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Slit lamp photographs of six cases of corneal perforation at presentation to our hospital. (A) Left eye of Case 1: Peripheral perforation is observed on the inferior nasal side with disappearance of the anterior chamber and iris depression. (B) Left eye of Case 2: Peripheral perforation on the superior nasal side with iris depression and disappearance of the anterior chamber. (C) Right eye of Case 3: Inferior temporal peripheral perforation with iris depression. (D) Left eye of Case 4: Temporal paracentral perforation with iris depression and disappearance of the anterior chamber. (E) Right eye of Case 5: Inferior temporal paracentral perforation with iris depression and disappearance of the anterior chamber. In addition, blood vessels invading a part of the cornea are observed. (F) Left eye of Case 5: Temporal paracentral perforation with iris depression and vascular invasion into the cornea and corneal opacity. (G) Left eye of Case 6: Inferior nasal paracentral perforation with iris depression and disappearance of the anterior chamber. (H) Same eye as in (G): Concretions in the lacrimal canaliculi are visible through the punctum (black arrow).
Source publication
Purpose
To report seven eyes of six patients diagnosed with corneal perforation and lacrimal canaliculitis in a single facility.
Methods
Clinical records of patients with corneal perforation accompanied by lacrimal canaliculitis seen by the authors were reviewed.
Results
Six patients (7 eyes) with corneal perforation accompanied by lacrimal canal...
Citations
... 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. ...
... 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. ...
... The involvement of pathogens in the tear ducts and their roles in corneal ulcers and perforations have indeed been discussed in the literature. 14,15 Accumulating cases of corneal ulcers and perforations associated with lacrimal duct obstruction have revealed their characteristics [5][6][7][8][9]12 . In most cases, cellular in ltration was minimal at the site of ulcer and perforation, which is clearly different from infectious keratitis. ...
Purpose: The purpose of this study was to determine the frequency of corneal epitheliopathy in patients with lacrimal duct diseases and to elucidate the clinical characteristics of patients with corneal epitheliopathy.
Methods: Among patients diagnosed with lacrimal duct diseases comprising chronic dacryocystitis and lacrimal canaliculitis at our institution between 2015 and 2022, those who had corneal epitheliopathy were studied. Severity of corneal epitheliopathy was evaluated using the National Eye Institute/Industry (NEI) corneal grading scale. Systemic diseases, ocular diseases, and types of eye drops used were extracted from medical records. Pathogens cultured from ocular secretions in lacrimal duct or revealed by pathological examination of concretions were examined. NEI scores before and after treatment for lacrimal duct diseases were compared.
Results: 161 eyes with lacrimal duct diseases consisted of 138 eyes with chronic dacryocystitis and 23 eyes with lacrimal canaliculitis. Corneal epitheliopathy was found in 13 eyes (8.1%) with lacrimal duct diseases; 11 eyes (8.0%) with chronic dacryocystitis, and 2 eyes (8.7%) with lacrimal canaliculitis. None of the patients with corneal epitheliopathy had specific systemic or ocular diseases. Six patients used antibiotic eye drops, but only one patient used corticosteroid eye drops. Pathogens were detected in the lacrimal duct in 12 of 15 eyes with corneal epitheliopathy. Corneal epitheliopathy improved in all eyes after treatment for lacrimal duct diseases.
Conclusion: Lacrimal duct diseases may potentially lead to corneal epitheliopathy. In a case of refractory corneal epitheliopathy accompanied by conjunctival congestion and ocular secretions lacrimal duct disorders should be investigated and treated appropriately.
