Primary ductal adenocarcinoma of the lacrimal gland

The morphological similarity of salivary and lacrimal gland tumors is known. Many clinicopathological studies and characteristics of salivary duct carcinoma, which bears histological similarities to mammary duct carcinoma, have been recently reported; however, only one case of lacrimal duct carcinoma is reported. A second case of lacrimal duct carcinoma is presented. A 67-year-old male with a painless mass in the right upper eyelid underwent total removal of the tumor mass. Microscopic examination of the tumor mass revealed ductal adenocarcinoma of the lacrimal gland, which was the equivalent of salivary duct carcinoma. The immunohistological studies of the lacrimal duct carcinoma showed similar results to those reported for salivary duct carcinoma. The recurrent tumor in the subdural spaces was removed 2 years after the initial surgery and the patient is followed as an outpatient.     

Medial canthoplasty for optimum support of the lower eyelid in 14 patients

BACKGROUND AND OBJECTIVES: Medial canthoplasty surgically fuses the upper and lower lids medial to the puncta. The authors modified the procedure by inserting a temporary lacrimal stent in order to avoid kinking and scar contracture of the canaliculi. PATIENTS AND METHODS: A medial canthoplasty successfully corrected lower eyelid laxity in 14 patients with the following conditions: (1) exposure and/or neurotrophic keratitis with medial ectropion and/or retraction of the lower eyelid (11 patients), and (2) inability to retain a prosthesis because of lower eyelid ectropion and contracture of the inferior conjunctival fornix (3 anophthalmic patients). RESULTS: All patients had a satisfactory cosmetic result despite minimal vertical and horizontal narrowing of the palpebral fissure. Complications included partial wound dehiscence and pyogenic granuloma. CONCLUSION: The modified medial canthoplasty described in this article corrects medial ectropion with minimal cosmetic deformity.     

Tumors arising in the palpebral lobe of the lacrimal gland

PURPOSE: Tumors arising in the palpebral lobe of the lacrimal gland are uncommon. There have been only eight reported patients, all of whom had pleomorphic adenomas. The authors present another six patients with primary palpebral lobe tumors. METHODS: The clinical presentation, computed tomographic, and pathologic findings of these six patients were reviewed. RESULTS: Tumor types include three pleomorphic adenomas, one well-differentiated adenoid cystic carcinoma, one carcinoma in pleomorphic adenoma, and one carcinoma ex pleomorphic adenoma. All six patients presented with a painless mass in the upper outer eyelid without significant displacement of the globe, but the superficial location of these lesions led to early detection. The tumors were localized to the lacrimal gland, predominantly anterior to the orbital rim. In all six patients, the involved palpebral lobe was removed, five via a direct anterior subcutaneous approach and one by superolateral orbitotomy. In two patients (adenoid cystic carcinoma and carcinoma ex pleomorphic adenoma), repeat surgery via superolateral orbitotomy was necessary to achieve complete removal of the lacrimal gland and surrounding tissue. No recurrences were detected during follow-up (range, 6 months to 7 years; mean, 26 months). CONCLUSION: Palpebral lobe tumors of the lacrimal gland are more common and consist of a greater variety of histologic types than previously described. In our series, these tumors comprise 17% of all epithelial lacrimal gland lesions. These are the first reported cases of malignancy in this location. A longer follow-up period is necessary to determine the true recurrence rate of these tumors.     

Cryotherapy of basal cell carcinoma in oculoplastic surgery

Cryotherapy was an effective modality in the treatment of basal cell carcinoma in the eyelid and periorbital area and cured 93% of the 29 lesions in 25 patients. This method was especially advantageous in patients with blood clotting disorders; those with medical contraindications to, or who refused, classical surgery; patients who had prior radiation or surgery; patients with the basal cell nevus syndrome or xeroderma pigmentosa; and in patients with medial canthal tumors. Experimental cryotherapy in the albino rabbit showed their lacrimal system is not adversely affected by freezing in the temperature range required for tumor death.     

Cell surface regulators of complement, 5I2 antigen, and CD59, in the rat eye and adnexal tissues

PURPOSE: Cell surface complement regulatory proteins have been identified in high levels in ocular tissues, but no experimental model is available for examining their physiological roles. To develop such a model, the distribution of 5I2 antigen, a protein possessing the functions of the human decay-accelerating factor (DAF [CD55]) and membrane cofactor protein (MCP [CD46]), and rat inhibitory protein (CD59), the homologue of the human membrane inhibitor of reactive lysis (MIRL[CD59]) were characterized in the rat eye and ocular adnexal structures. METHODS: After euthanasia of female Wistar rats, followed by orbital exenteration, eyelids and orbital tissue including the lacrimal gland were separated from the globes and immediately snap-frozen in liquid nitrogen at -70 degrees C. Tissues then were sectioned at -20 degrees C and examined immunohistochemically for 5I2 antigen and rat CD59. RESULTS: Both molecules were found to be present in high levels in multiple sites. Corneal and conjunctival epithelia showed moderate to intense labeling for both regulators. Fibroblasts in the corneal stroma, conjunctiva, and sclera labeled similarly. Corneal endothelial cells showed intense labeling for rat CD59 but not for 5I2 antigen. The iris and ciliary body showed intense labeling for both proteins. The retina showed labeling at multiple levels, with that of rat CD59 being more intense than that of 5I2 antigen. The lacrimal gland labeled for both regulators. Vessels, muscle, and nerves in the orbit labeled intensely for both antigens. In the eyelid, conjunctiva, sebaceous glands, and muscle and nerve tissues labeled moderately to intensely for both molecules, whereas skin epithelium labeled less intensely. CONCLUSIONS: 5I2 antigen and rat CD59 are expressed in high levels and distributed similarly in the rat eye and lacrimal gland to DAF, MCP, and MIRL in the human eye and lacrimal gland. These findings establish the rat ocular surface as a model for studying the role of cell surface complement regulators in this site. This first identification of copious expression of these proteins in eyelid structures, which also participate in protection of the ocular surface, further suggests an important role for surface complement regulatory proteins in this location.     

Diagnostic significance of CT in the orbital inflammatory lesions

OBJECTIVE: To analyze and summarize the CT signs of orbital inflammatory lesions. METHOD: HITACH-W, or EXEL 2400 pattern of CT was applied for the orbital scanning of 52 cases with orbital inflammatory lesions proved by clinicopathology. RESULTS: The CT signs of orbital inflammatory lesions in our series included exophthalmos, orbital mass, ill-marginated mass, multiple space involvement, extraocular muscle enlargement, scleral thickening, eyelid thickening, optic nerve thickening, orbital fat density increasing, lacrimal gland enlargement, sinusitis, subperiosteal abscess, ring-enhancement in masses, etc. CONCLUSION: All these findings on CT are of important significance for the diagnosis of orbital inflammatory lesions.     

Oncocytic lesions of the caruncle and other ocular adnexa

This is a clinicopathologic study of 18 oncocytic lesions involving the ocular adnexa. These lesions most commonly occur in elderly patients (median age 73), and there is a striking predilection for women. The broad spectrum of lesions included oncocytic adenomatous hyperplasia, oncocytomas, and oncocytic carcinoma. Ten lesions, all of which were oncocytomas, involved the caruncle, four the conjunctiva, and one the mucocutaneous junction of the eyelid. Two tumors involved the lacrimal sac and one the lacrimal gland. A review of the literature disclosed only 17 previously reported oncocytic lesions of the ocular adnexa. A small yellowish-tan or reddish caruncular mass, especially in an elderly woman, should alert the ophthalmologist to consider the possibility of oncocytoma in his differential diagnosis.     

Scintigraphy of the lacrimal ducts

Scintigraphy of the lacrimal pathways is an examination method which informs us on the function of the efferent lacrimal system. The authors made bilateral scintigraphic examinations in 32 patients with obstruction or stenosis of the lacrimal pathways, 22 times they made concurrent contrast examinations of the lacrimal pathways. In seven suprasaccal and 5 saccal obstructions and stenoses they did not find penetration of activity from the conjunctival sac into the lacrimal pathways. In 16 subsaccal obstructions, 12 times penetration of activity into the lacrimal sac was found. In five patients with a partly preserved patency of the lacrimal pathways three times activity was detected in the lacrimal sac and in one instance slow penetration of activity into the nasal cavity. In complete obstructions and severe stenoses scintigraphy does not provide, as compared with conclusions of other examinations (fluorescein tests, irrigation, probing, contrast dacryocystography) new information on the type of obstruction. The method is useful in particular in conditions with a preserved patency of the lacrimal pathways, in examinations of very mild stenoses, intermittent lacrimation and doubtful cases. Scintigraphy of the lacrimal pathways is a supplementary method which must be evaluated in the context with other methods, in particular methods which provide information on the anatomy of the lacrimal system (dacryography).     

Eyelid imbrication. An unrecognized cause of chronic ocular irritation

BACKGROUND: Eighteen patients with chronic ocular irritation were examined over a 3-year period. All patients demonstrated papillary conjunctivitis and, occasionally, tarsal ulcers. Six also had floppy eyelid syndrome. Underlying every patient's symptoms was the overriding or imbrication of a lax upper eyelid on an often equally lax lower eyelid, allowing lower eyelid lashes to chronically rub the upper eyelid tarsal conjunctiva. METHODS: Chronic ocular irritation in five patients was managed with ocular lubricants. Two of these patients had floppy eyelid syndrome and required nightime shielding for nocturnal eyelid eversion. Thirteen patients underwent eyelid surgery to correct the overriding upper eyelid. Surgical procedures included full-thickness upper eyelid wedge resection, lateral canthal tendon plication, and lower eyelid horizontal shortening, using a tarsal strip procedure. RESULTS: Follow-up averaged 2.5 years. Symptomatology was adequately controlled in all patients. In addition to the five patients who received medical treatment for their symptoms, two with complicated ocular problems required continued ocular lubrication after surgery. Seven patients were successfully treated with eyelid shortening procedures and lateral canthal tendon plication. The remaining six patients underwent a variety of additional eyelid surgeries. All patients undergoing surgery had complete resolution of eyelid imbrication. CONCLUSIONS: Eyelid imbrication is a previously unrecognized cause of chronic ocular irritation. In this condition, eyelid laxity causes the upper eyelid to override the lower eyelid, allowing the lower eyelid to chronically rub and chafe the upper eyelid tarsal conjunctiva. In some cases, symptoms can be managed medically. More often, surgical intervention is required to correct eyelid laxity and prevent overriding of the upper eyelid.     

Dacryocystitis associated with malignant lymphoma of the lacrimal sac

BACKGROUND: Tumors of the lacrimal sac are unusual, and lymphomas of the lacrimal sac are quite rare. Four patients with a history of well-differentiated, small cell lymphoma or chronic lymphocytic leukemia presented with either acute or chronic dacryocystitis and epiphora due to lymphomatous infiltration of the lacrimal sac. METHODS: All four patients underwent dacryocystorhinostomy with lacrimal sac biopsy. All tissues underwent complete histopathologic evaluation including immunohistochemical studies for cell surface markers and, in addition, were compared with previous biopsies performed for the initial diagnosis of lymphoma. FINDINGS: All biopsies demonstrated small cell well-differentiated lymphoma on histologic and immunofluorescent examination. No patient demonstrated orbital involvement on computed tomography. One patient had previously diagnosed chronic lymphocytic leukemia and one patient demonstrated diffuse lymph node involvement on postoperative systemic evaluation. All four patients underwent additional chemotherapy. No recurrence of dacryocystitis or epiphora occurred. CONCLUSION: Four patients presented with dacryocystitis secondary to lacrimal sac lymphoma. Lymphomatous lacrimal sac infiltration is an unusual cause of dacryocystitis. Biopsy of the lacrimal sac plays a diagnostically important role in dacryocystorhinostomy even in the absence of obvious tumorous involvement of the lacrimal sac mucosa.     

DNA modifications by the mutagen glyoxal: adduction to G and C, deamination of C and GC and GA cross-linking

OBJECTIVE: This study aimed to describe the clinical and histopathologic findings in four patients with complex limbal choristomas associated with linear nevus sebaceous syndrome (LNSS), a rare disorder including nevus sebaceous, seizures, and mental retardation, and often accompanied by ocular anomalies. DESIGN: Small observational case series. METHODS: A retrospective review of the clinical and histopathologic records of four patients. RESULTS: Each of four patients had complex limbal choristomas in the setting of clinical and histopathologic LNSS. The limbal choristomas were multiple in three patients and bilateral in two patients. Most choristomas involved the superotemporal limbus (6 of 10), although nasal (3 of 10) and inferior (1 of 10) limbal tumors also were present. Three patients had significant corneal astigmatism or involvement of the central cornea requiring surgical removal of their choristomas, one accompanied by a lamellar keratoplasty and another accompanied by two consecutive penetrating keratoplasties. Each graft eventually vascularized, reducing vision. One patient's vision was limited by amblyopia and another by occipital cortical dysgenesis with visual impairment. Histopathologic examination of the excised choristomas showed foci of lacrimal gland (3 of 4 patients), adipose tissue (3 of 4), neural tissue (1 of 4), cartilage (1 of 4), lymphoid follicles (1 of 4), skin adnexal tissue (1 of 4), and smooth muscle (1 of 4). Other associated ocular findings included an eyelid mass (1 of 4), colobomas of the eyelid (3 of 4), colobomas of the choroid and retina (2 of 4), nonparalytic strabismus (2 of 4), scleral ectasia (1 of 4), partial oculomotor palsy with ptosis and anisocoria (1 of 4), microphthalmia (1 of 4), hypertelorism (1 of 4), and cortical visual impairment (1 of 4). CONCLUSIONS: Complex limbal choristomas, although rare, can occur in the setting of LNSS and can be associated with multiple ocular and systemic abnormalities. Visual prognosis appears poor in most cases despite aggressive management.     

Immunohistochemical localization of human tear lysozyme

Possible local sources of human tear lysozyme were investigated using an indirect immunofluorescence technique. Lysozyme was identified in 20% to 50% of acinar and ductular epithelial cells of both main and accessory lacrimal glands. The staining was granular in character and confined to the apices of the cells. Cells that stained positive tended to be grouped. Interstitial tissues of main and accessory lacrimal tissues did not stain. Conjunctiva and all other ocular tissues examined were unstained by antilysozyme antisera. Our findings are compatible with lysozyme either being produced in lacrimal tissue or being concentrated from plasma. The absence of any other lysozyme-specific fluorescence in the interstitial elements of the lacrimal tissues supports the notion of local synthesis by acinar lacrimal tissue.     

Management of postblepharoplasty lower eyelid retraction with hard palate grafts and lateral tarsal strip

Lower eyelid malposition is the most common long-term complication following transcutaneous lower eyelid blepharoplasty. The malposition may include rounding of the lateral canthal angle, lower eyelid retraction with inferior scleral show, or frank ectropion. The result is cosmetically unacceptable and may be associated with tearing, irritation, and other exposure keratitis symptoms. Multiple factors, including lower eyelid laxity, shortage of skin, and scarring of the middle lamella, may be responsible for this malposition. A systematic examination of the lower eyelid, as presented, helps to assess the degree to which each of these factors is responsible for the malposition. Patients with the most severe degree of lower eyelid malposition generally have middle lamella scarring. If this abnormality is not addressed, lower eyelid procedures aimed at correcting the malposition are doomed to failure. In the presence of significant middle lamella scarring, a spacer is required to provide vertical height and stiffness to support the lower eyelid following release of the cicatrix. A systematic approach aimed at addressing the underlying abnormalities was developed. In patients with significant middle lamella scarring, hard palate mucosa grafts were used as spacers in 29 eyelids (17 patients). A lateral canthotomy and transconjunctival incision allow access to the scarring in the lower eyelid retractors and septum. After careful release of all cicatrix, a hard palate mucosa graft is inserted between the lower border of the tarsal plate and the recessed conjunctiva, lower eyelid retractors, and septum. Horizontal lower eyelid laxity, when present, is corrected by performing a lateral tarsal strip. Most patients do not have a true deficiency of the anterior lamella (skin and orbicularis oculi muscle). When a moderate amount of anterior lamella deficiency is present with significant scarring of the middle lamella, the technique we describe allows correction of the lower eyelid malposition without a skin graft. After a follow-up interval of 6 to 30 months (mean 14 months), excellent results were obtained in all eyelids. Complications included corneal abrasions in two eyes before routine use of bandage cornea contact lenses at the end of surgery and a secondary bleed from the roof of the mouth in one patient. Palate mucosa closely resembles tarsus and provides excellent vertical support to the eyelid. It is stiff enough to maintain eyelid contour without causing a cosmetically unacceptable bump. Tissue can be obtained with ease. The technique, as described, addresses the underlying causes of lower eyelid malposition and gives excellent functional and cosmetic results.     

Dacryoscintigraph evaluation of the repaired lacrimal drainage system

We have used dacryoscintigraphy to study the efficiency of the lacrimal system following the repair of a divided lower canaliculus in 4 children. This test has been reliable in evaluating lacrimal function and suggests that a canaliculus can be repaired and splinted satisfactorily. Our experience with dacryoscintigraphy confirms that it is a safe comfortable, and reliable method for studying the patency of the lacrimal drainage system.     

Elimination protocols in atopic dermatitis

Both dacryocystography and dacryoscintigraphy are well established in the evaluation of stenoses of the lacrimal drainage system. They provide limited information about the ductal anatomy itself and about periductal structures. MR imaging was evaluated for its capability to directly visualize the lacrimal drainage system in detail and simultaneously provide functional characterization of dacryostenosis. SUBJECTS AND METHODS: Twenty-seven lacrimal drainage systems of 23 patients suffering from epiphora were examined in an MR unit before and after conjunctival and intravenous application of Gd-DTPA using a surface coil. RESULTS: Dacryostenosis was found in 23 of 27 lacrimal systems. Stenoses were localized to the canalicular (n = 3), saccular (n = 8), and ductal (n = 12) level, and were classified as stenosis or occlusion. CONCLUSION: MR imaging with conjunctival contrast application allows within one examination both detailed morphological and functional assessment of the lacrimal drainage system with depiction of surrounding structures. Limitations arise mainly from demands on technical and patient-related preconditions.     

Aspartate and alanine aminotransferase activity in the adrenal cortex of human embryos and fetuses

In most cases of congenital lacrimal fistulae occuring in the ophthalmic literature the condition is diagnosed only during later life. Then, however, the congenital nature is doubtful. This paper describes a new-born with bilateral congenital lacrimal fistulae. Furthermore, the underfed patient has heart and genital malformations. The indication for surgical management of congenital lacrimal fistulae is discussed.     

Covariation of alternative measures of responding in rabbit (Oryctolagus cuniculus) eyeblink conditioning during acquisition training and tone generalization.

The likelihood, size, and speed of eyelid movements are thought to covary during the acquisition and expression of conditioning in rabbits (Oryctolagus cuniculus) and are generally accepted as interchangeable measures of the associative strength activated by the conditioned stimulus (CS). To test this assumption, the authors examined the patterns of covariation in these eyelid movement measures in acquisition and stimulus generalization in the upper eyelid and nictitating membrane. Rather than the expected covariation among these measures, eyelid movement magnitudes during the CS were distributed in approximately a bimodal manner. That is, eyelid activity consisted largely of a mixture of very small ( 1 mm) movements. The results are discussed with respect to their implications for real-time models of eyelid conditioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bilateral cerebellar lesions disrupt conditioned eyelid responses in unrestrained rats.

Electromyographic eyelid responses in unrestrained rats were classically conditioned in a Pavlovian delay paradigm by using a tone conditioned stimulus (CS) and periorbital shock unconditioned stimulus (US). After eyelid conditioning was complete, bilateral electrolytic lesions were made in the dentate-interpositus region of the cerebellar nuclei. Initial eyelid conditioning was reliable and very similar to that previously observed in the rabbit, although the asymptotic eyelid responses contained a short-latency startle response in addition to the usual conditioned and unconditioned responses (CR and UR). Substantial decrements in CRs were observed in 13 of the 14 rats with accurately placed lesions. In contrast, startle responses and URs were unaffected. Results replicate the effects of cerebellar lesions on eyelid CRs in the rabbit and suggest that the anatomical basis of eyelid conditioning in both species is similar. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Morphologic study of the musculature of the third eyelid in the cat (Felis catus)

The presence of smooth and striated muscles associated with protrusion or retraction of the feline third eyelid was investigated histologically in eight cats. Nine smooth muscle strands extending into the third eyelid are described and illustrated. No striated muscle fibers extending into or within the third eyelid were observed.     

Vascular anatomy of the eyelids

PURPOSE: The eyelids have a rich vascular supply, and bleeding may compromise both surgical technique and postoperative results. Generally, it is known that the eyelids contain a marginal and peripheral arcade, but detailed anatomic information is not available. This study therefore was undertaken to determine the detailed anatomy of eyelid vascularity. METHOD: The common carotid arteries of six fresh cadaver heads were injected with a compound consisting of a partially polymerized monomer, to which a catalyst and promoter were added to cause hardening. The soft tissue was then digested, using 40% potassium hydroxide, to obtain detailed casts of the eyelid arteries, arterioles, and capillaries. RESULTS: The authors describe the eyelid vascularity and anastomotic network with average distance measurements from clinically relevant soft tissue landmarks in the 12 cadaver eyelids. CONCLUSIONS: Consistent patterns of eyelid vascularity were observed. A better understanding of the eyelid vascularity should allow modification of surgical techniques and reduce postoperative complications after eyelid surgery.