| BACKGROUND: Bacterial dacryoadenitis is rare and suppuration leading to abscess formation within the lacrimal gland has been very rarely reported in the antibiotic era. methods: The medical records and investigation results, including computed tomography (CT), of two patients with lacrimal gland abscess were reviewed. RESULTS: Two cases of lacrimal gland abscess, one a 28-year-old male and the other a 64-year-old female, are described. Both demonstrated a characteristic low-density area within an enlarged lacrimal gland on CT. The first case had been treated with antibiotics and the abscess, when drained, was sterile. The second case settled spontaneously. Neither patient suffered any sequelae of dry eye. CONCLUSIONS: Although rare, lacrimal gland abscess may still occur and may require surgical drainage if spontaneous resolution does not occur. ( info) |
2/138. mucocele in an orbitoethmoidal (Haller's) cell (accidentally combined with acute contralateral dacryocystitis). Haller's cells--according to recent terminology now called orbitoethmoidal cells (OEC)--are defined as anterior or posterior ethmoidal cells that have developed into the orbital floor. They can be excessively pneumatized and thus contribute to obstruction of the ostiomeatal complex area. We present the case of a 42 year old white male, who was admitted for treatment of an acute dacryocystitis on the right side. The CT scan revealed moderate sinusitis of the right ethmoid and maxillary sinuses and coincidentally a mucocele in an OEC on the left side. An endoscopic dacryocystorhinostomy on the right and a revision of the mucocele on the left side were performed in the same sitting. We consider both indications--stenosis of the nasolacrimal duct as well as mucoceles rewarding indications for endoscopic surgery. An external approach to the nasolacrimal duct in this case would have been problematic, as the external skin and soft tissue covering the duct already showed severe inflammatory changes. The operation of the up until that time asymptomatic mucocele was of prophylactic character. To our knowledge this is the first report of a mucocele developing in an OEC in the literature. ( info) |
3/138. Chronic dacryoadenitis misdiagnosed as eyelid edema and allergic conjunctivitis. PURPOSE: To report the case of a 53-year-old woman with a 2-year history of episodic upper eyelid swelling and nonspecific complaints, who was diagnosed as having allergic conjunctivitis. methods: A complete ocular examination, orbital computerized tomographic (CT) scans followed by complete physical and systemic examinations. RESULTS: The results of physical and systemic examinations were unremarkable for systemic lymphoma and a primary focus of cancer. The results of the ocular examination were normal. CT scans demonstrated well-defined lesions bilaterally with a homogeneous internal structure in the lacrimal gland fossa, which suggested a diagnosis of chronic dacryoadenitis. The differential diagnosis included lymphoma and orbital metastases. The patient refused a biopsy and was started on a tapering dose of 60 mg oral prednisolone daily. The follow-up CT scans 1 month after cessation of 6-week oral corticosteroid treatment showed near complete resolution of the orbital lesions. CONCLUSION: This case demonstrates that orbital inflammation can be misdiagnosed as refractory allergic conjunctivitis. ( info) |
4/138. Acute dacryocystitis as a presenting sign of pediatric leukemia. PURPOSE: To report acute dacryocystitis with preseptal cellulitis as the presenting sign of leukemia in a child. methods: Case report and literature review. RESULTS: During the initial evaluation of a 17-month-old child with epiphora, left lower eyelid swelling, and a tender left medial canthal mass, a complete blood cell count demonstrated pancytopenia. bone marrow biopsy disclosed replacement of normal cellular architecture with a dense infiltrate of leukocyte blast forms. dna analysis disclosed a translocation between chromosome 10 and 11, consistent with the diagnosis of nonlymphocytic leukemia. Although the adjacent lower eyelid cellulitis responded to intravenous antibiotics, lacrimal sac distention decreased only after chemotherapy was initiated. CONCLUSIONS: dacryocystitis with preseptal cellulitis can be a presenting sign of leukemia. This blood malignancy should be considered in patients whose leukocyte counts do not correlate with their clinical presentation. ( info) |
5/138. Lymphocytic hypophysitis associated with dacryoadenitis: an autoimmunologically mediated syndrome. We report a rare case of lymphocytic hypophysitis followed by dacryoadenitis. Lymphocytic hypophysitis is a rare disease that can easily be mistaken for neoplastic proliferation. Because combination with rheumatoid arthritis, thyroiditis, or pernicious anemia is frequent, an immunological pathogenesis is likely. ( info) |
6/138. nasolacrimal duct obstruction secondary to ectopic teeth. OBJECTIVE: To describe two patients with nasolacrimal duct obstruction (NLDO) caused by ectopic eruption of teeth. The literature concerning nasal and other unusual ectopic sites of tooth eruption is reviewed. DESIGN: Two interventional case reports and literature review. PARTICIPANTS: A 3-year-old girl with epiphora and recurrent dacryocystitis of the right eye. Previous medical and surgical management was unsuccessful. A 32-year-old female with a long history of right eye discomfort and epiphora. Previous examinations and workup were negative. INTERVENTION: A computed tomographic (CT) scan of the orbits and sinuses was performed in both patients. The ectopic teeth were surgically removed. MAIN OUTCOME MEASURES: Nasolacrimal system function and response to treatment at the last follow-up were recorded. RESULTS: In the first patient, CT imaging disclosed two teeth within the right inferior meatus compressing the nasolacrimal duct. In the second patient, CT revealed a large dental structure in the maxillary sinus compressing the nasolacrimal duct. Endoscopic tooth extraction and nasolacrimal duct probing in the first patient and surgical removal of the dental structure in the second patient effected complete resolution of symptoms. Both patients were symptom free at last follow-up. CONCLUSIONS: These cases suggest that ectopic eruption of teeth should be added to the differential diagnosis of NLDO. Surgical removal of the ectopic teeth compressing the nasolacrimal duct results in resolution of the lacrimal drainage obstruction. ( info) |
7/138. Epstein-Barr virus dacryoadenitis. PURPOSE:To describe the clinical features of lacrimal gland inflammation associated with Epstein-Barr virus infection. methods:The clinical records, laboratory data, and radiographs of patients who had inflammation of one or both lacrimal glands that had begun less than 4 weeks previously were reviewed.RESULTS:Sixteen patients with dacryoadenitis were encountered between 1980 and 1996, a cumulative frequency of approximately one case per 10,000 new ophthalmic outpatients. Six individuals had serologic or other evidence of recent Epstein-Barr virus infection and were distinguished by the presence of regional lymphadenopathy, no purulent discharge, and a duration of symptoms of 6 weeks. CONCLUSION:Epstein-Barr virus is a probable cause of unilateral and bilateral dacryoadenitis in young adults. ( info) |
8/138. nasolacrimal duct foreign body--endoscopic removal. Foreign body in the nasolacrimal duct is extremely rare. We present a case of foreign body of nasolacrimal duct responsible for recurrent dacryocystitis which was removed with the help of an endoscope. ( info) |
9/138. Localized orbital inflammation: a case of dacryoadenitis. Nonspecific orbital inflammatory syndrome includes a variety of ocular inflammatory disorders. These may be classified by location (anterior or posterior) and by time of presentation (acute or chronic). The four subclassifications of nonspecific orbital inflammatory syndrome are myositis, perineuritis, periscleritis, and dacryoadenitis. When a proper diagnosis is established using clinical signs, imaging studies, and laboratory results, treatment of the condition can be initiated. Treatment of the acute form is with oral corticosteroids. This case discusses the diagnosis and treatment of a patient with an acute onset of inflammatory dacryoadenitis. ( info) |
10/138. Clinostomum trematode from human eye. The first human case of Clinostomum lacramalitis in thailand is reported. A 38-year-old man visited an ophthalmology clinic after having itchy pain in the right eye for two days. Ophthalmological examination revealed a living worm adhered to the lacramal opening and after removal, it was identified as Clinostomum sp. The patient admitted that he used to eat raw freshwater fish, he caught in Prachin Buri Province where he lives. ( info) |