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1.
Arq. bras. oftalmol ; 84(3): 209-213, May-June 2021. graf
Article in English | LILACS | ID: biblio-1248967

ABSTRACT

ABSTRACT Purpose: To identify the lymphatic vessels in orbital specimens from human cadavers using light microscopy and immunohistochemical analysis. Methods: A postmortem study included 10 orbital specimens from 10 human cadavers. The orbital specimens were obtained no later than 12 hours after death. The orbital specimens were dissected into lacrimal gland, optic nerve, fat tissue, and oculomotor muscles. The histologic criteria to qualify as a lymphatic vessel were thin-walled channels of endothelium without a well-developed basal membrane and with an erythrocyte-free, irregular lumen. The immunohistochemical criteria were irregularly shaped, thin-walled vessels with an erythrocyte-free, irregular lumen and immunopositivity for podoplanin D2-40. Results: The lacrimal gland, optic nerve, fat tissue, and extraocular muscle sections were positively stained with podoplanin D2-40. Conclusions: This study demonstrated lymphatic vessels in the human orbit, more precisely, in the lacrimal gland, dura mater of the optic nerve, adipose tissue, and extrinsic oculomotor muscles via light microscopy and immunohistochemistry.(AU)


RESUMO Objetivos: Identificar vasos linfáticos em espécimes orbitários de cadáveres humanos através de microscopia óptica e análise imunohistoquímica. Métodos: Um estudo postmortem incluiu dez espécimes orbitários provenientes de dez cadáveres humanos. Todos os espécimes orbitários foram obtidos até 12 horas após a morte com uma técnica cirúrgica de exenteração orbitária e dissecados em glândula lacrimal, nervo óptico, gordura órbitária e músculos extraoculares. Para classificar como um vaso linfático, os critérios histológicos incluíram vasos endoteliais de parede única sem membrana basal bem desenvolvida, irregulares e lúmen sem hemácias, e os critérios imunohistoquímicos incluíram vasos endoteliais de parede única, com formato irregular e lúmen sem hemácias e reagentes a podoplanina D2-40. Resultados: As lâminas histológicas de glândula lacrimal, nervo óptico, tecido adiposo e músculos extraoculares reagiram positivamente a podoplanina D2-40. Conclusão: Este estudo demonstrou vasos linfáticos na órbita humana, mais exatamente, na glândula lacrimal, no nervo óptico, na gordura orbitária e nos músculos extrínsecos extraoculares via microscopia óptica e imunohistoquímica.(AU)


Subject(s)
Optic Nerve/anatomy & histology , Orbit/anatomy & histology , Lymphatic Vessels/diagnostic imaging , Immunohistochemistry , Lacrimal Apparatus/anatomy & histology , Microscopy/instrumentation , Oculomotor Muscles/anatomy & histology
2.
Arq. bras. oftalmol ; 84(1): 78-82, Jan.-Feb. 2021. graf
Article in English | LILACS | ID: biblio-1153102

ABSTRACT

ABSTRACT This report is of three cases of sicca syndrome, initially suspected to be Sjögren's syndrome, which was ruled out by clinical and laboratory investigations. The patients were a 24-year-old woman, a 32-year-old man, and a 77-year-old woman with chronic symptoms of sicca syndrome, including dry eye syndrome. The first case was associated with the use of isotretinoin, a retinoic acid. The second was associated with the use of anabolic androgenic steroids, and the third was related to a prolactin- secreting pituitary adenoma. All cases manifested sicca, including dry eye syndrome, after those events, and the manifestations persisted. Magnetic resonance imaging revealed bilateral atrophy of the lacrimal gland. The medical history, ocular examinations, laboratory exams, and magnetic resonance images confirmed dry eye syndrome; however, the exams were all negative for Sjögren's syndrome. The lacrimal gland was absent on magnetic resonance imaging in all three cases. The clinical history revealed that the signs and symptoms appeared after chronic exposure to retinoic acid, anabolic androgenic steroids, and a prolactin-secreting pituitary adenoma, respectively. Chronic isotretinoin, anabolic androgenic steroids, and prolactin-secreting pituitary adenoma or, in this last case, its inhibitory treatment, can cause lacrimal gland atrophy, sicca syndrome, and dry eye syndrome, and a differential diagnosis of Sjögren's syndrome. Further studies on doses, time, and other susceptibilities to the long-lasting adverse effects of retinoic acid, anabolic androgenic steroids, and the repercussions of prolactin-secreting pituitary adenoma are necessary to confirm and expand upon these associations.


RESUMO O relato descreve três casos de síndrome de sicca, inicialmente suspeitos de serem a síndrome de Sjögren, que fo­ram negados pela investigação clínica e laboratorial. O primeiro associado ao uso de isotretinoína, um ácido retinóico, o segundo ao uso de esteroides androgênicos anabolizantes e o terceiro relacionado ao adenoma da hipófise secretora da prolactina, todos manifestaram sicca, incluindo a síndrome do olho seco após esses eventos e as manifestações persistem. A ressonância magnética revelou atrofia bilateral da glândula lacrimal. Eles eram uma mulher de 24 anos, um homem de 32 anos e uma mulher de 77 anos com sintomas crônicos da síndrome de sicca, incluindo a síndrome do olho seco. A história médica, o exame ocular, os exames laboratoriais e a ressonância magnética foram confirmados como síndrome do olho seco, no entanto, todos os exames foram negativos para a síndrome de Sjögren. A glândula lacrimal estava ausente na ressonância magnética nos três casos. A história clínica revelou que sinais e sintomas se manifestaram após exposição crônica ao ácido retinóico, esteróides anabolizantes androgênicos e adenoma secretivo da prolactina hipofisária, respectivamente. Isotretinoína crônica, esteroides anabólicos androgênicos e adenoma hipofisário secretor de prolactina ou, neste último caso, seu tratamento inibitório pode ser a causa da atrofia da glândula lacrimal, síndrome da sicca e síndrome do olho seco e diagnóstico diferencial da síndrome de Sjögren. Estudos adicionais sobre doses, duração e outras suscetibilidades aos efeitos adversos duradouros do ácido retinóico, esteroides androgênicos anabólicos e repercussões do adenoma da hipófise secretora da prolactina são necessários para confirmar e detalhar essas associações.


Subject(s)
Humans , Male , Female , Adult , Aged , Dry Eye Syndromes , Sjogren's Syndrome , Lacrimal Apparatus , Prolactin , Atrophy , Dry Eye Syndromes/diagnosis , Dry Eye Syndromes/chemically induced , Dry Eye Syndromes/pathology , Isotretinoin/adverse effects , Sjogren's Syndrome/diagnosis , Sjogren's Syndrome/chemically induced , Sjogren's Syndrome/pathology , Diagnosis, Differential , Androgens , Lacrimal Apparatus/pathology , Lacrimal Apparatus/diagnostic imaging
3.
Medicentro (Villa Clara) ; 24(3): 564-577, jul.-set. 2020. tab
Article in Spanish | LILACS | ID: biblio-1125016

ABSTRACT

RESUMEN Introducción: la dacriocistorrinostomía externa es la técnica más empleada por la mayoría de los cirujanos oculoplásticos para tratar a los pacientes con obstrucción del canal nasolagrimal. Es posible que los galenos cometan algunos errores en este tipo de cirugía, a pesar de los grandes avances en las tecnologías ópticas, las técnicas quirúrgicas y el uso de modernos materiales de intubación. La principal causa de los errores es el cierre de la osteotomía por tejido cicatrizal o de granulación, con la formación de sinequias en la cavidad nasal. La mitomicina C es el antibiótico alquilante más estudiado en la prevención del exceso de cicatrización en el área de la osteotomía; sin embargo, existen acuerdos y desacuerdos entre estudiosos del tema sobre la eficacia, dosis y tiempo de exposición de este medicamento. El papel de cada una de estas variables en el resultado final de la cirugía es controversial. Objetivo: brindar evidencias sobre el papel de la aplicación transoperatoria de la mitomicina C en la dacriocistorrinostomía externa. Métodos: se realizó una revisión de la bibliografía actualizada disponible en idioma español e inglés. Se consultaron los textos completos y resúmenes en las bases de datos: PubMed, Ebsco, Google Académico y Scielo. También se revisaron novedosos artículos en prestigiosas revistas especializadas. Conclusiones: la mayoría de los autores coinciden en que este medicamento contribuye a elevar la tasa de éxito de la dacriocistorrinostomía externa; aunque su aplicación es segura, todavía se estudian algunas variables que mejorarían su eficacia.


ABSTRACT Introduction: external dacryocystorhinostomy is the most used technique by oculoplastic surgeons to treat patient with nasolacrimal duct obstruction. Physicians may make some mistakes in this type of surgery despite great advances in optical technologies, surgical techniques and the use of modern materials for intubation, The main cause of errors is the closure of the osteotomy due to scar tissue or granulation with synechia formation in the nasal cavity. Mitomycin-C is the most studied alkylating antibiotic in the prevention of excessive scarring in the osteotomy area; however, there are some agreements and disagreements among scholars on the efficacy, dosage and time of exposure of this drug. The role of each of these variables in the final outcome of the surgery is controversial. Objective: to provide some evidences about the transoperative application of Mitomycin-C in external dacryocystorhinostomy. Methods: a review of the updated bibliography available in Spanish and English languages was carried out. Complete texts and abstracts were consulted in the databases: PubMed, Ebsco, Google Scholar and Scielo. Novel articles were also reviewed in prestigious specialized journals. Conclusions: must authors agree that this drug appears to improve the success rate of external dacryocystorhinostomy. Although its application is safe, some variables are still being studied that would improve its efficacy.


Subject(s)
General Surgery , Dacryocystorhinostomy , Mitomycin , Lacrimal Apparatus , Lacrimal Duct Obstruction
4.
Arq. bras. med. vet. zootec. (Online) ; 72(3): 749-753, May-June, 2020. ilus
Article in English | ID: biblio-1129166

ABSTRACT

This study aims to describe the first Brazilian report of a nictitating membrane cyst's surgical treatment in a dog. A 6-month-old female French Bulldog presented at HOSVET-UNIME with a reddish mass-like structure in the medial canthus of both eyes, with a history of recurrent third eyelid gland prolapse previously treated with two surgeries performed at another clinic. Physical examination revealed a third eyelid gland prolapse in the right eye and a cyst in the left eye's third eyelid. The animal was submitted to surgical correction of the right eye's third eyelid prolapse using pocket technique and of the left eye's third eyelid using marsupialization technique for the cyst's treatment. 180 days after th1e surgical procedure no recurrence was observed. The marsupialization technique for the treatment of a third eyelid's lacrimal cyst in a dog allowed the maintenance of its gland and prevented the formation of a new cystic cavity.(AU)


O objetivo do presente trabalho é descrever o primeiro relato no Brasil de tratamento cirúrgico de um cisto da membrana nictitante em um cão. Um Buldogue Francês, fêmea, seis meses, foi atendido no Hosvet-Unime, com queixa de aumento de volume avermelhado no canto medial de ambos os olhos, com histórico de recidiva de prolapso de glândula da terceira pálpebra, onde haviam sido realizadas duas cirurgias anteriormente em outro local. Ao exame físico, foi observado prolapso de glândula da terceira pálpebra no olho direito e a presença de um cisto na terceira pálpebra do olho esquerdo. O animal foi submetido ao procedimento cirúrgico de sepultamento de glândula da terceira pálpebra no olho direito e uma marsupialização na terceira pálpebra do olho esquerdo para o tratamento do cisto. Cento e oitenta dias após o procedimento cirúrgico, não foi observada recidiva. A técnica de marsupialização para tratamento de cisto lacrimal na terceira pálpebra em um cão possibilitou a manutenção da sua glândula e impediu a formação de nova cavidade cística.(AU)


Subject(s)
Animals , Female , Dogs , Cysts/veterinary , Lacrimal Apparatus/surgery , Nictitating Membrane/surgery , Prolapse , Surgical Procedures, Operative/veterinary
5.
Int. arch. otorhinolaryngol. (Impr.) ; 23(4): 422-426, Out.-Dez. 2019. ilus, tab
Article in English | LILACS | ID: biblio-1024327

ABSTRACT

Introduction: Chronic rhinosinusitis (CRS) is a highly prevalent pathology in our society. Due to the prevalence of this condition and to the persisting symptoms despite an appropriate medical treatment, surgical techniques are often required. Lately, minimal invasive techniques have been described, such as lacrimal diversion devices (LDDs). This technique offers a fast and convenient choice for delivery of sinus irrigation and topical medication. Objective: We aimed to describe our experience with LDDs and evaluate the safety and effectiveness of the procedure in patients with moderate to severe CRS without nasal polyposis (CRSsNP) and persistent symptomatology despite medical therapy. Methods: A total of 7 patients underwent bilateral lacrimal stents placement in the operating room. A retrospective observational study was conducted. The Sino-Nasal Outcome Test-20 (SNOT-20) survey was performed and the score obtained was compared before and 1 month after the procedure. Results: The LDDs were used for an average of 80 days. During the follow-up, only three patients had a mild complication with the device (granuloma in the punctum, obstruction, and early extrusion). The mean baseline SNOT-20 score dropped significantly ( p = 0.015) from 25.85 to 11.57 (mean: - 14.29) 1 month after the procedure. Conclusion: According to our experience and results, the use of LDD is a novel, feasible, and less invasive technique to treat refractory CRS. It reduces the risk of mucosal stripping, provides short-term outcomes, and the surgical procedure does not require advanced training in endoscopic sinus surgery. Moreover, it can be performed in-office under local anesthesia or sedation (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Sinusitis/surgery , Stents , Rhinitis/surgery , Nasal Surgical Procedures/methods , Retrospective Studies , Minimally Invasive Surgical Procedures/methods , Lacrimal Apparatus/surgery
6.
Arq. bras. oftalmol ; 82(5): 394-399, Sept.-Oct. 2019. graf
Article in English | LILACS | ID: biblio-1019429

ABSTRACT

ABSTRACT Purpose: Punctal stenosis can result in symptoms such as epiphora and can significantly reduce the quality of life of patients. Perforated punctal plug insertion is an easy procedure that is commonly used as the first step of treatment for punctal stenosis. Methods: Clinical, demographic, and outcome data were retrospectively collected for 54 eyes of 21 males and 11 females who consecutively presented to our Oculoplastic Clinic and underwent silicone Micro Flow perforated punctal plug insertion. All patients had epiphora with punctal stenosis. Results: Of the 54 plugs, 26 plugs (48.1%) were lost and 28 (51.8%) stayed in place. Of the latter, eight were explanted because of the occlusion of the plug with secretions and recurrent conjunctivitis; moreover, two plugs migrated deep into the vertical canaliculus. Of the 54 plugs, only 18 (33.3%) were well-tolerated with significant symptomatic improvement. Conclusion: Plug loss is a prominent problem in patients implanted with perforated punctal plugs. Silicone punctal plugs failed in 66.7% of our patients over a mean follow-up of 14.2 months.


RESUMO Objetivo: A estenose punctal pode resultar em sintomas como a epífora e diminuir significativamente a qua­lidade de vida dos pacientes. A inserção de um tampão perfurado é um procedimento fácil que é comumente usado como o primeiro passo do tratamento para a estenose punctal. Métodos: Dados clínicos, demográficos e de resultado foram coletados retrospectivamente de 54 olhos de 21 homens e 11 mulheres que consecutivamente se apresentaram em nossa Clínica de Oculoplástica e foram submetidos a inserção de um tampão de silicone perfurado Micro Flow. Todos os pacientes tinham epífora com estenose punctal. Resultados: Dos 54 tampões, 26 (48,1%) foram perdidos e 28 (51,8%) permaneceram no local. Destes últimos, 8 foram removidos devido a oclusão do tampão com secreção e conjuntivite recorrente, além disso, 2 migraram profundamente no canalículo vertical. Dos 54 tampões, apenas 18 (33,3%) foram bem tolerados com significativa melhora dos sintomas. Conclusão: A perda de tampões é um problema de destaque em pacientes implantados com tampões perfurados. Tampões de silicone falharam em 66,7% dos pacientes durante um seguimento médio de 14,2 meses.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Silicones/administration & dosage , Dry Eye Syndromes/surgery , Punctal Plugs/adverse effects , Lacrimal Apparatus/surgery , Lacrimal Duct Obstruction/therapy , Prostheses and Implants , Tears , Dry Eye Syndromes/complications , Prosthesis Implantation , Lacrimal Duct Obstruction/etiology
7.
Biosci. j. (Online) ; 35(4): 1173-1178, july/aug. 2019. graf, ilus
Article in English | LILACS | ID: biblio-1048854

ABSTRACT

The tear lipid layer (oily outer layer) reduces evaporation and prevents tear overflow. In dogs, reductions in the lipid components of this layer (cholesterol, triglycerides and phospholipids) can cause eye serious diseases. In this way, the tear crystallization test analyzes the lacrimal quality, however, it is less used in veterinary. As phytosterol reduces blood cholesterol, the objective of this study was to investigate, through the tear crystallization test, whether the systemic administration of this drug influences the lacrimal quality of healthy dogs and, in addition, to verify differences in the interpretation of the ophthalmic test between different evaluators. Eight beagles, healthy, of both sexes, young and adults, without clinical ophthalmic signs apparent were selected. Basal lacrimal samples (D0) were collected from the right and left eye of all animals with glass capillary tube and arranged on a glass slide for scanning the images and subsequent microscopic analysis. Subsequently, all were medicated with the phytosterol (Collestra® 650 mg: 1 capsule, orally, every 12 hours, for 15 days). After seven (D7) and fifteen (D15) days of this systemic administration, the tear crystallization test in both eyes of all dogs was again performed for statistical comparison with the baseline results. The photographs of the slides were classified by four evaluators (AV1 and AV2 with professional experience in ophthalmology and AV3 and AV4 without previous professional experience in ophthalmology), following standards established by Rolando (1984). The results were statistically verified by analysis of simple variance (ANOVA One-Way). There was no statistical difference in the tear crystallization test between the established periods and in relation to the different ophthalmic test evaluators (p≤0.05). Although phytosterols reduce blood cholesterol levels, it was observed in the present study that these drugs when administered systemically did not interfere in the tear lipid layer and, consequently, in the lacrimal quality of healthy dogs, and may be prescribed as lipid-lowering agents for patients with ocular diseases, especially the lacrimal ones.


A camada lipídica lacrimal (camada externa oleosa) reduz a evaporação e previne o transbordamento lacrimal. Em cães, reduções nos componentes lipídicos desta camada (colesterol, triglicérides e fosfolipídios) podem causar doenças graves nos olhos. Desta forma, o teste de cristalização lacrimal analisa a qualidade lacrimal, no entanto, é menos utilizado em veterinária. Como o fitoesterol reduz o colesterol sanguíneo, o objetivo deste estudo foi investigar, através do teste de cristalização lacrimal, se a administração sistêmica deste fármaco influencia na qualidade lacrimal de cães hígidos e, além disso, verificar diferenças na interpretação do teste oftalmológico entre diferentes avaliadores. Oito beagles, saudáveis, de ambos os sexos, jovens e adultos, sem sinais oftalmológicos clínicos aparentes foram selecionados. Amostras lacrimais basais (D0) foram coletadas do olho direito e esquerdo de todos os animais, com tubo capilar de vidro e, dispostas em lâmina de vidro para escaneamento das imagens e posterior análise microscópica. Ato contínuo todos foram medicados com o fitoesterol (Collestra® 650 mg: 1 cápsula, por via oral, a cada 12 horas, durante 15 dias). Após sete (D7) e quinze (D15) dias desta administração sistêmica, o teste de cristalização lacrimal em ambos os olhos de todos os cães foi novamente realizado para comparação estatística com os resultados basais. As fotografias das lâminas foram classificadas por quatro avaliadores (AV1 e AV2 com experiência profissional em oftalmologia e AV3 e AV4 sem experiência profissional prévia em oftalmologia), seguindo padrões estabelecidos por Rolando (1984). Os resultados foram estatisticamente verificados pela análise de variância simples (ANOVA One-Way). Não houve diferença estatística no teste de cristalização lacrimal entre os períodos estabelecidos e em relação aos diferentes avaliadores de teste oftalmológico (p≤0,05). Embora os fitoesteróis reduzam os níveis de colesterol no sangue, observou-se no presente estudo que esses fármacos quando administrados sistemicamente não interferiram na camada lipídica da lágrima e, consequentemente, na qualidade lacrimal de cães hígidos, podendo ser prescritos como agentes hipolipemiantes para pacientes com doenças oculares, especialmente as lacrimais.


Subject(s)
Ophthalmology , Phytosterols , Dogs , Lacrimal Apparatus , Lipids
8.
Article in English | WPRIM | ID: wpr-719449

ABSTRACT

BACKGROUND/AIMS: This study investigated the clinical and pathological features of immunoglobulin G4 (IgG4)-related ophthalmic disease. To clarify the features, we compared IgG4-related ophthalmic disease and orbital inflammatory pseudotumor. METHODS: We retrospectively reviewed the medical records of 103 patients who were initially diagnosed with orbital inflammatory pseudotumor, and identified 16 cases in which the diagnosis was based on surgical biopsy and for which data in medical records were sufficient for analysis. Immunohistochemical staining of pathological specimens for IgG and IgG4 was performed. Finally, six of IgG4-related ophthalmic disease patient and 10 of orbital inf lammatory pseudotumor patient were analyzed. RESULTS: The IgG4-related ophthalmic disease group had more IgG4-positive plasma cells and a higher IgG4/IgG plasma cell ratio than the orbital inflammatory pseudotumor group. Collagenous fibrosis and lacrimal gland involvement were significantly more frequent in the IgG4-related ophthalmic disease group. Dense lymphocyte infiltration, obliterative phlebitis, and bilateral lesions were more frequent in IgG4-related ophthalmic disease, but the differences were not significant. The recurrence-free period was shorter in the IgG4-related ophthalmic disease group (p = 0.035). CONCLUSIONS: The location of the lesion (lacrimal gland), count and ratio of IgG4-positive plasma cells, and collagenous fibrosis aid the diagnosis of IgG4-related ophthalmic disease in patients with idiopathic orbital mass-like lesions. In addition, maintenance therapy should be considered in patients with IgG4-related ophthalmic disease to prevent recurrence.


Subject(s)
Biopsy , Collagen , Diagnosis , Fibrosis , Humans , Immunoglobulin G , Immunoglobulins , Lacrimal Apparatus , Lymphocytes , Medical Records , Orbit , Orbital Pseudotumor , Phlebitis , Plasma Cells , Recurrence , Retrospective Studies
9.
Immune Network ; : e3-2019.
Article in English | WPRIM | ID: wpr-740211

ABSTRACT

Aging is a complex process associated with dysregulation of the immune system and low levels of inflammation, often associated with the onset of many pathologies. The lacrimal gland (LG) plays a vital role in the maintenance of ocular physiology and changes related to aging directly affect eye diseases. The dysregulation of the immune system in aging leads to quantitative and qualitative changes in antibodies and cytokines. While there is a gradual decline of the immune system, there is an increase in autoimmunity, with a reciprocal pathway between low levels of inflammation and aging mechanisms. Elderly C57BL/6J mice spontaneously show LGs infiltration that is characterized by Th1 but not Th17 cells. The aging of the LG is related to functional alterations, reduced innervation and decreased secretory activities. Lymphocytic infiltration, destruction, and atrophy of glandular parenchyma, ductal dilatation, and secretion of inflammatory mediators modify the volume and composition of tears. Oxidative stress, the capacity to metabolize and eliminate toxic substances decreased in aging, is also associated with the reduction of LG functionality and the pathogenesis of autoimmune diseases. Although further studies are required for a better understanding of autoimmunity and aging of the LG, we described anatomic and immunology aspects that have been described so far.


Subject(s)
Aged , Aging , Allergy and Immunology , Animals , Antibodies , Atrophy , Autoimmune Diseases , Autoimmunity , Cytokines , Dilatation , Eye Diseases , Humans , Immune System , Inflammation , Lacrimal Apparatus , Mice , Ocular Physiological Phenomena , Oxidative Stress , Pathology , Tears , Th17 Cells
10.
Immune Network ; : e7-2019.
Article in English | WPRIM | ID: wpr-740207

ABSTRACT

Sjögren's syndrome (SS) is a chronic inflammatory autoimmune disorder that affects mainly salivary and lacrimal glands, but its cause remains largely unknown. Clinical data indicating that SS occurs in a substantial proportion of patients with lupus points to common pathogenic mechanisms underlying the two diseases. To address this idea, we asked whether SS develops in the lupus-prone mouse strain sanroque (SAN). Owing to hyper-activation of follicular helper T (Tfh) cells, female SAN mice developed lupus-like symptoms at approximately 20 wk of age but there were no signs of SS at that time. However, symptoms typical of SS were evident at approximately 40 wk of age, as judged by reduced saliva flow rate, sialadenitis, and IgG deposits in the salivary glands. Increases in serum titers of SS-related autoantibodies and numbers of autoantibody-secreting cells in cervical lymph nodes (LNs) preceded the pathologic manifestations of SS and were accompanied by expansion of Tfh cells and their downstream effector cells. Thus, our results suggest that chronic dysregulation of Tfh cells in salivary gland-draining LNs is sufficient to drive the development of SS in lupus-prone mice.


Subject(s)
Animals , Autoantibodies , Autoimmunity , Disease Models, Animal , Female , Humans , Immunoglobulin G , Lacrimal Apparatus , Lupus Erythematosus, Systemic , Lymph Nodes , Mice , Saliva , Salivary Glands , Sialadenitis
11.
Article in Korean | WPRIM | ID: wpr-738619

ABSTRACT

PURPOSE: When there is a mass in the superior temporal orbit area, a lacrimal gland tumor should be suspected. We report a rare case of orbital lymphatic malformation that was histologically diagnosed in a patient with typical clinical features of the lacrimal gland. CASE SUMMARY: A 55-year-old female with no underlying disease and no ophthalmic history visited our clinic with a right upper eyelid edema associated with an enlarged painless eyelid mass 1 month prior to her visit. The patient stated that she discovered the mass 1 year previously.The palpebral lobe of the lacrimal gland protruded slightly with congestion of the surrounding conjunctiva. Enhanced computed tomography showed a 3 cm well-defined heterogeneous mass in the right lacrimal gland area and several well-defined round calcifications within the mass. Orbital tissue or bone involvement was not observed. The pleomorphic adenoma of the lacrimal gland was the most clinically suspicious, so complete resection of the mass was performed using lateral orbitotomy. Histopathologically, lymphangioma (lymphatic malformation) originating from the lacrimal gland was diagnosed. CONCLUSIONS: Orbital lymphatic malformation can occur in the lacrimal gland. The present case showed that differential diagnosis can reveal the presence of an adult lacrimal gland tumor.


Subject(s)
Adenoma, Pleomorphic , Adult , Conjunctiva , Diagnosis, Differential , Edema , Estrogens, Conjugated (USP) , Eyelids , Female , Humans , Lacrimal Apparatus , Lymphangioma , Middle Aged , Orbit
12.
Article in Korean | WPRIM | ID: wpr-738597

ABSTRACT

PURPOSE: Congenital double puncta are usually unilateral, and the accessory punctum exists on the medial side in a slit configuration that is distinct from the shape of the normal punctum. We report a case of an unusual case of double lacrimal puncta which the lateral, rather than the medial, punctum was judged to be the accessory punctum. CASE SUMMARY: A 39-year-old male patient with no underlying disease and no ophthalmologic history visited our clinic with right eye epiphora of 2 weeks duration. On slit lamp examination, double puncta were observed in the right lower eyelid and the remaining puncta were normal. On lacrimal syringing test and dacryocystography were performed and revealed incomplete obstruction with partial narrowing of the nasolacrimal duct. Silicone tube intubation was performed through the right lower medial punctum and symptoms improved postoperatively. CONCLUSIONS: The present case is an unusual case of double lacrimal puncta which has not been reported in Korea. Unlike the previous literature, the lateral, rather than the medial, punctum was judged to be the accessory punctum. Because accessory punctm can be present on the lateral side, it is necessary to distinguish between the accessory punctm and the main punctum through the accurate dacryocystography and lacrimal syringing test for the treatment of the patient.


Subject(s)
Adult , Eyelids , Humans , Intubation , Korea , Lacrimal Apparatus , Lacrimal Apparatus Diseases , Male , Nasolacrimal Duct , Silicon , Silicones , Slit Lamp
13.
Article in English | WPRIM | ID: wpr-762791

ABSTRACT

Telecanthus is a common symptom accompanied by Waardenburg syndrome, a rare genetic disorder. The optimal surgery for telecanthus correction is still debated. A 28-year-old patient with Waardenburg syndrome underwent transnasal wiring canthopexy using a Y-V epicanthoplasty for telecanthus correction. A Mini-Monoka stent was used to prevent damage to the lacrimal apparatus. The intercanthal distance decreased from 50 mm to 43.2 mm. The easily designed Y-V epicanthoplasty incision provides sufficient operative field for oblique transnasal wiring, which is effective in properly positioning the medial canthal tendon. It has minimal scarring resulting in satisfactory cosmetic outcomes.


Subject(s)
Adult , Cicatrix , Congenital Abnormalities , Craniofacial Abnormalities , Humans , Lacrimal Apparatus , Stents , Tendons , Waardenburg Syndrome
14.
Article in English | WPRIM | ID: wpr-762786

ABSTRACT

The purpose of this study is to discuss several approaches to addressing naso-orbito-ethmoidal (NOE) fracture. Orbital fracture, especially infraorbital fracture, can be treated through the transconjunctival approach easily. However, in more severe cases, for example, fracture extending to the medial orbital wall or zygomatico-frontal suture line, only transconjunctival incision is insufficient to secure good surgical field. And, it also has risk of tearing the conjunctiva, which could injure the lacrimal duct. Also, in most complex types of facial fracture such as NOE fracture or panfacial fracture, destruction of the structure often occurs, for example, trap-door deformity; a fracture of orbital floor where the inferiorly displaced blowout facture recoils to its original position, or vertical folding deformity; fractured fragments are displaced under the other fragments, causing multiple-packed layers of bone.


Subject(s)
Congenital Abnormalities , Conjunctiva , Fractures, Multiple , Lacrimal Apparatus , Maxillary Fractures , Orbit , Orbital Fractures , Sutures , Tears
15.
Article in English | WPRIM | ID: wpr-762775

ABSTRACT

Orbital tuberculosis is a rare form of extrapulmonary tuberculosis, even in endemic areas. It may involve the soft tissue, lacrimal gland, periosteum, or bones of the orbital wall. We present a case of orbital tuberculosis on the lower eyelid. An 18-year-old woman with no underlying disease visited our clinic for evaluation of an oval nodule (1.5× 1.2 cm) on the right lower eyelid. Incision and drainage without biopsy was performed 2 months ago in ophthalmology department, but the periorbital mass had deteriorated, as the patient had erythematous swelling, tenderness, and cervical lymphadenopathy. Visual acuity was normal; there were no signs of proptosis, diplopia, or ophthalmoplegia. Computed tomography revealed a small abscess cavity without bony involvement. We performed an excision and biopsy through a percutaneous incision under local anesthesia. Histological examination revealed a granuloma and was diagnosed as orbital tuberculosis. The patient was additionally treated with anti-tuberculosis therapy for 6 months and recovered without complication or recurrence by 7 months. Orbital tuberculosis occurs in patients with or without associated pulmonary tuberculosis, and should be considered as a differential diagnosis in patients with inflammatory orbital disease and an orbital mass. If recurrence occurs despite adequate initial treatment, we recommend an additional examination and excisional biopsy.


Subject(s)
Abscess , Adolescent , Anesthesia, Local , Biopsy , Diagnosis, Differential , Diplopia , Drainage , Exophthalmos , Eyelids , Female , Granuloma , Humans , Lacrimal Apparatus , Lymphatic Diseases , Ophthalmology , Ophthalmoplegia , Orbit , Orbital Diseases , Periosteum , Recurrence , Tuberculosis , Tuberculosis, Pulmonary , Visual Acuity
16.
Article in Korean | WPRIM | ID: wpr-766877

ABSTRACT

PURPOSE: We report an unusual case of a keratinizing cyst on the lacrimal punctum. CASE SUMMARY: A 49-year-old female presented with an outpouching punctal mass at the left lower lid that occurred a week prior to her visit. Histopathological examination revealed a cyst filled with keratin arranged in lamina and surrounding the bacterial colony. The epithelial wall was composed of multilaminar, keratinizing squamous epithelium without goblet cells. The features were consistent with a keratinizing cyst. There was no recurrence at 4 months after the excision, and the punctum was patent. CONCLUSIONS: Keratinizing cyst should be considered as a differential diagnosis of the cystic mass of the punctum. Because it has an excellent prognosis after surgical resection, complete resection should be performed if a keratinizing cyst is suspected.


Subject(s)
Diagnosis, Differential , Epithelium , Female , Goblet Cells , Humans , Lacrimal Apparatus , Middle Aged , Prognosis , Recurrence
17.
Article in Korean | WPRIM | ID: wpr-766843

ABSTRACT

PURPOSE: To report a case of primary amyloidosis localized to the conjunctiva. CASE SUMMARY: A 19-year-old male with a conjunctival mass and foreign body sensations in the right eye transferred from another hospital. A 0.5 × 2.5 cm reddish mass was present in the medial canthus of the right conjunctiva with no other clinically specific signs. Surgical excisional biopsy was performed. Histological examination showed amyloid deposition. There was no other orbital involvement apart from the conjunctiva. Abnormalities were not found in the systemic examination. CONCLUSIONS: We report a case of primary amyloidosis localized to the conjunctiva.


Subject(s)
Amyloidosis , Biopsy , Conjunctiva , Conjunctival Neoplasms , Foreign Bodies , Humans , Lacrimal Apparatus , Male , Orbit , Plaque, Amyloid , Sensation , Young Adult
18.
Article in English | WPRIM | ID: wpr-786497

ABSTRACT

Immunoglobulin G4 (IgG4)–related diseases are a spectrum of systemic inflammatory conditions of unknown etiology, which are characterized by infiltration of tissues by IgG4 plasma cells and sclerosing inflammation (Cheuk and Chan Adv Anat Pathol 17:303-32, 2010). Although this condition was initially described in relation to autoimmune pancreatitis, now it has been reported in almost every organ system of body (Zen and Nakanuma Am J Surg Pathol 34:1812-9, 2010, Masaki et al. Ann Rheuma Dis 68:1310-5, 2009). Orbital involvement by IgG4 disease can involve extraocular muscles (EOM), lacrimal glands, conjunctiva, eyelids, infraorbital nerve, orbital fat, and nasolacrimal system (McNab and McKelvie. Ophthal Plast Reconstr Surg 31:167-78, 2015, Katsura et al. Neuroradiology 54:873-82, 2012). The basis of using ⁶⁸Ga-DOTANOC PET/CT in IgG4 orbital disease is the known expression of somatostatin receptors in chronic inflammatory cells (Cuccurullo et al. Indian J Radiol Imaging 27:509-16, 2017) and also avidity shown previously in other IgG4-related diseases (Cheng et al. Clin Nucl Med 43:773-6, 2018).


Subject(s)
Conjunctiva , Eyelids , Immunoglobulin G , Immunoglobulins , Inflammation , Lacrimal Apparatus , Muscles , Orbit , Orbital Diseases , Pancreatitis , Plasma Cells , Positron Emission Tomography Computed Tomography , Receptors, Somatostatin
19.
Article in English | WPRIM | ID: wpr-786343

ABSTRACT

PURPOSE: To describe the effects and long-term outcomes of incision and curettage treatment in patients with lacrimal gland ductulitis.METHODS: Twenty-four patients (24 eyes) with lacrimal gland ductulitis who were treated at Saevit Eye Hospital from June 2010 to November 2016. All patients underwent incision and curettage through the lacrimal ductule, and granules or concretions were removed. After the procedure, oral and topical antibiotics, oral anti-inflammatory agent were used for a week. Clinical presentations of the patients were analyzed. The resolution of symptoms and inflammatory signs and recurrence were evaluated more than 12 months after the procedure including telephone follow-up by a specialist nurse.RESULTS: Common symptoms were a painful, swelling mass with mucous discharge (17 eyes) and conjunctival injection (7 eyes) at the lateral canthal area. During the procedure, 22 patients (91.7%) had typical sulfur granule of Actinomyces, and 10 patients (41.7%) had many cilia in the expressed debris from the ductule. Twenty-three of 24 patients had resolution of symptoms after the procedure and all but one patient (95.8%) showed no recurrence.CONCLUSIONS: Incision and curettage is a simple and less invasive procedure that may be considered as a first treatment option for lacrimal gland ductulitis. Furthermore, incision and curettage of the affected lacrimal ductule has been shown to be effective at minimizing long-term recurrence of lacrimal ductulitis.


Subject(s)
Actinomyces , Anti-Bacterial Agents , Cilia , Curettage , Follow-Up Studies , Humans , Lacrimal Apparatus , Recurrence , Specialization , Sulfur , Telephone
20.
Article in Chinese | WPRIM | ID: wpr-813299

ABSTRACT

To investigate the values of orbital single photon emission computed tomography/computerized tomography (SPECT/CT) with 99mTc-diethylene triamine pentaacetic acid (99mTc-DTPA) on the evaluation of lacrimal gland inflammation in patients with thyroid associated ophthalmopathy (TAO).
 Methods: A total of 58 TAO patients were retrospectively recruited for this study, all of whom were categorized into all active group and all inactive group based on the clinical active score (CAS). Another 12 patients with the negative images on SPECT/CT served as a normal control group (NC). All patients were undergone the 99mTc-DTPA orbit SPECT/CT. Quantitative parameters of lacrimal gland including width, length, volume, and the count ratio of region of interest (ROI) drawn on lacrimal gland to the region of occipital brain (target/non-target ratio, T/NT), were measured on axial and coronal slices, respectively. Quantitative parameters were compared among the 3 groups, and the diagnostic value on discrimination of TAO patients from inactive to active ones was evaluated.
 Results: All parameters in TAO patients (except the length on coronal slices and the mean radioactive counts of axial T/NT in the TAO inactive group) were much greater than those in the NC group (P<0.05). All parameters in the TAO active group (except the length on axial and coronal slices) were much greater than those in the TAO inactive group (P<0.05). There were significant lineal positive correlations between the parameters in all TAO patients (except the length on coronal slices ) and CAS. The best diagnostic value was detected by the max radioactive counts of axial T/NT (area under the curve=0.82, P<0.01).
 Conclusion: As an invasive imaging modality, 99mTc-DTPA orbital SPECT/CT is helpful to estimate the lacrimal gland inflammation and to assess the disease activity in TAO patients.


Subject(s)
Graves Ophthalmopathy , Humans , Inflammation , Lacrimal Apparatus , Orbit , Retrospective Studies , Tomography, Emission-Computed, Single-Photon , Tomography, X-Ray Computed
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