Tumor de glándula lacrimal: a propósito de un caso / Lacrimal gland tumor: a case proposal

INTRODUCCIÓN: El carcinoma adenoide quístico (CAQ) es conocido por su lento crecimiento, su tendencia a la recurrencia local y al desarrollo de metástasis a distancia incluso décadas después del diagnóstico inicial, y a pesar de terapias agresivas. OBJETIVO: Presentar el caso de una paciente con CAQ de la glándula lagrimal, tumor muy infrecuente que representa casi el 10% de las lesiones orbitarias ocupantes de espacio. De éstas el 20-30% son de origen epitelial, de las cuales el 55% son lesiones benignas y el 45% malignas. El CAQ es el más común de los tumores epiteliales malignos de la glándula lagrimal (65%). CASO CLÍNICO: Presentamos el caso clínico de una paciente con CAQ de glándula lacrimal diagnosticado de forma incidental tras la realización de TAC desde la consulta de psiquiatría. RESULTADOS Y CONCLUSIONES: El síntoma de presentación más frecuente suele ser la proptosis, acompañada o no de dolor, aunque también puede presentarse como ptosis mecánica, reducción de visión y diplopía. La cirugía radical no ha demostrado mejorar la supervivencia o reducir la recurrencia local en comparación con un abordaje quirúrgico, más conservador en pacientes con tumores de menor tamaño y sin afectación ósea. Las mayores tasas de supervivencia se han conseguido, en pacientes tratados con quimioterapia, con quimioterapia citorreductiva intra-arterial seguida de exenteración orbital y radioterapia.

INTRODUCTION:The adenoid cystic carcinoma (ACC) is known for its slow growth, a tendency to local recurrence and the development of distant metastases even decades after the initial diagnosis, and despite aggressive therapies. AIM:We present the case of a patient with a lacrimal gland tumor. They are very rare tumors that represent almost 10% of space-occupying orbital lesions, of which 20-30% are of epithelial origin, of these, 55% are benign and 45% are malignant. The ACC is the most common malignant epithelial tumor (65%). CASE REPORT :We present the clinical case of a patient with ACC of the lacrimal gland incidentally diagnosed after performing a CT scan from the psychiatric office. RESULTS AND CONCLUSIONS:The most frequent presentation symptom is usually proptosis, accompanied or not accompanied by pain, although it can also occur as mechanical ptosis, vision reduction, and diplopia. Radical surgery has not been shown to improve survival or reduce local recurrence compared to a more conservative surgical approach in patients with smaller tumors and without bone involvement. The highest survival rates have been achieved, in patients treated with chemotherapy, with intra-arterial cytoreductors (IACC) followed by orbital exenteration and radiotherapy.

Primary bilateral and symmetric MALT lymphoma of the lacrimal sac mimicking chronic dacryocystitis / Linfoma MALT primário, bilateral e simétrico do saco lacrimal simulando dacriocistite crônica

Abstract We report a case of primary bilateral mucosa associated lymphoid tissue (MALT) lymphoma of the lacrimal sac. MALT lymphoma is a subtype of Non-Hodgkin's Lymphoma of the ocular adnexa. When the primary site of the lymphoma is the lacrimal sac, it mimics chronic dacryocystitis. This may delay diagnosis, with potentially lethal results.

Resumo Descrevemos um caso de um linfoma MALT bilateral, simétrico e primário de saco lacrimal. O linfoma MALT é um subtipo do Linfoma Não-Hodkin dos anexos oculares. Quando o local primário do linfoma é o saco lacrimal, ele pode simular uma dacriocistite crônica. Essa situação pode atrasar o diagnóstico e ter consequências fatais.

A 20-year study on microvascular autologous transplantation of submandibular gland for treatment of severe dry eye / 北京大学学报(医学版)

Severe dry eye is a refractory ophthalmologic disease. Our multidisciplinary research group treated severe dry eye by microvascular autologous transplantation of submandibular gland (SMG) during the past 20 years. The SMG, with its blood vessels and Wharton's duct, was harvested from the submandibular triangle and transferred to the temporal area. The blood vessels in the SMG were anastomosed with the temporal blood vessels using a microsurgical technique. Then, the distal end of Wharton's duct was sutured to form an opening in the upper lateral conjunctival fold. The tear was replaced by the secretion of the transplanted SMG to lubricate the ocular surface. In our study, the surgical techniques of blood vessel management were continuously modified to increase the survival rate of the transplanted SMG. A novel surgical modality of partial transplantation of SMG was established to prevent postoperative epiphora. A clinical study with the largest case number in the world was conducted and the effectiveness of transplantation of SMG for severe dry eye was fully confirmed. In order to resolve two main clinical problems including ductal obstruction resulted from low secretion rate during the latent period, and epiphora due to over secretion of the transplanted SMG in the later term of transplantation, the regulation of the secretion mechanism of the normal and transplanted SMG were investigated. New opinions on mechanisms of saliva secretion were provided. Based on the priniciple of translational medicine, the results of related basic research were applied in the clinic. The clinical guidelines for secretion regulation of transplanted SMG were established. A concept of chronic obstructive sialadenitis of transplanted SMG was provided and its diagnostic criteria, diagnostic technique of sialography, and therapeutic regimen were established. As a result, the surgical success rate was obviously elevated, the surgical complications were decreased, and life quality of the patients was greatly improved.

Adenoid cystic carcinoma of the lacrimal sac: case report / Carcinoma adenóide cístico do saco lacrimal: relato de caso

ABSTRACT Lacrimal sac tumors are rare with a clinical presentation that typically includes obstruction of the lacrimal drainage system and epiphora as the most frequent symptom. Cribriform adenoid cystic carcinoma (ACC) is the most common malignant epithelial tumor of the lacrimal gland and minor salivary glands; however, its occurrence in the lacrimal drainage apparatus is extremely rare. Given the rarity of ACC, definitive diagnosis is almost invariably late conferring a poor prognosis. Herein we report the case of a 41-year-old woman with primary ACC of the lacrimal sac and describe the ophthalmological examination, diagnosis, and multidisciplinary treatment of this rare type of tumor.

RESUMO Tumores do saco lacrimal são raros. A apresentação clínica muitas vezes mostra uma obstrução no sistema de drenagem lacrimal sendo a epífora o sinal mais frequente. Carcinoma adenóide cístico cribriforme (ACC) é o tumor epitelial maligno mais comum da glândula lacrimal e glândulas salivares menores, mas a sua ocorrência no aparelho de drenagem lacrimal é extremamente rara. Infelizmente, devido a raridade destes tumores, o diagnóstico preciso é quase sempre atrasado, o que por sua vez leva a um pior prognóstico. Nós relatamos o caso de uma mulher de 41 anos de idade, com ACC primário do saco lacrimal e analisamos o exame oftalmológico, diagnóstico e tratamento multidisciplinar deste tipo de tumor.

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.

Síndrome de Fraser: relato de caso nas vias lacrimais / Fraser Syndrome: case report in lacrimal system

A síndrome de Fraser é uma condição sistêmica caracterizada por criptoftalmo, sindactilia e anomalia da genitália, podendo se associar com alterações dos rins, do ouvido, do nariz, da laringe e do esqueleto. O criptoftalmo pode representar um achado isolado, representado por herança autossômica dominante, associado a outras anomalias congênitas, relatado como herança autossômica recessiva. Criança do sexo feminino, 9 meses, avaliada no ambulatório de vias lacrimais da Universidade Federal de São Paulo. Filha de pais consanguíneos. Ao exame, foram observados criptoftalmo total à esquerda, epífora em olho direito associada à secreção mucopurulenta, nariz em sela, implantação baixa das orelhas, malformação de conduto auditivo, aumento de grandes lábios e sindactilia de mãos e pés. A tomografia de crânio evidenciou braquicefalia ausência de septo pelúcido, proeminência dos ventrículos laterais, importante falha óssea na calota craniana, presença de afilamento do manto tecidual cerebral, fossa posterior pequena, desorganização do segmento anterior, afacia e descolamento total da retina.

Fraser syndrome is a systemic condition characterized by cryptophthalmos, syndactyly and abnormal genitalia, which may be associated with urinary tract, ear, nose, larynx and skeletal abnormalities. Cryptophthalmos can be an isolated finding (that has been reported as an autosomal dominant trait) or associated with other congenital anomalies (reported as an autosomal recessive disorder). Child, female, nine month of life, evaluated in the lacrimal setor of Federal University of São Paulo. Child of consanguineous parents. Her physical examination showed total unilateral cryptophthalmos (left side), epiphora (right side) with mucopurulent discharge, depressed nasal bridge, low set ears, atresia of the external auditory canal, prominent labia majora and syndactyly of the fingers and toes. Ocular ultrasonography showed brachycephaly, absence of septu pellucidum prominence of the lateral ventricles, a major bone defect in the skull, the presence of thinning of the mantle tissue of the brain,a reduced anterior-posterior ocular diameter, anterior segment disorganization, absence of the lens and total retinal detachment in the left eye.

Probing for congenital nasolacrimal duct obstruction in older children

The purpose of this study was to evaluate the role of probing in congenital nasolacrimal duct obstruction in children age 2 years and older and to establish factors predictive of the outcome. A prospective study was conducted on consecutive patients older than 24 months with congenital nasolacrimal duct obstruction. All patients were treated with a simple nasolacrimal duct probing as primary treatment. Outcome measures included an ophthalmologic examination plus a parental history of residual symptoms at one and 6 months after surgery. A total of 82 children with a mean age of 34.5 months [range, 24 months to 60 months] underwent nasolacrimal duct probing. The complete response rate was 54%. Partial response and failure were observed in 25% and 20.8% of the eyes, respectively. Bilateral obstruction was associated with failure of probing [P = 0.007, Odds Ratio: 5.76]. However, age older than 36 months was not associated with the failure rate. Primary probing maintains a high success rate without any age related decline in congenital nasolacrimal duct obstruction

Application of tele-ophthalmology in remote diagnosis and management of adnexal and orbital diseases.

Purpose: To assess the feasibility of making a diagnosis of adnexal and orbital diseases by Tele-ophthalmological means. Materials and Methods: Tele-consultation for eye diseases was done for 3497 patients from remote areas of Tamilnadu as part of the rural tele-ophthalmology project of a tertiary eye care hospital during a period of nine months from October 2004 to June 2005. These patients were comprehensively examined on-site by optometrists. Using digitized images sent by store and forward technique and videoconferencing, the ophthalmologist made a diagnosis and advised treatment. Results: Adnexal or orbital diseases were detected in 101 out of 3497 patients (2.88%). Medical treatment was advised to 13 of 101 patients (12.8%). Surgery was advised in 62 of 101 patients (61.28%) whereas 18 of 101 patients (17.8%) required further investigations at a tertiary center. Conclusion: It was feasible to apply the satellite based tele-ophthalmology set-up for making a presumptive diagnosis and planning further management of adnexal and orbital diseases based on live interaction and digital still images of the patients.

Un enfoque holístico de las enfermedades de la superficie ocular / A holistic approach for ocular surface diseases

La transparencia comeal es producto de un complejo sistema de interacciones. El conocimiento de estas es muy importante para establecer una terapia adecuada para patologías tan diversas como son la disfunción lagrimal, el haze comeal post PRK, y el rechazo comeal. La conjuntiva y el epitelio comeal indemnes son imprescindibles para mantener la función del sistema ocular. A su vez la integridad de estas estructuras depende de la integridad de párpados y lágrimas. Actualmente sabemos que la interacción entre estos cuatro componentes permite mantener en equilibrio la homeostasis de la superficie ocular. Asegurando la indemnidad de las células progenitoras límbicas. La alteración en cualquiera de estos factores produce ojo rojo, infecciones, mayor predisposición a úlceras, y alteraciones de la epitelización. Desequilibrios en el funcionamiento de este sistema se engloban hoy como enfermedades de la superficie ocular, y están dando origen a una nueva subespecialidad. Ya que los avances en el conocimiento de la fisiopatología de la lagrima y de su interacción con la come a, han permitido el desarrollo de una mirada más racional de la patología de este segmento creemos interesante revisar este conjunto de desordenes y proponer una aproximación terapéutica.

Comeal transparency is own to a complex system of interactions. Settle the right therapeutic approach in quite different pathologies as comeal haze, comeal rejection and tears disfunction, is related with the knowledge ofthese relationships. Comeal and conjunctival epithelium integrity is essential in ocular system function, as lids and tears . Nowadays we know that reciprocal relations between this items are essential in ocular surface homeostasis. Any disruption means the rise of redness, infections, ulcers predisposition, and disruptions in epithelization. Today all this malfunctions are known as Ocular Surface Pathologies rising a new subspeciality. Since new advances in tears physiology allows a rational approach to diagnosis and treatment ,we find useful to list out this disorders and proposing a therapeutic schedule.

Lacrimal Silicone Intubation for Anatomically Successful but Functionally Failed External Dacryocystorhinostomy

PURPOSE: To investigate the efficacy of lacrimal silicone intubation for the management of epiphora in patients who have previously undergone anatomically successful dacryocystorhinostomy (DCR). METHODS: The authors recruited 13 patients (4 male, 9 female) who had persistent epiphora after an anatomically successful primary external DCR and conducted lacrimal silicone intubation through the dacryocystorhinostomy site. RESULTS: Mean patient age was 54.2 years (range 42-80) and mean follow-up was 13.8 months (range 6-30). Epiphora was resolved in all 13 patients following silicone intubation. Spontaneous tube extrusion occurred in three patients, but a new one was easily reintubated. CONCLUSIONS: Lacrimal silicone intubation is a simple safe and effective procedure for patients with epiphora even after anatomically successful DCR.

Lacrimal Silicone Intubation for Anatomically Successful but Functionally Failed External Dacryocystorhinostomy

PURPOSE: To investigate the efficacy of lacrimal silicone intubation for the management of epiphora in patients who have previously undergone anatomically successful dacryocystorhinostomy (DCR). METHODS: The authors recruited 13 patients (4 male, 9 female) who had persistent epiphora after an anatomically successful primary external DCR and conducted lacrimal silicone intubation through the dacryocystorhinostomy site. RESULTS: Mean patient age was 54.2 years (range 42-80) and mean follow-up was 13.8 months (range 6-30). Epiphora was resolved in all 13 patients following silicone intubation. Spontaneous tube extrusion occurred in three patients, but a new one was easily reintubated. CONCLUSIONS: Lacrimal silicone intubation is a simple safe and effective procedure for patients with epiphora even after anatomically successful DCR.

Tratamento cirúrgico das canaliculites crônicas: relato de nossa experiência em 7 casos / Surgical treatment of of chronic canaliculitis: report of our experience in 7 cases

Objetivo: Discutir as principais formas de tratamento existentes atualmente e relatar a nossa experiência com o tratamento cirúrgico das canaliculites crônicas. Métodos: Estudo retrospectivo com 7 casos atendidos na Clínica Oftalmológica do HC-FMUSP nos últimos 3 anos. Resultados: Todos os pacientes submetidos a tratamento cirúrgico tiveram cura completa dos sinais e sintomas. Conclusöes: Devemos sempre lembrar da possibilidade de canaliculite em pacientes com queixa de epífora e secreçäo crônica no ponto lacrimal para que seja realizado o tratamento cirúrgico adequado.

Probing for blocked nasolacrimal duct in adults [an alternative to D.C.R.]

An investigation was conducted into the efficacy of probing syringing the blocked nasolacrimal ducts. [NLD] in adults with epiphora. It was done under local anaesthesia. Watering improved subjectivly in 42% of the cases after a single procedure. This improvement was seen in only 16% is cases with mucocele and not in cases with pus regurgitation

Congenital lacrimal amniotocele

To report a very rare congenital lacrimal /disorder with controversy regarding its origin, difficulty in differential diagnosis, and management. Patients and methods: Six newborns with age range between two days and one month, were seen between 1986 and 1996. All had pinkish swellings inferior to the medial canthal tendon. One case was treated by hot soaks, massage, and local antibiotic. Two cases were seen with complicated mucoceles, and had developed erythema of the tissues overlying their distended lacrimal sacs. Those three patients were probed and irrigated under general anesthesia. The first of those three patients had bilateral congenital cataract, the other who presented with pointing infected sacs which were drained percutaneously Cultures from the aspirates of all sacs were done. None of the patients developed epiphora or needed probing later on. There was no fistula formation for those who were drained. In order to avoid inappropriate investigations and hasten treatment, congenital amniotocele must be diagnosed early and differentiated from other congenital masses in the area. Initially, amniotocele must be treated conservatively in the same way as congenital nasolacrimal duct obstruction, but if the conservative treatment fails or if the patient is referred with infected sac, probing is recommended

Problemas associados com a conjuntivo-dacriocistorrionostomia / Problems associated with conjunctivodacryocystorhinostomy

Trinta e um paciente submeteram-se a conjuntivodacricistorrinostomia para tratamento de obstruçäo lacrimal alta, mas somente vinte e cinco tiveram um período de seguimento adequado para serem incluídos neste trabalho. Foram analisadas as causas da obstruçäo, assim como resultados e complicaçöes da cirurgia. As causas mais frequentes se referem aos casos de fracasso de cirurgias prévias de dacriocriocistorrinostomia e aos pacientes com agenesias, seguidas dos traumas e dos casos idiopáticos. Houve sucesso primário da cirurgia em 16 dos 25 pacientes (19 de 28 olhos), compreendendo 67,9 por cento dos casos. Cinco outros casos foram recuperados com reoperaçöes elevando os bons resultados para 85,7 por cento do total. As principais complicaçöes incluiram mal posicionamento (deslocamento) do tubo em 5 casos, extrusäo do tubo em 10 casos com granuloma conjuntival. Apesar destes problemas, a conjuntivo-dacriocistorrinostomia com tubo de Jones continua sendo o tratamento de escolha para obstruçäo definitiva da via lacrimal alta