Dacryocystitis in a Patent Nasolacrimal Drainage System: A Literature Review.

INTRODUCTION: Acute dacryocystitis is an acute infection and the lacrimal sac secondary to pathogenic microorganism growth within the stagnant fluid in the lacrimal sac secondary to nasolacrimal duct obstruction. METHODS: A literature review was conducted on the PubMed database using the following search terms "dacryocystic retention" and "dacryocystitis" or "dacryolith" or "lacrimal duct" or "pseudo-dacryocystitis". RESULTS: The literature review suggests that dacryocystitis in a patent nasolacrimal drainage system can stem from diverse causes including the mechanical impaction by dacryoliths, viral infections and anatomical variations. It is believed that these causes lead to transient obstruction to the nasolacrimal excretory system predisposing to secondary infections. Idiopathic temporary dacryocystic retention is also highlighted in this review. CONCLUSIONS: This review broadens the understanding of dacryocystic retention and highlights the need for careful diagnosis and tailored treatment plans, particularly in cases deviating from the traditional etiological pathways.

Microbial profile of lacrimal system Dacryoliths in American Midwest patient population.

PURPOSE: Dacryoliths of the canalicular pathway are classically attributed to Actinomyces species as the most common organism. However, global shifts toward Streptococcus and Staphylococcus species have been reported. The objective of this article is to update the American Midwest epidemiology of lacrimal system dacryoliths for targeted clinical treatment. MATERIALS AND METHODS: A retrospective chart review from January 2015 to 2021 of patients with a history of surgical procedure for lacrimal removal of dacryolith for canaliculitis, canalicular obstruction, dacryocystitis, and nasolacrimal duct obstruction was included. Specimens were sent for histopathological evaluation and microbial culture. RESULTS: A total of 48 specimens were included. The most common organism isolated for canalicular pathology was Actinomyces spp (23%), followed by Staphylococcus spp (21%) and Streptococcus spp (19%). Histopathological staining accounted for 45% of Actinomyces isolation when culture data inconclusive. In a subgroup analysis of lacrimal sac dacryoliths, the most common organism was Staphylococcus spp (29%). Actinomyces species were not isolated from the lacrimal sac or nasolacrimal duct. CONCLUSION: Actinomyces maintains a microbial predominance in canalicular dacryoliths and requires careful culture and histopathological analysis for its fastidious nature. Lacrimal sac and nasolacrimal duct dacryolith found no isolates of Actinomyces, and the most common organism was Staphylococcus.

Computed tomography imaging features for amyloid dacryolith in the nasolacrimal excretory system: A case report.

BACKGROUND: Nasolacrimal duct obstruction leading to epiphora is a common ophthalmologic complaint, and it may derive from amyloidosis in rare cases. There are a few reports about localized amyloidosis, and amyloidosis with involvement and obstruction of the nasolacrimal duct is exceedingly rare. CASE SUMMARY: A 54-year-old male presented with a 2-year history of a lump overlying the left lacrimal sac that had grown rapidly for nearly half a year. Physical examination touched a firm lump in the left lacrimal sac. Nasal endoscopy discovered lesions in appearance of sediments with easy bleeding at the entry of the nasolacrimal duct of the left inferior nasal meatus. Computerized tomography scan revealed speckle high density in the left lacrimal sac and the dilated nasolacrimal duct. During an endoscopic exploration and excision, a large number of dacryoliths were exposed. Pathology indicated amorphous pink material and multinucleated giant cell reaction in the fibrous tissue. CONCLUSION: This case showed amyloidosis in localized form mimicking dacryolith with nasolacrimal duct obstruction. In clinical practice, we should be aware of the possibility of localized amyloidosis in the nasolacrimal excretory system.

Etiopathogenesis of lacrimal sac mucopeptide concretions: insights from cinematic rendering techniques.

BACKGROUND/AIM: To investigate the structural features following the cinematic rendering of lacrimal sac mucopeptide concretions (MPC). METHODS: The study was performed on five mucopeptide concretions obtained from the lacrimal sac during dacryocystorhinostomy. All the concretions were imaged using special protocols of CT scans to obtain ultra-thin slices. Cinematic rendering (CR) techniques (Siemens Healthineers AG, Erlangen, Germany) were utilized to allow real-time computation of the interaction of photons and scanned patient images using the Monte Carlo path tracing algorithms. The CR algorithms facilitated volumetric reconstruction of the mucopeptide concretions to visualize the texture and inner structures. Each concretion could be sliced and viewed at 100-µm intervals. False color display and the use of different transfer functions were utilized to display variable densities of the concretions in color during visualization. Images obtained by virtual camera were further analysed to assess the structural features. RESULTS: The 3D cinematic rendered images of MPC showed uniform structural consistency on the surface and minimal heterogeneity from the surface up to the core. As the image slicing occurs towards the core, a well-defined structure of grossly different consistency (nidus) from the rest of the MPC was noted. This area was usually located in the paracentral region and constitutes approximately < 10% of the entire area. If a color display was assigned to the internal structure of the MPC, most of it appears to be compact and dense but the density reduces in the periphery of the nidus and delineates it well. Further structural enhancements with the 3D cinematic rendering in some MPCs demonstrate occasional 1-2 more areas with similar features as that of nidus. CONCLUSIONS: 3D CR is a useful modality to study the internal structure of MPC. The CR findings also provide further evidence to support the earlier etiopathogenesis theory based on ultrastructural and immunohistochemistry features.

A stone in the lacrimal gland: a case report and literature review.

A 59-year-old man presented with recurrent localized redness of the right eye for 3 months duration despite topical antibiotic and steroid administration. Examination revealed focal conjunctival injection in the temporal region and a palpable right lacrimal gland. During incisional biopsy, a small, white, hard mass was noted within the lacrimal gland, which was surgically removed. Histopathological examination revealed a lacrimal gland ductule stone. The conjunctival injection resolved immediately after surgery. A thorough review of literature was done, which yielded 19 cases of lacrimal gland stones reported in modern literature and these cases were reviewed.

Binding of metals in dacryoliths by means of biomineralization.

Dacryoliths are organomineral aggregates released from human lacrimal ducts, and are known to include a 1 to 3 % (by volume) of a mineral (inorganic) component This study was based on a collection of approximately 800 dacryoliths collected from a patient in Siberia. The shapes and sizes of mineral grains, their composition and their distribution in the organic matrix are very diverse; our detailed investigation identifies a number of inorganic phases that were not previously recognized. These were imaged on a scanning electron microscope (Tescan VEGA II LMU), and the chemical composition of the inorganic component was determined by energy dispersive X-Ray spectroscopy (INCA Energy350, Oxford Instrument), and X-ray analysis (X-ray diffractometer XPert PRO (PANalytical). For the first time, we identified the following minerals which can be divided into three groups: 1) oxide Si, pyrite, calcium oxalate, barite, which are often present in the tissues of the living organism and are also known in geological processes; 2) abundant complex mineral phases, consisting of Al, Si, K and Ti or Fe (titanium and iron aluminosilicates), which are also present in organism but have no analogues in the abiogenic environment; and 3) oxygen-containing compounds of Ni and Pb-Cr (possibly nickel oxide and lead chromate, respectively) which are only found in the abiogenic environment. Those mineral phases of biogenic origin are due to an endogenous (pathological) process in the body caused by internal factors (hypoergosis and metabolic disorders). This biomineralization may have a role in the removal of toxic and / or excess ions of Fe, Ti, Cr, Pb, Ni, Al, and Si from tissues.

A huge lacrimal gland ductule dacryolith with a hairy nucleus: a case report.

BACKGROUND: Dacryoliths in lacrimal gland ductule are a rare condition and an unusual cause of conjunctivitis. Here we report a case with a large lacrimal gland ductule stone with an unique hairy nucleus. CASE PRESENTATION: A 38-year-old female presented with a red left eye for one month. Physical examination revealed an inflammatory granuloma in the lateral canthus and a fistula with purulent secretion. Antibiotics did not ameliorate the symptoms. After we incised the fistula, a huge dacryolith (10 mm × 5 mm × 3 mm) was identified at the end of the dilated lacrimal gland ductule and was removed surgically. Histopathologic examination showed a hairy nucleus surrounded by lamellar structure. The symptoms were resolved in 2 weeks after dacryolith extraction. The formation of the hair-centered dacryolith might be associated with the patient's personal history of being a rabbit raiser for years. CONCLUSION: We should be aware of lacrimal gland ductule dacryolith as a rare cause of conjunctivitis. The relationship between dacryolithiasis and fur-bearing animal raising warrants further investigation.

Electron microscopic features of the lacrimal sac mucopeptide concretions.

PURPOSE: The aim of this study was to examine the ultrastructural features of the mucopeptide concretions obtained from the lacrimal sac. METHODS: Mucopeptide concretions obtained from the lacrimal sacs of 10 patients during a dacryocystorhinostomy were immediately fixed for electron microscopic analysis. The surfaces were studied separately and longitudinal and transverse ultra-thin sections were obtained at different levels and all were studied using the standard protocols of scanning electron microscopy (SEM) and transmission electron microscopy (TEM). RESULTS: Mucopeptide concretions based on their extent take the shape of the lacrimal sac and nasolacrimal duct. The external surfaces and cut sections show mostly areas of homogenous deposits with occasional intervening heterogenic areas. Two distinct types of craters were noted, mostly in the heterogeneous areas. The core of the concretions was made up of extensive networks of fibril like tangles filled predominantly with granular material and red blood cells with occasional presence of granulocytes and epithelial cells. Numerous vacuoles and fissures appear to be more of artifacts than any metabolic process. No organic fibers of fungal filaments were noted within the concretions. There was no evidence of any bacterial biofilms other than few focal areas of scattered bacteria. Possible events in the development of mucopeptide concretions have been hypothesized based on the ultrastructural findings. CONCLUSION: Ultrastructural features of mucopeptide concretions from the lacrimal sac help in better understanding of their etiopathogenesis and tissue interactions. Further exploration of different stages of a concretion is needed to understand the potential factors that trigger its genesis and evolution.

Actinomycetes canaliculitis complicating congenital nasolacrimal duct obstruction in an infant.

Actinomyces israelii is a Gram-positive anaerobic organism commonly associated with canaliculitis in adults. Pediatric canaliculitis is relatively rare, especially in infancy. We report the case of an 11-month-old boy who presented with co-existing canaliculitis and congenital nasolacrimal obstruction. The presenting signs included epiphora, discharge, conjunctival congestion, and matting of lashes. On examination, punctual pouting, regurgitation, and yellow canaliculiths were noted. A punctoplasty and canalicular curettage were performed along with nasolacrimal probing. Microbiological tests confirmed the organisms to be A. israelii. We discuss the clinical features and management of Actinomyces-associated canaliculitis and review the available literature on pediatric canaliculitis.

Clinicopathological Study of Lacrimal Sac Dacryolith in Patients Treated for Nasolacrimal Duct Obstruction

PURPOSE: To evaluate the correlation between clinical manifestation of patients with nasolacrimal duct obstruction and pathological characteristics of lacrimal sac and dacryolith found during endoscopic dacryocystorhinostomy. METHODS: This retrospective study included 158 patients (189 eyes) who received endoscopic dacryocystorhinostomy. We defined lacrimal dacryolith by gross discovery in the lacrimal sac during surgery or findings during pathological examination as dacryolith or calcification, including size and distribution in pathology slides. We correlated the relationship between the patients' clinical manifestations, surgical results, lacrimal sac's pathological findings including calcification, inflammation and fibrosis, and pathological findings of lacrimal sac dacryolith. RESULTS: Dacryolith was found in 61 eyes (32.3%) and among them, grossly found in 13 eyes (6.9%). Dacryolith's filling defect on dacryocystography was found in 17 eyes (9.0%) and based on grossly found dacryolith, dacryocystography's sensitivity and specificity were 58.8% and 1.7%, respectively. The average size of dacryolith was 0.3 +/- 0.8 mm2 with an average distribution of 20.1 +/- 17.9%. Distribution of dacryolith and the proportions of inflammatory cells and fibrosis in the lacrimal sac were negatively correlated (p < 0.05). The size of dacryolith and the proportions of fibrosis in the lacrimal sac were also negatively correlated (p = 0.008). In cases where the proportion of calcification in pathology slides was over 50%, the duration of symptoms in the calcification-dominant group was shorter than in other groups (p = 0.006). The success rates of endoscopic dacryocystorhinostomy with dacryolith and without dacryolith were 91.8% and 80.5%, respectively (p = 0.046). CONCLUSIONS: The patients with lacrimal sac dacryolith in nasolacrimal duct obstruction showed shorter duration of symptoms, lower fibrosis of lacrimal sac, and higher surgical success rates than the other cases. Therefore, additional research may be necessary to determine the mechanism of dacryolith formation and early treatment in nasolacrimal duct obstruction with lacrimal sac dacryolith.

Clinical Evaluation of Lacrimal Gland Ductal Disease

PURPOSE: To investigate the clinical characteristics and management of lacrimal gland ductal disease, a rare disease often mistaken for other diseases. METHODS: A retrospective chart review of 11 patients (11 eyes, 5 males, 6 females) diagnosed with lacrimal ductal disease between March 2007 and April 2013 was performed. RESULTS: Among 11 eyes in 11 patients, 4 were diagnosed with dacryops and 7 with lacrimal gland ductulitis initiated by dacryolith. The mean age of the subjects was 47.9 years (range, 30-80 years). Lacrimal gland ductulitis patients received treatment for conjunctivitis or hordeolum for several months. Four cases involved the right eye and 7 cases involved the left eye. Symptoms included foreign body sensation, pus-like discharge and palpable mass. Biopsy was performed in 3 cases and showed no specific findings. Patients with dacryops underwent marsupialization, whereas patients diagnosed with lacrimal gland ductulitis underwent excision and dacryolith curettage. During the 2-month follow-up period, all cases showed no signs of recurrence or complications. CONCLUSIONS: Lacrimal gland ductal disease can be mistaken for other diseases such as conjunctivitis, hordeolum, or orbital cyst, thus requiring accurate diagnosis and appropriate management.

Canine dacryolithiasis: a case description and mineral analysis.

A 4-year-old, female, spayed, Labrador retriever was presented with a painless swelling of the left ventromedial eyelid and epiphora of 3 months duration. Bilateral patency of the nasolacrimal system was confirmed by the appearance of fluorescein dye at both nares. Ultrasonography revealed a well-demarcated fluid-filled structure containing echogenic ill-defined material in close proximity to the nasolacrimal system. A transconjunctival surgical approach confirmed the close anatomical proximity of the cyst and the absence of a communication with the inferior canaliculus. The cyst contained multiple intraluminal calculi (dacryoliths). Following surgical excision of the cyst, the epiphora resolved and no recurrence was noted over a 12-month follow-up period. On histopathology, the cystic structure was lined by stratified squamous epithelium, consistent with lacrimal canaliculus epithelium. Presumed progression of a canalicular diverticulum to a cyst with the formation of intraluminal dacryoliths was suspected. Mineral analysis of the dacryoliths revealed a calcium carbonate composition.

A Case of Lacrimal Ductal Cyst with Dacryolith

PURPOSE: Lacrimal gland duct cysts constitute a rare clinical entity and may be preceded by trauma, infection, or inflammation without antecedent history. The purpose of this study is to report one case of lacrimal gland duct cyst accompanied by a dacryolith. METHODS: A 41-year-old man presented with sudden enlarging mass in the left superotemporal conjunctival fornix 3 days ago. The lesion was about 10 X 10 mm in size. There was no tenderness or erythema in adjacent area. The CT scan was done and excisional biopsy was performed under local anesthesia. RESULTS: Specimen consisted of cystic membranous tissue in 9.0 X 7.0 mm in size and mucous material and a light brown dacryolith of 1mm in diameter within cyst. Specimen included normal lacrimal tissue. Microscopic examination found cyst was covered with stratified columnal epithelium accompanied by acute and chronic inflammation and eosinophilic acellular dacryolith mixed with inflammatory exudates. There was no bacterial colony and polarizing microscope found no birefringence. CONCLUSIONS: Such case of a eosinophilic dacryolith within lacrimal gland duct cyst has never been reported at home and abroad.

A Case of Morphological and Chemical Analysis of Recurrent Dacryoliths after Dacryocystorhinostomy

PURPOSE: To present the morphological and chemical analysis of dacryoliths and review factors contributing to form dacryoliths with previous studies. METHODS: From a 58-year-old female patient operated with dacryocystorhinostomy, dacryoliths were obtained during the procedure and postoperative follow-up period. Morphological and microbial analysis of the dacryoliths was performed by culture and light microscopic examination. Various electrolytes in the dacryoliths were analyzed by flame atomic absorbable spectrometry(FAAS) for Na+ and K+ and by inductively coupled plasma atomic emission spectrometry(ICPAES) for Ca2+ and Mg2+. RESULTS: No bacterial and fungal organisms were cultured, but multiple bacterial colonies were found by H&E stain. Chemical analysis revealed mainly organic composition 97.91% and inorganic composition 2.09%. Inorganic composition was consisted with Ca2+ 0.82%, Na+ 0.76%, Mg2+ 0.27%, and K+ 0.24% in order. CONCLUSIONS: To prevent the recurrence of the nasolacrimal duct obstruction by the dacryoliths after dacryocystorhinostomy, pathogenesis of the dacryoliths formation may be studied with morphological and chemical analysis of the Dacryoliths.