Orbital tuberculosis is a rare form of extrapulmonary tuberculosis, even in endemic areas. It may involve the soft tissue, lacrimal gland, periosteum, or bones of the orbital wall. We present a case of orbital tuberculosis on the lower eyelid. An 18-year-old woman with no underlying disease visited our clinic for evaluation of an oval nodule (1.5× 1.2 cm) on the right lower eyelid. Incision and drainage without biopsy was performed 2 months ago in ophthalmology department, but the periorbital mass had deteriorated, as the patient had erythematous swelling, tenderness, and cervical lymphadenopathy. Visual acuity was normal; there were no signs of proptosis, diplopia, or ophthalmoplegia. Computed tomography revealed a small abscess cavity without bony involvement. We performed an excision and biopsy through a percutaneous incision under local anesthesia. Histological examination revealed a granuloma and was diagnosed as orbital tuberculosis. The patient was additionally treated with anti-tuberculosis therapy for 6 months and recovered without complication or recurrence by 7 months. Orbital tuberculosis occurs in patients with or without associated pulmonary tuberculosis, and should be considered as a differential diagnosis in patients with inflammatory orbital disease and an orbital mass. If recurrence occurs despite adequate initial treatment, we recommend an additional examination and excisional biopsy.
Abscess ; Adolescent ; Anesthesia, Local ; Biopsy ; Diagnosis, Differential ; Diplopia ; Drainage ; Exophthalmos ; Eyelids ; Female ; Granuloma ; Humans ; Lacrimal Apparatus ; Lymphatic Diseases ; Ophthalmology ; Ophthalmoplegia ; Orbit ; Orbital Diseases ; Periosteum ; Recurrence ; Tuberculosis ; Tuberculosis, Pulmonary ; Visual Acuity

PURPOSE: We developed predictive models using different programming languages and different computing platforms for machine learning (ML) and deep learning (DL) that classify clinical diagnoses in patients with epiphora. We evaluated the diagnostic performance of these models.METHODS: Between January 2016 and September 2017, 250 patients with epiphora who underwent dacryocystography (DCG) and lacrimal scintigraphy (LS) were included in the study. We developed five different predictive models using ML tools, Python-based TensorFlow, R, and Microsoft Azure Machine Learning Studio (MAMLS). A total of 27 clinical characteristics and parameters including variables related to epiphora (VE) and variables related to dacryocystography (VDCG) were used as input data. Apart from this, we developed two predictive convolutional neural network (CNN) models for diagnosing LS images. We conducted this study using supervised learning.RESULTS: Among 500 eyes of 250 patients, 59 eyes had anatomical obstruction, 338 eyes had functional obstruction, and the remaining 103 eyes were normal. For the data set that excluded VE and VDCG, the test accuracies in Python-based TensorFlow, R, multiclass logistic regression in MAMLS, multiclass neural network in MAMLS, and nuclear medicine physician were 81.70%, 80.60%, 81.70%, 73.10%, and 80.60%, respectively. The test accuracies of CNN models in three-class classification diagnosis and binary classification diagnosis were 72.00% and 77.42%, respectively.CONCLUSIONS: ML-based predictive models using different programming languages and different computing platforms were useful for classifying clinical diagnoses in patients with epiphora and were similar to a clinician's diagnostic ability.
Classification ; Dataset ; Diagnosis ; Humans ; Lacrimal Apparatus Diseases ; Learning ; Logistic Models ; Machine Learning ; Nuclear Medicine ; Programming Languages ; Radionuclide Imaging

Epiphora is one of the most common problems in ophthalmological practice, and is caused by dysfunction of the lacrimal pathway. The lacrimal drainage system is a continuous anatomical structure consisting of the lacrimal punctum, inferior and superior canaliculi, common canaliculus, lacrimal sac, and nasolacrimal duct. Lacrimal disease can be medically treated in case of acute inflammation or partial obstruction at the beginning of treatment, but surgical treatment is necessary in most cases. This paper discusses the etiology, clinical features, diagnosis, and surgical treatment of various lacrimal diseases through a selective review of the relevant literature. Advances in lacrimal duct surgery can now be performed in such a way that the structural integrity and normal physiological function of the entire efferent lacrimal pathway is preserved.
Dacryocystorhinostomy ; Diagnosis ; Drainage* ; Inflammation ; Lacrimal Apparatus ; Lacrimal Apparatus Diseases ; Lacrimal Duct Obstruction ; Nasolacrimal Duct

PURPOSE: To compare the outcomes of endonasal dacryocystorhinostomy in patients with secondary lacrimal drainage obstruction associated with systemic chemotherapy or radioactive iodine therapy. METHODS: We retrospectively reviewed the clinical records of patients diagnosed with secondary lacrimal drainage obstruction after systemic chemotherapy or radioactive iodine therapy for thyroid disease and surgical treatment by endonasal dacryocystorhinostomy between January 2009 and January 2015. The control group included randomly selected patients who underwent endonasal dacryocystorhinostomy after diagnosis of primary lacrimal drainage obstruction. RESULTS: Patients were separated into a chemotherapy group (13 eyes of 9 patients), a radioactive iodine therapy group (44 eyes of 32 patients), and a control group (50 eyes of 40 patients). Duration from the onset of systemic chemotherapy or radioactive iodine to the first epiphora symptom was shorter in the chemotherapy group than the radioactive iodine therapy group (p < 0.001). There was no significant difference between the three groups in success rate of endonasal dacryocystorhinostomy. CONCLUSIONS: Most patients with secondary lacrimal drainage obstruction associated with systemic chemotherapy or radioactive iodine therapy had successful outcome of endonasal dacryocystorhinostomy. The success rate of dacryocystorhinostomy was comparable to that in patients with primary lacrimal drainage obstruction.
Dacryocystorhinostomy* ; Diagnosis ; Drainage* ; Drug Therapy* ; Humans ; Iodine* ; Lacrimal Apparatus Diseases ; Retrospective Studies ; Thyroid Diseases

PURPOSE: To report a case of lacrimal gland mucosa-associated lymphoid tissue (MALT) lymphoma in a patient with primary Sjögren's syndrome and Behcet's disease. CASE SUMMARY: A 49-year-old female patient with primary Sjögren's syndrome and Behcet's disease presented with a one-year history of painless upper and lower eyelid swelling in her right eye. Lacrimal gland incisional biopsy was performed, and the patient was diagnosed with malignant lymphoma (extranodal marginal zone B cell lymphoma of MALT). No distant metastases were detected on whole-body computed tomography or positron emission tomography, and the patient was treated with Rituximab, Cyclophosphamide, Vincristine, Prednisone (R-CVP) regimen chemotherapy. After 8 consecutive chemotherapy cycles, her eyelids appeared normal externally, and partial regression was found radiologically. CONCLUSIONS: The possibility of MALT lymphoma should be considered as a differential diagnosis if patients with autoimmune diseases such as primary Sjögren's syndrome show eyelid swelling or palpable mass.
Autoimmune Diseases ; Biopsy ; Cyclophosphamide ; Diagnosis, Differential ; Drug Therapy ; Eyelids ; Female ; Humans ; Lacrimal Apparatus* ; Lymphoid Tissue ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone* ; Middle Aged ; Neoplasm Metastasis ; Positron-Emission Tomography ; Prednisone ; Rituximab ; Vincristine

PURPOSE: Spontaneous regression of squamous cell carcinoma is a very rare event. We report a case of primary squamous cell carcinoma in the lacrimal sac which showed spontaneous regression without any treatment. CASE SUMMARY: A 69-year-old woman presented with epiphora and ocular discharge from the right eye. Under the diagnosis of nasolacrimal duct obstruction, we performed dacryocystorhinostomy. Two years after the surgery, the patient presented again with severe epiphora and ocular pain accompanied by proptosis and adduction limitation in the right eye. Computed tomography demonstrated a mass occupying the right lacrimal sac and incisional biopsy showed poorly differentiated invasive squamous cell carcinoma. Additional treatment was recommended, but the patient denied any treatments. At 6 months after the biopsy, the medial orbital wall was partially destructed. On positron emission tomography/computed tomography, metastasis was suspected in the cervical, para-aortic, sub-carinal, and peri-esophageal lymph nodes. However, at 15 months after the biopsy, the orbital tumor had almost disappeared. On positron emission tomography/computed tomography, fluorodeoxyglucose uptake was reduced in all areas including the cervical and mediastinal lymph nodes. CONCLUSIONS: This case exhibited a generally natural course of a malignant tumor, including medial orbital wall destruction and lymph node metastasis. However, the course then improved naturally without any treatment. The reason for the spontaneous regression of squamous cell carcinoma is still unclear but might be due to complex effects of one or several factors.
Aged ; Biopsy ; Carcinoma, Squamous Cell* ; Dacryocystorhinostomy ; Diagnosis ; Electrons ; Epithelial Cells* ; Exophthalmos ; Female ; Humans ; Lacrimal Apparatus ; Lacrimal Apparatus Diseases ; Lymph Nodes ; Nasolacrimal Duct* ; Neoplasm Metastasis ; Neoplasm Regression, Spontaneous ; Orbit

No abstract available.
Aged, 80 and over ; Amyloidosis/*complications/diagnosis ; Biopsy ; Dacryocystorhinostomy/methods ; Humans ; Lacrimal Apparatus/*diagnostic imaging/surgery ; Lacrimal Apparatus Diseases/*diagnosis/etiology/surgery ; Male ; Tomography, X-Ray Computed

PURPOSE: To report a case of orbital mucosa-associated lymphoid tissue (MALT) lymphoma that occurred in a patient with rheumatoid arthritis (RA). CASE SUMMARY: A 70-year-old male with alleged RA presented with a 3-month history of spontaneous and painless upper and lower eyelid swelling in the right eye. On initial examination, palpable nodules were observed at the right upper and lower eyelids and orbital computed tomography (CT) revealed a contrast-enhancing nodule just inferior to the lacrimal gland, thus an incisional biopsy was performed. The pathological report showed malignant orbital lymphoma (low grade extranodal marginal zone B cell lymphoma of MALT). Since distant metastases were not detected on whole-body CT and positron emission tomography, the patient was advised to keep previous medication and regular follow-up examinations. CONCLUSIONS: The possibility of MALT lymphoma should be considered as a differential diagnosis in patients with eyelid swelling and autoimmune diseases such as RA.
Aged ; Arthritis, Rheumatoid* ; Autoimmune Diseases ; Biopsy ; Diagnosis, Differential ; Eyelids ; Follow-Up Studies ; Humans ; Lacrimal Apparatus ; Lymphoid Tissue ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone* ; Male ; Neoplasm Metastasis ; Orbit* ; Positron-Emission Tomography

No abstract available.
Bone Marrow/*pathology/radiography/radionuclide imaging ; Carcinoma, Adenoid Cystic/*diagnosis ; Eye Neoplasms/*diagnosis ; Female ; Humans ; Lacrimal Apparatus/*pathology/radiography/radionuclide imaging ; Lacrimal Apparatus Diseases/*diagnosis ; Maxilla ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local ; *Positron-Emission Tomography ; *Tomography, X-Ray Computed

No abstract available.
Aged ; Biopsy ; Carcinoma, Squamous Cell/diagnosis/*etiology ; Dacryocystorhinostomy/*adverse effects ; Eye Neoplasms/diagnosis/*etiology ; Female ; Humans ; Lacrimal Apparatus/pathology/*surgery ; Lacrimal Apparatus Diseases/diagnosis/*etiology ; *Postoperative Complications ; Tomography, X-Ray Computed