PURPOSE: To evaluate the classification of punctal stenosis based on the shape of the external punctum, clinical characteristics and histopathologic features. METHODS: Patients who experienced tearing and were diagnosed with punctal stenosis were evaluated in this study. Punctal stenosis was classified according to the shape of the lower external punctum, which included membranous type, slit type, horseshoe type, and pinpoint type. Tear meniscus height, 2% fluorescein dye disappearance test and lacrimal pathway irrigation were measured or performed. For treatment, a punctal snip operation and silicone tube placement were performed, and the peripunctal histopathological findings were evaluated. RESULTS: Punctal stenosis was classified into four types: membranous type (17 eyes, 21.5%), slit type (11 eyes, 13.9%), horseshoe type (25 eyes, 31.6%), and pinpoint type (26 eyes, 32.9%). The tear meniscus was significantly higher, and the 2% fluorescein dye disappeared significantly more slowly in the punctal stenosis group. However, correlation of the tear meniscus height and 2% fluorescein dye disappearance test with the punctum shape was not statistically significant. A history of previous chemotherapy was significantly associated with the occurrence of punctal stenosis, especially the membranous type (p < 0.05). Histopathologic evaluation of the punctum showed differences between the punctum types. Pinpoint puncta exhibited a high density of muscle fibers, while they were faintly visible in the membranous type. CONCLUSIONS: Acquired punctal stenosis has various shapes, and the major types of stenotic puncta exhibited unique histopathologic features. Punctal stenosis and its pathophysiology may be related to multiple factors, such as age and systemic 5-fluorouracil chemotherapy history.
Classification* ; Constriction, Pathologic* ; Drug Therapy ; Fluorescein ; Fluorouracil ; Humans ; Lacrimal Apparatus ; Lacrimal Apparatus Diseases* ; Silicon ; Silicones ; Tears

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

Acupuncture Therapy ; Adult ; Aged ; Female ; Humans ; Lacrimal Apparatus Diseases ; therapy ; Male ; Middle Aged

No abstract available.
Carcinoma, Non-Small-Cell Lung* ; Drug Therapy* ; Humans ; Lacrimal Apparatus Diseases* ; Lung Neoplasms ; Pemetrexed*

Severe dry eye is a refractory ophthalmologic disease. Our multidisciplinary research group treated severe dry eye by microvascular autologous transplantation of submandibular gland (SMG) during the past 20 years. The SMG, with its blood vessels and Wharton's duct, was harvested from the submandibular triangle and transferred to the temporal area. The blood vessels in the SMG were anastomosed with the temporal blood vessels using a microsurgical technique. Then, the distal end of Wharton's duct was sutured to form an opening in the upper lateral conjunctival fold. The tear was replaced by the secretion of the transplanted SMG to lubricate the ocular surface. In our study, the surgical techniques of blood vessel management were continuously modified to increase the survival rate of the transplanted SMG. A novel surgical modality of partial transplantation of SMG was established to prevent postoperative epiphora. A clinical study with the largest case number in the world was conducted and the effectiveness of transplantation of SMG for severe dry eye was fully confirmed. In order to resolve two main clinical problems including ductal obstruction resulted from low secretion rate during the latent period, and epiphora due to over secretion of the transplanted SMG in the later term of transplantation, the regulation of the secretion mechanism of the normal and transplanted SMG were investigated. New opinions on mechanisms of saliva secretion were provided. Based on the priniciple of translational medicine, the results of related basic research were applied in the clinic. The clinical guidelines for secretion regulation of transplanted SMG were established. A concept of chronic obstructive sialadenitis of transplanted SMG was provided and its diagnostic criteria, diagnostic technique of sialography, and therapeutic regimen were established. As a result, the surgical success rate was obviously elevated, the surgical complications were decreased, and life quality of the patients was greatly improved.
Humans ; Lacrimal Apparatus Diseases/therapy* ; Salivary Ducts ; Submandibular Gland/transplantation* ; Tears ; Transplantation, Autologous

A 32-year-old man visited our clinic with complaints of left epiphora and neck masses. A computed tomographic scan demonstrated a well-demarcated homogeneous mass in left lacrimal sac area and a polypoid mass in ethmoidosphenoidal sinuses, and showed multiple lymphadenopathy in neck. Dacryocystectomy and ethmoidosphenoidectomy were performed. Pathologic diagnosis by immunohistochemical study and electron microscopic examination was alveolar type rhabdomyosarcoma. Subsequently, chemotherapy and radiotherapy were done. There was no evidence of recurrence of the tumor in lacrimal sac and paranasal sinus throughout 9 months of follow-up period. The masses in the neck nearly disappeared. Rhabdomyosarcoma in one's thirties is extremely rare and to our knowledge, this patient represents the first case reported to have developed such a tumor in the lacrimal sac. Although rhabdomyosarcoma is very uncommon, there is a rationale for including it in differential diagnosis of a rapidly growing tumor in the lacrimal sac.
Adult* ; Diagnosis ; Diagnosis, Differential ; Drug Therapy ; Follow-Up Studies ; Humans ; Lacrimal Apparatus Diseases ; Lymphatic Diseases ; Neck ; Radiotherapy ; Recurrence ; Rhabdomyosarcoma*

Acupuncture Therapy ; instrumentation ; Adult ; Aged ; Facial Paralysis ; complications ; Humans ; Lacrimal Apparatus Diseases ; etiology ; therapy ; Male ; Middle Aged ; Needles ; Young Adult

PURPOSE: To investigate the efficacy of lacrimal silicone intubation for the management of epiphora in patients who have previously undergone anatomically successful dacryocystorhinostomy (DCR). METHODS: The authors recruited 13 patients (4 male, 9 female) who had persistent epiphora after an anatomically successful primary external DCR and conducted lacrimal silicone intubation through the dacryocystorhinostomy site. RESULTS: Mean patient age was 54.2 years (range 42-80) and mean follow-up was 13.8 months (range 6-30). Epiphora was resolved in all 13 patients following silicone intubation. Spontaneous tube extrusion occurred in three patients, but a new one was easily reintubated. CONCLUSIONS: Lacrimal silicone intubation is a simple safe and effective procedure for patients with epiphora even after anatomically successful DCR.
Adult ; Aged ; Aged, 80 and over ; *Dacryocystorhinostomy ; Female ; Follow-Up Studies ; Humans ; Intubation/*instrumentation ; *Lacrimal Apparatus ; Lacrimal Apparatus Diseases/*therapy ; Male ; Middle Aged ; Retrospective Studies ; *Silicone Elastomers ; Time Factors ; Treatment Failure

PURPOSE: To investigate the efficacy of lacrimal silicone intubation for the management of epiphora in patients who have previously undergone anatomically successful dacryocystorhinostomy (DCR). METHODS: The authors recruited 13 patients (4 male, 9 female) who had persistent epiphora after an anatomically successful primary external DCR and conducted lacrimal silicone intubation through the dacryocystorhinostomy site. RESULTS: Mean patient age was 54.2 years (range 42-80) and mean follow-up was 13.8 months (range 6-30). Epiphora was resolved in all 13 patients following silicone intubation. Spontaneous tube extrusion occurred in three patients, but a new one was easily reintubated. CONCLUSIONS: Lacrimal silicone intubation is a simple safe and effective procedure for patients with epiphora even after anatomically successful DCR.
Adult ; Aged ; Aged, 80 and over ; *Dacryocystorhinostomy ; Female ; Follow-Up Studies ; Humans ; Intubation/*instrumentation ; *Lacrimal Apparatus ; Lacrimal Apparatus Diseases/*therapy ; Male ; Middle Aged ; Retrospective Studies ; *Silicone Elastomers ; Time Factors ; Treatment Failure

The authors report a caruncular abscess caused by actinomycosis. A 47-year-old woman was admitted with persistent purulent discharge from the caruncle of the left eye for a duration of six months. Excisional drainage was performed, and 'sulfur granules' were observed, consistent with actinomyces infection. Intraoperative lacrimal probing and irrigation were performed to confirm that the abscess and canaliculus were not connected. Oral and topical antibiotics were administered postoperatively; the lesion resolved with no evidence of recurrence, and the symptom improved.
Abscess/drug therapy/*microbiology ; Actinomycosis/*diagnosis/drug therapy ; Anti-Bacterial Agents/therapeutic use ; Female ; Humans ; Lacrimal Apparatus Diseases/drug therapy/*microbiology ; Middle Aged