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The surgical management of congenital lacrimal fistulae.

Congenital lacrimal fistulae are developmental anomalies of the lacrimal apparatus that are usually symptomatic, frequently causing epiphora and occasionally causing fistulitis or dacryocystitis. They may be associated with other abnormalities of the lacrimal system or with systemic anomalies. Complete excision alone, or in combination with nasolacrimal intubation and/or dacryocystorhinostomy is recommended for treatment.

Dacryocystorhinostomy↗

Orbital presentation of ethmoid sinus adenocarcinoma.

Ethmoid sinus adenocarcinoma with orbital invasion is distinctly uncommon. This case presented with epiphora, whereas proptosis and decreased ocular motility were later signs. Treatment was delayed for 4 months, while misdiagnoses like dacryocystitis and thyroid eye disease were entertained. Even an incisional biopsy was not sufficient for a conclusive diagnosis and adenomatous differentiation was only present in a small proportion of tissue available after an excisional attempt. The aggressive behaviour including this patient's death of metastatic disease, underlines the importance of considering secondary invasion from a sino-nasal malignancy in uncharacteristic orbital disease.

Adenocarcinoma↗

Management of congenital dacryocele.

Congenital dacryocele is a distension of the naso-lacrimal sac usually present at birth or in the first three months of life. It occurs commonly in females and may present with dacryocystitis. Treatment includes probing and antibiotics if infection is present.

Female↗

Primary lymphoma of the lacrimal sac: an EORTC ophthalmic oncology task force study.

AIM: To define the clinical and histopathological characteristics of primary lacrimal sac lymphoma in a predominantly white population. METHODS: Specimens of lacrimal sac lymphoma and follow up data were solicited from members of the Ophthalmic Oncology Task Force of the European Organization for Research and Treatment of Cancer (EORTC) and the European Ophthalmic Pathology Society (EOPS). Specimens were stained with haematoxylin and eosin and an immunohistochemical panel against leucocyte antigens was applied. Diagnosis was reached by consensus of five experienced pathologists according to the World Health Organization classification system. The histopathological findings were correlated with the clinical data. RESULTS: Of 15 primary lacrimal sac lymphomas, five (33%) were diffuse large B cell lymphoma (DLBCL), five (33%) were extranodal marginal zone B cell lymphoma of mucosa associated lymphoid tissue (MALT lymphoma), three were classified as "transitional MALT lymphoma," being in transition from MALT lymphoma to DLBCL, and two were unclassified B cell lymphomas. Nine of the patients were female, and the median age at the time of diagnosis was 71 years (range 45-95 years). The most frequent presenting symptoms were epiphora (85%), swelling in the region of the lacrimal sac (79%), and dacryocystitis (21%). All but one patient presented in stage I. Systemic spread occurred in three of nine patients (33%). The 5 year overall survival was 65%. CONCLUSIONS: DLBCL and MALT lymphoma are equally common in the lacrimal sac in contrast with the remaining periorbital and/or orbital region where MALT lymphoma predominates.

Aged↗

Dacryolith formation around an eyelash retained in the lacrimal sac.

A dacryolith was discovered in the lacrimal sac during a dacryocystorhinostomy for chronic dacryocystitis in which there was mucocele formation. Morphological examination confirmed the presence of an eyelash at the centre of the stone and electron microscopy demonstrated the presence of fungi (Candida sp.) in a matrix which was of markedly vairable morphology. The mechanism by which a hair enters the punctum and passes along the canaliculus may be attributed to the step-like pattern of ridges on the surface of a hair. The directional nature of these ridges dictates preferential movement towards the root end of the hair and prevents movements in the opposite direction.

Calculi↗

Acute bacterial infections of the eye: their aetiology and treatment.

The aerobic microbial flora of 823 eyes with acute bacterial conjunctivitis, corneal ulceration, dacryocystitis, discharging sockets, blepharitis, and postoperative infections has been investigated. Staphylococci, Streptococcus pneumoniae, and nonfermenting Gram-negative bacilli including Pseudomonas aeruginosa were the main pathogens. Fermenting coliforms were also infrequently isolated. The least overall resistance of 30.9% was to chloramphenicol, but no one antibiotic was effective against all pathogens. Cloxacillin is the best drug for staphylococcal and polymyxin B for pseudomonas infections.

Acute Disease↗

Ocular complications of heart, lung, and liver transplantation.

AIM: To document the nature and frequency of ocular complications in a large group of patients who underwent heart, lung, or liver transplantation. METHODS: A retrospective audit of the medical records of all patients undergoing heart, lung, or combined heart-lung transplantation at St Vincent's Hospital, Sydney, or liver transplantation at Royal Prince Alfred Hospital Sydney, was performed to detect patients with symptomatic ocular complications following transplantation. 19 of 860 patients were identified as having ocular complications. RESULTS: Ocular complications occurred in 2% of patients with 65% of these being opportunistic infections. Herpes group viral retinitis (77%) and fungal chorioretinitis (22%) were seen. Other complications included choroidal pseudolymphoma, central retinal vein occlusion, herpes zoster ophthalmicus, herpetic keratitis, dacryocystitis, cyclosporin retinopathy, and rifabutin associated uveitis. CONCLUSION: Herpes group viral retinitis was the most common ocular opportunistic infection and occurred most frequently during the second year after transplantation. Delayed diagnosis was associated with poor visual outcome.

Adult↗

Biotypes and serotypes of Haemophilus influenzae ocular isolates.

AIM: To determine which subtypes of Haemophilus influenzae are most commonly associated with ocular disease, and whether the site of ocular H influenzae infection is correlated with specific subtypes of the organism. METHODS: The biotypes and serotypes of ocular H influenzae isolates collected at the Francis I Proctor Foundation between March 1989 and January 2000 were examined. A total of 62 ocular isolates were retrieved from frozen storage and plated on chocolate agar. Biotypes were assigned based upon the ability of the isolates to produce indole, urease, and ornithine decarboxylase. Capsular subtypes a-f were determined by slide agglutination using commercially available subtype specific antisera. Identified biotypes and serotypes were then analysed with regard to site of infection. RESULTS: Patient age ranged from 1 to 92 years with a median age of 45 years. 38 (61%) of the isolates were biotype II, 23 (37%) were biotype III, and one (2%) was biotype VII. All of the isolates were non-encapsulated and thus serologically non-typable. H influenzae biotype II was found in 28 of 48 (58%) conjunctivitis cases, five of eight (63%) keratitis cases, and two of two (100%) endophthalmitis cases. Biotype III was found in 20 of 48 (42%) conjunctivitis cases, two of eight (25%) keratitis cases, and a single case of dacryocystitis. Biotype VII was associated with one of eight (13%) keratitis cases. CONCLUSION: Most ocular H influenzae isolates appear to be serologically non-typable strains from biotypes II and III, less virulent subtypes that frequently colonise the nasopharynx. In addition, the site of ocular H influenzae infections appears to be largely independent of species subtype.

Adolescent↗

Complications by liquid plastics in ophthalmic surgery. Histopathologic study.

Retrospective morphological studies of ocular tissues after treatment with liquid plastics reveal many complications induced by the material. Cyanoacrylates for punctal occlusion glide into the lacrimal sac and lead to obstructive dacryocystitis and even to reactive xanthogranuloma. The use of this glue in combination with a hard contact lens as 'artificial epithelium' provokes a remarkable stromal and endothelial cell loss of the cornea. Intraocular silicone oil sometimes induces a massive epiretinal macrophage activity with storage of the material or reactive fibrosis when it gets into the subretinal space. Liquid alloplasts for intraocular lens surgery of the future are tested in experimental studies but are still not satisfactory.

Animals↗

Squamous cell carcinoma of the lacrimal drainage system: case report and literature review.

AIMS AND BACKGROUND: Epithelial malignant tumors of the lacrimal drainage system are rare. The most prevalent type is squamous cell carcinoma. These tumors generally present with aspecific symptoms suggestive of chronic dacryocystitis, with the result that diagnosis and treatment are often delayed. METHODS AND STUDY DESIGN: We present the case of a patient with a squamous cell carcinoma of the lacrimal ducts and discuss the clinical and pathological features of these neoplasms, together with diagnostic and therapeutic strategies according to the data available in the literature. RESULTS AND CONCLUSIONS: The diagnostic and therapeutic approach to this kind of rare tumors has to be planned carefully. Radiographic examination of all masses arising in the medial canthus is essential. Dacryocystography allows the identification of space-occupying tumors in the lacrimal sac. Computed tomography and magnetic resonance imaging provide the most useful information about the extent of the neoplasm and its relationship with surrounding bone structures and soft tissues. Histological examination of a biopsy sample obtained by standard dacryocystectomy is essential to confirm the diagnosis. The treatment of choice is primarily surgical, consisting of complete resection with long-term follow-up. A number of surgical procedures have been described, which are more or less aggressive depending on the extension of the tumor. Radiotherapy is indicated when bone or lymphatic invasion is evident, and when neoplastic cells are present in the resection margins. Radiotherapy alone is not considered a treatment of choice, but only a palliative option in selected cases. The follow-up data available in the literature are incomplete. In most of the literature reports, relapse occurs in 50% of patients within 5 years.

Carcinoma, Squamous Cell↗

Congenital lacrimal fistula.

PURPOSE: Congenital lacrimal fistula is a rare abnormality of the lacrimal system. The patients may be asymptomatic but treatment of those with symptoms such as epiphora and dacryocystitis is still controversial. METHODS: The clinical findings, methods of surgical treatment and results were evaluated in seven patients (four male, three female) with congenital lacrimal fistula. Three were asymptomatic, types of surgical treatment were fistula excision with dacryocystorhinostomy (DCR) (two cases), fistula excision with conjunctival DCR (one case) and closed fistula excision alone (one case). RESULTS: Three of the four patients who underwent surgery had relief of symptoms. The fistula recurred in the case that had undergone fistula excision alone. CONCLUSIONS: It is difficult to design controlled studies to detect which method is superior for the treatment of lacrimal fistula, considering the small number of cases in the literature. We recommend treating each case according to its own characteristics.

Adult↗

Expulsion of a lacrimal dacryolith by sneezing: a rare event.

PURPOSE: To describe the case of a man presenting with intermittent epiphora of the right eye and a low grade dacryocystitis due to a dacryolith. METHODS/RESULTS: He was treated conservatively and was offered a Dacryocystorhinostomy. A few weeks before surgery, he developed swelling and pain over the right medial canthus followed by violent sneezing with spontaneous extrusion of the dacryolith. DISCUSSION: The authors propose that the dacryolith fragmented spontaneously and once it reached the nasal cavity, was expelled by violent sneezing to the nostril, a mechanism not previously reported. CONCLUSIONS: Reformation of dacryolith is a likely possibility, and recurrence of symptoms in such cases may ultimately require a Dacryocystorhinostomy.

Calculi↗

The Caldwell-Luc procedure: institutional review of 670 cases: 1975-1985.

The Caldwell-Luc procedure, which has long been fundamental in the treatment of perisinus disease, has undergone increasing scrutiny when used for inflammatory antritis. Individual morbidity rates of less than 10% to greater than 40% have been reported. To assess the data from our own institution, a retrospective study of 670 Caldwell-Luc procedures was undertaken. Patients ranged in age from 10 to 82, with a mean age of 42.9 years. There were 271 males and 325 females. Parameters studied included symptoms, physical findings, operative techniques, surgical findings, length of hospitalization, and postoperative complications. Immediate postoperative complications included facial swelling in 89% of patients, cheek discomfort in 33%, significant hemorrhage in 2.9%, and temperature elevation in 12.1%. Long-term follow-up ranged from 2 years to 10 years. Overall complication rates in 464 patients included facial asymmetry (3), facial numbness or paresthesia (42), oroantral fistulas (5), gingivolabial wound dehiscences (7), dacryocystitis (12), devitalized tooth (2), recurrent sinusitis (56), and recurrent polyposis (25). A revision antrostomy was required in 37 patients, a revision Caldwell-Luc in 22 patients, an intranasal sphenoethmoidectomy in 17, and root canal therapy in 2 patients. The most frequent complication was recurrent nasal obstruction, occurring in 28% of patients. Overall complication rates tended to increase with a longer follow-up period.

Adolescent↗

Other uses of non-vascular stents.

New generation metallic stents are making an impact on coronary, peripheral vascular and biliary diseases. However, their use is not limited to these: other areas include the oesophagus and upper gastrointestinal tract, the small bowel, large bowel and dacryocystic duct.

Carcinoma↗

Spontaneous ophthalmic diseases in 586 New Zealand white rabbits.

The purpose of this study was to investigate spontaneous eye disease in New Zealand White (NZW) rabbits, which are commonly used for toxicity tests, and to provide reference materials for pharmaceutical companies and research centers. A total of 586 NZW rabbits were randomly chosen without sex preference and were examined using ocular equipment, including a direct ophthalmoscope, an indirect ophthalmoscope, a slit-lamp biomicroscope, a focal illuminator, and a fundus camera. This study showed that the incidence rate of temporary cataracts, regarded as a change within normal variation, was 0.5% in the NZW rabbits. Regarding abnormal ophthalmic disease, blepharitis was the most commonly observed ocular disease. Other findings included cataract, conjunctivitis, choroidal hypoplasia, keratitis, corneal scarring, eyelid laceration, posterior synechiae, uveitis, dacryocystitis, and persistent pupillary membrane. In total, the incidence rate of ophthalmic diseases was 9.6%. Based on sex and age distributions, females had more ocular diseases than males, and rabbits were less susceptible to eye diseases as they got older. In this study, photographs were taken to document findings, such as normal fundus, normal variations, ophthalmic disease, and histopathologic examination.

Animals↗

Progressive supranuclear palsy in a sample of Brazilian population: clinical features of 16 patients.

Progressive supranuclear palsy (PSP) is an uncommon disorder characterized by marked postural instability, vertical gaze abnormalities and axial rigidity. The purpose of this study is to report the clinical features of 16 consecutive subjects seen over a 10-year period at a Movement Disorders Clinic. These subjects fulfilled criteria for probable PSP namely those of the National Institute of Neurologic Disorders and Stroke (NINDS) and the Society for PSP (SPSP). This patient-group represented 2.1% of all degenerative parkinsonians observed and the mean age of onset of the disease was 64.7 years (sd = +/- 7.2). Postural instability with falls was the most frequent initial feature presented in PSP patients (62.5%). The hallmark of the disease, the supranuclear vertical gaze palsy, appeared after 2.3 years of disease onset, and only 12.5% had such manifestation at the first evaluation. Transient tremor was observed with a relatively high frequency in this group (44%), but only 19% had rest tremor. Chronic dacryocystitis, probably related to a paucity of blinking, was observed in two patients as an inaugural manifestation. In the first evaluation, only 19% of the 16 patients were diagnosed as probable PSP. The mean interval prior to the final diagnosis was 2.4 years.

Aged↗

[Rhinolithiasis].

INTRODUCTION: A rhinolith is a rock which forms in the nose. It occurs from the solidification of mucus and nasal debris: by mineral salts, calcium, magnesium phosphate and carbonate, and it leads to unilateral obstruction of the nasal airway followed by inflammatory changes of the nasal mucus membrane and paranasal cavities. This inflammatory process may lead to a purulent form with complications, intracranial propagation and dacryocystitis. CASE REPORT: This is a case report of a patient with rhinolithiasis, 30 years of age, complaining of breathing difficulties for 10 years, with nasal secretion, reduced olfactory function and headaches. She underwent the following procedures: frontal rhinoscopy, epipharyngoscopy, nasal mucus analysis (fungi and bacteria), x-ray check-up as well as pathohistological analysis of the removed rhinolith. DISCUSSION AND CONCLUSION: The significance of computer tomography of paranasal cavities was confirmed in coronal lines, as the most valid radiological analysis which provides adequate diagnosis, differential diagnosis and helps in making the decision on surgical treatment. Surgery is obligatory and in most cases it is endonasal endoscopy. Bigger nasal stones (rhinoliths), progressing into the surrounding anatomic structures, are treated using rhinotomy and trepanation (Caldweell-Luc). In cases of greater rhynoliths with propagation into neighboring anatomic areas, cases of surgical treatment by lateral rhynotomy and trepancy of the sinuses (Caldwel-Luc) were shown.

Adult↗

Value of bacterial culturing in the course of congenital nasolacrimal duct (NLD) obstruction.

The role of infection in the etiology and persistence of congenital nasolacrimal duct (NLD) obstruction is examined in a group of 334 infants who had conjunctival swabs cultured. One hundred and fifty eight (47%) of these had evidence of NLD obstruction and 176 (53%) did not. The types of organism grown from those with and without NLD obstruction were similar and occurred in almost equal proportions in each group. In addition, the rate of spontaneous resolution in those with NLD obstruction was the same, whether pathogenic bacteria were grown or not. There were no cases of orbital cellulitis, dacryocystitis, or ocular infection in those with NLD obstruction and no suggestion that secondary infection was more common in this group.

Bacteria↗