Authors: Jeong Min Lee, Ji Sun Baek

PURPOSE

This study aimed to analyze the common causes of epiphora in Korean patients and their response to subsequent management.

METHODS

We retrospectively analyzed the medical records of 180 patients who visited Kim's Eye Hospital for epiphora between December 2017 and January 2019. This study included 320 eyes of 180 patients.

RESULTS

In the 320 eyes of 180 patients, the most common etiology of epiphora was reflex tearing due to dry eye syndrome, which occurred in 167 eyes (52.19%). The other etiologies of epiphora included anatomical abnormality (68 eyes, 21.25%), multifactorial (60 eyes, 18.75%), functional epiphora (14 eyes, 4.38%), ocular surface disease (seven eyes, 2.19%), and eyelid abnormality (four eyes, 1.25%).

CONCLUSIONS

The most common etiology of epiphora in Korean patients was reflex tearing due to dry eye syndrome, followed by lacrimal passage abnormality, multifactorial, functional epiphora, anterior segment disease, and eyelid malposition. Most patients with reflex tearing reported improvement in their symptoms after lubrication.

Topics: Dry Eye Syndromes; Eyelid Diseases; Humans; Lacrimal Apparatus; Lacrimal Apparatus Diseases; Retrospective Studies

PubMed: 34237206
DOI: 10.3341/kjo.2021.0069

Review

Authors: Yamini Krishna, Sarah E Coupland

Tumors of the lacrimal sac are rare but their recognition and early management are imperative, as they are locally invasive and potentially life-threatening. Because of their rarity, large clinical studies with statistically significant data on the natural course, management, and prognosis of these neoplasms are unavailable. Current practices are therefore based on a few case series and a small number of isolated case reports. Most tumors are primary and of epithelial origin (60-94%), of which 55% are malignant. Lacrimal sac tumors typically present with epiphora and a palpable mass over the medial canthus and are thus often erroneously diagnosed as chronic dacryocystitis. A full history with clinical and diagnostic workup is essential to plan treatment, which is often multi-disciplinary. Statistically significant associations have been shown with higher tumor staging and size with increased metastatic risk and lower survival rates. Management usually involves complete surgical resection with adjuvant radiotherapy and/or chemotherapy for malignant lesions. Long-term follow-up is required, as recurrences and metastases can occur many years after initial treatment.

Topics: Combined Modality Therapy; Disease Management; Eye Neoplasms; Humans; Lacrimal Apparatus; Lacrimal Apparatus Diseases

PubMed: 28399337
DOI: 10.22608/APO.201713

Review

Authors: P-Y Robert, J Delmas, O Vernat-Tabarly...

In addition to being a drainage system, the lacrimal ducts actively defend the eye through the action of the lacrimal pump, the presence of resident flora (lacriome) and the mucosa-associated immune tissue. Infection occurs when mucosal immune functions are overwhelmed. Lacrimal infection is a vicious circle, in which infection leads to inflammation and post-inflammatory sequelae, themselves a source of occlusion and stagnation, which in turn encourages infection. Whatever the initial trigger - post-traumatic occlusion, inflammation (e.g. allergic) or infestation by a virulent germ, the management of lacrimal duct infection must take account of this vicious circle. When infection sets in, changes in the mucosa can range from submucosal inflammatory infiltrates to pseudocysts, and in the most severe cases to metaplasia, dysplasia and squamous cell carcinoma. Histological sampling is therefore imperative in the case of surgery on a chronically infected mucosa. Clinical assessment, aided if necessary by a dacryoscan, must be able to detect differential diagnoses (lacrimal sac carcinoma, dacryocystocele in children) and serious forms (gonococcal ophthalmia neonatorum, peridacryocystitis), look for signs of dacryoliths, and differentiate between acute and chronic infection. Antibiotic treatment should be adapted to the identified or presumed organism involved or used sparingly in cases of chronic infection. Dacryoliths can be removed by curettage in the case of canaliculitis with concretions, but surgery is required for larger dacryoliths (canaliculotomy, or dacryocystorhinostomy in the case of lacrimal sac dacryoliths). Antibiotic prophylaxis for lacrimal surgery is recommended only in cases with associated rhinosinusitis, inflammation of the lacrimal sac, or a history of infected mucocele or dacryocystitis.

Topics: Humans; Lacrimal Apparatus Diseases; Eye Infections; Dacryocystitis; Lacrimal Duct Obstruction

PubMed: 39488146
DOI: 10.1016/j.jfo.2024.104345

Authors: Marina L Leis, Lynne S Sandmeyer

Topics: Animals; Dog Diseases; Dogs; Female; Keratoconjunctivitis Sicca; Lacrimal Apparatus Diseases; Parotid Gland

PubMed: 30197449
DOI: No ID Found

Authors:

Topics: Aging; Animals; Aortic Aneurysm, Abdominal; B-Cell Activating Factor; COVID-19; Disease Models, Animal; Disease Progression; Gene Expression Profiling; History, 21st Century; Host-Pathogen Interactions; Humans; Lacrimal Apparatus Diseases; Mice; Molecular Diagnostic Techniques; Neoplasm Invasiveness; Pathology, Clinical; Publishing; SARS-CoV-2; Secondary Prevention; Urinary Bladder Neoplasms; Zebrafish

PubMed: 34666040
DOI: 10.1016/j.ajpath.2021.10.001

Authors: Pedro Carneiro de Sousa, Marta Neves, Delfim Duarte...

INTRODUCTION

Newborns are obligatory nasal breathers. Therefore, nasal obstruction can lead to cyanosis and desaturation. In spite of being very rare, congenital bilateral dacryocystocele is a possible etiology for neonatal respiratory distress.

CASE SUMMARY

Case report of a male newborn with respiratory distress caused by a bilateral polypoid and bluish lesion occupying almost the entire inferior nasal meatus. Imaging confirmed bilateral dacryocystocele. Treatment was conservative. There was spontaneous drainage, with relief of respiratory distress. Discussion The diagnosis of congenital dacryocystocele is clinical, although imaging exams may be requested to confirm it. Treatment is controversial, because the natural history is variable. An initial conservative management may be recommended, but, if there is a permanent respiratory obstruction without improvement, surgical management is mandatory.

Topics: Anti-Bacterial Agents; Conservative Treatment; Humans; Infant, Newborn; Lacrimal Apparatus Diseases; Male; Massage; Mucocele; Nasal Obstruction; Nose Diseases; Respiratory Distress Syndrome, Newborn

PubMed: 30337239
DOI: 10.1016/j.anorl.2017.10.006

Review

Authors: Simon Andreasen, Bita Esmaeli, Sarah Linéa von Holstein...

Lacrimal gland tumors are rare and constitute a wide spectrum of different entities ranging from benign epithelial and lymphoid lesions to high-grade carcinomas, lymphomas, and sarcomas with large differences in prognosis and clinical management. The symptoms and findings of a lacrimal gland lesion are a growing mass at the site of the lacrimal gland, including displacement of the eyeball, decreased motility, diplopia, and ptosis. Pain is the cardinal symptom of an adenoid cystic carcinoma. Radiological findings characteristically include an oval, well-demarcated mass for benign lesions whereas malignant lesions typically display calcifications, destruction of bone, and invasion of adjacent structures. The diagnosis ultimately relies on histology, as does the choice of treatment and the prognosis. In recent years, the understanding of the biology of numerous types of lacrimal gland neoplasia has improved and the choice of treatment has changed accordingly and holds further promise for future targeted therapies. Treatment of benign epithelial lesions is surgical excision whereas carcinomas often require adjuvant radiotherapy and/or chemotherapy. In contrast, the cornerstone in management of lymphoid lesions is chemotherapy, often including a monoclonal antibody. This article presents an update on the clinical, radiological, histological, and molecular features, along with treatment strategies for tumors of the lacrimal gland.

Topics: Combined Modality Therapy; Eye Neoplasms; Humans; Lacrimal Apparatus; Lacrimal Apparatus Diseases; Neoplasm Staging; Neoplasms, Glandular and Epithelial; Prognosis

PubMed: 28399336
DOI: 10.22608/APO.201707

Review

Authors: Oluwatobi O Idowu, Georgia Kaidonis, Sameera Husain...

SIGNIFICANCE

Hemolacria (bloody tears) is a rare clinical presentation with varied underlying etiologies. Thorough clinical evaluation is essential to diagnosis and management.

PURPOSE

This study aimed to report unilateral hemolacria in a known contact lens wearer with an occult, palpebral, conjunctival pyogenic granuloma and review the literature.

CASE REPORT

A 21-year-old female contact lens wearer presented to the clinic after three episodes of sudden painless bloody tears from the right eye. She was referred to the oculoplastic clinic for evaluation. On everting her right upper lid, a fleshy, nontender, ovoid, pedunculated mass was found attached to the palpebral conjunctiva of the right, nasal, upper tarsus. Surgical excision was performed in the office, and pathological examination of the lesion was consistent with pyogenic granuloma.

CONCLUSIONS

Unilateral hemolacria should raise clinical suspicion for a hidden conjunctival lesion such as pyogenic granuloma, although other more sinister causes of hemolacria must also be considered. Thorough evaluation including eyelid eversion is critical in identifying and managing occult conjunctival lesions.

Topics: Blood; Cautery; Conjunctival Diseases; Contact Lenses; Crying; Female; Granuloma, Pyogenic; Humans; Lacrimal Apparatus Diseases; Tears; Young Adult

PubMed: 33633021
DOI: 10.1097/OPX.0000000000001653

Authors: Leticija Zlatar, Thomas Timm, Günter Lochnit...

Mucopeptide concretions, previously called dacryoliths, are macroscopic stones that commonly obstruct the lacrimal sac. The mechanism behind dacryolithiasis remains unclear; however, the involvement of various immune cells, including neutrophils, has been confirmed. These findings remain limited, and no information on neutrophil extracellular traps (NETs), essentially involved in the pathogenesis of other lithiases, is available yet. Here, we employ microcomputed tomography, magnetic resonance tomography, histochemistry, mass spectrometry, and enzyme activity analyses to investigate the role of neutrophils and NETs in dacryolithiasis. We classify mucopeptide concretions into three types, with respect to the quantity of cellular and acellular material, polysaccharides, and mucosubstances. We propose the role of neutrophils and NETs within the existing model of gradual formation and growth of mucopeptide concretions, with neutrophils contributing to the initial stages of dacryolithiasis, as they localized on the inner (older) parts of the tissue. As NETs localized on the outer (newer) parts of the tissue, we link their role to the late stages of dacryolithiasis, presumably maintaining the proinflammatory environment and preventing efficient clearance. An abundance of IgG on the surface indicates the involvement of the adaptive immune system later as well. These findings bring new perspectives on dacryolithiasis, in which the innate and adaptive immune system are essentially involved.

Topics: Humans; Extracellular Traps; X-Ray Microtomography; Lacrimal Apparatus Diseases; Neutrophils

PubMed: 37508521
DOI: 10.3390/cells12141857

Authors: Eiman Usmani, Yinon Shapira, Dinesh Selva...

PURPOSE

To determine the etiology of epiphora in a tertiary Australian lacrimal clinic and highlight the high proportion of 'functional' cases.

METHODS

Single-center retrospective review: Records of adult patients presenting to a tertiary lacrimal clinic from January 2011 to February 2021 with epiphora were reviewed. Patients underwent testing with syringing/probing and lacrimal imaging to reach a diagnosis of functional epiphora. Functional epiphora was diagnosed based on the exclusion of alternate causes of epiphora on clinical examination, patent lacrimal syringing, normal dacryocystography, and delay on dacryoscintigraphy.

RESULTS

Five hundred and seventy-six symptomatic eyes of 372 adult patients (mean 66.2 ± 15.5 years, 63.4% females) with epiphora were evaluated for causes. Post-sac obstruction (stenosis/complete obstruction) and functional epiphora (non-anatomical delay) were the most common causes of presentations to the lacrimal clinic (26% each). Functional epiphora with post-sac delay was substantially more common than functional epiphora with pre-sac delay (89% vs. 11% of functional epiphora cases). In 16% of the cases, no cause for the epiphora was found while more than one cause (multifactorial) was present 11% of the time.

CONCLUSION

Functional epiphora was found to be as common as a nasolacrimal anatomical obstruction when lacrimal imaging is utilized.

Topics: Adult; Female; Humans; Male; Lacrimal Duct Obstruction; Dacryocystorhinostomy; Nasolacrimal Duct; Australia; Lacrimal Apparatus Diseases; Lacrimal Apparatus

PubMed: 36952153
DOI: 10.1007/s10792-023-02668-4