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)

Acute dacryocystitis: another clinical manifestation of sporotrichosis

Sporotrichosis associated with exposure to domestic cats is hyperendemic in Rio de Janeiro, Brazil. A review of the clinical records at our institute revealed four patients with clinical signs of dacryocystitis and a positive conjunctival culture for Sporothrix who were diagnosed with Sporothrix dacryocystitis. Three patients were children (< 13 years of age) and one patient was an adult. Two patients reported contact with a cat that had sporotrichosis. Dacryocystitis was associated with nodular, ulcerated lesions on the face of one patient and with granulomatous conjunctivitis in two patients; however, this condition manifested as an isolated disease in another patient. All of the patients were cured of the fungal infections, but three patients had chronic dacryocystitis and one patient developed a cutaneous fistula. Sporotrichosis is usually a benign disease, but may cause severe complications when the eye and the adnexa are affected. Physicians, especially ophthalmologists in endemic areas, should be aware of the ophthalmological manifestations and complications of sporotrichosis.

Dacriocistorrinostomia endoscópica: nossa experiência e revisão de literatura / Endoscopic dacryocystorhinostomy: our experience and literature review

Objetivo: Apresentar nossa experiência em dacriocistorrinostomia endoscópica, discutindo os resultados com os encontrados na literatura. Métodos: O material desse estudo consistiu de 16 dacricistorrinostomias realizadas em 12 pacientes acompanhados no período de 2009 a 2011. Analisamos sexo, idade no momento da cirurgia, etiologia da dacriocistite, quadro clínico, número de cirurgias necessárias para a correção, seguimento pós-operatório. Resultados: Houve predomínio do sexo feminino em relação ao masculino (5:1) com idades entre 8 e 71 anos, com média de 35,2 anos. Com relação à etiologia, oito foram classificados como idiopáticos; três, pós-traumáticos e um iatrogênico. Os pacientes foram acompanhados em média durante o período de seis meses, com melhora dos sintomas. Apenas dois pacientes evoluíram com permanência de epífora, sendo um deles reoperado com êxito por via externa. Conclusão:A cirurgia endoscópica endonasal deve ser considerada nos pacientes com obstrução das vias lacrimais, devido ao seu alto índice de sucesso, além de ser um procedimento seguro, com menor morbidade e proporcionar melhor resultado estético.

Objective:To present our experience in endoscopic dacryocystorhinostomy, discussing the results with those found in the literature. Methods: The material in this study consisted of sixteen surgeries performed in twelve patients followed between 2009 to 2011. We analyzed gender, age at surgery, etiology of dacryocystitis, clinical features, number of surgeries required to repair, follow-up. Results: There was a predominance of females compared to males (5:1) aged between 8 and 71 years, mean35.2 years. With regard to etiology, eight were classified as idiopathic, three, posttraumatic, and one, iatrogenic. Patients were followed on average over the period of six months, with improvement of symptoms. Only two patients had persistence of epiphora, one being reoperated successfully by external approach. Conclusion: Endoscopic endonasal surgery should be considered in patients with lacrimal obstruction, due to its high success rate, besides being safe procedure with less morbidity and give better cosmetic results.

Estudo epidemiológico da dacriocistite crônica / Epidemiological study of chronic dacryocystitis

OBJETIVO: O objetivo deste projeto de pesquisa é documentar as características epidemiológicas dos casos de dacriocistites crônicas atendidos em um hospital público. MÉTODOS: Estudo retrospectivo e documental dos prontuários de 60 pacientes com história pregressa de dacriocistite crônica que foram atendidos, no período de 12 de janeiro de 2009 a 9 de junho de 2010. Os pacientes, no período em estudo, foram submetidos à avaliação oftalmológica: inspeção ocular, biomicroscopia,Teste de Milder e Teste de Jones I e II. RESULTADOS: A média de idade dos pacientes com dacriocistite crônica atendidos foi de 55 anos, sendo 73 por cento (44) do sexo feminino e 27 por cento (16) do sexo masculino. O envolvimento unilateral ocorreu em 95 por cento (57) dos casos de dacriocistite crônica e somente 5 por cento (3) foram bilaterais.. Neste trabalho, o acometimento do lado direito foi de 45 por cento (26) e do lado esquerdo 55 por cento (31) respectivamente. Em relação à raça, prevaleceu a branca com 92 por cento (54) dos casos de dacriocistite crônica e 8 por cento (6 ) da raça negra. A evolução para dacriocistite aguda ocorreu em 20 por cento dos pacientes. Em relação à etiologia da dacriocistite crônica, houve predominância da idiopática em 95 por cento ( 57) dos casos e somente 5 por cento (3) devido a trauma. CONCLUSÃO: A dacriocistite é mais frequente nas mulheres, rara na raça negra e apresenta predisposição hereditária, aumentando a incidência a partir da 6ª década.

PURPOSE: The goal of this project is to document the epidemiological characteristics of chronic dacryocystitis cases assisted in a public hospital. METHODS: This is a retrospective study of medical records of patients who developed chronic dacryocystitis assisted in the period of january 12th , 2009 to june 9th, 2010 .The patients were ophthalmologist evaluated: ocular inspection, biomicroscopy, Milder Test, Test of Jones I and II. RESULTS: The gender with chronic dacryocystitis belonged to 55 years. There were 73 percent female and 27 percent male.The unilateral involvement occurred in 95 percent of the cases and only 5 percent were bilateral. In this work, the side of this pathology was on the right in 45 percent and on the left in 55 percent. Negroid races have a lower rate of illness than caucasians.Regarding the chronic dacryocystitis ethiology, there was a predominance of the idiopathic in 95 percent of the cases and only 5 percent of trauma. CONCLUSION: The dacryocystitis is more frequent in women, rare in blacks and presents hereditary predisposition, increasing the incidence from the 6th decade.

Craniodiaphyseal dysplasia: an unusual cause of recurrent dacryocystitis.

We describe a rare syndrome characterized by severe craniofacial hyperostosis, sclerosis, obliteration of paranasal sinuses and foramina of skull base, in a 10-year-old female child who presented with abnormal facial features and recurrent dacryocystitis due to narrowing of nasolacrimal duct.

Dacriocistitis aguda neonatal 1996-2005 / Acute neonatal dacryocystitis 1996-2005

Se realizó un estudio longitudinal y retrospectivo en diez años (1996-2005), de todos los neonatos cuyo motivo de ingreso en nuestra Unidad de Cuidados Intensivos Neonatales fue ser portadores de dacriocistitis aguda. Se obtuvo los siguientes resultados: incidencia 0,04 c/ 100 ingresos. Predominio: edades entre 7-27días (sepsis tardía), sexo femenino 66,6 porciento, nacidos de embarazos a término y con buen peso al nacer 100 porciento. Etiología no precisada 83,3 porciento. Tratamiento utilizado: antibioticoterapia (penicilina + gentacina, 4 pacientes, 66,6 porciento), (unasyn, 1 paciente, 16,6 porciento), (amoxicilina + unasyn + gentamicina, 1 paciente, 16,6 porciento); uso de inmunoglobulina humana en 2 pacientes. Complicaciones: celulitis facial y periorbitaria 66,6 porciento; absceso periorbitario 33,3 porciento; fiebre (33,3 porciento) y obstrucción nasal 16,6 porciento. Evolución satisfactoria con seguimiento por Oftalmología después del egreso hospitalario, en 100 porciento de los casos.

A retrospective longitudinal study of all neonates admitted to our Intensive Care Unit because they suffered from acute dacryocystitis was performed for 10 years (1996-2005). The results were as follows: incidence rate of 0,04 per 100 admissions; prevalence: 7-27d age groups (late sepsis), females with 66,6percent; neonates born to term pregnancies and with good birthweight in 100percent. Inaccurate etiology in 83,3 porciento. Treatment: antibiotic therapy (penicilline + gentamycin in 4 paients, 66,6porciento), (unasyn, one patient, 16,6 percent), (amoxycillin + unasyn +gentamycin, 1 patient, 16.6 porciento). Use of human immunoglobulin in 2 patients. Complications: facial and periorbital cellulitis, 66,6percent; periorbital abscess 33,3 percent; fever (33,3 percent) and nasal obstruction (16,6 percent). Satisfactory recovery with ophtalmological follow-up after discharge from hospital in 100 percent of cases.

A Silastic Sheet found during Endoscopic Transnasal Dacryocystorhinostomy for Acute Dacryocystitis

PURPOSE: To report the case of a silastic sheet that was found during an endoscopic transnasal dacryocystorhinostomy for treatment of acute dacryocystitis with necrosis of the lacrimal sac. METHODS: A thirty-two year old male presented with painful swelling on the nasal side of his left lower lid two weeks prior to visiting this clinic. Fourteen years ago, the patient was involved in a traffic accident and underwent surgery to reconstruct the ethmoidal sinus. Lacrimal sac massage showed a regurgitation of a purulent discharge from the left lower punctum. Therefore, the patient was diagnosed with acute dacryocystitis and an endoscopic transnasal dacryocystostomy was performed the next day. RESULTS: The surgical finding showed severe necrosis around the lacrimal sac and a 20 x 15-mm sized silastic sheet was found crumpled within the purulent discharge. The sheet was removed, the lacrimal sac was irrigated with an antibiotic solution, and a silicone tube was intubated into the lacrimal pathway. After surgery, the painful swelling on the nasal side of left lower lid resolved gradually, and there were no symptomatic complications three months later. CONCLUSIONS: We report the first case where a silastic sheet applied during a facial reconstruction had migrated adjacent to the lacrimal sac resulting in severe inflammation.

Dacriocistite crônica secundária a sarcoidose: relato de caso / Chronic dacryocystitis secondary to sarcoidosis: case report

Descreve-se um caso de dacriocistite crônica secundária a sarcoidose. Foram revistos os dados clínico-patológicos e a técnica cirúrgica usada no tratamento da paciente. Foi realizada dacriocistorrinostomia e intubação da via lacrimal à esquerda. O exame anatomopatológico foi compatível com sarcoidose, que constitui achado raro nas afecções das vias lacrimais.

Nasolacrimal duct foreign body--endoscopic removal.

Foreign body in the nasolacrimal duct is extremely rare. We present a case of foreign body of nasolacrimal duct responsible for recurrent dacryocystitis which was removed with the help of an endoscope.