João Amaro Ferrari Silva

Congenital dacryocystocele: diagnosis using ante and post-natal ultrasonography

Congenital dacryocystocele is an unusual type of nasolacrimal obstruction. Treatment with antibiotics or surgical removal is practiced to reduce the risks of infection (acute dacryocystitis) and potentially lethal septicemia. Here, we report a case of congenital dacryocystocele, antenatal ultrasonographic diagnosis (intrauterine), and postnatal reassessment.

Congenital Nasolacrimal Duct Obstruction in Premature Children

PURPOSE To determine the incidence of congenital nasolacrimal duct obstruction (CNLDO) in premature and full-term children. METHODS Medical records of 200 premature and 200 full-term children from July 2004 to November 2009 at the Peri-Peri Health Center were retrospectively reviewed. Fifty-three nasolacrimal ducts in 32 premature children (21 patients were bilateral) and 9 nasolacrimal ducts in 7 full-term children (2 patients were bilateral) diagnosed as having CNLDO were retrospectively examined. RESULTS Of the 200 premature children, 32 (16%) had CNLDO compared with 7 (3.5%) of the 200 full-term infants (P < .0001). Thirty premature infants and five full-term children underwent conservative treatment. Bilateral obstruction was found in all 3 extremely premature children (gestational age < 28 weeks), in 9 (69.23%) moderately premature children (gestational age of 28 to 31 weeks), in 9 (56.25%) mildly premature children (gestational age of 32 to 36 weeks), and in 2 (28.57%) full-term children (gestational age > 37 weeks). CONCLUSIONS This study reported a higher incidence of CNLDO in preterm infants when compared to full-term infants. This might be expected in light of the normal development of the nasolacrimal duct system, the patency of which normally occurs after the preterm infant is born.

Using thermography for an obstruction of the lower lacrimal system

Obstructions in the lacrimal pathways quite often require accurate and reliable image scanning for confirmation and documentation. Infrared thermal imaging, known as thermography, is a resource that complements diagnosis; it does not require touching the patient or applying contrast materials and has been used in various medical procedures for decades. However, there have been few studies in the literature about its use in ophthalmology. In this paper, the authors have presented a case of dacryocystitis where the obstruction of the lacrimal punctum was so acute that conventional dacryocystography could not be used. The authors have successfully reported the use of thermography as a complementary propaedeutic and will discuss the method they used.

Dacriocistite aguda: relato de 2 casos

The adult lacrimal obstruction can be congenital or acquired. In the case of the acquired form, the etiology classifies in not-specific (it involves the coating epithelium and/or the vascular plexus submucosae of the lacrimal duct) and specific (infections, inflammations, tumours and iatrogenies). The diagnosis is established by means of the anamnesis and clinical evaluation based on semiology of the lacrimal sack. The patients with lacrimal obstruction present epiphora, acute pains and swelling, mostly in the region of the lacrimal sack causing ectasye of various degrees whichn culminate with cutaneous fistulization. The image exams routinely proposed for dacryocysto-graphy, which represent a great help in showing the best surgical technique for dacryocystorhinostomy, will be indicated as soon as the acute inflammatory state is treated.

Síndrome de Fraser: relato de caso nas vias lacrimais

Fraser syndrome is a systemic condition characterized by cryptophthalmos, syndactyly and abnormal genitalia, which may be associated with urinary tract, ear, nose, larynx and skeletal abnormalities. Cryptophthalmos can be an isolated finding (that has been reported as an autosomal dominant trait) or associated with other congenital anomalies (reported as an autosomal recessive disorder). Child, female, nine month of life, evaluated in the lacrimal setor of Federal University of Sao Paulo. Child of consanguineous parents. Her physical examination showed total unilateral cryptophthalmos (left side), epiphora (right side) with mucopurulent discharge, depressed nasal bridge, low set ears, atresia of the external auditory canal, prominent labia majora and syndactyly of the fingers and toes. Ocular ultrasonography showed brachycephaly, absence of septu pellucidum prominence of the lateral ventricles, a major bone defect in the skull, the presence of thinning of the mantle tissue of the brain,a reduced anterior-posterior ocular diameter, anterior segment disorganization, absence of the lens and total retinal detachment in the left eye.

Recanalização do ducto nasolacrimal com radiofrequência: estudo preliminar

PURPOSE: To evaluate the nasolacrimal duct reconstitution with radio frequency for restoration of lacrimal flow in cases of nasolacrimal duct obstruction. METHODS: The procedure was carried out in 16 eyes of 16 patients (13 women and 3 men) by the same surgeon, with monopolar high-frequency device at 450 kHz and 150 W, with local anesthesia under sedation. Inclusion criteria were lower lacrimal system obstruction (confirmed by dacryocystogram) and age over 18 years old. Exclusion criteria were previous trauma, acute dacryocystitis, cutaneous fistula, mucocele, previous lacrimal surgery and cardiac pacemaker. RESULTS: Patients were followed for at least 120 days, patients were clinically evaluated at outpatient clinics for the presence of secretion, epiphora, reflux at compression of the lacrimal sac, placement of silicone tube and Milder test. At the 90-day postoperative visit, 13 patients had positive irrigation (81.25%) with clearance of lacrimal duct and 3 cases (18.75%) presented irrigation failure. CONCLUSION: Nasolacrimal duct reconstitution with radio frequency was effective in treating nasolacrimal duct obstruction.

Ultrasound parameters of normal lacrimal sac and chronic dacryocystitis

PURPOSE To compared the ultrasound findings of the lacrimal sac between subjects with normal lacrimal systems those with chronic dacryocystitis. METHODS A retrospective study of 10 subjects with a normal lacrimal system (Group 1) and 10 with chronic dacryocystitis (Group 2) diagnosed according to B-mode ultrasound with a 10-MHz transducer and the direct-contact technique (AVISO, Quantel Medical) for lacrimal sac assessment. We analyzed the dimensions, features, and content of the sacs. Characteristics of the population: female: 6, Group 1; 8, Group 2; mean age 48.4 years (SD=19.9; range, 22-80 years), Group 1; 50.5 years (SD=15.5; range, 25-75 years), Group 2. RESULTS The dimensions of the lacrimal sac were as follows: anteroposterior 1.86 and 10.99 mm in Groups 1 and 2, respectively, p<0.0001; vertical 9.79 and 14.13 mm in Groups 1 and 2, respectively, p=0.049. Qualitative evaluation of the lacrimal sac contents showed hypoechogenic content in Group 1 (10, 100%) and hyperechogenic punctiform content in Group 2 (10, 100%) with partial filling in seven cases (70%). CONCLUSIONS Ultrasonography can differentiate normal lacrimal sacs from sacs compromised by chronic dacryocystitis, thus being useful as an adjunct to clinical examination and surgical planning.

Miíase na topografia de saco lacrimal

Myiasis is the invasion of human tissues by Diptera larvae. Ocular involvement is rare. The objective of this paper is to report a case of myiasis in the topography of the lacrimal sac and discuss current treatments for this disease.

Obstrução da via lacrimal após radioiodoterapia: relato de caso e conduta

Iodotherapy represents the radioactive iodine therapy. The beta radiation emitted by radioactive iodine are particles that will be stored in the thyroid tissue destroying cancer cells that were left after surgery (thyroidectomy). It is important to emphasize a possible deleterious effect of therapy which affects the mucosa of the lacrimal system which results in a process of vascular inflammation and scarring producing disorders hypovascular, hypocellular and hypoxic.

Dacriocistocele congênita: relato de caso e conduta

A dacriocistocele representa uma rara anomalia congenita da regiao medial da orbita, causada pela obstrucao distal (ao nivel da valvula de Hasner) e proximal (ao nivel da valvula de Rosenmuller) da via lacrimal, com subsequente dilatacao do saco lacrimal. Recebe o nome de mucocele, quando seu conteudo representa muco, ou amniocele, quando o seu conteudo e preenchido por fluido amniotico. Acomete somente 0.1% das criancas, com obstrucao do ducto lacrimonasal, sendo comumente unilateral e mais frequente no sexo feminino e com predisposicao familiar. O diagnostico e realizado pelas caracteristicas clinicas: lesao cistica tensa, abaixo do tendao cantal medial, de coloracao azulacinzentada, rosea ou vermelha acompanhada por epifora desde o nascimento. No entanto podemos utilizar exames de imagem para diagnosticar esta anomalia congenita tais como: tomografia computadorizada, ressonância magnetica e ultrassonografia.