Evaluation of the upper and lower proximal lacrimal canaliculi using spectral-domain optical coherence tomography in normal Beagle dogs.

OBJECTIVE: To confirm the feasibility of visualizing upper and lower proximal lacrimal canaliculi (LC) using spectral-domain optical coherence tomography (SD-OCT). ANIMALS STUDIED: Eight eyes of four normal Beagle dogs. PROCEDURES: To obtain an upper proximal LC image, the head was turned in the opposite direction to the eye being imaged, and the medial part of the upper eyelid was everted to expose the LC. To obtain a lower LC image, the lower eyelid was everted just below the punctum. Using "angle mode", the scan line was placed parallel on the long axis of the LC. The inlet LC width (LCW) was measured. Artificial tears (AT) were instilled, and LCW was compared before and after AT instillation. Additionally, the return time to the initial LCW inlet width was recorded. RESULTS: Before AT instillation, there was a significant difference between the mean upper and lower LCW (91.8 ± 3.2 µm and 110.1 ± 8.4 µm, respectively). After AT instillation, the mean upper and lower LCW were 236.9 ± 27.7 µm and 238.4 ± 30.4 µm, respectively. Significant differences in the LCW before and after AT instillation in both the upper and lower LCWs were observed. The mean return time of the upper and lower LCW to their initial widths after AT instillation was within 4 min. CONCLUSIONS: Spectral-domain optical coherence tomography was an effective method for providing high-resolution images of the upper and lower proximal LC. This method enables observation of LC changes after instillation of eyedrops in veterinary clinical practice.

[Optical coherence tomography in the diagnosis of pathologies of the horizontal portion of the lacrimal drainage system]. / Opticheskaya kogerentnaya tomografiya v diagnostike patologii gorizontal'nogo otdela slezootvodyashchikh putei.

This article reviews literature on the use of optical coherence tomography in studying the anatomical structure of the proximal lacrimal drainage system, as well as in diagnosing its pathological changes. Determining the reference values of the parameters of the lacrimal punctum and the lacrimal canaliculus remains an important issue. The review describes the advantages and disadvantages of this method, as well as the prospects for its application in clinical practice.

Characteristics of lacrimal passage diseases by 80-MHz ultrasound biomicroscopy: an observational study.

PURPOSE: To investigate the microstructure of the lacrimal canaliculus and the characteristics of lacrimal canalicular diseases by 80-MHz ultrasound biomicroscopy (UBM). METHODS: This study included 33 participants: 20 normal subjects (40 eyes), 2 patients with chronic lacrimal canaliculitis (4 eyes), 10 patients with chronic dacryocystitis (16 eyes), and 1 patient with lacrimal punctum atresia (2 eyes). All participants underwent 80-MHz UBM; disease-specific features were noted. RESULTS: On 80-MHz UBM of the lacrimal canaliculi (vertical section) in normal subjects, low echo of the lacrimal canalicular lumen and high echo of the lacrimal canalicular wall were observed. The uniform low echo near the wall was the mucosal epithelium. The outermost layer of medium-to-high echo was the subepithelial elastic fibrous layer. In the horizontal section, the lumen was continuous. Two linear high echoes parallel to the canalicular wall could be observed at the center of the lacrimal canaliculus, which were sometimes attached and sometimes separated. When separated, the center of the lacrimal canaliculus was a low echo area (lumen). Lacrimal canaliculitis (vertical section) showed obvious ectasia of the lacrimal canalicular lumen, with a high echo mass shadow, which might have been calculi, and uneven thickness of the mucosal epithelium with a slightly high echo shadow. In the horizontal section, the lumen varied in size with clear boundaries of medium and high echoes. The central linear high echoes of the lumen were absent, and the echoes of the mucosal epithelium were discontinuous. In chronic dacryocystitis, the lacrimal canalicular lumen was extensively enlarged, with continuous echoes and uniform thickness of the mucosal epithelium and homogeneous patches of slightly higher echoes. Lacrimal punctum atresia indicated that the lacrimal canaliculus existed in both eyes and its structure was normal. CONCLUSIONS: The 80-MHz UBM is a new non-invasive technique that can be used for clear visualization of the fine structure of the lacrimal canaliculus, including the mucosal epithelium and subepithelial elastic fiber layer. The use of this approach will improve understanding of the hierarchical structure of the lacrimal canaliculi and provide a comprehensive basis for diagnosis, differential diagnosis, and treatment plan in patients with lacrimal passage diseases.

A New Isolation Method of Human Lacrimal Canaliculus Epithelial Stem Cells by Maintaining Close Association with Their Niche Cells.

Purpose: To investigate whether lacrimal canaliculus epithelial stem cells (LCESC) could be isolated and expanded in vitro. Methods: The lacrimal canaliculus epithelium of 6 patients with limbal stem cell deficiency (LSCD) caused by alkali burn or Stevens Johnson Syndrome were examined by lacrimal endoscope. Cadaveric eyelids were fixed and prepared for cross section and stained with HE and antibodies against PCK, Vim, p63α, SCF and c-Kit. Canaliculus tissue was separated under an operating microscope using a lacrimal probe as an indicator and digested with collagenase A. The clusters of epithelial cells with closely associated stroma were further digested with Trypsin/EDTA to obtain single cells for culture on Matrigel-coated plastic plates in MESCM media. The expression of SCF, c-Kit and p63α was determined by immunostaining. The colony-forming efficiency on 3T3 feeder layers was also measured by calculating the percentage of the clone number divided by the total number cells seeded. Results: The epithelial layers of five out of six inferior lacrimal canaliculi and all the six superior lacrimal canaliculi were visually normal in appearance. Five to fifteen layers of the epithelium in the human lacrimal canaliculi were present with a small, tightly compacted basal layer of cells expressing PCK, p63α, SCF and c-Kit. LCESC were isolated by collagenase A and obtained clonal growth in MESCM. The colony-forming efficiency of LCESC holoclones on a 3T3 feeder layer was 3.2%, compared to 1.9% for those of limbal stem cells (LSC). Conclusions: Herein, we first report that LCESCs can be isolated and have stem cell characteristics, similar to those of LSCs. Such a discovery raises a promising substrate resource of stem cells for LSC reconstruction in LSCD patients.

Two Types of the Sinus of Maier: An Anatomic Study.

PURPOSE: To show the morphological characteristics of two different types of the sinus of Maier, one with a lacrimal sac diverticulum supplied by separate canalicular openings, and the other with a terminal dilatation of the common lacrimal canaliculus. METHODS: Twelve coronal specimens (6 right and 6 left) from 6 Japanese cadavers (age range, 70-90 years at death) and 15 axial specimens of 11 Japanese cadavers (8 right, 7 left; age range, 45-89 years at death), fixed in 10% buffered formalin, were used. All specimens were stained with Masson's trichrome. RESULTS: The sinus of Maier, with a lacrimal sac diverticulum supplied by separate canalicular openings, was shown in one coronally sectioned group, with a diameter of 1.29 mm. The mucosa between both openings (0.282 mm length) comprised stratified squamous epithelia, which was characteristic of the lacrimal canaliculi. The diverticular mucosa was lined by a stratified columnar epithelium, which corresponded to the lacrimal sac. The sinus of Maier, with a terminal dilatation of the common lacrimal canaliculus and with a diameter of 0.51 mm, was demonstrated in one axially sectioned group. CONCLUSIONS: The morphological characteristics of two types of the sinus of Maier were described in this study. One type was the lacrimal sac diverticulum supplied by separate canalicular openings, and the other was the terminal dilatation of the common lacrimal canaliculus.

Canine dacryolithiasis: a case description and mineral analysis.

A 4-year-old, female, spayed, Labrador retriever was presented with a painless swelling of the left ventromedial eyelid and epiphora of 3 months duration. Bilateral patency of the nasolacrimal system was confirmed by the appearance of fluorescein dye at both nares. Ultrasonography revealed a well-demarcated fluid-filled structure containing echogenic ill-defined material in close proximity to the nasolacrimal system. A transconjunctival surgical approach confirmed the close anatomical proximity of the cyst and the absence of a communication with the inferior canaliculus. The cyst contained multiple intraluminal calculi (dacryoliths). Following surgical excision of the cyst, the epiphora resolved and no recurrence was noted over a 12-month follow-up period. On histopathology, the cystic structure was lined by stratified squamous epithelium, consistent with lacrimal canaliculus epithelium. Presumed progression of a canalicular diverticulum to a cyst with the formation of intraluminal dacryoliths was suspected. Mineral analysis of the dacryoliths revealed a calcium carbonate composition.

Bleeding From the Eye: An Unusual Presentation of Lacrimal Canaliculitis.

Chronic canaliculitis is an uncommon condition secondary to an infection of the lacrimal canaliculus, frequently caused by Actinomyces israelii. It is often misdiagnosed due to its symptoms mimicking more common pathologies and regularly fails to respond to antibiotics alone. Surgical intervention is the definitive treatment. We present a case of chronic canaliculitis with an unusual presentation.

Primary lacrimal canaliculitis - A clinical entity often misdiagnosed.

PURPOSE: Primary lacrimal canaliculitis (PLC) is a unique disorder which often gets misdiagnosed by the general as well as speciality-trained ophthalmologists. Elderly patients with history of chronic or recurrent epiphora with discharge, often get mislead towards chronic dacryocystitis. The aim of our report is to discuss the misleading diseases in our PLC patients and to revisit this hidden disease. METHODS: The patients of PLC who were previously misdiagnosed were studied. The clinical history, presenting clinical features, misdiagnosis, and final management of the patients is described. RESULTS: There were 5 misdiagnosed female patients. A history of chronic redness, watering, discharge, and medial canthal region edema lead to the misdiagnosis of chronic dacryocystitis in 3 (60%) and medial marginal chalazion in 2 (40%) cases. Slit-lamp examination revealed localized hyperemia (n = 5), classical pouting of lacrimal punctum (n = 3), and expressible purulent discharge (n = 3). Two patients without punctum pouting had an explicit yellowish hue/discoloration of the canalicular region. Our patients had a mean 4 visits before an accurate diagnosis. Three-snip punctoplasty with canalicular curettage was performed in three while two were managed conservatively. At last follow-up, all patients were symptom-free with punctum and canalicular scarring in three, who underwent surgery. CONCLUSION: PLC is a frequently misdiagnosed clinical entity which delays the initiation of appropriate treatment. A succinct magnified examination of punctum and canalicular region can provide sufficient clues pivotal for accurate diagnosis.

Effect of nasolacrimal duct packing combined with sodium hyaluronate gel injection in locating the nasal broken end in lacrimal canaliculus anastomosis which is difficult to find the broken end / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the effect of nasolacrimal duct packing combined with sodium hyaluronate gel injection in locating the nasal broken end in lacrimal canaliculus anastomosis which is difficult to find the broken end.METHODS:A total of 13 patients(13 eyes)with traumatic single lacrimal canaliculus rupture were treated in our hospital. RS lacrimal duct drainage tube was inserted into the lacrimal duct from intact lacrimal canaliculus to fill the nasolacrimal duct, then sodium hyaluronate gel was injected to make sodium hyaluronate gel overflow from the nasal broken end of fractured lacrimal canaliculus, which was used to locate the nasal broken end which was difficult to find and completed the lacrimal anastomosis operation.RESULTS: Among the patients with 13 eyes who were difficult to find the broken end, the nasolacrimal duct was filled with RS lacrimal duct drainage tube. After injection of sodium hyaluronate gel, the gel overflowed from the nasal broken end under direct vision of the microscope, and the lacrimal duct drainage tube was successfully inserted, and the success rate of finding the broken end was 100%. Thirteen eyes were extubated after being placed for 3mo, and then were followed up for 6mo. Among them, 9 eyes were cured, 3 eyes were markedly effective and 1 eye was ineffective. The cure rate was 69%, and the total effective rate was 92%.CONCLUSION: A new technique for rapid location of nasal broken end is proposed for patients in which are difficult to find the broken end. This method is simple to operate and requires a relatively low clinical experience. It is suitable for patients with different degrees of single lacrimal canaliculus rupture and can complete complex lacrimal canaliculus rupture anastomosis in a short time.

Diagnosis of lacrimal canalicular diseases using ultrasound biomicroscopy: a preliminary study.

AIM: To evaluate the application of ultrasound biomicroscopy (UBM) in the examination of lacrimal canalicular diseases, and to investigate UBM image characteristics of lacrimal canaliculi in disease states. METHODS: Sixty cases (63 eyes, 69 canaliculi) of lacrimal canalicular diseases were enrolled that included 32 patients (32 eyes, 32 canaliculi) with chronic lacrimal canaliculitis, 18 patients (18 eyes, 18 canaliculi) with previous lacrimal canalicular laceration, 9 patients (12 eyes, 18 canaliculi) with congenital absence of lacrimal puncta and canaliculi, and 1 case (1 eye, 1 canaliculus) of canalicular mass. The patients were examined using UBM, and disease-specific features of the UBM images were noted. RESULTS: UBM imaging of lacrimal canaliculi in chronic canaliculitis patients showed obvious ectasia of the lacrimal canalicular lumen. Dot-like moderate echoic signals were detected on some ectatic lumina of the lacrimal canaliculus. Some lumen-like structures of the lower lacrimal canaliculus were observed in 2 (2 eyes, 2 canaliculi) of the 9 patients (12 eyes, 18 canaliculi) with congenital absence of the lacrimal canaliculus. Of the 18 patients (18 eyes, 18 canaliculi) with previous lacrimal canalicular laceration, the lacerated end on the nasal side of the lacrimal canaliculus was detected only in 14 patients (14 eyes, 14 canaliculi). CONCLUSION: UBM can be used to evaluate lacrimal canalicular diseases and can provide an imaging basis for the diagnosis of lacrimal canalicular diseases.

Course of the vertical portion of the lower lacrimal canaliculus.

The nomenclature of each part of the lacrimal canaliculus, for example the vertical portion, does not always reflect the true course. Since we have sometimes observed findings suggesting the so called vertical portion of the lower lacrimal canaliculus inclined laterally, we re-examined the course of the vertical portion. Twenty-eight postmortem lower eyelids in 16 Japanese were examined and divided into 2 groups. The first group was 14 lower eyelids of 7 cadavers. Eyelids were incised sagittally from the lower lacrimal punctum. The second group was 14 lower eyelids of 9 cadavers; these were incised from the lower lacrimal punctum with 5 degrees lateral inclination to the sagittal plane. In the first group, 10 canaliculi of 7 cadavers were interrupted at the halfway point of the vertical portion. Four canaliculi of 4 cadavers included the whole length of the vertical portion. In the second group, all specimens included the whole length of the vertical portion. Most vertical portions of the lower lacrimal canaliculus demonstrated a laterally inclined course of approximately 5 degrees, although some took a completely vertical course.

Nursing about using the Worst lacrimal probe to repair the lacerateon of lacrimal canaliculus / 中国实用护理杂志

Objective To explore the ideal postoperative nursing methods of repair the lacerateon of lacrimal canaliculus. Methods Using pigtail probe to repair the lacerateon of lacrimal canaliculus in 49 patients, observed the postoperative nursing points in different clinical phases. Results There were 2 patients had the anstomotic stoma split, 1 patient had the canaliculitis. There were 46 patients had successful extubation. Conclusion The Worst lacrimal probe is an satisfactory and reliable method to repair the lacerateon of lacrimal canaliculus. The detailed interpretation and the skillful nursing care are the guarantee for successful operation.

Use of Conjunctiva and Labial Mucosa for Dacryocystoplasty / 昆明医科大学学报

A new menthod for treating old laceration of Lacrimal canaliculus with dacryocystoplasty using conjunctiva or labial mucosa was recommended by the authors. Out of 14 cases,9 cases were operated on with conjunctiva.7 cases were markedly effec- tive,1 cases improved and 1 cases failed.5 cases were operated on with labial mucosa.4 cases were markdly effective and 1 cases improved. The advantages of these two kinds of transplants have been compared.Labial mucosa is better than conjunctiva,and dacryocystoplasty with labial mucosa is more handy and appli- cable.