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Lacrimal Gland Secretion MimickingEpiphora—Reply

Lacrimal Gland Secretion MimickingEpiphora—Reply In reply Apparently congenital ectopic lacrimal gland secretion sites are notas uncommon as we believed.1 In additionto similar cases described and reviewed by Dr Cogen,2,3 wehave been made aware of an unpublished case managed by a colleague. Althoughthe case described by Drs Putterman and Shields4 wastemporally associated with trauma, its resemblance suggests that the patientlikely had a similar congenital defect. With regard to cause, Dr Patrinely and colleagues5 suggestedthe possibility of choristoma. Since the time of publication of our article,1 our patient returned requesting surgical correction.A ductule arising from the lacrimal gland was found and excised along theaccompanying lashes. He remained asymptomatic without recurrence for morethan 6 months. The cause of the cases described by Dr Cogen and Drs Puttermanand Shields were similarly misdirected lacrimal gland ductules. Although weagree that it is reasonable to consider a choristoma in such cases, this wasnot the abnormality in our patient. Of interest is the alternate management technique used by Dr Putterman.4 Before referral, his patient was treated unsuccessfullywith partial excision of the anomalous ductule with closure of the overlyingsoft tissue. Dr Putterman reported subsequent successful management with surgicalredirection of the ductule to the superior fornix. Using a technique similarto the one suggested by Dr Cogen, we successfully treated our patient withcomplete excision of the ductule. It appears that patients with congenitalectopic lacrimal gland secretion sites can be successfully treated with surgicalredirection or complete excision of the ductule and, as illustrated by DrPutterman's patient, partial excision may result in recurrence. References 1. McCulley TJYip CCKersten RCKulwin DR An ectopic site of lacrimal gland secretion mimicking epiphora. Arch Ophthalmol. 2002;1201586- 1587PubMedGoogle Scholar 2. Cogen MSLewis ARKelly AG Anomalous lacrimal ductule: case report and review. J Pediatr Ophthalmol Strabismus. 1994;31327- 329PubMedGoogle Scholar 3. Blanksma LJvan de Pol BA Congenital fistulae of the lacrimal gland. Br J Ophthalmol. 1980;64515- 517PubMedGoogle ScholarCrossref 4. Putterman AM Eyelid epiphora secondary to lacrimal gland fistula. Ophthalmic Surg. 1980;11682- 685PubMedGoogle Scholar 5. Gordon AJPatrinely JRKnupp JAFont RL Complex choristoma of the eyelid containing ectopic cilia and lacrimalgland. Ophthalmology. 1991;981547- 1550PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

Lacrimal Gland Secretion MimickingEpiphora—Reply

McCulley, Timothy J.
Archives of Ophthalmology , Volume 122 (5) – May 1, 2004
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References (5)

Publisher
American Medical Association
Copyright
Copyright © 2004 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.122.5.791-d
Publisher site
See Article on Publisher Site

Abstract

In reply Apparently congenital ectopic lacrimal gland secretion sites are notas uncommon as we believed.1 In additionto similar cases described and reviewed by Dr Cogen,2,3 wehave been made aware of an unpublished case managed by a colleague. Althoughthe case described by Drs Putterman and Shields4 wastemporally associated with trauma, its resemblance suggests that the patientlikely had a similar congenital defect. With regard to cause, Dr Patrinely and colleagues5 suggestedthe possibility of choristoma. Since the time of publication of our article,1 our patient returned requesting surgical correction.A ductule arising from the lacrimal gland was found and excised along theaccompanying lashes. He remained asymptomatic without recurrence for morethan 6 months. The cause of the cases described by Dr Cogen and Drs Puttermanand Shields were similarly misdirected lacrimal gland ductules. Although weagree that it is reasonable to consider a choristoma in such cases, this wasnot the abnormality in our patient. Of interest is the alternate management technique used by Dr Putterman.4 Before referral, his patient was treated unsuccessfullywith partial excision of the anomalous ductule with closure of the overlyingsoft tissue. Dr Putterman reported subsequent successful management with surgicalredirection of the ductule to the superior fornix. Using a technique similarto the one suggested by Dr Cogen, we successfully treated our patient withcomplete excision of the ductule. It appears that patients with congenitalectopic lacrimal gland secretion sites can be successfully treated with surgicalredirection or complete excision of the ductule and, as illustrated by DrPutterman's patient, partial excision may result in recurrence. References 1. McCulley TJYip CCKersten RCKulwin DR An ectopic site of lacrimal gland secretion mimicking epiphora. Arch Ophthalmol. 2002;1201586- 1587PubMedGoogle Scholar 2. Cogen MSLewis ARKelly AG Anomalous lacrimal ductule: case report and review. J Pediatr Ophthalmol Strabismus. 1994;31327- 329PubMedGoogle Scholar 3. Blanksma LJvan de Pol BA Congenital fistulae of the lacrimal gland. Br J Ophthalmol. 1980;64515- 517PubMedGoogle ScholarCrossref 4. Putterman AM Eyelid epiphora secondary to lacrimal gland fistula. Ophthalmic Surg. 1980;11682- 685PubMedGoogle Scholar 5. Gordon AJPatrinely JRKnupp JAFont RL Complex choristoma of the eyelid containing ectopic cilia and lacrimalgland. Ophthalmology. 1991;981547- 1550PubMedGoogle ScholarCrossref

Journal

Archives of Ophthalmology – American Medical Association

Published: May 1, 2004

Keywords: bodily secretions,lacrimal gland

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