Investigation of the mechanism of onset of dacryocystitis after rebamipide ophthalmic solution administration

Abstract

Purpose : To investigate the pathogenesis of dacryocystitis after rebamipide ophthalmic solution administration.

Methods : Eleven dacryoliths collected from ten patients with dacryocystitis after rebamipide ophthalmic solution administration were examined. All dacryoliths were divided into five pieces. Two pieces were examined using light and fluorescence microscopes, after staining with Gram and Fungi Flora Y reagents, respectively. Two pieces were fixed using Karnovsky fixation solution and 10% formaldehyde. With regard to the former sample, surface morphology and the components of the dacryoliths were examined using scanning electron microscopy with energy dispersive X-ray (SEM-EDX). Calcium and fungi in the latter sample were examined histopathologically by von Kossa and Grocott’s staining, respectively. The final piece was fixed by drying for high performance liquid chromatography. The onset mechanism of dacryocystitis was investigated based on the above examinations, present illness, past history, and usage of eye drops.

Results : The subjects were aged between 72 and 81 years (average 77.8 years old), and all patients were female. Nine patients (81.8%) had acute dacryocystitis, and 2 (18.2%) had chronic dacryocystitis. All patients with acute dacryocystitis had redness, swelling, and pain in the skin around the lacrimal sac region. Three patients (27.3%) used hyaluronic sodium ophthalmic solution and 2 (18.2%) used fluorometholone ophthalmic solutions. Four patients (36.4%) had a history of Sjögren's syndrome or another autoimmune diseases. Light microscopy revealed Gram-negative crystal-like structures and several bacteria were detected in all dacryoliths. Fungi were detected in two dacryoliths. Calcium phosphate crystals with sharp morphology were detected in all dacryoliths using SEM-EDX. High performance liquid chromatography revealed that the dacryoliths had rebamipide content >50%.

Conclusions : Dacryocystitis occurring after rebamipide ophthalmic solution administration is likely to be caused by the accumulation of microorganisms on the calcium phosphate crystals in the lacrimal sac.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.