). All the dacryocysto-rhinal canals remained unblocked. CONCLUSIONS: The modified dacryocystorhinostomy with the help of innovated mucous scalpel has high success rate, high efficiency and low complications. It deserves wide application as the first choice for chronic dacryocystitis.

Adolescent↗