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PubMed1988

Palpebral dacryoadenectomy for epiphora.

The efficacy of palpebral dacryoadenectomy (PDA) to relieve epiphora was studied in 37 patients. Symptomatic relief and postoperative Schirmer testing was used in the evaluation. The technique is described. All patients had patent lacrimal excretory systems: 62% of patients undergoing lacrimal lobectomy had complete relief of epiphora; 19% had some improvement, but incomplete relief; 76% had postoperative decrease in their Schirmer testing; and 14% had postoperative foreign body sensation and some degree of dry eye.

Adult↗
PubMed1994

Lacrimal ultrasonography.

Lacrimal ultrasonography (echography) evaluates lesions in that drainage system in a painless, noninvasive way in the office. The technique complements other imaging methods and can be correlated with histological results. The authors survey the principles and technique and describe the normal ultrasound, indications, applications, and limitations. Lacrimal ultrasound, whose potential has just lately been recognized, only reveals gross anatomic abnormalities and cannot evaluate the functional integrity of the lacrimal excretory system.

Humans↗
PubMed1994

Primary adenoid cystic carcinoma of the lacrimal sac: report of a case.

A 41-year-old white woman presented with a 1-month history of epiphora and a painless medial canthal mass on the left that was unresponsive to antibiotic treatment. Computerized tomography (CT) and magnetic resonance imaging (MRI) scans delineated a soft tissue mass with bony destruction originating in the area of the left lacrimal sac with extension into the maxillary and ethmoid sinuses and inferomedial orbit. Open biopsy of the mass revealed adenoid cystic carcinoma (ACC). On surgical exploration, the tumor was found to originate from the lacrimal sac wall. Radical surgery with wide excision of surrounding bone and periorbital tissue was performed in light of the histological diagnosis and tumor extension. Orbital exenteration was not performed in order to preserve the patient's left eye. A 6-week course of adjunctive radiotherapy was applied without complication. The patient was clinically and radiologically free of tumor at 1-year follow-up. This case represents only the third time that primary ACC arising from the lacrimal sac has been reported.

Adult↗
PubMed1994

Lacrimal sac tumors.

This is a clinicopathologic study of 115 lacrimal sac neoplasms in adults (mean 52 years). The most common presenting signs and symptoms were epiphora (53%), recurrent dacryocystitis (38%), and/or lacrimal sac mass (36%). The tumors were divided into epithelial (82 cases) and nonepithelial (33 cases) neoplasms. Benign epithelial tumors included squamous and transitional cell papillomas (32), oncocytomas (4), and benign mixed tumors (2). The malignant epithelial neoplasms included squamous cell carcinoma (22), transitional cell carcinoma (5), adenocarcinoma (4), mucoepidermoid (3), adenoid cystic (3), and poorly differentiated carcinoma (1). The nonepithelial tumors consisted of fibrous histiocytoma (13), lymphoid lesions (10), malignant melanoma (6), hemangiopericytoma (1), lipoma (1), granulocytic sarcoma (1), and neurofibroma (1). Review of the literature, including our own series, discloses a 55% malignancy rate for tumors originating in the lacrimal sac. Malignant epithelial neoplasms, especially invasive transitional cell carcinoma, often recur locally and can metastasize and be fatal. Epithelial malignancies tend to grow along the epithelium of the lacrimal drainage system, and thus cure is dependent on a wide surgical excision of the tumor and of the entire lacrimal drainage system (canaliculi, sac, and nasolacrimal duct) combined with a lateral rhinostomy and radiation therapy.

Adolescent↗
PubMed1995

Benign mixed tumor arising from an accessory lacrimal gland of Wolfring.

We report a 59-year-old man who had a slowly enlarging mass of the central upper eyelid that proved histopathologically to be a benign mixed tumor (pleomorphic adenoma) arising from an accessory lacrimal gland of Wolfring. The tumor was totally separate from the main lacrimal gland, and its deep location in the lid excluded origin from dermal sweat glands. Benign mixed tumors of the accessory lacrimal glands are exceedingly rare tumors of the ocular adnexa.

Eyelid Neoplasms↗
PubMed1997

An immortalized cell culture from a malignant mixed tumor of the lacrimal gland.

Tumor cells from a malignant mixed tumor of the lacrimal gland were maintained in tissue culture for more than 55 generations. Comparative immunohistochemical analysis was performed on whole tumor sections and on the tumor cell culture to define the origin of the cells in culture. The cultured cells expressed cytokeratin, smooth-muscle actin, S-100 protein, and vimentin and were negative for glial fibrillary acidic protein. Tumor sections expressed cytokeratin but were negative for muscle-specific actin, vimentin, and glial fibrillary acidic protein. Through tissue culture studies of salivary gland epithelial neoplasias, which are very similar to lacrimal gland epithelial neoplasias, pluripotential stem cells have been identified. Similar tissue culture analysis of lacrimal gland epithelial neoplasms can be a valuable tool for studying the origin of these uncommon tumors.

Antigens, Neoplasm↗
PubMed1999

Lacrimal sac diverticula associated with a patent lacrimal system.

PURPOSE: To describe the clinical features of lacrimal sac diverticula. METHODS: Orbital masses were evaluated in 3 patients. One patient had a large tumor extending from the medial orbit associated with upward globe displacement, one had a mass inferior to the medial canthus, and one had an inflamed mass in the right lower lid. Two of the patients had no history of chronic epiphora, sinus disease, or nasal trauma. In all patients, irrigation demonstrated lacrimal drainage system patency. RESULTS: Surgical exploration confirmed the diagnosis of lacrimal sac diverticulum in all patients. Two diverticula were associated with a dacryolith. Each patient was successfully managed with excision of the diverticulum and dacryocystorhinostomy. CONCLUSIONS: Lacrimal sac diverticula should be considered in the diagnosis of medial orbital tumors, and computed tomography is useful in the diagnosis of lacrimal sac diverticula.

Adult↗
PubMed2000

Lacrimal canalicular diverticulum: a cause of epiphora and discharge.

PURPOSE: To report a rare cause of epiphora and chronic discharge: lacrimal canalicular diverticulum. METHODS: Case report. RESULTS: A distended left lower eyelid canaliculus was associated with chronic epiphora and discharge. A suspected canalicular diverticulum was noted on dacryocystogram. CONCLUSIONS: Canalicular diverticula should be considered in the differential diagnosis in patients that present with epiphora and discharge with a patent nasolacrimal system. Dacryocystography is diagnostic.

Anti-Bacterial Agents↗
PubMed2002

Involvement of the lacrimal drainage system by leukemia or lymphoma.

PURPOSE: To determine the clinical characteristics and outcomes of patients with leukemic or lymphomatous involvement of the lacrimal drainage system (LDS). METHODS: A computerized retrieval system was used to identify patients with histologically proven leukemic or lymphomatous involvement of the LDS. Medical records were reviewed. RESULTS: Biopsies of the lacrimal sac or nasolacrimal duct obtained during dacryocystorhinostomies (DCR) performed at the Mayo Clinic (Rochester, Minnesota) between January 19, 1989, and August 26, 1997, were positive for leukemia or lymphoma in 11 patients (15 LDS). Ten patients had previously diagnosed leukemia or lymphoma; the interval between the diagnosis of systemic disease and DCR averaged 5.8 years (range, 7 months to 13 years; median, 5 years). The median age at the time of LDS involvement was 72 years (range, 49 to 85 years). Seven patients (64%) were women, and all were white. The median postoperative follow-up after DCR was 38 months (range, 10 to 65 months). Eight patients had leukemic infiltration of the LDS, 2 patients had B-cell lymphoma, and 1 patient had cutaneous T-cell lymphoma. Four patients had bilateral LDS involvement, and the remainder had unilateral disease (right eye, 1 patient; left eye, 6 patients). The most common initial presentation, in 9 patients (82%), was epiphora. Lacrimal irrigation of 2 LDS was deferred because of acute dacryocystitis. Of the remaining 13 systems, 8 were completely obstructed. The blockage was low (in the lower sac or in the nasolacrimal duct) in 6 systems and high (in the upper sac or common internal punctum) in 2 systems. Four LDS were anatomically patent to irrigation but were functionally obstructed. Chemotherapy was the primary treatment in 7 patients, whereas 4 patients underwent radiation therapy. Nine patients responded well to treatment, with alleviation of signs and symptoms, and none of these patients had local recurrence during the follow-up interval. CONCLUSIONS: Leukemic or lymphomatous involvement of the LDS is an unusual cause of tearing in elderly patients, but it should be suspected in patients with known systemic disease. Treatment comprising multiple interventions improves the signs and symptoms of this complication of lymphoproliferative disorders in most patients.

Aged↗
PubMed2001

A different concept in the application of dacryoscintigraphy.

PURPOSE: Current dacryoscintigraphy methods have several potential pitfalls, the most important of which is the outflow of tears. Another is the difficulty in fixing the head with the patient seated. To overcome these difficulties, a new method was applied. MATERIALS AND METHODS: The study included 77 persons: 43 controls and 34 patients with epiphora. Two methods were applied to the two groups. In the first, protocol 1 (the current conventional protocol), the patient was seated in front of a gamma camera and one drop (50 microl) Tc-99m pertechnetate containing 50 to 100 microCi radioactivity was instilled in the inferior fornix or outer canthus of the eye and dynamic and static images were obtained for approximately 15 to 20 minutes. In the other, protocol 2 (our protocol), 100 microCi (10 microl) Tc-99m pertechnetate was instilled in the outer canthus of the eye using a micropipette with the patient in the supine position under the gamma camera. Dynamic images were taken for only 5 minutes. CONCLUSION: The pitfalls and difficulties seen with protocol 1 were lessened to a great degree in protocol 2.

Adult↗
PubMed1991

Oncocytoma of the caruncle: a case report and ultrastructural study.

A case of oncocytoma of the lacrimal caruncle is reported, in which extensive ultrastructural studies were completed on the surgical specimen. Individual oncocytes were columnar in shape with apical surface microvilli. Their cytoplasm was filled with two types of mitochondria. Most were very large and ovoid with cristae arranged in a wide array of patterns. A smaller number of mitochondria were long and slender with more typical cristae. Two types of granular inclusions, presumed to represent alpha- and beta-glycogen deposits, were found within a small number of the large mitochondria. Poorly differentiated desmosomes joined the lateral surfaces of adjacent oncocytes. In some cases, these junctions had mitochondria attached to their cytoplasmic surfaces. A comparison is made between ultrastructural features of oncocytes in the caruncle and those found elsewhere. The relationship noted between mitochondria and desmosomes, which occurs predominantly in secretory epithelia, is also discussed.

Adenoma↗
PubMed1991

Wegener's granulomatosis presenting as dacryoadenitis.

Wegener's granulomatosis is a life-threatening condition characterized by the triad of necrotizing granulomatous inflammation of the respiratory tract, vasculitis, and glomerulonephritis. During early stages of the disease, some patients may present with only one or two components of the triad. Other patients may be affected by the limited form of Wegener's which lacks the renal involvement. We report an 18-year-old female who initially presented with bilateral dacryoadenitis. A lacrimal gland biopsy was consistent with Wegener's granulomatosis. A few months later she developed glomerulonephritis and responded well to cyclophosphamide treatment. Wegener's granulomatosis remains a diagnostic challenge and is frequently underdiagnosed. Early diagnosis is crucial in saving many lives because the disease is potentially curable with cytotoxic therapy. Dacryoadenitis may be one of the initial presentations of Wegener's granulomatosis.

Adolescent↗
PubMed2000

Keratoconus associated with continual eye rubbing due to punctal agenesis.

PURPOSE: To highlight a possible causal effect of eye rubbing in the etiology of keratoconus. METHODS: A 43-year-old man presented to the practice of one of the authors (I.F.G.) with the complaint of gradual onset reading difficulty. History revealed the patient to have experienced constant epiphora in the right eye throughout his life as a result of punctal agenesis, which necessitated frequent wiping of this eye. Vision in the patient's right eye had been reduced for approximately 20 years. RESULTS: Based on ocular examination, the patient was diagnosed as having unilateral keratoconus in the right eye. CONCLUSION: It is thought by some that keratoconus is associated with, or indeed caused by, persistent rubbing of the anterior eye. While a number of studies support a genetic basis for keratoconus in some patients, it is possible that mechanical factors play a role in the development of this condition in other patients. This paper presents a case of unilateral keratoconus, where there is a confirmed history of habitual eye rubbing and wiping of excess tears as a result of punctal agenesis in the ipsilateral eye, thereby suggesting a possible causal relationship of eye rubbing in the etiology of keratoconus.

Adult↗
PubMed1976

Dacryoscintigraph evaluation of the repaired lacrimal drainage system.

We have used dacryoscintigraphy to study the efficiency of the lacrimal system following the repair of a divided lower canaliculus in 4 children. This test has been reliable in evaluating lacrimal function and suggests that a canaliculus can be repaired and splinted satisfactorily. Our experience with dacryoscintigraphy confirms that it is a safe comfortable, and reliable method for studying the patency of the lacrimal drainage system.

Child, Preschool↗
PubMed1979

The crocodile tear syndrome.

Gusto-lacrimation, or "crocodile tear syndrome," is a rare complication, with 95 cases reported in the literature. Two patients are presented here, one after a facial fracture which apparently extended into the temporal bone proximal to the optic ganglion, and one after a Bell's palsy. The mechanism appears to be a misdirection of regenerating gustatory fibers destined for the salivary glands, so that they become secretory fibers to the lacrimal gland and cause homolateral tearing while the patient is eating. A simple procedure, involving subtotal resection of the palpebral lobe of the involved lacrimal gland, proved to be an effective corrective measure in these cases. Although it was not done in these cases, it would perhaps be advisable to do a Schirmer's test to assist in determining the amount of gland to be removed.

Adult↗