Morphological Characteristics of the Lacrimal Apparatus in its Obstruction of Various Genesis

Purpose: morphological assessment of the lacrimal ducts at various anatomical levels in patients with primary (PANDO) and secondary (SALDO) obstruction after radioactive iodine therapy.Methods. The material was obtained during endoscopic dacryocystorinostomy with revision of Hasner's valve in patients with PANDO (n=7) in the distal segments of the nasolacrimal duct and in patients with SALDO (n=7) after radioactive iodine therapy. During the surgery, a biopsy of Hasner's valve, as well as a biopsy of the lacrimal sac wall were performed. The resulting material was stained with hemotoxylin and eosin, alcyan blue and by Masson method. Morphological and morphometric analyses were performed in semi-automatic mode. The results of histochemical staining of sections were translated into points taking into account the area and optical density (chromogenicity) in relative units: 1 – weak (0 – 0.3); 2 – moderate (0.3 – 0.6); 3 – significant (>0.6). The nonparametric Mann-Whitney criterion was used for statistical analysis. The differences were considered significant at p<0.05.Results. The comparative morphological study both confirmed the available information concerning the radiation nature of the obstruction and allowed to quantify the fibrosis level of the stromal component and other lacrimal ducts structures.Conclusion. It was shown that the nasolacrimal duct sclerosis is significantly lower (p=0.029) in patients with SALDO than in patients with PANDO while fibrosis in the lacrimal sac is the same in patients of the compared groups.

Surgical and Anatomic Consideration in Endoscopic Dacryocystorhinostomy of a Patient with Damaged Sinonasal Anatomy Post–Caldwell-Luc Surgery: A Case Report

Background: The Caldwell-Luc (CL) procedure, an outdated operative procedure that is used to treat inflammatory sinus diseases, is rarely performed presently. However, physicians may encounter patients with a history of CL surgery who develop considerable postoperative changes that may lead to diagnostic confusion in imaging evaluation; increase the difficulty of future surgery, such as sinonasal surgery; and increase the incidence of future intraoperative complications. Case summary: A 67-year-old man with a surgical history of chronic sinusitis reported epiphora of the left eye for five years. Balloon dacryocystoplasty was attempted but failed. Endo-DCR (Endoscopic dacryocystorhinostomy) was indicated; however, preoperative CT (computed tomography) imaging and nasal endoscopic examination showed sinonasal anomalies and the loss of internal landmarks for localizing the lacrimal sac. Preoperative CT results indicated previous CL surgery. Endo-DCR was performed with the aid of nasal forceps and a 20-gauge vitreoretinal fiberoptic endoilluminator. A six-month follow-up revealed the complete resolution of symptoms and no signs of recurrence. Conclusions: Epiphora might be a delayed complication of the CL procedure. Before performing endo-DCR, ophthalmologists should be familiar with the sinonasal anatomy and carefully assess preoperative imaging to identify anatomical variations. Nasal forceps and transcanalicular illumination can assist in determining the precise location of the lacrimal sac during endo-DCR.

Acquired nasolacrimal duct obstruction: clinical and histological findings of 275 cases

Background Acquired nasolacrimal duct obstruction is a blockage of the lacrimal outflow system usually caused by local nonspecific inflammation of the lacrimal sac and the nasolacrimal duct. However, cases exist where the primary nasolacrimal system obstruction is caused by malignancies. Our aim was to investigate lacrimal sac pathologies in patients with acquired nasolacrimal duct obstruction and compare their clinical manifestations. Methods This retrospective clinical study included 275 patients with acquired nasolacrimal duct obstruction who underwent external dacryocystorhinostomy and lacrimal sac biopsy. Cases were classified into tumor or nonspecific pathology groups and subdivided according to the level of inflammation. Histological and clinical data were analyzed. Results Three tumors (1.1%) (an adenoid cystic carcinoma, an eccrine spiradenoma and small B cell lymphoma) were diagnosed. Chronic nongranulomatous inflammation was the most common histological finding, corresponding to 194 cases (70.5%). The other 81 (29.5%) were subacute, acute forms of nongranulomatous inflammation, tumors and fibrosis cases. Epiphora with continuous purulent discharge was the most common clinical sign reported by 144 (52.4%) patients, and two (0.7%) patients had a palpable mass near the medial canthal tendon, which was identified as an eccrine spiradenoma and small B cell lymphoma. There was no significant difference in the clinical symptoms, duration or case history between the nonspecific pathology and tumor groups (p = 0.292). Conclusions Chronic nongranulomatous inflammation of the lacrimal sac was the most common finding among acquired nasolacrimal duct obstruction cases. There were no associations between the histological findings and clinical presentation. The authors recommend a lacrimal sac biopsy only in cases when a tumor is clinically suspected.

A case report of exophytic nasal papilloma with acute dacryocystitis as the first symptom

Background This study aims to explore a case of exophytic nasal papilloma with acute dacryocystitis as the first symptom. Case presentation A 72-year-old male patient complaining of “a 10-year history of tearing and purulent discharge from the right eye, with subsequent redness and pain in the inner canthus for three days” was initially diagnosed with acute dacryocystitis of the right eye. The patient was treated with anti-inflammatory therapy. However, the redness and swelling of the inner canthus continued to increase. An endoscopic dacryocystorhinostomy of the right eye was performed under general anesthesia. A large amount of purulent secretion was drained during the operation. As a result, the swelling of the inner canthus was significantly reduced. A routine intra-operative biopsy of the wall of the lacrimal sac revealed an exophytic nasal papilloma. A second biopsy, 1 week after the surgery, revealed the same result. The patient was advised to undergo a dacryocystectomy once the swelling had subsided. However, the patient was reluctant to undergo this surgery and remains under clinical observation. Conclusion It is rare for an exophytic nasal papilloma, which is a benign tumor in the lacrimal sac, which has the potential for recurrence and malignant transformation, to manifest with acute dacryocystitis as the first symptom. Therefore, this case report could provide a reference for the future clinical diagnosis of this disease.

The Clinical Feature and Treatment Outcome of Ocular Melanoma: A 34-Year Experience in a Tertiary Referral Center

Malignant melanoma can arise from melanocytes in various structures of the eye, orbit, and ocular adnexa. We reviewed the clinical features and long-term results of all subjects with histologically proved melanoma originating from any of the ocular and periocular structures in a tertiary referral center. Overall, 88 patients including 47 men were recruited. The tumor was primarily located in the uvea, followed by the conjunctiva, orbit, eyelid, and lacrimal sac. Patients with uveal melanoma were diagnosed at a relatively younger age (47.0 years), while those with orbital and eyelid melanomas were older at presentation (79.5 years and 78.5 years, respectively). The overall local recurrence rate was 9% at a median follow-up of 41.0 months, among which orbital and eyelid melanomas recurred most commonly. The overall mortality rate was 41% in a median duration of 27.2 months (IQR, 13–58 months) from diagnosis, with the highest for lacrimal sac melanoma, followed by melanoma of the orbit, uveal, conjunctiva, and eyelid. Despite prompt local control, the risk for metastasis and mortality was high. Therefore, efficient modalities for early diagnosis and treatment of ocular melanoma are necessary.

Functional metagenomic profile of the lacrimal sac microbial communities in primary acquired nasolacrimal duct obstruction: The Lacriome paper 2

Purpose To study the functional metagenomic profile of the microbes isolated from the lacrimal sac of patients with primary acquired nasolacrimal duct obstruction. Methods A prospective study was performed on 10 consecutive lacrimal sac samples obtained for the metagenomic analysis from patients with primary acquired nasolacrimal duct obstruction ( who underwent endoscopic dacryocystorhinostomy at a tertiary care Dacryology service. The samples were collected intraoperatively soon after a full-length lacrimal sac marsupialization and immediately transported on ice to the laboratory. Following DNA extraction and library preparation, a whole shotgun metagenome sequencing was performed on the Illumina NOVASEQ 6000TM platform. The downstream processing and bioinformatics of the samples were performed using multiple software packaged in SqueezeMetaTM pipeline and functional analysis using the MG-RASTTM pipeline. Results The microbial gene mapping and protein prediction demonstrated proteins with known functions to range from 66.41% to 84.03% across the samples. The functional category distribution of Kyoto Encyclopedia of Genes and Genomes ortholog (level 1 data) showed metabolism to be the most commonly involved function followed by environmental information processes, genetic information processes and cellular processes. The functional subsystem profiling demonstrated genes associated with carbohydrate, protein and RNA metabolism, Amino acids and their derivatives, cofactors and prosthetic groups and factors involved in cell structure regulation and cell cycle control. Conclusion This is the first functional metagenomic profile of the lacrimal sac microbiota from patients with primary acquired nasolacrimal duct obstruction. Functional analysis has provided newer insights into the ecosystem dynamics and strategies of microbial communities inhabiting the lacrimal sac. Further Lacriome studies may provide clues for better understanding of the disease etiopathogenesis.