Lacrimal gland atrophy and dry eye related to isotretinoin, androgen, and prolactin: differential diagnosis for Sjögren's syndrome / Atrofia das glândulas lacrimais e olho seco relacionados aisotretinoína, androgênio e prolactina: diagnóstico diferencial com a síndrome de Sjögren

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.

Evaluation of lacrimal gland dimensions with MR imaging in a Turkish population sample / Evaluación de las dimensiones de la glándula lagrimal con imágenes de RM en una muestra de población turca

SUMMARY: We aimed to evaluate the morphology of normal lacrimal gland in three different axes in a Turkish population sample by using magnetic resonance (MR) images in relation to sex, age, and side. Cranial MR images obtained by 3 Tesla MR unit of 85 individuals (40 female, 45 male; mean age 42.20±23.30 years; age range 2-83 years) performed in Göztepe Medical Park Hospital between December 2015 and July 2017 for non-orbital diseases were evaluated retrospectively. Anteroposterior, craniocaudal, and transverse dimensions of the lacrimal gland were measured on axial, coronal, and sagittal planes of MR images, and were evaluated in relation to side, age, and sex. Axial transverse and sagittal craniocaudal dimensions of lacrimal gland were significantly greater in the right side, as the coronal craniocaudal and sagittal anteroposterior dimensions were greater in the left side. Female and male individuals showed differences in terms of right-left sides in most of the parameters. In Spearman's correlation analysis, age of individuals was negatively correlated with left axial anteroposterior (r=-0.347, p=0.020), left axial transverse (r=-0.439, p=0.003), left coronal transverse (r=-0.429, p=0.003), and right coronal transverse (r=-0.436, p=0.003) dimensions of lacrimal gland. This is the first study determining certain morphometric parameters of the lacrimal gland in Turkish population sample. The side of lacrimal gland, and sex and age of individuals affect its dimensions. On the basis of reference measurements in the present study, orbital MR imaging can be used for the evaluation of lacrimal gland and its pathologies.

RESUMEN: El objetivo de este estudio fue evaluar la morfología de la glándula lagrimal normal en tres ejes diferentes en una muestra de población turca, mediante el uso de imágenes de resonancia magnética (RM) en relación con el sexo, la edad y lados izquierdos- derechos. Las imágenes RM obtenidas por RM 3 Tesla, en 85 individuos (40 mujeres y 45 hombres, edad media 42.20 ± 23.30 años, rango de edad entre 2 y 83 años) se realizaron en Göztepe Medical Park Hospital, entre diciembre de 2015 y julio de 2017. Considerando las enfermedades no orbitales, estas fueron evaluadas retrospectivamente. Se midieron las dimensiones anteroposterior, craneocaudal y transversal de la glándula lagrimal en los planos axial, coronal y sagital de las imágenes, y se evaluaron en relación con el lado, la edad y el sexo. Las dimensiones craneocaudal axiales transversales y sagitales de la glándula lagrimal fueron significativamente mayores en el lado derecho, y las dimensiones craneocaudal y anteroposterior sagital coronal fueron mayores en el lado izquierdo. Individuos femeninos y masculinos mostraron diferencias en términos de lados derecho-izquierdo en la mayoría de los parámetros. En el análisis de correlación de Spearman, la edad de los individuos se correlacionó negativamente con el anteroposterior axial izquierdo (r = -0.347, p = 0.020), transversal axial izquierdo (r = -0.439, p = 0.003), transversal coronal izquierdo (r = -0.429, p = 0.003), y las dimensiones transversales coronales derechas (r = -0.436, p = 0.003) de la glándula lagrimal. Este es el primer estudio que determina ciertos parámetros morfométricos de la glándula lagrimal en la muestra de la población turca. El lado de la glándula lagrimal, y el sexo y la edad de los individuos afectan sus dimensiones. En el presente estudio basado en las mediciones de referencia, la RM orbital se puede utilizar para la evaluación de la glándula lagrimal y sus patologías.

Solitary fibrous tumor of the lacrimal gland mimicking pleomorphic adenoma / Tumor fibroso solitário de glândula lacrimal simulando adenoma pleomórfico

ABSTRACT Solitary fibrous tumor (SFT) is a rare mesenchymal spindle-cell neoplasm commonly found in the pleura; it is rare in the orbit and extremely rare in the lacrimal gland. We herein report a case of SFT of the lacrimal gland that mimicked a pleo morphic adenoma. We discuss the clinical, radiological, histopathological, and immunohistochemical findings that provided insight and rationale to accurately diagnose this case.

RESUMO Os autores relatam um caso de tumor fibroso solitário (TFS) de glândula lacrimal simulando um adenoma pleomórfico. O TFS é um raro tumor mesenquimal de células fusiformes, comumente encontrado na membrana pleural, raramente en contrado na órbita e extremamente raro na glândula lacrimal. Os autores discutem os achados clínicos, radiológicos, histológicos e imunohistoquímicos que são a chave para o correto diagnóstico desta rara entidade.

Accidental lacrimal gland removal during resection of the levator palpebrae superioris muscle / Remoção acidental da glândula lacrimal em cirurgia de ressecção do músculo levantador da pálpebra superior

ABSTRACT Accidental removal of the lacrimal gland is a rare complication of ptosis surgery. We report two children who underwent large unilateral levator palpebrae superioris resections (LPSr). After surgery, both patients developed dry eye. Post-operatively, the parents of both patients noticed no tears in the affected eye when their child cried. Computed tomography proved the absence of the lacrimal gland in the operated eye in both patients. Oculoplastic surgeons should pay close attention to the anatomy of the levator muscle and its proximity to surrounding tissues in order to avoid lesions on important orbital structures, including the lacrimal gland, and to avoid the development of long-term dry eye.

RESUMO A remoção acidental da glândula lacrimal é uma complicação rara da cirurgia de ptose. Relatamos duas crianças que foram submetidas à grandes ressecções unilaterais do músculo levantador da pálpebra superior que desenvolveram olho seco após a cirurgia. No pós-operatório, os pais notaram ausência de secreção lacrimal durante o choro no olho operado. Tomografia computadorizada de órbitas comprovou ausência da glândula lacrimal no olho submetido à cirurgia, em ambos os casos. Cirurgiões oculoplásticos devem estar atentos à anatomia do músculo levantador e estruturas relacionadas para evitar lesões em importantes estruturas orbitais como as da glândula lacrimal que podem induzir permanente olho seco.

Primary Systemic Amyloidosis Involving the Lacrimal Sac

No abstract available.

Lacrimal Intrasaccal Cyst

No abstract available.

Dacryoscintigraphic Findings in the Children with Tearing

PURPOSE: To investigate the diagnostic effectiveness of dacryoscintigraphy in children with tearing; to evaluate tear clearance rate as a diagnostic factor of dacryoscintigraphy in children with tearing; and to analyze the results of treatment according to dacryoscintigraphic findings in children with tearing. METHODS: Between January 2010 and April 2014, 176 eyes of 88 children with tearing (49 boys and 39 girls; mean age, 23.81 ±14.67 months; range, 12 to 72 months) were studied retrospectively. Of these, 37 of 88 children with tearing were bilateral cases, and 51 were unilateral cases. None of the patients had a history of craniofacial disorder or trauma. The chief complaint of tearing with or without eye discharge and delivery mode, past history of neonatal conjunctivitis, syringing, or probing were collected from parents, grandparents, or previous hospital data. The drainage pattern of the nasolacrimal duct was analyzed, and the clearance rate of 50 microCi 99m technetium pertechnetate was measured by dacryoscintigraphy. RESULTS: According to the dacryoscintigraphy results, 98 of 125 eyes (78.4%) with tearing showed nasolacrimal obstruction and 29 of 51 eyes (56.9%) without tearing showed patency. There was a significant difference between tearing eyes and normal eyes (p = 0.001). The clearance rate difference after 3 and 30 minutes was 16.41 ± 15.37% in tearing eyes and 23.57 ±14.15% in normal eyes. There was a significant difference between epiphoric eyes and normal eyes (p = 0.05). Based on the dacryoscintigraphic findings, nasolacrimal-duct obstruction was treated with probing or silicone-tube intubation. The majority of patients showed symptom improvement (75.2%) during the two months of follow-up. CONCLUSIONS: Dacryoscintigraphy is a non-invasive method of qualitatively and quantitatively diagnosing nasolacrimal duct obstruction in children with tearing.

Helical computed tomographic dacryocystography and its role in the diagnosis and management of lacrimal drainage system blocks and medial canthal masses.

AIM: To study the indications, technique and diagnostic utility of helical computed tomographic dacryocystography (CTDCG). MATERIALS AND METHODS: Retrospective analysis of 13 patients who underwent CTDCG with subsequent surgical intervention, during the period January 2003 to December 2005, was done. Axial plain computed tomography (CT) scan was performed, followed by administration of water-soluble contrast in the conjunctival cul de sac or by cannulation of the lacrimal passages. Thin-slice helical CT with two-dimensional (2D) and three-dimensional (3D) coronal and sagittal reformation was done. RESULTS: Four patients were males and 9 were females. Age range was 5 to 62 years. Seven patients presented with watering and 6 patients with a medial canthal mass. Three patients had history of trauma. CTDCG was performed by instillation technique in 10 patients and by cannulation in 3 patients. CTDCG showed mass lesion displacing the sac in 5 cases, nasolacrimal duct obstruction in 6 cases and mucocele in 2 cases. Based on the findings on CTDCG, 5 patients underwent mass excision, 7 underwent dacryocystorhinostomy and 1 patient underwent primary silicone tube intubation. CONCLUSION: Helical CTDCG is a safe and useful diagnostic tool for the lacrimal surgeon. Instillation technique is a physiological and convenient method, and cannulation is needed only in cases where adequate visualization is not achieved.

Dacryocystography in congenital epiphora

This work aimed to study the role of dacryocystography in the management of congenital epiphora. Twenty-four dacryocystograms of 17 children with congenital epiphora showed bilaterally of the disease in 41% of the cases. The site of obstruction was found in nasolacrimal duct. The obstruction was detected in 58.34% of the eyes in upper part of nasolacrimal duct and in 41.66% in its lower part. Lipiodol injection could relieve 33.3% of the obstructions and probings was successful in 50% while 16.7% of the obstructions did not improve. It was concluded that dacryocystography is an essential investigation in congenital epiphora. The lower the obstruction of nasolacrimal duct the better the prognosis. Lipiodol injection alone could relieve 33.3% of the affected eyes. 28.6% of the eyes with upper nasolacrimal duct obstruction were resistant to probing and need dacryocystorhinostomy