Dacryops - A review

Endoscopy-assisted dacryocystorhinostomy in a dog

OBJECTIVE

To describe the use of an endoscope to assist in performing minimally invasive dacryocystorhinostomy in a dog to successfully manage a nasolacrimal duct cyst (dacryocyst).

ANIMAL STUDIED

A 4-year-old female spayed American Staffordshire Terrier with chronic epiphora and swelling ventromedial to the nasal canthus of the right eye and reverse sneezing.

PROCEDURES

Computed tomography revealed a fluid-filled cystic lesion of the right nasolacrimal duct with extensive nasal extension and secondary obstructive frontal sinusitis. Aspiration of serosanguinous fluid with no growth of microbial organisms and histopathology confirmed the cystic nature of the structure. A 2.7 mm, 30 deg, 11 cm foreward-oblique endoscope with arthroscopic cannula was passed through a mucosal stab incision in the dorsal buccal recess into the cyst to allow for exploration. A separate instrument portal was placed in the center of the cyst through the skin which allowed for transcutaneous dacryocystorhinostomy with a meniscal probe to be performed. No clear communication was evident caudodorsally into the frontal sinus on endoscope examination. A small frontal sinus trephination was performed and lavage flowed easily into the cystic cavity and out of the nostril.

RESULTS

Follow-up at 10 days and 17 months postoperatively showed complete resolution of clinical signs with an excellent cosmetic outcome.

CONCLUSION

Endoscopy-assisted dacryocystorhinostomy demonstrated an effective minimally invasive technique to treat a functionally obstructive dacryocyst of the right nasolacrimal duct in a dog.

[Interdisciplinary Management of Orbital Diseases]

Diagnosis and therapy of orbital diseases is an interdisciplinary challenge, in which i.e. otorhinolaryngologists, ophthalmologists, radiologists, radiation therapists, maxillo-facial surgeons, endocrinologists, and pediatricians are involved. This review article describes frequent diseases which both, otolaryngologists and ophthalmologists are concerned with in interdisciplinary settings. In particular the inflammatory diseases of the orbit including orbital complications, autoimmunological diseases of the orbit including Grave´s orbitopathy, and primary and secondary tumors of the orbit are discussed. Beside describing the clinical characteristics and diagnostic steps the article focusses on the interdisciplinary therapy. The review is completed by the presentation of most important surgical approaches to the orbit, their indications and possible complications. The authors tried to highlight the relevant facts despite the shortness of the text.

Clinical characteristics and surgical outcomes of transcutaneous versus transconjunctival excision of Wolfring gland ductal cysts

PURPOSE

To analyze the clinicopathological characteristics and surgical outcomes of patients with Wolfring gland ductal cysts (WGDCs).

METHODS

A retrospective, consecutive, interventional comparative case series was performed over a period of 7 years. Data on demographic and clinical characteristics, pathological findings and outcomes of surgically excised cysts were collected. A comparison between the transconjunctival and transcutaneous approaches was also assessed.

RESULTS

Forty-eight patients (48 eyelids) were included in the final analysis. The most common presenting symptom was painless eyelid swelling (81.3%). The median symptom duration was 11.5 months (IQR, 18.25). The upper eyelid was involved in 31 (64.6%) patients, 29/31 of whom had cysts in a medial or centromedial location. Forty-five (93.8%) cysts were bluish gray and transilluminable with clear contents on lid eversion and a median largest dimension of 22 mm (IQR, 8). A transverse conjunctival fibrotic band was observed along the proximal tarsal border in the cyst area in all patients. Signs of chronic trachoma were noted in 38 (79.2%) patients. Preoperative significant ptosis was present in 28/31 (90.3%) of the upper eyelid cysts. Thirty cysts (62.5%) were excised through the skin, and 18 cysts (37.5%) were excised transconjunctivally. Intraoperative cyst rupture, the need for conjunctival grafting and postoperative residual upper lid ptosis were significantly greater in the transconjunctival group (p = 0.009, p < 0.001, and p = 0.016, respectively).

CONCLUSION

The present study highlights the clinicopathological characteristics of a relatively large series of surgically excised WGDCs. Transcutaneous excision of WGDCs has proven to be an effective treatment with fewer adverse sequelae than the transconjunctival approach.

An Unusual Case of Lacrimal Gland Dacryops in a 10-Year-Old Child

Lacrimal gland dacryops are an unusual type of benign epithelial neoplasm. Most of the literature refers to dacryops of the lacrimal palpebral lobe, with orbital lobe involvement less frequent. The authors report a case of dacryops in a 10-year-old child involving the orbital lobe of the lacrimal gland. [J Pediatr Ophthalmol Strabismus. 2023;60(6):e79-e82.].

Giant Lacrimal Gland Cyst in a Pediatric Patient: Case Report and Review of the Literature

Lacrimal gland cysts are rare clinical entities in the pediatric population. Herein is described a 6-year-old male patient presenting with progressive left upper lid ptosis, found to have a large ipsilateral superotemporal orbital mass. Diagnosis of a giant lacrimal gland cyst was confirmed excisional biopsy. Despite the resolution of mechanical blepharoptosis, the patient maintained visual acuity limitation due to suspected deprivation amblyopia. The pathophysiology and clinical manifestations of lacrimal gland cysts in the pediatric population are reviewed to emphasize the importance of expedited identification and management in this patient cohort.

Dacryops and clinical diagnostic challenges

OBJECTIVE

The study aims to describe the clinical and histopathologic features of different types of dacryops and their clinical diagnostic challenges.

METHODS

This is a retrospective cohort study of all surgically excised cases of dacryops in 2 tertiary eye hospitals in Riyadh, Saudi Arabia.

RESULTS

The study included 58 dacryops specimens from 55 patients with an average age of 41.2 years (range, 4-78 years). The most common location was the upper lid (60.3%), whereas the least expected location was the caruncle (6.9%). The most common site of dacryops occurrence was in the accessory lacrimal gland (55.2%), the main lacrimal gland (32.8%), and then ectopic dacryops (12%). All patients presented with lid swelling alone except for 3 patients who experienced secondary mechanical ptosis. On physical examination, conjunctival scarring existed in 4 patients (6.9%). Preoperative diagnosis of dacryops was accurate in 44.8% of the cases. Dacryops of the main lacrimal gland was accurately diagnosed clinically in all cases compared with other locations, which was statistically significant (p < 0.001). The causes of inaccurate clinical diagnoses were hidrocystoma (26.9%), inclusion cyst (11.5%), and dermoid cyst (7.7%), whereas the remaining cases were diagnosed as cysts without a specific subtype (53.9%). Recurrence of the lesion was observed in 2 cases (3.5%). No clinical or histopathologic factors were associated with a risk of recurrence.

CONCLUSION

Dacryops can represent a diagnostic challenge to ophthalmologists. Familiarity with clinical presentations and findings is required to diagnose dacryops outside the main lacrimal gland.

Dacryops of the lacrimal gland in an elderly woman: A case report

INTRODUCTION

Dacryops is a rare benign cystic lesion of the lacrimal gland often developing in the palpebral gland. The exact etiology of dacryops remains unclear. Diagnosis could be suspected clinically and established histopathologically. Treatment is commonly surgical.

PRESENTATION OF CASE

We report the case of a 75-year-old woman with past history of total conservative parotidectomy for a benign tumor 10 years ago. She presented to the Ophtalmology Department at Farhat Hached University Hospital of Sousse with a painful swelling of the left supero-external orbital angle. The patient underwent complete excision of the cyst using the conjunctival approach. Histopathological examination showed characteristic features of dacryops with foci of chronic inflammatory cell infiltrates.

DISCUSSION

Dacryops is commonly seen in young adults or middle-aged individuals with a slight female preponderance. In some cases, cystic enlargement of dacryops can lead to mechanical ptosis, dystopia, limitation of extraocular movements, diplopia, and, in rare cases, blepharoptosis. However in this case, the patient was an elderly woman presenting a painless mass without ptosis. As in our case, excision using the conjunctival approach under microscope has excellent results without complications. Histopathological examination confirms the diagnosis and helps to rule out differential diagnoses.

CONCLUSION

As reported in the present case, histopathological examination confirms clinically recognized or suspected dacryops. If untreated, dacryops may lead to ptosis, proptosis and/or dystopia. Complete excision of the cyst is often curative.

Rare Diseases of the Orbit

This article provides an overview of rare orbital diseases. Congenital malformations, inflammatory diseases, benign and malignant neoplasias are described. Although it represents a relatively small area of the body the orbit contains multiple different tissues. Therefore, a great variety of diseases can be found within the orbital space. That is the reason, why both the completeness and the level of detail in the description of particular diseases must be somewhat limited. Nevertheless, clinical manifestations, important aspects of diagnosis, treatment strategies, and, when specific data are available, the prognosis are described. The authors tried to highlight the most characteristic aspects of the different diseases to describe their relevant aspects in spite of the brevity of the subsections.

Dacryops with extensive lacrimal and maxillary bone defects in four dogs

OBJECTIVE

To describe and discuss ventromedial orbital lacrimal gland or duct cysts (dacryops) in dogs with extensive bone defects based on their symptoms, results of diagnostic imaging and histopathological examination, and therapy and discuss their potential origin based on the morphology.

ANIMALS STUDIED

Four dogs of different breeds, age, and sex were presented with a unilateral round, slow growing, indolent, and non-tender process ventromedial to the nasal canthus of the eye.

PROCEDURES

Transverse computed tomography showed a low-density, non-contrast-enhancing cystic process ventromedial to the globe with extensive defects in the lacrimal and maxillary bones in all cases. The cystic character of the structure was confirmed by the aspiration of the brownish fluid without cellular and microbiological contents. For treatment, the cystic fluid was aspirated, and the sclerosing agent polidocanol was injected in three cases. Cystorhinostomy (nasal marsupialisation) was performed in one case as the first choice and in another case following failure of sclerotherapy. Histopathological examination of the cyst walls was performed in two cases and confirmed the diagnosis of dacryops.

RESULTS

Follow-up between 2 and 18 months showed no recurrence and very good to excellent cosmetic results.

CONCLUSIONS

Aberrant lacrimal gland or duct tissue with secondary development of dacryops should be included in the differential diagnoses of ventromedial orbital cysts. Large cysts near the lacrimal drainage system with extensive bone defects in dogs should be treated by nasal marsupialization. Treatments such as evacuation of the cyst and inducing sclerosis (sclerotherapy) should be reserved for exceptional cases.

Bilateral temporal dacryops in a cat

A 1-year-old Maine Coon female spayed cat was presented for a 7-week history of bilateral pinkish masses located over the dorsotemporal conjunctival quadrants. Ophthalmic examination revealed the presence of bilateral temporal, slightly hyperemic, subconjunctival masses, fluctuant, and nonpainful. The remainder of the ocular examination was unremarkable. Ultrasound biomicroscopy and B-scan ultrasonography confirmed the presence of a bilateral cavitated and tubular structure, extending within the temporal orbit, with anechoic fluid-like content. Surgical removal was performed. Histopathology described the lesions as lacrimal gland tissue, markedly infiltrated by inflammatory cells, associated with cavitated structures filled with proteinaceous debris, and lined by flattened bilayered cuboidal epithelial cells. Bilateral adenitis of unknown origin and dacryops of the temporal lacrimal glands were diagnosed. Both surgical sites healed uneventfully, and no recurrence was reported on either eye during a 12-month follow-up period.