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BACKGROUND Dacryocystitis is the most common pathology affecting lacrimal drainage system, representing 79 - 87 % of all lesions. This retrospective study was conducted to understand the clinical spectrum and management patterns of dacryocystitis in the past 5 years in a tertiary care hospital of coastal Karnataka. METHODS This is a five-year retrospective review of the case records of patients with dacryocystitis from the year 2015 to 2019. The records were retrieved from the electronic medical record system of the hospital using the International Statistical Classification (ICD) 10 codes. Data retrieved included, demographic profile, clinical history, presenting symptoms, past surgical interventions, examination findings, systemic comorbidities, pattern of management, medical or surgical management and complications if any. 45 cases that had completed medical records were included in the study. RESULTS The mean age of presentation was 49.37 (± 19.59). The condition was more common in females with a male to female ratio of 1:2.5. The condition was almost equal on both sides. 11 (24.44 %) had bilateral involvement. The patients were mostly from coastal areas or dry plains. Most common presentation was chronic dacryocystitis. Aggravated epiphora was the most common symptom (33) 73.3 %. Diabetes mellitus (15) and hypertension (10) were the most common systemic comorbidities. (22) 48.8 % had no comorbidities. The complications seen were (4) 8.9 % fistula, (1) 2.2 % lacrimal abscess, (2) 4.4 % conjunctivitis and (1) 2.2 % preseptal cellulitis. The patients who underwent nasal examination were (31) 68.9 % out of which, 26 had no abnormal finding in the nose. Surgical treatment was performed in 29 (64.4 %) mainly in the form of dacryocystectomy (DCT) 24 (53.3 %) while only 5 (11.1 %) underwent conventional dacryocystorhinostomy (DCR). CONCLUSIONS Chronic dacryocystitis is the most common form of presentation with higher incidence in the females in the fifth decade of life. Epiphora was the commonest symptom. Most patients who underwent a preoperative nasal examination did not have any pathology. DCT was the more commonly performed procedure. KEYWORDS Acute Dacryocystitis, Chronic Dacryocystitis, Dacryocystectomy, Dacryocystorhinostomy, Epiphora

Solitary fibrous tumor (SFT) is a benign spindle cell neoplasm of mesenchymal fibroblast cells. It can appear in various locations, but SFT of the lacrimal sac is rare. Due to their variable clinical, histological, and radiological presentation, it can be easily misdiagnosed. We report a rare case of SFT of the lacrimal sac with its radiological, histological, and immunochemical characterization.

Dacryocystectomy is a procedure that involves complete surgical extirpation of the lacrimal sac. It was first described by Woolhouse in 1724 and became the gold standard for the management of lacrimal system obstruction and dacryocystitis before the advent of dacryocystectomy. Many minimally invasive methods are currently available to treat lacrimal disorders, but there are several specific indications for dacryocystectomy, such as malignant lacrimal sac tumors. Generally, the procedure is performed under local anesthesia, which avoids risks that are associated with general anesthesia or sedation in ailing or elderly patients. Dacryocystectomy can also also avoid skin scars. In 2013, Shams and Selva were the first to perform endoscopic dacryocystectomy. This article discusses indications, contraindications, goals, techniques, and complications of dacryocystectomy.

BackgroundWe report a case of a 4-year-old girl with acute dacryocystitis complicated with giant lacrimal abscess who underwent open dacryocystectomy as resolutive surgery.Case presentationA 4-year-old previously healthy girl presented to the emergency department with a voluminous and erythematous, fluctuant warm mass localized inferiorly to the medial canthus of the right eye. She had a 2-week history of right inferior eyelid oedema and hyperemia, treated firstly with dexamethasone and netilmicin by eye drops, and then with per oral amoxicillin clavulanate. Ultrasound examination showed a well-circumscribed round lesion filled by anechoic fluid with punctate echoes, confirming a diagnosis of acute dacryocystitis complicated by lacrimal abscess. Parents refused a head CT. Systemic antibiotic treatment was started and, on 5th day from admission, open dacryocystectomy was performed with good esthetical result.ConclusionsPediatric acute dacryocystitis is a potentially serious condition, which must be treated with intravenous antibiotic therapy followed by surgery tailored to the clinical history. Even if probing and dacryocystorhinostomy are the most used surgery in adults and children, open dacryocystectomy is a safe and successful option, mainly in severe cases where imaging studies are not available.

Purpose: To describe the outcome of external dacryocystorhinostomy (DCR) as a suitable alternative to dacryocystectomy (DCT) in cases of isolated lacrimal sac rhinosporidiosis. Methods: This was a retrospective, interventional case series. Institutional review board approval was obtained for the study. The chart review of 13 patients who underwent external DCR surgery for isolated lacrimal sac rhinosporidiosis between July 2012 and May 2018 was performed. Demographic details, clinical presentation, preoperative and intraoperative findings, surgical technique used, postoperative management, surgical outcome and duration of follow up were reviewed for each patient. Results: Thirteen patients were included in the study. Nine (69.2%) were male and four (30.8%) were female. The mean age was 22.1 years (range: 8–46 years). Involvement was unilateral in all cases. The commonest presenting complaint was epiphora with discharge seen in 10 cases (76.9%). An intrasac granuloma was grossly identified intraoperatively in 12 out of the 13 patients. Mean follow up was 26.9 months (range: 1.5–68 months). Till the last follow up, all cases were symptom free and did not have any evidence of recurrence of infection. Conclusion: From this series of cases reported by the authors, external DCR with appropriate precautions to prevent recurrence appears to be a suitable alternative to conventional DCT with excellent long-term outcomes without disease recurrence.

Purpose: Aim of this work is to highlight the advantages of a new surgical technique performed over 15 patients affected dacryocystitis and treated by using a venous catheter. The arrangement of a 30 mm venous catheter used at the end of a dacryocystectomy (DCT) was performed in 15 patients with dacryocystitis. The venous catheter was removed at 30 days after the surgery. The use of the venous catheter allows washing the lacrimal drainage system, reducing the risk of postoperative infections and supports the recanalization of the lacrimal drainage system 30 days after surgery. The presented cases demonstrated how the technique is easy and it reduces the possibility of the post-operative infection. It could be performed under regional anesthesia. Furthermore, after the surgery the recanalization of the lacrimal drainage system with a significant reduction of the epiphora in 6 months after surgery has been observed.

Background/Context: Probing is a simple operative procedure, can be performed easily in adults under local anesthesia, and is associated with minimal postoperative morbidity. The study aimed to determine the efficacy of probing in adults with epiphora due to common canalicular block (CCB) and nasolacrimal duct obstruction (NLDO). Materials and Methods: A prospective, interventional study was conducted on 44 patients with epiphora. Probing was done through upper and lower canaliculus under local anesthesia in all patients with epiphora due to CCB and NLDO. Probing was considered successful if the epiphora had been resolved or reduced to an acceptable level and if the lacrimal system was patent on lacrimal syringing for 6 months. Results: Patients comprised 36 women and eight men with the age group between 25 and 80 years who had epiphora for 3–24 months. Twenty-six patients had common CCB and 18 had complete NLDO. Complete patency was achieved in 12 and 5 and partial patency in 9 and 6 patients with CCB and NLDO, respectively. Treatment was successful in 72.72% of the patients. Ten patients underwent uneventful cataract surgery and 12 failed cases needed dacryocystectomy. Conclusion: Since probing is a simple, quick, cost-effective, and daycare procedure with low morbidity and obviates the need for further nasolacrimal surgery, probing can be recommended as an initial treatment in adults with epiphora.

Objective:In this study, we evaluated the feasibility and safety of dacryocystectomy associated with lacrimal intubation, for the treatment of recurrent dacryocystitis and epiphora secondary to lacrimal obstruction with compromised lacrimal sac, was evaluated.Subjects and Methods:32 patients underwent dacryocystectomy with Crawford tubes canalicular insertion, performed by a single surgeon. Post-operative visits were scheduled at 1stand 10th day, 1, 3, and 6 months. At each follow-up visit, the prevalence of epiphora and dacryocystitis was evaluated and compared with baseline data. Also, we evaluated the prevalence of local and systemic post-operative adverse events during the follow-up period.Results:11 patients (34.38%) reported persistent epiphora, which lasted for 30 days after surgery. Among them, 9 subjects (28.13%) complained occasional epiphora even at the six months follow-up. In the event of dacryocystitis or subacute phlogosis before surgery, patients reported a definitive symptom resolution. Other reported adverse events were epithelial corneal erosion due to Crawford tube protrusion (4 cases, 12.5%), a Crawford tube extrusion case (3.13%), 3 cases of surgical wound dehiscence (9.36%), and a case of mild local bleeding persisting for 15 daysConclusion:A significative epiphora reduction was observed after surgery with an acceptable safety profile, expanding dacryocystectomy indications. This procedure provides a satisfactory resolution of recurrent dacryocystitis. However, this approach should be performed only in well-selected cases: elderly/frail patients with altered lacrimal sacs, epiphora associated with recurrent infections, and failure after dacryocystectomy.

Purpose The aim of this study was to examine the ultrastructural features of the canalicular entrance into the lacrimal sac. Methods Ten openings of the common canaliculus into the lacrimal sac from 10 lacrimal sacs obtained during a dacryocystectomy were studied. Each of the openings were completely excised with 3-4 mm margins on all sides and transported to the laboratory in 2.5% glutaraldehyde. The analysis was performed using the standard protocols of scanning electron microscopy (SEM). The openings, their edges, canalicular lacrimal sac-mucosal folds, and internal surfaces were studied. Results Of the 10 common canalicular openings studied, the upper and lower canaliculi opened into a common canaliculus in all the cases. The terminal portion of the 2 canaliculi had a common wall, which appeared like a septum, just proximal to the beginning of the dilated common canalicular portion. In 60% (6/10) of the cases, a diverticular or a type III sinus of Maier (SOM) was noted. The surface of this diverticulum was smooth and lined by stratified columnar epithelium, reflecting its lacrimal sac origins. Interestingly, the junction of the epithelial change from stratified squamous to columnar could be appreciated clearly in 80% (8/10) of the cases and was mostly located just within from the edge of the internal common opening (ICO). The canalicular lacrimal sac-mucosal folds could be appreciated in 70% (7/10) samples, being very defined and prominent in 30% (3/10). Conclusions The common merged wall of the 2 canaliculus is the most proximal and prominent structure noted on an end-on view of the ICO. Diverticular variant of the sinus of Maier is common. The junction of the epithelial change from stratified squamous to columnar is appreciated just within the edge of the ICO.Detailed anatomical features of the common canalicular opening into the lacrimal sac can help our understanding of the focal anatomy and tear rheology.

Purpose: The aim of this study was to perform a histopathological assessment of the efficacy of sclerosing agents in dacryocystosclerotherapy (DCST) and to evaluate its role as an alternati...

Made available in DSpace on 2018-11-26T17:54:27Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-01-01 Purpose: To report indications and success rates of dacryocystectomy (DCT) in a tertiary hospital. Methods: A retrospective chart review was performed of all patients who underwent DCT at the King Khaled Eye Specialist Hospital, Saudi Arabia, from 2008 to 2015. Data included patient demographics, symptoms before and after surgery, and complications. Univariate analysis using parametric and non-parametric methods was performed. Results: Forty-seven DCT surgeries were performed over the study period. The median age of patients was 58.2 +/- 2 years old, 63.8% were female, 60% of surgeries were performed on the left side, and 8% of patients underwent bilateral simultaneous DCT. Chronic dacryocystitis was the surgical indication for DCT for all of the patients and 23.5% of them had dry eye preoperatively. Successful treatment was observed in 80.8% of patients and 8.5% complained of tearing after DCT. Conclusion: The main indication for DCT in our hospital was chronic dacryocystitis with good outcomes for elderly patients with dry eyes. King Khalid Eye Specialist Hosp, Oculoplast & Res Dept, Riyadh, Saudi Arabia Complejo Asistencial Palencia, Dept Ophthalmol, Palencia, Spain Univ Estadual Paulista, Fac Med, Dept Ophthalmol, Botucatu, SP, Brazil Univ Estadual Paulista, Fac Med, Dept Ophthalmol, Botucatu, SP, Brazil

Made available in DSpace on 2018-12-11T17:14:03Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-11-02 To evaluate the dacryocystectomy (DCT) outcomes for chronic dacryocystitis in an elderly population over 70 years old. A retrospective chart review was performed for patients over 70 years old who were diagnosed with chronic dacryocystitis and underwent DCT at the Botucatu School of Medicine, UNESP, Brazil, from 2007 to July 2014. Data were collected about patient demographics, age, gender, previous nasal, or ophthalmic diseases, symptoms related to the lacrimal drainage system preoperatively and postoperatively, signs of enlargement of the lacrimal sac (regurgitation of secretion), and histopathologic evaluation. The study sample was comprised of 17 patients with an average age of 76.5 ± 8.5 years. The major complaint for all patients was tearing and 17.6% patients had an additional complaint of discharge. Regurgitation of secretion with lacrimal sac expression was present in 76.5% of patients. Postoperatively, 76.5% of the patients reported improvement of the initial complaint, likely due to the total excision of the lacrimal sac which removed the focal site of chronic infection. Epiphora persisted in 23.5% of patients, of whom 11.7% underwent successful lacrimal stent intubation. DCT for chronic dacryocystitis should be considered a primary procedure in individuals over 70 years old. This procedure has a much lower risk to these patients who often have associated comorbidities. Department of Ophthalmology Botucatu Medical School–UNESP King Khaled Eye Specialist Hospital Department of Ophthalmology Complejo Asistencial de Palencia Department of Pathology Botucatu Medical School–UNESP Department of Ophthalmology Botucatu Medical School–UNESP Department of Pathology Botucatu Medical School–UNESP

Nasolacrimal system serves as a conduit for tear flow from eye to the nasal cavity. Periodic blinking initiates a pump mechanism, helping in the even distribution of tears over the ocular surface, which then flows into the lacrimal sac and finally to the nasal cavity via the nasolacrimal duct (NLD). Obstruction in this system leads to inadequate tear drainage, which clinically presents as epiphora. Lacrimal outflow system disorders are very annoying to the patients, and sometimes vision threatening. Surgery is a definitive solution for most outflow obstructions, and patients should be counseled accordingly. Chronic use of topical medications for NLD problems is neither cost-effective nor efficacious, but only prolongs agony. This article aims to provide a comprehensive insight into the commonly performed lacrimal drainage surgeries. Literature search using PubMed, Cochrane, and Google Scholar with a combination of various words appropriate to this article was done and relevant articles were reviewed.

Dacryocystectomy is a well-established oculo plastics procedure that refers to a complete surgical extirpation of the lacrimal sac. It was first described by Woolhouse in 1724 and was the standard of care before the advent of dacryocystorhinostomy for management of dacryocystitis and lacrimal fistulas. Although it is a seldom performed procedure worldwide, it still has its place in the surgical armamentarium for certain specific indications like malignant lacrimal sac tumors. It is almost always performed through an external skin incision except in certain exceptional circumstances where endoscopic dacryocystectomy may be needed. This article discusses the indications, goals, techniques, and complications of a dacryocystectomy.

Objective: The surgical treatment of epiphora and dacryocistitis includes Dacryocystorhinostomy (DCR) and Dacryocystectomy (DCT). To date, dacryocystectomy has been considered a secondary procedure and is not properly considered among the currently available surgical options. Intubation of the lacrimal system often improves surgical outcomes. In this study, a new variant of surgical technique, dacryocystectomy with lacrimal canalicula silicone intubation, is presented. All novel aspects and possible indications are discussed.Methods: Patients with chronic dacryocystitis associated with epiphora and lacrimal stenosis were enrolled for dacryocystectomy with silicon intubation. During follow-up, prevalence of epiphora, disease recurrences and adverse events have been investigated. Also, a retrospective clinical charts comparison with patients that received dacryocystorhinostomy ab externo has been performed.Results: No significant differences were found in terms of postoperative epiphora, silicon tube dislocation and overall adverse events have been observed between the compared groups (p>0.1). Persistent bleeding events were significantly more frequent in the DCR group (p

Aim To assess the practice patterns pertaining to pre-cataract screening for nasolacrimal duct obstruction (NLDO) among oculoplastic surgeons in India. The survey was aimed at obtaining data on the current screening and treatment strategies for NLDO and the interval between lacrimal surgery and subsequent cataract surgery. Methods An online survey was sent to all members of Oculoplastic Association of India. All valid responses were tabulated and analyzed. Results Majority of the respondents (92%) felt that nasolacrimal duct patency should be checked prior to performing cataract surgery: 59.6% felt that checking for regurgitation on pressure over the lacrimal sac (ROPLAS) was sufficient and 32.6% preferred to perform lacrimal irrigation to check for NLD patency. Dacryocystorhinostomy (DCR) was the preferred surgery for NLDO thus detected. The preferred interval between a DCR and subsequent cataract surgery was 4weeks (48.9%). A small minority (7.9%) of the respondents felt that pre-cataract screening for NLDO was not required. Also, a small but significant number (12.6%) felt that no treatment was required for NLDO in such patients and that to could go ahead with cataract surgery even in the presence of coexisting NLDO. Conclusions There is a general agreement on the need for pre-cataract screening for NLDO and a majority indicated that checking for ROPLAS was sufficient. Most surgeons prefer to perform a DCR in cases of NLDO and wait for 4weeks before intraocular surgery. There is however, a lacuna in the literature on guidelines regarding the optimal interval between lacrimal surgery and subsequent intraocular surgery.

Amblyopia screening is often either costly or laborious. We evaluated the Canon Powershot TX1 (CPTX1) digital camera as an efficient screener for amblyogenic risk factors (ARF). We included 138 subjects: 84-amblyopes and 54-normal. With the red-eye-reduction feature off, we obtained Bruckner reflex photographs of different sized crescents which suggested anisometropia, while asymmetrical brightness indicated strabismus; symmetry implied normalcy. Eight sets of randomly arranged 138 photographs were made. After training, 8 personnel, marked each as normal or abnormal. Of the 84 amblyopes, 42 were strabismus alone (SA), 36 had anisometropia alone (AA) while six were mixed amblyopes (MA). Overall mean sensitivity for amblyopes was 0.86 (95% CI: 0.83-0.89) and specificity 0.85 (95% CI: 0.77-0.93). Sub-group analyses on SA, AA and MA returned sensitivities of 0.86, 0.89 and 0.69, while specificities were 0.85 for all three. Overall Cohen's Kappa was 0.66 (95% CI: 0.62-0.71). The CPTX1 appears to be a feasible option to screen for ARF, although results need to be validated on appropriate age groups.

In this retrospective case series, we studied the predisposing factors, causative organisms, clinical spectrum, and outcomes of 12 cases of culture-proven infectious scleritis. Nine of 12 patients had a history of preceding trauma (surgical or accidental). Past surgical history included small-incision cataract surgery (4), pterygium surgery (1), and trabeculectomy (1). Six patients had multifocal scleral abscesses due to Pseudomonas, Klebsiella, or Nocardia. Only 2 patients retained useful vision (>6/18). A poor visual acuity at presentation usually resulted in a worse visual outcome (P = 0.005). Four eyes developed phthisis. The addition of surgical intervention did not result in a significantly better visual outcome than medical management alone (P = 0.209), but resulted in a higher globe preservation rate (P = 0.045). Therefore, we concluded that infection must be ruled out in cases of scleritis with preceding history of trauma, and aggressive surgical intervention improves the anatomical outcome but does not change the visual outcome.

Congenital eyelid imbrication syndrome (CEIS) is an extremely rare, benign, transient, self-limiting eyelid malposition disorder. The classic triad of signs in patients with a CEIS consists of bilateral upper eyelids overriding the lower eyelids when child was in sleep, bilateral medial and lateral canthal tendon laxity and tarsal conjunctival hyperemia. We report a third case of congenital combined eyelid imbrication and floppy eyelid syndrome in healthy neonate that was resolved within a week with conservative treatment.

The purpose of this study was to determine the characteristics of primary diffuse large B-cell lymphoma (DLBCL) of the lacrimal sac. A 77-year-old man had epiphora of the right eye for three years. After visiting five clinics and hospitals, he was referred to our hospital, and the preoperative magnetic resonance imaging findings suggested a lacrimal sac mass. Dacryocysteography showed an obstruction of the right nasolacrimal duct, so we performed dacryocystectomy. After a histopathologic examination of the specimen, the patient was diagnosed with a DLBCL. Positron emission tomography scanning excluded metastases, and the final diagnosis was made of a primary DLBCL of the right lacrimal sac. He underwent radiotherapy with 30.6 Gray in total to the right lacrimal sac. After radiotherapy, no recurrence has been observed anywhere in his body for one year. Although a malignant lymphoma of the lacrimal sac is rare, clinicians should consider a primary malignant lymphoma in the differential diagnosis in patients with chronic dacryocystitis.

Systemic imaging of patients with suspect ocular tuberculosis include chest X-rays and computed tomography (CT) scans. Reports have suggested a role for 18 fluorodeoxyglucose-positron emission tomography/CT (FDG-PET/CT) scans. We report on the clinical utility of 18 FDG PET/CT in two patients. Case 1: A 38-year-old female patient presented with recurrent anterior uveitis. A 18 FDG-PET scan revealed metabolically active supraclavicular and chest lymph nodes. An aspiration cytology of the cervical lymph node revealed caseating granulomas suggestive of tuberculosis. Case 2: A 58-year-old female patient presented with recurrent anterior uveitis. A 18 FDG-PET scan revealed metabolically active lymph nodes in the neck. A biopsy of the cervical lymph node revealed epithelioid granulomas suggestive of tuberculosis. Both patients were started on standard antitubercular therapy with a subsequent marked reduction of activity. PET/CT scans may suggest the sites of safe high-yield biopsies.

We are presenting the initial results of inverted internal limiting membrane (ILM) flap technique for large macular hole. Five eyes of five patients with large diameter macular hole (>700 μm) were selected. All patients underwent inverted ILM flap technique for macular hole. Anatomical closure and functional success were achieved in all patients. There was no loss of best-corrected visual acuity in any of the patients. Inverted ILM flap technique in macular hole surgery seems to have a better hole closure rates, especially in large diameter macular holes. Larger case series is required to assess the efficacy and safety of this technique.

Dacryocystectomy or DCT refers to a complete surgical extirpation of the lacrimal sac. It was first described by Thomas Woolhouse in 1724 and was the standard of care in its crude form, before the advent of dacryocystorhinostomy for management of dacryocystitis and lacrimal fistulae [1]. Rudolph Berlin later popularized it in the nineteenth century [1]. Dacryocystectomy in its journey since then has unfortunately seen many ups and downs and suffered major humiliation in the 1920s wherein it was described by few authors as “an act of surgical despair”; “a useless and barbaric mutilation”; and “a malpractice.” [1] We have come far from those days and DCT is now considered an important part of the lacrimal surgeon’s armamentarium. The usual approach in most of the cases is through a transcutaneous incision, except in certain exceptional circumstances where endoscopic approach may be needed [2].

Eccrine adenocarcinoma of the lacrimal sac region is described in a 48-year-old man. The case was first diagnosed as an adenocarcinoma and removed by dacryocystectomy, but unfortunately the neoplasm recurred after a period of 1 year. Examinations with periodic acid-Schiff (PAS) and several antibodies indicate that this is a hitherto undescribed eccrine adenocarcinoma, and finally the case was managed by orbital exenteration. This is the first case of eccrine adenocarcinoma of the lacrimal sac region to be documented in the world literature.

Post traumatic nasolacrimal drainage obstruction is an uncommon presentation of naso-orbito-ethmoid fracture. Dacryocystorhinostomy (DCR) with or without silicon intubation is the universally accepted treatment modality. Here we report a case of recurrent lacrimal sac abscess due to post traumatic nasolacrimal drainage obstruction following naso-orbito-ethmoid fracture. The patient had previously undergone incision and drainage thrice and twice failed DCR. In the background of extensive nasal synechiae and twice failed DCR, dacryocystectomy was performed. Post operatively patient has improved and is symptom free for past 14 months. This is the first report of a successful dacryocystectomy for a post traumatic dacryocystitis.

Three patients had recurrent chronic dacryocystitis but no epiphora associated with failed dacryocystorhinostomies. Dacryocystectomy was performed on all three patients. These patients were cured of dacryocystitis following dacryocystectomy and none had epiphora postoperatively. There may be a group of patients with dry eyes and chronic dacryocystitis in whom dacryocystorhinostomy is likely to fail. Such patients may respond favorably to dacryocystectomy. [Ophthalmic Surg Lasers 1996;27: 133-136.]

WOS: 000330854300019, PubMed ID: 24088642, Unilateral extensive myelination of the peripapillary nerve fibers may be associated with anisometropic myopia, strabismus, and reduced vision. Myelination of optic nerve fibers terminate at lamina cribrosa. Yet in some patients, myelination progresses into the peripapillary retinal nerve fibers and may affect the visual acuity. In this report, we described 4 patients. All patients presented extensive peripapillary myelinated nerve fibers associated with myopic anisometropia. After routine ophthalmic and orthoptic examinations, all patients underwent treatment for amblyopia through correction with spectacles, contact lenses, and the occlusion of the good eye. Corrected visual acuity improved in 1 patient, but 3 patients had no increase in visual acuity despite treatment with full cycloplegic refraction and appropriate patching. Probably because of structural abnormalies of the macula, visual results are often disappointing with appropriate correction of the refractive error and occlusion.

The procedure of dacryocystectomy is described in a patient with Wegener's granulomatosis where bone preservation is essential for future reconstructive procedures. With the aid of canalicular clamps, viscoelastic substance is used to distend the lacrimal sac thereby facilitating easier dissection. We describe the use of canalicular clamping and injection of a viscoelastic substance into the lacrimal sac to facilitate easier dissection during dacryocystectomy.

A mass that recurred after dacryocystectomy for benign squamous papilloma of the lacrimal sac was diagnosed as a high-grade mucoepidermoid carcinoma in a 53-year-old man on histopathology. Local excision to the orbital periosteum was performed and gave a margin free of invasion. Neither local recurrence nor systemic metastasis was found 3 years after local excision. Mucoepidermoid carcinoma of the lacrimal sac is extremely rare and spreads locally in an aggressive manner; a cure typically requires exenteration, radical resection, or adjuvant radiotherapy. In this rare case, despite the high malignancy, the patient underwent successful local excision, achieved an aesthetically satisfying result, and has had a long-term cancer-free period.

Dacryocystectomy is the surgery of choice for elderly patients with chronic dacryocystitis with a fibrotic sac. Although a simple procedure, it can cause serious complications (however rare) such as visual impairment. A 65-year-old woman who underwent bilateral dacryocystectomy is described. On the first postoperative day, she complained of pain in her left eye. Her visual acuity was light perception in the left eye. Computed tomography scan of the orbit revealed a retrobulbar hematoma on the left eye. The hematoma was drained, but the patient did not regain vision. A rare complication of visual loss following dacryocystectomy is described. [Ophthalmic Surg Lasers Imaging 2006;37:494-496.] AUTHORS From the O. E. U. Institute of Ophthalmology, Kasturba Medical College, Mainpal, Karnataka State, India. Accepted for publication May 24, 2006. Address reprint requests to Vijaya H. Pai, MS, DOMS, Professor & Head, O. E. U. Institute of Ophthalmology, Kasturba Medical College, MANIPAL-576104, Karnataka State, India.

After the advent of dacryocystorhinostomy (DCR), dacryocystectomy (DCT) was regarded as mutilant surgery and reserved for lacrimal sac tumors.To present current indications for dacryocystectomy.Eighteen eyes from 11 patients subjected to DCT were reviewed retrospectively. Nine patients had chronic dacryocystitis confirmed by dacryocystography and two patients had lacrimal sac tumors.The indications for DCT were: three patients with systemic medical problems, three patients with dry eye, two cases of lacrimal sac tumors, two cases of traumatic dacryocystitis and one case of cutaneous leishmaniasis. Dacryocystitis was resolved in 17 of 18 eyes; the two cases of tumor evolved without epiphora. One patient (traumatic dacryocystitis) had recurrence of dacryocystitis.DCT is mainly performed when a lacrimal sac tumor is suspected but, since it avoids the intra- and postoperative complications related to dacryocystorhinostomy, it can be indicated in cases of dacryocystitis with significant lacrimal discharge and an enlarged or altered lacrimal sac.

The procedure of dacryocystectomy is described in a child with craniodiaphyseal dysplasia. Fibrin tissue adhesive is used to distend and delineate the lacrimal sac and fistula to aid complete dissection.

Four case reports of epithelial carcinoma of the lacrimal sac are presented. The different manifestations of the condition are described, and the dangers of misdiagnosis as da-cryocystitis highlighted. The investigation and management of nasolacrimal sac carcinoma are discussed, including both surgery and radiotherapy. A review of the literature on this rare tumour is presented, including its prognosis and pathology. Although rare, a high index of suspicion should be maintained for nasolacrimal sac tumour, in order to optimize therapeutic opportunity.

Tumors of the lacrimal sac are rarely encountered in clinical practice. The importance of recognizing this entity lies in the fact that the majority of the lacrimal sac tumors turn out to be malignant and thereby potentially life-threatening. Hence appropriate management of the lacrimal sac tumors is of utmost importance. We report a case of transitional cell carcinoma of the lacrimal sac, its presentation and management along with the review of the published literature.

We investigated a case of unilateral optic nerve hypoplasia using spectral domain optical coherence tomography (SDOCT). Optical coherence tomography was done on both eyes using 5-line Raster scan for the fovea to analyze the retinal nerve fiber layer thickness, inner retinal layer thickness, outer retinal layer thickness, and optic disc cube scan for the disc. Retinal nerve fiber layer thickness, inner retinal layer thickness, and outer retinal layer thickness were manually measured at 21-points of each five lines, and results were compared between both eyes. Retinal nerve fiber layer thickness and inner retinal layer thickness of optic nerve hypoplasia were significantly thinner than the opposite eye, but there was no significant difference in the thickness of the outer retinal layer between both eyes.

Purpose: To characterize the clinical presentation of Myobacterium fortuitum dacryocystitis, an unusual microbial cause of this disease. Methods: The authors present a detailed description of a case of M. fortuitum chronic dacryocystitis and a review of the literature. Findings: Although M. fortuitum is a well-recognized cause of chronic keratitis and corneal ulcer, it has only been reported once previously as a cause of dacryocystitis. Multiple factors that alter the ocular environment of the host may predispose to infection with this organism. The diagnosis requires isolation of the organism in the appropriate clinical setting. The authors' case represents the first patient successfully treated with dacryocystectomy. Conclusions: M. fortuitum is a rare cause of chronic dacryocystitis that may respond favorably to surgical therapy alone.

A case of malignant melanoma of the lacrimal sac in a 41-year-old woman is reported, which is propably the 12th one in the world literature. Dacryocystectomy is advisable at a localized stage. The importance of early diagnosis is discussed.

Tumors of the lacrimal sac are a rare entity in ophthalmology, but represent a potentially life-threatening situation that can easily be overlooked. This paper will review the literature and describe clinically and pathologically the more common types of lacrimal sac tumors, and give a description of the less common types of primary and secondary tumors of the lacrimal sac and a case presentation.

SUMMARY A high index of suspicion is very important in the early diagnosis and treatment of potentially lethal tumors of the lacrimal sac. The triad of a mass above the medial canthal tendon, chronic dacryocystitis which irrigates freely and bloody reflux on irrigation should alert the ophthalmologist of this potentially fatal situation. Complete surgical excision and postoperative irradiation are important in the treatment of malignant tumors.

DACRYOCYSTORHINOSTOMY in adults has become the procedure of choice for the cure of chronic dacryocystitis, mucocele, and epiphora. The marked trend from dacryocystectomy to dacryocystorhinostomy is due to the high percentage of successes of the latter in relieving the purulent discharge and tearing. There is apparently no reason for any other procedure being performed for these conditions so long as at least one canaliculus is patent. Age is not a contraindication. Rychener1has employed this operation on patients from the age of 18 months to 72 years. I have performed the operation for the relief of recurrent acute dacryocystitis in a patient 80 years of age. The need for dacryocystorhinostomy in young children has been mentioned only in the recent literature. Redmond2reported its use bilaterally in a 3-year-old child, with success, and Aalde,3in a 3-month-old boy. Simpson4successfully performed dacryocystorhinostomy on a 7-year-old boy

In dissecting the lacrimal sac for the purpose of dacryocystectomy or for effecting permanent drainage by one of the several well described methods, the surgeon usually experiences difficulties of two kinds: first, excessive bleeding which constantly obscures the operating field and, second, loss of anatomic orientation. These difficulties are easily remedied by a slight modification of the operative technic, and operation on the lacrimal sac, which is frequently considered as technically rather difficult, becomes a simple and clean procedure. IMPROVED TECHNIC The one refinement of the technic consists in using a higher concentration of epinephrine in the procaine hydrochloride used for infiltration anesthesia. The usual surgical concentration of epinephrine is 1: 100,000 in 1 or 2 per cent procaine hydrochloride. By adding to this epinephrine-procaine hydrochloride mixture, obtained in ampules, 1 drop of sterile, but not boiled or autoclaved, solution of epinephrine (1: 1,000) for each cubic centimeter of

Methods of testing for lacrimal drainage insufficiency and a modification of the Jones fluorescein dye tests are presented. Despite their excellence, Jones tests have never been widely employed because of difficulty in dye retrieval. The modification consists of instilling one drop of the dye three times at 15 second intervals, and after a one minute period, placing the head down at a 45 degree angle for ten minutes. Anatomic and roentgenogram studies show that the dye can be easily lost posteriorly unless this is done. No nasal vasoconstrictors are used to avoid false negatives.

• Fibrous histiocytoma is a soft-tissue tumor that was first described in 1961. The orbit is a site of predilection. Chronic epiphora, which was caused by a mass involving the lacrimal sac, developed in a woman. She subsequently underwent dacryocystectomy. On pathological examination, the tumor was found to be a fibrous histiocytoma. This is, to our knowledge, the first reported case of a fibrous histiocytoma originating in the lacrimal sac.

MALIGNANT epithelial tumors of the lacrimal drainage system are rarely encountered. In over 100 cases of malignant lacrimal sac tumors reported, about one half have been carcinomas.1-5Predominant among these carcinomas is a nonkeratinizing epidermoid carcinoma which is usually moderately well differentiated. The tumor has been called transitional carcinoma, cylindrical cell carcinoma, and squamous cell carcinoma. Similar tumors have been reported arising in the nasal cavities, nasopharynx, and paranasal sinuses.1When such a lesion occurs in the lacrimal drainage system, it may produce early epiphora despite patency of the system to probing and irrigation.6Later, tumefaction develops in the medial canthal area. After dacryocystectomy, the lesions often recur locally and sometimes metastasize to distant organs.7 A case which illustrates this lesion and its sequelae has been observed. It involved both lacrimal canaliculi and the lacrimal sac. Canalicular involvement by such neoplasms may account for some of