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Spadaro JZ, Sinard J, Habib L. Bilateral dacryoadenitis as the initial presentation of ANCA-associated vasculitis in a pediatric patient. Orbit 2024; 43:231-235. [PMID: 35801829 DOI: 10.1080/01676830.2022.2093920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/18/2022] [Indexed: 10/17/2022]
Abstract
A 14-year-old female presented with 2 weeks of progressive right eye pain, erythema, and proptosis. Examination demonstrated an enlarged palpable mass along the right superior lateral orbit and bilateral conjunctival petechiae. Of note, she was asymptomatic on the left side, and the petechiae were present only on the superior bulbar conjunctiva with eyelid eversion. Imaging demonstrated bilateral lacrimal gland enhancement. Testing was significant for elevated inflammatory markers, but otherwise negative workup. Biopsy of the right lacrimal gland demonstrated acute-on-chronic inflammation without evidence of lymphoproliferative disease. On repeat testing, myeloperoxidase antibody levels (MPO/p-ANCA) were elevated, indicative of an underlying immune-mediated vasculitis. This case illustrates a rare presentation of ANCA-associated vasculitis in a pediatric patient. It further demonstrates the phenomenon of initial negative serology and subsequent auto-antibody seroconversion in a patient with localized granulomatosis with polyangiitis.
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Affiliation(s)
- Jane Z Spadaro
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
| | - John Sinard
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Larissa Habib
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
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Karube D, Kamiya K, Sugihara N, Maekawa T, Komine M, Ohtsuki M. A case of bilateral dacryocystitis caused by Streptococcus constellatus and Actinomyces israelii. J Dermatol 2024; 51:e135-e136. [PMID: 37997462 DOI: 10.1111/1346-8138.17041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/15/2023] [Accepted: 10/31/2023] [Indexed: 11/25/2023]
Affiliation(s)
- Daiki Karube
- Department of Dermatology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Koji Kamiya
- Department of Dermatology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Natsuko Sugihara
- Department of Dermatology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Takeo Maekawa
- Department of Dermatology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Mayumi Komine
- Department of Dermatology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Mamitaro Ohtsuki
- Department of Dermatology, Jichi Medical University, Shimotsuke, Tochigi, Japan
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3
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Gupta A, Saini P, Bothra N, Ali MJ. Acute dacryocystitis: changing practice pattern over the last three decades at a tertiary care setup. Graefes Arch Clin Exp Ophthalmol 2024; 262:1289-1293. [PMID: 37924496 DOI: 10.1007/s00417-023-06300-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/15/2023] [Accepted: 10/23/2023] [Indexed: 11/06/2023] Open
Abstract
AIM To compare the demographics, clinical features, and changes in the management pattern of acute dacryocystitis at a tertiary care eye institute. METHODS A retrospective review was performed of electronic medical records of all patients diagnosed with acute dacryocystitis from January 2013 to January 2023. Data retrieved include demographics, history, presenting symptoms, duration of symptoms, surgical interventions, associated systemic conditions, management, complications, and outcomes. A successful anatomical outcome was defined as patency on lacrimal irrigation, and a successful functional outcome was defined as the resolution of infection and epiphora. The data parameters obtained were compared with the historical published data of the earlier two decades from the same Institute. RESULTS A total of 363 eyes of 349 patients were enrolled in this retrospective study. The median age was 45 years (range: 19-94 years). There were 216 (62%) females and 133 (38%) males. Surgery was performed in 320 (88%) patients. Needle aspiration or incision and drainage were performed in 102(32%) patients with lacrimal abscesses. Of the 320 patients, an endoscopic DCR was performed in 138 (43%) patients and an external DCR in 182 (57%). Of the 320 patients who underwent DCR surgery, 308 (96%) demonstrated anatomical and functional success at 1-year follow-up. CONCLUSION There is a changing trend towards endoscopic DCR being incorporated as the primary procedure for managing acute dacryocystitis with the advantages of quicker resolution and reduced morbidity. There is a trend for choosing needle aspiration over the traditional incision and drainage in the initial management of lacrimal abscess.
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Affiliation(s)
- Adit Gupta
- Govindram Seksaria Institute of Dacryology, LV Prasad Eye Institute, Road No 2, Banjara Hills, Hyderabad-34, India
- Department of Orbit and Oculoplasty, Shantilal Shanghvi Eye Institute, Mumbai, India
| | - Pragya Saini
- Govindram Seksaria Institute of Dacryology, LV Prasad Eye Institute, Road No 2, Banjara Hills, Hyderabad-34, India
| | - Nandini Bothra
- Govindram Seksaria Institute of Dacryology, LV Prasad Eye Institute, Road No 2, Banjara Hills, Hyderabad-34, India
| | - Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, LV Prasad Eye Institute, Road No 2, Banjara Hills, Hyderabad-34, India.
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Stein M, Bethmann D, Viestenz A, Wickenhauser C, Struck HG, Heichel J. [Concrements of the lacrimal apparatus]. Laryngorhinootologie 2024; 103:187-195. [PMID: 37989218 DOI: 10.1055/a-2192-3865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
Concrements of the lacrimal apparatus, known as dacryoliths, can occur at different localizations and can cause a variety of symptoms. A common clinical sign is chronic inflammation, possibly exhibiting acute exacerbation. Based on a literature review and descriptive clinical cases with histopathological correlations, this contribution summarises the most important information concerning epidemiology, aetiopathogenesis, composition, histology, and therapy of lacrimal concrements. Furthermore, factors known to affect lacrimal lithogenesis are addressed. Concrements of the lacrimal gland cause a swelling at the lateral canthus. With only mild pain, this manifests as circumscribed conjunctival hyperaemia. Histologically, the gland tissue is characterised by acute-erosive to chronic inflammation. The concrements consist of amorphic material. Inflammatory infiltration is dominated by neutrophil granulocytes. Canalicular concrements are highly correlated with chronic canaliculitis. Besides epiphora, patients present with purulent discharge at the affected canaliculus. Actinomyces are frequently found inside these deposits and form drusen-like formations. The surrounding tissue reacts with plasma-cellular and granulocytic inflammation. Dacryoliths (concrements of the lacrimal sac) are associated with dacryocystitis, whereby acute and chronic types are common. Stones can be found in up to 18% of patients undergoing dacryocystorhinostomy or dacryoendoscopy. Preoperative diagnostic testing is challenging, as many lacrimal sac stones cannot be reliably visualised by diagnostic procedures. Recurring episodes of epiphora, mucopurulent discharge, and dacryocystitis are common indicators of dacryoliths. Lacrimal syringing is often possible and shows that total blockage is not present. Histology of the lacrimal mucosa reveals lymphocytic infiltration and submucosal fibrosis. The immediate vicinity of the dacryoliths shows acute inflammation. Therapy consists of stone extraction and improving lacrimal drainage, as the latter is recognised as the main risk factor for dacryolith formation.
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Affiliation(s)
- Marlene Stein
- Universitätsklinik und Poliklinik für Augenheilkunde, Universitätsklinikum Halle (Saale), Halle (Saale), Germany
| | - Daniel Bethmann
- Institut für Pathologie, Martin-Luther-Universitat Halle-Wittenberg, Halle, Germany
| | - Arne Viestenz
- Universitätsklinik und Poliklinik für Augenheilkunde, Universitätsklinikum Halle (Saale), Halle (Saale), Germany
| | - Claudia Wickenhauser
- Institut für Pathologie, Martin-Luther-Universitat Halle-Wittenberg, Halle, Germany
| | - Hans-Gert Struck
- Universitätsklinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg, Halle / Saale, Germany
| | - Jens Heichel
- Klinik für Augenheilkunde, Universitätsklinik Halle, Halle, Germany
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5
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Goel R, Saini S, Golhait P, Shah S. Association of primary chronic dacryocystitis and meibomian gland dysfunction. Indian J Ophthalmol 2024; 72:185-189. [PMID: 38099354 PMCID: PMC10941948 DOI: 10.4103/ijo.ijo_1449_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 08/09/2023] [Accepted: 09/12/2023] [Indexed: 12/19/2023] Open
Abstract
PURPOSE To evaluate the association between meibomian gland dysfunction (MGD) and primary chronic dacryocystitis (PCD) and the effect of dacryocystorhinostomy (DCR) on tear film stability and MGD. METHODS This prospective, interventional, non-randomized study involved 50 unilateral acquired PCD cases and 50 age-matched healthy controls. Patients with lid abnormalities, ocular trauma, previous ocular surgery, contact lens wearers, and chronic topical or systemic drug users were excluded from the study. After a detailed history, the ocular surface disease index (OSDI) was calculated. The ocular assessment included visual acuity, tear meniscus height (TMH), tear break-up time (TBUT), tear well diameter (TWD), Schirmer 1 test, meibomian gland (MG) expressibility, and meibography. PCD eyes underwent external DCR, and the tests were repeated after 8 weeks. RESULTS The mean age of PCD cases was 42.58 ± 12.74 years, the male: female ratio was 7:19, and the mean duration of epiphora was 2.2 ± 1 years. The MG expressibility grade of ≥2 was seen in 98% (49/50) PCD eyes, which was strongly associated with PCD as compared to controls (OR = 563, P = 0.00, 95% CI = 60.71-5229.70). MG loss ≥50% was seen in 62% (31/50) of PCD eyes and none of the control eyes. Following DCR, MG loss remained unchanged, and a significant decrease occurred in OSDI scores, TWD and Schirmer 1 values, and MG expressibility grade (Z = -6.85). The mean TMH decreased from 767.60 ± 331.60 µm to 384 ± 204.29 µm ( P = 0.004) post DCR. CONCLUSIONS PCD is strongly associated with MGD. DCR reverses the functional MG changes with improvement in the tear film stability but no effect on MG loss.
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Affiliation(s)
- Ruchi Goel
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India
| | - Swati Saini
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India
| | - Priyanka Golhait
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India
| | - Shalin Shah
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India
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Ohana O, Maeng MM, Johnson TE. Orbital Abscess Secondary to Nasolacrimal Duct Obstruction in an Extremely Preterm Infant. Ophthalmic Plast Reconstr Surg 2024; 40:e14-e16. [PMID: 38241629 DOI: 10.1097/iop.0000000000002521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
Orbital abscesses are rarely encountered in children younger than 1 year. The literature is limited to isolated case reports and a few case series. Most such cases are reported in infants born at term, with the earliest reported gestational birth age at 34 weeks. Children are more prone to orbital cellulitis compared with adults due to their underdeveloped sinuses and immature immune systems, and the origin is most commonly an ethmoid sinus infection. Orbital cellulitis secondary to dacryocystitis is even less common, with only a few isolated cases reported in infants and children. Herein, the authors present a case of a large extraconal and intraconal orbital abscess secondary to nasolacrimal duct obstruction and dacryocystitis in an extremely preterm infant. We discuss the diagnosis and multidisciplinary management of this challenging case.
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Affiliation(s)
- Oded Ohana
- Oculoplastic Division, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida, U.S.A
- Department of Ophthalmology, "Meir" Medical Center, Kfar-Saba, Israel
| | - Michelle M Maeng
- Oculoplastic Division, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida, U.S.A
- Department of Ophthalmology and Visual Sciences, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Thomas E Johnson
- Oculoplastic Division, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida, U.S.A
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Boualila L, Bouirig K, Tagmouti A, Boutimzine N, Cherkaoui LO, Bouanane R, Touarsa F, Jiddane M, Alloul N, El Ouanass M. Acute suppurative bacterial dacryoadenitis (ASBD) in a child: A rare pseudomonal etiology. J Fr Ophtalmol 2023; 46:e381-e383. [PMID: 37620191 DOI: 10.1016/j.jfo.2023.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 08/26/2023]
Affiliation(s)
- L Boualila
- Département d'ophtalmologie, Hôpital des spécialités, CHU Ibn Sina, Université Mohamed V, Rabat, Maroc..
| | - K Bouirig
- Département d'ophtalmologie, Hôpital des spécialités, CHU Ibn Sina, Université Mohamed V, Rabat, Maroc
| | - A Tagmouti
- Département d'ophtalmologie, Hôpital des spécialités, CHU Ibn Sina, Université Mohamed V, Rabat, Maroc
| | - N Boutimzine
- Département d'ophtalmologie, Hôpital des spécialités, CHU Ibn Sina, Université Mohamed V, Rabat, Maroc
| | - L O Cherkaoui
- Département d'ophtalmologie, Hôpital des spécialités, CHU Ibn Sina, Université Mohamed V, Rabat, Maroc
| | - R Bouanane
- Département de radiologie, Hôpital des spécialitiés, CHU Ibn Sina, Université Mohamed V, Rabat, Maroc
| | - F Touarsa
- Département de radiologie, Hôpital des spécialitiés, CHU Ibn Sina, Université Mohamed V, Rabat, Maroc
| | - M Jiddane
- Département de radiologie, Hôpital des spécialitiés, CHU Ibn Sina, Université Mohamed V, Rabat, Maroc
| | - N Alloul
- Laboratoire de bactériologie, Hôpital militaire d'instruction Mohammed V, CHU Ibn Sina, Université Mohamed V, Rabat, Maroc
| | - M El Ouanass
- Laboratoire de bactériologie, Hôpital militaire d'instruction Mohammed V, CHU Ibn Sina, Université Mohamed V, Rabat, Maroc
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Huo Y, Li L, Mo Y, Guo S. A case report of chronic dacryocystitis caused by nasal stones. BMC Ophthalmol 2023; 23:445. [PMID: 37926842 PMCID: PMC10626694 DOI: 10.1186/s12886-023-03185-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 10/26/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND This paper reports a case of chronic dacryocystitis due to nasal stones. CASE PRESENTATION An 84-year-old male patient was admitted to the hospital with chronic dacryocystitis of the right eye due to tearing and purulent discharge from the right eye for more than 1 month. Antibiotic treatments such as gatifloxacin eye drops were given at other hospitals but did not relieve the symptoms. A computed tomography(CT) scan of the lacrimal duct in our department showed a high-density shadow in the right lacrimal sac area, hypertrophy of the right inferior turbinate, and many nasal calculi in the nasal cavity. The patient was transferred to our otolaryngology department for further treatment, and nasal stones were removed under nasal endoscopy. Three days after surgery, the symptoms affecting the patient's right eye gradually resolved. One month after surgery, the patient underwent a follow-up examination in the ophthalmology clinic; there was no lacrimal purulent discharge from the right eye, and the lacrimal duct could be flushed smoothly. CONCLUSION Chronic dacryocystitis is often caused by primary nasolacrimal duct obstruction. Cases of chronic dacryocystitis caused by secondary nasolacrimal duct obstruction due to nasal stones are rare in the clinic. This case can serve as a reference for the clinical diagnosis and treatment of chronic dacryocystitis.
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Affiliation(s)
- Yandi Huo
- Department of Opthalmology, Chengdu University of Traditional Chinese Medicine, No.37 Shi-Er-Qiao Road, Chengdu, 610072, Sichuan Province, People's Republic of China
| | - Luoxiang Li
- Department of Pathology, Hospital of Chengdu University of Traditional Chinese Medicine, No.39 Shi-Er-Qiao Road, Chengdu, 610072, Sichuan Province, People's Republic of China
| | - Ya Mo
- Department of Opthalmology, Chengdu University of Traditional Chinese Medicine, No.37 Shi-Er-Qiao Road, Chengdu, 610072, Sichuan Province, People's Republic of China.
- Department of Opthalmology, Hospital of Chengdu University of Traditional Chinese Medicine, No.39 Shi-Er-Qiao Road, Chengdu, 610072, Sichuan Province, People's Republic of China.
| | - Sirui Guo
- Department of Opthalmology, Chengdu University of Traditional Chinese Medicine, No.37 Shi-Er-Qiao Road, Chengdu, 610072, Sichuan Province, People's Republic of China
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9
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Dossantos J, Goldstein SM. Herpes Zoster Ophthalmicus With Dacryoadenitis Complicated by Recurrent Orbital Inflammation. Ophthalmic Plast Reconstr Surg 2023; 39:e204-e206. [PMID: 37486336 DOI: 10.1097/iop.0000000000002471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Herpes zoster ophthalmicus represents a zoster infection in the first division of the trigeminal nerve and has potentially serious complications involving the ocular and orbital structures. Herpes zoster ophthalmicus occurs in approximately 10% to 20% of individuals with herpes zoster and can lead to significant morbidity, particularly in patients with multiple comorbidities. The authors present a case of herpes zoster ophthalmicus along with dacryoadenitis in a patient with uncontrolled diabetes and rheumatoid arthritis who was misdiagnosed, had delayed treatment, and experienced recurrence with orbital symptoms during follow up. Prompt recognition, initiation of therapy and careful monitoring and follow up are important for treating herpes zoster ophthalmicus and preventing recurrence and long-term sequelae.
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Affiliation(s)
- Jason Dossantos
- Department of Ophthalmology, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
| | - Scott M Goldstein
- Tri-Century Eye Care, Southampton, Pennsylvania
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
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10
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Awada B. Chronic bilateral dacryoadenitis caused by SARS-CoV-2 infection: a case report. J Med Case Rep 2023; 17:441. [PMID: 37872576 PMCID: PMC10594824 DOI: 10.1186/s13256-023-04175-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/11/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Dacryoadenitis is inflammation of the lacrimal gland, mainly caused by viral infection. It can also be caused by bacterial pathogens and non-infectious processes such as auto-immune diseases and malignancy. Chronic dacryoadenitis is rarely linked to SARS-CoV-2 infection, with only five reports in the literature. REPORT A 26-year-old Arab woman experienced chronic inflammatory dacryoadenitis after a mild SARS-CoV-2 infection, which was successfully treated with oral prednisone. CONCLUSIONS Dacryoadenitis can occur due to inflammation caused by either SARS-CoV-2 exposure. The treatment typically involves the administration of steroids, with duration to be decided based on clinical response.
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Affiliation(s)
- Bassem Awada
- Division of Infectious Diseases, Department of Internal Medicine, Sultan Qaboos Comprehensive Cancer Care and Research Center, Al Khoud, PO Box 566, Muscat, Sultanate of Oman.
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Ozkan Arat Y, Bezci Aygün F, Özoğul E, Kalyoncu U. New Onset Isolated Granulomatous Dacryoadenitis During Etanercept Therapy. Ocul Immunol Inflamm 2023; 31:1727-1729. [PMID: 35797360 DOI: 10.1080/09273948.2022.2089687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 06/07/2022] [Indexed: 10/17/2022]
Abstract
Anti-tumor necrosis factor alpha (TNF- α) biological agents can rarely cause sarcoid-like granulomatosis. A 20-year-old woman presented with a 1-month history of painful left upper eyelid swelling. She was on subcutaneous etanercept and methotrexate for 1 year for juvenile idiopathic arthritis. Imaging showed diffuse enlargement of the left and minimal enlargement of the right lacrimal gland. There was no finding in favor of sarcoidosis on systemic evaluation. Incisional biopsy of the left lacrimal gland revealed non-caseating granulomatous dacryoadenitis. The findings showed significant regression 1 month after cessation of Etanercept therapy. To the best of our knowledge, this report illustrates the first case of an isolated granulomatous dacryoadenitis during TNF-α antagonist therapy.
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Affiliation(s)
- Yonca Ozkan Arat
- Department of Ophthalmology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Figen Bezci Aygün
- Department of Ophthalmology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ece Özoğul
- Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Umut Kalyoncu
- Department of Internal Medicine, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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12
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Singh S, Gandhi A, Das S. Dacryoadenitis post COVID-19 infection and immunization. Indian J Ophthalmol 2023; 71:3100-3102. [PMID: 37530288 PMCID: PMC10538829 DOI: 10.4103/ijo.ijo_30_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 06/22/2023] [Accepted: 06/28/2023] [Indexed: 08/03/2023] Open
Abstract
Dacryoadenitis can be a rare presentation following COVID-19 infection or can be an immunological response post COVID-19 vaccination. Herein we report two cases of lacrimal gland involvement, one post COVID-19 infection, and the other post COVID-19 vaccination. A definitive causal relationship, however, remains uncertain.
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Affiliation(s)
- Saumika Singh
- Oculoplasty and Ocular Oncology Services, Dr. Shroff’s Charity Eye Hospital, New Delhi, India
| | - Arpan Gandhi
- Laboratory Services, Dr. Shroff’s Charity Eye Hospital, New Delhi, India
| | - Sima Das
- Oculoplasty and Ocular Oncology Services, Dr. Shroff’s Charity Eye Hospital, New Delhi, India
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13
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Jossy A, Kaviyapriya N, Kasturi N, Rekha JS. Isolated tubercular dacryoadenitis in a non-immunocompromised healthy adult. INDIAN J PATHOL MICR 2023; 66:608-610. [PMID: 37530351 DOI: 10.4103/ijpm.ijpm_489_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
A middle-aged woman presented with a slowly enlarging mass in the right superotemporal orbit and ptosis. The patient had an elevated erythrocyte sedimentation rate, and incisional biopsy showed granulomatous inflammation with Langhan's giant cells suggestive of a tubercular etiology. Tuberculin skin test was negative. The patient responded well to anti-tuberculous therapy. Tubercular dacryoadenitis is a rare presentation of a lacrimal gland mass.
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Affiliation(s)
- Ajax Jossy
- Department of Ophthalmology, Jawaharlal Postgraduate Medical Education and Research, Puducherry, India
| | - N Kaviyapriya
- Department of Ophthalmology, Jawaharlal Postgraduate Medical Education and Research, Puducherry, India
| | - Nirupama Kasturi
- Department of Ophthalmology, Jawaharlal Postgraduate Medical Education and Research, Puducherry, India
| | - J Sree Rekha
- Department of Pathology, Jawaharlal Postgraduate Medical Education and Research, Puducherry, India
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14
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Martínez Díaz M, Copete Piqueras S, Blanco Marchite C, Vahdani K. Acute dacryoadenitis in a patient with SARS-CoV-2 infection. Orbit 2022; 41:374-377. [PMID: 33402004 DOI: 10.1080/01676830.2020.1867193] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/16/2020] [Indexed: 06/12/2023]
Abstract
We describe a retrospective case report of dacryoadenitis associated with orbital inflammatory disease in a patient with confirmed SARS-CoV-2 infection.A 22-year-old previously fit and healthy male presented with 4-day history of right ocular redness, eyelid swelling and blurred vision associated with discomfort and pain in the lacrimal gland area. He was found to have right acute dacryoadenitis based on clinical examination and orbital imaging. One day after initiation of oral antibiotic and non-steroidal anti-inflammatory therapy, he developed worsening of the orbital inflammation and partial ophthalmoplegia. Oral steroids were commenced resulting in rapid resolution of symptoms within a few days and clinical stability at 2 months.The patient did not have any systemic features of COVID-19 but he was in close contact with his mother and with his partner who both had respiratory symptoms and tested positive for SARS-CoV-2 antigen (PCR testing) 4 weeks prior. PCR testing from nasopharyngeal swab was negative for SARS-CoV-2 RNA; however, the serological test was positive for IgM/IgG SARS-CoV-2 antibodies. Extensive laboratory workup including infectious and autoimmune screening and chest x-ray were unremarkable.Orbital inflammatory disease due to infectious process or immunological response may potentially occur in COVID-19 patients, although the causal relationship remains uncertain.
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Affiliation(s)
| | | | | | - Kaveh Vahdani
- Adnexal Service, Moorfields Eye Hospital, NHS Trust, London, UK
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15
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Wai KM, Wolkow N, Yoon MK. Infectious Dacryoadenitis: A Comprehensive Review. Int Ophthalmol Clin 2022; 62:71-86. [PMID: 35325911 DOI: 10.1097/iio.0000000000000412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Ozturker C, Kaynak P. Epiphora and Dacryocystitis After Transcanalicular Laser-assisted Dacryocystorhinostomy due to an Undiagnosed Dacryolith. Ophthalmic Plast Reconstr Surg 2022; 38:e59-e62. [PMID: 34873124 DOI: 10.1097/iop.0000000000002102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 45-year-old female patient who had previously undergone endoscopic dacryocystorhinostomy (EN-DCR) at another surgical center was diagnosed with functional failure after DCR and underwent an uneventful transcanalicular laser-assisted DCR (TCL-DCR). After 5 months, the patient underwent endoscopic examination due to persistent epiphora and dacryocystitis attacks. Endonasal visualization revealed a large dacryolith that filled the ostium and sac and was removed en bloc mechanically with forceps. Carbonized material on the dacryolith's superior part indicated that it was perforated through-and-through by the laser beam during TCL-DCR. The patient's complaints were resolved completely following the removal of the dacryolith. The transcanalicular lacrimal procedures do not allow complete visualization of the contents of the lacrimal sac, and the laser beam can ablate even an undetected dacryolith and may result in unsuccessful DCR, although the surgical course may look completely uneventful.
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Affiliation(s)
- Can Ozturker
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Pelin Kaynak
- Ophthalmic Plastic and Reconstructive Surgery Division, Rufus Eye Microsurgery Center, Istanbul, Turkey
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17
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Vahdani K, Luthert PJ, Rose GE. Chronic Granulomatous Dacryoadenitis Associated With Pleomorphic Adenoma. Ophthalmic Plast Reconstr Surg 2022; 38:e54-e57. [PMID: 34812181 DOI: 10.1097/iop.0000000000002096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chronic granulomatous inflammation occurs rarely alongside pleomorphic adenomas of the major salivary glands but would not appear to have been reported with lacrimal gland adenomas. We describe the clinical features, imaging and histopathology for 4 patients (3 female) who had granulomatous inflammation alongside lacrimal gland adenomas-the patients being with age 39, 44, 48, and 53 years at time of surgery. One patient had an asymptomatic lesion found on imaging, and the other 3 had symptoms for between 3 years and several decades. Conjecturally, this rare phenomenon might arise from an inflammatory response to leakage of secretions from the ductular components of the glands.
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Affiliation(s)
- Kaveh Vahdani
- Adnexal Service, Moorfields Eye Hospital, London, United Kingdom
| | - Philip J Luthert
- University College London (UCL) Institute of Ophthalmology, London, United Kingdom
| | - Geoffrey E Rose
- Adnexal Service, Moorfields Eye Hospital, London, United Kingdom
- University College London (UCL) Institute of Ophthalmology, London, United Kingdom
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18
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Neerukonda VK, Stagner AM, Wolkow N. Lymphoma of the Lacrimal Sac: The Massachusetts Eye and Ear Experience With a Comparison to the Previously Reported Literature. Ophthalmic Plast Reconstr Surg 2022; 38:79-86. [PMID: 34269767 DOI: 10.1097/iop.0000000000001997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the frequency, clinical features, and histologic subtypes of biopsy proven lacrimal sac lymphomas, and to compare these results to the previously published literature. METHODS A retrospective chart review was performed at a single institution from 2004 to 2017. Pathology reports, operative notes, and patients' medical charts were reviewed. RESULTS Of 566 lacrimal sacs submitted for routine histopathologic evaluation, 16 cases of lymphoma were identified. All were low-grade, non-Hodgkin B-cell lymphomas, biopsied at an average age of 71 years. Thirteen patients (81.25%) had a pre-existing lymphoma diagnosis; the average interval between the diagnosis of systemic or nonocular adnexal lymphoma and lacrimal sac lymphoma was 7.9 years (range 2-26 years; median 5.5 years). Three cases of primary lacrimal sac lymphoma were identified. Histopathology showed 3 cases (18.75%) of follicular lymphoma, 3 (18.75%) of extranodal marginal zone lymphoma, and 10 (62.5%) of chronic lymphocytic leukemia/small lymphocytic lymphoma. Primary cases presented with epiphora and nasolacrimal duct obstruction, while secondary cases predominantly manifested as dacryocystitis. All lacrimal sac neoplasms were locally responsive (without local recurrence) to chemotherapy, radiation, or both. CONCLUSIONS Lacrimal sac lymphoma is uncommon but should be suspected among patients with known lymphoma who develop dacryocystitis. In this series, primary lacrimal sac lymphoma most often presented as a mass or nasolacrimal duct obstruction. Chronic lymphocytic leukemia/small lymphocytic lymphoma was the most commonly identified cause of secondary lacrimal sac lymphoma. Distinguishing primary from secondary lacrimal sac lymphomas is important, as the extent of disease and histopathologic subtypes differ, which may affect patient management.
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Affiliation(s)
| | | | - Natalie Wolkow
- David G. Cogan Laboratory of Ophthalmic Pathology
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
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Amjad MM, Jacobs SM, Callahan MA, Gonzalez ML, Tavakoli M. Small Cell Neuroendocrine Carcinoma Presenting as Recurrent Dacryocystitis: Case Report of a Rare Entity. Ophthalmic Plast Reconstr Surg 2022; 38:e2-e6. [PMID: 34431823 DOI: 10.1097/iop.0000000000002052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
An 84-year-old man presented with a localized, firm, tender mass over the right lacrimal sac. He had a history of acute dacryocystitis in the same eye 6 months before presentation, which resolved with antibiotics followed by uneventful dacryocystorhinostomy. At repeat presentation, the patient underwent orbital imaging and excisional biopsy of the lesion. Histologic studies revealed a small cell neuroendocrine carcinoma. The patient was subsequently treated with chemotherapy and radiation. Although there are rare reports of small cell neuroendocrine carcinoma originating in the sino-orbital-lacrimal region, this is the first report of tumor presentation with acute dacryocystitis in a patient with prior dacryocystorhinostomy.
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Affiliation(s)
- Muhammad M Amjad
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Sarah M Jacobs
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Michael A Callahan
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Manuel Lora Gonzalez
- Department of Pathology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, U.S.A
| | - Mehdi Tavakoli
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
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Watanabe T, Yamashita T, Sugawara H. Epstein-Barr Virus Dacryoadenitis in a Young Woman. Intern Med 2022; 61:1629. [PMID: 35569929 PMCID: PMC9177378 DOI: 10.2169/internalmedicine.8004-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tamami Watanabe
- Division of General Medicine, Department of Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University, Japan
| | - Takeshi Yamashita
- Division of General Medicine, Department of Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University, Japan
| | - Hitoshi Sugawara
- Division of General Medicine, Department of Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University, Japan
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21
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Yoshida Y, Kondo T, Hosokawa Y, Oki K, Yukawa K, Araki K, Kohno H, Kuranobu T, Tokunaga T, Oi K, Sugimoto T, Oda K, Nojima T, Hirata S, Sugiyama E. A Rare Case of IgG4-Related Disease Presenting as a Unilateral Severe Dacryoadenitis Complicated by Hypophysitis and Hypertrophic Pachymeningitis. J Clin Rheumatol 2021; 27:S571-S573. [PMID: 30724757 DOI: 10.1097/rhu.0000000000000989] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Abstract
PURPOSE To analyze the clinical presentation, course, and management in a large cohort of pediatric acute dacryocystitis subjects and to examine whether hospitalization and urgent surgical intervention are indeed mandatory. METHODS A retrospective analysis of all pediatric subjects diagnosed with dacryocystitis at the Children's Hospital of Philadelphia over a 12-year period (2009-2020). RESULTS One-hundred sixty-nine pediatric acute dacryocystitis patients were included in this study. Management included admission in 117 cases (69%). Sixty-eight patients (40%) were treated medically with no surgical intervention, 75 cases (44%) required urgent surgical intervention, and 26 additional cases (15%) required surgery due to persistent tearing symptoms after medical management. The urgent procedures included most commonly: 1) endonasal examination and microdebridement of intranasal cysts in 26 cases (35%); 2) probing and irrigation without examination and microdebridement, with or without stent intubation, in 30 cases (40%); and 3) dacryocystorhinostomy (13 endonasal and 4 external) in 17 cases (23%). CONCLUSIONS Management of pediatric acute dacryocystitis should be tailored individually for each case. Hospital admission and early surgical intervention are not mandatory, as 31% of cases resolved without admission, and 56% without early surgical intervention. Although a specific age cutoff is not plausible, hospital admission for younger patients is more commonly advocated. When surgical intervention is indicated, endonasal examination and microdebridement of any associated intranasal cyst and probing with possible stenting are the initial procedures of choice. Dacryocystorhinostomy is reserved for more complex obstructions. Although pediatric acute dacryocystitis is an infection with serious potential problems, when managed appropriately, complications are rare.
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Affiliation(s)
- Daphna Prat
- Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
- Department of Ophthalmology, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Katie Magoon
- Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
| | - Karen E Revere
- Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
| | - James A Katowitz
- Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
| | - William R Katowitz
- Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
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23
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Habib M, Saunders PJ, Rubinstein TJ. Stenotrophomonas maltophilia-Associated Dacryocystitis in Leukemia-Infiltrated Lacrimal Sacs: Case and Review of Literature. Ophthalmic Plast Reconstr Surg 2021; 37:e143-e145. [PMID: 33782323 DOI: 10.1097/iop.0000000000001925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 91-year-old female with a history of chronic lymphocytic leukemia developed recurrent bouts of bilateral dacryocystitis. She underwent incision and drainage of the lacrimal sac with culture demonstrating the rare bacteria Stenotrophomonas maltophilia. She underwent subsequent dacryocystectomy with biopsy revealing bilateral involvement of chronic lymphocytic leukemia in the lacrimal sac. Stenotrophomonas maltophilia has been associated with immune suppression and is rarely seen in dacryocystitis. Local and/or systemic immune deregulation or suppression may play a role in lacrimal sac infection with this bacterium in some patients.
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Affiliation(s)
| | - Peter J Saunders
- Division of Ophthalmology, Albany Medical Center
- Department of Pathology, Albany Medical Center
| | - Tal J Rubinstein
- Division of Ophthalmology, Albany Medical Center
- Ophthalmic Plastic Surgery, Albany, New York, U.S.A
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24
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Qing H, Yang Z, Shi M, Zhang J, Sun S, Han L. Microbial spectrum and antibiotic sensitivity in infantile dacryocystitis. Graefes Arch Clin Exp Ophthalmol 2021; 259:1263-1272. [PMID: 33417095 DOI: 10.1007/s00417-020-05026-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 11/03/2020] [Accepted: 11/23/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To identify the characteristics and the spectrum of microbial agents of infantile dacryocystitis and to assess the trends in both antibiotic sensitivities and pathogens over the past 10 years. METHODS The microbial and medical records of 546 culture-proven patients (546 eyes) of infantile dacryocystitis diagnosed at Henan Eye Hospital between January 2009 and December 2018 were retrospectively reviewed. Patient demographics, microbial analysis, and susceptibility rates to various antibiotics were done. A chi-squared test for trends was applied to evaluate changes in antibiotic susceptibility and microbial spectrum over time. RESULTS A total of 546 patients with infantile dacryocystitis were documented. The average age was 2.97 ± 4.15 months, and 42.7% were female. The proportion of gram-positive microbes, gram-negative microbes, and fungi was 80.2, 19.4, and 0.4%, respectively. Minocycline was sensitive to gram-positive bacteria (98.0%). Imipenem was sensitive to gram-negative bacteria (89.2%). Increasing susceptibility was observed in two bacterial isolates: Staphylococcus aureus (P = 0.005) and Streptococcus mitis (P = 0.001). Decreasing susceptibility was observed in one bacterial isolate: Staphylococcus epidermidis (P < 0.0001). Increasing microbial susceptibility over time was detected for 12 antibiotics. Decreasing microbial sensitivity was observed for one antibiotic. CONCLUSIONS The most common cause of infantile dacryocystitis is Staphylococcus epidermidis. Though a significant trend towards increasing microbial sensitivity to some antibiotics was observed, including glycopeptides, cephalosporins, fluoroquinolones, tetracyclines, and lincosamides, a significant trend towards decreasing microbial sensitivity to amikacin was also detected.
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Affiliation(s)
- Huiling Qing
- Department of Ophthalmology, Henan Eye Hospital, Henan Eye Institute, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, NO.7, Wei-wu Road, Zhengzhou, 450003, China.
| | - Zhengwei Yang
- Department of Ophthalmology, Henan Eye Hospital, Henan Eye Institute, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, NO.7, Wei-wu Road, Zhengzhou, 450003, China
| | - Menghai Shi
- Department of Ophthalmology, Henan Eye Hospital, Henan Eye Institute, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, NO.7, Wei-wu Road, Zhengzhou, 450003, China
| | - Junge Zhang
- Department of Ophthalmology, Henan Eye Hospital, Henan Eye Institute, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, NO.7, Wei-wu Road, Zhengzhou, 450003, China
| | - Shengtao Sun
- Department of Ophthalmology, Henan Eye Hospital, Henan Eye Institute, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, NO.7, Wei-wu Road, Zhengzhou, 450003, China
| | - Lei Han
- Department of Ophthalmology, Henan Eye Hospital, Henan Eye Institute, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, NO.7, Wei-wu Road, Zhengzhou, 450003, China
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25
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Saratziotis A, Zanotti C, Baldovin M, Emanuelli E. Ectopic lacrimal gland in the lacrimal sac mimicking tumour: literature review. BMJ Case Rep 2020; 13:13/7/e235187. [PMID: 32699057 DOI: 10.1136/bcr-2020-235187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
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.
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Affiliation(s)
- Athanasios Saratziotis
- ENT Department of Otolaryngology, General University Hospital of Larissa, Larissa, Thessaly, Greece
| | - Claudia Zanotti
- Otolaryngology and Otologic Surgery, University of Padova, Padova, Veneto, Italy
| | - Maria Baldovin
- Otolaryngology and Otologic Surgery, University of Padova, Padova, Veneto, Italy
| | - Enzo Emanuelli
- Otolaryngology and Otologic Surgery, University of Padova, Padova, Veneto, Italy
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26
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Montgomery ML, Callegan MC, Fuller KK, Carr DJJ. Ocular Glands Become Infected Secondarily to Infectious Keratitis and Play a Role in Corneal Resistance to Infection. J Virol 2019; 93:e00314-19. [PMID: 31167909 PMCID: PMC6675880 DOI: 10.1128/jvi.00314-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 05/29/2019] [Indexed: 12/27/2022] Open
Abstract
Ocular glands play a critical role in eye health through the secretion of factors directly onto the ocular surface. The cornea is a normally transparent tissue necessary for visual acuity located in the anterior segment of the eye. Corneal damage can occur during microbial infection of the cornea, resulting in potentially permanent visual deficits. The involvement of ocular glands during corneal infection has been only briefly described. We hypothesized that ocular glands contribute to resistance as an arm of the eye-associated lymphoid tissue and may also be susceptible to infection secondary to microbial keratitis. Utilizing a mouse model of herpes simplex virus 1 (HSV-1) keratitis, we found that infection of corneas resulted in subsequent infection of ocular glands, including harderian glands (HGs) and extraorbital glands. Similarly, infection of corneas with Pseudomonas aeruginosa resulted in secondary infection of ocular glands. A robust immune response, characterized by increased numbers of immune cells and inflammatory mediators, occurred within ocular glands following HSV-1 keratitis. Removal of HGs altered corneal resistance to HSV-1, as measured by increased viral load, decreased corneal edema, and decreased inflammatory cell infiltration. These novel findings suggest that ocular glands are involved in microbial keratitis through their susceptibility to secondary infection and contribution to corneal resistance.IMPORTANCE Microbial keratitis accounts for up to 700,000 clinical visits annually in the United States. The involvement of ocular glands during microbial keratitis is not readily appreciated, and treatment options do not address the consequences of ocular gland dysfunction. The present study shows that ocular glands are susceptible to direct infection by common ocular pathogens, including HSV-1 and Pseudomonas aeruginosa, subsequent to microbial keratitis. Additionally, ocular glands contribute soluble factors that play a role in corneal resistance to HSV-1 and alter viral load, corneal edema, and immune cell infiltration. Further studies are needed to elucidate the mechanisms by which this occurs.
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Affiliation(s)
- Micaela L Montgomery
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Michelle C Callegan
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Kevin K Fuller
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Daniel J J Carr
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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27
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Sagar P, Shankar R, Wadhwa V, Singh I, Khurana N. Primary tubercular dacryocystitis - a case report and review of 18 cases from the literature. Orbit 2019; 38:331-334. [PMID: 30142013 DOI: 10.1080/01676830.2018.1513044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 08/14/2018] [Indexed: 06/08/2023]
Abstract
Tuberculosis is an airborne communicable disease primarily affecting lungs. Primary tuberculosis of the lacrimal sac is very rare. A 15-year-old girl presented with bilateral epiphora for 8 months. Examination revealed bilateral nasolacrimal duct obstruction. During dacryocystorhinostomy, bone over lacrimal sac was found partially eroded. Lacrimal sac was found filled with caseous white material. Biopsy from the lacrimal sac revealed tubercular granulomas. Patient improved after anti-tubercular therapy. Abbreviations: PCR: polymerase chain reaction; NAAT: nucleic acid amplification test.
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Affiliation(s)
- Poonam Sagar
- a Department of ENT & Head & Neck Surgery, Maulana Azad Medical College & Associated Lok Nayak Hospital , Delhi , India
| | - Ravi Shankar
- b Department of Head and Neck Surgery, Tata Memorial Hospital , Mumbai , India
| | - Vikram Wadhwa
- a Department of ENT & Head & Neck Surgery, Maulana Azad Medical College & Associated Lok Nayak Hospital , Delhi , India
| | - Ishwar Singh
- a Department of ENT & Head & Neck Surgery, Maulana Azad Medical College & Associated Lok Nayak Hospital , Delhi , India
| | - Nita Khurana
- c Department of Pathology, Maulana Azad Medical College & Associated Lok Nayak Hospital , Delhi , India
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28
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Tengku-Fatishah A, Abdullah B, Sanjeevan N, Nurul-Shuhada AH, Sharifah-Emilia TS, Haron J, Shatriah I. Dermoid cyst simulating recurrent dacryocystitis in a toddler. Can J Ophthalmol 2019; 54:e196-e199. [PMID: 31358169 DOI: 10.1016/j.jcjo.2018.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/05/2018] [Accepted: 10/09/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Amir Tengku-Fatishah
- Departments of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Baharudin Abdullah
- Departments of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Nadarajah Sanjeevan
- Departments of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | | | | | - Juhara Haron
- Departments of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Ismail Shatriah
- Departments of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.
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Abstract
Rabbits have become a popular house pet that is encountered with increasing frequency in small animal veterinary practice. The unique anatomy of the rabbit predisposes them to developing surface ocular problems including the development of dacryocystitis, as well as conjunctivitis and keratitis. This article endeavors to give an updated outline of the various conditions affecting the rabbit ocular surface, with emphasis on diagnosis and treatment.
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Affiliation(s)
- Kathleen M Bedard
- Comparative Ophthalmology, University of Georgia, 2200 College Station Road, Athens, GA 30202, USA.
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30
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Lyons C, Godoy F, Vanden Driessche K. Bilateral subacute lacrimal gland enlargement mimicking dacryoadenitis in a 7-year-old boy: a rare adverse effect of valproic acid (sodium valproate). J AAPOS 2017; 21:257-258. [PMID: 28359767 DOI: 10.1016/j.jaapos.2017.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 02/15/2017] [Indexed: 11/30/2022]
Abstract
A healthy 7-year-old boy presented with bilateral symmetrical lacrimal gland enlargement; a week later salivary gland enlargement was also noted. Clinical investigations suggested no diagnosis, and surgical biopsy was considered. Valproic acid (sodium valproate), which he was taking for absence seizures, has been reported to cause salivary gland swelling in adults. Suspecting that a similar mechanism could be causal, the drug was discontinued. Complete resolution of the lacrimal and salivary gland enlargement rapidly ensued. This is the first report of lacrimal gland enlargement caused by valproic acid.
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Affiliation(s)
- Christopher Lyons
- Department of Ophthalmology, University of British Columbia, Vancouver, Canada.
| | - Flavia Godoy
- Department of Ophthalmology, University of British Columbia, Vancouver, Canada
| | - Koen Vanden Driessche
- Division of Infectious Diseases, University of British Columbia, Vancouver, Canada; Department of Pediatrics, University of British Columbia, Vancouver, Canada
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Sengor T, Yuzbasioglu E, Aydın Kurna S, Irkec M, Altun A, Kökcen K, Yalcin NG. Dacryoadenitis and extraocular muscle inflammation associated with contact lens-related Acanthamoeba keratitis: A case report and review of the literature. Orbit 2017; 36:43-47. [PMID: 27874294 DOI: 10.1080/01676830.2016.1243132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The present report discusses a new case of dacryoadenitis with extraocular muscle inflammation associated with Acanthamoeba keratitis (AK) in a contact lens wearer. A 41-year-old male, who has worn silicone hydrogel contact lenses on an extended basis for about 10 years, attended with the complaints of vision disturbance, hyperemia, and pain in his right eye. His history revealed that 1.5 month ago, he had been diagnosed with allergic conjunctivitis and had used steroid eye drops. Biomicroscopic examination revealed eyelid edema, chemosis, and ring infiltration, radial keratoneuritis and an epithelial defect in the cornea. Magnetic resonance imaging demonstrated enlarged lacrimal gland with edematous changes consistent with inflammation due to dacryoadenitis. There were also thickening and edema of the right superior oblique and lateral rectus muscle. The treatment protocol for AK was applied with no specific treatment for dacryoadenitis. After 4 months of the treatment, dacryoadenitis and keratitis regressed. Dacryoadenitis and extraocular muscle inflammation may accompany AK more frequently than expected and previously known. The evaluation of the lacrimal gland and extraocular muscles in presence of AK might be beneficial for understanding better the exact clinical picture and course of the keratitis.
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Affiliation(s)
- Tomris Sengor
- a Department of Ophthalmology , Bilim University, Florence Nightingale Hospital , Istanbul , Turkey
| | - Erdal Yuzbasioglu
- a Department of Ophthalmology , Bilim University, Florence Nightingale Hospital , Istanbul , Turkey
| | - Sevda Aydın Kurna
- b Clinic of Ophthalmology , Fatih Sultan Mehmet Education and Research Hospital , Istanbul , Turkey
| | - Murat Irkec
- c Department of Ophthalmology , Hacettepe University , Ankara , Turkey
| | - Ahmet Altun
- b Clinic of Ophthalmology , Fatih Sultan Mehmet Education and Research Hospital , Istanbul , Turkey
| | - Kubra Kökcen
- b Clinic of Ophthalmology , Fatih Sultan Mehmet Education and Research Hospital , Istanbul , Turkey
| | - Nazli Gul Yalcin
- a Department of Ophthalmology , Bilim University, Florence Nightingale Hospital , Istanbul , Turkey
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Uth CC, Voorde PT, Boljanovic S. [Dacryocystitis in a three-week-old girl]. Ugeskr Laeger 2015; 177:V04150369. [PMID: 26509540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Dacryocystocele is a rare disease, which can be difficult to distinguish from haemangioma, dermoid cyst or encephalocele. Proper diagnosis and treatment is important as the risk of complications is high. A newborn baby with dacryocystitis was referred to a department of plastic surgery with a bluish tumour in the medial corner of the eye. The girl was treated with i.v. antibiotics and the dacryocystocele disappeared in 20 days. Knowledge of the disease is important so patients quickly can be treated medically and possibly surgically in order to avoid fatal complications.
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Coloma-González I, Ceriotto A, Flores-Preciado J, Corredor-Casas S, Salcedo-Casillas G. [Comparative study of clinical features between unilateral and bilateral orbital IgG4-related disease]. Arch Soc Esp Oftalmol 2015; 90:407-413. [PMID: 25865652 DOI: 10.1016/j.oftal.2015.02.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 02/09/2015] [Accepted: 02/24/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Descriptive and comparative study of patients with orbital IgG4-related disease. MATERIAL AND METHODS A review and analysis of the cases diagnosed with inflammatory orbital lesion related to IgG4 by the Ophthalmic Pathology Service in the Dr. Luis Sánchez Bulnes Hospital. RESULTS A total of 9 cases were found, in which 66% were women, and with a mean age of 48 years and time to diagnosis of 2 years. Unilateral involvement was observed in 56% of cases. All the females experienced pain, and there was an optimal response to corticosteroid treatment in 100% of patients who required medical treatment (one case showed spontaneous resolution). In bilateral cases (44%), only 25% were female, and none had pain as a presenting symptom. Furthermore, 25% of these patients required a combination with immunosuppressants to control inflammation. CONCLUSIONS Clinical presentation of patients with unilateral orbital IgG4-related disease differs from those with bilateral involvement.
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Affiliation(s)
- I Coloma-González
- Servicio de Órbita, Párpados y Vía Lagrimal, Hospital Dr. Luis Sánchez Bulnes, Asociación para Evitar la Ceguera IAP, México D.F. México.
| | - A Ceriotto
- Servicio de Órbita, Párpados y Vía Lagrimal, Hospital Dr. Luis Sánchez Bulnes, Asociación para Evitar la Ceguera IAP, México D.F. México
| | - J Flores-Preciado
- Servicio de Órbita, Párpados y Vía Lagrimal, Hospital Dr. Luis Sánchez Bulnes, Asociación para Evitar la Ceguera IAP, México D.F. México
| | - S Corredor-Casas
- Servicio de Órbita, Párpados y Vía Lagrimal, Hospital Dr. Luis Sánchez Bulnes, Asociación para Evitar la Ceguera IAP, México D.F. México
| | - G Salcedo-Casillas
- Servicio de Órbita, Párpados y Vía Lagrimal, Hospital Dr. Luis Sánchez Bulnes, Asociación para Evitar la Ceguera IAP, México D.F. México
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Casado A, Sánchez-Gutiérrez V, Barrancos C, Albandea A. [Atypical presentation of lacrimal gland pleomorphic adenoma with necrotic foci]. Arch Soc Esp Oftalmol 2015; 90:432-434. [PMID: 25843695 DOI: 10.1016/j.oftal.2015.02.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 10/14/2014] [Accepted: 02/25/2015] [Indexed: 06/04/2023]
Abstract
CLINICAL CASE The case is presented of 48 year-old male complaining of a painful left upper eyelid and swelling of the lacrimal gland, with a suspicion of dacryoadenitis. Removal was decided after dacriops suspicion. Histopathology diagnosed a pleomorphic adenoma of the lacrimal gland, with areas of necrosis. DISCUSSION Lacrimal gland pleomorphic adenoma usually presents as a slowly progressive painless mass. However, painful presentation in this case might be related with necrotic foci found in the histopathological examination. Although not described in lacrimal glands, pleomorphic adenomas have already been reported in the major and minor salivary glands, and these patients also presented with a painful mass.
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Affiliation(s)
- A Casado
- Departamento de Oftalmología, Hospital Universitario Ramón y Cajal, Madrid, España.
| | - V Sánchez-Gutiérrez
- Departamento de Oftalmología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - C Barrancos
- Departamento de Oftalmología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - A Albandea
- Departamento de Oftalmología, Hospital Universitario Ramón y Cajal, Madrid, España
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Kurdi M, Allen L, Wehrli B, Chakrabarti S. Solitary fibrous tumour of the lacrimal sac presenting with recurrent dacryocystitis. Can J Ophthalmol 2015; 49:e108-10. [PMID: 25284109 DOI: 10.1016/j.jcjo.2014.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 05/23/2014] [Accepted: 05/26/2014] [Indexed: 11/19/2022]
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36
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Griffiths U, Kumar D, Trimble M, Prabhavalkar S. An unusual Cause of Periorbital Swelling in a Young Female. Acute Med 2015; 14:68-94. [PMID: 26529797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Abstract
The aim of this report is to present a case of a patient with bilateral lacrimal gland abscesses in the course of dacryoadenitis. A 45-year-old female patient with a long history of cocaine abuse presented with bilateral bacterial dacryoadenitis and upper lid inflammation with purulent discharge from a palpebral wound of the right upper lid. The diagnosis was confirmed with microbiology culture and an orbital CT scan, which revealed lacrimal gland abscesses. The patient admitted to vigorous eye scratching, which we believe was the mechanism responsible for the process. The infection resolved on targeted antibiotic therapy. This is the first reported case of bilateral infectious dacryoadenitis produced in a self-inflicted mechanism in a cocaine addict.
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Affiliation(s)
- Marta Latasiewicz
- Department of Ophthalmology, Hospital Clinic de Barcelona , Barcelona , Spain
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Jakobiec FA, Rashid A, Lane KA, Kazim M. Granulomatous dacryoadenitis in regional enteritis (crohn disease). Am J Ophthalmol 2014; 158:838-844.e1. [PMID: 25036879 DOI: 10.1016/j.ajo.2014.07.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 07/10/2014] [Accepted: 07/11/2014] [Indexed: 12/25/2022]
Abstract
PURPOSE To evaluate the clinical and immunopathologic features of 2 patients with bilateral dacryoadenitis associated with regional enteritis. DESIGN Retrospective, clinicopathologic study. METHODS Clinical records, photographs, and imaging studies were reviewed and microscopic sections of lacrimal gland biopsy samples were critically re-evaluated. The microscopic slides were stained with hematoxylin and eosin, special stains for organisms, and a range of immunohistochemical biomarkers, including CD3, CD4, CD5, CD8, CD20, CD68, CD138, CD1a, and immunoglobulins Ig G, IgG4, and IgA. RESULTS Both patients were young women with a well-established diagnosis of regional enteritis. Histopathologic examination of biopsy samples disclosed moderate intraparenchymal fibrosis and lymphoplasmacytic infiltrates without lymphoid follicles. Small to medium intraparenchymal, noncaseating granulomas lacking multinucleated giant cells and, in 1 patient, CD68-positive and CD1a-negative palisading granulomas in widened interlobular fibrous septa were detected. Vasculitis and IgG4 plasma cells were not observed. Additional immunohistochemical studies revealed that CD8 T lymphocytes (suppressor or cytotoxic subset) predominated over CD4-positive T lymphocytes (helper cells) surrounding the necrobiotic foci and were intermixed with the CD68-positive histiocytes in the absence of CD20 B lymphocytes. Special stains for organisms demonstrated negative results. CONCLUSIONS Dacryoadenitis is the rarest form of ocular adnexal involvement in regional enteritis, which affects the orbit far more frequently than ulcerative colitis. It is a granulomatous process with the possibility of palisading necrobiotic foci. In contrast, ulcerative colitis causes an interstitial lymphocytic and nongranulomatous myositis. Sarcoidosis, Wegener granulomatosis, and pseudorheumatoid nodules must be ruled out. Treatment options entail a wide variety of agents with selection based on empirical considerations and tailored to the patient's symptoms.
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Affiliation(s)
- Frederick A Jakobiec
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
| | - Alia Rashid
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | | | - Michael Kazim
- Edward S. Harkness Eye Institute of the New York Hospital Presbyterian Medical Center, and Columbia University, New York, New York
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Brovkina AF, Steshenko ON, Nechesniuk SI. [Peculiarities of tear production in patients with dacryoadenitis]. Vestn Oftalmol 2014; 130:27-33. [PMID: 25306720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The influence of chronic adenitis and its surgical treatment on tear production and osmolarity was studied. A long-term follow-up (2-65 months) after lacrimal gland extirpation showed a trend for recovery of both basal and reflex lacrimation. Comparison of complaints and functional and pathohistological results allowed to consider retention cysts as a risk factor for dry eye syndrome in the postoperative period.
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40
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Mostovych NK, Rabinowitz MR, Bilyk JR, Pribitkin EA. Endoscopic ultrasonic dacryocystorhinostomy for recurrent dacryocystitis following rhinoplasty. Aesthet Surg J 2014; 34:520-5. [PMID: 24658062 DOI: 10.1177/1090820x14526615] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED The lacrimal sac is the structure most vulnerable to injury when performing rhinoplastic osteotomies. When performed in a low lateral position or along the frontal process of the frontal-maxillary suture, osteotomies can potentially tear the medial canthal tendon and injure the underlying lacrimal sac, possibly resulting in dacryocystitis. In this case report, the authors discuss a case of dacryocystitis following primary rhinoplasty; this injury was repaired with endoscopic dacryocystorhinostomy (DCR) using a Sonopet ultrasonic bone aspirator (Stryker, Kalamazoo, Michigan) at a single institution. This method achieved nasolacrimal duct patency, and the patient continued to be symptom-free at an 18-month follow-up. This is the first reported case of recurrent dacryocystitis following rhinoplasty as treated by endoscopic DCR. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Nadia K Mostovych
- Dr Mostovych and Dr Rabinowitz are Residents and Dr Pribitkin is a Professor in the Department of Otolaryngology-Head & Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Ali MJ, Joshi SD, Naik MN, Honavar SG. Clinical Profile and Management Outcome of Acute Dacryocystitis: Two Decades of Experience in a Tertiary Eye Care Center. Semin Ophthalmol 2013; 30:118-23. [PMID: 24171807 DOI: 10.3109/08820538.2013.833269] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Mohammad Javed Ali
- Dacryology Service, Ophthalmic Plastics Surgery, L.V. Prasad Eye Institute , Hyderabad , India
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43
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Yu G, Hu M, Liu W, Zhang CY, Cui YH, Fan YW, Cao WH, Lin Q, Cui J, Wu Q. [Congenital dacryocystocele: presentation and treatment]. Zhonghua Yan Ke Za Zhi 2013; 49:263-267. [PMID: 23866709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To report the presentation, complications, and treatment strategies for infants with congenital dacryocystocele. METHOD We performed a retrospective chart review of all patients presenting with dacryocystoceles to Beijing Children's Hospital between 2007 and 2011. RESULTS Thirty-one patients (33 eyes) were identified, presenting at a median age of 10 days of life. Twenty-four (72.72%) patients presented with cellulitis or dacryocystitis and required systemic antibiotics. Two (6.45%) patients presented with respiratory compromise. Resolution occurred with conservative treatment for 6 eyes, but 27 (81.82%) required surgical intervention. All 27 eyes received probing, and 20 (74.07%) were successful. The other 7 eyes required marsupialization of an intranasal cyst. CONCLUSIONS Although congenital dacryocystoceles may resolve with conservative measures, many become infected and require systemic antibiotic treatment, and most require surgical intervention. Referral in the early neonatal period can aid in timely intervention before complications such as infection occur.
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Affiliation(s)
- Gang Yu
- Department of Ophthalmology, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, China
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44
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Hanada K, Miyokawa N, Sano A, Igarashi S, Yoshida A. [Fungal dacryocystitis with cacosmia after penetrating keratoplasty--taxonomy and identification of pathogenic fungi based on DNA sequence analysis]. Nippon Ganka Gakkai Zasshi 2012; 116:1144-1149. [PMID: 23379204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
CASE A 76-year-old woman with a history of penetrating keratoplasty had cacosmia associated with dacryocystitis. Two species of yeast-like fungi were isolated from the contents of her lacrimal sac. Each cultured fungus had a unique, distinctive odor. Althogh treated with an oral antifungal agent and washing of the nasolacrimal duct, the cacosmia was not improved. The continuous dacryocystitis with cacosmia was treated by dacryocystectomy. Two yeast-like fungi were again isolated from the contents of the lacrimal sac. Pathological examination confirmed a diagnosis of fungal dacryocystitis based on the fungal hyphae observed on the excised lacrimal sac wall. The cacosmia promptly disappeared. The fungi isolated from the contents of lacrimal sac were identified by DNA sequencing as Wickerhamomyces anamalus (Pichia anomala-Candida pelliculosa) and Galactomyces geotrichum (Geotrichum candidum). CONCLUSION The cause of cacosmia in the present case was fungal dacryocystitis. Antibiotic eye drops and steroid eye drops for the treatment of penetrating keratoplasty can cause atypical fungal presentation in the inconsistently treated lacrimal system and can induce dacryocystitis. Careful usage and consideration is necessary in the long-term use of antibiotics and steroids following corneal transplantation.
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Affiliation(s)
- Kazuomi Hanada
- Department of Medicine and Engineering Combined Research Institute, Asahikawa Medical University, Hokkaido, Japan.
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45
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Abstract
Swollen eyelids are commonly ascribed to allergic conjunctivitis, contact dermatitis, eczema, angioedema, or acute sinusitis. The differential diagnosis extends to thyroid eye disease; blepharitis; Sjögren's syndrome; Churg-Strauss vasculitis; Wegener's granulomatosis; Gleich syndrome; orbital and ocular lymphoid hyperplasia or adnexal lymphoma; idiopathic orbital inflammatory disease/idiopathic sclerosing orbital inflammation; rarely, orbital parasitosis; and IgG4-related diseases. The likely diagnosis proceeds from the more to the less common in patients without a history of allergy or infection. Both ocular lymphoid hyperplasia and ocular adnexal lymphoma must be considered in the differential diagnosis of persistent disease, and neither of these entities can be recognized or differentiated from one another clinically or radiologically. Early diagnosis is essential because therapy may consist of frequent follow-up and/or active intervention. Outcomes in patients treated early and appropriately are often favorable.
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Affiliation(s)
- Anthony J Ricketti
- Section of Allergy and Immunology, Department of Medicine, St. Francis Medical Center, Trenton, New Jersey 08629-1986, USA
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Hanioka Y, Yamagami K, Yoshioka K, Nakamura T, Kishida M, Nakamura T, Yamaguchi T, Koshimo N, Inoue T, Imanishi M. Churg-Strauss syndrome concomitant with chronic symmetrical dacryoadenitis suggesting Mikulicz's disease. Intern Med 2012; 51:2457-61. [PMID: 22975568 DOI: 10.2169/internalmedicine.51.7725] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A case of Churg-Strauss syndrome complicated by chronic symmetrical dacryoadenitis suggestive of Mikulicz's disease is herein presented. A 72-year-old Japanese man, who had been previously diagnosed with asthma, presented with weakness of the left leg and purpura on the lower extremities. A neurological examination showed multiple mononeuropathies and a laboratory examination revealed elevated eosinophil counts, IgE levels and the presence of Myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCAs). Churg-Strauss syndrome was diagnosed, although the patient also exhibited bilateral swelling of the lachrymal glands. Furthermore, elevated serum IgG4 levels, an infiltration of a relatively large number of IgG4-positive plasmacytes in the nasal mucosa and hypocomplementemia were also observed. These findings were consistent with a diagnosis of Mikulicz's disease (MD). Oral prednisolone (30 mg) was administered and the swelling of the lachrymal glands resolved. Churg-Strauss syndrome may be accompanied by Mikulicz's disease (an IgG4-related disease), and common pathogeneses between Churg-Strauss syndrome and IgG4-related disease may exist.
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Affiliation(s)
- Yusuke Hanioka
- Department of Internal Medicine, Osaka City General Hospital, Japan.
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Abstract
PURPOSE To analyze the clinical and microbiological characteristics and factors associated with the outcome of lacrimal canaliculitis. METHODS Thirty four patients (34 eyes) treated for lacrimal canaliculitis between January 2001 and December 2006 in a tertiary medical centre were retrospectively reviewed. Clinical and microbiological profiles, treatment outcome, and risk factors related to recurrence and concretions formation were evaluated. RESULTS There were 10 males and 24 females with a mean age of 64 years. The average time lapse to diagnosis was 18 months. Lower canaliculus (91%) was most commonly involved. Six patients (18%) had both upper and lower canaliculitis. Culture positive specimens were 21 of 25 (84%), with a mixed infection of 7 (28%). Streptococcus species (28%), Staphylococcus species (20%), and Actinomyces (16%) were the most commonly cultured organisms. Concretions were noted in nine patients (26%). All cultures of concretions were positive. No specific factor was found to be related to concretions formation. Canaliculotomy was performed in 25 patients (74%). Recurrence developed in seven patients (21%), with a mean time to recurrence of 24 months. Multivariate analysis demonstrated that male patients (p=0.038) and presence of concretions (p=0.001) were associated with higher recurrent rate. Both patients with Haemophilus influenzae isolate developed recurrence (100%). CONCLUSION Canaliculitis are often delayed diagnosed and prone to recur or persist. Male gender and concretions are important risk factors for recurrence. Surgical removal of all possible concretions is essential for cure.
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Affiliation(s)
- Shuai-Chun Lin
- Department of Ophthalmology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
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48
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Abstract
Churg-Strauss syndrome (CSS) is a rare form of vasculitis involving small-to medium-sized blood vessels. CSS typically affects blood vessels of the lungs, gastrointestinal system, and peripheral nerves, but can also involve the heart, skin and kidneys. Here we present two CSS patients presenting with unusual ocular manifestations. Although ophthalmic complications remain relatively uncommon in vasculitides such as Churg-Strauss syndrome, these conditions should be considered in patients presenting with ocular manifestations and concurrent ear, nose and throat symptoms, arthralgia or with positive ANCA and eosinophilia.
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Affiliation(s)
- Natasha Jordan
- St. Thomas' Hospital, Louise Coote Lupus Unit, London, United Kingdom.
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49
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Palamar M, Midilli R, Ozsan N, Egrilmez S, Sahin F, Yagci A. Primary diffuse large B-cell lymphoma of the lacrimal sac simulating chronic dacryocystitis. Auris Nasus Larynx 2011; 38:643-5. [PMID: 21353409 DOI: 10.1016/j.anl.2011.01.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Revised: 12/08/2010] [Accepted: 01/05/2011] [Indexed: 11/18/2022]
Abstract
Primary diffuse large B-cell lymphoma of the lacrimal sac is rare. Herein we report a 55-year-old female presented with epiphora in the right eye. Distention of the lacrimal sac secondary to nasolacrimal duct obstruction was observed. She was scheduled for external dacryocystorinostomy for the next month. When she came for surgery, a growing mass was recognised over the lacrimal sac region. On computer tomography scan, a subdermal mass causing nasal bone destruction was detected. Excisional biopsy of the mass was performed. Histopathologic and immunohistochemical evaluations revealed primary diffuse large B-cell non-Hodgkin lymphoma of the lacrimal sac. She was treated with cyclophospamide, vincristine, adriablastine and prednisone for eight courses combined with rituximab for 6 months. During a follow-up period of 25 months, patient is stable with no systemic disease. Although rare, lacrimal sac tumors can mimic dacryocystitis and must be considered in differential diagnosis. In suspicious cases incisional biopsy is recommended.
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Affiliation(s)
- Melis Palamar
- Ege University Faculty of Medicine, Department of Ophthalmology, Izmir, Turkey
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50
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Brissette A, Schweitzer K, Arthur B. Ophthaproblem. Can you identify this condition? Dacryocystitis. Can Fam Physician 2011; 57:55-59. [PMID: 21252133 PMCID: PMC3024164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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