Autoimmune liver diseases are different entities that sometimes have overlapping features. They share many of the general characteristics of autoimmune diseases, with systemic involvements. Here, we report a 30-year-old woman with ophthalmic symptoms of conjunctivitis and DACRYOCYSTITIS who was treated completely. After a few months, the patient presented with autoimmune cholangiopathy. Sequelae of autoimmunity have been considered in different organs in this case.

Background :Rhinoplasty is among the most common cosmetic surgeries worldwide, including in Iran. Given the proximity of the nasolacrimal system to the surgical site, there is a potential for injury or infection transmission. Although rare, DACRYOCYSTITIS and epiphora may occur postoperatively. Objectives :This study aims to investigate the prevalence and risk factors associated with these complications. Methods :In this retrospective cohort study, we reviewed the medical records of 124 patients aged 20 - 40 years who underwent rhinoplasty at Taleghani Hospital between January 2022 and December 2023. Inclusion criteria were a minimum of 3-month follow-up and no prior lacrimal pathology, rhinoplasty, or head/neck surgeries. Follow-up was conducted at 1 week, 1 month, and 3 months postoperatively. Outcomes were defined as clinically diagnosed DACRYOCYSTITIS (characterized by swelling, erythema, and discharge near the medial canthus) and epiphora (persistent excessive tearing not explained by environmental causes). Logistic regression analysis was used to evaluate predictors of complications. Bias was reduced by excluding patients with prior lacrimal disease and standardizing follow-up assessments. Sample size was calculated based on a prior prevalence estimate of 3.6% for nasolacrimal obstruction, yielding a minimum of 81 cases, with all eligible patients included to improve power. All outcomes were assessed by an attending ophthalmologist during follow-up visits. Results :The mean age was 29.19 ± 5.2 years, and 71% were female. DACRYOCYSTITIS occurred in 2.4% of cases, exclusively among women. Epiphora was reported in 19.3% of patients at one week, decreasing to 3.2% at three months. Multivariate analysis showed that obesity (OR = 1.83, P = 0.009), female gender (OR = 0.72, P = 0.021), smoking (OR = 1.66, P = 0.006), and lateral osteotomy (OR = 1.6, P = 0.016) were significant predictors. Conclusions :The incidence of DACRYOCYSTITIS following rhinoplasty is low but significantly associated with modifiable risk factors. Epiphora showed a declining trend over time. This study highlights the importance of preoperative risk assessment and surgical planning to minimize nasolacrimal complications.

Background: Untreated chronic DACRYOCYSTITIS (CD) can lead to serious ocular complications. Objectives: This study aimed to analyze the efficacy of modified endoscopic dacryocystorhinostomy (DCR) in the treatment of CD and the effects on ocular surface, inflammatory response, and immune function of patients. Methods: A retrospective cohort study was conducted to examine the clinical data of 110 patients (110 eyes) with CD who visited The First People's Hospital of Wenling, China, from July 2018 to February 2021, and they were divided into a conventional group (62 patients and 62 eyes underwent conventional DCR) and modified group (48 patients and 48 eyes received modified endoscopic DCR). The perioperative indexes, efficacy, and complications of the two groups were compared, and the changes in ocular surface, inflammatory response, and immune function of the patients before and 3 months after the surgery were observed. Results: The intraoperative bleeding, hospitalization cost, and 12-h postoperative visual analogue scale (VAS) score were lower, while the operative time and hospitalization time were shorter in modified group than in the conventional group (P<0. 05). The total treatment efficacy was higher (91. 67%) in the modified group than in the conventional group (72. 58%), and the recurrence rate was lower in the modified group (4. 17%) than in the conventional group [16. 13%, P<0. 05]. The ocular surface symptom scores, Schirmer I test, tear breakup time, degree of tear overflow scores were lower in the modified group than in the conventional group at 3 months postoperatively (P<0. 05),soluble interleukin-1β, , interleukin-6, high-sensitivity C-reactive protein, CD8+ levels were lower, and CD3+, CD4+, CD4+/CD8+ levels were higher in the modified group than in the conventional group at 3 months postoperatively (P<0. 05). At 3 months postoperatively, the scores of activity impairment, general health, and visual status on the National Eye Institute 25-Item Visual Function Questionnaire were higher in the modified group than those in the conventional group (P<0. 05). The overall complication rate in the modified group (8. 33%) was not different from that in the conventional group [14. 52%, P>0. 05]. Conclusion: Modified DCR has the advantages of short operation time, less trauma, less pain and fewer complications, and is conducive to improving ocular surface function, reducing inflammatory response, and improving immune function and quality of life of patients.

Background: Recent studies haveshownan increasing incidence of antibiotic resistance in DACRYOCYSTITIS. Managementof diseases may include determining microbial agents and choosing appropriate antibiotics for treatment. Objectives: This study aimed to present the best treatments for DACRYOCYSTITIS. To this end, specimens’ microbiology and antibiotic susceptibility were examined in patients with DACRYOCYSTITIS in the microbiology laboratory of the Kashan University of Medical Sciences. Methods: This cross-sectional study was performed on 172 patients presenting with acute and chronic DACRYOCYSTITIS at the Matini Hospital, Kashan, between 2017-2018. Patient characteristics, culture isolates, and antimicrobial susceptibility data were collected. The PCR assay of the mecA gene was performed in all methicillin-resistant Staphylococcus isolates. Results: The most common bacteria were coagulase-negative staphylococci (CoNS), Staphylococcus aureus, Pseudomonas aeruginosa, and Acinetobacter baumannii. The majority of the isolated microbes were sensitive to rifampicin, linezolid, amikacin, and gentamicin. In Gram-negative bacilli, nine of the isolates were extended-spectrum beta-lactamase positive. The PCR test showed the frequency of mecA gene of resistant S. aureus and resistant CoNS isolates to be 40 and 46. 3%, respectively. Conclusions: Coagulase-negative staphylococci were the most frequently isolated bacteria. The highest antibiotic susceptibility was observed to rifampin, linezolid, amikacin, and gentamicin. A high percentage of CoNS carried the mecA gene.

Background: Nasolacrimal duct obstruction (NLDO) is characterized by epiphora and recurrent episodes of acute DACRYOCYSTITIS. Despite the temporary effect of antibiotics in the acute phase, it is primarily managed by dacryocystorhinostomy (DCR). There is a new modification of external DCR that is performed without either anterior or posterior flaps. This study aimed to compare the outcomes of flapless and single-flap external DCR in adult patients with chronic symptomatic DACRYOCYSTITIS secondary to NLDO. Methods: In this retrospective, non-randomized, interventional, comparative study of patients with chronic DACRYOCYSTITIS secondary to primary acquired NLDO, we compared the surgical outcomes and complication rates of flapless external DCR to those of external DCR with only anterior flap suturing. We excluded patients who declined participation and those with soft stops, nasal problems, lid margin abnormalities, lid malposition or laxity, previous lacrimal surgery, lacrimal fistula, trauma involving the lacrimal drainage system, lack of adequate follow-up, or severe septal deviation or turbinate hypertrophy. Anatomical and functional success rates were determined at the last follow-up visit and were compared. Postoperative complications were recorded and compared between groups. Results: We included 53 patients with a male-to-female ratio of 16 (30. 2%) to 37 (69. 8%),25 eyes underwent flapless DCR (group 1) and 28 eyes underwent anterior flap suturing DCR (group 2). The two groups had comparable demographic characteristics (all P > 0. 05). Furthermore, anatomical (92. 0% in group 1 and 92. 9% in group 2) and functional (84. 0% in group 1 and 92. 9% in group 2) success rates at final follow-up were comparable between groups (both P > 0. 05). At the one-month postoperative examination, premature tube extrusion was more often reported in group 1 (12. 0%) compared to group 2 (7. 1%). At the two-month follow-up examination, tube extrusion was noted in 4. 0% in group 1 and 0. 0% in group 2, yet the difference failed to attain statistical significance (P > 0. 05). Conclusions: We found that neither surgical method was superior in terms of anatomical or functional success rate at a maximum of one year after external DCR. Flapless DCR is a simple, effective, and reproducible alternative to the single anterior flap suturing technique for managing NLDO in adults with chronic DACRYOCYSTITIS. However, further randomized clinical trials with larger sample sizes and longer follow-up periods are recommended before generalization can be justified.

INTRODUCTION: Blockage of the lacrimal drainage system results in impairment of normal tear channeling into the nose. Dacryocystorhinostomy (DCR) operation, which involves fistulization of the lacrimal sac into the nasal cavity, may alleviate the symptoms. The operative approach to the sac may be external or endoscopic. In endoscopic DCR, laser, rongeur, drill, curette and chisel have been used to remove the nasal mucosa, lacrimal bone and the thick bone of the maxilla forming the anterior lacrimal crest and lacrimal sac to establish lacrimal drainage. In this study we used suction cautery to remove nasal mucosa in bloodless field. METHODS: Suction cautery-assisted DCR was performed on 43 patients (31 female and 12 male) with chronic epiphora or DACRYOCYSTITIS who underwent operation during 2002-2003 in Kashani Hospital, Isfahan. The technique involved usage of suction cautery and true cut forceps for removal of mucosa and bone over the lacrimal sac. The follow-up period was 6-12 months and the patients had a mean age of 38.7 years. RESULTS: The endoscopic DCR was successful in 38 of the 43 cases (88.3%). Four cases of failure in the first operation were reevaluated in the second operation. Complete bony closure and reformed bone was observed in one of these cases. In the other three cases, adhesion of middle turbinate and rhinostoma was the cause of failure and the endoscopic technique was easily performed. DISCUSSION: Excellent patient tolerance was observed, with minimal morbidity and no major complications. As compared to the external approach, endoscopic suction cautery-assisted DCR is less traumatic, less time-consuming, practical and cosmetically convenient, with minimal preoperative and postoperative complications. It also allows simultaneous correction of any intranasal disease. It requires minimal instrumentation and is a relatively easy and fast technique.