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Der Ophthalmologe : Zeitschrift Der... Jun 2021This article presents the case of a strictly unilateral dry eye syndrome in a male patient. Based on a stepwise diagnostic procedure the spectrum of possible causes...
This article presents the case of a strictly unilateral dry eye syndrome in a male patient. Based on a stepwise diagnostic procedure the spectrum of possible causes could be gradually limited, whereby the magnetic resonance imaging of the lacrimal gland in particular provided important diagnostic information. Ultimately, in the synopsis of the findings and combined with the medical history of the patient, a traumatic atrophy of the lacrimal gland could be determined as the triggering factor.
Topics: Atrophy; Dry Eye Syndromes; Humans; Lacrimal Apparatus; Male
PubMed: 32647926
DOI: 10.1007/s00347-020-01168-5 -
Medicine Aug 2019To investigate the efficacy of lacrimal endoscopy in the diagnosis and treatment of primary canaliculitis.This is a retrospective, interventional study. Fifteen patients...
To investigate the efficacy of lacrimal endoscopy in the diagnosis and treatment of primary canaliculitis.This is a retrospective, interventional study. Fifteen patients diagnosed as primary canaliculitis were investigated, who underwent surgery with lacrimal endoscopy from January 2015 to December 2017 at Zhejiang Provincial People's Hospital. Patients were subsequently followed post-operatively for at least 6 months. Pre- and post-operative main measurement included ocular surface symptoms, signs of canaliculitis, intraoperative images, treatment response and complications.Twelve patients (12 eyes) were enrolled. Endoscopy was successful in revealing the residual concretion and pathological change of lacrimal duct. With its unique direct vision and micro drill, all concretions got removed and lacrimal ducts got patent. On postoperative month 6, all of the patients got cured with no signs of redness, swelling of the punctum and eyelid, epiphora with discharge and pain. None serious complications such as false canalicular passage were observed.Lacrimal endoscopy is indispensable in diagnosis, treatment and follows up of primary canaliculitis. With less iatrogenic injury, higher resolution rate and direct observation of canalicular mucosa, lacrimal endoscopy should be widely applied in the management of lacrimal diseases.
Topics: Adult; Aged; Canaliculitis; Endoscopy; Female; Humans; Lacrimal Apparatus; Male; Middle Aged; Retrospective Studies; Treatment Outcome
PubMed: 31415384
DOI: 10.1097/MD.0000000000016789 -
Eye (London, England) Aug 2020To review the outcome for primary or revisional external dacryocystorhinostomy in patients with granulomatous polyangiitis.
AIM
To review the outcome for primary or revisional external dacryocystorhinostomy in patients with granulomatous polyangiitis.
PATIENTS AND METHODS
Retrospective case-note review to include age at presentation, duration of prior GPA, immunosuppression at time of surgery, nature of first lacrimal surgery, and symptomatic control.
RESULTS
Forty-eight patients (25 female; 52%) presented at an average age of 50.5 years and 7 (15%) had prior lacrimal surgery on one (5/7; 71%) or both sides. The duration of systemic GPA varied, with 40% having disease for up to 3 years prior to lacrimal referral, and 41/48 (85%) being on systemic immunosuppression. Forty-eight patients had 71 affected drainage pathways-having symptoms for an average of 22 months (range <1 month to 7 years). Surgery was undertaken on 70/71 systems-62/70 primary DCRs (20 unilateral; 8 simultaneous bilateral; 13 sequential bilateral). Of nine systems with persistent symptoms after prior surgery, eight underwent revisional surgery (six unilateral; one sequential bilateral). With a follow-up of 2.5 years (range 3 months to 14 years), volume symptoms were cured in all 70 cases. Flow symptoms were controlled in 58/62 (94%) systems after primary DCR, and all eight after revisional surgery. Of four sides with persistent epiphora, one was cured with revisional DCR and three with placement of Jones' canalicular bypass tubes.
CONCLUSION
Mucoid discharge, dacryocystitis and recurrent conjunctivitis were cured in all patients with GPA after either primary and revisional surgery. Continued epiphora was controlled in most patients with additional closed procedures.
Topics: Dacryocystitis; Dacryocystorhinostomy; Female; Humans; Lacrimal Apparatus; Lacrimal Apparatus Diseases; Lacrimal Duct Obstruction; Middle Aged; Nasolacrimal Duct; Retrospective Studies; Treatment Outcome
PubMed: 31685972
DOI: 10.1038/s41433-019-0662-1 -
Eye (London, England) Mar 2021To assess the diagnostic information provided by digital subtraction dacryocystography (DCG) and dacryoendoscopy in patients with epiphora.
OBJECTIVE
To assess the diagnostic information provided by digital subtraction dacryocystography (DCG) and dacryoendoscopy in patients with epiphora.
METHODS
Sixty-eight lacrimal systems of 34 patients with epiphora were prospectively studied. Patients were initially examined with syringing, followed by digital subtraction DCG and dacryoendoscopy to confirm the diagnosis. Obstructions in lacrimal pathways were evaluated by degree, location, and cause. The weighted kappa coefficient was used to compare the agreement between the tests.
RESULTS
Of the 68 lacrimal pathways, partial or complete obstructions were identified in 56 cases (82.3%) with syringing, in 38 cases (55.9%) with DCG, and in 60 cases (88.2%) with dacryoendoscopy. DCG and dacryoendoscopy showed the same result in 42 of the 68 (61.8%) lacrimal pathways. The weighted kappa value for DCG and dacryoendoscopy was 0.60 (95% CI: 0.40-0.81). The most common sites of obstruction were the common canaliculus (36.7%) and the nasolacrimal duct (28.3%) in dacryoendoscopy. Thirty-three lacrimal pathways (48.5%) were identified to have obstructions on the same level between DCG and dacryoendoscopy. Among the 30 lacrimal pathways (44.1%) that were normal by DCG, obstruction was revealed in 22 cases by dacryoendoscopy, with 11 cases in the common canaliculus. Additional useful information on the cause of obstruction and identification of multiple obstructed sites was provided by dacryoendoscopy.
CONCLUSIONS
DCG and dacryoendoscopy showed moderate agreement in detecting lacrimal pathway obstruction. Dacryoendoscopy allowed for comprehensive investigations of the lacrimal pathway and can help explain unidentified factors associated with lacrimal pathway obstruction in patients with epiphora.
Topics: Dacryocystorhinostomy; Humans; Lacrimal Apparatus; Lacrimal Apparatus Diseases; Lacrimal Duct Obstruction; Nasolacrimal Duct
PubMed: 32467631
DOI: 10.1038/s41433-020-0990-1 -
Swiss Dental Journal 2017
Topics: Adult; Contrast Media; Female; Humans; Image Enhancement; Iopamidol; Lacrimal Apparatus Diseases; Lacrimal Duct Obstruction; Nasolacrimal Duct; Tomography, X-Ray Computed
PubMed: 28134968
DOI: No ID Found -
The British Journal of Ophthalmology Nov 2023We report visual outcomes and ocular complications in patients with lacrimal gland carcinoma who had eye-sparing surgery followed by radiotherapy. (Review)
Review
BACKGROUND
We report visual outcomes and ocular complications in patients with lacrimal gland carcinoma who had eye-sparing surgery followed by radiotherapy.
METHODS
This review included consecutive patients with lacrimal gland carcinoma who underwent eye-sparing surgery and adjuvant radiotherapy or concurrent chemoradiation therapy between 2007 and 2018. Clinical data, including details of ophthalmological examinations and radiation treatment were reviewed.
RESULTS
The study included 23 patients, 15 males and 8 females, with median age 51 years. Twenty patients (87%) received intensity-modulated proton therapy; 3 (13%) received intensity-modulated radiotherapy. Nineteen patients (83%) received concurrent chemotherapy. After a median follow-up time of 37 months (range: 8-83), 13 patients (57%) had best-corrected visual acuity 20/40 or better, 3 (13%) had moderate vision loss (between 20/40 and 20/200) and 7 (30%) had severe vision loss (20/200 or worse). The most common ocular complications were dry eye disease (21 patients; 91%), radiation retinopathy (16; 70%) and cataract progression (11; 49%). Tumour crossing the orbital midline (p=0.014) and Hispanic ethnicity (p=0.014) were associated with increased risk of severe vision loss. The risk of radiation retinopathy was significantly different among the three racial groups; Hispanic patients (n=3) had the highest rate of retinopathy (p<0.001). Tumour size, initial T category and total prescribed radiation dose were not significantly associated with severe vision loss.
CONCLUSION
Eye-sparing surgery followed by adjuvant radiotherapy in patients with lacrimal gland carcinoma has a reasonable overall visual prognosis. Patients with tumours crossing the orbital midline and Hispanic patients have a higher risk of severe vision loss.
Topics: Male; Female; Humans; Middle Aged; Radiotherapy, Adjuvant; Lacrimal Apparatus; Eye Neoplasms; Carcinoma; Dry Eye Syndromes; Retinal Diseases; Retrospective Studies
PubMed: 36229179
DOI: 10.1136/bjo-2022-321889 -
Eye (London, England) Jun 2021To assess the exclusive role and outcomes of Crigler's lacrimal sac compression in the management of congenital nasolacrimal duct obstruction (CNLDO).
PURPOSE
To assess the exclusive role and outcomes of Crigler's lacrimal sac compression in the management of congenital nasolacrimal duct obstruction (CNLDO).
METHODS
Retrospective interventional case-series was performed on patients diagnosed with CNLDO and who were advised Crigler's lacrimal sac compression (CLSC) at a tertiary care Dacryology Institute from Jan 2016 to June 2019. CNLDO patients who were practicing incorrect techniques of lacrimal sac compression at presentation were separately assessed. All the patients were assigned to four groups (Gr 1: 0-3 months, Gr 2: >3 & <6 months, Gr 3: >6 & <9 months and Gr 4: >9 and <12 months) based on the age at which the CLSC was initiated and followed up quarterly or as needed till at least 1 year of age. The parameters studied include patient demographics, clinical presentation, age of initiation of CLSC, success rate with CLSC, and need for additional interventions. Success was defined as the subjective resolution of epiphora and discharge with objective measures of normal tear meniscus height and dye clearance on fluorescein dye disappearance test.
RESULTS
A total number of 1240 patients with CNLDO were assessed. Of these, 1037 patients were advised correct techniques of CLSC from the beginning, and the remaining 203 patients were referred but performing it incorrectly at presentation. Of the 1037 patients, 236 were lost to follow-up; hence, a total of 1004 patients (801 + 203) were included for final analysis. CLSC was found to be an effective conservative strategy in the management of CNLDO. The rate of resolution of CNLDO in Gr 1 to Gr 4 was 87.3%, 78.9%, 77.9%, and 76.8%, respectively. There were no statistically significant differences in the outcomes based on the age of CLSC initiation. The referred patients whose techniques were rectified following the initial incorrect techniques showed a resolution of 61.2% (79/129). The correct techniques of CLSC appeared to influence the outcomes. However, the age of its initiation did not substantially impact the outcomes. Significantly high resolution was noted even beyond nine months of age and encouraging results beyond 12 months of age.
CONCLUSIONS
It is crucial to initiate the correct techniques of Crigler's lacrimal sac compression to achieve favourable outcomes. Age of initiation of CLSC in infancy does not appear to influence the outcomes. The resolution rate continued to be significantly high up to 1 year of age. There is a need to assess the role of CLSC beyond 12 months of age.
Topics: Dacryocystorhinostomy; Humans; Infant; Lacrimal Apparatus; Lacrimal Duct Obstruction; Nasolacrimal Duct; Retrospective Studies; Treatment Outcome
PubMed: 32778741
DOI: 10.1038/s41433-020-01125-1 -
Stem Cell Research & Therapy Jan 2020Aqueous-deficient dry eye disease (ADDED) resulting from dysfunction of the lacrimal gland (LG) is currently incurable. Although LG stem/progenitor cell-based therapy is...
BACKGROUND
Aqueous-deficient dry eye disease (ADDED) resulting from dysfunction of the lacrimal gland (LG) is currently incurable. Although LG stem/progenitor cell-based therapy is considered to be a promising strategy for ADDED patients, the lack of a reliable serum-free culture method to obtain enough lacrimal gland stem cells (LGSCs) and the basic standard of LGSC transplantation are obstacles for further research.
METHODS
Adult mouse LGSCs were cultured in Matrigel-based 3D culture under serum-free culture condition, which contained EGF, FGF10, Wnt3A, and Y-27632. LGSCs were continuously passaged over 40 times every 7 days, and the morphology and cell numbers were recorded. LGSCs were induced to differentiate to ductal cells by reducing Matrigel rigidity, while fetal bovine serum was used for the induction of acinar cells. RT-PCR or qRT-PCR analysis, RNA-sequence analysis, H&E staining, and immunofluorescence were used for characterization and examining the differentiation of LGSCs. LGSCs were allotransplanted into diseased LGs to examine the ability of repairing the damage. The condition of eye orbits was recorded using a camera, the tear production was measured using phenol red-impregnated cotton threads, and the engraftments of LGSCs were examined by immunohistochemistry.
RESULTS
We established an efficient 3D serum-free culture for adult mouse LGSCs, in which LGSCs could be continuously passaged for long-term expansion. LGSCs cultured from both the healthy and ADDED mouse LGs expressed stem/progenitor cell markers Krt14, Krt5, P63, and nestin, had the potential to differentiate into acinar or ductal-like cells in vitro and could engraft into diseased LGs and relieve symptoms of ADDED after orthotopic injection of LGSCs.
CONCLUSION
We successfully established an efficient serum-free culture for adult mouse LGSCs aiming at LG repair for the first time. Our approach provides an excellent theoretical and technical reference for future clinical research for ADDED stem cell therapy.
Topics: Animals; Cells, Cultured; Humans; Lacrimal Apparatus; Mice; Mice, Inbred NOD; Stem Cells
PubMed: 31915062
DOI: 10.1186/s13287-019-1541-1 -
Korean Journal of Ophthalmology : KJO Oct 2017To analyze the features of lacrimal drainage system obstruction confirmed during external dacryocystorhinostomy surgeries and report the surgical outcomes.
PURPOSE
To analyze the features of lacrimal drainage system obstruction confirmed during external dacryocystorhinostomy surgeries and report the surgical outcomes.
METHODS
We reviewed the medical records of a total of 769 cases who underwent external dacryocystorhinostomy for primary lacrimal drainage obstruction between 2005 and 2014. Data about detailed location and extent of obstruction were collected intraoperatively. The sites of obstruction were classified into nasolacrimal duct obstruction (NLDO), common canalicular obstruction (CCO), and canalicular obstruction. Lacrimal sac mucosa and lumen were grossly inspected, and the frequency of lacrimal sac changes, such as significant inflammation or fibrosis, was analyzed in cases of CCO or canalicular obstruction. The surgical success rate was also evaluated including effect of lacrimal sac status in the CCO and canalicular obstruction groups.
RESULTS
Of 769 cases, primary NLDO with patent canaliculi was diagnosed intraoperatively in 432 cases (56.2%), CCO in 253 (32.9%), and canalicular obstruction in 84 (10.9%). Of 253 cases with CCO, 122 (48.2%) showed clear lacrimal sac lumen, and the other 131 (51.8%) showed significant inflammation or fibrosis of the lacrimal sac. In cases with canalicular obstruction, 35 of 84 (41.7%) showed a clear lacrimal sac, and the other 49 cases (58.3%) cases revealed mucosal changes of the lacrimal sac. The functional success rate was 87.5% for primary NLDO, 75.5% for CCO, and 72.6% for canalicular obstruction. In the CCO group, the functional success rate was lower in cases with significant lacrimal sac change (p = 0.044).
CONCLUSIONS
Even in patients with CCO or canalicular obstruction, a large number of cases have lacrimal sac changes, and those changes were associated with lower functional success rate.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Dacryocystorhinostomy; Endoscopy; Female; Follow-Up Studies; Humans; Intraoperative Period; Lacrimal Apparatus; Lacrimal Duct Obstruction; Male; Middle Aged; Retrospective Studies; Time Factors; Treatment Outcome; Young Adult
PubMed: 28913995
DOI: 10.3341/kjo.2016.0096 -
BMJ Case Reports Jul 2020An 80-year-old man referred with repeated episode of dacryocystitis from the left lacrimal drainage system and palpable swelling. For many years, he has being presented... (Review)
Review
An 80-year-old man referred with repeated episode of dacryocystitis from the left lacrimal drainage system and palpable swelling. For many years, he has being presented with epiphora unilaterally with chronic dacryocystitis. Investigations with dye-test revealed subocclusion of the natural passage of the tears, and CT and MRI scans revealed solid mass in the lacrimal sac. The lacrimal sac was opened by endonasal endoscopic approach, the sacral mass was identified and completely removed. The histopathological examination showed lacrimal gland in ectopic position. Patient followed for 18 months with complete recovery of symptoms. In our differential diagnosis, the ectopic lacrimal gland is also identified, when a mass in the lacrimal sac and duct is present. Successful surgical excision required considerable multidisciplinary teamwork between ophtalmologist-ENT (Otolaryngologist) and radiologist. Endonasal endoscopic approach is perfectly safe with direct control and ensures a smooth postoperative recovery.
Topics: Aged, 80 and over; Dacryocystitis; Humans; Lacrimal Apparatus; Male; Nasolacrimal Duct; Treatment Outcome
PubMed: 32699057
DOI: 10.1136/bcr-2020-235187