Rhinosporidiosis of lacrimal sac: An interesting case of orbital swelling

Abstract

Rhinosporidiosis is a chronic localized granulomatous disease caused by Rhinosporidium seeberi, an aquatic protistan parasite belonging to a clade, Mesomycetozoea. Infestation of Rhinosporidiosis to the eye and adnexa is termed oculosporidiosis, in such cases, conjunctival mucosa is mostly involved; however in our case, it involved only the lacrimal sac and deeper periorbital tissue and presented as a case of orbital swelling. Surgical excision of the lesion was done, postoperatively dapsone therapy was given for 6 months, and the patient responded very well with no recurrence till date.

Lacrimal sac rhinosporidiosis: case report and review of literature with a new grading system to optimize treatment

“…However, epiphora when present, may be continuous[3], [9], [11] intermittent[9], [14], [18] or blood stained [10], [21], [23]. NLD was fully patent in some studies,[11], [20], [24], [32], [34] partially patent in others 14 and completely blocked in the rest [1], [3], [27], [30], [35]…”

“…Isolated rhinosporidiosis of the LS is very rare[11], [20] and it becomes difficult to suspect a LS swelling to be due to infestation by rhinosporidium 5 and thus imaging modalities are helpful. On computed tomography, rhinosporidiosis is commonly seen as a homogenously enhancing lobulated lesion in the inferior nasal cavity with adjacent bone erosion 36 .…”

“…Various authors have published their results using surgical procedures like dacryocystorhinostomy (DCR) involving endoscopic DCR[18], [19] external DCR, 9 modified DCR 10 and Dacryocystectomy (DCT)[3], [11], [20], [21], [22], [23] with a success rate varying from 28.5% to 92.3%.…”

“…contrast passed through NLD in circumferential manner till it drained in IM, with asymmetry in lateral wall of noseGelatinous lesion attached to superior wall of lacrimal sac extending into NLD. Details of excision not mentioned.NM5 monthsNMNMPakistan7Basu et al 20 20161Pinkish swelling over left lower orbital area for 3 years with a deep T scar from the previous interventionNMPatentNilLS & NLDEnhancing soft tissue mass in lacrimal sac region extending to superior aspect of right maxillary antrum, disruption of medial wall of the left orbit and blurred adjacent fat planes.DCT, excision of mass with sacNIL6 months100 mg OD X6 days for 6 monthsNMKolkata (India)8Mishra et al 1 20151Soft, non-tender swelling at the medial canthus of left eye, 4cmx2cm in sizeNMBlockedPresentLS + NLDHyperdense lesion with mean CT attenuation of 48 hounsfield unit lesion is extending to upper part of NLDAn elliptical incision was made over the medial canthus of left eye. Mass with sac removed.…”

Rhinosporidiosis of the lacrimal sac masquerading as chronic dacryocystitis: a rare presentation

“…Approximately 26% of the cases of ocular rhinosporidiosis are associated with either nasal or conjunctival involvement. 12 Isolated lacrimal sac rhinosporidiosis is very rare in the clinical practice with only a few reports in the literature. 9,10 It is always a challenge to suspect a case of isolated lacrimal sac rhinosporidiosis as the clinical feature always resembles a chronic dacryocystitis.…”