Analysis of lacrimal duct morphology from cone-beam CT dacryocystography in a Japanese population

Dacryocystorhinostomy (DCR) is the first-line treatment for lacrimal duct stenosis and obstruction in western countries. Endoscopic-assisted nasolacrimal duct intubation (ENDI) is spreading steadily as a minimally invasive treatment in Northeast Asia. ENDI is prevalent in this area because Northeast Asians have relatively flat facial features, with a less elevated superior orbital rim than other ethnic groups. This allows for relatively easy manipulation of a dacryoendoscope. Evidence has accumulated that the morphology and inclination of the lacrimal duct differ among individuals and ethnic groups. In this study, we collected anthropometric data from a Japanese population of 100 samples—the parameters vital for designing a dacryoendoscope probe. The data we provided was essential in designing the overall length, bending point, and curve-line of the dacryoendoscope probe. Although the Japanese data measured in this study would not be directly applicable to other ethnic groups, we hope that the parameters provided by this study will contribute to the accumulation of valuable anthropometric data for the design of endoscopic probe morphologies and the development of therapeutic devices for lacrimal tract diseases—in terms of designing optimal morphologies, specific to ethnic groups and populations.

Comparing Efficacy of Punctum-incised Surgery versus Punctum- Sparing Surgery in Primary Canaliculitis Patients

Purpose: This study aims to describe the characteristics of canaliculitis patients and compare the operative outcomes between punctum-sparing canaliculotomy and traditional punctum-incised canaliculotomy.Methods: The medical records of 58 patients who were diagnosed with canaliculitis were reviewed from March 1, 2010, to December 31, 2020. The demographic characteristics, symptoms, time to disease onset, location of involvement, operation information, and prognosis were recorded and analyzed.Results: Canaliculitis showed a female (67%) predominance. Epiphora with discharge was the most common symptom which happened in 56 (97%) patients. The recurrence rates of the punctum-incised group and the punctum-sparing group were 5% and 9% respectively, and there was no significant difference between the two groups. (p=0.514)Conclusion: The recurrence rate of the punctum-sparing group showed no significant difference with punctum-incised group. Patients with recurrence finally recovered after multiple treatments. Squeezing by tweezers was a good way to locate the infected lacrimal duct. Punctum-incised surgery can be the first-line therapy for canaliculitis.

Small Cell Neuroendocrine Carcinoma of the Lacrimal Sac Presenting with Lacrimal Duct Obstruction

Purpose: We report a case of primary small cell neuroendocrine carcinoma arising from the lacrimal sac. Case summary: A 54-year-old man presented with epiphora that had been present for 1 month. He underwent lacrimal syringe analysis of the lower punctum in the right eye, which demonstrated fluid regurgitation from the upper punctum. Computed tomography revealed a 3.0 × 3.4 × 3.0 cm mass with an ill-defined margin in the right lacrimal sac, which demonstrated invasion of the lacrimal duct and bony destruction of the inferior and medial orbital walls. Incisional biopsy and histologic examination showed that the tumor was composed of small round tumor cells. On the basis of histopathological and immunohistochemical evaluations, a diagnosis of small cell neuroendocrine carcinoma was made. The patient received chemotherapy.Conclusions: To the best of our knowledge, this is the first case of primary small cell neuroendocrine carcinoma arising from the lacrimal sac in Korea. Small cell neuroendocrine carcinoma in the lacrimal sac should be regarded as a differential diagnosis for patients with a nasolacrimal duct obstruction.

Influence of Indwelling Lacrimal Drainage Tube on the Curative Effect of Endonasal Endoscopic Dacryocystorhinostomy

Endonasal endoscopic dacryocystorhinostomy (EES-DCR) has gradually become the main surgical method for treating chronic dacryocystitis. Whether the placement of the lacrimal drainage tube during the operation can improve the operation’s success rate is an issue. This study observes the effect of an indwelling lacrimal drainage tube on the curative effect of EES-DCR in patients with chronic dacryocystitis. The cure rate of the Lacrimal duct drainage tube non-indwelling group A was 93.8% (46/49). The 3 cases failed because of the nasal cavity’s inflammation, which resulted in the adhesion of the anastomotic stoma and the middle turbinate. The cure rate of the Lacrimal drainage tube indwelling group B was 85.7% (42/49). The 7 cases failed because of the excessive proliferation of the tissue around the anastomosis, the hyperplasia of granulation tissue, the shedding of the lacrimal duct drainage tube, the crack of the lacrimal duct, and the premature removal of the lacrimal duct drainage tube caused the contraction of the mucosa around the anastomosis, resulting in the anastomosis obstruction. There was no obvious difference between the two groups (P > 0.05). At 6 months, 46 cases of the EES-DCR group A had gradually epithelialized anastomoses without granulation tissue growth with the follow up time extension. In the EES-DCR group B, 42 cases of anastomoses were gradually epithelialized without granulation tissue growth. Nasal endoscopic dacryocystorhinostomy combined with an indwelling lacrimal duct drainage tube can be used to treat chronic dacryocystitis, but an indwelling lacrimal duct drainage tube has no significant effect on the efficacy of chronic dacryocystitis.

Seasonal Variation in Acute Dacriocystitis

Objectives: Seasonal variation is possible in some medical conditions.Acute dacryocystitis is very disturbing clinical picture and can develop in any time of the year in patients with lacrimal duct obstruction. We aimed to investigate whether there is a seasonal relationship with the emergence of acute dacryocystitis.Material and Methods:The files of the patients who applied to the ophthalmology outpatient clinic with the complaints of tearing and discharge for five years and diagnosed with acute dacryocystitis were analyzed retrospectively. Age, gender, date of occurrence of the complaints and the date of diagnosis of acute dacryocystitis were recorded. In order to determine the seasonal relationship, the data regarding the number of cases who applied every month of the year were analyzed statistically by Rayleigh test.Results: The mean age of 60 patients (45 females, 15 males) included in the study was 54.70 ± 16.80 years. It was found that all patients were not equally likely to arrive at the hospital and the onset of their complaints throughout the months of the year (p <0.05). The frequency of applications was higher between May and August.Conclusion: There seems to be a seasonal relationship with the timing of the acute dacryocystitis. In our series, more acute dacryocystitis cases were encountered in the first spring-summer months. The reason for the increase of acute dacryocystitis cases in hot seasons of the year may be due to the increase in infectious agents in these seasons.

Transconjunctival excision of a conjunctival cyst using computer-assisted 3-D surgical planning in a dog

Investigation of exophthalmos and blood-colored discharge from the left ventral punctum in a dog was consistent with a conjunctival cyst. 3-D prints of the cyst and surrounding facial bones identified a successful transconjunctival approach without an orbitotomy and patency of the left lacrimal duct was re-established.