Stine Dahl Vest, Lauge Hjorth Mikkelsen, Frederik Holm, Geeta K. Vemuganti, Bradley A. Thuro, Steffen Heegaard
To characterize the clinical features of subtype-specific lacrimal gland lymphoma and their effect on patient survival.
Multicenter retrospective interventional case series.
Patient data were collected from 6 international eye cancer centers from January 1, 1980, through December 31, 2017. All patients with histologically verified primary or secondary lymphoma of the lacrimal gland were included. Primary endpoints were overall survival (OS) and disease-specific survival (DSS).
A total of 260 patients with lacrimal gland lymphoma were identified. The median age was 58 years and 52% of patients were men. Non-Hodgkin B-cell lymphomas constituted 99% (n = 258) and T-cell lymphomas constituted 1% (n = 2). The most frequent lymphoma subtypes were extranodal marginal zone B-cell lymphoma (EMZL) (n = 177, 68%), follicular lymphoma (FL) (n = 26, 10%), diffuse large B-cell lymphoma (DLBCL) (n = 25, 10%), and mantle cell lymphoma (MCL) (n = 17, 7%). Low-grade lymphomas (EMZL and FL) were most commonly treated with external beam radiotherapy (EBRT), whereas high-grade lymphomas (DLBCL and MCL) were treated with chemotherapy in combination with rituximab and/or EBRT. The prognosis was relatively good with a 5-year OS and DSS of 73.8% and 87.5%, respectively. Lymphoma subtype was a statistically significant predictor for DSS, with EMZL (5-year DSS: 93.4%) having the best prognosis and DLBCL (5-year DSS: 52.6%) having the poorest.
This is the largest reported collection of data of subtype-specific lacrimal gland lymphoma. The subtype distribution of lacrimal gland lymphoma resembles that of the ocular adnexa. Prognosis is good and the histologic subtype is a significant predictor for disease-specific survival.
Ingvild Ramberg, Peter Bjerre Toft, Steffen Heegaard
Malignant tumors of epithelial origin are the most frequent neoplasms of the lacrimal drainage system (LDS). A total of 539 cases are reported in the literature from 1960 to 2019. LDS carcinoma is a disease of the middle-aged and elderly population, with a median age at diagnosis of 57 years. Overall, there is a slight male predominance. Reported risk factors are chronic inflammation, LDS papilloma, and infection with oncogenic viruses. Symptoms of an LDS carcinoma resemble those of benign, inflammatory diseases, with epiphora from obstruction of the LDS as the most frequently encountered symptom. The median time from symptoms to diagnosis is 12 months and even longer for patients reporting epiphora as the only initial symptom. This diagnostic delay leads to a substantial fraction of patients with locally advanced tumors and lymph node spread at the time of diagnosis. Surgery with adjuvant radiotherapy is the treatment of choice for most patients; however, the extension and aggressiveness of the disease and the patient’s general health and preferences determine the definite treatment. Five-year overall survival is reported to range from 61 to 87.6%. A large tumor size and positive lymph node status correlate with a decreased overall and disease-free survival.
Hamad M. Alsulaiman , Dalal R. Fatani , Osama Al Sheikh , Sahar Elkhamary , Azza Maktabi , Hind M. Alkatan & Silvana Artioli Schellini
The authors are describing two rare cases of dacryops involving the Krause accessory lacrimal glands and affecting the orbit. In both cases, the lesion was located in the inferior fornix, with no preceding trauma, surgery or trachomatous conjunctival scarring. The first case involved a clear orbital extension with evidence of optic nerve compression. The second case extended from the anterior orbit to the limbus. Both had surgical removal with good outcome. As Krause gland dacryops are similar to other orbital cysts, clinical, imaging and histopathologic evaluation are essential to confirm the final diagnosis.
Albert Wu , David S Curragh , Rebecca Morrow , Dinesh Selva & Garry Davis
Sebaceous carcinoma (SC) is the third most common eyelid malignancy in Australia, and is potentially fatal. It usually presents as a nodule or diffuse eyelid thickening, and is commonly misdiagnosed. We describe a case of SC with lacrimal sac involvement, presenting with clinical features of nasolacrimal duct obstruction. At the time of endoscopic dacryocystorhinostomy (DCR), nasal endoscopy revealed a polypoid mass of the opened lacrimal sac. Biopsy of the mass showed poorly differentiated SC. The lacrimal drainage apparatus was later excised via a combined external and endoscopic approach. Conjunctival map biopsies showed extensive intraepithelial disease, which was treated with topical mitomycin C. At three-month follow-up, there was no evidence of residual disease on nasal endoscopy or repeat conjunctival biopsy.
Aric Vaidya , Tushar Sarbajna , Hirohiko Kakizaki & Yasuhiro Takahashi
A 35-year-old woman complained of an unpleasant odor for a few days after a change in foundation cream. The patient had previously undergone conjunctivo-dacryocystorhinostomy with a Jones tube fixed with non-absorbable suture. Slit-lamp examination revealed an orange-colored discharge in the tube. A culture test of the discharge showed Corynebacterium kroppenstedtii (1+), Aspergillus versicolor (1+), and Mycobacterium chelonae (1+). After medical treatment and suture removal, the discharge completely disappeared. This is the first reported case of a Jones tube infection following conjunctivo-dacryocystorhinostomy with multiple microorganisms, including C. kroppenstedtii.
Edward J. Wladis , Hirah Khan & Valerie H. Chen
To compare the outcomes of patients with and without a history of dacryocystitis that undergo dacryocystorhinostomy without systemic intra- and post-operative antibiotics.
A retrospective review was performed to identify all cases of patients that received surgery under this paradigm and had at least three months of follow up care. Key demographic and outcome data were captured, and a statistical analysis was performed via a dedicated software package (Microsoft Excel, Redmond, WA).
For the study period, 83 patients without and 69 patients with a history of dacryocystitis were identified, and the two groups were not statistically significantly different in age, gender, or postoperative follow up duration (mean = 6.4 months for patients without and 6.3 months for those with dacryocystitis, respectively). No patient developed a postoperative infection or a recurrence of dacryocystitis during the follow up period.
While many surgeons routinely use systemic antibiotics in patients with a history of dacryocystitis who undergo dacryocystorhinostomy, these agents may not be necessary. As a result, patients may be able to avoid the complications and side effects inherent to systemic antibiotics. Large-scale, prospective studies will likely help to further clarify this issue.
Nandini Bothra , Abhimanyu Sharma , Oshin Bansal & Mohammad Javed Ali
To describe the outcomes of punctal dilatation and non-incisional canalicular curettage in patients with infectious canaliculitis.
A retrospective analysis of 53 canaliculi of 47 eyes of 46 consecutive patients diagnosed with canaliculitis was performed from November 2015 to December 2018. All patients were treated with punctal dilatation and a non-incisional canalicular curettage. Parameters studied include demographics, clinical presentation, microbiological analysis, management and treatment outcomes. The outcome measures were clinical resolution of canaliculitis and resolution of epiphora.
The mean age at presentation was 59.34 years with female preponderance (M:F = 19:28). Left eye was more affected (64%, n = 30) as compared to the right (36%, n = 17). Only one patient presented bilaterally. Lower canaliculus was most commonly involved (68%, n = 32). Six eyes showed involvement of both upper and lower canaliculus. Presenting symptoms include discharge (81%), swelling of the eyelids (64%), watering (55%), redness (51%) and pain (39%). Punctal dilatation and non-incisional canalicular curettage were performed using punctum dilator and a small chalazion scoop (1 mm Meyhoefer chalazion curette). Of the 53 involved canaliculi, 14 canaliculi of 14 eyes underwent a repeat curettage for complete resolution and 1 canaliculus underwent the same procedure thrice. The most common micro-organisms isolated were Streptococci species (28% cases). At a mean follow-up of 6.8 months, resolution of canaliculitis was achieved in all patients; however, epiphora persisted in two eyes (4%).
Non-incisional canalicular curettage is a minimally invasive technique with good preservation of the punctal and canalicular anatomy. It also facilitates good anatomical and functional outcomes in infectious canaliculitis
Zuzana Sipkova , Ebube E. Obi , Oyinka Olurin , Peter M. Mota , Oana Vonica & Andrew R. Pearson
Assessment of lacrimal resistance in patients with patent lacrimal systems is important in determining whether dacryocystorhinostomy (DCR) surgery is appropriate. Current techniques, including lacrimal syringing and dacryoscintigraphy (DSG), can be unreliable. We compare the results of a manometric tear duct test (mTDT) irrigation technique with DSG in these patients.
All symptomatic patients in a specialist lacrimal clinic had full work-up apart from syringing. Lacrimal resistance was assessed using mTDT which applies a fixed head of fluid pressure via a cannula sealed to punctum. Conventional syringing was also performed in cases with abnormal mTDT. Symptomatic patients with delayed tear clearance, no external cause for watering and patent lacrimal systems had DSG. MTDT and DSG results were compared, including in asymptomatic fellow eyes.
105 tear ducts were examined, 85 symptomatic. Symptomatic eyes had a significantly higher mean mTDT resistance (p = .0003) and more had abnormal mTDT (52%) compared to asymptomatic eyes (10%). Although mean tear duct resistance was higher in those with nasolacrimal duct stenosis (NLDS) than freely patent (FP) on syringing (8.5 vs 10.8 dpm), this was not significant (p = .6). High proportions of both FP and NLDS groups had no flow at all on mTDT (60% and 53%, respectively). DSG showed no significant difference in the symptomatic versus asymptomatic eyes (p = .36), nor between those with a normal or abnormal mTDT (p = .25), nor between FP and NLDS groups (p = .25).
In contrast to DSG, the mTDT provides valuable, objective information on lacrimal resistance that can guide a decision to DCR surgery.
Kevin B. H. Vo , Mark J. Lucarelli & Suzanne W. van Landingham
This report presents two cases of epidemic keratoconjunctivitis (EKC)-associated dacryocystitis. Both patients presented with preseptal edema. Orbital computed tomography (CT) scans were performed out of concern for orbital cellulitis and revealed soft tissue edema involving the preseptal aspect of the eyelids and also the lacrimal sac. Both patients were initially diagnosed with bacterial preseptal cellulitis with dacryocystitis and admitted for treatment with intravenous antibiotics. After no improvement on antibiotics, both patients were noted to have exam findings consistent with viral conjunctivitis, and one patient had a positive conjunctival swab for adenovirus. Both patients were subsequently treated with topical steroids, and symptoms improved. EKC has previously been identified as a cause of acquired nasolacrimal duct obstruction and canalicular stenosis, and acute inflammation of the lacrimal apparatus may explain this link. Dacryocystitis may also be contributory to the copious tearing seen in patients with epidemic keratoconjunctivitis.
Akshay Gopinathan Nair, Indumati Gopinathan, Vandana Jain
Ocular surface squamous neoplasia (OSSN) encompasses a variety of conjunctival and corneal epithelial tumors including dysplasia, carcinoma in situ, and invasive carcinoma. OSSN commonly affects the interpalpebral conjunctiva and typically arises from the nasal limbus as a solitary growth. It is generally believed that these tumor cells originate from dysfunctional limbal stem cells that have been altered by various mutagenic agents, such as UV radiation; however, these lesions can also be seen to extend across the limbus to involve the cornea. Rarely, OSSN may be seen to arise from atypical locations such as the palpebral conjunctiva.,, In addition, there have been documented cases of squamous cell carcinoma of the lacrimal sac and canaliculus presenting as punctal masses and canaliculitis as well.,, To the best of our knowledge, there has been no previous documented case of conjunctival squamous cell carcinoma presenting as an isolated peri-punctal mass with no involvement of the lacrimal sac. This study was adherent with the tenets of the Declaration of Helsinki.