Subcutaneous emphysema of the eyelids after dacryocystorhinostomy.
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Five patients with dacryocystorhinostomy failures were examined with computed tomography or computed tomographic dacryocystography. In computed tomographic dacryocystography, radiopaque dye was instilled into the lacrimal sac before computed tomography to show its shape, location, and relation to surrounding structures. Problems with the bony ostium were detected in all five patients. Recurrent nasal polyposis, a retained metallic clip, and an unresected ethmoid air cell were also identified. Computed tomography and computed tomographic dacryocystography provided important information that facilitated reoperation after dacryocystorhinostomy failure.
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PURPOSE: To describe the clinical features of lacrimal gland inflammation associated with Epstein-Barr virus infection. METHODS: The clinical records, laboratory data, and radiographs of patients who had inflammation of one or both lacrimal glands that had begun less than 4 weeks previously were reviewed. RESULTS: Sixteen patients with dacryoadenitis were encountered between 1980 and 1996, a cumulative frequency of approximately one case per 10,000 new ophthalmic outpatients. Six individuals had serologic or other evidence of recent Epstein-Barr virus infection and were distinguished by the presence of regional lymphadenopathy, no purulent discharge, and a duration of symptoms of 6 weeks. CONCLUSION: Epstein-Barr virus is a probable cause of unilateral and bilateral dacryoadenitis in young adults.
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BACKGROUND: Acute dacryoadenitis is an uncommon disease. CASE: We present what we believe to be the first reported case of herpes zoster ophthalmicus with the onset of acute dacryoadenitis. OBSERVATIONS: A 30-year-old man complained of severe ocular pain and hyperemia in his right eye. Magnetic resonance imaging (MRI) demonstrated enlargement of the right lacrimal gland and acute dacryoadenitis was diagnosed. Two days after treatment with systemic antibiotics he developed iridocyclitis and skin lesions confined to the first division of the trigeminal nerve; therefore, herpes zoster ophthalmicus was diagnosed. Treatment with acyclovir immediately resolved the ocular pain and swelling of the upper eyelid. MRI conducted in the 4 months after the initial examination showed there was no longer enlargement of the right lacrimal gland. CONCLUSION: Clinicians should be aware that varicella-zoster virus may cause acute dacryoadenitis.
PURPOSE: To report the case of a 53-year-old woman with a 2-year history of episodic upper eyelid swelling and nonspecific complaints, who was diagnosed as having allergic conjunctivitis. METHODS: A complete ocular examination, orbital computerized tomographic (CT) scans followed by complete physical and systemic examinations. RESULTS: The results of physical and systemic examinations were unremarkable for systemic lymphoma and a primary focus of cancer. The results of the ocular examination were normal. CT scans demonstrated well-defined lesions bilaterally with a homogeneous internal structure in the lacrimal gland fossa, which suggested a diagnosis of chronic dacryoadenitis. The differential diagnosis included lymphoma and orbital metastases. The patient refused a biopsy and was started on a tapering dose of 60 mg oral prednisolone daily. The follow-up CT scans 1 month after cessation of 6-week oral corticosteroid treatment showed near complete resolution of the orbital lesions. CONCLUSION: This case demonstrates that orbital inflammation can be misdiagnosed as refractory allergic conjunctivitis.
The mRNAs for acute-phase proteins and kininogens were found to be increased in the submandibular gland (SMG) and extraorbital and intraorbital lacrimal gland (ELG and ILG) in response to experimentally induced inflammation in rats; i.e., 24 hours after subcutaneous injection of turpentine oil, mRNAs for C-reactive protein (CRP), serum amyloid P component (SAP), and H- and T-kininogens were induced in the SMG, ELG, and ILG of rats, whereas these mRNAs were not detected in the same tissues of normal control rats. The induction of mRNAs for these inflammatory proteins by turpentine oil was preceded by a transient increase in the level of mRNA for tumor necrosis factor-alpha (TNF-alpha) at 6 hours after subcutaneous injection of the oil. This was confirmed by injection of another inflammation inducer, lipopolysaccharide (LPS), which induced the TNF-alpha mRNA in the same way at 6 hours as turpentine oil did. The up-regulation of acute-phase proteins including kininogens in the SMG, ELG, and ILG suggest the existence of a strict defense system in the exocrine glands.
Overall, the primary care physician can diagnose most cases of red eyes in children, if specific attention is paid to which ocular structures are involved. Accurate diagnosis allows appropriate primary care treatment for most disorders and can aid in determining which cases need referral.
Discussed is the treatment of a variety of conditions that affect the structures responsible for the production and drainage of tears.
The lacrimal gland region can be involved in a wide spectrum of orbital pathology, including inflammatory, lymphoproliferative, and epithelial tumors. This article focuses on benign and malignant epithelial tumors of lacrimal gland and simulating lesions. The clinical presentations, MR imaging, and pathologic findings of lacrimal gland tumors are reviewed.
Few studies have investigated the pharmacological response of agents that act on the cholinergic system from the point of view of age. The present article investigated central responses (tremor) and peripheral responses (chromodacryorrhea) subsequent to the administration of oxotremorine to young (3-6 months of age) and aged rats (24-30 months of age). The aged rats presented greater duration and intensity of tremor in three doses utilized (0.25, 0.5, and 1.0 mg/kg) compared to young rats. These two groups of animals did differ in latency for the onset of the tremor. The aged rats presented more intense chromodacryorrhea than the young rats in all utilized doses. These data are indicative that both responses--central and peripheral--are affected by aging, possibly as a result of pharmacokinetic alterations and/or alterations in functionality of the cholinergic system in aged rats.
PURPOSE: To describe the rare occurrence of a concha bullosa mucocele producing secondary nasolacrimal duct obstruction and dacryocystocele. DESIGN: Case report. PARTICIPANT: Forty-two-year-old man with 6-month history of left medial canthal mass. INTERVENTION: Clinical evaluation with lacrimal testing, computed tomography and surgical exploration, including biopsy, dacryocystorhinostomy, and excision/marsupialization of the middle turbinate concha bullosa mucocele were performed. RESULTS: The medial canthal mass was confirmed to be a dacryocystocele associated with nasolacrimal duct obstruction and bone destruction caused by concha bullosa mucocele. CONCLUSIONS: Concha bullosa mucoceles are uncommon and even more rarely can produce secondary nasolacrimal duct obstruction and dacryocystocele formation. The clinical and radiologic features may mimic a lacrimal sac malignancy.
OBJECTIVE: To clarify the characteristics of ocular manifestations in Churg-Strauss syndrome (allergic granulomatosis and angiitis). DESIGN: Two interventional case reports and literature review. PARTICIPANTS: Two patients with Churg-Strauss syndrome with ocular manifestations are described; 15 previously reported cases and the present 2 cases of Churg-Strauss syndrome with ocular manifestations are reviewed. INTERVENTION: Ocular manifestations were divided into two groups: orbital inflammatory pseudotumor and ischemic vasculitis. MAIN OUTCOME MEASURES: The onset, conjunctival involvement, orbital imaging, antineutrophil cytoplasmic antibodies (ANCA), and visual prognosis were evaluated. RESULTS: The characteristics of the orbital inflammatory pseudotumor type (eight cases) are chronic onset, positive conjunctival involvement, abnormalities in orbital imaging studies, negative ANCA, and good visual prognosis. The ischemic type (nine cases) is characterized by sudden onset, no conjunctival involvement or abnormalities in imaging studies, positive ANCA, and occasional poor visual prognosis. CONCLUSIONS: Orbital inflammatory pseudotumor and ischemic vasculitis may represent two essential characteristics of Churg-Strauss syndrome, granulomatosis and angiitis, respectively. The clinical features of the two types are so distinct that differentiation may be meaningful for diagnosis and treatment of Churg-Strauss syndrome with ocular manifestations.
OBJECTIVE: To determine whether organized mucosa-associated lymphoid tissue (MALT) is a normal component of the human efferent tear ducts or is acquired in reaction to chronic inflammation. DESIGN: Nonrandomized comparative (cadaver controlled) study with histopathologic correlations. MATERIALS: Tissue specimens from nasolacrimal ducts of 38 patients undergoing endonasal dacryocystorhinostomy in postinflammatory dacryostenosis with signs of chronic inflammation were analyzed using histologic examination and immunohistochemical studies. Only tissue specimens revealing proliferative sclerotic forms of chronic fibrosis were chosen for the study. Eighty specimens from the lacrimal systems of body donors served as controls. TESTING: Tissue specimens from each lacrimal system were prepared and processed with paraffin, sectioned, stained using different histologic methods with an array of specific antibodies, and examined by light microscopy. MAIN OUTCOME PARAMETERS: The distribution of intraepithelial and subepithelial defense cells was analyzed to identify plasma cells, secretory immunoglobulins, lymphocytes, dendritic cells, and organized mucosa-associated lymphoid tissue. RESULTS: The presence of secretory immunoglobulin A was demonstrated in subepithelial plasma cells and in the cytoplasm of apical epithelial cells in both chronically inflamed and healthy lacrimal systems. In more than one third of cases from body donors, but in only a few biopsy specimens from patients, organized lymphoid tissue was found with the cytomorphologic and immunophenotypical features of MALT. All other cases showed a diffuse infiltrate of defense cells within the lamina propria. CONCLUSIONS: The development of tear duct-associated lymphoid tissue (TALT) is a common feature that is often found in symptomatically normal nasolacrimal ducts. Because TALT seems to be lost associated with the scarring of symptomatic dacryostenosis, it is unlikely that the presence per se of TALT leads to scarring. Future studies are needed to explain the development of TALT.
BACKGROUND: Soft tissue infection after open lacrimal surgery is said to be uncommon. This study was designed to determine the rate of infection and the effect of early antibiotic prophylaxis after open lacrimal surgery. METHODS: Two consecutive patient groups undergoing open lacrimal surgery were studied by review of case notes: the first group (152 patients) did not receive antibiotic prophylaxis after surgery, and the second group (128 patients) did. RESULTS: Infection occurred in 2 of the 128 patients who were given prophylactic antibiotics (1.6%) and in 12 of the 152 patients who were not (7.9%; P < 0.02). Silicone intubation did not affect the infection rate, but patients who had sustained previous facial trauma did have a significantly increased rate of infection (P < 0.01). CONCLUSIONS: Soft tissue infection occurs in approximately 8% of patients after open lacrimal surgery. A 5-fold reduction in this rate can be achieved with routine administration of antibiotics after surgery. The use of silicone tubing does not increase the risk of infection.