Giant Dacryocystomucopyocele in an Adult: A Review of Lacrimal Sac Enlargements With Clinical and Histopathologic Differential Diagnoses

Dacryocystocele and Subsequent Dacryocystectomy in a Patient With Bosma Arhinia Microphthalmia Syndrome (BAMS): A Case Report and Review of Literature

Bosma arhinia microphthalmia syndrome (BAMS) is a rare syndrome consisting of several craniofacial abnormalities, including congenital arhinia. In this case report, the authors present the first case of a patient with BAMS and dacryocystocele who successfully underwent dacryocystectomy. Dacryocystectomy may serve as a viable surgical approach for dacryocystocele in patients with abnormal nasal anatomy. [J Pediatr Ophthalmol Strabismus. 2024;61(3):e16-e18.].

Comparison of Endoscopic Dacryocystorhinostomy Outcomes With or Without Bicanalicular Silicone Tube Intubation in Acquired Lacrimal Sac Mucocele

PURPOSE

This paper was established to validate the necessity of bicanalicular silicone tube intubation (BSTI) in patients with acquired lacrimal sac mucocele (ALSM) receiving endoscopic dacryocystorhinostomy (DCR).

METHODS

In total, 92 patients (92 eyes) diagnosed with ALSM undergone endoscopic DCR from November 2016 to December 2021 were recruited for our research. Patients were allocated into 2 equal treatment groups: group A (patients undergoing BSTI) and group B (patients not receiving this procedure). The tubes were removed 2 months postoperation in group A. Surgical outcomes and related complications were evaluated 12 months postoperation.

RESULTS

Ultimately, this study included 83 patients with ALSM, consisting of 43 patients in group A and 40 patients in group B. All patients exhibited notable mass shrinkage with the opening of the lacrimal sac during the surgery and the swelling in the lacrimal sac area was completely relieved within 5 days postoperation. At the 12-month follow-up, no distinct difference was observed in the anatomic success rate between the 2 groups (group A: 93.0%; group B: 90.0%) ( t = 0.010, P > 0.05). However, patients in group A presented higher functional success rates (90.7%) in contrast to those patients in group B (72.5%) ( t = 4.635, P < 0.05). In both groups, the failure of the lacrimal passage reconstruction was attributed to granulation tissue formation or scar formation at the ostium. No sac mucocele recurrence occurred during the follow-up.

CONCLUSION

Endoscopic DCR treatment for ALSM achieves satisfactory postoperative effects without recurrence, and BSTI may improve the functional success rate.

Clinico-radiologic characteristics of lacrimal sac area swellings misdiagnosed as dacryocystocele or mucocele

PURPOSE

Several non-lacrimal lesions can present with lacrimal sac area swelling mimicking a dacryocystocele or mucocele with a possibility of misdiagnosis. This study investigates the clinic-radiologic characteristics of the mimicking conditions compared to true lacrimal sac distension.

DESIGN

Retrospective, comparative, interventional case series.

PARTICIPANTS

Patients referred by primary care ophthalmologists between January 2015 and October 2021 with a misdiagnosis of dacryocystocele or lacrimal sac mucocele (n = 39) and an age-matched group of proven true lacrimal sac swelling (TLS group, n = 44).

METHODS

Data collected included demographics, presenting features, investigations, management, histopathology, and outcomes. Both groups were statistically compared for several clinical and radiological variables.

RESULTS

Final diagnoses in the mimicking group were skin/subcutaneous swellings (14/39, 35.9%), vascular malformations (10/39, 25.6%), inferomedial anterior orbital cysts (7/39, 17.9%), sino-orbital masses (5/39, 12.8%). Female gender (<0.001), epiphora (p = 0.001), and discharge (p < 0.001) were significantly more frequent in the TLS group. The mimicking group was more likely to be associated with a longer swelling duration (p < 0.001), a swelling extending beyond the lacrimal sac area (p <0.001), orbital signs (p <0.001), and periorbital abnormality. Non-patent lacrimal irrigation (p < 0.001) was significantly more frequent in the TLS group. On imaging, all swellings in the mimicking group were separate from the lacrimal pathway and 94.9% (37/39) extended beyond the lacrimal sac fossa.

CONCLUSION

Various cutaneous, subcutaneous, vascular, inferomedial orbital cystic, and sinonasal pathologies can present with lacrimal sac area swelling and mimic a TLS. A high index of suspicion, a thorough clinical evaluation and proper imaging are essential to avoid a misdiagnosis.

Behavior and outcomes of 70 adult lacrimal sac mucoceles

Purpose: To study the clinical profile and outcomes in adults with lacrimal sac mucoceles.Methods: A retrospective, interventional study on consecutive adult patients with lacrimal sac mucoceles who underwent dacryocystorhinostomy (DCR)/dacryocystectomy surgery. Primary outcome measure was subsidence of lacrimal sac swelling after intervention. Secondary outcome measure was anatomical patency of the lacrimal system.Results: A total of 70 patients were studied, mean age of the group being 49.2 ± 13.5 years. Majority of the patients were female (n = 49; 70%) and all had unilateral disease. An appreciable number (n = 14; 20%) presented with acute dacryocystitis of which 6(8%) developed a lacrimal sac fistula. Encystment of the lacrimal sac mucocele was seen in 47 (67%) patients, 3(4%) developed preseptal cellulitis and 3(4%) needed imaging. Resolution of sac swelling after intervention was seen in 70 (100%) patients. Definitive management was DCR in 57 (81%) patients, of which anatomical patency was achieved in 55 (96%) patients, mean duration of follow up of the group being 138 ± 70.2 days. A trend to prefer adjuvants like Mitomycin-C and/or intubation was noted in 56 (98%) of patients.Conclusions: Adult lacrimal sac mucocele is more commonly seen in females and unilaterally. Complications of this entity include encysted mucocele (67%), acute dacryocystitis (20%), lacrimal sac fistula (8%), and preseptal cellulitis (4%). It is essentially a clinical diagnosis and favourable outcomes are seen with DCR surgery.

Idiopathic Acquired Dacryocystocele Presenting Only with Epiphora: A Very Rare Case Report

A 42-years-old male presented with left medial canthal swelling, accompanied with only mild epiphora. There was no history of dacryocystitis, mid-facial trauma, surgery, or bloody tears. On examination, there was an immobile, subcutaneous, non-inflammatory mass below the medial canthal tendon. Lacrimal irrigation showed blockade at the nasolacrimal duct. A computerized axial tomography (CAT) scan revealed a non-enhancing, low-density, cystic lesion at the inferomedial margin of the orbit. There were no signs of bony erosion, consistent with idiopathic acquired dacryocystocele. The patient underwent external dacryocystorhinostomy (DCR) with silicone tube intubation. The patient’s symptoms of epiphora resolved after surgery. Idiopathic acquired dacryocystocele with only epiphora, although rare, should be considered in differential diagnosis of medial canthal, non-inflammatory swellings. In areas with insufficient endoscopic facilities, external dacryocystorhinostomy gives similar promising results.

Foreign body mimicking malignancy in acquired dacryocystocele

A featured malignant‐like granulation tissue can be the only preoperative clinical clue of a concealed foreign body in the nasal cavity. Thus, endoscopic Dacryocystorhinostomy (DCR) should be completed with intraoperative nasal exploration to reveal non‐apparent foreign bodies that might be the underlying etiology of chronic dacryocystocele.

Bilateral Sequential Dacryocystitis in a Patient With Graft-Versus-Host Disease

A 29-year-old woman with a history of 2 bone marrow transplants for acute myelogenous leukemia developed bilateral sequential dacryocystitis in the context of known ocular graft-versus-host disease. With each infection, the patient underwent uneventful dacryocystorhinostomy. Postoperatively, she developed severe dry eye disease requiring replacement of punctal plugs and use of a prosthetic replacement of the ocular surface ecosystem lens. Histopathologic and immunohistochemical examination of the lacrimal sac showed a dense diffuse nonfollicular lymphocytic subepithelial infiltrate in the lacrimal sac that contained moderately more T-cells than B-cells. This is the first report of acute dacryocystitis associated with graft-versus-host disease. The authors caution that similar patients may develop worsening of ocular surface dryness due to restoration of normal lacrimal outflow.

Dacryocystocele After Successful External Dacryocystorhinostomy: A Variant of the Lacrimal Sump Syndrome

A 25-year-old man presented with a mass on the right medial canthus after a successful dacryo cys torhinostomy performed 3 years ago. On examination, there was a firm, nondepressible mass inferior to the medial canthal ligament and a linear vertical scar on the lateral wall of the nose. Syringing through the right lower punctum indicated his lacrimal system was patent. Computed tomography and magnetic resonance imaging disclosed a large cystic lesion in the lacrimal sac fossa. No bone erosion was detected. The mass was approached through a tear trough incision and completely resected. The lacrimal anastomosis that was highly placed remained patent after surgery. Histopathology of the specimen revealed a cystic lesion compatible with lacrimal origin (dacryocystocele).

Entire lacrimal sac within the ethmoid sinus: outcomes of powered endoscopic dacryocystorhinostomy

BACKGROUND

The aim of this study was to report the outcomes of powered endoscopic dacryocystorhinostomy (PEnDCR) in patients with lacrimal sac within the sinus.

MATERIALS AND METHODS

Retrospective analysis was performed on all patients who underwent PEnDCR and were intraoperatively documented to have complete lacrimal sac in sinus. Data collected included demographics, clinical presentations, associated lacrimal and nasal anomalies, intraoperative findings, intraoperative guidance, complications, postoperative ostium behavior, and anatomical and functional success. A minimum follow-up of 6 months postsurgery was considered for final analysis.

RESULTS

A total of 17 eyes of 15 patients underwent PEnDCR using standard protocols, but with additional intraoperative guidance where required and careful maneuvering in the ethmoid sinus. The mean age of the patients was 37.2 (range 17-60) years. Of the unilateral cases, 69% (nine of 13) showed left-side predisposition; 80% of patients showed regurgitation on pressure over the lacrimal sac area. Associated lacrimal and nasal anomalies were observed in 13.3% (two of 15) and 40% (six of 15), respectively. At a mean follow-up of 6.6 months, anatomical and functional success were observed in 93.3% (14 of 15). One patient showed failure secondary to cicatricial closure of the ostium.

CONCLUSION

An entire sac within an ethmoid sinus poses a surgical challenge. Good sinus-surgery training, thorough knowledge of endoscopic anatomy, careful maneuvering, and use of intraoperative navigation guidance result in good outcomes with PEnDCR.

Clinical, radiological, microbiological, and histopathological aspects of acquired dacryocystoceles

Purpose. The aim of this study is to investigate the etiology and the clinical, microbiological, histopathological, and radiological findings of acquired dacryocystoceles. Methods. In this retrospective study, we reviewed the clinical records of 10 eyes of 8 patients with dacryocystoceles who underwent external dacryocystorhinostomy (DCR) surgery. Etiology, presenting symptoms and radiological findings as well as microbiological and histopathological assessment results and outcome were analyzed. Results. The records of 8 patients with dacryocystoceles were included in this study. In the histopathological evaluations of the samples collected from the lacrimal sac wall, chronic inflammation was found in all biopsied samples and fibrosis was observed in two histopathological evaluations. Computerized tomography (CT) imaging showed fluid collection separated from adjacent tissues by a thin rim, corresponding to dacryocystoceles in the sac. In the microbiological culture examination of samples collected from the fluid within the cyst, no bacterial growth in 5 eyes, gram-negative bacillus growth in 3 eyes, and gram-positive cocci growth in 2 eyes were found. Conclusions. Acquired dacryocystoceles were observed extremely rarely and a definite pathogenic agent could not be identified in any of the cases, either microbiologically or histologically, whereas chronic inflammation was detected in all cases in our study.

Canaliculops: clinicopathologic features and treatment with marsupialization

PURPOSE

To report the features of the rare and under-recognized condition of canaliculops (or canaliculocele) of the eyelid, which is a dilation of the canaliculus, and to evaluate treatment with marsupialization.

DESIGN

Retrospective interventional case series.

METHODS

The records of 2 patients with canaliculops from the Massachusetts Eye and Ear Infirmary were reviewed. Data collected included clinical history, surgical technique, histopathologic analysis, and comparative immunohistochemical analysis of a range of cytokeratins in normal conjunctival epithelium, normal canalicular epithelium, and canaliculops epithelium.

RESULTS

Two women, 53 and 66 years of age, experienced chronic, noninflammatory, painless medial eyelid and eyelid margin fluctuant swelling after earlier trauma or eyelid surgery. The external mass was accompanied by a whitish opalescent or bluish discoloration of a palpebral surface bulge. Biopsy revealed multilaminar (up to 12 cells thick), nonkeratinizing, tightly packed small squamous epithelial cells that surmounted a highly regimented basal layer with a picket fence arrangement. No goblet cells or subepithelial inflammation were present. Immunohistochemistry revealed only superficial CK7 immunostaining and positive patchy suprabasilar CK17 staining in the canaliculops epithelium, contrasting with their full-thickness positivity and negativity, respectively, in normal conjunctival epithelium. Marsupialization achieved resolution of the condition in each patient.

CONCLUSIONS

An improved awareness of the normal canalicular epithelial structure and its immunohistochemical features can definitively separate canaliculops from conjunctival cysts. Previous treatment of canaliculops has involved complete excisions. Canaliculops may, however, be effectively treated with less invasive marsupialization while obtaining an adequate biopsy specimen for histopathologic diagnosis.