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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.

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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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

THE value of draining an infected sac into the nose was recognized 1500 years ago by surgeons of the Byzantine School, who performed a crude dacryocystorhinostomy by passing a cautery through the sac and lacrimal bone. But such openings made by simple penetration rapidly close, and much surgical ingenuity has since been devoted to the problem of fashioning a permanent communication. At the beginning of the 20th century, Toti (1904) laid the foundation of the modern operations of external dacryocystorhinostomy. Since then the careful work ofmany surgeonshas resultedin procedures which give a high percentage of success Traquair (1940), 80 per cent.; Scott (1949), dacryocystitis 99.4 per cent., epiphora 76.9 per cent.; Stallard (1950), 89 per cent.; Rycroft (1951), over 80 per cent. Despite these excellent results, dacryocystectomy is still being very generally performed because it is believed that dacryocystorhinostomy is successful only in exceptionally experienced hands, is time-consuming, is often beset with technical difficulties. and sometimes involves painful post-operative treatment.