Dacryocystectomy: A fibrin glue-assisted subfascial excision

This article describes a technique of dacryocystectomy involving dissection within the subfascial plane, in which the lacrimal sac fascia is preserved and the orbital fat remains undisturbed. The lacrimal sac cavity was directly injected with Tisseel fibrin glue mixed with trypan blue. This led to sac distension and facilitated its separation from surrounding periosteal and fascial attachments. Staining the lacrimal sac epithelium improved definition of the mucosal lining. Transverse sections of the lacrimal sac specimen were histologically analyzed, which confirmed that dissection was completed within a subfascial plane. The technique herein described facilitates en bloc excision of the lacrimal sac without breaching the fascial plane that separates the sac from orbital fat.

Rhinosporidiosis of the lacrimal sac in a tertiary care hospital of India - A retrospective case study

Purpose: Though rhinosporidiosis of the lacrimal sac is a rare disease across the globe, the frequency with which these patients come to the outpatient department in western Odisha is quite alarming. This study was undertaken to upgrade the knowledge about the clinical profile and management of rhinosporidiosis of the lacrimal sac. Methods: This is a retrospective study comprising 32 clinically diagnosed and histopathologically proved cases of lacrimal sac rhinosporidiosis who were managed with dacryocystectomy with meticulous excision. Intraoperative copious irrigation with 5% povidone–iodine for 5 min and postoperative dapsone therapy for 3–6 months had been administered to all the patients. The mean follow?up period was 16.7 months. The study was conducted over 5 years from August 2015 to July 2020. Results: Rhinosporidium seeberi, an aquatic protistan parasite, was found to be the causative agent. Males and females were affected equally. Children less than 10 years of age comprised 56.2% (18 cases). History of pond bathing was found in 100% of cases. The most common presentation was boggy swelling over the lacrimal sac. The involvement was unilateral in all the cases. None of the patients were found to have nasal involvement. In 65.6%, the lesion was limited within the sac. Recurrence was noted in 25% of cases. Conclusion: Rhinosporidiosis of the lacrimal sac should be excluded in all patients presenting with boggy swelling of the lacrimal sac with a history of pond bath. The recurrence can be minimized by meticulous excision, intraoperative betadine, and postoperative dapsone therapy

Anatomy of lacrimal sac fossa affecting success rate in DCR surgery / Шинэ санаа Шинэ нээлт

Background@#Primary acquired nasolacrimal duct obstruction (PANDO) is a common cause of epiphora in adults, standard surgery for blockage of the lacrimal outflow tract is the dacryocystorhinostomy (DCR). The majority of studies have analyzed the lacrimal system of whites anatomically and presented guidelines for endonasal DCR. It has been our experience that DCR procedures for Asians are more difficult than for whites and we reasoned that the difficulty might be attributable to the anatomic differences in the intranasal structures between the races. Before we started doing endoscopic endonasal DCR in Mongolia, there was no hospital doing this surgery and there was lack of study done on anatomy of lacrimal fossa and DCR surgery result among Mongolians are our rationale of study.@*Goal@#To study the effect of anatomical variance of lacrimal sac fossa on dacryocystorhinostomies performed by the endoscopic endonasal approach.@*Methods@#METHODS: A total of 292 consecutive cases of DCR were performed age between 16-75 years old who have primary nasolacrimal obstruction (ICD-H04.559). This study was approved by the Ethics Committee of Mongolian National University of Medical Sciences. A total of 146 EX-DCR and 146 EN-DCR patients were identified. Full success was defined as no symptoms of tearing after surgery and anatomical patency with lacrimal irrigation. Standard Lac-Q questionnaire was used to compare satisfaction of the surgery in both groups. All statistical tests were two-sided, and a p-value of <0.05 was considered to be statistically significant. Statistical analysis was performed using STATA for Windows version 11.2.@*Results@#There was no significant difference in age or gender distribution between the two groups. Frontal process of the maxillary bone is 4.41± 1.96 mm in successful group and 4.97± 1.04 in failed group (p<0.05). The uncinate process was attached to the lacrimal sac fossa in 80.1% of the all cases and 100% in surgery failed group (p<0.05). The variation that agger nasi cell adjacent to the lacrimal sac fossa was in 93.9%. The operculum of the middle turbinate was attached to the lacrimal sac fossa in 94.5% of the cases (p=0.76). Postoperative assessment was performed for 6 months. Patients who underwent endonasal group reported a 11.0-point improvement (IQR, 9.0–16.5). @*Conclusions@#A thick frontal process of the maxilla and uncinate process, operculum of the middle turbinate, and ethmoid cells adjusting to lacrimal fossa are dominant in Mongolians. Patients who have these features are prone to have recurrence of nasolacrimal duct obstruction after DCR surgery. The EN-DCR have a high surgical success rate and good result on reduce of symptoms and improvement in quality of life by using the Lac-Q standard questionnaire.

Compared outcomes of using histoacryl and tube insertion for endoscopic endonasal dacryocystorhinostomy surgery / Шинэ санаа Шинэ нээлт

Background@#Dacryocystorhinostomy (DCR) is a surgical treatment for site of obstruction in the nasolacrimal duct system [1]. This surgery is performed in cases of congenital nasolacrimal obstruction, partial and complete occlusion of the nasolacrimal duct in adults, chronic tearing disorders, ineffective probing treatment and placement of a silicone tube in the nasolacrimal system [2,3]. the present findings indicate that preservation of lacrimal sac flaps with end-to-end anastomosis to the nasal mucosa using histoacryl has a positive impact on surgical outcome in patients undergoing endonasal endoscopic dacryocystorhinostomy [4]. Histoacryl glue is one of the most commonly surgical materials used recently. The basis of our study is the lack of research on the use of this glue in the practice of oculoplastic and reconstructive surgery.@*Purpose@#The purpose of this study to comparing outcomes of surgical methods of histoacryl glue and silicone tube during endoscopic endonasal dacryocystorhinostomy.@*Methods@#Retrospective, case series study. The study included 83 patients who underwent endonasal endoscopic dacryocystorhinostomy between January 2017 to June 2020. Whole case was divided into two groups. In group 1, an anastomosis was made during surgery by using histoacryl glue to the posterior wall of the lacrimal sac and the wall formed by the nasal mucosa [5]. In group 2, a silicone tube was placed in the nasolacrimal duct during endonasal dacryocystorhinostomy and the results were evaluated in the 1st, 3rd, 6th, and 12th months after surgery. Statistical calculations were performed using SPSS software.@*Results@#The age of the whole cases was between 17 and 82 years. There were no significant difference among the age groups. In terms of gender, n=48 (78.7%) were female and n=13 (21.3%) were male, indicating that dacryocystitis was predominant in women. Study reports no significant difference in intraoperative and postoperative complication. The surgical success rate was significantly higher in histoacryl group 94.9%, than silicone tube group 79.5%. Recurrent cases n=2 (5.1%) in group 1 and n=9 (20.4%) in group 2 respectively. @*Conclusion@#Histoacryl glue is highly effective, commodity, inexpensive and easy to apply during endonasal endoscopic dacryocystorhinostomy surgery.

Compared outcomes of using histoacryl and tube insertion for endoscopic endonasal dacryocystorhinostomy surgery / Монголын Анагаах Ухаан

Introduction@#Dacryocystorhinostomy (DCR) is a surgical treatment for site of obstruction in the nasolacrimal duct system. This surgery is performed in cases of congenital nasolacrimal obstruction, partial and complete occlusion of the nasolacrimal duct in adults, chronic tearing disorders, ineffective probing treatment and placement of a silicone tube in the nasolacrimal system. the present findings indicate that preservation of lacrimal sac flaps with end-to-end anastomosis to the nasal mucosa using histoacryl has a positive impact on surgical outcome in patients undergoing endonasal endoscopic dacryocystorhinostomy. Histoacryl glue is one of the most commonly surgical materials used recently. The basis of our study is the lack of research on the use of this glue in the practice of oculoplastic and reconstructive surgery.@*Purpose@#To report the use of fibrin glue as an adjunctive procedure in endoscopic dacryocystorhinostomy (En-DCR) surgery and compare it to silicone tubing@*Material and Method@#Patients with primary nasolacrimal duct obstruction were retrospectively reviewed for endo-DCR between January 2017 and December 2019. Group I patients applied fibrin glue and Group II used silicone tube insertion. The fibrin glue group received end-to-end anastomosis of the nasal mucosa and lacrimal sac using fibrin glue at the end of surgery. The demographics, recurrence, causes of failure, formation of scars, final ostium size and the success rate were compared. This study was approved by the Institutional Review Board of the Chang Gung Memorial Hospital Clinical Research Ethnics Committee and followed the Declaration of Helsinki. All statistical analysis was performed with SPSS version 24.0 software (SPSS Inc., Chicago, IL, USA), and a P value < .05 was considered statistically significant. Continuous variables were presented as mean ± standard deviation, while categorical data was represented as numbers and percentages. Independent t-tests were used to compare the differences in parametric variables. The Mann-Whitney U test was performed to compare the follow-up period. Pearson’s chi-squared and Fisher’s exact tests were used to compare categorical variables. Multivariate logistic regression was used to identify the risk factors associated with recurrence. @*Result@#The age of the whole cases was between 17 and 82 years. There was no significant difference among the age groups. In terms of gender, n=48 (78.7%) were female and n=13 (21.3%) were male, indicating that dacryocystitis was predominant in women. Study reports no significant difference in intraoperative and postoperative complication. The surgical success rate was significantly higher in histoacryl group 94.9%, than silicone tube group 79.5%. Recurrent cases n=2 (5.1%) in group 1 and n=9 (20.4%) in group 2 respectively.@*Conclusion@#Fibrin glue improves the surgical outcome in patients undergoing Endo-DCR compared to commonly used silicone stenting by securing flaps apposition and maintaining the ostium opening.

Anatomy of lacrimal sac fossa affecting success rate in endoscopic and external dacryocystorhinostomy surgery / Монголын Анагаах Ухаан

Introduction@#Primary acquired nasolacrimal duct obstruction (PANDO) is a common cause of epiphora in adults, standard surgery for blockage of the lacrimal outflow tract is the dacryocystorhinostomy (DCR). The majority of studies have analyzed the lacrimal system of whites anatomically and presented guidelines for endonasal DCR. It has been our experience that DCR procedures for Asians are more difficult than for whites and we reasoned that the difficulty might be attributable to the anatomic differences in the intranasal structures between the races. Before we started doing endoscopic endonasal DCR in Mongolia, there was no hospital doing this surgery and there was lack of study done on anatomy of lacrimal fossa and DCR surgery result among Mongolians are our rationale of study.@*Goal@#To study the effect of anatomical variance of lacrimal sac fossa on dacryocystorhinostomies performed by the endoscopic endonasal approach.@*Material and Methods@#A total of 292 consecutive cases of DCR were performed age between 16-75 years old who have primary nasolacrimal obstruction (ICD-H04.559). This study was approved by the Ethics Committee of Mongolian National University of Medical Sciences. A total of 146 EX-DCR and 146 EN-DCR patients were identified. Full success was defined as no symptoms of tearing after surgery and anatomical patency with lacrimal irrigation. Standard Lac-Q questionnaire was used to compare satisfaction of the surgery in both groups. All statistical tests were two-sided, and a p-value of <0.05 was considered to be statistically significant. Statistical analysis was performed using STATA for Windows version 11.2.@*Results@#There was no significant difference in age or gender distribution between the two groups. Frontal process of the maxillary bone is 4.41± 1.96 mm in successful group and 4.97± 1.04 in failed group (p<0.05). The uncinate process was attached to the lacrimal sac fossa in 80.1% of the all cases and 100% in surgery failed group (p<0.05). The variation that agger nasi cell adjacent to the lacrimal sac fossa was in 93.9%. The operculum of the middle turbinate was attached to the lacrimal sac fossa in 94.5% of the cases (p=0.76). Postoperative assessment was performed for 6 months. Patients who underwent endonasal group reported a 11.0-point improvement (IQR, 9.0–16.5). @*Conclusions@#A thick frontal process of the maxilla and uncinate process, operculum of the middle turbinate, and ethmoid cells adjusting to lacrimal fossa are dominant in Mongolians. Patients who have these features are prone to have recurrence of nasolacrimal duct obstruction after DCR surgery. The EN-DCR have a high surgical success rate and good result on reduce of symptoms and improvement in quality of life by using the Lac-Q standard questionnaire.

Study on the angle between the long axis of lacrimal sac and bony nasolacrimal duct in patients with chronic dacryocystitis / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the difference of the angle between the long axis of lacrimal sac and bony nasolacrimal duct(BNLD)in patients with chronic dacryocystitis and normal eyes, and discuss the relationship between the angle and chronic dacryocystitis.<p>METHODS:A total of 218 patients(248 diseased eyes)from Sichuan Province who visited the ophthalmology department of our hospital from January 2016 to March 2019 were collected retrospectively. All patients underwent computed tomography dacryocystography(CT-DCG)immediately after bilateral lacrimal duct irrigation, and three-dimensional reconstruction of the nasolacrimal duct structure was performed. The structures of the nasolacrimal duct, lacrimal sac and its surrounding tissues were observed in the coronal position, and the lacrimal sac-BNLD angles of the diseased eyes and the normal eyes were measured respectively.<p>RESULTS:The lacrimal sac-BNLD angle of the diseased eyes \〖23.55°(17.30°, 29.90°)\〗 was higher than that of the normal eyes \〖20.05°(15.40°, 28.35°)\〗(<i>P</i><0.05). Among them, the angle of the diseased eyes in female patients \〖24.60°(17.75°, 31.00°)\〗 was significantly higher than that in normal eyes \〖21.15°(15.10°, 27.35°)\〗(<i>P</i><0.05), while there was no significant difference in the angle between the diseased eyes and normal eyes in male patients(<i>P</i>>0.05). In addition, the angle of the diseased eyes in the age group of 41-60 a \〖25.20°(17.90°, 33.00°)\〗 was significantly higher than that in normal eyes \〖21.60°(15.25°, 29.05°)\〗(<i>P</i><0.05).<p>CONCLUSION: The angle between the long axis of lacrimal sac and bony nasolacrimal duct increased in patients with chronic dacryocystitis, which may be one of the factors causing the onset of chronic dacryocystitis in middle-aged and elderly women.

Valor del ultrasonido en el diagnóstico de los tumores del saco lagrimal / Value of the ultrasound in the diagnosis of lacrimal sac tumor

RESUMEN Los tumores del saco lagrimal son extremadamente raros, y el benigno primario más común es el papiloma escamoso. Clínicamente se manifiestan como una zona de tumefacción en la región cantal medial, asociado a epifora y dacriocistitis crónica-recurrente. Dentro de las pruebas de imagen recomendadas están: dacriocistografía, tomografía computarizada, resonancia magnética y dacrioescintifotografía. Sin embargo, muy pocos sugieren el uso del ultrasonido. Se presenta el caso de un papiloma mixto del saco lagrimal diagnosticado por ultrasonido. Se trata de una paciente femenina de 39 años, quien fue remitida por cuadros repetidos de dacriocistitis derecha en los últimos 3 años. En consulta se constató celulitis preseptal ipsolateral, por lo que se indicó antibiótico-terapia, y se logró la remisión de los signos inflamatorios agudos, pero persistió el aumento del volumen cantal medial derecho. La vía lagrimal se exploró y se comprobó que estaba obstruida. Se realizó ultrasonido, donde el saco lagrimal derecho apareció ocupado por una masa ecogénica, que se extendía al conducto lacrimonasal y mostraba ligera vascularidad. Seguidamente se hizo tomografía computarizada, y se confirmaron los hallazgos ecográficos, pero sin lograr delimitar la lesión intrasaco descrita, aún tras la administración de contraste yodado endovenoso. Se sugirió dacriocistitis crónica derecha, secundaria al tumor intrasaco de aspecto benigno, probable papiloma, por lo que se efectuó cirugía y examen histopatológico que ratificaron dicho diagnóstico. En conclusión, el ultrasonido del saco lagrimal es un método complementario de gran valor, que en algunos casos hará el diagnóstico, y en otros brindará información que optimizará la decisión de quienes serían tributarios a estudios más complejos(AU)

ABSTRACT Lacrimal sac tumors are extremely rare, and the most common benign primary is squamous papilloma. Clinically, they manifest as a zone of swelling in the medial canthal region, associated with epiphora and chronic-recurrent dacryocystitis. Among the recommended imaging tests are dacryostography, computed tomography, magnetic resonance imaging, and dacryoscintifotography. However, very few suggest the use of ultrasound. The case of a mixed papilloma of the lacrimal sac diagnosed by ultrasound is presented. This is a 39-year-old female patient, who was referred for repeated cases of right dacryocystitis in the last three years. In consultation, ipsolateral preseptal cellulitis was found, for which antibiotic therapy was indicated, and the remission of acute inflammatory signs was achieved, but the increase in right medial canthal volume persisted. The lacrimal duct was explored and found to be obstructed. Ultrasound was performed, where the right lacrimal sac appeared occupied by an echogenic mass, which extended to the lacrimal duct and showed slight vascularity. Subsequently, computed tomography was performed, and the ultrasound findings were confirmed, but without defining the described intrasaccal lesion, even after administration of intravenous iodinated contrast. It was suggested chronic right dacryocystitis, secondary to apparently benign intrasaccal tumor, probable papilloma, so surgery and histopathological examination were performed, which that ratified the diagnosis. In conclusion, ultrasound of the lacrimal sac is a complementary method of great value, which in some cases will make the diagnosis, while in others it will provide information that will optimize the decision of those who would be candidate to more complex studies(AU)

External dacryocystorhinostomy for isolated lacrimal sac rhinosporidiosis – A suitable alternative to dacryocystectomy

Purpose: To describe the outcome of external dacryocystorhinostomy (DCR) as a suitable alternative to dacryocystectomy (DCT) in cases of isolated lacrimal sac rhinosporidiosis. Methods: This was a retrospective, interventional case series. Institutional review board approval was obtained for the study. The chart review of 13 patients who underwent external DCR surgery for isolated lacrimal sac rhinosporidiosis between July 2012 and May 2018 was performed. Demographic details, clinical presentation, preoperative and intraoperative findings, surgical technique used, postoperative management, surgical outcome and duration of follow up were reviewed for each patient. Results: Thirteen patients were included in the study. Nine (69.2%) were male and four (30.8%) were female. The mean age was 22.1 years (range: 8–46 years). Involvement was unilateral in all cases. The commonest presenting complaint was epiphora with discharge seen in 10 cases (76.9%). An intrasac granuloma was grossly identified intraoperatively in 12 out of the 13 patients. Mean follow up was 26.9 months (range: 1.5–68 months). Till the last follow up, all cases were symptom free and did not have any evidence of recurrence of infection. Conclusion: From this series of cases reported by the authors, external DCR with appropriate precautions to prevent recurrence appears to be a suitable alternative to conventional DCT with excellent long-term outcomes without disease recurrence.

Anastomoses Between Infraorbital Artery And Ophthalmic Artery Within The Orbit

Documentation of contributions from infraorbital artery to branches of the ophthalmic artery are lacking withrespect to the orbit. While there have been sources that suggest anastomoses between the infraorbital artery andophthalmic artery within the orbit, there has been no clear consensus on the location and significance of theseanastomoses. This study aimed to identify and track the course of the infraorbital artery within the orbit and itspossible anastomoses and supply to the orbit. Cadaveric analysis of 19 individuals (38 orbits) revealed acommon pattern of anastomosis between the infraorbital and inferior palpebral arteries (95%; 89% bilaterally)as well as course to the lacrimal sac (91%; 73% bilaterally). These findings demonstrate the significance ofinfraorbital artery supply with respect to the inferior orbit as well as the lacrimal sac, which can prove clinicallyuseful, such as in the context of surgical repair of orbital trauma.

Bilateral simultaneous endoscopic dacryocystorhinostomy: outcome and impact on the quality of life of the patients

Introduction: Bilateral simultaneous endoscopic dacryocystorhinostomy (endo-DCR) has received little attention in the literature, thus many surgeons continue to address bilateral nasolacrimal duct obstruction at two stages, rather than in the same setting. Objective: To evaluate the feasibility and the outcome of simultaneous bilateral Endo- DCR and its impact on the quality of life of the patients. Methods: We have conducted a retrospective analysis of patients who underwent bilateral simultaneous endo-DCR between March 2013 and February 2017 at our tertiary care institution. The reviewed data included clinical presentation; operative details; success rate; pre and postoperative evaluation of the symptoms of the patients, using the Nasolacrimal Duct Obstruction Symptom Score Questionnaire; satisfaction of the patients, and improvement in the quality of life, assessed by the Glasgow Benefit Inventory (GBI) questionnaire. Results: Out of 128 cases in which endo-DCRs were performed, 13 were bilateral (26 sides). Postoperative success was documented in 24 of the 26 sides (92.3%), with a mean follow-up duration of 16.2 months. The two failed sides were reported in the same case. The preoperative symptom score ranged between 12 and 80 (mean ± standard deviation [SD]: 38.23 ± 15.7). The postoperative symptom score was significantly lower (mean ± SD: 5.4 ± 12.9). The success rates in unilateral and bilateral cases were comparable, with no statistically significant difference. A notable improvement in the quality of life of the patients was also reported, with a mean GBI score of 81.38 ± 12.37. Conclusion: Our results support that a simultaneous bilateral endo-DCR is a safe procedure that offers a high success rate, spares the patient from the stress of a second surgery, provides the patient with a bilateral resolution of the symptoms, and confers an immediate improvement in the quality of life of the patients (AU)

Primary Marginal Zone B-cell Lymphoma of Mucosa-associated Lymphoid Tissue of the Lacrimal Sac Mimicking Dacryocystitis

PURPOSE: We report a case of a young female patient who was diagnosed with a marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT lymphoma) of the lacrimal sac which mimicked dacrocystitis. CASE SUMMARY: A 23-year-old female suffered from epiphora for 3 years in the right eye. She had swelling and a painful lesion at the lacrimal sac 4 months prior and was referred to our hospital due to nasolacrimal duct obstruction and dacryocystitis. Lacrimal irrigation was performed with no passing and regurgitation with mucoid discharge. We performed orbital computed tomography and magnetic resonance imaging which showed a suspected tumor of the lacrimal sac in the right eye. We then performed excision and biopsy of the tumor through the skin approach. The patient was diagnosed with a MALT lymphoma with no systemic involvement. After six cycles of chemotherapy involving rituximab with cyclophosphamide, vincristine, and prednisone, the lesion of the mass and the painful symptoms decreased, which was regarded as a complete response. However, epiphora and eye discharge persisted, showing a nasolacrimal duct obstruction, so we performed endoscopic dacryocystorhinostomy with a lacrimal sac biopsy. The histological examination showed chronic inflammation, but not lymphoma. There was no recurrence of lymphoma at one year postoperatively. CONCLUSIONS: If there is an epiphora and palpable lesion in the lacrimal sac area, MALT lymphoma mimicking dacyocystitis may be suspected. After the lymphoma is first diagnosed by excision and biopsy, systemic chemotherapy with dacryocystorhinostomy could be an effective treatment.

Postpartum regular massage on lacrimal sac to prevent neonatal dacryocystitis / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To early massage lacrimal sac to prevent and reduce the neonatal dacryocystitis. ·METHODS: We collected 4048 cases of neonatal, there were 2650 cases of natural birth including 5300 eyes and 1398 cases of Cesarean section including 2796 eyes. There were 2131 cases with preventive massage on lacrimal sac including 1396 cases in natural labor,2792 eyes, and 735 cases in cesarean delivery, 1470 eyes. Then, we determined whether neonatal dacryocystitis occurrence in the observation period. ·RESULTS: After preventive massage on lacrimal sac, there were 104 cases of neonatal dacryocystitis that included 68 cases of natural labor,75 eyes and 36 cases of cesarean delivery, 47 eyes; 140 cases of neonatal dacryocystitis that included 49 cases of natural labor, 57 eyes and 91 cases of cesarean delivery, 148 eyes, in the neonatal without massage. In the comparison of preventive massage group with control group,there were significant differences of the incidence of neonatal dacryocystitis(χ2=32.141,P<0.01). ·CONCLUSION: The preventative massage on lacrimal sac significantly reduce the incidence of neonatal dacryocystitis.

Curative effects of nasal lacrimal sac anastomosis combined with tube insertion under nasal endoscope on patients with chronic dacryocystitis and nasolacrimal duct obstruction / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the effects of nasal lacrimal sac anastomosis combined with tube insertion under nasal endoscope on patients with chronic dacryocystitis and nasolacrimal duct obstruction. <p>METHODS: Totally 70 patients(70 eyes)with chronic dacryocystitis and nasolacrimal duct obstruction in our hospital from December 2011 to December 2014 were selected, and were randomly divided into control group and study group. The control group were treated with nasal cavity lacrimal sac anastomosis under nasal endoscope, and the study group were treated with nasal lacrimal sac anastomosis combined with tube insertion under nasal endoscope. Total effective rates and fistula areas at 1, 6 and 12mo before and after operation were compared between the two groups. <p>RESULTS: At 1mo after operation, there was no significant difference in total effective rates between the control group(97%)and the study group(100%; <i>P</i>>0.05). At 6mo after operation, the total effective rate in the study group(97%)was significantly higher than that in the control group(77%; <i>P</i><0.05). At 12mo after operation, the total effective rate in the study group(94%)was significantly higher than that in of the control group(71%; <i>P</i><0.05). There was no significant difference in fistula areas between the two groups at 1mo after the operation(<i>P</i>>0.05), while fistula areas in the study group were larger than those in the control group at 6 and 12mo after operation(<i>P</i><0.05). <p>CONCLUSION: The effects of nasal lacrimal sac anastomosis combined with tube insertion under nasal endoscope on patients with chronic dacryocystitis and nasolacrimal duct obstruction are remarkable.

Clinical Characteristics of Lacrimal Sac Tumors: Report of Ten Cases

BACKGROUND AND OBJECTIVES: To review our experience with lacrimal sac tumors in an effort to identify features, to evaluate the results of various methods of management, and to compare our data with previous studies. METHODS: We reviewed the medical records of all patients with lacrimal sac tumors who were managed in our institution between January 1990 and December 2015. The pre-operative clinical data, imaging, operation notes, and follow-up records were reviewed for each patient. RESULTS: The study group consisted of four men and six women with a mean age of 47.6 years. Most patients experienced long-standing epiphora, for a mean period of 20 months. Two of the tumors were benign, and eight of them were malignant. The benign tumors were treated with dacryocystectomy. All but one malignant tumor were treated with medial or total maxillectomy. Adjuvant radiotherapy was administered to four patients with malignant tumors. In the eight patients with malignant tumors, the mean follow-up period was 65 months. CONCLUSIONS: Important characteristics of lacrimal sac tumors include dacryocystitis, epiphora, and in some cases, a palpable medial canthal area mass. Wide en bloc resection via medial or total maxillectomy and/or postoperative radiotherapy are proper treatments for malignant lesions of the lacrimal sac.

Ultrasonic 3D reconstruction and measurement of lacrimal sac in normal adult Chinese population / Reconstrucción 3D con ultrasonido y mediciones del saco lagrimal en una población china de adultos normales

To apply the ultrasonic 3D reconstruction method to measure the anatomic image data of lacrimal sac in the normal adult Chinese population, providing imaging anatomical basis for the clinical diagnosis and treatment of lacrimal duct diseases. 80 volunteers without lacrimal duct diseases were enrolled. The GE Voluson E8 ultrasonic diagnostic apparatus was used, with gynecological intracavitary probe (frequency: 5 ~ 12MHz) for the examination and measurement. Each datum was repeated three times for the average value. Among the 80 eyes, the lacrimal sacs of 74 eyes exhibited the clear imaging, with the imaging rate as 92.5 %. the vertical diameter of lacrimal sac cavity (LSC): 13.3±2.2 mm; anteroposterior diameter: 6.0±1.1 mm; trans diameter: 4.9±0.9 mm; the vertical distance from the sac cavity top to the skin surface: 6.3±0.12 mm, the vertical distance from the sac cavity bottom to the skin surface: 6.5±0.11 mm; the distance from the angular artery to the medial canthus: 7.8±0.05 mm; the vertical distance from the angular artery to the skin surface: 7.7±0.08 mm. The lacrimal sac and angular artery in the adults could be shown clearly in ultrasonic 3D reconstruction, the accumulated anatomical parameters could provide the instructive meanings towards the clinical diagnosis and treatment of lacrimal diseases.

El objetivo de este estudio consistió en aplicar el método de reconstrucción 3D de ultrasonidos para medir los datos de las imágenes anatómicas del saco lagrimal en una población china adulta normal, proporcionando imágenes con base anatómica para el diagnóstico clínico y el tratamiento de las enfermedades de los conductos lagrimales. La muestra consistió en 80 voluntarios sin enfermedades de los conductos lagrimales. Se utilizó el aparato de ultrasonido GE Voluson E8, con una sonda intracavitaria ginecológica (frecuencia: 5 ~ 12 MHz) para realizar el examen y la medición. Cada dato se repitió tres veces para obtener el valor medio. De los 80 ojos, los sacos lagrimales de 74 ojos mostraron una imagen clara, siendo la tasa de formación de imágenes del 92,5 %. Se realizaron mediciones: diámetro vertical de la cavidad del saco lagrimal (LSC): 13,3 ± 2,2 mm; diámetro anteroposterior: 6,0 ± 1,1 mm; diámetro transversal: 4,9 ± 0,9 mm; distancia vertical desde la porción superior de la cavidad del saco lagrimal hasta la superficie de la piel: 6,3 ± 0,12 mm, distancia vertical desde el fondo de la cavidad del saco lagrimal hasta la superficie de la piel: 6,5 ± 0,11 mm; distancia desde la arteria angular al canto medial: 7,8 ± 0,05 mm; distancia vertical desde la arteria angular a la superficie de la piel: 7,7 ± 0,08 mm. El saco lagrimal y la arteria angular en los adultos se podría demostrar claramente en la reconstrucción 3D con ultrasonido. Los parámetros anatómicos acumulados podrían ser de significativo valor para un certero diagnóstico clínico y tratamiento de enfermedades de los sacos lagrimales.

Miíase na topografia de saco lacrimal / Lacrimal sac topography myiais

RESUMO A miíase é a infestação dos tecidos humanos por larvas Diptera. O comprometimento ocular é raro. Os autores apresentam um caso de miíase na topografia do saco lacrimal e discutem as modalidades terapêuticas para o tratamento desta doença.

ABSTRACT Myiasis is the invasion of human tissues by Diptera larvae. Ocular involvement is rare. The objective of this paper is to report a case of myiasis in the topography of the lacrimal sac and discuss current treatments for this disease.

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.