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Introduction Incomplete punctal canalization is an uncommon congenital disorder characterized by a dysgenetic punctum with membranes. External membranes, the most common type of incomplete punctal canalization are flat and overlie the punctum as a veil. We describe a newer variant of incomplete punctal canalization, its clinical profile, diagnostic criteria and management. Case presentation A 9-year-old Indian boy presented with watering of his right eye since birth. His right eye lower punctal area showed an avascular translucent elevation that appeared to have a smooth dome shape. An examination at high magnification showed the slopes of the dome gradually merging and contiguous with the tarsal conjunctiva. Based on a very high degree of suspicion, an impression of atypical external membrane variety of incomplete punctal canalization was made. Membranotomy was successful in the management of his condition. Conclusions A high degree of suspicion is the key point in the diagnosis of this variant, keeping in mind the other features described for incomplete punctal canalization- external membrane. It is possible that ballooning of these membranes may represent an evolutionary stage in the process of complete canalization and this could be the starting point for further dacryoembryologic exploration and correlations. [ABSTRACT FROM AUTHOR]

Aims This study aimed to evaluate the expression of nuclear survivin in adenoid cystic carcinoma ( ACC) of the lacrimal gland and to determine if this expression is associated with histopathological features, markers of apoptosis and proliferation or clinical outcomes. Methods and results Immunohistochemical staining for survivin, p53, Ki-67 and Bcl-2 was analyzed in 55 cases of ACC of lacrimal gland. Thirty-one cases (56.3%) expressed nuclear survivin. All cases expressed p53, Ki-67 and Bcl-2. Eleven cases (35.5%) had a high nuclear survivin score ( NS- SCORE) and 20 cases (64.5%) had a low NS- SCORE. Cases with a high NS- SCORE had a shorter progression-free survival ( PFS) ( P < 0.0001), higher expression of Ki-67 ( P < 0.005) and a solid tumour pattern >30% ( P < 0.005). Conclusion Nuclear expression of survivin impacts prognosis significantly and is thus a promising prognostic marker in ACC of the lacrimal gland. [ABSTRACT FROM AUTHOR]