[Lateral anastomosis of the lacrimal apparatus and lacrimal ductules].
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A total of 178 patients with pathologies in the lacrimal apparatus (including 81 patients with dacryocystitis, 51 patients with imperforation of the lacrimal canals' opening and 46 patients with dacryostenosis) were investigated. Crystallographic examination (CGE) of the lacrimal fluid was made for both eyes before and after surgery. 32 virtually healthy persons made up the control group. Normal types were defined and an operational scheme, which ensured the detection of 4 main types of crystals typical of the discussed pathologies, was elaborated. CGE was found to enable a reliable detection of relapses' threat, which can be a criterion in choosing the time for removing the intubation tube after canaliculardacryocystorhinostomy (CDCT) and an extra source of information in specifying a stage of dacryostenosis. CGE provides for determining indirectly the presence of an allergic or inflammatory component in the disease course. Finally, CGE is a simple and sufficiently informative method, which can turn into an additional tool in the diagnosis, differential diagnostics and evaluation of the efficiency of conducted therapy and in forecasting a clinical disease course in the lacrimal apparatus.
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Patients who suffer from epiphora can benefit from reconstructive surgery in many cases of obstructive and nonobstructive lesions of the lacrimal apparatus. We describe our technique of digital subtraction macrodacryocystography (DSM) and discuss its efficacy in the evaluation of various abnormalities involving the lacrimal drainage pathway. A variety of pathologic conditions of the lacrimal apparatus are portrayed. DSM is an accurate, easy to perform, but relatively unrecognized method of anatomic localization of obstructive lesions within the lacrimal drainage system.
The paper reports on a synthesis of an important part of ophthalmology: congenital affections of the lacrimal apparatus. The first part presents topographically the congenital lacrimal entities. The authors survey then the methods of classic and modern investigations and conclude with a synthetic presentation of the techniques of surgery.
The aim of the present study was to determine the possible expression of the mucin MUC16 in the lacrimal apparatus. Expression and distribution of MUC16 in lacrimal gland, accessory lacrimal glands, and nasolacrimal ducts was monitored by RT-PCR and immunohistochemistry. MUC16 was expressed and detected in all tissues investigated. Comparable to conjunctiva and cornea it was membrane-anchored in accessory lacrimal glands whereas in lacrimal gland acinar cells and columnar cells of the nasolacrimal ducts it was stored in intracytoplasmic vesicles without membrane-association. Subepithelial serous glands of the nasolacrimal ducts revealed staining of the secretion product. Intracelluar production of MUC16 is present in lacrimal gland and epithelial cells of the nasolacrimal ducts but it is not clear whether this MUC16 is secreted. MUC16 seems to be shedded or secreted from the epithelial surface of subepithelial serous glands of the nasolacrimal ducts. Our results show that MUC16 is present in the whole lacrimal apparatus. Its distribution pattern suggests different physiological functions with regard to tear film physiology and tear outflow. Moreover, the results demonstrate the existence of so far not recognized qualitative differences in the secretion product of main lacrimal gland and accessory lacrimal glands (glands of Krause).
The Harderian gland is a poorly understood anterior ocular gland that occurs in most terrestrial vertebrates. Numerous extraorbital functions have been ascribed to the Harderian gland, principally based on its association with the nasolacrimal duct. Few studies have centered on archosaurs and the majority of those available focused solely on the Harderian gland of birds. Little is known about the lacrimal apparatus of the crocodilians. We examined the lacrimal apparatus of several specimens of Alligator mississippiensis anatomically, histologically, and histochemically and studied the embryogenesis of this system. The nasolacrimal duct possesses a distal secretory area, which is more convoluted than that of typical mammals or lepidosaurs. The alligator Harderian gland possesses a unique combination of characteristics found in lepidosaurs, birds, and mammals. Like that of both mammals and lepidosaurs, it is a large, tuboloacinar gland that appears to secrete both mucoprotein and lipids. However, the presence of blood vessels and immune cells is reminiscent of that of the avian Harderian gland. The immunogenesis of the alligator Harderian gland appears to be tied to the development of the vascular system. The presence of a distinct palpebral gland in the anterior aspect of the ventral eyelid is a feature unique to alligators. Based on position, this gland does not appear to be homologous to the anterior lacrimal gland of lepidosaurs. Lymphatic aggregations were also found in the palpebral gland. The presence of interstitial immune cells in the orbital glands of alligators suggests that the alligator lacrimal apparatus, like that of birds, may play a role in the head-associated lymphatic tissue system.
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Repair of mutilated lacrimal passages should be adapted to the anatomy and physiology. Whenever possible, this should be performed as an emergent operation and come in as part of an overall therapeutic strategy. Repair methods used are simple end-to-end approximation of permeable segments, in case of limited lesions, and use of arterial grafts or of adjacent, nasal or saccular mucous flaps, in case of extended lesions. When reconstruction is not feasible owing to the extent of the lesions or to failure of the repair methods, tear derivation is carried out directly via the lacrimal sac or nasal fossa, by means of intermediate flaps (primarily nasal mucosa) or indwelling drains. Objectively, the functional outcome of repair is hard to assess, as tearing can, by no means, be considered a clinical criterion of obstruction, in the same way as lack of tearing is not a criterion of permeability. Only dacryography or, when possible, postoperative scintigraphy of the lacrimal passages allow for an objective evaluation of the results. Thus, although satisfactory results are the rule, long-term objective observation often leads to mitigating feelings.
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An infant with congenital agranulocytosis (Kostmann's syndrome) presenting with necrosis of the eyelids and lacrimal apparatus is reported. Although the disease is rare, its presence should be considered in infants with severe localized pyogenic infections.
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