Lacrimal Diseases Research Articles

Application of artificial intelligence in oculoplastics

Oculoplastics is a subspecialty of ophthalmology/dermatology concerned with eyelid, orbital, and lacrimal diseases. Artificial intelligence (AI), with its powerful ability to analyze large data sets, has dramatically benefited oculoplastics. The cutting-edge AI technology is widely applied to extract ocular parameters and to use these results for further assessment, such as screening and diagnosis of blepharoptosis and predicting the progression of thyroid eye disease. AI also assists in treatment procedures, such as surgical strategy planning in blepharoptosis. High efficiency and high reliability are the most apparent advantages of AI, with promising prospects. The possibilities of AI in oculoplastics may lie in three-dimensional modeling technology and image generation. We retrospectively summarize AI applications involving eyelid, orbital, and lacrimal diseases in oculoplastics, and we also examine the strengths and weaknesses of AI technology in oculoplastics.

Oculoplastic publication trends in general ophthalmology journals.

To examine the publication trend of oculoplastic articles throughout the last decade in general ophthalmology journals. A review of all abstracts published between January 2010 to December 2019 in general, clinical ophthalmic journals was conducted. Articles that were categorized as original articles in general and clinical journals were included in the study. Totally 10 281 abstracts were included. Of them 465 (4.5%) were oculoplastic publications. The mean number of annual-publications was 46.5 and the mean annual-rate of oculoplastic publications was 4.51%. A significant decreasing trend in the number of oculoplastic publication in the last decade was found (P<0.01, R 2=0.770). However, there was no significant change in the annual-rate of oculoplastic publications during the last decade (P=0.191, R 2=0.203). From the 465 oculoplastic articles: 179 (38.5%) were articles about eyelid diseases, 160 (34.40%) were about orbit diseases, 92 (19.80%) were about lacrimal diseases and 34 (7.30%) were about thyroid eye disease (TED). A significant decreasing trends in the number of orbital and eyelids publications were found (P<0.01, P<0.01). However, there were no significant changes in the annual-rate of orbital, eyelids, TED and lacrimal-diseases publications throughout the last decade. Oculoplastic subspecialty deals with a wide range of pathologies in different ages. However, less than 5% of the articles in general, clinical, high impact factor ophthalmology journals are about oculoplastic diseases. One of the best way for ophthalmologists from different subspecilties, nowadays, to be updated, is to read high-impact-factor, general ophthalmology journals. Therefore, it is important that those journals will include articles about breakthroughs in oculoplastic.

A summary of oculoplastic and orbital surgery in China in the past 70 years

Oculoplastic and orbital surgery is concerned with the occurrence, manifestation, diagnosis, treatment and prevention of the eyelid, orbit and lacrimal diseases, as well as the repair and reconstruction of the related deformities and defects. Since the beginning of the new century, the number of patients with eyelid and orbital diseases has increased continuously, and the team of specialists has expanded rapidly. The development of oculoplastic and orbital surgery in China has entered an all-round new stage, especially with the establishment of Chinese Society of Oculoplastic Surgery and Orbital Disease in 2013. Oculoplastic and orbital surgery in China has made outstanding achievements in strengthening the training of professional talents, promoting interdisciplinary and international exchanges, improving the academic level of basic research, and emphasizing on the research of translational medicine. The technique of ocular plastic surgery has been progressing continuously. Cosmetic surgery of the eye has gained widespread popularity and standardization. Orbital surgery has recorded an innovative, interdisciplinary and rapid growth. International exchanges have helped to expand the international influence and competitiveness. This article is written to celebrate the 70th anniversary of Chinese Journal of Ophthalmology. (Chin J Ophthalmol, 2020, 56: 805-810).

The clinical effects of acupuncture combined with Mingmu-Dihuang pill on dry eyes

Objective To evaluate the effect and safety of acupuncture combined with Mingmu-Dihuang pill in patients with dry eyes. Methods A total of 100 patients with dry eye were enrolled in line with the inclusion criteria and divided into experimental group and control group by random figure table. The experimental group was treated with acupuncture combined with Mingmu-Dihuang pill, and the control group was treated with artificial tears. After 2 months of treatment, the Schirmer test (schirmerI, SIT), tear film break up time (BUT), fluorescent staining (FL) and clinical symptom score were observed and compared, and the clinical efficacy and safety were evaluated. Results The total effective rate of the experimental group was 89.0% (89/100) and the control group was 67.0% (67/100), and the difference was significant (χ2=14.121, P<0.001). After treatment, the levels of BUT (7.89 ± 1.65 s vs. 5.01 ± 1.72 s, t=8.543), SIT (7.45 ± 1.68 mm vs. 5.01 ± 1.72 mm, t=5.991) in the experimental group were significantly higher than those of the control group, and the difference is significant (P<0.01). The FL score and dry eye score in the experimental group were significantly lower than those of the control group (t were 11.551, 12.342, P<0.01). Conclusions Acupuncture combined with Mingmu-Dihuang pill has better clinical effect and good safety for the treatment of dry eye patients. Key words: Xerophthalmia; Acupuncture therapy; Acupuncture reinforcing method; Mingmu-Dihuang pill; Therapies, investigational; Lacrimal apparatus diseases

Application of lacrimal endoscopy in the diagnosis and treatment of primary canaliculitis: Practical technique and graphic presentation.

To investigate the efficacy of lacrimal endoscopy in the diagnosis and treatment of primary canaliculitis.This is a retrospective, interventional study. Fifteen patients diagnosed as primary canaliculitis were investigated, who underwent surgery with lacrimal endoscopy from January 2015 to December 2017 at Zhejiang Provincial People's Hospital. Patients were subsequently followed post-operatively for at least 6 months. Pre- and post-operative main measurement included ocular surface symptoms, signs of canaliculitis, intraoperative images, treatment response and complications.Twelve patients (12 eyes) were enrolled. Endoscopy was successful in revealing the residual concretion and pathological change of lacrimal duct. With its unique direct vision and micro drill, all concretions got removed and lacrimal ducts got patent. On postoperative month 6, all of the patients got cured with no signs of redness, swelling of the punctum and eyelid, epiphora with discharge and pain. None serious complications such as false canalicular passage were observed.Lacrimal endoscopy is indispensable in diagnosis, treatment and follows up of primary canaliculitis. With less iatrogenic injury, higher resolution rate and direct observation of canalicular mucosa, lacrimal endoscopy should be widely applied in the management of lacrimal diseases.

Ultrasonography-guided removal of plant-based foreign bodies from the lacrimal sac in four dogs

BackgroundDacryocystitis is an inflammation of the lacrimal drainage system. One of the most common causes of dacryocystitis in dogs is due to plant-based foreign bodies typically located in the lacrimal sac. The aim of this case series was to describe an ultrasonography-guided technique for dogs with plant-based foreign bodies in the lacrimal sac, as both a diagnostic and therapeutic tool.Case presentationFour dogs with clinically suspected plant-based foreign body in the lacrimal sac (with a total of five eyes affected) were evaluated by ultrasound with a multifrequency (8–14 MHz) linear probe. Under general anesthesia, the foreign body was removed using Hartmann alligator forceps inserted thorough the upper puncta. Ultrasound was used to guide the forceps in grasping the foreign body. Ultrasound was positive in four out of five lacrimal sac diseases. All identified foreign bodies were successfully removed by the ultrasonography-guided technique.ConclusionsThe results show that ultrasound is a fast, non-invasive, and inexpensive method for the assessment of dacryocystitis due to foreign bodies in dogs. Ultrasound is also useful not only for identification, but also in the non-invasive removal of the foreign body from the lacrimal sac. To the best of authors’ knowledge, this is the first study to describe the sonographic approach to the palpebral medial cantus as an initial diagnostic step in canine dacriocystitis.

Clinicopathological analysis of 22 cases with primary malignant tumors of the lacrimal sac

Objective To analyze the clinicopathological features sac of primary malignant tumors of lacrimal. Methods The clinical and pathologic data of 22 eyes of 22 patients with primary malignant tumors from lacrimal sac of Jan. 2014 to Dec. 2017 were analyzed retrospectively. Results All cases received pathological examination of tumors after surgical excision. Among 12 cases(54.50%) of epithelial malignant tumor: there were squamous cell carcinoma in 5 cases(41.70%), inverted papilloma with malignant transformation in 2 cases(16.70%), undifferentiated carcinoma in 2 cases(16.70%), basal cell carcinoma in 1 case(8.33%), adenocarcinoma in 1 case(8.33%) and adenoid cystic carcinoma in 1 case(8.33%). Among 10 cases(45.50%)with nonepithelial malignant tumors: there were B-cell lymphoma of mucosa-associated lymphoid tissue in 5 cases(50.00%), malignant melanoma in 3 cases(30.00%), lacrimal sac leiomyosarcoma in 1 case(10.00%) and dermatofibrosarcoma protuberans in 1 case(10.00%). Conclusion Most malignant lacrimal tumors are squamous cell carcinoma, B-cell lymphoma of mucosa-associated lymphoid tissue and malignant melanoma. Key words: Lacrimal apparatus diseases; Carcinoma, squamous cell; Carcinoma, basal cell; Lymphoma mucosa-associated lymphoid tissue

The proportion of ocular surface diseases in untreated patients with epiphora.

PurposeVarious ocular surface disorders, such as dry eye, infectious and non-infectious inflammation, anatomical anomalies in lid structure, and/or obstruction of the tear outflow tract, can cause epiphora. However, few reports have described the proportions of causative diseases in patients with epiphora. Therefore, we investigated the frequent causes of epiphora in older adult patients.Materials and methodsWe enrolled 220 patients (70 men, 150 women) who visited a primary eye care clinic from January 2016 to August 2017 with lacrimation as a chief complaint. The mean age of the patients was 61.3±10.9 years. The causes of epiphora were assessed by slit-lamp examinations, dry eye tests, fluorescein disappearance tests, and lacrimal pathway washing.ResultsThe causes of epiphora were dry eye in 96, conjunctivochalasis in 56, lacrimal obstruction in 30, conjunctivitis in 20, trichiasis in 16, and facial palsy in 2 patients. Ocular surface diseases were identified in 187 of the 220 (85%) patients who complained of epiphora. Conjunctivochalasis was observed in 36 of the 96 (38%) patients with dry eye. Among the patients with dry eye, 99% had short break-up time type dry eye, with the random break type being the most frequent type (61/96; 64%) in patients with epiphora.ConclusionAmong older adult patients whose main complaint was epiphora, 85% had ocular surface diseases. In contrast, only 15% of patients had lacrimal diseases. Short break-up time dry eye, especially the random break type, was the most frequently observed form of dry eye in our cohort.

Methodology of a rabbit model of chronic dacryocystitis

Background Chronic dacryocystitis is a common infectious lacrimal apparatus disease.Whether infection factors or lacrimal duct obstruction play a major role in the process of recurrent lesions is still controversial.Establishing a reasonable animal model contributes to its pathogenesis study.However, an effective methodology on establishing chronic dacryocystitis animal model is lack. Objective This study was to develop a method of establishing chronic dacryocystitis animal model. Methods Sixty-six Japanese white rabbits were randomized into 6 groups and 11 for each, and the right eye of each rabbit served as the experimental eye.The solution of 2, 4-toluene disocyanate (TDI) with olive oil was droped in the right nasal cavity to induce allergic rhinitis in the temporary lacrimal duct obstruction group; 0.15 ml mixture of methyl methacrylate (MMA) with polymethyl methacrylate (PMMA) was injected into lacrimal duct via lacrimal punctum in the permanent lacrimal duct obstruction group; 0.3 ml Staphylococcus aureus suspension at the concentration of 1×107/ml was injected into lacrimal duct via punctum in the only bacterial inoculation group, and the Staphylococcus aureus suspension was injected folowing the operation of allergic rhinitis or mixture of MMA injection respectively in the temporary lacrimal duct obstruction+ bacterial group and permanent lacrimal duct obstruction+ bacterial group.An equal volume of sterile saline solution was injected into the lacrimal duct in the normal control group.The clinical manifestations were observed before operation, immediately at operation, 1 day and 7 days after operation as a criteria of model of chronic dacryocystitis.Sringing of lacrimal duct was performed to evaluate the lacrimal patency, and parallel lacrimal CT angiography of lacrimal duct was carried out to identify the location of obstruction.The specimens of lacrimal sac and duct walls were collected for the bactriology and histopathology examination.The use and care of the experimental amnimals comlied with ARVO Statement. Results The animals were observed for consecutive 3 months.No chronic dacryocystitis occurred in the temporary lacrimal duct obstruction group, only bacterial inoculation group, temporary lacrimal duct obstruction+ bacterial group and normal control group.The chronic dacryocystitis models were successfully established in 8 eyes in the permanent lacrimal duct obstruction group and 9 eyes in the permanent lacrimal duct obstruction+ bacterial group.The lacrimal duct was closed, with the liquid completely reflux in the model eyes by sringing of lacrimal duct.Lacrimal CT angiography displayed the visible completely blockage of nasolacrimal duct in nasolacrimal duct distal namely nasolacrimal duct bone and nasal segment of the turning point and a visible expansion of proximal of obstructive site.Gram-negative bacilli were found in the models of the permanent lacrimal duct obstruction group and Staphylococcus aureus was dominant bacteria in the permanent lacrimal duct obstruction+ bacterial group.No abnormality was found in the specimens from temporary lacrimal duct obstruction group, only bacterial inoculation group, temporary lacrimal duct obstruction+ bacterial group and normal control group, and infiltration of inflammatory cells and proliferatin of mucosa were seen in the model eyes of permanent lacrimal duct obstruction group and permanent lacrimal duct obstruction+ bacterial group. Conclusions Permanent obstruction of lacrimal duct is a necessary condition to the establishment of animal model of chronic dacryocystitis, which plays a key role in the occurrence of rabbit chronic dacryocystitis. Key words: Dacryocystitis, chronic; Model, animal; Lacrimal apparatus diseases; Nasolacrimal duct/pathology; Lacrimal duct obstruction

Progress in diagnosis and surgical treatment of congenital lacrimal duct absence

Lacrimal passage diseases are common and frequently encountered eye diseases, and congenital lacrimal duct absence is the most serious one. Epiphora often shows in early age, and it is difficult inclinical treatment. Part or whole defect of lacrimal passage is often accompanied by dacryocystitis, dacryocystocele or other dysplasia clinically. With the improvement of demand for health and the development of medical science and technology, the diagnosis and surgical treatment of congenital lacrimal duct absence have achieved considerable progress in recent years. The progress in researches of diagnosis and surgical treatment, as well as the causes, pathomechanism, clinical manifestation, examination, differential diagnosis and the remained problems of congenital lacrimal duct absence were reviewed in this paper. Key words: Lacrimal duct absence, congenital; Clinical manifestation; Surgical treatment; Literature review

Clinical observation of laser ablation combined with lacrimal duct intubation for the treatment of chronic dacryocystitis

Objective To observe the clinical efficacy of laser ablation combined with lacrimal duct intubation for the treatment of chronic dacryocystitis with other lacrimal passage diseases. Methods A total of 310 eyes of 264 cases diagnosed as chronic dacryocystitis with lacrimal duct stenosis or obstruction who received laser lacryocystoplasty and silicone stent intubation in our hospital were retrospectively analysed. The follow-up time was 6-12 months. The patient's symptoms and lacrimal passage irrigation condition after extubation were analysed. Results There were 272 eyes recovered(87.74%), 27 eyes improved (8.71%) and 11 eyes invalid(3.55%). Conclusion Laser ablation combined with lacrimal duct intubation has good curative effect, few damage, low cost and doesn't change the normal lacrimal duct structure and affect the appearance, which can be considered as the preferred treatment for chronic dacryocystitis with other lacrimal passage diseases. Key words: Dacryocystitis, chronic; Diseases, lacrimal passage; Laser ablation; Intubation, stent

Современные возможности применения ботулинического токсина типа А при патологии слезных органов глаза

Современные возможности применения ботулинического токсина типа А при патологии слезных органов глаза

Potential candidate cells for constructing tissue-engineered lacrimal duct epithelium: a histological and cytological study in rabbits.

Injury and deficiency of the lacrimal duct epithelium (LDE) can lead to a variety of lacrimal diseases. The purpose of this study was to characterize potential candidate cells for constructing a tissue-engineered LDE. Different areas of the conjunctiva and lacrimal duct tissue were removed from male adult New Zealand white rabbits for histological evaluation. Hematoxylin and eosin staining and immunohistochemical staining of cytokeratin AE1+AE3, cytokeratin 4, Ki-67, and MUC5AC were observed by light microscopy. The surface morphologies of different epithelial tissues and cellular structures were examined using field-emission scanning electron microscopy and transmission electron microscopy. Epithelial cells were isolated from tissues and identified by specific markers. In vitro, proliferative ability and Western blot analyses of the proliferating cell nuclear antigen (PCNA) of different epithelial cells cultured in identical environments were investigated and compared. Histologically, the epithelial specific markers, cytokeratin AE1+AE3 and cytokeratin 4, were expressed in the conjunctiva epithelium and the LDE. Notably, highly proliferative cells stained with Ki-67 were concentrated under the epithelium in a dome structure of the posterior palpebral conjunctiva. Differentiated goblet cells were also found to a lesser extent in this region. Primary palpebral and fornical conjunctival epithelial cells (PFCECs), bulbar conjunctival epithelial cells (BCECs), and lacrimal duct epithelial cells (LDECs) were successfully separated from tissues. In vitro, rabbit PFCECs and LDECs grew faster and expressed more PCNA than BCECs. PFCECs are anatomically similar to LDECs. They also have similar morphological characteristics, immune phenotypes, and proliferation features. PFCECs are therefore potential candidate cells to replace LDECs in tissue engineering to treat lacrimal duct diseases.

Preliminary study on features of three-dimensional ultrasound reconstruction of the lacrimal sac of normal adults

To measure and accumulate imaging anatomical data of lacrimal sac and medial canthal artery, and provide the knowledge for clinical diagnosis and therapy of lacrimal diseases. 80 volunteers(80 eyes) who were eliminated the tearing related diseases by ophthalmologist were included. GE Voluson E8 ultrasound diagnostic apparatus with probe of high frequency 5-12 MHz was used, the probe of the three-dimensional ultrasound contacted eyes indirectly. The vertical diameter, anteroposterior diameter, width of lacrimal sac were measured, and vertical distance between top to bottom of lacrimal sac and medial canthus to skin, vertical distance between medial canthal artery and medial canthus to skin were also measured. The measurement results of adult male subjects of lacrimal sac cavity vertical diameter and anteroposterior diameter and diameter were (13.3 ± 2.0) mm, (6.2 ± 1.1) mm, (5.0 ± 0.9) mm; the measurement results of adult female subjects of lacrimal sac cavity vertical diameter and anteroposterior diameter and diameter were (13.1 ± 2.2) mm, (5.8 ± 1.0) mm, (4.8 ± 0.8) mm, the difference was not statistically significant(t = 1.63, 1.45, 1.41, P > 0.05). The measurement results of adult male subjects of lacrimal sac cavity (top, bottom) to the top of the skin surface and medial canthal were (6.5 ± 0.1) mm, (5.9 ± 0.1) mm, (6.8 ± 0.1) mm, (8.8 ± 0.1) mm; the adult female group measurements were (6.1 ± 0.1) mm, (5.7 ± 0.1) mm, (6.2 ± 0.1) mm, (8.6 ± 0.1) mm, the difference was not statistically significant(t = 1.30, 1.56, 1.45, 1.63, P > 0.05). The measurement results of adult male subjects vertex are angular artery to the skin surface and medial canthal were (7.7 ± 0.1) mm, (8.0 ± 0.0) mm; the adult female group measurements respectively (7.6 ± 0.1) mm, (7.9 ± 0.1) mm, the difference was not statistically significant(t = 1.38, 1.34, P > 0.05). Lacrimal sac and medial canthal artery can be showed clearly in three-dimensional ultrasound reconstruction, this can provide the guidance for clinical diagnosis and therapy of lacrimal diseases.

Therapie der Aktinomykose der ableitenden Tränenwege

Canaliculitis is a rare disease of the lacrimal pathway, especially of the canaliculi. It is often not identified, therefore misdiagnosed and inadequately treated. It accounts 2 % of all lacrimal diseases. False diagnoses are usually conjunctivitis, blepharitis, dacryocystitis, hordeolum and chalazion. Besides viruses and fungi a variety of bacteria can cause a canaliculitis. Actinomyces is the most common pathogenic agent of canaliculitis. Its generic name was first described by Harz in 1877. In 1854 von Graefe as well as Kipp and others in 1883 identified actinomyces as the agent for intracanalicular dacryoliths. Although for years actinomyces has wrongly been attributed to ray fungi because of its filamentary and branched nature it actually belongs to facultative anaerobic, non-motile, non-spore-forming, non-acid-fast, pleomorphic bacilli. In the context of canaliculitis caused by actinomyces sulphur granules, also called plagues or actinomyces granules, can often be found in the affected canaliculi. Actinomyces can be identified by light microscopy, culture, biochemical and molecular biological procedures. The most appropriate treatment is to incise the lacrimal punctum, to perform a canaliculotomy and canalicular curettage and if necessary to perform a silicone intubation of the lacrimal system for prophylaxis of stenosis. A postoperative local therapy with a broad-spectrum antibiotic should be initiated for 1 - 2 weeks.

Diagnosis and therapy of lacrimal system diseases by micro lacrimal endoscope

The lacrimal endoscope is applied to the diagnosis and therapy of the disorders of the lacrimal system in combination with laser or micro drills under orthophoria. The changes of mucous membranes, the characteristics of pathological changes and the predilection sites of lacrimal system diseases were initially approached. One hundred and forty six pairs of eyes of 128 patients with lacrimal system disease were observed by the lacrimal endoscope in the Ophthalmology Department of Tongji Hospital from June 2006 to March 2007. The dynamic changes in mucous membranes, lesion sites, secreted substances and formation of membrane could be observed under orthophoria. Combined with laser or micro drill, the endoscope was applied to the therapy of lacrimal system disorders and the difference before and after the treatment was observed. Results are as follows: (1) The examination and therapy using the lacrimal endoscope were completed under topical anesthesia in 122 patients, and 6 patients of neonatorum dacryocystitis were examined and treated under general anaesthesia. All patients reported painless. (2) Sharp images of the lacrimal system were obtained by the endoscope. Normal lacrimal mucosal membrane was smooth and light pink, expanded and unobstructed during irrigation. In chronic dacryocystitis patients, the inhomogeneous colour of mucosal membranes was red and white, with different degrees of fibrotic membranes at the superior, middle and inferior parts of the nasolacrimal canals and secreted substances at sac could be observed. The lacrimal ducts could not be expanded and obstructed during irrigation. The patients with lacrimal system obstruction had different extents of membrane formation, and stenosis or complete obstruction of the lacrimal duct could be observed, and the corresponding mucosal membrane was not smooth which could not be expanded and obstructed during irrigation. (3) After the treatment by the endoscope combined with laser or micro drill, the major proliferation of the membrane disappeared and the lacrimal duct was unobstructed during irrigation. The cure rate and effective rate were 80.1% and 93.1%, respectively. The lacrimal endoscope is a new method in the diagnosis of lacrimal system diseases. Through a combination with laser or micro drill to carry out the therapy under orthophoria, it will bring a great change to the diagnosis and therapy of lacrimal system diseases.

Drug allergy induced salivary and lacrimal diseases: clinical analysis of 25 cases

我们在重症角结膜干燥症治疗的临床实践中发现,大量重症角结膜干燥症的患者由药物过敏引起.在本课题组经治的53例重症角结膜干燥症中,有25例由药物过敏引起.这类患者具有典型特点.现将我们的诊治经验总结如下。

Diagnosis and treatment of lacrimal diseases

Diagnosis and treatment of lacrimal diseases

Use of ultrasound diagnostics in lacrimal sac diseases

Ultrasonographic examinations of the lacrimal drainage system demonstrated that the Ultrascan System IV apparatus used was not able to represent the normal-size lacrimal canaliculi, the common canaliculus, the lower part of the nasolacrimal duct and the lacrimal ostium. It can be used routinely, however, in the diagnostics of diseases of the lacrimal sac and its surrounding tissue, for surgical indication and in order to examine the postoperative condition, in most cases without other expensive diagnostic methods. The advantages over dacryocystography are that it is simple, quick, and inexpensive, it can be used post-operatively immediately, the patient is not exposed to radiation, it can be used without any contrast medium, and it is useful when the common canaliculus is occluded.

The Lacrimal System, vol 3, Advances in Ophthalmic Plastic and Reconstructive Surgery

This is the third in a series of books on selected subjects in ophthalmic plastic surgery. It contains an exhaustive summary of current modalities of diagnosis and treatment of lacrimal diseases in its 47 chapters, each written by a prominent oculoplastic specialist. The book is intended for those who have a subspecialty interest in lacrimal disease, and it frequently offers different opinions on several areas of controversy, from the question of pediatric lacrimal probing to the treatment of epithelial tumors of the lacrimal gland. Other lesser known entities, such as lacrimal sac tumors, lacrimal embryology, and the syndrome of conjunctivalchalasis, are discussed in detail. Excellent descriptions of lacrimal anatomy, intubation techniques for lacrimal obstruction, microsurgical repair in lacrimal trauma, and the variety of surgical techniques for dacrocystorhinostomy can also be found. ... a very comprehensive review of current concepts of lacrimal disease and management. Leading authorities present editorial comments on problematic