Endoscopic dacryocystorhinostomy among the old and oldest-old populations - A case control study.

OBJECTIVE: Despite increased risks of nasolacrimal duct obstruction (NLDO) with age, and the continuous growth of the old population proportion, data on endoscopic dacryocystorhinostomy (eDCR) among the old is lacking. This study aims to evaluate long-term eDCR efficacy and safety in the old and oldest-old population. METHODS: A retrospective case-control study of patients aged 80 ≤ (oldest-old) and 65-79 (old) compared with younger controls who underwent eDCR, between 2002 and 2017. Pre-, intra- and postoperative factors were collected using an integrated hospital-community system. Success rates were analyzed and measured at the first visit following surgery (immediate success), and after five years. Demographics, comorbidities, complications rates, and outcomes were compared between the groups. RESULTS: The study groups included 52 oldest-old patients (mean age 83.4 ± 3.6), 127 old patients (72.3 ± 4.14) and 142 control patients (57.8 ± 18.0). The immediate and success rates were 94.2%, 93.7% and 90.8% and five-year success rates were 80.0%, 76.6% and 80% among oldest-old, old and controls, respectively. No significant differences in success rates were found, even despite higher comorbidity rates among the study's group (96 and 92.8% vs. 63.2%, among oldest-old, old and controls respectively, p <0.001). Intra- and postoperative complications rates were low in all groups. CONCLUSIONS: Among older population, including oldest-old and old, eDCR safety and long-term outcomes are comparable with younger patients, suggesting that eDCR should be offered to NLDO patients, regardless of age.

Ocular adnexal lymphoma in Denmark: a nationwide study of 387 cases from 1980 to 2017.

BACKGROUND: Nationwide studies of ocular adnexal lymphoma (OAL) are very rare in the literature, and knowledge on incidence, subtype distribution and long-term survival data is limited. This is the largest national study of OAL to date. This study sought to find information on incidence, changes in incidence, clinical findings, distribution of subtypes, survival and prognostic factors. METHODS: Patients diagnosed with OAL from January 1, 1980 to December 31, 2017 were identified in Danish registers, and clinical as well as survival data were collected. The data were analysed with Kaplan-Meier plots and log-rank test. RESULTS: 387 patients were included in the study. The major lymphoma subtypes were extranodal marginal-zone B cell lymphoma (EMZL) (55%), diffuse large B cell lymphoma (DLBCL) (13%), mantle cell lymphoma (MCL) (11%) and follicular lymphoma (FL) (10%). OAL is a disease of the elderly (median age 69 years). The incidence of lymphoma of the ocular adnexal region has increased significantly throughout the time period of the study (Pearson correlation coefficient, r=0.65; P<0.001). In the period 1980-1984, the incidence was 0.086 per 100 000, which increased to 0.307 per 100 000 in the period 2013-2017. Low-grade, low-stage primary lymphomas were treated with radiotherapy, whereas patients with high-stage, high-grade and/or relapsed disease were treated with chemotherapy. Low-grade subtypes EMZL (89%) and FL (56%) had better 10-year disease-specific survival than the high-grade lymphomas DLBCL (38%) and MCL (31%)(p<0.001). CONCLUSION: OAL is increasing in incidence in the Danish population for unknown reasons. However, the prognosis for most OAL is favourable, as highlighted in this national long-term study.

Endoscopic Denker's Approach for the Treatment of Extensive Sinonasal Tumors: Our Experience.

OBJECTIVES: Surgical management of large sinonasal tumors, spreading to the pterygopalatine, and infratemporal fossae have always been a challenge for the ENT surgeon and the multidisciplinary team. METHODS: Endoscopic Denker's approach allows complete exposure of the anterior, inferior, and lateral recesses of the maxillary sinus, without necessitating a gingivobuccal or a transseptal incision. Moreover, endoscopic Denker's approach facilitates direct, straight entry to the pterygopalatine and infratemporal fossae. RESULTS: Twenty-two patients with extensive sinonasal pathology underwent resection via an endoscopic Denker's approach at our institution, with the majority of them being diagnosed with JNA and inverted papilloma. Denker's procedure facilitated wide exposure of the surgical field and total tumor resection, without significant perioperative complications and good disease-free results in follow up. CONCLUSIONS: Our experience is in accordance with the literature, where this approach seems to be superior to alternative options for accessing the pterygopalatine and infratemporal fossae. We believe that adequate expertise in endoscopic sinonasal surgery is necessary prior to embarking on this technique, but in general, it represents a valuable tool in the surgeon's armamentarium. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:1458-1462, 2021.

Lymphoma of the Lacrimal Gland - An International Multicenter Retrospective Study.

PURPOSE: To characterize the clinical features of subtype-specific lacrimal gland lymphoma and their effect on patient survival. DESIGN: Multicenter retrospective interventional case series. METHODS: Patient data were collected from 6 international eye cancer centers from January 1, 1980, through December 31, 2017. All patients with histologically verified primary or secondary lymphoma of the lacrimal gland were included. Primary endpoints were overall survival (OS) and disease-specific survival (DSS). RESULTS: A total of 260 patients with lacrimal gland lymphoma were identified. The median age was 58 years and 52% of patients were men. Non-Hodgkin B-cell lymphomas constituted 99% (n = 258) and T-cell lymphomas constituted 1% (n = 2). The most frequent lymphoma subtypes were extranodal marginal zone B-cell lymphoma (EMZL) (n = 177, 68%), follicular lymphoma (FL) (n = 26, 10%), diffuse large B-cell lymphoma (DLBCL) (n = 25, 10%), and mantle cell lymphoma (MCL) (n = 17, 7%). Low-grade lymphomas (EMZL and FL) were most commonly treated with external beam radiotherapy (EBRT), whereas high-grade lymphomas (DLBCL and MCL) were treated with chemotherapy in combination with rituximab and/or EBRT. The prognosis was relatively good with a 5-year OS and DSS of 73.8% and 87.5%, respectively. Lymphoma subtype was a statistically significant predictor for DSS, with EMZL (5-year DSS: 93.4%) having the best prognosis and DLBCL (5-year DSS: 52.6%) having the poorest. CONCLUSIONS: This is the largest reported collection of data of subtype-specific lacrimal gland lymphoma. The subtype distribution of lacrimal gland lymphoma resembles that of the ocular adnexa. Prognosis is good and the histologic subtype is a significant predictor for disease-specific survival.

Epidemiology of invasive ocular surface squamous neoplasia in Canada during 1992-2010.

BACKGROUND: Ocular surface squamous neoplasia (OSSN) is the most common non-pigmented ocular surface malignancy. It is classified as invasive OSNN (IOSSN) when the underlying stroma are infiltrated by dysplastic squamous epithelial cells through the basement membrane. Here, we present the descriptive epidemiology and geographical distribution of IOSSN in Canada. METHODS: We determined the incidence and geographical distribution of IOSSN cases diagnosed between 1992 and 2010 using two independent population-based cancer registries: the Canadian Cancer Registry and Le Registre Québécois du Cancer. RESULTS: The mean annual age-standardised incidence rate (WHO 2000-2025) of IOSSN for 1992-2010 was 0.45 cases per million individuals per year with an average annual percent increase in incidence of 4.5%. IOSSN localisation to the conjunctiva was documented in at least 57% of the reported cases. IOSSN exhibited a male predilection ratio of 3.3:1.0 with a mean age at diagnosis of 69 years. Incidence rates of IOSSN across Canadian provinces and cities showed no significant differences from the crude national average. CONCLUSIONS: Our results, particularly concerning IOSSN patient age and male predilection, corroborate with data reported from the USA. Additional studies are needed to determine whether the observed increase in incidence rate over the study period (1992-2010) is significant.

Dacryops - A review.

Purpose: To review and summarize the epidemiology, clinical presentations, histopathologic characteristics and management of dacryops.Methods: A comprehensive PubMed, Embase and Google Scholar search of all articles written in English and non-English language articles with abstract translated to English on dacryops were reviewed. Data reviewed included epidemiology, etiology, pathogenesis, clinical presentations, histopathologic characteristics and management of dacryops.Results: Lacrimal ductal cysts or dacryops are classified based on locations: palpebral lobe cysts (simple dacryops); orbital lobe cysts; cysts of the accessory lacrimal glands of Krause and Wolfring; and cysts of ectopic (choristomatous) lacrimal glands. The exact etiology of dacryops remains unknown. Dacryops is usually asymptomatic but can present with varied symptoms depending on the type and associated complications. While complete excision of dacryops is generally recommended, marsupialization is also a safe and effective method for the treatment of dacryops in the palpebral lobe of lacrimal gland. Complete surgical excision via orbitotomy is required for deep orbital lesions.Conclusion: Dacryops is an uncommon benign cystic lacrimal gland tissue neoplasm. Dacryops can be classified into four types based on locations. Lesions could be either superficial that can be seen through the fornix or deep into the orbit. Observation is also an option for small or asymptomatic lesions. Surgery remains the mainstay of treatment for symptomatic cases, but approaches are different depending on the location of the lesions.

Epiphora after nasolacrimal duct fracture in patients with midfacial trauma: A retrospective study.

The aim of this study was to identify the factors related to occurrence of epiphora or requirement of dacryocystorhinostomy (DCR) in patients with midfacial trauma.We performed a retrospective analysis of the medical records of 1038 patients with midfacial trauma from January 2005 to December 2015. Fifty-one patients (55 cases) diagnosed with nasolacrimal duct (NLD) fracture using facial bone computed tomography were enrolled. Correlation analysis was performed of patient- and injury-related factors, including age, sex, facial trauma etiology, accompanying injury, type and level of the NLD fracture, and time from injury to initial surgery, with the occurrence of epiphora and requirement for DCR.Epiphora occurred in 14.5% and DCR was performed in 5.5% of the patients with NLD fracture. The correlation analysis revealed no significant relationship among the factors with the occurrence of epiphora and requirement for DCR.In patients with midfacial trauma and NLD fracture, epiphora occurred in 14.5% and endoscopic DCR was performed due to persistent epiphora in 5.5% and its result was all successful.

Clinicopathologic features of biopsied lacrimal gland masses in 95 Korean patients.

PURPOSE: To investigate the clinicopathologic features of lacrimal gland masses biopsied in a tertiary referral hospital in Korea. METHODS: Records from 95 Korean patients who underwent lacrimal gland mass biopsy were retrospectively reviewed. Data included demographics, clinical presentation, imaging findings, histopathologic diagnosis, and associated systemic disease. RESULTS: The median age was 52.0 years (range, 16-76 years), and 51 patients (53.7%) were female. Thirty-three patients (34.7%) had bilateral disease. The histopathologic diagnoses were as follows: chronic dacryoadenitis (52.6%, n = 50;29 non-specific and 21 immunoglobulin G4-related disease (IgG4-RD)), lymphoproliferative disease (25.5%, n = 24; 18 lymphoma and six lymphoid hyperplasia), benign epithelial tumour (13.7%, 13 pleomorphic adenoma), malignant epithelial tumour (3.2%, three adenoid cystic carcinoma), dacryops (3.2%, n = 3), solitary fibrous tumour (1.1%, n = 1), and xanthogranulomatous inflammation (1.1%, n = 1). Patients with chronic dacryoadenitis were significantly more likely to be younger (mean 47.5 years), have bilateral involvement (52.0%), and have a longer symptom period (mean 15.6 months) than those with lymphoproliferative disease (60.0 years, 25.0%, and 6.7 months, respectively; p < 0.05, each comparison). Patients with IgG4-related dacryoadenitis were significantly more likely to have bilateral involvement (85.7%) and have associated systemic involvement (52.4%) than those with non-specific dacryoadenitis (37.9 and 0%, respectively; p < 0.05, each comparison). Sixteen patients (16.8%) had associated systemic involvement: 11 with IgG4-RD and 5 with lymphoma. CONCLUSIONS: Chronic dacryoadenitis and lymphoproliferative disease were the most common causes of lacrimal gland masses in our cohort. Younger patients with bilateral involvement and a longer symptom period were more likely to have chronic dacryoadenitis than lymphoproliferative disease. Associated systemic involvement was not rare in patients with IgG4-RD or lymphoma. Our results suggest that biopsy of chronic lacrimal gland masses should be performed for proper evaluation and management.

Overview of benign and malignant lacrimal gland tumors.

PURPOSE OF REVIEW: The goal of this article is to review the key clinical and radiological features, treatment strategies, and prognosis of lacrimal gland tumors. RECENT FINDINGS: Debulking of the orbital lobe of the lacrimal gland may offer improved control rates in dacryoadenitis without compromise of tear film function. Contrary to previous belief, careful biopsy of the lacrimal gland prior to excision does not appear to increase the risk of recurrence in cases with suspected pleomorphic adenoma. Low-dose radiation (4 Gy) in two 2-Gy fractions appears to be effective and well tolerated in indolent non-Hodgkin lymphoma of the ocular adnexa with high local control rate. Eye-sparing surgery for adenoid cystic carcinoma (ACC) leaving minimal or no tumor residual in the orbit followed by adjuvant radiation therapy or chemoradiotherapy may provide good local control and long-term survival outcomes. Intra-arterial chemotherapy has been found to decrease recurrence and improve survival in ACC and can also be used as part of an eye-sparing treatment strategy. The development of targeted drugs may offer palliation for patients with unresectable or metastatic disease in lacrimal gland carcinoma. SUMMARY: This article offers an update on diagnosis, management, and prognosis of the major lacrimal gland lesions.

Prevalence of nasolacrimal canal obstruction and epiphora following maxillary orthognathic surgery.

Acquired injuries of the nasolacrimal apparatus may be the result of craniomaxillofacial surgical procedures, facial trauma, or inflammation. Injury to the nasolacrimal duct system following maxillary orthognathic surgery is rarely reported. This study evaluated the importance of early diagnosis and treatment of epiphora developing after Le Fort I surgery. The records of 83 patients who underwent maxillary orthognathic surgery over a 2-year period were reviewed. The prevalence of postoperative epiphora was 3.6% and it persisted for a mean of 32.7 days. No patient required further surgical treatment of the nasolacrimal duct obstruction. Clinicians should evaluate the lacrimal canal position and schedule close postoperative follow-up of injuries to the nasolacrimal apparatus. These may become permanent, necessitating additional surgery.

[A Retrospective Investigation of Lacrimation in Patients Treated with S-1].

Lacrimation is among the typical adverse drug reactions associated with S-1 treatment. However, lacrimation frequencies differ between reports, and a clear consensus regarding reaction times, risk factors, and symptomatic treatment for lacrimation is lacking. We retrospectively investigated the reaction times, risk factors, and outcomes of symptomatic treatment for lacrimation in 202 patients treated with S-1. The median estimated creatinine clearance noted upon initiation of cancer treatment was 75.8mL/min. The median of the relative treatment intensity was 87.1%, while the incidence of lacrimation was 26.7%. The median cumulative dose of S-1 before the onset of lacrimation was 23,520 mg in all patients, and 5,050 mg in those who developed lacrimation. Of the patients who developed lacrimation, 40.7% developed this symptom within 2 months after starting S-1 treatment. There were no apparent risk factors. The most frequently employed symptomatic treatment was a physiological saline ophthalmic solution provided as a hospital preparation. After treatment with this ophthalmic solution, 29.4% of the affected patients showed improvement and 70.6% showed no change; none however, experienced worsening of symptoms. These results suggest that clinicians should assess the presence of lacrimation after starting treatment with S-1. Symptomatic treatment with an ophthalmic solution that does not have a tear retention capacity may be useful in patients who have developed lacrimation.

The Epidemiological, Clinical, and Histopathological Characteristics of Lacrimal Gland Biopsies in a Tertiary Care Center in Israel.

BACKGROUND: The distribution of pathology and clinical characteristics of lacrimal gland diseases are different in different areas of the world. OBJECTIVES: To evaluate the incidence rate, patient characteristics, and indications for surgical intervention of lacrimal gland lesions in a tertiary care center in Israel. METHODS: All biopsied or surgically removed lacrimal gland lesions at the Goldschleger Eye Institute from 2009 to 2015 were identified. The following data were collected: age, gender, indications for surgical intervention, diagnosis, treatment, and prognosis. RESULTS: We evaluated 28 lacrimal gland biopsies from 26 patients (11 men, 15 women). Mean age at biopsy was 47.5 years old. The most common presenting symptoms were: eyelid swollenness (57.14%), ptosis (32.14%), and proptosis (10.71%). All patients underwent computed tomography and magnetic resonance imaging. In 28 cases, infiltrations of the lacrimal gland were found. In nine cases infiltration of muscles or orbital extension were found. The most common pathologies were non-specified inflammation (44.82%), lymphoma (20.68%), and immunoglobulin G4-related disease (10.34%). The treatment was diverse according to the patient diagnosis. Prognosis of lacrimal gland disease was good; however, in five patients the systemic disease progressed. CONCLUSIONS: Lesions of the lacrimal gland comprise a wide variety of pathological findings that require different treatment strategies. Lacrimal gland biopsies enable physicians to precisely recognize the pathology; therefore, it is important to consider this surgical method in any patient with lesions in the lacrimal gland.

Clinical profile of the patients with pediatric epiphora in a tertiary eye care center.

PURPOSE: To study the clinical profile of children aged <10 years presenting with epiphora at a tertiary eye care center, to compare the clinical profile between the early onset (<3 years) and the late-onset (≥3 years) group, and to study the success of different treatment modalities. MATERIALS AND METHODS: A prospective nonrandomized observational study was conducted in 209 eyes of 167 patients (42 bilateral cases). The main outcome measure was postoperative relief of presenting symptoms and signs at 3 months follow-up. RESULTS: Fifty-five percent cases (92 of 167) were early-onset cases, and 45% (75 of 167) were late onset. The male:female ratio was 1.9:1. Seventy-five percent cases were unilateral. The etiological profile was -76% cases of congenital nasolacrimal duct obstruction (NLDO), 18% traumatic/surgical, 4% acquired NLDO, and 2% punctal causes. The overall success rate of all the treatment modalities in our study was 80% (167/208) -82% for sac massage, 77% for probing, 79% for intubation dacryocystorhinostomy, and 100% for punctal surgery. A significant association was noted between the treatment outcome and laterality (P = 0.04), presence of infection (P = 0.032), symptom severity (P = 0.027), history of previous treatment (P = 0.024), and age. No significant association was found between the treatment outcome and gender (P = 0.73), socioeconomic status (P = 0.43), etiology (P = 0.45), and treatment modality (P = 0.33). CONCLUSION: This study describes the complete range of causes and treatment modalities for pediatric epiphora and highlights the etiology, signs and symptoms, treatment, and the comparative outcome between the early versus the late-onset group and analyses the factors predictive of the outcome.

Frequência de ocorrência das afecções dos anexos oculares e do olho externo / Frequency of occurrence of affections of the adnexa and external eye

RESUMO Objetivo: Observar a frequência de ocorrência das afecções que acometem os anexos oculares e o olho externo, assim como descrever o perfil demográfico dos portadores, na região centro oeste do estado de São Paulo. Métodos: Estudo prospectivo, populacional e aleatorizado, no qual foram avaliadas 11.000 pessoas da região centro-oeste do Estado de São Paulo, nos anos de 2004/2005, por meio de consultas oftalmológicas e utilizando uma unidade móvel. Foi realizado exame oftalmológico completo. Os dados foram transferidos para tabela Excel, utilizando-se para o presente estudo dados referentes aos anexos e doenças do olho externo. A frequência de ocorrência dos problemas detectados foi analisada estatisticamente. Resultados: Foram detectadas 1.581 (14,6%) afecções de anexos ou do olho externo, sendo as mais frequentes o pterígio (9,4%), o hordéolo (0,8%) e as alterações do posicionamento palpebral (1,7%) (ectrópio, ptose e triquíase). Trauma, ectrópio e pterígio foram estatisticamente mais frequentes na população masculina. Conclusão: Das afecções pesquisadas, a de maior ocorrência na população foi o pterígio, seguido das alterações inflamatórias e do posicionamento palpebral.

ABSTRACT Purpose: To observe the frequency of occurrence of affections involving the adnexa or the external eye, as well as to describe the demographic profile of patients. Methods: A prospective, population based, randomized study was done in the Midwest region of the state of São Paulo, in the years 2004/2005. Using a Mobile Ophthalmic Unit we evaluated 11,000 people. A comprehensive eye exam was performed. Data were transferred to excel table and for this study we used information relating to annexes and external eye diseases. The frequency of occurrence of the problems detected was statistically analyzed. Results: We identified 1,581(14.4%) disorders in the adnexa or in the external eye. The most common disorders were pterygium (9.4%), hordeolum (0.8%) and changes in eyelid position (1.7%) (ectropion, ptosis and trichiasis). Trauma, ectropion and pterygium were statistically more frequent in the male population. Conclusion: Of the surveyed disorders the most frequent in the population was pterygium, followed by inflammatory changes and alterations in the eyelid position.

[The Interdisciplinary Conference on Lacrimal System Disorders of ophthalmic and ENT surgeons at the University Hospital Halle : An analysis of present patient material]. / Die interdisziplinäre Tränenwegskonferenz von Ophthalmo- und Rhinochirurgen am Universitätsklinikum Halle (Saale) : Eine Auswertung des bisherigen Krankenguts.

BACKGROUND AND AIM: The lacrimal system (LS) crosses regions of ocular adnexa, the nose, and the paranasal sinuses. Surgery of disorders requires a targeted ophthalmologic and otolaryngologic examination. Since 2013, an Interdisciplinary Conference on Lacrimal System Disorders (ICLSD) has existed at the University Hospital Halle. First results of our experiences with this cooperation between ophthalmic and ENT surgeons are presented. METHODS: In a retrospective study at the Department of Ophthalmology, University Hospital Halle, all patients aged 22-80 years (n = 43, 10 with bilateral manifestation; mean age 65.1 years) having had a consultation in ICLSD between February 2013 and May 2015 were analyzed. Thereby, 53 LS were included in the descriptive evaluation. RESULTS: The main relevant pathology in terms of ophthalmologic manifestation was chronic dacryocystitis and its complications (n = 42), whereas nasal septum deviation (n = 11) and chronic rhinosinusitis (n = 10) were the most frequent otorhinolaryngologic pathologies. Prior to consultation, ENT (n = 34) and/or ophthalmic surgery (n = 40) had been performed. During ICLSD, an individualized therapeutic regime for each patient was developed. Surgery was required in 43 out of 53 LS. Of these, 32 were mainly ophthalmic, 11 mainly ENT interventions. At the time of evaluation (median 3 months; range 1 to 24 months), 29 out of 38 patients (76.3 %) were free of complaints. CONCLUSION: Since 2013, competences of ophthalmic and ENT surgeons have been integrated in ICLSD for advanced diagnosis and therapy of lacrimal disorders at the University Hospital Halle. Encouraging functional results are shown in this study, as most patients have had a long and complicated history of lacrimal system disorders. ICLSD enables interdisciplinary patient care.

Epiphora after Uncomplicated Phacoemulsification: Study of Prevalence and Associated Factors.

PURPOSE: To describe the prevalence of epiphora and associated factors after uncomplicated phacoemulsification. METHODS: Prospective and descriptive design. A group of 125 patients was asked about tearing one to two weeks after cataract surgery. A comprehensive examination was performed on the patients who answered affirmatively. All patients were re-interviewed by phone after three months and those who complained of epiphora were explored again. RESULTS: Two weeks after surgery, prevalence of epiphora was 10.4%, but only 3.2% appeared after surgery. In patients with preoperative epiphora, the most frequently associated factors were ocular surface alterations (89%) and unctual and canalicular stenosis (56%). In patients with "new onset" epiphora (4 patients), these factors were: blepharitis (2/4), low tear break-up time (2/4), high tear meniscus (2/4), partial nasolacrimal duct obstruction (2/4), and unctual stenosis (1/4). Three months after surgery, the prevalence of epiphora was 13%, but only 7% appeared after surgery (6 patients). Of those 6 patients, 4 were re-examined: nasolacrimal duct obstruction (2/4), ocular surface problems (3/4), and unctual stenosis (1/4). CONCLUSIONS: Presence of epiphora two weeks after phacoemulsification was infrequent, despite being present in a high proportion of patients before surgery. There was not a noticeable increase in epiphora at three months. The most frequently related factors were mixed disorders of the ocular surface and lacrimal system, without an important incidence of unctual and canalicular stenosis. We consider that our perception about complaints from patients after phacoemulsification may be biased due to those who had previously suffered from epiphora.

Excessive watering eyes in gastric cancer patients receiving S-1 chemotherapy.

BACKGROUND: Watering eyes is a common late adverse event associated with S-1 chemotherapy; however, the frequency and predictive factors are not known. METHODS: This study included 304 consecutive gastric cancer patients treated with adjuvant S-1 monotherapy for 1 year at Shizuoka Cancer Center. We retrospectively evaluated the frequency of watering eyes, and explored other nonhematological adverse events during the first course of S-1 monotherapy which could become predictive factors for watering eyes. RESULTS: The severest grade of watering eyes during S-1 monotherapy was grade 2 in 41 patients (13.5 %) and grade 3 in 36 patients (11.8 %). The median time to onset of grade 2 and grade 3 watering eyes was 82 days (range 6-344 days) and 249 days (range 84-653 days), respectively, and the median cumulative S-1 dose at the onset of grade 2 and grade 3 watering eyes was 4174 mg/m(2) (range 491-16,095 mg/m(2)) and 10,243 mg/m(2) (range 4943-16,341 mg/m(2)), respectively. Multivariate analysis showed that anorexia (odds ratio 2.37, P = 0.008), oral mucositis (odds ratio 3.86, P = 0.0003), skin hyperpigmentation (odds ratio 3.84, P = 0.0001), and rash (odds ratio 3.76, P = 0.01) observed during the first course were significantly associated with watering eyes. CONCLUSION: The risk of watering eyes was higher in patients who also had anorexia, oral mucositis, skin hyperpigmentation, or rash during first course of S-1 monotherapy than in those without them.

Accessory lacrimal gland duct cyst: 23 years of experience in the Saudi population.

BACKGROUND AND OBJECTIVES: Accessory lacrimal gland ductal cyst is a rare clinical entity that has been reported after trauma, infection, or conjunctival inflammation. Trachoma has been postulated as an etiologic factor for this dacryops in Saudis. We studied the prevalence, demographics, clinicopathological features and surgical approach for these lesions. DESIGN AND SETTING: Retrospective study of 23 consecutive ductal cysts diagnosed clinically and proved histopathologically at King Khaled Eye Specialist Hospital (KKESH) over 23 years (1991-2014). PATIENTS AND METHODS: Data on patient demographics, clinical features, surgery, and outcome were collected by chart review. The histopathologic slides were reviewed by a single pathologist. RESULTS: Of 23 cases of accessory lacrimal gland ductal cysts confirmed histopathologically, 14 were males and 9 females with a median age of 38.8 years. Cysts were located in the upper eyelid in 73.9%. The commonest presentation was a painless eyelid mass in 91.3%. Excision by conjunctival incision was performed in 14 and intra-operative perforation occurred in 9. Trachomatous scarring was evident in 39.1% but did not have significance in relation to this rupture. No recurrences have been observed with a mean follow up of 34.6 months. CONCLUSION: The approximate prevalence of accessory lacrimal gland dacryops in the Saudi population is 1/6800. Trachoma does not seem to be a major predisposing factor. They are more frequent in males. Their histopathological appearance is identical regardless of origin. The presence of conjunctival scarring, dacryops size, and the surgical incision type did not seem to have significant correlation with the iatrogenic rupture of the cyst. We recommend careful dissection for complete cyst excision through conjunctival approach with no expected recurrence.

Incidence of neoplasia in patients with unilateral epiphora.

BACKGROUND: Nasolacrimal duct obstruction is common and is usually a result of benign stricture formation.Although neoplasia near or around the lacrimal system may produce epiphora, the incidence of neoplasia from within the lacrimal system as a cause of nasolacrimal duct obstruction is not well documented. METHODS: A retrospective study was performed on all patients undergoing dacryocystorhinostomy with a history of epiphora. The incidence of patients with operative findings of intra-lacrimal neoplasm was sought. Histopathologically confirmed cases were included. RESULTS: The study comprised 537 patients, who underwent a total of 631 endoscopic dacryocystorhinostomy procedures between January 1998 and July 2013. Non-stenotic causes of nasolacrimal duct obstruction were encountered in 3.01 per cent of dacryocystorhinostomy procedures, and included neoplastic, inflammatory and infectious pathologies. Inverted papilloma was the most common cause, encountered in 0.79 per cent of dacryocystorhinostomy operations. CONCLUSION: These findings suggest that neoplasia is an uncommon but not a rare cause of nasolacrimal duct obstruction. Surgical teams performing high numbers of dacryocystorhinostomy procedures should be aware of such pathology and patients counselled appropriately.

Epidemiology of Oculoplastic and Reconstructive Surgeries Performed by a Single Specialist With 15 Years' Experience at a Tertiary Center.

PURPOSE: To evaluate the prevalence of oculoplastic surgeries performed in a tertiary hospital in South Korea and to highlight the proper choice of surgery according to disease. METHOD: Retrospective chart review was conducted over a 12-month period (March 2013 to February 2014) on all of the patients who underwent oculoplastic and reconstructive surgery by a single oculoplastic specialist with 15 years' experience. RESULTS: A total of 656 patients were enrolled in the current study. Of them, 355 patients (54.1%) had eyelid surgery, 151 patients (23.0%) had orbital surgery, and 150 patients (22.8%) had lacrimal surgery. Orbital surgery was more commonly performed in men (122 male patients versus 29 female patients, P = 0.00 by Pearson chi-squared test) and was also more common in younger patients than in other surgery groups (56.3 years in eyelid surgery versus 39.3 years in orbital surgery versus 46.9 years in lacrimal surgery, P = 0.001 by Pearson chi-squared test). Blepharoplasty was the most common eyelid surgery, contributing 24.2% of total eyelid surgeries, followed by lid mass excision (68 patients, 19.1%), Hotz operation (59 patients, 16.6%), and levator advancement (47 patients, 13.2%). Among orbital surgeries, reconstruction of orbital wall fractures was the most common, and was performed in 89 patients (58.9%) of total orbital surgeries, followed by orbital tumor debulking surgery (25 patients, 16.5%) and orbital decompression for dysthyroid optic neuropathy (19 patients, 12.5%). Endoscopic endonasal dacryocystorhinostomy (DCR) was the most common lacrimal surgery (84 patients), occurring in 56% of total lacrimal surgeries, followed by Monoka tube intubation (16 patients, 10.6%) for congenital nasolacrimal duct obstruction and conjunctivo-DCR using Jones tube (12 patients, 8%). CONCLUSIONS: Eyelid-related conditions, especially cosmetic blepharoplasty, were among the most commonly encountered surgeries in the Oculoplastics Department of a tertiary care hospital in South Korea. Blowout fracture repair and endoscopic DCR were the most common in orbital and lacrimal surgery. The authors hope that the current survey will contribute to the surgical training of ophthalmology residents and, on a larger scale, health care policies.