Conjunctivodacryocystostomy.
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Adolescent↗
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Results for “DACRYOCYSTITIS”
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Fusobacterium in presumed Actinomyces canaliculitis.
Based on stained smears of material obtained from the canaliculus, three cases of canaliculitis were presumed to be caused by Actinomyces. Cultures of these cases showed Fusobacterium to be the probable infectious agent producing the disease.
Actinomyces↗
Combined Jones tube-canalicular intubation and conjunctiva dacryocystorhinostomy.
Six patients underwent combined Jones tube-canalicular intubation and conjunctival dacryocystorhinostomy. These patients had epiphora secondary to partial obstruction of the upper and lower canaliculi, complete obstruction of the common canaliculus or a single canaliculus, or paresis of the orbicularis oculi muscle. In these patients we would have performed a dacryocystorhinostomy with silicone elastic intubation, risking recurrent obstruction, or a conjunctival dacryocystorhinostomy with placement of a Jones tube, risking failure of the procedure and complete obstruction of patent canaliculi by placement of the tube. The combined Jones tube-canalicular silicone elastic intubation and conjunctival dacryocystorhinostomy ensured successful treatment of epiphora for this group of patients. Intubating the canaliculi with Bowman probes during placement of the Jones tube avoids injury and subsequent postoperative canalicular obstruction. After several months, the silicone elastic tubing is removed and the Jones tube is plugged. If the patient is asymptomatic and the canaliculi are patent and can be irrigated freely to the nasal cavity, the Jones tube can be removed. However, if epiphora occurs, the plug can be removed and the tube left in place to drain the tears without additional surgery.
Adult↗
Combined clinical and computed tomographic diagnosis of primary lacrimal fossa lesions.
We studied 39 patients who had solid mass-lesions primary in the lacrimal gland by computed tomography and reviewed their clinical histories. Twenty-three patients had either inflammatory conditions (16 cases) or lymphoid tumors (seven cases), with average symptomatic periods of less than a year. In this group, soft-tissue contour analysis in the axial and corneal projections demonstrated diffuse, compressed, and molded enlargements of the lacrimal gland in an oblong fashion, and there were no associated bone defects. Sixteen parenchymal benign or malignant tumors (six benign mixed tumors, one schwannoma, and nine malignant epithelial tumors) exhibited rounded or globular soft-tissue outlines and were frequently associated with contiguous bone changes. The benign tumors had smooth encapsulated outlines at their margins, whereas the malignant tumors displayed microserrations indicative of infiltration. The patients with the benign mixed tumors had had symptoms, on the average, for more than a year, whereas those with epithelial malignancies became symptomatic or had a preexisting benign mixed tumor that became exacerbated in periods of less than six months. Contour analysis of the soft-tissue mass depicted in coronal and axial tomograms is a valuable adjunct that leads to more accurate preoperative diagnosis when combined with a radiographic search for bone changes and the clinical history. Once a diagnosis regarding the presumptive lesional family has been made preoperatively, corticosteroid therapy may be instituted for acute inflammation and biopsies through the eyelid should be performed for suspected chronic inflammations, lymphoid lesions, or epithelial malignancies. A lateral orbitotomy without prior biopsy should be performed for rounded, well-encapsulated masses of long duration that are likely to be benign mixed tumors.
Adolescent↗
Lacrimal drainage system inflammatory masses from retained silicone tubing.
In two cases studied we found inflammatory masses of the lacrimal system associated with retained silicone material. We saw the first patient two years after a failed dacryocystorhinostomy. A mass of the superior punctum mimicking a lacrimal sac or canalicular neoplasm consisted of chronic granulomatous inflammation centered around retained silicone tubing. In the second patient, a foreign body giant cell inflammatory reaction occurred in the lacrimal sac in which there were retained knots of silicone tubing. We believed the inflammation in these patients to be caused by the knots and the cut ends of the silicone tubing present in the lacrimal drainage system.
Aged↗
The pattern and incidence of nasolacrimal injury in naso-orbital-ethmoid fractures: the role of delayed assessment and dacryocystorhinostomy.
A detailed review of forty-six patients with severe naso-orbital-ethmoid injury confirms that naso-lacrimal system injury is less common than originally suspected. Post-operative epiphora is more frequently due to eyelid malposition than naso-lacrimal obstruction. Eight patients (17.4%) required eventual dacryocystorhinostomy. Three out of five patients (60%), treated with closed reduction and external splint fixation, needed dacryocystorhinostomy. This treatment predisposes to external compression of the naso-lacrimal system by malpositioned bone fragments and segments. Open reduction and internal fixation of all fractures provides optimal repair and minimizes the incidence of post-operative epiphora. During fracture repair, the naso-lacrimal sac should be identified, but not probed or intubated unless obviously lacerated. The upper lacrimal pathway is protected by the medial canthal ligament. Obstruction usually occurs in the bony naso-lacrimal canal. Telecanthus invariably accompanies severe naso-orbital-ethmoid injuries and subsequent naso-lacrimal obstruction. Dacryocystography is useful in the investigation of naso-lacrimal function. When dacryocystorhinostomy is necessary, it should be performed at least 3 months after the primary repair.
Dacryocystitis↗
Computerized tomography of the orbit using thin sections.
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Arteriovenous Fistula↗
Stenoses and functional disorders of the lacrimal drainage apparatus. Radiological examination.
The diagnosis of epiphora can be greatly aided by a special radiologic technique, performed during bilateral injection of contrast medium into the lacrimal passages and utilizing seriography, magnification and image subtraction. The authors describe the technique, discuss the interpretation of the various radiologic patterns, and stress the importance of this method for evaluating inflammation, stenoses and functional alterations of the lacrimal passages.
Dacryocystitis↗
The nonspecific orbital inflammatory syndromes.
The nonspecific orbital inflammatory syndromes are a peculiar group of inflammations that may occur in acute or subacute forms and can become chronic. They may be diffuse or primarily localized to a specific tissue of the orbit. The nonspecific inflammations that are targeted toward specific tissues are myositis, dacryoadenitis, perineuritis, and periscleritis. Each of these syndromes has definite signs, symptoms, ultrasonic and radiologic findings. Therefore, this group of nonspecific inflammations should be more clearly classified for purposes of better understanding and better management. All of these inflammatory syndromes in the acute form respond well to high doses of oral corticosteroids tapered gradually over a period of months, but may be reoccurrent or become chronic. The subacute form responds less well. Occasionally, patients require radiation to stop the inflammation in the subacute or chronic state, but these patients are often left with a functional deficit. The cause, although presumed to be an immune disorder involving the orbital tissues, remains unknown.
Adult↗
Acute pseudotumor of the orbit.
A case is presented of a 22-year-old man with a history of bilateral eye injection, lacrimation, and rhinorrhea. The right orbit was inflamed and its globe proptotic, with medial and lateral gaze deficits. Tomography revealed swelling about the right lacrimal gland. He was admitted and treated with high-dose steroids, which caused regression of his symptoms. This presentation and response to steroids is pathognomonic for acute pseudotumor of the orbit, a condition rarely described in the emergency medicine literature. If left untreated, pseudotumor of the orbit may progress to blindness and ophthalmoplegia.
Adult↗
A postmortem study of focal adenitis in salivary and lacrimal glands.
Investigations were carried out on 102 consecutive medicolegal post-mortem subjects to identify signs of focal adenitis in labial, submandibular, and lacrimal glands. There were 19 subjects (18.6%) with focus scores exceeding 1 in one or two of the types of glands. Among the 19, five had had a disease which is generally associated with Sjögren's syndrome or is autoimmune in nature. In another 63 subjects occasional lymphocytic foci were found in one, two, or all three types of gland. Fibrosis, atrophy, and fatty change had occurred most often in the labial salivary glands in those over 50 years of age with or without high focus scores. Fibrosis, atrophy, and fat infiltration had hardly ever occurred in the lacrimal glands, although this is the type of gland in which high focus scores occur most often. The results suggest that there may be a common autoimmune basis for Sjögren's syndrome and other diseases, the mechanisms of which are still incompletely understood. A focus score exceeding 1 may be an indicator of Sjögren's syndrome, but the diagnosis should not be established on the biopsy findings alone.
Adolescent↗
Antiinflammatory therapy for dry eye.
PURPOSE: To present evidence establishing the relationship between inflammation and dry eye and supporting the use of antiinflammatory therapy for dry eye. DESIGN: Analysis of literature. METHODS: Research studies that evaluated inflammation in dry eye pathogenesis and clinical trials of antiinflammatory therapies for dry eye were reviewed. RESULTS: There is increasing evidence that decreased tear secretion, decreased tear turnover, and desiccation promote inflammation on the ocular surface. An increase in soluble mediators (cytokines and proteases) in the tear fluid, adhesion molecule expression by the conjunctival epithelium, and T-cell infiltration of the conjunctiva have been observed in dry eye patients. This inflammation appears to have a role in the pathogenesis of the ocular surface epithelial disease, termed keratoconjunctivitis sicca (KCS), that develops in dry eye. Clinical improvement of KCS has been observed after therapy with antiinflammatory agents including corticosteroids, cyclosporin and doxycycline. Cyclosporin A emulsion was approved by the Food and Drug Administration as therapy for dry eye. Randomized placebo-controlled FDA clinical trials showed that cyclosporine A was superior to vehicle in stimulating aqueous tear production, decreasing corneal punctuate fluorescein staining, reducing symptoms of blurred vision, and decreasing artificial tear use in patients with KCS. No ocular or systemic toxicity was observed from this medication. CONCLUSIONS: Ocular surface and lacrimal gland inflammation has been identified in dry eye that plays a role in the pathogenesis of KCS. Antiinflammatory therapy has efficacy for treating KCS. Cyclosporin A is the first FDA approved therapy for this indication. It improved signs and symptoms of KCS, and it is safe for long-term use.
Anti-Inflammatory Agents↗
Effect of inflammation on lacrimal gland function.
The lacrimal gland is the main contributor to the aqueous layer of the tear film. It secretes proteins, electrolytes and water, which helps to nourish and protect the ocular surface. Lacrimal gland secretion is primarily under neural control, which is achieved through a neural reflex arc. Stimuli to the ocular surface activate afferent sensory nerves in the cornea and conjunctiva. This in turn activates efferent parasympathetic and sympathetic nerves in the lacrimal gland to stimulate secretion. Sex steroid hormones are also important regulators of lacrimal gland functions. A decrease or lack of lacrimal gland secretion is the leading cause of aqueous tear deficient dry eye syndrome (DES). It has been suggested that DES is an inflammatory disorder that affects the ocular surface and the lacrimal gland. In several pathological instances, the lacrimal gland can become a target of the immune system and show signs of inflammation. This can result from autoimmune diseases (Sjögren's syndrome), organ transplantation (graft versus host disease), or simply as a result of aging. The hallmarks of lacrimal gland inflammation are the presence of focal lymphocytic infiltrates and increased production of proinflammatory cytokines. The mechanisms leading to lacrimal gland dysfunction are still poorly understood. Apoptosis, production of autoantibodies, hormonal imbalance, alterations in signaling molecules, neural dysfunction, and increased levels of proinflammatory cytokines have been proposed as possible mediators of lacrimal gland insufficiency in disease states.
Animals↗
Meningitis and Pneumocephalus. A rare complication of external dacryocystorhinostomy.
Meningitis due to fracture of the fovea ethmoidalis during external dacryocystorhinostomy is a rare complication. We report a case of pneumocephalus and meningitis in a 51-year-old female who underwent an external dacryocystorhinostomy (DCR). Although extracranial complications during or after external DCR have been well-described, only one case of meningitis has been reported in the literature. Physical examination, computerised tomography, lumbar puncture, and bacteriologic cultures were used to make the diagnosis. The patient responded well to antibiotic therapy. Her symptoms resolved immediately and she was discharged on the 21st post-operative day. This complication emphasises the importance of careful surgical technique and a thorough knowledge of regional anatomy, during DCR and similar procedures.
Dacryocystitis↗
Encephalomyocarditis (EMC) virus-induced sialodacryoadenitis in mice.
The mode of occurrence of the D variant of encephalomyocarditis (EMC-D) virus-induced acute sialodacryoadenitis was investigated using three strains of mice differing in their sensitivity to EMC-D virus-induced diabetes (C57BL/6: resistant; BALB/c: moderately sensitive; DBA/2: highly sensitive). Mice were intranasally inoculated with high (10(5) PFU/mouse) or low dose (10(2) PFU/mouse) of EMC-D virus. Although there were individual differences, the blood virus titer generally reached the peak earlier in the high-dose group than in the low-dose group. Signals of viral RNA and histopathological changes were seen in parotid glands and intraorbital and extraorbital lachrymal glands. In these glands, signals of viral RNA and histopathological changes were detected only in acinar cells and initial lesions were characterized by pyknosis of acinar cells. Coagulative necrosis with interstitial inflammatory cell infiltration developed later in parotid glands of BALB/c mice of the high-dose group and in intraorbital and extraorbital lachrymal glands of all groups except for C57BL/6 mice of the low-dose group. Such changes were not observed in epithelial cells of the ductal system. The present results indicate that EMC-D virus shows clear tissue and cell tropism within the salivary and lachrymal glands, probably due to the distribution of receptors for EMC virus.
Animals↗
[Endonasal and endocanalicular dacryocystorhinostomy by diode laser. Preliminary results].
AIM OF THE STUDY: To describe the surgical technique and to evaluate the clinical results after having performed the transcanalicular and endocanalicular dacryocystorhinostomies by diode laser, including the advantages and limits of this technique. METHODS: 34 were performed by diode laser in patients with clinical history of epiphora, with or without mucopurulent secretion, for nasolacrimal duct obstruction. The study was prospective, interventional, non randomized and non comparative. Diode laser was used to realize vaporization of lacrimal sac, osteotomy and vaporization with coagulation of nasal mucosa. The mean of surgical time was 15 minutes (range 7 to 29 minutes). Bicanalicular intubation was performed with a silicone tube and prolene filament for two months in all cases. Postsurgical follow-up was between 4 and 11 months. The degree of epiphora was evaluated by the Munk scale and lacrimal permeability was evaluated by endoscopic functional staining test in all cases. RESULTS: Out of the 34 DCR-EDN+ENC that were performed, 32 cases (94.11%) remain asymptomatic. Two of them (5.88%) required endonasal dacryocystorhinostomies by drilling, because the bony perforation was impossible to achieve by laser fiber. Two cases (5.88%) presented fibrosis and lacrimal and lower canaliculi obstruction, without epiphora because the superior canaliculi was permeable. CONCLUSION: Endonasal and endocanalicular dacryocystorhinostomy technique performed by diode laser is a valid method. It does not cause cutaneous scarring, it decreases thermic canalicular damage, it respects the lacrimal pump, it minimizes pain and bleeding, it needs less surgical time and it has turned into an out-patient procedure with a minimal surgical and postsurgical morbility.
Adult↗
Epstein-Barr virus dacryoadenitis resulting in keratoconjunctivitis sicca in a child.
PURPOSE: To describe a case of severe dry eye syndrome in a child. METHODS: Observational case report. The authors describe a 10-year-old male with severe dry eyes who was profoundly disabled by pain and photophobia despite aggressive conventional therapy. Lacrimal gland histology was consistent with the primary Sjögren syndrome, and serologic and immunohistologic evidence supported the hypothesis of Epstein-Barr virus causality. RESULTS: Treatment with systemic acyclovir and cyclosporin A resulted in dramatic and rapid reversal of the profound sicca syndrome and enabled the patient to resume his normal activities. CONCLUSION: Epstein-Barr virus dacryoadenitis should be considered in the differential diagnosis of keratoconjunctivitis sicca in children. Epstein-Barr virus can cause keratoconjunctivitis sicca, which can be treated successfully with acyclovir therapy in addition to suppression of the inflammatory response.
Acyclovir↗
Juvenile xanthogranuloma of the lacrimal sac fossa.
PURPOSE: Masses involving the medial canthus and lacrimal sac fossa include dacryocystoceles and, less commonly, mucoceles, hemangiomas, diverticula, and lacrimal sac neoplasms. To our knowledge, juvenile xanthogranuloma presenting as a lacrimal sac fossa mass has not been previously reported. METHODS: We examined a 2-year-old boy who had epiphora in the left eye since birth and a mass in the left lacrimal sac fossa for 6 weeks. During surgery, left lacrimal probing disclosed obstruction at the level of the common canaliculus and lacrimal sac. Exploration and excision of the mass were performed. RESULTS: Histopathologic evaluation disclosed a juvenile xanthogranuloma characterized by an inflammatory cell infiltrate with foamy histiocytes and scattered Touton-type multinucleated giant cells. CONCLUSION: Juvenile xanthogranuloma should be included in the differential diagnosis of a medial canthal and lacrimal sac fossa mass.
Child, Preschool↗