Rozległy ropień przedprzegrodowy jako późne powikłanie pourazowe oczodołowe – przegląd piśmiennictwa i opis przypadku

Preseptal orbital cellulitis and orbital abscess are rare post-traumatic late orbital complications. Authors reported a case of anterior orbital abscess following craniofacial trauma in a 47-year-old men. Diagnostic procedures, therapeutic intervention were presented and literature reviewed.

Corneal Melt Associated With Idiopathic Dacryoadenitis

A 15-year-old boy presented with left-sided ptosis, upper eyelid swelling, proptosis, conjunctivitis, and a central corneal epithelial defect with thinning. MRI demonstrated an enhancing orbital mass associated with the lacrimal gland. Biopsy findings were consistent with orbital inflammatory syndrome. Topical cyclosporine and 1% methylprednisolone eliminated the anterior segment inflammation; subsequent treatment with systemic prednisone reduced the ptosis and edema. To our knowledge, this is the only reported case of orbital inflammatory syndrome associated with a corneal epithelial defect and thinning.

Management of Complications after Insertion of the SmartPlug Punctal Plug

PURPOSE

To characterize and describe the management of complications seen in patients who have undergone insertion of the SmartPlug permanent punctal plug.

DESIGN

Retrospective case series.

PARTICIPANTS

Patients who experienced complications after SmartPlug insertion and were treated by 1 of 18 ophthalmic plastic and reconstructive surgeons between January 2004 and October 2005.

METHODS

Presenting symptoms and signs and the management of complications were analyzed.

MAIN OUTCOME MEASURES

Prevalences of canaliculitis and dacryocystitis, tearing at presentation, and outcome of conservative and/or surgical management of the SmartPlug complications.

RESULTS

Twenty-eight patients were included in the study; 13 had bilateral involvement. On initial presentation, 18 patients had inflammation, including 17 with canaliculitis and 1 with recurrent acute dacryocystitis. Ten patients had little or no inflammation; all 10 had tearing of the involved eye(s). In 5 patients, complications resolved after office irrigation of the lacrimal drainage system; in a sixth patient, silicone intubation was performed as well. Canaliculotomy was performed in 13 patients (bilateral in 3) and combined with silicone intubation (3 patients). Canaliculotomy was planned in an additional 2 patients. Canaliculitis in 1 patient responded to a course of oral antibiotics; the plug was massaged out of the punctum in a retrograde fashion in another patient. In still another patient, the plugs expressed themselves at the time of planned canaliculotomy. In 4 patients, dacryocystorhinostomy (DCR) with silicone intubation was necessary. Two additional patients refused further treatment including DCR and canaliculotomy; both were lost to follow-up.

CONCLUSIONS

Canaliculitis, acute dacryocystitis, and tearing may be seen in patients who have had SmartPlugs and may be managed by removal of the plug. A trial of topical and oral broad-spectrum antibiotics followed by retrograde massage of the plug through the canaliculus may be helpful should plug removal be deemed appropriate. If conservative measures fail, canaliculotomy with removal of the plug may be considered; DCR may be necessary. Although lacrimal irrigation may resolve the problem, irrigation also may dislodge the plug from its canalicular position and cause permanent obstruction of the lacrimal drainage system.

Dacryoadenitis Associated With Acanthamoeba Keratitis

OBJECTIVE

To report the incidence of dacryoadenitis as a symptom associated with Acanthamoeba keratitis.

METHODS

We investigated all cases of Acanthamoeba keratitis (20 patients and 21 eyes) diagnosed and treated at Tokyo Dental College, Ichikawa General Hospital, Ichikawa, Japan, between May 1, 1994, and November 30, 2005. We recorded the incidence of dacryoadenitis diagnosed using clinical signs of lacrimal gland swelling and pain on pressure, computed tomography, magnetic resonance imaging, and histopathologic analysis.

RESULTS

Eight eyes (38%) of 8 patients had dacryoadenitis simultaneously with Acanthamoeba keratitis. Dacryoadenitis was diagnosed using histopathologic analysis and computed tomography in 1 patient, histopathologic analysis and magnetic resonance imaging in 1, magnetic resonance imaging in 2, and clinical signs alone in 4. Histopathologic examination in 2 patients revealed moderate infiltration of lymphocytes and plasma cells in the lacrimal gland compatible with dacryoadenitis. No Acanthamoeba organisms were found in the lacrimal gland. The standard protocol for Acanthamoeba keratitis was performed without particular treatment of dacryoadenitis in all patients. Lacrimal gland swelling improved after a mean of 10 weeks (range, 4-17 weeks) in conjunction with symptoms of keratitis; however, 1 patient (patient 1) required levator muscle surgery and blepharoplasty for residual ptosis.

CONCLUSION

Dacryoadenitis is a clinical finding associated with Acanthamoeba keratitis.

[Diagnostic image (274). A neonate with a 'red eye']

A 4-day-old girl presented with a left periorbital cellulitis due to an infected dacryocystocele.

Preservation of tear film integrity and inhibition of corneal injury by dexamethasone in a rabbit model of lacrimal gland inflammation-induced dry eye

PURPOSE

The aim of this study was to establish a clinically relevant short-term animal model of dry eye with utility in identifying compounds with potential therapeutic efficacy.

METHODS

Rabbit lacrimal glands were injected with the T-cell mitogen Concanavalin A (Con A) and inflammation, tear function, and corneal epithelial cell integrity were subsequently assessed. The inflammatory response was characterized by quantifying biochemical markers of inflammation ex vivo and by confirming inflammatory cell influx by histology. Matrix metalloproteinase-9 (MMP-9) and proinflammatory cytokines IL-1beta, IL-8, and TGF-beta1 were quantified in tissue extracts. Tear function was monitored by measuring tear fluorescein clearance and tear breakup time (TBUT). Corneal epithelial cell integrity was determined by quantifying the uptake of methylene blue dye following the exposure of rabbits to a low-humidity environment. The anti-inflammatory corticosteroid, dexamethasone, was administered topically as indicated for each study.

RESULTS

Histopathologic evaluation of lacrimal glands injected with Con A revealed a pronounced inflammatory process characterized by lymphocytic infiltration, multifocal necrosis, and fibroplasia. Elevated levels of MMP-9 and cytokines IL-1beta, IL-8, and TGF-beta1 were detected in the lacrimal gland and cornea. Inflammation of the rabbit lacrimal gland following an injection of Con A significantly reduced tear clearance and TBUT and increased susceptibility to desiccation-induced corneal damage. Dexamethasone was prophylactically and therapeutically effective in this inflammation model of dry eye, restoring tear function and inhibiting corneal injury following topical ocular application.

CONCLUSIONS

Characteristics of this rabbit lacrimal gland inflammation model of dry eye are consistent with the current understanding of dry eye as a local ocular surface inflammatory response to abnormal tear volume and composition. These results suggest that this rabbit model of dry eye may be employed to assess the therapeutic efficacy of mechanistically diverse agents on clinically relevant signs of ocular surface disease. These methods were strategically developed to be applicable for advancing drug discovery for a broad spectrum of dry eye patients.

Microbiological analysis of chronic dacryocystitis

AIMS

To investigate the microbiology of specimens from patients with chronic dacryocystitis.

METHODS

A total of 100 samples were obtained from the contents of the lacrimal duct in 91 consecutive patients with chronic dacryocystitis, including nine bilateral cases. These samples were cultured for aerobic and anaerobic bacteria and fungi with a routine microbiological technique. Positive cultured isolates were identified.

RESULTS

A total of 180 strains were isolated from the 85 bacterial samples, including 150 strains of aerobic bacteria and 30 strains of anaerobic bacteria. Fungi were found in eight samples and actinomyces in three samples. The bacterial species that were most frequently found were Staphylococcus species, representing 34.5% of all strains, followed by Corynebacterium diphtheroides (15.5%). The sensitivity tests revealed that levo-ofloxacin and amikacin were the most effective antibiotics.

CONCLUSIONS

Gram positive cocci was the predominant pathogen of chronic dacryocystitis. Levo-ofloxacin and amikacin had the best effect in vitro.

Dacryoadenitis associated with subcutaneous Sweet's syndrome in a patient with acute myeloid leukemia

A 26-year-old woman presented with a painful skin eruption which led to the diagnosis of acute myeloid leukemia. During chemotherapy, she developed an unusual orbital inflammation. Careful observation of the clinical course, computed tomography, and orbital biopsy were necessary to establish the diagnosis of dacryoadenitis associated with subcutaneous Sweet's syndrome. The skin eruption and the dacryoadenitis resolved rapidly with corticosteroid therapy. This is the first report of dacryoadenitis in the course of subcutaneous Sweet's syndrome.

Changing bacterial isolates and antibiotic sensitivities of purulent dacryocystitis

PURPOSE

To examine the current spectrum of bacterial isolates in cases of chronic dacryocystitis and dacryoabcess and to determine their antibiotic sensitivities.

MATERIALS AND METHODS

We carried out a prospective study in which 39 patients who presented to the outpatient clinic with chronic purulent dacryocystitis or acute dacryoabscess had cultures taken. All patients were antibiotic-free for at least one week prior to culturing.

RESULTS

The 39 positive cultures grew 41 bacterial isolates, as two patients grew two species of bacteria. Sixteen isolates (39%) were Gram positive and 25 (61%) were Gram negative. The most common isolates were Pseudomonas (22%), Staphylococcus aureus (13%), Enterobacter (10%), Citrobacter (10%), Streptococcus pneumoniae, Escherichia coli, and Enterococcus (7%). Uncommon Gram-negative bacteria were also cultured: Alcaligenes in 2 cases (5%) and one case of Stenotrophomonas maltophilia (2.5%). No anaerobic bacteria were isolated. Gram-negative isolates were sensitive to ceftazidime in 95%, ciprofloxacin in 86% and cefuroxime in 50%, with a sensitivity of less than 30% to cefalexin and ampicillin in those tested. All Pseudomonas isolates (100%) were sensitive to ceftazidime, 86% were sensitive to ciprofloxacin, while only 20% were sensitive to ampicillin and 14% to cefalexin. Alcaligenes was resistant to all antibiotics tested with the exception of ceftazidime.

CONCLUSION

This study demonstrates a significant change in bacterial flora and antibiotic treatment requirements of purulent dacryocystitis from previously published data. A higher incidence of Gram-negative organisms, particularly Pseudomonas, with resistance to commonly used antibiotics was found. The emergence of rarer, highly resistant, Gram-negative microorganisms may also indicate a trend in lacrimal sac infections. These findings suggest that the antibiotic treatment protocol before and after lacrimal surgery should be reconsidered in this subgroup of patients.

Changing bacterial isolates and antibiotic sensitivities of purulent dacryocystitis

OBJECTIVE

To examine the current spectrum of bacterial isolates in cases of chronic dacryocystitis and dacryoabcess and to determine their antibiotic sensitivities.

MATERIALS AND METHODS

We carried out a prospective study in which 39 patients who presented to the outpatient clinic with chronic purulent dacryocystitis or acute dacryoabscess had cultures taken. All patients were antibiotic-free for at least one week prior to culturing.

RESULTS

The 39 positive cultures grew 41 bacterial isolates, as two patients grew two species of bacteria; 16 isolates (39%) were Gram-positive and 25 (61%) were Gram-negative. The most common isolates were Pseudomonas (22%), Staphylococcus aureus (13%), Enterobacter (10%), Citrobacter (10%), Streptococcus pneumoniae, E. coli, and Enterococcus (7%). Uncommon Gram-negative bacteria were also cultured: Alcaligenes in two cases (5%), and one case of Stenotrophomonas maltophilia (2.5%). No anaerobic bacteria were isolated. Gram-negative isolates were sensitive to ceftazidime in 95%, ciproxin in 86%, and cefuroxime in 50% of cases, with sensitivity of less than 30% to cephalexin and ampicillin in those tested. All Pseudomonas isolates (100%) were sensitive to ceftazidine, 86% were sensitive to ciprofloxacin, with only 20% being sensitive to ampicillin and 14% to cephalexin. Alcaligenes was resistant to all antibiotics tested with the exception of ceftazidine.

CONCLUSION

This study demonstrates a significant change in bacterial flora and antibiotic treatment requirements of purulent dacryocystitis from previously published data. A higher incidence of Gram-negative organisms, particularly Pseudomonas, with resistance to commonly used antibiotics was found. The emergence of rarer highly resistant Gram-negative microorganisms may also indicate a trend in lacrimal sac infections. These findings suggest that the antibiotic treatment protocol before and after lacrimal surgery should be reconsidered in this subgroup of patients.

Intralesional Steroid Injection for Management of Acute Idiopathic Dacryoadenitis: A Preliminary Result

PURPOSE

To evaluate the efficacy of intralesional injection of steroid as a new line of therapy in treatment of the acute form of an isolated idiopathic dacryoadenitis.

METHODS

Five patients with unilateral isolated acute idiopathic dacryoadenitis were included in the study. In 2 patients, the pathology was recurrent. Intralesional injection of 2 to 4 ml betamethasone suspension (1 ml contains 2 mg betamethasone sodium phosphate and 5 mg betamethasone dipropionate) was followed by cold compression for 6 hours. Systemic nonsteroidal anti-inflammatory drugs were given for 2 weeks after the injection.

RESULTS

Dramatic response was achieved within 7 days after injection in all cases. No patient had recurrence during the follow-up period of 8 to 19 months.

CONCLUSIONS

The excellent preliminary results make this new line of therapy highly promising. However, more study and long-term follow-up are recommended.

[Domestic 1.44 mcm Nd:YAG laser in combined treatment of dacryocystitis complicated by abscess formation]

We have treated 12 patients with acute dacryocystitis complicated by abscess formation. All the patients were examined by an ophthalmologist and otolaryngologist. The patients received intravenous antibiotics followed by Nd:YAG laser dacryocystorhinostomy via transcanalicular approach under the endonasal endoscopic control. The treatment resulted in resolution of symptoms and signs of acute dacryocystitis complicated by abscess formation in all the patients. No recurrence of acute dacryocystitis occurred during the median follow-up period of 11 months. Ostium patency defined as the absence of epiphora and observation of irrigated lacrimal fluorescein at the ostium was achieved in 9 patients. Epiphora recurred in 3 cases. Use of Nd:YAG laser reduces the duration of the operation and provides maximal functional and cosmetic results.

[Bilateral lacrimal gland inflammation in a 42-year-old entrepreneur]

Eine Tränendrüsenschwellung als Erstmanifestation einer Sarkoidose tritt in weniger als 1% der Fälle auf. Im Rahmen dieser Systemerkrankung werden die verschiedenen Augenabschnitte und die Adnexe unterschiedlich isoliert oder kombiniert betroffen. Unser Fallbericht zeigt, dass die Diagnostik bei einer Tränendrüsenschwellung schwierig sein kann und dass eine konklusive Diagnose eventuell erst im weiteren Krankheitsverlauf einer Multisystemerkrankung gestellt werden kann.

Intraoperative fluorouracil in endonasal laser dacryocystorhinostomy

BACKGROUND

Although endonasal laser dacryocystorhinostomy (ELDCR) offers many advantages compared with conventional techniques, postoperative scarring leading to occlusion of the rhinostomy is more common with ELDCR.

OBJECTIVE

To investigate whether fluorouracil applied to the rhinostomy site intraoperatively has an effect on the outcome.

PARTICIPANTS

We randomly allocated 155 consecutive patients (201 procedures) to a control group and a fluorouracil group. Patients and investigators were masked to the choice of treatment.

METHODS

All patients underwent ELDCR. A pledget soaked in isotonic sodium chloride solution or 0.5-mg/mL fluorouracil, randomly allocated by the pharmacy, was applied to the rhinostomy site for 5 minutes at the time of surgery. Patients were followed up for 12 months and their symptoms were assessed at each visit.

RESULTS

Among patients followed up for 12 months or longer, ELDCR procedures performed with topical application of fluorouracil to the rhinostomy site were successful in 65 (76%), compared with 52 (63%) for the control group. This was not statistically significant when patients who failed to attend follow-up at or after 12 months were not counted as successfully treated (P =.21, chi(2) test). Even if those who failed to attend for follow-up were counted as successes, the effect of fluorouracil did not reach significance at the.05 level (P =.08, chi(2) test).

CONCLUSION

The topical application of fluorouracil failed to increase the patency rates in ELDCR.

A case of acute dacryoadenitis associated with herpes zoster ophthalmicus

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.

Dacryoadenitis as the earliest presenting manifestation of systemic Wegener's granulomatosis

PURPOSE

To report a case presenting with dacryoadenitis as the earliest manifestation of systemic Wegener's granulomatosis (WG).

DESIGN

Observational case report.

METHODS

A 41-year-old woman initially presented symptoms of bilateral dacryoadenitis. She subsequently developed upper and lower respiratory tract involvement, scleritis and keratitis.

RESULTS

Cytoplasmic antineutrophil antibody (c-ANCA) titer was positive. The lacrimal gland and lung biopsies were consistent with WG. The patient responded well to cyclophosphamide and prednisolone.

CONCLUSIONS

Dacryoadenitis maybe the earliestpresenting manifestation of WG andprompt immunosuppressive chemotherapy may control it preventing the limited disease from progressing to a complete form and reducing its morbidity and mortality.

Ocular complications associated with brucellosis in an endemic area

PURPOSE

To report the ocular manifestations associated with brucellosis in an endemic area.

METHODS

We prospectively evaluated 147 patients with the diagnosis of brucellosis between May 1996 to May 2000 and recorded the ocular and systemic findings. The diagnosis was based on clinical findings, positive serological and bacteriological tests (Brucella agglutination test: over 1/160 titer, blood culture).

RESULTS

Thirty-eight patients (26.0%) with brucellosis had ocular complications: conjunctivitis in 26 (17.7%), anterior uveitis in six (4.1%), posterior uveitis in one (0.7%), dacryoadenitis in two (1.4%), episcleritis in three (2.1%). Three of the seven patients with uveitis had spondylitis associated with brucellosis. Osteoarticular complications in brucellosis were more frequent in the patients with ocular involvement though the difference was not statistically significant compared with patients without ocular involvement.

CONCLUSIONS

Ocular manifestations are frequent in brucellosis so an ophthalmologic examination should be routinely performed in patients with brucellosis in endemic areas.

Combined coliform and anaerobic infection of the lacrimal sac

A case is reported of combined coliform and anaerobic bacterial infection of the lacrimal sac, a condition of which there is only one other published case report. In addition, a literature review is presented of the bacteriology of acute dacryocystitis as it applies to this case. Recommendations for the microbiological investigation and management of acute dacryocystitis are made.

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.

Bacteriology and antibiotic therapy in congenital nasolacrimal duct obstruction

AIMS

To determine the current bacteriology of mucopurulent discharge in congenital nasolacrimal duct obstruction (CNDO), the in vitro response to different antibiotics and clinical effectiveness of the antibiotics used to relieve babies from mucopurulent discharge.

METHODS

A clinical study evaluated the effectiveness of local antibiotic agents clinically and in vitro. 50 samples were obtained from the lacrimal sac in 47 young children with CNDO. The patients' mean age was 21.45 +/- 17.09 months. The cultures were incubated and the infectious agents isolated. Sensitivity testing was performed in each case, testing 10 different local antibiotics. A control group of 10 babies expected for cataract surgery was constituted.

RESULTS

Cultures were positive for bacteria from 72.64% of the samples. 73 isolates were recovered from the 50 samples. The bacterial species most frequently cultured was Streptococcus pneumoniae, representing 35.4% of the isolates, followed by Haemophilus influencae (19.6%). The sensitivity testing revealed ofloxacin and tetracycline to be the most effective drugs as monotherapy. Clinically the combination of bacitracin and neomycin, primarily used in half of the patients as initial therapy, was successful in curing the dacryocystitis in 82.5% of all patients.

CONCLUSION

Chronic dacryocystitis due to CNDO is associated with an equal proportion of Gram positive and negative bacteria, which can be treated with a high effectiveness by a combination drug of bacitracin and neomycin.

Brucella melitensis dacryoadenitis: a case report

PURPOSE

To present a case of brucellosis-related unilateral dacryoadenitis.

METHODS

A 16-year-old boy had unilateral lacrimal gland enlargement, shown by magnetic resonance imaging of the orbits. Clinical findings, tube agglutination, the culture of a lacrimal gland aspirate, and histopathological examination confirmed the diagnosis of brucellosis.

RESULTS

Tube agglutination testing for brucellosis gave a titer of over 1/640. The aspirate from the lacrimal glands grew Brucella melitensis and histopathological findings were consistent with brucellosis.

CONCLUSIONS

Dacryoadenitis may occur in the course of systemic brucellosis caused by Brucella melitensis.

Epstein-Barr virus dacryoadenitis

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.

Localized orbital inflammation: a case of dacryoadenitis

Nonspecific orbital inflammatory syndrome includes a variety of ocular inflammatory disorders. These may be classified by location (anterior or posterior) and by time of presentation (acute or chronic). The four subclassifications of nonspecific orbital inflammatory syndrome are myositis, perineuritis, periscleritis, and dacryoadenitis. When a proper diagnosis is established using clinical signs, imaging studies, and laboratory results, treatment of the condition can be initiated. Treatment of the acute form is with oral corticosteroids. This case discusses the diagnosis and treatment of a patient with an acute onset of inflammatory dacryoadenitis.

Lymphocytic hypophysitis associated with dacryoadenitis: an autoimmunologically mediated syndrome

We report a rare case of lymphocytic hypophysitis followed by dacryoadenitis. Lymphocytic hypophysitis is a rare disease that can easily be mistaken for neoplastic proliferation. Because combination with rheumatoid arthritis, thyroiditis, or pernicious anemia is frequent, an immunological pathogenesis is likely.

Acute dacryocystitis as a presenting sign of pediatric leukemia

PURPOSE

To report acute dacryocystitis with preseptal cellulitis as the presenting sign of leukemia in a child.

METHODS

Case report and literature review.

RESULTS

During the initial evaluation of a 17-month-old child with epiphora, left lower eyelid swelling, and a tender left medial canthal mass, a complete blood cell count demonstrated pancytopenia. Bone marrow biopsy disclosed replacement of normal cellular architecture with a dense infiltrate of leukocyte blast forms. DNA analysis disclosed a translocation between chromosome 10 and 11, consistent with the diagnosis of nonlymphocytic leukemia. Although the adjacent lower eyelid cellulitis responded to intravenous antibiotics, lacrimal sac distention decreased only after chemotherapy was initiated.

CONCLUSIONS

Dacryocystitis with preseptal cellulitis can be a presenting sign of leukemia. This blood malignancy should be considered in patients whose leukocyte counts do not correlate with their clinical presentation.

Infectious mononucleosis presenting with dacryoadenitis

BACKGROUND

A case of severe, bilateral, acute dacryoadenitis in a rarely reported association with infectious mononucleosis is described.

METHODS

A 16-year-old girl had acute, bilateral, lacrimal gland enlargement demonstrated with computed tomographic scanning of the orbits. Clinical findings and laboratory investigations confirmed the diagnosis of infectious mononucleosis. Treatment with systemic steroids was initiated.

RESULTS

There was rapid resolution of the clinical findings with systemic steroids.

CONCLUSION

Dacryoadenitis is an uncommon presentation of infectious mononucleosis and may overshadow the other manifestations of this disease. The diagnosis of infectious mononucleosis should be considered in patients with acute dacryoadenitis. Systemic steroids play an important role in rapidly resolving the dacryoadenitis.

[Actinomycetes canaliculitis--case reports]

Canaliculitis is a relatively rare dacryocanal infection which occurs most unilateral. It can easily be misinterpreted and not sufficiently treated. Typical agents of the canaliculitis are actinomyces, that can cause infections of the hollow spaces with formation of concrements. The clinical courses of two patients are shown. One of them was treated for a dacryocystitis for 3 years and the other one had been referred to the eye hospital for chalazion removal. Only a microbiologic examination including cultivation of the surgically obtained dacryolithes and secretion enabled us to a reliable proof of the actinomyces and to an appropriate therapy for canaliculitis.

Canalicular infection caused by Actinomyces

We present 7 cases of canalicular involvement with Actinomyces collected over a 5-year period. All patients had involvement of one canaliculus, upper or lower, with lacrimal drainage patent to syringing. Curettings obtained by incising the involved canaliculi yielded Actinomyces species (5 cases) and Arachnia propionica (2 cases), typically in association with a mixed bacterial growth. Our results show that these patients often remain undiagnosed for months or even years, and are treated inappropriately for their recurrent symptoms. Despite sensitivity of Actinomyces to a broad spectrum of antibiotics, medical therapy alone does not eradicate the disease, and surgical evacuation of all concretions is essential to achieve a cure.

Treatment of experimental autoimmune dacryoadenitis with cyclosporin A

Experimental autoimmune dacryoadenitis (EAD) was induced in SJL/J mice by a single injection of purified lacrimal gland antigen (LG-Ag) in complete Freund's adjuvant. The disease is characterized by lymphocytic infiltration of the lacrimal gland and production of lacrimal gland-specific antibodies. We examined the effects of cyclosporin A (CsA) on the development and progression of this inflammatory disease. CsA (100 mg/kg/day), given from the time of immunization for 14 days, completely blocked the development of EAD in all treated mice. Both cellular and humoral immune responses to LG-Ag were markedly reduced by the administration of CsA as evidenced by the near absence of lymphocyte proliferative response and the reduced production of circulating anti-LG-Ag antibodies. Delayed CsA treatment beginning on Day 7 after immunization totally abrogated the development of lacrimal histological lesions and lymphocyte proliferative response to LG-Ag. However, serum anti-LG-Ag titers were only marginally decreased in CsA-treated animals. Treatment with CsA was found effective even when daily injections were started 14 days after immunization with LG-Ag. CsA prevented the inflammatory cell response in 5 of 10 mice when the disease was established. The lymphocyte proliferative response to LG-Ag was moderately depressed in CsA-treated animals, but antibody titers were the same as those in the oil-treated control. These studies demonstrate that CsA has a therapeutic effect in this murine model of dacryoadenitis and suggest a critical role for T lymphocytes in the pathogenesis of EAD.

Acquired dacryocystitis: microbiology and conservative therapy

The dacryocystitis in adults is mainly caused by postsaccal stenosis of the lacrimal ducts. The banking up of the lacrimal fluid leads to an accumulation of germs and following infection. This report describes the clinical and microbiological findings in a large consecutive series of patients that presented at the outpatient clinic of the 2nd Department of Ophthalmology of the University of Vienna with the signs of acute, chronic recurrent or chronic infections of the lacrimal system between 1983 and the end of 1990. Within the bacterial genus Staphylococci (S. aureus, S. epidermidis and S. saprophyticus) were the most frequently isolated organisms (74 cultures = 50% out of samples with positive cultures). It was quite interesting that a significant number of gram-negative rods (37 = 25.5%) could be isolated. Of these microorganisms Escherichia coli was most frequently growing on special media (17 cases = 11.7%) when cultures were obtained from acute inflamed lacrimal sacs of patients who suffered from chronic recurrent infections. Conservative therapy of purulent dacryocystitis constitutes the last possible preparation for a necessary surgical intervention and therefore the authors want to point out the importance of microbiological examinations so as to optimize antibiotic therapy.

Acute dacryoadenitis and Crohn's disease: findings and management

Concurrent orbital pseudotumor and Crohn's disease, although rare, have been described. To the best of our knowledge, pseudotumor isolated to the lacrimal gland (dacryoadenitis) with concurrent Crohn's disease has never been reported. We present the clinical course and ultrasonographic and radiologic findings of an acute case of isolated bilateral lacrimal gland pseudotumor in a patient with Crohn's disease. The treatment and review of the literature are discussed.

Infections of the lacrimal system

Deficiency of the tears or obstruction to the free flow of tears predispose to infections of the lacrimal system. The relevant anatomy of the lacrimal system and the pathologic conditions leading to obstruction are outlined. The clinical manifestations of infections of the lacrimal gland, the canaliculus, and the lacrimal sac are described, and the basis for medical and surgical treatment is discussed.

Bilateral dacryocystitis after punctal occlusion with thermal cautery

A 61-year-old woman developed acute bilateral dacryocystitis secondary to Staphylococcus aureus 3 weeks after undergoing punctal occlusion with thermal cautery for keratoconjunctivitis sicca. The dacryocystitis resolved with intravenous antibiotics, aspiration of the lacrimal sacs, injection of sulfacetamide into the lacrimal sacs, and bilateral dacryocystorhinostomy. Preexisting bilateral nasolacrimal duct obstruction was postulated as the underlying cause. In these cases, irrigation of the lacrimal system is recommended before proceeding with punctal occlusion.

[Conjunctivitis and lacrimal apparatus infections]

The term conjunctivitis covers all inflammatory processes affecting the conjunctiva. Bacterial and viral infections are the most frequent causes. Infectious conjunctivitis is rarely severe in industrialized countries, but trachomatous kerato-conjunctivitis is still the main cause of blindness all over the world. Most cases of bacterial conjunctivitis are treated with topical antibiotics. Viral conjunctivitis is frequent and, with the exception of herpetic conjunctivitis, has no specific treatment. Canaliculitis and dacryocystitis are rare but require specialized examination, treatment and follow-up.

Infectious mononucleosis presenting as bilateral acute dacryocystitis

A case of infectious mononucleosis presenting as bilateral acute dacryocystitis in a 7-year-old girl is reported. Acute dacryocystitis is uncommon in this age group, and an underlying systemic illness should be suspected particularly when it is bilateral.

Clinicobacteriological correlates of congenital dacryocystitis

One hundred and fourteen eyes with congenital dacryocystitis have been studied clinically and bacteriologically. Gram positive cocci constituted the major bacterial isolates (57.9%) with streptococcus pneumoniae predominating (28.9%). The most effective antibiotic was cloxacillin with an overall efficacy of 77%. Normal conjunctival flora was sterile in majority (75%) of cases. Positive cases showed preponderance of gram positive cocci (21.6%) with staphylococcus albus (13.3%) being the major isolate. Normal nasal flora revealed diphtheroids (alone or in combination) to be the commonest bacteria (62.1%). A statistically significant correlation was not observed between the normal conjunctival or nasal flora and flora from the affected eyes.