Lacrimal Sac Research Articles

Способ профилактики рубцового заращения дакриостомы

Purpose. To evaluate the effectiveness of the developed method for preventing cicatricial fusion of dacryostomy (DS) after endonasal endoscopic dacryocystorhinostomy. Material and methods. The study included 58 patients (58 eyes) with chronic purulent dacryocystitis who underwent endonasal endoscopic dacryocystorhinostomy. All patients were divided into 2 groups: the main group (29 people) – at the final stage of the operation, a glove turunda was installed between the middle nasal concha and the cavity of the lacrimal sac under the control of a rhinoscope; comparisons (29 people) – they underwent surgical treatment according to standard technology. The criteria for evaluating the effectiveness of surgical treatment was the study of active and passive patency of the formed lacrimal ducts. Turunda was removed 6–7 days after surgery in patients of the main group and fibrinous clots in the area of the formed anastomosis in patients of the comparison group. Results. One month after the operation, all patients of the main group and the vast majority of patients (27 people – 93 %) of the comparison group showed good patency of the formed anastomosis. While 2 people of the comparison group (7 %) had contact between the DS mucosa and the middle turbinate, which led to the formation of a cicatricial strand of the “web” type and a recurrence of the disease by 3 months after the operation. In the period of 6 months, these patients were operated again. Conclusion. The developed method for the prevention of cicatricial fusion of DS using glove turunda after surgical treatment of dacryocystitis is an effective way to restore and maintain the full function of lacrimal drainage through natural pathways with a follow-up period of 12 months. Keywords: dacryostomy, infection prevention, chronic suppurative dacryocystitis.

Sinus Plain Film Can Predict a Risky Distance from the Lacrimal Sac to the Anterior Skull Base: An Anatomic Study of Dacryocystorhinostomy.

Background: Removal of the surrounding bone during dacryocystorhinostomy may present a higher risk of skull base injury in patients with frontal sinus aplasia. We used sinus plain films to predict cases with a greater risk of a reduced skull base distance in dacryocystorhinostomy. Methods: Sinus plain films and computed tomography data from patients were retrospectively evaluated. The frontal sinus was classified as normal, hypoplastic, or aplastic according to Waters’ view. Correlations of the frontal sinus roof-supraorbital margin (F-O) and the frontal sinus roof-nasion (F-N) distances on plain film with the closest lacrimal sac-anterior skull base (LS-ASB) distance measured on computed tomography images were assessed. Results: We evaluated 110 patients. In total, 16 (11.8%) patients had frontal sinus aplasia, of whom 6 (2.7%) had bilateral and 10 (9.1%) had unilateral aplasia. Sides with frontal sinus aplasia based on Waters’ view had a shorter median LS-ASB distance than normal or hypoplastic sides. The F-O and F-N distances in Waters’ view were significantly positively correlated with the computed tomographic LS-ASB distance. The F-O margin and F-N distance thresholds for predicting an LS-ASB distance < 10 mm, considered a risky distance, were 11.6 and 14.4 mm, respectively, with sensitivities of 100% and 91.7%, and specificities of 76% and 82.7%, respectively. Conclusions: The LS-ASB distance is closer on aplastic frontal sinus sides. Waters’ view on plain sinus films can provide a fast and inexpensive method for evaluating the skull base distance and sinonasal condition during planning for dacryocystorhinostomy.

A Case-Control Study to Determine the Microbiological Spectrum and Antibiotic Sensitivity Patterns in Congenital Nasolacrimal Duct Obstruction.

Purpose:To analyze the microbiological spectrum and antibiotic sensitivity patterns in children with congenital nasolacrimal duct obstruction (CNLDO).Methods:One hundred thirty-four eyes of 123 children in the age group of 0–16 years with a diagnosis of CNLDO who underwent lacrimal surgical procedures were included in this prospective comparative study. Sixty-two children in the age-matched group planned for intraocular surgery with patent nasolacrimal duct were deemed controls. The conjunctival swab after performing Regurgitation on Pressure over the Lacrimal Sac in the CNLDO group and the conjunctival swab in controls were sent for microbiological analysis. Antibiotic susceptibility testing was done for commonly employed antibiotics by the Kirby Bauer disk diffusion method.Results:Of 134 samples collected in the CNLDO group, 111 (82.8%) samples were culture positive. There were 165 bacteria isolated, among which 139 (84.24% of isolates) were Gram-positive bacteria, and 26 (15.75% of isolates) were Gram-negative. Fungal isolates were obtained in 2.23% of cases. The most common Gram-positive isolate was Staphylococcus epidermidis (S. epidermidis) (n = 51, 30.9% of total isolates), and the most common Gram-negative isolate was Haemophilus influenza species (n = 9, 5.5% of total isolates). Gram-positive isolates were sensitive mostly to gentamicin and vancomycin (95.5% each), and Gram-negative isolates to amikacin (92.3%). Both Gram-positive and Gram-negative isolates were susceptible to gatifloxacin (80% each). Probing outcomes were similar among Gram-positive (success, 84.6%) and Gram-negative (success, 84.0%) organisms.Conclusions:There was a predominance of Gram-positive isolates in children with CNLDO with S. epidermidis being the most common. The microbiological profile did not have any effect on the outcomes of probing.

Systemic sarcoidosis presenting as nasolacrimal duct obstruction – A rare presentation

Lacrimal sac sarcoidosis is rare and reported in 7.7% of the cases of systemic sarcoidosis. Nasolacrimal duct obstruction, as the initial presentation of sarcoidosis, is very rare. A 50-year-old woman presented to us with complaints of watering and discharge from the right eye for the past 3 months. On examination, she was found to have a right-sided nasolacrimal duct obstruction and underwent external dacryocystorhinostomy (DCR). Intraoperatively, a biopsy was done because of the abnormally thickened sac wall. The histopathology examination was suggestive of granulomatous inflammation. After ruling out tuberculosis and fungal infection with the appropriate investigation, a diagnosis of pulmonary sarcoidosis with lacrimal sac involvement was made because of the mediastinal lymphadenopathy on computed tomography. She was treated with a course of oral steroids along with immunosuppressants for 3 months. There was no evidence of recurrence at 8 months of follow-up.

Flap suturing endonasal dacryocystorhinostomy assisted by ultrasonic bone aspirator

Background In the external dacryocystorhinostomy (DCR), a sutured anastomosis technique performed between the nasal mucosal and lacrimal sac flaps reported by Dupuy-Dutemps and Bourguet was the gold standard and was believed to lead to the success of the surgery. However, because of the small working space, a flap suturing technique has not been completely established in endonasal DCR (END-DCR). Objectives The effect of the modified flap suture anastomosis technique using a Sonopet ultrasonic bone aspirator was retrospectively compared to that using a diamond burr in patients with nasolacrimal duct obstruction. Materials and Methods One hundred ten patients underwent the modified flap suturing technique using the Sonopet, and 30 patients were operated on using a diamond burr. Results Successful patency of the lacrimal ostium (LO) was obtained in all patients in both groups. The rates of successful suturing during the operation and of a large diameter of the LO 3 months after the operation were significantly higher in patients in whom the Sonopet rather than the burr was used. Conclusions and Significance The Sonopet might offer similar surgical outcome to the traditional microdrill DCR and is a safer means of bone removal in END-DCR in the small working space.

Endonasal endoscopic removal of intra-orbital (extralacrimal, extraconjunctival) oculosporidiosis: Anatomical and surgical considerations.

This report illustrates the successful removal of a proper intra-orbital oculosporidiosis (extralacrimal, extraconjunctival) exclusively by the endonasal endoscopic approach. It also introduces the naso-orbital pseudofontanelle as an important surgical landmark and describes a hitherto undefined intra-orbital extramucosal three-dimensional potential wedge that harbored the Rhinosporidium seeberi infestation as a nodular conglomerate. The patient, a 50-year-old woman, was operated on three years ago for rhinosporidiosis of the nasal cavity and the distal lacrimal drainage system (lacrimal sac and nasolacrimal duct). The resulting alterations in regional anatomy were evident on imaging. They could explain the present recurrence and formation of the pseudofontanelle that allowed the conglomerate to bulge through the lateral nasal wall on digital pressure, making endoscopic intervention feasible. The primary principle for adopting this approach was to protect the facial skin from possible seeding. With an angled endoscope, the pseudofontanelle was breached and the intra-orbital extramucosal wedge between the bony orbital wall and the peri-orbita entered. The nodules that formed the conglomerate were densely adherent with the peri-orbita and skin. They were carefully and meticulously removed to avoid inadvertent injury to vital intra-orbital structures. Endonasal endoscopic intervention for a true intra-orbital oculosporidiosis has never been documented before. The surgical approach, the newly defined anatomical domain for the intra-orbital extramucosal oculosporidiosis, and the concept of pseudofontanelle characterize this report as a novel clinical experience worth presenting.

Evaluation of the Best Region for Measuring Eye Temperature in Dairy Cows Exposed to Heat Stress.

Eye temperature (ET) has long been used for predicting or indicating heat stress in dairy cows. However, the region of interest (ROI) and temperature parameter of the eye have not been standardized and various options were adopted by previous studies. The aim of this study was to determine the best ROI for measuring ET as the predictor of heat stress in dairy cows in consideration of repeatability and validity. The ET of 40 lactating Holstein dairy cows was measured using infrared thermography. The mean and maximum temperature of five ROIs—medial canthus (MC), lateral canthus, eyeball, whole eye (WE), and lacrimal sac (LS)—were manually captured. The results show that the ET of left eyes was slightly higher than that of right eyes. The ET taken in MC, WE, and LS within 2 min had a moderate to substantial repeatability. The maximum temperature obtained at the LS had the highest correlation coefficients with respiration rate and core body temperature (all p < 0.001). Therefore, the maximum temperature of LS should be considered by future studies that want to use ET as the predictor or indicator of heat stress in dairy cows.

Endoscopic dacryocystorhinostomy for refractory nasolacrimal duct obstruction with asmall lacrimal sac (≤ 5mm in diameter).

Although endoscopic dacryocystorhinostomy (DCR) is a standard procedure for nasolacrimal duct obstruction (NLDO), the failure rate remains approximately 10%. A small lacrimal sac is considered the main reason for surgical failure. We explored the efficacy of endoscopic DCR for the treatment of NLDO with a small lacrimal sac. The clinical data of 72 patients (88 eyes) diagnosed with NLDO and undergoing endoscopic DCR from 2012 to 2020, with at least 24months of follow-up were retrospectively collected. Intraoperatively, the Rosenmüller valves were fully exposed, mucosal flaps were preserved to cover the naked bone, and a silicone tube was implanted if necessary. Postoperative intervention was performed if necessary. The main outcome measures were symptomatic improvement and objective ostium patency. Eighty-eight eyes of 72 patients were divided into two groups: the refractory group (34 patients, 47 eyes), with a small lacrimal sac (≤ 5mm in diameter), and the simple group (38 patients, 41 eyes). Patients with small lacrimal sacs were more prone to bilateral eye disease than those in the simple group (P = 0.014) and required a longer postoperative follow-up (P < 0.001). Refractory NLDO and simple NLDO had a success rate of 91.5% and 95.1%, respectively, with no significant difference. Endoscopic DCR for refractory NLDO with a small lacrimal sac could achieve a beneficial result by exposing the Rosenmüller valves, preserving mucosal flaps, implanting necessary intubation, and intervening postoperatively. Thus, a small lacrimal sac should not be regarded as a contraindication to surgery.

Primary Mucoepidermoid Carcinoma of the Lacrimal Apparatus

In this study, we evaluated the clinicopathologic and molecular characteristics of lacrimal apparatus mucoepidermoid carcinoma (MEC) to define its typical diagnostic features. Retrospective observational case series. Institutional pathology records between 2011 and 2021 were searched for all cases of lacrimal apparatus MEC. A total of 2 male and 6 female patients ranging in age from 18 to 83 years (median 56, mean 54) were included. Six lacrimal apparatus MECs were found in the lacrimal gland, and 2 cases occurred in the lacrimal sac and nasolacrimal duct. Histologically, there were 6 cases of conventional MEC, 1 clear-cell variant of MEC, and 1 oncocytic variant of MEC for a total of 8 cases. There were 3 low-grade cases and 5 high-grade cases. All 8 cases were evaluated via immunohistochemistry, and the results were positive (scores 1-4) for pankeratin, 34betaE12, p63, p40, CK7, CK8, and CK19, with a relatively higher expression of p63 observed in high-grade MEC. The presence of human papillomavirus (HPV) type 6 DNA was found in 4 patients. MAML2 fluorescence in situ hybridization was positive for MAML2 rearrangement in 3 lacrimal gland tumors (2 low-grade and 1 high-grade). Six tumors were managed with radical resection, and 2 patients underwent orbital exenteration. Postoperative radiation therapy was delivered to 6 patients, and chemotherapy was administered to 1 patient. MECs of the lacrimal apparatus are rare tumors, and the rate of MAML2 translocations is lower than that in salivary MECs. Lacrimal gland and lacrimal sac MECs may not be of the same subtypes intrinsically because of the difference in MAML2 translocation, anatomy, and clinical course. The etiologic function of HPV type 6 infection should be explored in lacrimal apparatus MECs. Radical surgery is the treatment of choice. The description of these unique findings may assist in the definitive diagnosis of and improve our understanding of lacrimal apparatus MEC.

A Neonate with Acute Dacryocystitis

Acute dacryocystitis in neonates is an emergency condition that should be taken seriousely [1]. We report a case of a 25-day-old male newborn with inflammatory swelling of the inner canthus of the left eye. The ophtalmological examination revealed unilateral lacrimal sac abscess with compression of the lacrymal sac (Figure 1). Orbital CT scan confirmed the presence of abscess, with mild preseptal cellulitis (Figure 2), no signes of ethmoidal sinusitis were showen. The newborn was hospitalized and intravenous C3G antibiotherapy was started. Over the next day, we noticed an external fistula formation. General and local antibiotic therapy was continued for a short time, with a gentle massage of the lacrimal sac [2]. The evolution was marked by a progressive regression of the swelling as showed, and no recurrence of the condition was diagnosed in the follow up (Figure 1). This case is a reminder for our clinical practice to think of the presence of a potentiel dacryocyctocele in every acute dacryocystitis in neonates.

Differently Expressed Circular RNAs in Lacrimal Sacs From Patients With Chronic Dacryocystitis.

This study was designed to identify differently expressed circular RNAs (circRNAs) and investigate their potential roles in lacrimal sacs from patients with chronic dacryocystitis. The lacrimal sac samples of three chronic dacryocystitis patients and three control subjects were collected for RNA sequencing after ribosomal RNA was depleted. Differently expressed circRNAs and messenger RNAs (mRNAs) were used for co-expression analysis. CircRNA-microRNA (miRNA)-mRNA interaction network were also established by miRanda software. Meanwhile, pathway and functional enrichment analysis were conducted for the down- and up-regulated mRNAs in the circRNA-mRNA co-expression network. The expression levels of circRNAs and mRNAs in chronic dacryocystitis and control samples were validated by quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR). In all the 3,909 circRNAs predicted through RNA sequencing, 25 circRNAs (20 up-regulated and 5 down-regulated) expressed differently in chronic dacryocystitis samples. Besides, there identified 1,486 differentially expressed mRNAs. Of these differently expressed circRNAs and mRNAs, eight were validated by qRT-PCR, including MYH2, DSP, CD27, CCL5, FN1, has_circ_0004792, has_circ_0001062, and has_circ_0115476. Gene Ontology (GO) analysis indicated that the majority of altered mRNAs in this co-expression network were involved in immune system processes and meanwhile Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis revealed that these altered expressed mRNAs were also amplified in bacterial invasion of epithelial cells, both of which were thought to be involved in the pathogenesis of chronic dacryocystitis. In the circRNA-miRNA-mRNA interaction network, six circRNAs were found to be related to Th1 and Th2 cell differentiation, which was closely associated with the development of chronic dacryocystitis. This study identified statistically significant differences between circRNAs and mRNAs of lacrimal sac samples of chronic dacryocystitis patients and control individuals and provides novel insight into the regulatory mechanism of circRNAs, miRNAs, and mRNAs in the pathogenesis of chronic dacryocystitis.

Relationship of the anterior ethmoid sinus to the lacrimal sac: a computed tomography study

ObjectiveTo analyze the anatomical relationship between the lacrimal sac and the agger nasi cell on Computed Tomography (CT); to correlate the right and left sides on each scan. MethodsCT scans of adult patients were reviewed for pneumatization of the agger nasi and its relationship to the lacrimal sac. The degree of agreement between the right and left sides was also evaluated. ResultsA total of 130 CT scans were examined. An agger nasi cell was found medial to the lacrimal sac in 59.23% of scans. On 86.15% of scans, pneumatization was similar on both sides. ConclusionThe agger nasi air cell is located medial to the lacrimal sac in more than half of individuals. The right and left sides exhibit the same pneumatization pattern in approximately 80% of cases. Level of evidence4.

A glued technique of external dacryocystorhinostomy.

Purpose:Fibrin glue was used for anastomosis of lacrimal sac and nasal mucosal flaps and was compared with the conventional suture technique in external dacryocystorhinostomy.Methods:A prospective interventional randomized control study in which 50 consecutive patients of primary acquired nasolacrimal duct obstruction (PANDO) were equally allocated into two groups. The case group underwent glued technique of external dacryocystorhinostomy (Ext DCR) in which fibrin glue was used for the apposition of the anterior lacrimal sac and nasal mucosal flaps. In the control group, conventional technique of Ext DCR was used to suture the flaps. Functional success was assessed by improvement in epiphora and fluorescein dye disappearance test (FDDT), whereas anatomical success was assessed by lacrimal irrigation and endoscopic view of the osteotomy site.Results:The anatomical success in both the groups was 92%, whereas the functional success was 92% in the case group and 88% in the control group. The difference in the success rates between the two groups was statistically non-significant.Conclusion:Glued technique of Ext DCR is a simple and easy alternative to suturing of the flaps. Though the final outcome was comparable in both the groups, glue can be especially useful in uncooperative cases, in cases of excessive bleeding, or in situations where the flaps are very thin or have become friable.

'Stenting the Lacrimal System in Modified Denker's for Mucormycosis: Really Needed!'-A Longitudinal Study.

Recent advances in endoscopic paraphernalia have brought the once intricate anterior lateral wall of maxilla, within reach of the endoscopic surgeon. Endoscopic modified Denker's approach provides another route to reach the indiscernible sites of maxillary & other paranasal sinuses along with PPF (pterygo-palatine fossa)/ITF (infra-temporal fossa) region. This approach has been widely used Pan-India during the Post-Covid Mucormycosis Epidemic, in our country. As this approach mandates sacrifice of nasolacrimal duct, the suspicion in some quarters about post-op fibrosis and eventually obstruction of lacrimal drainage is genuine. The aim is to understand the legitimate effect of this approach on lacrimal drainage pathway and to determine the need for modification in this approach, like stenting the NLD. In total, 100 patients who underwent endoscopic modified Denker's maxillectomy for invasive rhino-orbito-cerebral mucormycosis were included in study. The patency of lacrimal drainage was checked by doing lacrimal sac syringing in each patient. Proportion of patients showing obstruction of lacrimal pathway was calculated. The ratio of lacrimal obstruction was found to be 9%. Hence, endoscopic modified Denker's approach for lesions involving anteroinferior and anterolateral part of maxillary sinus does not cause significant obstruction in the lacrimal drainage pathway.

Fusiform Anastomosis Technique with a Single Longitudinal Incision in the Lacrimal Sac in External Dacryocystorhinostomy

In the present study, we aimed to evaluate the surgical outcomes of the fusiform anastomosis technique in external dacryocystorhinostomy (ex-DCR) that we designed in the form of a physiological tube, which sufficiently covered the bone ostium with the mucosa. This was a retrospective observational study that included 145 eyes of 131 patients who underwent ex-DCR due to nasolacrimal duct obstruction. The patients were divided into two groups. Group 1 included 73 eyes of 65 patients who underwent fusiform anastomosis, and group 2 included 72 eyes of 66 patients who underwent conventional anterior and posterior flap anastomosis. The open nasolacrimal passage with lacrimal irrigation and the absence of reflux were accepted as anatomical success, and the absence of epiphora symptoms was accepted as functional success. The groups were compared in terms of anatomical success, functional success, and granulation tissue formation. Anatomical success was observed in 73 eyes (100%) in group 1 and 66 eyes (91.6%) in group 2 (p = 0.01). Functional success was observed in 72 of 73 eyes (98.6%) in group 1 and 65 of 72 eyes (90.2%) in group 2 (p = 0.02). Nasal endoscopic examination performed in 32 eyes in group 1 and 28eyes in group 2 revealed that granulation tissue was observed in 7 of 28 eyes (25%) in group 2, while there were no eyes with granulation tissue in group 1 (p = 0.01). The fusiform anastomosis technique in ex-DCR provided excellent anatomical success and extremely good functional success.

A rare case of eyelid abscess and orbital cellulitis following acute dacryocystitis

Acute dacryocystitis usually presents as a pre-septal cellulitis since the lacrimal sac lies anterior to the orbital septum. Orbital cellulitis secondary to acute dacryocystitis is very rare due to a variety of anatomic barriers to the orbit but can occur and result in abscess formation with risk of visual compromise.We describe a case of 28 yrs. old otherwise healthy adult who presented with almost complete visual loss following orbital cellulitis and lower lid abscess formation secondary to acute dacryocystitis in right eye. The clinical, radiological, intraoperative and postoperative findings are discussed. He underwent emergency lateral canthotomy and cantholysis, lower lid abscess drainage along with planned endoscopic endonasal dacryocystectomy as resolutive surgery.

Transnasal Medial Canthopexy Supported with Autogenous Bone Graft: A New Method for Repair of Traumatic Telecanthus.

The medial canthus is an important structure to maintain the shape of the eye and assist in drainage of the lacrimal sac. Traumatic telecanthus is a difficult deformity to treat which involves both esthetic and functional aspects. Transnasal wiring remains the gold standard for repair of the medial canthal tendon (MCT) avulsion; however, it is often complicated by canthal drift, extrusion of wires, and in-fracture of the contralateral orbital bones from pressure by tied wires. In order to overcome traditional transnasal wiring technique pitfalls, this study proposes a transnasal wiring fixation method supported with a bone graft to treat patients presenting with telecanthus following complex nasoorbitoethmoid fractures. From December 2018 to October 2020, 12 patients with traumatic telecanthus underwent transnasal wiring fixation of the MCT supported with bone graft. The wire holding the MCT was delivered through a single hole to the contralateral side and secured to a small bone graft by passing the wire through 2 holes in the graft in a button-like fashion. Then the wire end is pulled again to the affected side through the same hole and the 2 wires ends are tightly twisted after setting the MCT posterior to the lacrimal crest. Restoration of the MCT to its normal position was achieved in all patients. There were no observed major complications. Only 2 cases of wound infection and 1 case of dacrocystitis were encountered, which settled with conservative management. The preoperative palpebral fissure width (mean: 28.33mm ± 2.188mm) was significantly lower than the postoperative palpebral fissure width (mean: 34.17mm ± 1.03mm) ( P< 0.05). This study introduces a modified technique of transnasal wiring fixation to restore palpebral shape and intercanthal distance. The proposed technique could eliminate most of the frequently observed complications of the traditional methods.

Conservative management of orbital involvement in malignant tumors: is the paradigm evolving? A critical review

Purpose of review Review the recent literature regarding conservative management of orbital invasion in sinonasal cancers. Recent findings Recent data seem to confirm the possibility to preserve the orbital content in a significant number of patients. MRI is the best available imaging tool for evaluating orbital invasion. Limited periorbital and extraconal fat invasion should not be considered an indication for orbital cleaning. Histology-driven neoadjuvant chemotherapy should be attempted whenever possible, and could act as a prognosticator. Summary Orbital preservation strategy can be attempted even in case of limited extraconal fat invasion. When extraocular muscles, massive extraconal fat, lateral wall of the lacrimal sac, eyelids or even optic nerve/globe are invaded, a conservative procedure cannot be offered. Induction chemotherapy and postoperative radiotherapy are invaluable tools for maintaining oncological outcome while preserving ocular function. Frozen section should be used for guiding surgical procedures in borderline situations.

Acquired nasolacrimal duct obstruction: clinical and histological findings of 275 cases

BackgroundAcquired nasolacrimal duct obstruction is a blockage of the lacrimal outflow system usually caused by local nonspecific inflammation of the lacrimal sac and the nasolacrimal duct. However, cases exist where the primary nasolacrimal system obstruction is caused by malignancies.Our aim was to investigate lacrimal sac pathologies in patients with acquired nasolacrimal duct obstruction and compare their clinical manifestations.MethodsThis retrospective clinical study included 275 patients with acquired nasolacrimal duct obstruction who underwent external dacryocystorhinostomy and lacrimal sac biopsy. Cases were classified into tumor or nonspecific pathology groups and subdivided according to the level of inflammation. Histological and clinical data were analyzed.ResultsThree tumors (1.1%) (an adenoid cystic carcinoma, an eccrine spiradenoma and small B cell lymphoma) were diagnosed. Chronic nongranulomatous inflammation was the most common histological finding, corresponding to 194 cases (70.5%). The other 81 (29.5%) were subacute, acute forms of nongranulomatous inflammation, tumors and fibrosis cases. Epiphora with continuous purulent discharge was the most common clinical sign reported by 144 (52.4%) patients, and two (0.7%) patients had a palpable mass near the medial canthal tendon, which was identified as an eccrine spiradenoma and small B cell lymphoma. There was no significant difference in the clinical symptoms, duration or case history between the nonspecific pathology and tumor groups (p = 0.292).ConclusionsChronic nongranulomatous inflammation of the lacrimal sac was the most common finding among acquired nasolacrimal duct obstruction cases. There were no associations between the histological findings and clinical presentation. The authors recommend a lacrimal sac biopsy only in cases when a tumor is clinically suspected.

High-risk HPV-related Squamous Cell Carcinoma in the Conjunctiva and Lacrimal sac: Clinicopathologic Characteristics and Diagnostic Utility of p16 and Rb Immunohistochemistry.

High-risk human papillomavirus (HPV) infection in conjunctival and lacrimal sac squamous cell carcinomas (SCCs) has been sporadically reported; however, its prevalence, clinicopathologic significance and surrogate markers have not been fully elucidated. Here, we attempted to clarify these questions in Japanese patients with conjunctiva and lacrimal sac SCCs. We retrospectively collected 51 conjunctival SCC and 7 lacrimal sac SCC samples and analyzed them for (1) transcriptionally active high-risk HPV infection using messenger RNA in situ hybridization and (2) protein expressions of p16 and Rb using immunohistochemistry (IHC). Among a total of 58 cases, 25 (43.1%) and 16 (27.6%) tumors were positive for p16-IHC and HPV in situ hybridization, respectively. Ten (19.6%) of the 51 conjunctival SCCs, especially in the palpebral conjunctiva, and 6 (85.7%) of the 7 lacrimal sac SCCs were positive for high-risk HPV. High-risk HPV infection was significantly associated with younger patients, nonkeratinizing SCC histology, p16-positivity and partial loss of Rb expression, but not with recurrence risk. Notably, p16-IHC was not a perfect surrogate marker for high-risk HPV infection; only 64% (16/25) of p16-positive tumors were positive for high-risk HPV. In contrast, the p16+/Rb partial loss pattern was exclusively correlated with high-risk HPV-positivity. The results suggest that the combination of p16 and Rb expression patterns by IHC could be a useful method to predict high-risk HPV infection in conjunctival and lacrimal sac SCCs. HPV infection may be of less prognostic value in this field of cancers.