Ultrasound parameters of normal lacrimal sac and chronic dacryocystitis / Parâmetros ultrassonográficos do saco lacrimal normal e na dacriocistite crônica

ABSTRACT Purpose: To compared the ultrasound findings of the lacrimal sac between subjects with normal lacrimal systems those with chronic dacryocystitis. Methods: A retrospective study of 10 subjects with a normal lacrimal system (Group 1) and 10 with chronic dacryocystitis (Group 2) diagnosed according to B-mode ultrasound with a 10-MHz transducer and the direct-contact technique (AVISO, Quantel Medical) for lacrimal sac assessment. We analyzed the dimensions, features, and content of the sacs. Characteristics of the population: female: 6, Group 1; 8, Group 2; mean age 48.4 years (SD=19.9; range, 22-80 years), Group 1; 50.5 years (SD=15.5; range, 25-75 years), Group 2. Results: The dimensions of the lacrimal sac were as follows: anteroposterior 1.86 and 10.99 mm in Groups 1 and 2, respectively, p<0.0001; vertical 9.79 and 14.13 mm in Groups 1 and 2, respectively, p=0.049. Qualitative evaluation of the lacrimal sac contents showed hypoechogenic content in Group 1 (10, 100%) and hyperechogenic punctiform content in Group 2 (10, 100%) with partial filling in seven cases (70%). Conclusions: Ultrasonography can differentiate normal lacrimal sacs from sacs compromised by chronic dacryocystitis, thus being useful as an adjunct to clinical examination and surgical planning.

RESUMO Objetivo: Categorizar os achados ultrassonográficos do saco lacrimal em indivíduos com via lacrimal normal e em portadores de dacriocistite crônica. Métodos: Estudo retrospectivo de 20 indivíduos, 10 com via lacrimal normal (Grupo 1) e 10 com diagnóstico de dacriocistite crônica (Grupo 2) utilizando ultrassonografia modo B com transdutor de 10 MHz e técnica de contato (Aviso, Quantel Medical) para avaliar o saco lacrimal. Analisamos os seguintes parâmetros: dimensões, características e conteúdo. Resultados: Características da população estudada: sexo feminino: 6, Grupo 1; 8, Grupo 2; idade média: 48,4 anos (DP=19,93; variação, 22 a 80 anos), Grupo 1; 50,5 anos (DP=15,47; variação, 25 a 75 anos), Grupo 2. As dimensões do saco lacrimal foram aferidas: anteroposterior, 1,86 mm no Grupo 1 e 10,99 mm no Grupo 2, p<0,0001; vertical, 9,79 mm no Grupo 1 e 14,13 mm no Grupo 2, p=0,049. A avaliação qualitativa do conteúdo do saco lacrimal mostrou: conteúdo hipoecogênico no Grupo 1 (10, 100%); e conteúdo puntiforme hiperecogênico no Grupo 2 (10, 100%), com preenchimento parcial em 7 casos (70%). Conclusão: A ultrassonografia foi capaz de diferenciar a via lacrimal normal da acometida por dacriocistite crônica, e de determinar parâmetros úteis para suportar o acompanhamento clínico ou auxiliar no planejamento cirúrgico.

Dacriocistorrinostomía externa: resultados en un año de experiencia en Villa / External dacryocystorhinostomy: outcomes achieved in one-year experience in Villa Clara province

Objetivo: describir los resultados de la cirugía dacriocistorrinostomía externa en un año. Métodos: se realizó un estudio observacional, descriptivo longitudinal prospectivo en 25 pacientes, 28 ojos. Se consideraron las variables sexo, color de piel, edad, lado afectado, etiología, complicaciones y resultados de la cirugía. Resultados: hubo 7 pacientes masculinos y 18 femeninos; de ellos, 16 blancos y 9 no blancos con una diferencia estadísticamente significativa (p= 0,043). La edad promedio fue de 69 ± 11 años. En 13 pacientes (52,0 por ciento) se afectó el lado izquierdo y en el 68,0 por ciento la etiología fue involutiva con significación estadística (p= 0,0003). El sangramiento transoperatorio se presentó como complicación en el 24,0 por ciento de los pacientes. El 92,0 por ciento refirió mejoría de la sintomatología después de operados. Según el criterio del cirujano, la mejoría objetiva se obtuvo en el 88,0 por ciento de los casos. La dacriocistorrinostomía externa fue más frecuente en mujeres blancas encontradas entre su sexta y séptima década de vida. El lado izquierdo fue el más afectado con predominio de la etiología involutiva. Las complicaciones fueron escasas; dentro de ellas predominó el sangramiento transoperatorio. Conclusiones: la mayoría de los pacientes sintieron mejoría después de la cirugía; el criterio del cirujano estuvo a favor de los resultados positivos en la cirugía dacriocistorrinostomía externa(AU)

Objective: to describe the results of external dacryocystorhinostomy surgery in one year. Methods: a prospective, longitudinal descriptive and observational study was conducted in 28 patients from 25 patients. The study variables were gender, race, age, affected side, etiology, complications and surgery outcomes. Results: there were 7 male and 18 female patients, 16 Caucasians and 9 non-Caucasians with statistically significant difference (p= 0,043). The mean age was 69 ± 11 years. The obstruction involved the left side in 13 patients (52 percent) and involution was the main etiology in 68 percent with statistical significance (p= 0,0003). Perioperative bleeding was the main complication (24 percent). In the group, 92 percent said the symptoms had reduced after surgery, and according to the surgeon, objective improvement was attained in 88 percent of cases. Conclusion: external dacryocystorhinostomy was more frequent in Caucasian women aged 60 to 70 years. The left side was the most affected, with prevailing involution etiology. There were minimum complications, being perioperative bleeding predominant. Most of the patients felt better after surgery and the surgeon´s criteria were in favor of the positive results of this surgery(AU)

[Lacrimal drainage obstruction as an early presentation of lacrimal sac lymphoma]

To report a case of lacrimal sac lymphoma presenting with nasolacrimal obstruction. A 35-year-old women presented with epiphora and swelling of the left lacrimal sac area and cervical lymphadenopathy. She had undergone dacryocystorhinostomy [DCR] 6 months before. Computed tomography demonstrated a lacrimal sac mass involving the nasal cavity. Histopathologic examination revealed diffuse large cell lymphoma. According to immunohistologic staining, the tumor was B-cell type. The patient was treated with irradiation and chemotherapy. Lacrimal sac tumors may present with epiphora and dacryocystits masquerading as nasolacrimal canal obstruction

Clinicopathologic Findings after Nasolacrimal Polyurethane Stent Implantations

PURPOSE: To evaluate the results of nasolacrimal polyurethane stent implantations for the treatment of primary acquired nasolacrimal duct obstruction, and to determine the effects of various surgical procedures, including stent removal, in subsequent nasolacrimal duct obstruction. METHODS: This study included 15 patients who had nasolacrimal polyurethane implantations for the treatment of primary acquired nasolacrimal duct obstruction. Occluded stents were removed either by nasal endoscopy or during dacryocystorhinostomy (DCR). Cultures and biopsies were performed on the removed stents, and the results of the secondary DCR were analyzed for a 6-month follow-up period. RESULTS: During stent removal surgery, various degrees of chronic inflammatory reaction and fibrous tissue formation were detected in the lacrimal sac and nasolacrimal duct. Formations of granuloma and fibrous tissue were found in 15 eyes, and culture-positive reaction were found in nine of the 15 eyes. Conventional dacryocystorhinostomy surgery was performed in nine of the 15 eyes and a silicone tube was located at the canaliculi. Subjective and objective outcome were favorable in 13 of the 15 eyes. CONCLUSIONS: The success rate of nasolacrimal polyurethane stent implantation for the treatment of primary acquired nasolacrimal duct obstruction is low. This may result from a chronic inflammatroy reaction. Despite the low success rate of nasolacrimal polyurethane stent implantation, the success rate of endonasal DCR as a subsequent surgery is favorable.

Síndrome de Down e alterações de vias lacrimais / Down syndrome and lacrimal system disorders

OBJETIVO: Caracterizar as alteraçöes de vias lacrimais em portadores de síndrome de Down. MÉTODOS: Estudo retrospectivo descritivo envolvendo 11 olhos de 8 pacientes com diagnóstico de síndrome de Down, acompanhados no período de 1995 a 2001. RESULTADOS: Todos os pacientes apresentaram quadro de dacriocistite crônica com obstruçäo no ducto nasolacrimal. Um paciente cursou também com canaliculite por Strepto- coccus sp e outro paciente apresentava ausência do ponto lacrimal inferior. Cinco pacientes foram submetidos à dacriocistorrinostomia, três à sondagem e intubaçäo das vias lacrimais. A epífora foi resolvida em 4 olhos. CONCLUSÖES: Existem poucos relatos acerca do comprometimento das vias lacrimais em pacientes com síndrome de Down. A caracterizaçäo e a resoluçäo cirúrgica do mecanismo obstrutivo lacrimal säo importantes, uma vez que há interferência na qualidade de vida desses pacientes. No presente estudo, verificou-se que a obstruçäo da via lacrimal ocorreu no ducto nasolacrimal. O prognóstico cirúrgico foi ruim em 83,4 por cento das intubaçöes e em 57,2 por cento das dacriocistorrinostomias. Causas do insucesso cirúrgico podem estar relacionadas à maior fibrose pós-operatória nesses pacientes e à dificuldade de colaboraçäo dos mesmos no controle pós-cirúrgico. Estudos posteriores säo necessários para verificaçäo das presentes observaçöes

Pseudo-obstruçäo nasolacrimal na infância / Pseudonasolacrimal obstruction in infancy

Avaliamos 22 crianças de 6 meses a 8 anos de idade, portadoras e pseudo-obstruçäo nasolacrimal (PONL). A PONL ocorreu mais frequentemente no sexo feminino (68,2 por cento). A queixa e epífora foi esporádica, geralmente associada à processos obstrutivos de vias aéreas superiores. A dacriocistografia (DCG) mostrou vias lacrimais pérveas em todas as crianças e alteraçöes nasais, como hipertrofia de cornetos (77,3 por cento), velamento dos seios da face (18,2 por cento), desvio do septo nasal (18,2 por cento), espessamento mucoso dos seios da face (13,6 por cento) e dilataçäo do saco lacrimal (13,6 por cento). Os auotres sugerem que se pense na PONL quando se tem epífora esporádica, DCG com VL pérveas e sinais obstrutivos nasais