PMC8383486_01
(A) Patient's face at the first visit shows redness and swelling around the nasal side of the left lower eyelid. (B) Plain computed tomography image shows ocular deformation due to an orbital abscess. (C) Scanning electron microscopy with energy dispersive X-ray spectroscopy images of the lacrimal sac concretion removed from the lacrimal sac of the patient in case 1 show sharp structures (left). The structures contain calcium phosphate. Purple indicates the distribution of phosphorus (upper right). Green indicates the distribution of calcium (lower right). (D) Infrared spectrophotometry of the lacrimal sac concretion removed from the lacrimal sac of the patient in case 1. The red line denotes the absorption curve of the lacrimal sac concretion and the blue line denotes that of rebamipide. The lacrimal sac concretion has specific infrared absorption bands overlapping with characteristic peaks of rebamipide at 3,280 (speech bubble 1), 1,644 (speech bubble 3), 1,602 (speech bubble 4), 1,540 (speech bubble 5), and 760 (speech bubble 6) cm-1.
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F1
Redness and swelling were observed around the nasal side of her left lower eyelid (Figure 1A). Plain computed tomography performed on the same day revealed a high-density mass in the lacrimal sac, ocular cellulitis, and ocular deformation due to an orbital abscess (Figure 1B). Scanning electron microscopy with energy dispersive X-ray spectroscopy (SEM-EDX) revealed calcium phosphate crystals with a sharp edge (Figure 1C). Infrared spectrophotometry revealed that the spectra of the lacrimal sac concretion demonstrated specific infrared absorption bands near 3,280, 1,644, 1,602, 1,540, and 760 cm-1, which overlapped with the characteristic peaks of rebamipide (Figure 1D).
PMC8383486_02
(A) Anterior segments of the patient in case 2 show conjunctival hyperaemia and chemosis. (B) Fundus photograph of the patient in case 2 shows retinal artery occlusion and optic disc atrophy. (C) Microscopic picture of the lacrimal sac concretion after Diff-Quik staining (x1,000) shows bacteria around the amorphous crystal-like structure. (D) Microscopic picture of the lacrimal sac concretion after fungiflora Y staining shows yeast-like fungi.
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F2
She was referred to Kindai University Hospital in late April 2018 with complaints of severe pain in the right eye, lid swelling, conjunctival hyperemia, and chemosis (Figure 2A), which had started 7 days prior to her visit. Fifteen days after her first visit, visual acuity of her right eye reduced to 20/1,000 due to retinal artery occlusion (Figure 2B), which occurred even after systemic administration of 0.1 g minocycline daily for 7 days. Light and fluorescence microscopy of the lacrimal sac concretion revealed unstained amorphous crystal-like structures, bacteria (Figure 2C), and yeast-like fungi (Figure 2D).