Laser-assisted dacryocystorhinostomy of acquired dacryops in a dog.

OBJECTIVE: To describe a novel minimally invasive surgical approach to treatment of a nasolacrimal duct cyst in a dog and outcome. ANIMAL STUDIED: A 10-year-old, male entire, Springer Spaniel with a chronic right-sided maxillary swelling and associated right eye epiphora and sneezing. PROCEDURE: Computed tomography with dacryocystography confirmed a cystic structure and destruction of the right maxilla and zygomatic bone with invasion of the nasal cavity. Obstruction of the nasolacrimal duct was confirmed. Rhinoscopy was performed allowing visualization of the ventromedial wall of the cyst. Under direct visualization, dacryocystorhinostomy was performed and the wall of the cyst was ablated with the aid of a thulium laser fiber. RESULTS: No intraoperative complications occurred during the procedure. Full resolution of clinical signs was noted within 2 weeks of treatment. No recurrence had occurred on long-term follow-up at 32 months. CONCLUSIONS: Laser-assisted dacrocystorhinostomy under direct visualization was successful in the treatment and resolution of a nasolacrimal duct cyst (dacryops) in this case.

Endoscopy-assisted dacryocystorhinostomy in a dog.

OBJECTIVE: To describe the use of an endoscope to assist in performing minimally invasive dacryocystorhinostomy in a dog to successfully manage a nasolacrimal duct cyst (dacryocyst). ANIMAL STUDIED: A 4-year-old female spayed American Staffordshire Terrier with chronic epiphora and swelling ventromedial to the nasal canthus of the right eye and reverse sneezing. PROCEDURES: Computed tomography revealed a fluid-filled cystic lesion of the right nasolacrimal duct with extensive nasal extension and secondary obstructive frontal sinusitis. Aspiration of serosanguinous fluid with no growth of microbial organisms and histopathology confirmed the cystic nature of the structure. A 2.7 mm, 30 deg, 11 cm foreward-oblique endoscope with arthroscopic cannula was passed through a mucosal stab incision in the dorsal buccal recess into the cyst to allow for exploration. A separate instrument portal was placed in the center of the cyst through the skin which allowed for transcutaneous dacryocystorhinostomy with a meniscal probe to be performed. No clear communication was evident caudodorsally into the frontal sinus on endoscope examination. A small frontal sinus trephination was performed and lavage flowed easily into the cystic cavity and out of the nostril. RESULTS: Follow-up at 10 days and 17 months postoperatively showed complete resolution of clinical signs with an excellent cosmetic outcome. CONCLUSION: Endoscopy-assisted dacryocystorhinostomy demonstrated an effective minimally invasive technique to treat a functionally obstructive dacryocyst of the right nasolacrimal duct in a dog.

Dacryops with extensive lacrimal and maxillary bone defects in four dogs.

OBJECTIVE: To describe and discuss ventromedial orbital lacrimal gland or duct cysts (dacryops) in dogs with extensive bone defects based on their symptoms, results of diagnostic imaging and histopathological examination, and therapy and discuss their potential origin based on the morphology. ANIMALS STUDIED: Four dogs of different breeds, age, and sex were presented with a unilateral round, slow growing, indolent, and non-tender process ventromedial to the nasal canthus of the eye. PROCEDURES: Transverse computed tomography showed a low-density, non-contrast-enhancing cystic process ventromedial to the globe with extensive defects in the lacrimal and maxillary bones in all cases. The cystic character of the structure was confirmed by the aspiration of the brownish fluid without cellular and microbiological contents. For treatment, the cystic fluid was aspirated, and the sclerosing agent polidocanol was injected in three cases. Cystorhinostomy (nasal marsupialisation) was performed in one case as the first choice and in another case following failure of sclerotherapy. Histopathological examination of the cyst walls was performed in two cases and confirmed the diagnosis of dacryops. RESULTS: Follow-up between 2 and 18 months showed no recurrence and very good to excellent cosmetic results. CONCLUSIONS: Aberrant lacrimal gland or duct tissue with secondary development of dacryops should be included in the differential diagnoses of ventromedial orbital cysts. Large cysts near the lacrimal drainage system with extensive bone defects in dogs should be treated by nasal marsupialization. Treatments such as evacuation of the cyst and inducing sclerosis (sclerotherapy) should be reserved for exceptional cases.

Lacrimal ductal cyst of the medial orbit: a case report.

BACKGROUND: The lacrimal ductal cyst (dacryops) is an uncommon clinical entity. It occurs anywhere that lacrimal gland tissue is present but most often appears as an expanding mass in the region of the lacrimal gland. The presence involving the medial part of the orbit is rare, ectopic location can be misleading in the differential diagnosis of orbital masses. The authors report a 53-year-old man who presented with dacryops occurred in an unusual location with significant clinical presentations. CASE PRESENTATION: A 53-year-old man had a painless mass located in the right superomedial orbit accompanied with foreign body sensation and lachrymation for two months, which had rapidly grown within 10 days. Decrease of visual acuity, high intraocular pressure (IOP) and limitation of extraocular movements in the right eye were present. The result of visual evoked potential (VEP) test suggested the impaired function of the optic nerve. Magnetic resonance imaging (MRI) studies revealed the presence of an isolated cystic lesion. The mass was completely removed via a transcutaneous approach, histopathologic findings were consistent with the lacrimal ductal cyst. The ocular motility and high IOP returned to normal. There had been no post-operative complications or signs of recurrence over five months follow-up. CONCLUSION: Lacrimal ductal cysts can present in the medial orbit, clinicians should include this entity in the differential diagnosis of orbital masses and be aware of its variable presentations such as high IOP in this case. We comment on the fact that many reported cases of ectopic dacryops may be an extension of normal lacrimal gland tissue.

Bilateral temporal dacryops in a cat.

A 1-year-old Maine Coon female spayed cat was presented for a 7-week history of bilateral pinkish masses located over the dorsotemporal conjunctival quadrants. Ophthalmic examination revealed the presence of bilateral temporal, slightly hyperemic, subconjunctival masses, fluctuant, and nonpainful. The remainder of the ocular examination was unremarkable. Ultrasound biomicroscopy and B-scan ultrasonography confirmed the presence of a bilateral cavitated and tubular structure, extending within the temporal orbit, with anechoic fluid-like content. Surgical removal was performed. Histopathology described the lesions as lacrimal gland tissue, markedly infiltrated by inflammatory cells, associated with cavitated structures filled with proteinaceous debris, and lined by flattened bilayered cuboidal epithelial cells. Bilateral adenitis of unknown origin and dacryops of the temporal lacrimal glands were diagnosed. Both surgical sites healed uneventfully, and no recurrence was reported on either eye during a 12-month follow-up period.

Krause's accessory lacrimal gland dacryops - case report and literature review.

The authors are describing two rare cases of dacryops involving the Krause accessory lacrimal glands and affecting the orbit. In both cases, the lesion was located in the inferior fornix, with no preceding trauma, surgery or trachomatous conjunctival scarring. The first case involved a clear orbital extension with evidence of optic nerve compression. The second case extended from the anterior orbit to the limbus. Both had surgical removal with good outcome. As Krause gland dacryops are similar to other orbital cysts, clinical, imaging and histopathologic evaluation are essential to confirm the final diagnosis.

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.

Use of 1% polidocanol and pre- and post-computed tomography for treatment of a suspected nasolacrimal duct cyst in a dog.

OBJECTIVE: To describe the efficacy of the sclerosing agent 1% polidocanol in the treatment of a suspected nasolacrimal duct cyst in a dog. ANIMAL STUDIED: A 5-year-old castrated male Golden Retriever with chronic epiphora of the right eye. PROCEDURES: Ocular examination revealed epiphora and a negative Jones test of the right eye and was otherwise normal. Computed tomography with dacryocystography confirmed a cystic structure in the right ventral orbit that extended into the caudal nasal cavity adjacent to the orbit, causing partial physical obstruction of the right nasolacrimal duct. Cytologic analysis of fluid from the lesion was supportive of a diagnosis of a cyst. One percent polidocanol (compounded, People's Custom Rx, Memphis, TN) was injected into the cyst. RESULTS: Epiphora was resolved by two weeks post-injection. Repeated computed tomography with dacryocystography was performed 8 months post-injection, revealing complete resolution of the cyst and demonstrating mild enophthalmos of the right globe. CONCLUSIONS: Intralesional 1% polidocanol therapy was successful in resolving a suspected nasolacrimal duct cyst in a dog.

Clinical features and management of dacryops.

PURPOSE: To describe clinical, imaging findings, and management of dacryops cases. METHODS: A retrospective chart review was performed to identify the patients diagnosed with dacryops over a 5-year period. The clinical features based on clinical findings, computerized tomography and ultrasonography, and observation and surgical excision results were noted when available. RESULTS: We included 14 eyes of 14 patients. Seven (50%) were men with a median age of 48 years. The most common symptom was non-painful upper eyelid mass. All patients had the visible protruding cyst while eversion of the upper eyelid. Imaging studies, including orbital computerized tomography and ultrasonography were performed in six cases. Histological assessment of the excised cyst was done in two cases. Surgical excision was performed in five (36%) cases and observation was elected for nine (64%) cases. The median follow-up was 30 months. There was no recurrence of cysts in patients underwent surgery and the symptoms were not deteriorated in patients elected observation. CONCLUSION: Dacryops is a rare clinical entity that can be diagnosed easily with or without imaging methods. Surgical excision of the cyst could be curative and observation is also a safe method in selected cases.

Dacryops of the Third Eyelid in a cat.

A 9-month-old female Domestic Short-haired cat was presented with a mass of three-month duration at the base of the third eyelid of the right eye (OD). Fine-needle aspiration was carried out at another clinic, revealing clear fluid. The mass soon reformed, and the cat was referred. Ophthalmic examination revealed a pale-pink, smooth, oval mass under the conjunctiva on the anterior aspect of the third eyelid. Surgical removal of the mass was performed. Histopathology revealed a large dilated cyst together with a number of small cysts lined by simple cuboidal, and low squamous epithelium with some secretory cells. Dacryops of the third eyelid lacrimal gland was diagnosed. The eye healed uneventfully after surgery, and no recurrence was seen during one year of follow-up.

Differential diagnoses, investigation, and management of a periocular swelling close to the nasolacrimal duct in a horse - A case report of Dacryops.

To describe the differential diagnoses, investigation, and management of a periocular swelling close to the nasolacrimal duct in a horse that was consistent with a nasolacrimal duct dacryops (lacrimal cyst). A 16-year-old gelding, Connemara cross presented with a history of a periocular swelling rostroventral medial to the right eye that had been sampled by the referring veterinary surgeon. A cystic lesion was diagnosed following standing computed tomography. Surgical removal of the cystic lesion was performed, and the tissue was submitted for histopathologic and immunohistochemical examination. Surgical removal of the cyst was curative, and there was no recurrence of clinical signs 7 months later. There was a small amount of mineralized material in the center of the cyst. Histopathologic and immunohistochemical examination confirmed a nasolacrimal duct cyst. Dacryops can form in horses as well as other species and appears to have a favorable outcome if surgically removed.

Dacryops with dacryolithiasis in a dog.

BACKGROUND: A 10-year-old castrated male Maltese dog was presented with chronic swelling that had been present for at least 5 years in the medial canthus of the right eye (OD). OBJECTIVES: To describe the treatment outcome of dacryops with dacryolithiasis. METHODS: Bilateral patency of the nasolacrimal system was confirmed by flushing of both upper and lower puncta. Ocular ultrasonography revealed a well-defined, oval-shaped, heterogeneous mass with several hyperechoic foci. Dacryocystorhinography revealed no connection between the mass and lacrimal canaliculus. Gentle blunt dissection of the fibrous connective tissue around the cystic mass was performed. The mass was removed, which intraluminally contained multiple calculi. RESULTS: Histopathologically, the cystic structure was lined by simple cuboidal epithelium and surrounded by smooth muscle actin positive myoepithelial cells consistent with dacryops derived from the lacrimal glandular ductal system. In addition, several spherical basophilic minerals were observed in the lumen, which were identified as dacryoliths. CONCLUSION: Surgical removal of this dacryops with dacryolithiasis was curative without recurrence after four months.

Dacryops of the lacrimal gland in an elderly woman: A case report.

INTRODUCTION: Dacryops is a rare benign cystic lesion of the lacrimal gland often developing in the palpebral gland. The exact etiology of dacryops remains unclear. Diagnosis could be suspected clinically and established histopathologically. Treatment is commonly surgical. PRESENTATION OF CASE: We report the case of a 75-year-old woman with past history of total conservative parotidectomy for a benign tumor 10 years ago. She presented to the Ophtalmology Department at Farhat Hached University Hospital of Sousse with a painful swelling of the left supero-external orbital angle. The patient underwent complete excision of the cyst using the conjunctival approach. Histopathological examination showed characteristic features of dacryops with foci of chronic inflammatory cell infiltrates. DISCUSSION: Dacryops is commonly seen in young adults or middle-aged individuals with a slight female preponderance. In some cases, cystic enlargement of dacryops can lead to mechanical ptosis, dystopia, limitation of extraocular movements, diplopia, and, in rare cases, blepharoptosis. However in this case, the patient was an elderly woman presenting a painless mass without ptosis. As in our case, excision using the conjunctival approach under microscope has excellent results without complications. Histopathological examination confirms the diagnosis and helps to rule out differential diagnoses. CONCLUSION: As reported in the present case, histopathological examination confirms clinically recognized or suspected dacryops. If untreated, dacryops may lead to ptosis, proptosis and/or dystopia. Complete excision of the cyst is often curative.

Canalicular Cyst.

PURPOSE: To report a new entity discovered in the lacrimal drainage system, a congenital canalicular cyst (as opposed to a diverticulum or canaliculops). METHODS: Clinical, radiographic, histopathologic and immunohistochemical findings were reviewed. RESULTS: A 49-year-old man developed a left upper eyelid cyst seen by CT scanning to be attached to a small boney spicule. No connection to the lacrimal sac or canaliculus was discovered during surgical excision. Histopathologically, the cyst was lined mostly by canalicular epithelium, expressing a cytokeratin profile similar to that of a normal canaliculus and canaliculops. CONCLUSION: This case increases ophthalmologists' appreciation of the range of conditions that can affect the lacrimal drainage and canalicular system. The treatment for a diverticulum is marsupialization, whereas that for a canalicular cyst is complete excision.

[Atypical presentation of lacrimal gland pleomorphic adenoma with necrotic foci]. / Presentación atípica de un adenoma pleomorfo de la glándula lagrimal con focos de necrosis.

CLINICAL CASE: The case is presented of 48 year-old male complaining of a painful left upper eyelid and swelling of the lacrimal gland, with a suspicion of dacryoadenitis. Removal was decided after dacriops suspicion. Histopathology diagnosed a pleomorphic adenoma of the lacrimal gland, with areas of necrosis. DISCUSSION: Lacrimal gland pleomorphic adenoma usually presents as a slowly progressive painless mass. However, painful presentation in this case might be related with necrotic foci found in the histopathological examination. Although not described in lacrimal glands, pleomorphic adenomas have already been reported in the major and minor salivary glands, and these patients also presented with a painful mass.