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Lacrimal gland ductulitis is a rare infection of the lacrimal gland ductules. Individuals affected report a history of chronic mucopurulent conjunctivitis with "stringy" discharge. All patients are clinically noted to have an inflamed lacrimal gland ductule. Prior reports have suggested Actinomyces species as the "probable" etiology.We report the findings of a 42-year-old male found to have lacrimal gland ductulitis with a lacrimal gland abscess, confirmed by radiologic studies. Surgical drainage was necessitated and performed. Histopathologic analysis confirmed colonization by Actinomyces species, as well as the presence of sulfur granules. To our knowledge, this is the first report of Actinomyces lacrimal gland ductulitis resulting in a secondary lacrimal gland abscess.

Objective: To assess the role of colour Doppler flow imaging (CDFI) in the diagnosis and management of lacrimal fossa lesions., Methods: Institutional ethical committee approval was obtained. Fifty-one patients with 62 lacrimal fossa lesions were retrospectively included from 2003-2015. All patients underwent conventional ultrasonography and CDFI, with a qualitative and quantitative analysis of the vascularization. All patients had lacrimal gland surgery. Definitive diagnosis was based on pathological examination., Results: The study included 47 non-epithelial lesions (NEL) and 15 epithelial lesions (EL), with 24 (39 %) malignant lesions and 38 (61 %) benign lesions. NEL were significantly more likely to present with septa (p < 0.001), hypoechogenicity (p < 0.001), high vascular intensity (p < 0.001), both central and peripheral vascularization (p < 0.001), tree-shape vascularization (p < 0.05) and a low resistance index (RI) (p < 0.0001). EL were significantly more likely to present with the presence of cysts (p < 0.001), and a higher RI. Receiver operating characteristic curves identified a RI value of 0.72 as the best cut-off to differentiate NEL from EL, with a sensitivity and specificity of 100 %., Conclusion: CDFI is a valuable tool in the differential diagnosis of lacrimal fossa lesions. Resistance index measurement enables substantial distinction between EL and NEL, thus providing crucial data for surgical management., Key Points: • CDFI is a valuable tool in lacrimal fossa lesions. • Resistance Index measurement enables substantial distinction between epithelial and non-epithelial lesions. • Management of patients becomes more appropriate.

A 42-year-old man presented with a white plastic-like material exposed in the left medial canthal area, with a fistula and purulent discharge. He had undergone endonasal dacryocystorhinostomy 7 years earlier for left eye epiphora; he had persistent postoperative epiphora and recurrent dacryocystitis despite multiple drainage attempts and antibiotics elsewhere. Computed tomography showed bilateral enlarged cystic lacrimal sacs, with a well-defined contoured tunnel-like hole at the center of the left sac. Treatment included excision of the foreign body, which was a Griffiths' collar button nasolacrimal stent, excision of the fistula tract, and revision dacryocystorhinostomy with implantation of bicanalicular silicone stent. He recovered with no further symptoms or complications. This case highlights the importance of follow-up for removal of an implanted Griffiths' stent after dacryocystorhinostomy. Patients with recurrent dacryocystitis may benefit from a detailed history of previous surgery, careful examination, and imaging to evaluate for endogenous and exogenous foreign bodies such as lacrimal sac calculi, and retained lacrimal sac stents.

The purpose of this study is to highlight the rare possibility of spontaneous resolution of a lacrimal sac mucocele by means of a retrospective case note analysis. The authors identified 3 patients with nasolacrimal duct obstruction and clinical and radiological evidence of mucocele. In all 3 cases, resolution of symptoms was reported prior to dacryocystorhinostomy. In each case, the mucocele was no longer palpable, and the patency of the nasolacrimal duct was confirmed by sac washout. A lacrimal sac mucocele may rarely rupture in the nose and resolve spontaneously. Although this is a rare outcome, lacrimal surgeons should be aware of this prospect to avoid unnecessary surgery and investigations. The authors recommend that lacrimal surgeons present spontaneous resolution as one of the possible outcomes in their patient information literature.

Kuttner Tumour is a chronic inflammatory disease diagnosed histologically. It is under-diagnosed due to lack of awareness of the disease. We present a case of a 40-year old female with recurrent upper lid swelling. Biopsy revealed the diagnosis of Kuttner Tumours of the lacrimal glands. Although surgical excision is a treatment option, it can be treated with a course of steroids. Our patient opted for conservative management. We describe the presentation and course of the case, with an emphasis on the histological features of the tumour.

A 69-year-old man presented with a "lump" on his nose, after antibiotic therapy and warm compresses failed to resolve his presumed dacryocystitis. Because this disorder displayed atypical features (no tenderness, no redness, evidence of the greatest expansion of the nasolacrimal system inferior to the lacrimal sac fossa), a neoplastic process was considered. Orbital CT showed a mass obliterating the nasolacrimal system and maxillary sinus. Evaluation of the biopsy specimen revealed metastatic hepatocellular carcinoma of the orbit, making this case the first documentation of this disorder in the nasolacrimal system. Postoperative evaluations revealed an occipital lobe metastasis, and the patient died several months later from his intracranial disease. Clinicians should be aware of this entity, and the presence of atypical features warrants careful evaluation with specific consideration of neoplastic disease.

Background: After the advent of dacryocystorhinostomy (DCR), dacryocystectomy (DCT) was regarded as mutilant surgery and reserved for lacrimal sac tumors., Purpose: To present current indications for dacryocystectomy., Methods: 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., Results: 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., Conclusions: 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.

Background: Affections of the lacrimal drainage system are often seen by ophthalmologists. Inspection, palpation, diagnostic rinsing and sounding can distinguish anatomical stops before or after tear sac. For final diagnostics however more apparative examinations are necessary. The ultrasonic examination with contrast media is a simple method for diagnostics of affections of the lacrimal drainage system besides the dacryocystography, the scintigraphy and other ones., Patients and Methods: On 12 patients with a dysfunctional lacrimal drainage system and 12 normal controls the ultrasonic examination with instillation of contrast media: silicon oil, glycerine, dispersions of almond oil and viscoelastic substances was performed. All examinations were performed with the 13 B-scan., Results: The lacrimal drainage way was detectable from the canaliculus to the middle nasolacrimal duc, Conclusion: An additional advantage of the ultrasonic examination with contrast-media is the neglect of radiation, the simple and often repeatable examination method, especially the enhancement of the contrast of different valves and stenoses and mucinous deposits in stationary anatomical variations and dynamic defects.

Magnetic Resonance Imaging of a dacryocystography and a watersoluble computed tomographic dacryocystography were compared in 13 prospective cases after facial traumas, infections or without previous history. All had either watering eyes, ephiphora or dacryocystitis. This study demonstrated the superiority of computed tomography which must be used in first intention for complexe problems of the lacrimal drainage system. Only tumoral pathology (very rare) requires Magnetic Resonance Imaging. Combined computed tomography and dacryocystography in the same time provide diagnostic precision and less radiation. Confortable for the patient by helicoidal acquisition, computed tomography is cheaper than a Magnetic Resonance Imaging.

A- und B-scan echography is a useful method for the examination of certain parts of the lacrimal drainage system. In most cases it can substitute for dacryocystography and other expensive methods in the diagnosis of lacrimal sac diseases. Older methods of echography for examination of the lacrimal sac are direct contact, water bath, and rarely transocular contact methods. We have developed a new method, in which a rubber tube filled with fluid is placed between the transducer and the skin surface. Comparison of these methods demonstrates that this is the best method for ultrasound diagnostics of the lacrimal sac because it can be carried out as easily as the direct contact method, and the quality of the echograms is as good as in the water bath method. A special advantage is that causing an infection in the patient with the ultrasound probe can be avoided.

Twenty patients with mass lesions in the lacrimal gland region were evaluated with computed tomography (CT). The extent of the mass and its relationship to the globe, optic nerve, and extraocular muscles were clearly seen. The CT appearance on plain scan and the presence or absence of contrast enhancement, bone involvement, and cystic components often suggested the specific pathological diagnosis. Although orbital ultrasonography and CT were frequently complementary, ultrasonography was more definitive in inflammatory diseases, while CT demonstrated better extraorbital extension.

The lacrimal gland region can be involved in a wide spectrum of orbital pathology, including tumors and inflammatory and lymphoid lesions. This article focuses special attention on benign mixed tumors because of the excellent prognosis for the patient when it is completely excised at first surgery. The appearance of these lesions on CT is detailed in the illustrations of this article, and the findings of experts in the field are presented as well.