Lacrimal sac rhinosporidiosis
Description
INTRODUCTION
The Rhinosporidium seeberi epidemic in South India is the cause of the chronic mucocutaneous granulomatous illness known as rhinosporidiosis.
Originally categorised as a fungus, it is currently included within the Mesomycetozoa clade, which includes aquatic protistan parasites.
Common locations include the nasal mucosa (70–75%) and the eyes (15%).
The most common areas affected by ocular rhinosporidiosis, also known as "oculosporidiosis," are the conjunctiva (69%), lacrimal sac (24%), canaliculi (4%), and lids/sclera (4%).
Direct extension from the nose through the nasolacrimal duct or canaliculi is how it spreads.
rarely affects the lacrimal sac; the first instance was documented in 1916.
Clinical Features:
The patient is a male of 35 years old.
History: Nasal rhinosporidiosis was treated with surgery five years ago.
Among the symptoms is epiphora, or watering of the left eye.
The medial canthus region was pain-free for eight months.
No prior medical history of trauma, fever, discharge, nasal obstruction, eye changes, or diplopia.
Examination:
Soft, oval, doughy, non-tender, fluctuant swelling in left lacrimal sac region (medial canthus → infraorbital).
Pressure causes fluid to regurgitate from puncta.
EOM and visual acuity are normal.
The other ENT test is normal.
Investigations:
No nasal mucosal lesions were seen during the diagnostic nasal endoscopy (DNE).
CT (contrast-enhanced): Lacrimal sac lesion, ovoid, peripherally enhancing, centrally non-enhancing.
No erosion of bones.
Histopathology (HPE): Under stratified squamous epithelium, many sporocysts and sporangia in various stages.
For R. seeberi, this is confirmed.
Distinctive Diagnosis:
rhinosporidiosis of the lacrimal sac.
mucocele of the lacrimal sac.
tumour of the lacrimal sac.
mucocele that is ethmoidal.
Protocol
Treatment
The preferred course of therapy, surgical management:
Endoscopic dacryocystorhinostomy (DCR) of the left endonasal region.
total bulk removal.
The sac's medial wall was removed.
Electrocauterization of the nasolacrimal duct wall and adjacent margins.
Medical treatment: 100 mg of dapsone daily for three months.
Dapsone lowers recurrence, causes stromal fibrosis, and stops spore maturation.
Other (less effective) agents include povidone-iodine (5%), trimethoprim-sulphadiazine, and ketoconazole.
Problems Faced by Patients
Swelling and Painless Mass: As seen in the case study, patients may experience a doughy, fluctuating swelling in the medial canthus that occasionally extends to the infraorbital area.
Tearing and Epiphora: When the lacrimal sac is blocked, the eyes water continuously, which interferes with day-to-day activities.
Risk of Recurrence: It is known that rhinosporidiosis can recur, particularly if spores are left behind or if total excision is not accomplished during surgery.
Psychological Distress: Patients may experience worry or dread as a result of unusual swelling and persistent symptoms.
Medical and Surgical Management
Diagnosis: To determine the extent, contrast-enhanced CT scans, diagnostic nasal endoscopy, and clinical examination are utilised. Histopathological analysis provides a conclusive diagnosis.
Surgical Excision: To remove any remaining infectious tissue and stop recurrence, standard treatment involves total surgical excision, frequently performed by endonasal endoscopic dacryocystorhinostomy (DCR), along with electrocauterization.
Medical Therapy: To prevent recurrence, oral dapsone (100 mg/day for three months) is administered after surgery. This stops spore maturation and encourages fibrosis.
Follow-up: To identify recurrence early, regular monitoring over a number of years is required.
Nursing Interventions and Strategies Preoperative Care:
Assure the patient by allaying their concerns about oedema and potential recurrence.
Help with diagnostic tests (such as CT and nasal endoscopy) while making sure the patient is comfortable.
Postoperative Care: Keep an eye out for wound healing, infection, and bleeding.
Administer prescription drugs, like dapsone, and keep an eye out for side effects, like methemoglobinemia.
Inform the patient about wound care and recurrence indicators, such persistent discharge or oedema.
For long-term monitoring, make sure to schedule frequent follow-up sessions.
Patient Instruction:
In order to lower the risk of reinfection, emphasise the value of good hygiene, particularly the need to avoid bathing in potentially contaminated water sources.
Give advice on possible adverse effects and drug adherence.
Psychological Support: To lessen worry, offer emotional support by outlining the nature of the illness and the anticipated results.
Notes
For more details visit https://pmc.ncbi.nlm.nih.gov/articles/PMC8240581/
