Primary tubercular dacryocystitis - a case report and review of 18 cases from the literature

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.

Ocular Surface Disease of Rabbits

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.

Incision-sparing management of canaliculitis

PURPOSE

To report our results of canaliculitis treatment with our incision-sparing technique which includes dilation of the punctum and compression of the canaliculus to express the sulphur granules, curettage and irrigation of the canaliculus with antibiotic solutions, and topical antibiotic use.

METHODS

The medical records of all patients treated for canaliculitis between October 2009 and March 2013 were rewiewed. The punctum of affected canaliculus was dilated under local anesthesia. Then, starting just distal to common canaliculus, the horizontal canaliculus was compressed along its entire length using either a forceps or a cotton tip applicator on the conjunctival surface and a curette on the skin. Compression was repeated until no more sulphur granules appeared and the swelling of the canaliculus disappeared. A chalazion curette was inserted into canaliculus to evacuate any residual concretions. The canaliculus were irrigated with antibiotic solutions and the patients were prescribed topical antibiotic solutions for one month Patients with follow-up less than 3 months after the intervention were excluded from the study.

RESULTS

Nine patients met criteria for canaliculitis. There were 1 male and 8 female patients. Median age of the patients was 53 years (range 36-72 years). All patients had unilateral lower canaliculitis. Mean duration of the symptoms was 13.4 months (range 4-36 months). We followed up all patients for at least 3 months after the intervention. The signs and symptoms resolved completely in all patients within 1 month and recurrence was not observed in any patient. No patients reported epiphora after the procedure.

CONCLUSION

Our incision-sparing technique is effective in the treatment of canaliculitis. We suggest that minimally invasive or incision-sparing techniques be attempted before canaliculotomy to decrease postoperative complications rates.

Progress in screening and treatment of common congenital eye diseases

Congenital eye illnesses are caused by congenital ocular malformations and are a primary cause of poor visual acuity and blindness in infants. Early diagnosis and treatment of congenital eye illnesses are of great significance for affected infants, their families, and even society as a whole. This study describes the current situation for prenatal and infant screening for congenital eye diseases and briefly summarizes novel progress in the treatment of the five most common eye diseases (congenital dacryocystitis, congenital cataract, retinopathy of prematurity, congenital glaucoma and retinoblastoma). Current programs are now aimed at improvements in the prevention and treatment of congenital eye diseases in China.

Spherical headed silicone intubation in the treatment of 26 cases (31 eyes) of chronic dacryocystitis under nasal endoscopy

PURPOSE

To observe the clinical efficacy of spherical headed silicone implantation in the treatment of chronic dacryocystitis under nasal endoscopy.

METHODS

Twenty six patients (31 eyes) with chronic dacryocystitis were subjected to spherical headed silicone implantation under topical anesthesia (lacrimal passage and nasal mucosal surface). Lacrimal passage irrigation was performed daily throughout the first postoperative week , and once each month thereafter.

RESULTS

All spherical headed silicone tube placements were successfully performed. The operative time ranged from 6 to 11 minutes. Symptoms of epiphora were immediately ameliorated post-operatively, and irrigation demonstrated patency of the lacrimal system in all patients. All patients were followed from 7 to 24 months, during which symptoms of tearing were improved. The lacrimal ducts of 27 eyes (87.7%) were normal. The lacrimal ducts of 4 others (12.3%) were still blocked. Lacrimal passage irrigation was open and secretion disappeared in 28 eyes (90.3%). Tearing was observed in 3 eyes (9.68%).

CONCLUSION

Spherical headed silicone tube implantation under nasal endoscopy is successful in relieving symptoms of tearing.

Acute dacryocystitis causing orbital cellulitis and abscess

PURPOSE

Acute dacryocystitis commonly presents as preseptal cellulitis as lacrimal sac lies anterior to the orbital septum and hence infection localizes in the preseptal space. The purpose of this study is to describe presentation and management of cases of acute dacryocystitis presenting as orbital cellilitis and abscess secondary to acute dacryocystitis.

METHOD

This retrospective, non-comparative, interventional case series included 6 patients presenting with orbital cellulitis and abscess secondary to acute dacryocystitis. All patients underwent drainage of abscess under general anesthesia. External dcaryocystorhinostomy was advised as the definitive treatment for all pateints.

RESULT

Abscess was localized in the extraconal space in 4 patients and in the intraconal space in 2 patients. Patients with intraconal abscess had visual loss on presentation while vision could be preserved in patients with abscess in extraconal space. Both patients with intraconal abscess had history of acute dacryocystitis.

CONCLUSION

Acute dacryocystitis is an ophthalmic emergency that can cause orbital cellulitis with abscess formation, and even vision loss, if left untreated.

Management of Complications after Insertion of the SmartPlug Punctal Plug

PURPOSE

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

DESIGN

Retrospective case series.

PARTICIPANTS

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

METHODS

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

MAIN OUTCOME MEASURES

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

RESULTS

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

CONCLUSIONS

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

Superior ophthalmic vein thrombosis in a patient with dacryocystitis-induced orbital cellulitis

A 71-year-old-man presented with chronic left-sided epiphora and a 5-day history of progressive left orbital swelling that had started with a "bump" on the left side of his nose. Orbital CT revealed left-sided preseptal and postseptal inflammation, along with marked thickening of the left superior ophthalmic vein. Orbital MRI with gadolinium enhancement and fat suppression revealed a low-intensity signal in the left superior ophthalmic vein, consistent with a superior ophthalmic vein thrombosis. There was no cavernous sinus involvement. A diagnosis was made of left-sided dacryocystitis-induced orbital cellulitis and superior ophthalmic vein thrombosis. Treatment consisted of intravenous vancomycin, followed by early dacryocystorhinostomy and postoperative intravenous dexamethasone. Anticoagulation was not used. Within 1 week after surgery, the orbital congestion had dramatically improved. Though rare, isolated superior ophthalmic vein thrombosis can be a harbinger of cavernous sinus thrombosis; therefore, early detection is the key to avoiding cavernous sinus thrombosis.

Canaliculite lacrymale à Actinomyces

The authors report a case of unilateral chronic epiphora resistant to prolonged topical antibiotic treatment in a 62-year-old woman. Culture yielded some colonies of Actinomyces species. A dacryocystorhinostomy was found to be ineffective. Canaliculotomy with removal of cast resolved the chronic canaliculitis. Histological examination confirmed the diagnosis of solid cast of Actinomyces.

Dacryocystitis Caused by Community-Onset Methicillin-Resistant Staphylococcus Aureus

PURPOSE

To describe the occurrence of community-onset methicillin-resistant Staphylococcus aureus (MRSA) infections of the lacrimal system and their treatment.

METHODS

This cases series consisted of data obtained from seven clinical cases of acute or subacute MRSA dacryocystitis, with or without concurrent conjunctivitis, occurring in nonhospitalized individuals presenting between December 2001 and July 2003. Clinical presentations, microbial culture results, treatment modalities, and outcomes were retrospectively reviewed.

RESULTS

Three patients were successfully treated with antibiotics and lacrimal surgery with no recurrence of symptoms after surgery for 6 months or longer. Four patients had temporary relief of symptoms with antibiotic therapy, but surgery was not performed for non-ophthalmologic reasons, and recurrence occurred.

CONCLUSIONS

The treatment of MRSA dacryocystitis can be challenging. Microbiologic cultures should be performed in all patients with dacryocystitis that is unresponsive to conventional first-line antibiotic treatment and in patients at risk for acquisition of MRSA. Appropriate antibiotic therapy in combination with dacryocystorhinostomy appears to be the optimal treatment.

A case series on chronic canaliculitis

INTRODUCTION

Primary chronic canaliculitis is an uncommon disease, which is often misdiagnosed and insufficiently treated. We present two cases of canaliculitis caused by two different organisms, Actinomycetes spp. and Arcanobacterium haemolyticum. To the best of our knowledge, canaliculitis due to Arcanobacterium haemolyticum has not been reported before.

PATIENTS AND METHODS

The two cases described in this series show typical clinical features of canaliculitis with an inflamed upper canaliculus, not responsive to topical antibiotics. Appropriate treatment was delayed as they were initially treated for conjunctivitis. Both patients were treated with a canaliculotomy, with curettage and subsequent treatment with topical and systemic penicillin. The contents were sent for microbiological examination.

RESULTS

There was complete resolution following treatment. Actinomyces spp. was grown from one patient as expected. However, in the second patient, Arcanobacterium haemolyticum was isolated. Although this organism was not expected, the patient did respond to similar, conventional treatment.

DISCUSSION

Actinomyces spp. is a cast-forming Gram-positive anaerobe. They are difficult to isolate and identify and can cause infections of hollow spaces with formation of canaliculiths. Arcanobacterium (Corynebacterium) haemolyticum closely resembles Actinomyces (Corynebacterium) pyogenes. Ocular infections reported with this organism include orbital cellulitis and subperiosteal abscesses. The difficulty encountered in the isolation and identification of these organisms is discussed and the need for thorough curettage in the treatment of persistent or recurrent canaliculitis is emphasised.

CONCLUSION

Chronic canaliculitis should be considered in any patient who presents with chronic or recurrent conjunctivitis. Definitive cure will not be affected until all concretions are removed, either at surgery or by mechanical expression.

Prophylactic effect of IL-10 gene transfer on induced autoimmune dacryoadenitis

PURPOSE

To evaluate the effect of viral IL-10 on the lacrimal gland immunopathologic response in the ocular surface disease, induced autoimmune dacryoadenitis.

METHODS

Disease was induced in rabbits by injecting inferior lacrimal glands with peripheral blood lymphocytes activated by 5 days of coculture with autologous acinar cells in a mixed-cell reaction. In the treated group, an adenoviral vector carrying the vIL-10 gene was concurrently injected with activated lymphocytes. Tears were collected periodically for quantitation of IL-10 by ELISA. Two weeks after disease induction, tear production, tear film breakup time, and rose bengal staining score were determined. Sectioned glands were immunostained for expression of CD4, CD8, rabbit thymic lymphocyte antigen (RTLA), CD18 and major histocompatibility complex class II.

RESULTS

The titer of vIL-10 in tears was at its maximum on day 3, started to decline by day 7, and was undetectable by day 14. In the diseased group, the tear production rate and tear film breakup time were significantly decreased, and rose bengal staining was significantly increased. Diseased glands had immune cell infiltrates containing CD4+, RTLA+, and CD18+ cells, and major histocompatibility complex class II expression was increased. These changes were significantly ameliorated by expression of vIL-10.

CONCLUSIONS

In vivo transduction of the lacrimal gland with AdvIL-10 resulted in the transient appearance of vIL-10 in tears. The presence of vIL-10 partially suppressed the appearance of Sjögren-syndrome-like features of reduced tear production, accelerated tear breakup, ocular surface disease, and immunopathologic response. Anti-inflammatory cytokine gene expression may offer a therapeutic modality for the treatment of autoimmune dacryoadenitis, once suitable vectors become available.

Squamous cell carcinoma of the lacrimal sac

The clinical and histopathological findings in a 40-year-old man with a lacrimal sac tumor are reported. Although the clinical history indicated a lacrimal sac obstruction and recurrent dacryocystitis, the lesion was diagnosed by light microscopy as a squamous cell carcinoma.

Facial necrotizing fasciitis following acute dacryocystitis

PURPOSE

To report a case of progressive necrotizing fasciitis of the face following acute dacryocystitis.

DESIGN

Interventional case report.

METHODS

A 60-year-old woman presented with left acute dacryocystitis with abscess formation that had ruptured; a small wound remained. Erythematous swelling of the left eyelid and face developed 3 days later. Clinical progression and computed tomographic findings led to the diagnosis of necrotizing fasciitis with abscess formation. Early intravenous antibiotics and repeated surgical debridements were performed.

RESULTS

Soft tissue necrosis was found the fascial planes extending deep to the maxilla bone and periorbital fat. The patient was successfully treated without ocular, orbital, or facial complications.

CONCLUSIONS

Necrotizing fasciitis of the eyelid and face progresses rapidly. Early diagnosis, prompt intravenous antibiotic administration, and aggressive surgical debridement will prevent the associated morbidity and mortality.

Early and late assessment of internal drainage of chronic dacryocystitis

To evaluate the efficacy of internal drainage of a lacrimal abscess, we treated 10 patients with pyocele of the lacrimal sac, who did not want to undergo operative intervention. A temporary nasolacrimal stent was placed in the nasolacrimal duct, and the pussy material was collected for microbiological examination to adjust the preliminary antibiotic treatment which was given systemically and locally. The stents were removed after the infection had subsided clinically. Three years later, there was a recurrence of the infection in only 1 patient. This internal drainage of the lacrimal sac, combined with systemic and local antibiotics, was successful in 90% of the patients.

[Ocular infections of the elderly]

A CLINICAL ASPECT DEPENDING ON THE PHYSIOPATHOGENESIS: Ocular infections are a frequent motive for ophthalmological consultations in geriatric settings because of the mechanical factors related to age (modifications in palpebral dynamics and lacrymal function) and in local and general immune factors leading to the rapid and/or more severe development of infections. The mechanism of microbial contamination of the eye also determines the clinical damage: predominantly local (dirty hands, traumas) with involvement of the surface tissues (conjunctive and cornea) or general, hematogenic or neurogenic, frequently at the origin of more internal infections (iris, choroid, retina, optical nerve). CONJUNCTIVITIS AND KERATITIS: These provoke reddening of the eyes, tears and above all pain when the corneal epithelium is involved. Microbiological samples are useful in cases of severe, presumably infectious keratitis or conjunctivitis. Two emergency situations must be distinguished: any suspicion of herpes for which local corticosteroids are contraindicated and keratitis or conjunctivitis with the use of lenses, often due to Gram negative bacilli, amoeba or fungus, the treatment of which is intensive and the prognosis often severe. OPHTHALMOLOGICAL HERPES ZOSTER: The rapid diagnosis and introduction of efficient doses of antivirals reduces the initial pain, the ocular complications of herpes zoster and post-zoster pain. The latter, when it exists, requires specialized management. ACUTE UVEITIS: A context of intra-ocular inflammation in an elderly patient must always evoke a pseudo-uveitis syndrome, the principle cause of which is lymphoma. Conversely, an uveitis occurring in the days or weeks following ocular surgery, including cataract, must be considered as suggestive of a post-surgical infection and rapidly referred to a specialist. ACUTE DACRYOCYSTITIS: Is manifested by a hard and painful tumefaction below the internal angle of the eye. Following collection, it requires draining through an in incision in the skin, washing and packing of the sac, and systemic antibiotherapy. The preventive treatment of recurrences requires open dacryocystorhinostomy or via endonasal endoscopy.

Acute dacryocystitis presenting as an orbital abscess

Acute dacryocystitis usually presents as a preseptal infection, but can uncommonly be associated with orbital cellulitis. Orbital abscess formation is, however, very rare. The case is presented of a 60-year-old woman with an extraconal abscess secondary to acute dacryocystitis. The clinical, radiological and intraoperative findings are discussed.

[Clinical application of a new nasolacrimal stent]

Seventy-two patients(ninety-one eyes) with epiphore due to obstruction of the nasolacrimal duct underwent nasolacrimal stent of our own disign. The period postoperative follow-up was 6 to 20(mean 14.5) months. Seventy-six eyes demonstrated obvious resolution of epiphore, twelve eyes had partial resolution, and three eyes had no resolution. The success rate were 96.7%. The common complications included occluded stent and a slightly blood-stanied nasal discharge. The placement of the nasolacrimal stent is a safe simple and effective method for treatment of epiphore due to obstruction of the nasolacrimal duct.

Co-occurrence of pneumococcal keratitis and dacryocystitis

PURPOSE

To evaluate the specific risk factors responsible for the development of pneumococcal keratitis.

METHODS

In a retrospective analysis of 383 patients of culture-proven bacterial keratitis, seen between 1991 and 1995, 139 had monobacterial isolates on culture. We analyzed the various predisposing factors in these patients, with special emphasis on the patency of nasolacrimal drainage system.

RESULTS

Of the 139 patients with monobacterial keratitis, 48 (group 1) grew Streptococcus pneumoniae in culture. In the remaining 91 patients (group 2), Pseudomonas (18), coagulase-negative Staphylococci (15), Staphylococcus epidermidis (23), Staphylococcus aureus (16), Corynebacterium species (12), and others (seven) were isolated. Trauma was found to be a predisposing factor in 12 patients of group 1 and 27 patients of group 2 (p = 0.5601). Twelve (25%) patients of group 1 revealed chronic dacryocystitis, and nine of them underwent sac excision. On the contrary, only three patients of group 2 demonstrated dacryocystitis (p = 0.0003).

CONCLUSION

These results underscore the importance of assessing the patency of lacrimal drainage system in patients with infectious keratitis, especially of pneumococcal origin.

Lacrimal sac dilatation in balloon dacryocystoplasty

The authors report a case of balloon dacryocystoplasty in a patient who had a dilated lacrimal sac found in conventional surgery. A 52-year-old woman presented with persistent epiphora after a failed balloon dacryocystoplasty. She underwent an external dacryocystorhinostomy. The lacrimal sac was found to be dilated at its lower part, adjacent to the nasolacrimal ductus. Flaps were created more superiorly than usual. The operation was unsuccessful after 3 months. Previous balloon dacryocystoplasty, which is reported to be a harmless procedure, may pose some difficulty in subsequent conventional surgery.

Dacryology in China

PURPOSE

International Society of Dacryology held the IV International Congress in Stockholm on June 1996. I was warmly invited as a guest of honor beforehand to deliver a lecture on a special topic of "Dacryology in China" there, so that the world might understand the dacryology in China, and thus the international growth of dacryology as a discipline would be promoted.

METHODS

In China tear lab research and clinical research of LG are nearly empty except a few papers published. We had studied 3 items on LS for 28 years before 1979, and put our attention mainly on dacryology since 1979 by 3 stages: (1) collecting literatures (1979-81); (2) lab research (1981-84) and (3) clinical research, put DE as the key point by 4 steps: DE diagnosis (1984-86); DE treatment (1987-91); DE Condition Judgement (1989-92) & DE cause & mechanism (1991-95).

RESULTS

In the past 44 years, esp. from 1979 on, in a planned way, we have systematically researched the dacryology with main results below: created new word "Leiyexue" in Chinese & its English words, dacryology & lacrimology by adding-ology to dacrya & lacrima; made LS consisted of reflex LG & LP, and basic LG besides; found out the normal & abnormal data of tear and serum LF & its iron bindingcapacity; MDH, LDH & isoenzymes; beta 2 m; MDA & antioxidants; trace elements, prostaglandins, intramuscular gentamicin passing the blood-tear barrier; bacteria, fungi, anaerobe, virus & parasite; Ig, T cell & subsets, Langerhan cell, HLA antigen; in cidence (KCS, 0.3-3%, trancomatous DE 0.003%); the parallel correlations between DE graded by rb, BUT & Slt; and in SS, lymphocytes infiltration in LG; Lab G & conjunctiva; LF (< 100 mg%) & beta 2 m (> 1.7 mg%); and testosterone receptors in LG; negated presence of tear Beta-lysim; set up a series of models for researching & a complete set of measures to diagnose, grade, judge and treat DE, deviced new operations. AT & prescription for DE; proved SS being autoimmune & EB virus, its one cause.

CONCLUSIONS

This relatively, overall & systematical research of dacryology already have been widely applied to practice with over 100 papers published. It indicates that LS & its disease as a scientific discipline under the term of dacryology to grow up is entirely possible and extremely needful.

Orbital pseudotumor syndromes

The disorder known as orbital pseudotumor and its related syndromes of myositis and dacryoadenitis continue to be a source of controversy in terms of histopathologic classification and approach to diagnosis and management. This review references recent papers regarding these issues.

An orbital abscess secondary to acute dacryocystitis

An orbital abscess is an ophthalmic surgical emergency that is typically caused by the spread of bacteria from adjacent structures, such as the sinuses, eyelids, or teeth. Although acute dacryocystitis is commonly associated with preseptal cellulitis, it rarely causes orbital infection. Infection of the lacrimal sac will typically localize in the preseptal space because the lacrimal sac lies anterior to the orbital septum. To the authors' knowledge, this is the first report of an intraconal abscess secondary to acute dacryocystitis. The key points in the surgical management of this entity are discussed.

Pseudomonas dacryoadenitis secondary to a lacrimal gland ductule stone

Infectious dacryoadenitis is a rare condition. A case of Pseudomonas dacryoadenitis has not been reported previously. We treated a patient with Pseudomonas dacryoadenitis secondary to obstruction from a lacrimal gland ductule stone. Histologically, the calculus contained hairs.

Spectrum of pediatric dacryocystitis: medical and surgical management of 54 cases

BACKGROUND

Dacryocystitis in infants and older children is a serious complication of congenital or acquired nasolacrimal duct obstruction. To define the modes of presentation and treatment strategies of this disorder better, we reviewed the clinical courses of 54 children treated for dacryocystitis at St Louis Children's Hospital.

METHODS

Clinical, neuroradiologic, and laboratory data were collated for all cases of dacryocystitis treated from 1990 to 1995. Average follow up of the children in this consecutive series was 1.75 years (range, 4 months to 5 years).

RESULTS

Of the 54 patients, 36 (67%) had chronic low-grade dacryocystitis, which was treated with nasolacrimal duct probing on an outpatient basis. The remaining 18 patients (33%) had acute dacryocystitis, which was treated with a combined medical/surgical strategy. Medical treatment consisted of hospital admission for administration of intravenous antibiotics followed by inpatient surgery, which varied according to the age of the patient and the clinical history: 1) Acute dacryocystitis in neonates was treated surgically by nasolacrimal duct probing and nasal endoscopy for excision of intranasal duct cyst; 2) Acute dacryocystitis with periorbital cellulitis was treated surgically by nasolacrimal duct probing; 3) Acute dacryocystitis due to facial trauma was treated surgically by dacryocystorhinostomy and stent placement; and 4) Acute dacryocystitis complicated by orbital abscess was treated by inferior orbitotomy for orbital abscess drainage, simultaneous nasolacrimal duct probing, and stent placement.

CONCLUSION

Dacryocystitis in the pediatric population may present in either chronic or acute forms. An effective and safe treatment for acute dacryocystitis is hospital admission, both for administering intravenous antibiotics and monitoring to rule out orbital cellulitis or abscess formation. Intravenous antibiotic therapy is followed within a day or two by surgery tailored to the clinical history. In the majority of both chronic and acute cases, nasolacrimal duct probing appears to be an effective treatment strategy.

[Catheterization of the nasolacrimal duct]

A technique is described for passing a guide wire through the lacrimal duct into the nose following catheterisation of the duct. The wire is passed into the pharynx, a 7 F feeding tube is passed through the nose into the pharynx and these are then pulled out of the mouth with a Magill forceps. The tip of the feeding tube is then cut off and the guide wire introduced into a side hole of the catheter. By removing the catheter, the tip of the guide wire is pulled along and can be removed from the nose.

Nonsurgical placement of a nasolacrimal polyurethane stent: long-term effectiveness

PURPOSE

To evaluate the long-term effectiveness of a polyurethane stent in the treatment of obstruction of the lacrimal sac and the nasolacrimal duct.

MATERIALS AND METHODS

Fluoroscopically guided placement of a polyurethane nasolacrimal stent was evaluated in 283 obstructed lacrimal systems of 236 patients, with a follow-up period of more than 1 year (range, 52-134 weeks). The obstruction was at the junction between the lacrimal sac and the nasolacrimal duct in 192 systems, at the lacrimal sac in 52, and at the nasolacrimal duct in 39. The causes of obstruction were traumatic in 34 and idiopathic in 249 systems.

RESULTS

Stent placement was technically successful in 270 systems (95%). At 7 days after stent placement, 235 (87%) of the 270 systems with successful placement demonstrated complete resolution of epiphora, 27 (10%) had partial resolution, and the remaining eight (3%) had no resolution. There was recurrence in 81 systems due to obstruction of the stent (n = 77) or obstruction of the common canaliculus (n = 4). The recurrence rate was much higher in the systems with obstruction at the lacrimal sac (64%) than in the systems with obstruction at the junction (26%) between the lacrimal sac and nasolacrimal duct or at the nasolacrimal duct (15%).

CONCLUSION

Stent placement in the obstructed lacrimal system below the junction between the lacrimal sac and the nasolacrimal duct is valuable as an initial therapy.

Common eye disorders: six patients to treat, pitfalls to avoid

Primary care physicians have an important role in diagnosing and treating eye disorders--including dacryocystitis, blepharitis, and conjunctivitis--and in determining when ophthalmologic referral is needed. Fundus examination for diagnosis of glaucoma and diabetic eye complications should be a part of the routine examination in all adults. Patients with HIV or AIDS should be carefully monitored for cytomegalovirus retinitis. Children should be tested for amblyopia. Orbital cellulitis can have serious complications and must be vigorously treated. Finally, careful use of ophthalmologic topical agents, especially corticosteroid drops, is essential.

Pseudodacryocystitis arising from anterior ethmoiditis

The contiguous spread of inflammation from infected ethmoid sinuses to the surrounding tissues of the lacrimal drainage system can produce symptoms easily confused with acute dacryocystitis. We report the cases of two patients with presumed dacryocystitis whose patency of the lacrimal apparatus was established by probing, irrigation, and dacryocystography. Computerized tomography and magnetic resonance imaging demonstrated opacification of anterior ethmoid air cells adjacent to the region of the lacrimal sac. A greater awareness of this diagnostic possibility of pseudodacryocystitis arising from anterior ethmoiditis, together with improved noninvasive imaging techniques, will likely increase the observed incidence of this disease. This distinction is important since anterior ethmoidectomy, rather than dacryocystorhinostomy, is the treatment of choice when such pseudodacryocystitis proves unresponsive to antibiotic therapy. In misdiagnosed patients who undergo dacryocystorhinostomy, it is the coincidental limited anterior ethmoidectomy and not the lacrimal-nasal fistula that provides the cure.

[Timed retrograde catheterization of the nasolacrimal duct as a method of treatment in congenital dacryocystitis and acquired stenosis of the nasolacrimal duct in children]

The authors propose a procedure of timed catheterization of the nasolacrimal duct for use in children with the duct stenosis and congenital dacryocystitis. The catheter is inserted for 7-10 days. Out of 27 children treated (20 cases of congenital dacryocystitis and 7 cases of the stenosis), a persistent effect was achieved in 24. The authors advocate the method as effective and promising in the above conditions.

Canaliculitis: difficulties in diagnosis, differential diagnosis and comparison between conservative and surgical treatment

The most important clinical features of canaliculitis include a red, swollen eyelid in the area of the affected canaliculus, a unilateral conjunctivitis, a mucopurulent discharge and in some cases dacryoliths visible in the lacrimal punctum. Conservative therapy was found to be little effective: only 10% of the patients could be cured, 40% showed a recurrence after conservative treatment. 20 patients (50%) were treated by canaliculotomy: 16 of these were cured by this surgical treatment, 4 patients complained of epiphora, although diagnostic syringing showed free lacrimal pathways. The surgical treatment of canaliculitis in combination with conservative therapy yields far better results than conservative therapy alone.

Management of acute dacryocystitis in adults

Acute dacryocystitis frequently is extremely painful and slow to resolve even with systemic antibiotic therapy. We have identified that incision, drainage, and direct application of antibiotics inside the infected sac result in almost immediate resolution of pain and rapid control of infection. This also provides optimal culture material. Twelve consecutive patients treated in this manner had rapid control of the acute infectious process. All eight patients subsequently undergoing dacryocystorhinostomy were fully cured. A total of 58.3% of the patients were infected with gram-negative rods; 50% of the isolates were resistant to most oral antibiotics.

Treatment of acute dacryocystitis in neonates

Twenty-five newborns with acute dacryocystitis underwent probing of the nasolacrimal duct. All had a resolution of the acute dacryocystitis. Only one continued to have epiphora and had to undergo a subsequent probing with silicone intubation at 9 months of age. All were probed without anesthesia, being mummified and held by nurses while the author performed the probing. Only five were treated with parenteral and topical antibiotics for a week prior to probing while 20 were probed without any prior antibiotic therapy. Additionally, five of six mucoceles of the lacrimal sac which did not resolve in the 1st 2 weeks of life with massage were successfully probed without anesthesia. Four of the five mucoceles had developed an acute dacryocystitis on conservative management. Probing of the nasolacrimal duct in the newborn period is a safe and successful approach for acute dacryocystitis. It is a highly successful procedure for the treatment of acute dacryocystitis with a very low morbidity rate.

[Results of endonasal intubation of the nasolacrimal duct in children with congenital dacryocystitis]

Results of endonasal catheterization of the naso-lacrimal canal of 74 children with congenital dacryocystitis (bilateral problem in 10 of them) are presented. Prior to this manipulation, the patients were exposed to contrast X-ray study of the lacrimal sac for diagnostic purposes. Retrograde catheterization as a method for treating congenital dacryocystitis was very good in 97.3% children of up to 2 years old, 50% children of up to 3 years old, and 33.3% children between 3-4 years old. The patency of the naso-lacrimal canal also recovered in an 8-year-old child. All this gives evidence that, irrespective of children's age, retrograde catheterization should be applied to treat congenital dacryocystitis. After the patency of the naso-lacrimal canal was restored, the external fistula of the lacrimal sac was cauterized with 7% solution of trichloroacetic acid.

[Neonatal dacryocystitis. A case report]

The authors report one case of neonatal dacryocystitis. They consider the diagnostic and therapeutic problems. One surgical intervention, with a large orifice of the lacrimal meatus, upon the catheter, with rhinoscopy, seems them the best solution, in this precise case.

Dacryocystectomy for the treatment of dacryocystitis patients with Wegener's granulomatosis

We evaluated a woman with Wegener's granulomatosis who was experiencing recurrent dacryocystitis. Nasolacrimal duct obstruction had been present for many years and epiphora was not a significant concern. Our experience with the development of nasalcutaneous fistulas following dacryocystorhinostomy in several patients with Wegner's granulomatosis led us to perform a dacryocystectomy. The functional result was good, and there were no problems with wound healing. Dacryocystectomy should be considered as an alternative to dacryocystorhinostomy for dacryocystitis in patients with Wegener's granulomatosis and similar disorders in whom epiphora is not a major complaint.

Balloon catheter dilatation in lacrimal surgery

We performed balloon catheter dilatation in four patients with a failed dacryocystorhinostomy. Epiphora was relieved and a patent lacrimal drainage system was achieved after the procedure in three of the four. The fourth patient had a transient partial response. Epiphora recurring in one patient 3 1/2 months after the procedure responded to a second dilatation.