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Purpose: This study aims to assess the bony lacrimal fossa changes in chronic cases of primary acquired nasolacrimal duct obstruction versus acute dacryocystitis., Methods: A prospective study was performed on 25 bony lacrimal fossae of 25 eyes of 15 patients who underwent endoscopic dacryocystorhinostomy at a tertiary care Dacryology service over a period of 6 months. Ten patients with chronic PANDO (> 1 year) with bilateral involvement and five patients of unilateral acute dacryocystitis were recruited in the study. None of the patients had a history of trauma or previous surgeries or nasal disease in the past. The bone samples from the frontal process of the maxilla and the lacrimal bone were obtained during the osteotomy and subjected to routine histopathological examination. Special stains used were von Kossa, Masson trichrome, periodic acid Schiff, and Alcian blue. Immunohistochemistry was performed using CD68 antibodies. Patient demographics, clinical presentation, duration of the disease, and bony changes were analyzed in different patient subsets., Results: The mean disease duration in the chronic PANDO subset was 3.1 years, whereas acute dacryocystitis was 6.8 days. There was no correlation between the bony changes and the laterality in the chronic subset. Periosteal thickness and fibrosis were universal in the chronic group but not in the acute dacryocystitis. There were also differences in the number of osteocytes per sq mm, osteoblast, osteoclast, bony remodeling, bony canals structure, and intrastromal fibrosis between the subsets. These changes within the chronic group increased with the duration of the disease. Interestingly, there was no evidence of any bony inflammation across the subsets in all the samples studied., Conclusion: Characteristic bony changes can be demonstrated in patients with chronic PANDO but not in acute dacryocystitis. The lack of bony inflammatory infiltrates may provide clues in understanding the peri-sac disease pathogenesis in acute dacryocystitis.

Purpose: This study deduced the pathological and immunophenotypic features of idiopathic dacryoadenitis, and researched into the possible immune mechanism of this lesion., Methods: Here are 23 lesions of idiopathic lacrimal gland inflammation collected retrospectively, whose histopathologic types were classified based on different characteristics, while the fibrosis degrees were measured. The immunohistochemical staining was performed on tissue sections using monoclonal antibodies against CD20, CD45RO, IL-4 and IFN-γ, the percentages of mononuclear inflammatory cells staining for CD20, CD45RO and the quantities of cells staining positively for IL-4 and IFN-γ were enumerated., Results: Lymphoid follicular and sclerosing lesions are two most common pathological types with different lymphocyte and fibrosis pattern. The proportions of CD20 cells have significant difference between lymphoid follicular (48.6 ± 14.9%) and sclerosing lesions (21.8 ± 12.2%), and the proportions of CD45RO cells are also different in the two types (27.2 ± 6.5% and 43.5 ± 15.1%, respectively). The quantities of lacrimal inflammatory cells staining positively for IL-4 are significantly different in lymphoid follicular (43 ± 27) and sclerosing lesions (11 ± 9), and for IFN-γ are also different (13 ± 8 and 22 ± 16 respectively)., Conclusion: Different immune processes exist in idiopathic dacryoadenitis: Th2 mediated B-cell humoral immune response presents in lymphoid follicular type and Th1 mediated cellular immune response presents in sclerosing type.

Purpose: Th-cytokines play important roles in dacryoadenitis associated with Sjögren's syndrome (SS). The aims of this study were to (i) investigate whether interleukin (IL)-17, a newly identified Th-cytokine, participates in autoimmune dacryoadenitis of MRL/lpr mice and (ii) examine the relationships among IL-17, IL-4, and interferon (IFN)-γ in these mice., Methods: Three-month-old MRL/lpr mice with lacrimal gland inflammation and 3-month-old control BALB/c mice were used. Frozen sections of lacrimal glands and submandibular lymph nodes were stained with monoclonal antibodies to cytokines IL-17, IL-4, and IFN-γ. Concentrations of IL-17 in serum and 48-h splenocyte culture supernatants were detected by ELISA., Results: Marked lacrimal gland inflammation was observed in all MRL/lpr mice but not in any BALB/c control mice. In the lacrimal glands of MRL/lpr mice, the proportions of cells that stained were 5 ± 3% for IL-17, 32 ± 14% for IL-4, and 4 ± 2% for IFN-γ. In the submandibular lymph nodes of MRL/lpr mice, expression of IL-17 and IL-4 was significantly higher than that of IFN-γ, and all three cytokines were significantly higher in MRL/lpr mice than in BALB/c mice. Concentrations of IL-17 in both serum and splenocyte culture supernatants of MRL/lpr mice were elevated compared to BALB/c controls., Conclusions: Since expression of IL-17 is elevated in 3-month-old MRL/lpr mice, we suggest that it plays a role in the pathophysiology of autoimmune dacryoadenitis in these mice.