Canine lobular orbital adenoma: a report of 15 cases with distinctive features

Objective To describe a unique orbital neoplasm in dogs, of lacrimal or salivary gland origin. Animals studied Fifteen dogs with lesions consistent with a diagnosis of lobular adenomas involving the orbit were identified from the Comparative Ophthalmic Pathology Laboratory of Wisconsin from 1994 to 2001. Results The neoplasm occurred in nine females and six males. Affected dogs ranged in age from 7 to 17 years (mean = 9.7 years). Follow‐up information was available for 13 of the 15 cases. The clinical presentation included swollen/hyperemic eyelids (4/15), third eyelid protrusion (3/15), conjunctival mass (6/15), exophthalmos (4/15), resistance to retropulsion (2/15), or strabismus (1/15). In 13 cases the masses were composed of nodular, friable tissue and they were solid in two cases. Histologically, the tissue was found in encapsulated lobules resembling well differentiated lacrimal or salivary glands but completely lacking ducts. Granular PAS‐positive material was found within the cytoplasm. There was recurrence in 10 of the 13 cases available for follow‐up. Of those cases in which enucleation or exenteration was performed (3/15), there was recurrence of disease in one case. In three cases the dogs were euthanized before recurrence at 3 months, 5 months and 3 years post surgery. None of the deaths was related to the tumor. Conclusion In the 15 cases reviewed, lobular adenomas of the orbit presented clinically and histologically as a benign neoplasm of lacrimal or salivary gland origin. Recurrence was likely unless the mass was completely excised, at times requiring orbital exenteration.     

Unilateral orbital lacrimal gland abscess in a horse

A 20-year-old Thoroughbred gelding presented for evaluation of a periorbital dorsal swelling of the left eye that had been intermittently present for 3 months. Upon ocular examination, a firm, non-painful swelling was identified under the upper eyelid in the region of the orbital lacrimal gland, and was noted to extend anteriorly from underneath the dorsal orbital rim. Ultrasonographic examination revealed a mixed echogenic mass along the dorsal orbital rim that followed the contour of the globe. CT scan showed a moderately contrast enhancing mass that was contiguous with the eyelid. Differential diagnoses included neoplasia, inflammatory lesions such as a granuloma, foreign body or abscess. Surgical exploration and excision of the mass revealed a lobular structure with a purulent center. Histopathology identified the mass as the orbital lacrimal gland with concurrent severe dacryoadenitis. Culture of the purulent center of the mass revealed beta-hemolytic Staphylococcus aureus. The patient was maintained on supportive care and antibiotic treatment based on sensitivity postoperatively. No recurrence was reported 40 months later. This paper aims to identify bacterial dacryoadenitis as a cause for unilateral periorbital swelling in the horse. Differential diagnoses for this presentation, as well as successful surgical management are discussed. To the author's knowledge, this is the first case of bacterial dacryoadenitis and subsequent abscessation of the orbital lacrimal gland in the horse.     

Effect of lacrimal punctal occlusion on tear production and tear fluorescein dilution in normal dogs

OBJECTIVE: To evaluate effects of lacrimal punctal plugs positioned in either the upper, lower, or combination of upper and lower lacrimal canaliculi on plug retention and tolerance; tear production, as measured by the Schirmer tear test; and the dilution of fluorescein within the tear film in normal dogs. MATERIAL AND METHODS: Lacrimal punctal plugs were positioned in the lower, upper, or combination of lower and upper plugs in six laboratory-quality Beagles under topical anesthesia. Retention of plugs was evaluated daily from 8 to 23 days by visual inspection and slit-lamp biomicroscopy. Schirmer tear tests (STT 1 without topical anesthesia) were performed at 48-h intervals. Dilution of fluorescein was determined at 5- and 45-min post-fluorescein instillations once weekly. RESULTS: Lacrimal punctal plugs of 0.4 and 0.6 mm in diameter were retained for 14 (lower plugs: 100%) and 23 days (75%), and for the upper plugs at 8 days less often (75%), and were infrequently locally nonirritating. Combination of lower and upper plugs seemed to adversely affect retention of either plug. When loss of the plugs occurred, a next larger size plug was necessary suggesting some stretching of the lacrimal canaliculi occurred. Pre- and postplug placement STT results indicated no change with lower and combination lacrimal punctal plugs, but decreased levels following upper lacrimal punctal plugs. Tear fluorescein levels at 5 and 45 min in control eye (no punctum plugs) were 3.39% and 0.14%, respectively. With lower, upper, and the combination of lower and upper lacrimal puncta plugs, tear fluorescein levels at 45 min were higher than the controls (lower: 0.76%; upper: 0.45%, and combination 0.56%). CONCLUSION: Lacrimal punctal silicone plugs are retained for 8-23 days in the lower, upper, and combined lower and upper canaliculi at high rates. Effects on STT levels appear limited. Fluorescein within the tear film persists longer with all different positioned lacrimal punctum plugs than in the control eyes.     

Granulomatous conjunctivitis in an ostrich

Ostriches lack meibom glands, but have small lacrimal glands ventral to the lateral canthus, with ductules that open into the inside of the lower eyelid. Chalazion is a chronic granulomatous inflammation of the meibom glands that may develop from blockage of the ductules into the conjunctiva. A 2-year-old female ostrich presented with chronic granulomatous conjunctivitis, with clinical and histopathologic findings similar to chalazion of other species. The granulomatous dacryoadenitic mass was excised and no recurrence occurred at 4 months. This is the first case of chronic granulomatous conjunctivitis reported in the ostrich.     

Dacryops of the lacrimal gland in a dog

A case of congenital lacrimal cyst or dacryops of the lacrimal gland in an 8‐month‐old Neapolitan Mastiff dog is reported. The dog presented with a swelling dorsolateral to the left globe, which had been present since birth. In addition, hyperplasia and prolapse of the superficial gland of the left nictitating membrane, and bilateral macropalpebral fissure and ‘diamond eye’ conformation were apparent. On manual eversion of the upper eyelid, a subconjunctival mass was visible that was translucent and pink and affected the upper conjunctival fornix. B‐mode ultrasonography revealed the presence of an echolucent thin‐walled cystic structure measuring 15 by 12 mm and containing an echodense border and a distended tubular fluid‐filled structure that extended posteriorly. A viscous and transparent fluid was aspirated from the lesion. Surgery was performed to excise the lesion, reposition the nictitans gland, and correct the morphology of the palpebral fissure. Histopathology confirmed the mass to be a cyst and distended duct of the lacrimal gland. Although tear secretion was compromised, resection of the cyst was curative.     

Surgical excision of a feline orbital lacrimal gland adenocarcinoma with adjunctive cryotherapy and carboplatin‐impregnated bead implantation

The purpose of this report was to discuss the diagnosis, treatment, and outcome of a cat with an orbital lacrimal gland adenocarcinoma. A 14.5‐year‐old spayed female domestic shorthair cat was evaluated for a firm swelling at the left dorsotemporal orbital rim. The orbital mass was excised with preservation of the globe, and adjunctive cryotherapy was performed. A definitive diagnosis of lacrimal gland adenocarcinoma was obtained after histopathologic evaluation and histochemical staining with periodic acid–Schiff and mucicarmine. Thirteen months postoperatively, tumor regrowth occurred with a much larger osteolytic lesion, and a second surgery was performed consisting of tumor excision with implantation of carboplatin‐impregnated calcium sulfate hemihydrate beads. The cat has remained free of recurrence 11 months after the second surgery (26 months after initial diagnosis and surgery). A feline orbital lacrimal gland adenocarcinoma was successfully managed utilizing globe‐preserving surgical excision with adjunctive cryotherapy and subsequent carboplatin‐impregnated bead implantation. Orbital lacrimal gland adenocarcinoma in cats may not be as aggressive as other forms of periocular, head, and neck adenocarcinomas.     

Leiomyoma of the third eyelid in a dog

A 14‐year‐old neutered male Dachshund presented for the evaluation of oculus dexter (OD) third eyelid elevation ongoing for approximately 2 months. Complete ophthalmic examination revealed a large, nonpainful, well‐demarcated, soft mass at the base of the right third eyelid causing elevation and mild hyperemia. The mass was freely moveable with the third eyelid, and no right globe deviation was noted. No other abnormalities were noted on physical examination, routine blood chemistry, complete blood count, serum T4, urinalysis, or urine cortisol/creatinine ratio. Ocular B‐mode ultrasonography showed an anechoic, well‐demarcated, homogenous, soft tissue mass at the base of the third eyelid with no orbital extension. A leiomyoma was diagnosed after multiple punch biopsies were obtained from the palpebral surface of the mass. The right third eyelid was excised surgically. Histopathology confirmed a completely excised, nodular, unencapsulated, expansile mass within the third eyelid. Positive smooth muscle actin and negative S‐100 immunohistochemistry confirmed a leiomyoma. Bundles of normal smooth muscle were also present adjacent to the mass. The mass was compressing the adjacent lacrimal gland and associated with moderate dacryoadenitis. Twelve months postoperatively, the right globe position and motility remain normal with no evidence of mass regrowth. To the author's knowledge, this is the first reported case of a leiomyoma of the third eyelid in any species. In this case, the mass was completely excised and no regrowth has occurred twelve months after surgery. This case along with independently reviewed canine third eyelids clearly demonstrates the presence of smooth muscle within the canine third eyelid.     

Reconstruction of the lower eyelid by third eyelid lateral advancement and local transposition cutaneous flap after "en bloc" resection of squamous cell carcinoma in 5 cats

OBJECTIVE: To describe a novel technique for blepharoplasty to cover a tissue defect involving >/=50% of the lower eyelid. STUDY DESIGN: Prospective clinical study. ANIMALS: Five cats with lower eyelid squamous cell carcinoma (SCC). METHODS: En bloc resection of SCC by removing >/=50% of the lower lid with either the medial or lateral canthus was performed without other adjunctive treatment for SCC. The lid defect was reconstructed with a transposition skin flap derived from the frontal (medial defect) or temporal (lateral defect) region. The third eyelid was advanced laterally without dissection from its insertion; its outer conjunctival layer was removed, and the skin flap was sutured with single interrupted sutures dorsally over the nictitating membrane, ventrally to the cutaneous edge of the surgical wound and medially or laterally (depending on the canthus removed) to the skin of the remaining lower lid. RESULTS: Satisfactory cosmetic and functional results were achieved and the Schirmer tear tests were normal. In 2 cats, the skin flap needed monthly hair trimming to avoid corneal lesions. CONCLUSIONS: After en bloc resection of SCC involving >/=50% of the lower eyelid, reconstruction can be achieved by relocation of the third eyelid and use of a cutaneous transposition flap sutured to the scarified external surface of the third eyelid. Eyelid apposition and lacrimal function were preserved. CLINICAL RELEVANCE: Blepharoplasty using a cutaneous transposition flap sutured to the scarified surface of a relocated third eyelid should be considered for reconstruction of lower eyelid defects with >/=50% tissue loss of the lid margin.     

Conjunctival dacryops in a domestic shorthair cat

A 1-year-old spayed female domestic shorthair cat with a 1-week history of a conjunctival mass located in the dorsolateral quadrant of the right eye was presented to a referral hospital. Ophthalmic examination revealed a pink, fluctuant, and non-painful cystic swelling of the upper right palpebral conjunctiva. An ocular ultrasound confirmed the presence of a fluid-filled cystic structure that extended into the temporal orbit. The histopathology of the excisional biopsy revealed multiple cysts lined by ductal epithelium along with dilated lacrimal gland ducts and lymphocytic nodules adjacent to the dorsal lacrimal gland; consistent with a diagnosis of dacryops.     

Bilateral corneoconjunctival dermoids and nasal choristomas in a calf

A 5-day-old Angus x Hereford calf presented for bilateral haired masses on the eyes and nasolabial planum since birth. The masses were surgically excised from the inferonasal cornea and bulbar conjunctiva of both eyes and the left and right side of the dorsomedial nasolabial planum. Histopathology of the excised tissue confirmed bilateral corneoconjunctival dermoids with ectopic lacrimal glands, and bilateral nasal choristomas and ectopic nasal glandular tissue. Surgery was curative and healing was uneventful. Bilateral ocular dermoids in combination with nasal choristomas and ectopic glandular tissue have not been documented previously in cattle.     

Penetration of some antibiotics into the lacrimal fluid of sheep

Antibiotic concentrations were determined in the lacrimal fluid of sheep following subcutaneous application of penicillin/ dihydrostreptomycin into the lower eyelid, and intramuscular administration of spiramycin base, tiamulin, and oxytetracycline formulations. The penetration of penicillin and dihydrostreptomycin into the lacrimal fluid was poor. The spiramycin and tiamulin concentrations in the lacrimal fluid were 10‐ and 4‐fold higher than in the serum. The peak spiramycin concentration in the lacrimal fluid was 3.4 ±0.8 μg/ml at 8 h post injection (p.i.) and the drug could be detected at least 72 h p. i. For tiamulin and oxytetracycline (OTC) peak concentrations of 1.53 ±0.70 and 1.88 ±1.9 μg/ml, respectively, were achieved in the lacrimal fluid and these drugs could be detected 25 to 30 h p.i. The OTC and tiamulin concentration‐time curves for lacrimal fluid and serum were parallel, whereas for the spiramycin appearance in the lacrimal fluid was delayed.     

Keratinizing ameloblastoma in a 9-month-old llama (Lama glama).

A 9-month-old male llama (Lama glama) was presented because of a rapidly growing mass on the right side of the face. Radiographs revealed a marked expansion of the right caudal face region with bone lysis involving the maxilla and the nasal, lacrimal, zygomatic, and palatine bones. Cytologically, the mass consisted of atypical round to polygonal cells with round nuclei and basophilic cytoplasms that formed acini and rows. Histologically, the mass consisted of anastomosing cords and sheets of neoplastic odontogenic epithelial cells embedded in a loose fibrovascular connective tissue. Single layers of peripheral, polarized, palisading, columnar epithelial cells were seen at the edges of some cords. Within the centers of the cords, epithelial cells showed rapid progression to keratin production. The histologic diagnosis was keratinizing ameloblastoma. Ameloblastomas are neoplasms of odontogenic epithelium that tend to be locally aggressive and can cause substantial destruction of bony structures. Because ameloblastomas do not tend to metastasize, they can be successfully treated by complete surgical excision, performed before extensive bony destruction occurs. Ameloblastoma, although expected to be rare, should be onthe list of differential diagnoses for facial swelling in llamas.     

Orbital adenocarcinoma of lacrimal gland origin in a dog.

A 13-year-old intact female mixed-breed dog was presented for a progressive enlargement of the right eye, which had been treated previously for conjunctivitis. A round, firm mass, approximately 4 cm in diameter, was protruding from the superotemporal aspect of the right orbit, displacing the eyeball anteriorly and ventromedially. The mass was encapsulated, distinct from the eyeball, and not associated with the eyelids. On cut surface, there was a pale multilobulated periphery, with a dark red, soft, and depressed core. Histologically, tumor cells formed cords and tubules, which were stained with mouse anti-human cytokeratin antibody AE1/AE3. Residual glands were serous, and the majority of tumor cells were negative for mucin. The supraorbital location, encapsulation, and residual serous glands suggest that this mass was a low-grade adenocarcinoma of the lacrimal gland.     

Primary lacrimal gland adenocarcinoma of the third eyelid in a horse

A 5-year-old Draft Horse gelding presented for evaluation of a large, fleshy, ulcerated third eyelid mass OD of 3 weeks duration. Complete ophthalmic examination, ocular ultrasound and skull radiographs revealed a large soft-tissue mass involving the entire third eyelid OD and extending into the ventral right orbit to the level of the globe equator. No other abnormalities were noted on physical or ophthalmic examination. Surgical removal via exenteration was performed 3 months after initial presentation. A lacrimal adenocarcinoma of the third eyelid was diagnosed based on histopathology. Concurrent asymptomatic intra-ductal and intra-acinar Demodex caballi parasites were found in the eyelid sebaceous glands, likely as an incidental finding. No tumor recurrence or metastasis has occurred 12 months after excision. To the author's knowledge, this case is the first reported primary lacrimal adenocarcinoma in a horse. Complete surgical excision was curative.     

Orbito-nasal cyst in a young European short-haired cat

Purpose To describe a case of an orbito‐nasal cyst in a cat. Procedure An 18‐month‐old male European short‐haired cat was presented to the Ophthalmology service of the Vetsuisse Faculty, University of Zurich for a subcutaneous swelling in the medial canthal region of the right eye (OD). Ophthalmologic, ultrasound and CT examinations, and fine needle aspiration were performed. After lesion excision, the removed tissue was submitted for histopathology. CT examination was repeated 5 months after removal of the cyst. Results Ophthalmologic examination revealed a large fluctuant swelling inferonasal to OD. Despite patent lacrimal puncta, only the first few mm of the lacrimal canaliculi could be cannulated. A normal globe with moderate enophthalmos was present. Ultrasound examination showed a well‐defined lobulated cyst‐like structure in the right orbit, inferonasal and anterior to the eye. CT examination revealed extension of this lesion through the medial orbital wall into the right nasal cavity. Fine needle aspiration confirmed the cystic nature of the lesion. An orbito‐nasal cyst was diagnosed. The orbital part of the cyst was dissected from the surrounding tissue and excised from the periosteum in the medial orbital wall defect. Part of the maxillary bone was removed to allow removal of the cyst from the nasal cavity. Histologically, the cyst wall consisted of a single to multilayered, mostly cuboidal epithelium and surrounding connective tissue. Follow‐up revealed a good functional result and no recurrence 7 months after cyst removal. Conclusions Similar orbito‐nasal cystic structures were reported in dogs but not in cats.     

Unilateral exophthalmia in a European hedgehog (Erinaceus europaeus) caused by a lacrimal ductal carcinoma

A 5-year-old European hedgehog was examined because of exophthalmos of the left eye. A retrobulbar mass in the ventromedial orbit was suspected and confirmed by a computed tomography scan. Exophthalmos progressed despite systemic broad-spectrum antibiotic therapy. The left orbit was exenterated and the mass was partially removed. The histopathologic diagnosis was lacrimal ductal carcinoma. Lacrimal ductal carcinoma is rare in humans and animals. The long-term prognosis is guarded to poor.     

Bilateral intraocular glandular choristomas in a Thoroughbred foal

Intraocular choristomas are rare anomalies in domestic animals and are often associated with multiple ocular malformations. A Thoroughbred foal presented for ocular abnormalities and was diagnosed with microphthalmia, corneal dermoids, severe anterior segment dysgenesis (including glandular choristomas), aphakia, retinal dysplasia, and optic nerve hypoplasia. Morphological, histochemical, and immunohistochemical comparisons were made between ocular choristomatous tissues from this foal and lacrimal gland, third eyelid gland, nasopharynx, trachea, and lacrimal sac/nasolacrimal duct from normal horses. Morphologically the choristomatous tissues (glands and epithelium lining the anterior segment) were most similar to the lacrimal sac. Histochemistry of glandular components found the glands associated with the lacrimal sac/nasolacrimal duct to be serous, as was the glandular intraocular choristomas. Our findings suggest that the origin of intraocular glandular choristomas in this case is from the lacrimal sac.     

Ultrasound findings in horses with severe eyelid swelling, and recognition of acute dacryoadenitis: 10 cases (2004-2010)

Objective To report the sonographic findings, treatment, and outcome of horses with severe eyelid swelling, to describe the sonographic appearance of enlarged lacrimal glands, and to describe the clinical features of acute dacryoadenitis. Materials and methods Medical records of all horses with severe eyelid swelling that underwent an ultrasound evaluation of the globe and periorbital structures from 2004–2010 were examined. Cases were limited to those in which the eyelid swelling was so severe that the globe could not be visualized. Results Ten horses met the criteria for inclusion in the study. All cases were unilateral and acute. Marked enlargement of the lacrimal gland was found in five cases, and supported the diagnosis of acute dacryoadenitis. Eyelid abscessation was found in three horses, accompanied by mild to moderate lacrimal gland enlargement in two of the three. Enlarged lacrimal glands were slightly heterogeneous in appearance and could be differentiated from an abscess by imaging the protrusion of the gland from beneath the supraorbital rim. Only two cases of severe eyelid swelling were soley traumatic. Conclusions Severe eyelid swelling was often associated with dacryoadenitis and/or eyelid abscessation. The detection of marked lacrimal gland enlargement in horses with an acute onset of severe painful eyelid swelling is consistent with a diagnosis of acute dacryoadenitis. Ultrasonographic evaluation of eyelid swelling of any degree is warranted to determine if enlargement of the lacrimal gland, etiology notwithstanding, is an underlying or contributing cause.