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E. Domeier, M. Lehnert, A. Vogel, T. Wesendahl, F.G. Holz, K.U. Loeffler; Dacryoliths in the Excretory Duct of the Lacrimal Gland: Uncommon Localization and Configuration . Invest. Ophthalmol. Vis. Sci. 2005;46(13):4229.
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Purpose: Lacrimal duct obstruction is known to be occasionally associated with dacryolithiasis. Stone formation is usually found between the lacrimal sac and the nasolacrimal duct as well as at the outlet of the nasolacrimal duct. Only little has been described about dacryolithiasis in cystoid lesions of the lacrimal gland. We present a series of 4 cases of dacryolithiasis in the lateral fornix. Methods: All patients were examined by slit lamp microscopy, and ultrasound was performed in two. Further investigation followed during surgical intervention, and ophthalmopathologic examination of the excised tissue and the concretions was done by light microscopy including stains for microorganisms. Results: All patients (3 males, 1 female, age 21, 52, 62 and 66 years) demonstrated a short duration of symptoms (less than four month) with comparatively little pain that did not respond to conservative treatment. Lesions were located in the region of the outlet duct of the lacrimal gland at the lateral cantus and appeared slightly hyperemic and to a varying degree cystic. Ultrasound showed hyporeflective signals but did not demonstrate any concretion. In 3 patients, the dacryoliths were found intraoperatively during removal of the "tumor", while in patient #4 it was discharged spontaneously. Morphology varied between small multiple round whitish–yellow concretions of hard consistency (0.7mm in diameter, in association with a large dacryops) and bigger more irregular stones (up to 7mm, in patients without sourrounding cystoid structure). In all specimens, histopathologic examination revealed amorphous acellular organic material without any evidence of microorganisms. Conclusions: Dacryoliths of the lacrimal system can also – albeit rarely – form in the excretory duct of the lacrimal gland. Propably the comparatively shorter ductal system and the few organic components in tears prior to their exposure to lipids, cell debris and bacteria on the ocular surface are responsible for their rare incidence. Ultrasound appears ineffective in demonstrating at least small stones, and surgical intervention is required for symptomatic relief. In contrast to dacryoliths of the descending lacrimal system, dacryoliths within ducts of the lacrimal gland show no evidence of an infectious origin or a possible superinfection.
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