Clinical characteristics of lacrimal drainage pathway disease-associated keratopathy

Abstract

Purpose To report the clinical characteristics of 13 cases of noninfectious corneal ulceration related to lacrimal drainage pathway disease. Methods Medical records of 13 patients with lacrimal drainage pathway disease-associated keratopathy who were examined at Ehime University Hospital between April 2007 and December 2021 were analyzed. Results The predisposing lacrimal drainage pathway diseases for corneal ulceration were chronic dacryocystitis in seven patients and lacrimal canaliculitis in six patients. The corneal ulcers were located at the peripheral cornea in 10 patients and the paracentral cornea in three patients. All patients indicated few cellular infiltrations of the ulcerated area at the slit-lamp examination. Corneal perforation was found in seven patients. The primary identified organisms were Streptococcus spp. in chronic dacryocystitis and Actinomycetes spp. in lacrimal canaliculitis. All patients showed rapid healing of the epithelial defects after treatment of the lacrimal drainage pathway disease. The mean time elapsed between treatment of the lacrimal drainage pathway disease and re-epithelialization of corneal ulcer was 14.5 ± 4.8 days. Conclusion Lacrimal drainage pathway disease-associated keratopathy may be characterized by peripheral corneal ulcer with few cellular infiltrations, occasionally leading to corneal perforation. Treatment of the lacrimal drainage pathway disease could be the most effective treatment for lacrimal drainage pathway disease-associated keratopathy.

Corneal Perforation Associated with Lacrimal Canaliculitis: A Case Series

“…In previous reports of six cases in which the corneal perforation site was known, perforations were observed on the nasal side. 13 , 14 , 16 However, our case series shows that corneal perforation with lacrimal canaliculitis can occur in any part of the cornea.…”

“…In this report, all six patients with corneal perforation and lacrimal canaliculitis were female, and most of them were aged 70 years or above. Previous studies have reported two male cases and six female cases of corneal perforation associated with canalliculitis 13 , 14 , 16 , 17 It is possible that corneal perforation caused by lacrimal canaliculitis is much more common in females. A possible explanation is the preponderance of lacrimal duct diseases, including canaliculitis, in older females.…”

Lacrimal duct diseases are the potential cause of corneal epitheliopathy

“…Treatment of lacrimal drainage pathway disease combined with surgical intervention or contact lens wear for corneal perforation has shown favorable outcomes in patients with corneal ulcers and perforations. [7][8][9] Patients with lacrimal drainage pathway diseases exhibit elevated levels of various in ammatory cytokines in tear uid. [16][17][18] Recanalization of the lacrimal drainage pathway may reduce the levels of interleukins and matrix metalloproteinases.…”

“…These patients differ from patients with corneal ulcers and perforations associated with lacrimal duct obstruction, as those patients had systemic immune disorders such as rheumatoid arthritis and used topical corticosteroids. [6][7][8][9]12 The differences in patient background between corneal ulcers, perforations, and corneal epitheliopathy suggest that corneal epitheliopathy does not lead to the development of corneal ulcers or perforations, but rather each condition occurs independently in different groups of patients with tear duct disorders. In other words, corneal epitheliopathy may not be a precursor lesion to corneal ulcers or perforations.…”

“…4 Recent years have seen an increase in reported cases of corneal ulcers and corneal perforations caused by lacrimal duct disorders. [5][6][7][8][9] These conditions may lead to treatment failure and severe visual impairment if left untreated. However, previous reports have also indicated that with early recognition of lacrimal duct disorders and appropriate treatment, the prognosis is generally favorable.…”