Use of 1% polidocanol and pre‐ and post‐computed tomography for treatment of a suspected nasolacrimal duct cyst in a dog

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.

Laser-assisted dacryocystorhinostomy of acquired dacryops in a dog

OBJECTIVE

To describe a novel minimally invasive surgical approach to treatment of a nasolacrimal duct cyst in a dog and outcome.

ANIMAL STUDIED

A 10-year-old, male entire, Springer Spaniel with a chronic right-sided maxillary swelling and associated right eye epiphora and sneezing.

PROCEDURE

Computed tomography with dacryocystography confirmed a cystic structure and destruction of the right maxilla and zygomatic bone with invasion of the nasal cavity. Obstruction of the nasolacrimal duct was confirmed. Rhinoscopy was performed allowing visualization of the ventromedial wall of the cyst. Under direct visualization, dacryocystorhinostomy was performed and the wall of the cyst was ablated with the aid of a thulium laser fiber.

RESULTS

No intraoperative complications occurred during the procedure. Full resolution of clinical signs was noted within 2 weeks of treatment. No recurrence had occurred on long-term follow-up at 32 months.

CONCLUSIONS

Laser-assisted dacrocystorhinostomy under direct visualization was successful in the treatment and resolution of a nasolacrimal duct cyst (dacryops) in this case.

Dacryops with dacryolithiasis in a dog

Background

Objectives

Methods

Results

Conclusion

Polidocanol monotherapy for a superficial orbital venous malformation in a horse

OBJECTIVE

To describe the use of 1% polidocanol as the sole treatment for a superficial orbital venous malformation in a horse.

ANIMAL

A 23-year-old Welsh Cobb cross gelding with a distensible swelling affecting the left lower eyelid, and secondary palpebral margin abnormalities and superficial keratitis.

PROCEDURE

Color flow Doppler ultrasonography revealed non-pulsatile blood flow within the tortuous vascular network most consistent with a superficial orbital venous malformation appearing to involve the lateral palpebral and transverse facial veins. An intravenous catheter was placed within the lateral aspect of the venous malformation, and agitated saline was slowly injected into the vessel while simultaneously ultrasound imaging the medial aspect in which the bubbles were observed coursing across, consistent with lateral to medial flow. Contrast venography confirmed a corkscrew vessel along the ventral aspect of the orbital rim. Under standing sedation, 1% polidocanol solution was administered slowly through the intravenous catheter while manual pressure was applied on the medial and lateral aspects of the venous malformation.

RESULTS

Ultrasonography performed immediately after administration of polidocanol confirmed venous stasis, and formation of a thrombus. No adverse side effects were noted. The venous malformation and associated palpebral margin abnormalities and superficial keratitis resolved at the time of re-examination at 4 months.

CONCLUSION AND CLINICAL RELEVANCE

Polidocanol as the sole treatment for a superficial orbital venous malformation in a horse was well tolerated and led to clinical resolution. Sclerosant monotherapy may be a safe treatment option for superficial orbital venous malformations.

Transconjunctival excision of an orbital conjunctival cyst using computer-assisted 3-D surgical planning in a dog

Investigation of exophthalmos and blood-colored discharge from the left ventral punctum in a dog was consistent with a conjunctival cyst in the orbit. 3-D prints of the cyst and surrounding facial bones identified a successful transconjunctival approach without an orbitotomy and patency of the left lacrimal duct was reestablished.

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.