Clinicopathological Features of Dacryolithiasis in Japanese Patients: Frequent Association with Infection in Aged Patients

Abstract

Purpose. The purpose of this study is to elucidate the clinicopathological features of dacryolithiasis and prevalence of associated infection in Japanese patients. Materials and Methods. Out of 13,471 outclinic patients from 2006 to 2011, 268 patients were scheduled to be performed dacryocystorhinostomy (DCR) due to dacryocystitis with nasolacrimal duct obstruction. Actually 266 patients underwent dacryocystorhinostomy (DCR) and two patients were cured by only ophthalmic examination. Dacryoliths were found in 17 cases (6.3%). Among 17 cases of dacryolithiasis, three patients were male, and 14 were female. The age of the patients ranged from 32 to 82 (mean 67) years, and 13 cases (76%) were more than 65 years of age. Pathological examination disclosed the infectious agents in 9 cases (53%), and all patients with infection were more than 65 years of age. Special stains revealed colonies of fungus, suspicious of Aspergillus, in 6 cases and gram-positive rods, and suspicious of Actinomyces, in 3 cases. Conclusions. The current study showed the frequent association of infection with dacryolithiasis in aged Japanese patients. This should be taken into the consideration for the treatment of dacryolithiasis.

Konkremente des Tränenapparates

“…Anhand der exzidierten Konkremente im Rahmen einer Dakryozystorhinostomie lässt sich die Häufigkeit von Steinen des Tränensackes mit etwa 6 – 18% einordnen 20 , 30 , 31 , 32 , 33 . Weibliches Geschlecht und jüngeres Alter (30 – 50 Jahre) werden bisweilen als Risikofaktor angesehen 34 , 35 . Obwohl Frauen deutlich häufiger an Tränenabflussstörungen leiden, scheint die Dakryolithiasis jedoch keine eindeutige Geschlechterdominanz zu zeigen 20 , 32 , 36 , 37 .…”

“…Bisweilen sind reichhaltig vorhandene neutrophile Granulozyten vorzufinden 38 , 43 . Kubo et al zeigen, dass mit zunehmendem Patientenalter in über 50% eine zusätzliche Besiedlung durch Mikroorganismen auftritt (vor allem Aspergillus und Aktinomyzeten) 34 . Andere Studien weisen mitunter keinerlei Spuren mikrobieller Besiedlung nach 35 , 44 .…”

“…This could promote the aggregation of proteins, which could in turn be associated with increased formation of stones 7 , 33 . Bacteria and fungi seem to be etiologically irrelevant, or only to play a minor role, although histological and microbiological evidence of their presence is sometimes found 12 , 33 , 34 .…”

Congenital nasolacrimal duct obstruction with fungal dacryoliths

“…In adults, the incidence rate of dacryoliths identified during dacryocystorhinostomy is between 6% and 17% for patients with nasolacrimal duct obstruction. [1][2][3][4][5] In contrast, congenital nasolacrimal duct obstruction (CNLDO) is a common disease in infants whose parents note symptoms of epiphora and discharge. The prevalence rate of CNLDO is approximately 6% to 20% in infants.…”

“…The hallmarks of OAS are optic neuropathy and ophthalmoplegia. [1][2][3] OAS has historically been divided by the anatomic location of the lesion into 3 groups: superior orbital fissure syndrome (SOFS), OAS, and cavernous sinus syndrome. SOFS affects mainly the cranial nerves (CNs) III, IV, and VI, and the ophthalmic division of CN V without optic neuropathy.…”