Actinomycetes canaliculitis complicating congenital nasolacrimal duct obstruction in an infant

Actinomyces israelii is a Gram-positive anaerobic organism commonly associated with canaliculitis in adults. Pediatric canaliculitis is relatively rare, especially in infancy. We report the case of an 11-month-old boy who presented with co-existing canaliculitis and congenital nasolacrimal obstruction. The presenting signs included epiphora, discharge, conjunctival congestion, and matting of lashes. On examination, punctual pouting, regurgitation, and yellow canaliculiths were noted. A punctoplasty and canalicular curettage were performed along with nasolacrimal probing. Microbiological tests confirmed the organisms to be A. israelii. We discuss the clinical features and management of Actinomyces-associated canaliculitis and review the available literature on pediatric canaliculitis.

Clinicopathological Study of Lacrimal Sac Dacryolith in Patients Treated for Nasolacrimal Duct Obstruction

PURPOSE: To evaluate the correlation between clinical manifestation of patients with nasolacrimal duct obstruction and pathological characteristics of lacrimal sac and dacryolith found during endoscopic dacryocystorhinostomy. METHODS: This retrospective study included 158 patients (189 eyes) who received endoscopic dacryocystorhinostomy. We defined lacrimal dacryolith by gross discovery in the lacrimal sac during surgery or findings during pathological examination as dacryolith or calcification, including size and distribution in pathology slides. We correlated the relationship between the patients' clinical manifestations, surgical results, lacrimal sac's pathological findings including calcification, inflammation and fibrosis, and pathological findings of lacrimal sac dacryolith. RESULTS: Dacryolith was found in 61 eyes (32.3%) and among them, grossly found in 13 eyes (6.9%). Dacryolith's filling defect on dacryocystography was found in 17 eyes (9.0%) and based on grossly found dacryolith, dacryocystography's sensitivity and specificity were 58.8% and 1.7%, respectively. The average size of dacryolith was 0.3 +/- 0.8 mm2 with an average distribution of 20.1 +/- 17.9%. Distribution of dacryolith and the proportions of inflammatory cells and fibrosis in the lacrimal sac were negatively correlated (p < 0.05). The size of dacryolith and the proportions of fibrosis in the lacrimal sac were also negatively correlated (p = 0.008). In cases where the proportion of calcification in pathology slides was over 50%, the duration of symptoms in the calcification-dominant group was shorter than in other groups (p = 0.006). The success rates of endoscopic dacryocystorhinostomy with dacryolith and without dacryolith were 91.8% and 80.5%, respectively (p = 0.046). CONCLUSIONS: The patients with lacrimal sac dacryolith in nasolacrimal duct obstruction showed shorter duration of symptoms, lower fibrosis of lacrimal sac, and higher surgical success rates than the other cases. Therefore, additional research may be necessary to determine the mechanism of dacryolith formation and early treatment in nasolacrimal duct obstruction with lacrimal sac dacryolith.

Clinical Evaluation of Lacrimal Gland Ductal Disease

PURPOSE: To investigate the clinical characteristics and management of lacrimal gland ductal disease, a rare disease often mistaken for other diseases. METHODS: A retrospective chart review of 11 patients (11 eyes, 5 males, 6 females) diagnosed with lacrimal ductal disease between March 2007 and April 2013 was performed. RESULTS: Among 11 eyes in 11 patients, 4 were diagnosed with dacryops and 7 with lacrimal gland ductulitis initiated by dacryolith. The mean age of the subjects was 47.9 years (range, 30-80 years). Lacrimal gland ductulitis patients received treatment for conjunctivitis or hordeolum for several months. Four cases involved the right eye and 7 cases involved the left eye. Symptoms included foreign body sensation, pus-like discharge and palpable mass. Biopsy was performed in 3 cases and showed no specific findings. Patients with dacryops underwent marsupialization, whereas patients diagnosed with lacrimal gland ductulitis underwent excision and dacryolith curettage. During the 2-month follow-up period, all cases showed no signs of recurrence or complications. CONCLUSIONS: Lacrimal gland ductal disease can be mistaken for other diseases such as conjunctivitis, hordeolum, or orbital cyst, thus requiring accurate diagnosis and appropriate management.

A Case of Lacrimal Ductal Cyst with Dacryolith

PURPOSE: Lacrimal gland duct cysts constitute a rare clinical entity and may be preceded by trauma, infection, or inflammation without antecedent history. The purpose of this study is to report one case of lacrimal gland duct cyst accompanied by a dacryolith. METHODS: A 41-year-old man presented with sudden enlarging mass in the left superotemporal conjunctival fornix 3 days ago. The lesion was about 10 X 10 mm in size. There was no tenderness or erythema in adjacent area. The CT scan was done and excisional biopsy was performed under local anesthesia. RESULTS: Specimen consisted of cystic membranous tissue in 9.0 X 7.0 mm in size and mucous material and a light brown dacryolith of 1mm in diameter within cyst. Specimen included normal lacrimal tissue. Microscopic examination found cyst was covered with stratified columnal epithelium accompanied by acute and chronic inflammation and eosinophilic acellular dacryolith mixed with inflammatory exudates. There was no bacterial colony and polarizing microscope found no birefringence. CONCLUSIONS: Such case of a eosinophilic dacryolith within lacrimal gland duct cyst has never been reported at home and abroad.

A Case of Morphological and Chemical Analysis of Recurrent Dacryoliths after Dacryocystorhinostomy

PURPOSE: To present the morphological and chemical analysis of dacryoliths and review factors contributing to form dacryoliths with previous studies. METHODS: From a 58-year-old female patient operated with dacryocystorhinostomy, dacryoliths were obtained during the procedure and postoperative follow-up period. Morphological and microbial analysis of the dacryoliths was performed by culture and light microscopic examination. Various electrolytes in the dacryoliths were analyzed by flame atomic absorbable spectrometry(FAAS) for Na+ and K+ and by inductively coupled plasma atomic emission spectrometry(ICPAES) for Ca2+ and Mg2+. RESULTS: No bacterial and fungal organisms were cultured, but multiple bacterial colonies were found by H&E stain. Chemical analysis revealed mainly organic composition 97.91% and inorganic composition 2.09%. Inorganic composition was consisted with Ca2+ 0.82%, Na+ 0.76%, Mg2+ 0.27%, and K+ 0.24% in order. CONCLUSIONS: To prevent the recurrence of the nasolacrimal duct obstruction by the dacryoliths after dacryocystorhinostomy, pathogenesis of the dacryoliths formation may be studied with morphological and chemical analysis of the Dacryoliths.