Tear film osmolarity in epiphora.

PURPOSE: To examine whether patients complaining of epiphora have tears of a lower osmolarity. METHODS: Sixty-three eyes of 39 patients attending an oculoplastic clinic with a primary complaint of epiphora, had their tear osmolarity recorded. Subjects were excluded if they had current or recent topical eye therapy, active ocular infection or allergy, ocular surface scarring, evidence of dry eye, previous laser eye surgery, or a contact lens worn within the previous 12 hours. Patients were divided into 2 groups. The first included those whose primary complaint was of epiphora due to either punctal stenosis, nasolacrimal duct obstruction (partial or complete), or eyelid laxity (without evidence of frank ectropion or entropion). The second group formed the controls, and consisted of the second eye of some of the above patients, or those attending the clinic for other oculoplastic procedures not related to epiphora. Testing of tear osmolarity was performed in the clinic using the TearLab osmometer. RESULTS: Sixty-three readings were obtained, of which 32 were from patients with a primary complaint of epiphora and 31 were allocated to the control group. Patients with epiphora had a mean tear osmolarity of 291.8 mOsms/l (range, 269-324, standard deviation 16.6), compared with the control group mean of 303.7 mOsms/l (range, 269-354, standard deviation 24.1). This difference was found to be statistically significant (p = 0.025). CONCLUSION: Patients complaining of epiphora in the absence of other ocular surface pathology have a significantly lower tear osmolarity.

Inverted papilloma of lacrimal sac invading into the orbit: case report and review of literature.

Inverted papilloma (IP) is a sinonasal tumor of benign etiology with local invasion and malignant potential. IP arising in lacrimal sac invading the orbit is extremely rare with only one case reported so far. The presented case appears to be the second such case reported in the literature. A 60-year-old Caucasian male presented with a medial canthal mass and epiphora. Incisional biopsy confirmed a transitional neoplasm. The lesion was completely excised enbloc with clear margins by using a Weber-Ferguson incision; orbital clearance and nasolacrimalfossa clearance was achieved via a medial maxillectomy. Enbloc resection of orbital and nasolacrimal parts of the tumor with clear margins is recommended.

Management of periocular basal cell carcinoma by Mohs micrographic surgery.

BACKGROUND/AIMS: To determine the success of Mohs micrographic surgery (MMS) for periocular basal cell carcinoma (BCC) at a tertiary referral centre in the UK. DESIGN: A retrospective interventional case series covering 5 years of practice. METHODS: Review of medical records of 104 consecutive patients who underwent MMS for confirmed periocular BCC. The main outcome measure was biopsy-proven recurrence of BCC at the same anatomical location after MMS. Secondary outcome measures included tumour site, histological subtype and length of follow-up. RESULTS: 104 patients underwent MMS for periocular BCC from January 2003 to July 2008. 63 (62%) of the surgeries were for primary BCC and 25 procedures (25%) were for recurrent or residual BCC. 64% of tumours were nodular BCC. The mean follow-up was 28 months (range 1-85 months). Six recurrences were identified in total. The recurrence rate following MMS for primary BCC was 1.6% (1 patient) compared to 20% (5 patients) in the patient group treated for residual or recurrent tumours. The mean time to recurrence was 39 months (range 16-71 months). CONCLUSIONS: MMS for primary BCC has a very high success rate but the recurrence rate increases significantly in cases of recurrent or residual tumours.