Investigations for patients undergoing lacrimal surgery.
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Dacryocystorhinostomy↗
Biomedical subjects
R A Welham
Publications and source records attributed to R A Welham.
Paediatric dacryocystorhinostomy.
Of 258 cases of dacryocystorhinostomy performed on children in the period September 1981 to September 1991, 130 were for simple, unresolved congenital nasolacrimal duct obstruction. Other indications for surgery included punctal agenesis, lacrimal fistula, post-traumatic and post-inflammatory canalicular obstruction. Of 177 children without canalicular pathology, 171 (96%) were relieved of symptoms with one operation, without canalicular intubation. Of 81 cases with canalicular disease, 55 of 70 (79%) who underwent DCR plus canalicular intubation, and 10 of 11 who underwent DCR plus Lester-Jones tube, were substantially improved with one operation. No child required peroperative or postoperative blood transfusion. Dacryocystorhinostomy in childhood, in experienced surgical hands, is a safe procedure, achieving relief of symptoms in most cases, particularly in the absence of canalicular disease.
Adolescent↗
The management of punctal agenesis.
BACKGROUND: Agenesis of one or more lacrimal puncta is a rare cause of presentation to ophthalmologists. Where normal canalicular tissue lies within the lid, it may occasionally be successfully exteriorized to the conjunctival surface with relief of symptoms. The pattern of punctal agenesis, its relationship to the presence of underlying canalicular tissue, and its management have not been defined previously in a large cohort. METHODS: The authors reviewed the pattern of agenesis, underlying anatomic abnormalities and patient symptomatology in 57 patients seen over a 10-year period. A management plan was devised for eyes with no puncta and those with a single missing punctum. RESULTS: Both puncta were absent in 53 eyes, and a single punctum was missing in 41 eyes. In 86% of eyes with absence of both puncta, no canalicular tissue was identified when the lacrimal sac was opened at surgery. The underlying canaliculus also was absent in patients with one absent punctum. Nasolacrimal duct obstruction frequently accounted for the onset of symptoms in patients with a single punctum. Fifty-three (93%) of the 57 operated eyes were functionally cured at the completion of this report. CONCLUSION: Punctal agenesis usually is associated with the absence of underlying canalicular tissue. Where both puncta are absent, the authors recommend inspection of the internal opening of the common canaliculus at surgery and, if no canalicular tissue can be identified (86% in this series), insertion of a Lester-Jones tube. Symptomatic patients with a single punctum frequently require surgery to relieve nasolacrimal rather than canalicular obstruction.
Adolescent↗
Centurion syndrome. Idiopathic anterior displacement of the medial canthus.
PURPOSE: To describe a series of patients with epiphora due to a medial canthal anomaly. This anomaly consists of an anterior displacement of the anterior limb of the medial canthal tendon and a prominent nasal bridge, with lid malposition away from the globe and displacement of the lacrimal puncta out of the tear lake. The authors use the term Centurion syndrome to describe this anomaly. METHODS: The history, results of examination, investigations, and surgical management and outcome of 13 patients with Centurion syndrome were reviewed. Seven patients were recalled for examination to complete patient details. RESULTS: All patients had epiphora since childhood, which worsened at puberty, and all were patent to syringing. Lacrimal scintillography (ten cases) showed a functional block at the inner canthus, with hold up of activity before entry into the sac. Surgery to restore lid globe apposition medially by release of the anterior limb of the medial canthal tendon (eight patients), sometimes combined with dacryocystorhinostomy (four patients), relieved the epiphora. CONCLUSION: There is a group of patients with unexplained epiphora due to a medial canthal anomaly, which the authors have termed Centurion syndrome. It is important to recognize this anomaly, as it can be corrected surgically by medial canthal tendon release or by medial canthal tendon release combined with dacryocystorhinostomy if there is concomitant lacrimal outflow obstruction.
Adolescent↗
Congenital lacrimal fistula.
Congenital lacrimal fistula is a rare developmental condition. Patients may be asymptomatic or have tearing from the fistula, the eye or both. The clinical features of 60 patients are reviewed, including presenting symptoms, presence of other lacrimal or systemic anomalies and morphology of the fistula. A detailed description is given of the surgical technique utilised in patients whose symptoms warrant surgical intervention. The results of this technique are presented and alternative treatment strategies are discussed. Theories of the aetiology of the condition are reviewed and morphological and histological evidence is presented to support our belief that congenital lacrimal fistulae represent aberrant canaliculi.
Adolescent↗
Jones' lacrimal canalicular bypass tubes: twenty-five years' experience.
The results after implantation of Lester Jones canalicular bypass tubes in 326 eyes (310 patients) are reviewed. The bypass tubes were implanted after canalicular obstruction from a variety of causes, of which post-herpetic or post-traumatic obstruction accounted for one-half of all cases. With up to 23 years' follow-up, replacement of the bypass tube was needed in 142 (44%) patients, the majority after spontaneous loss. The median interval to first replacement may be estimated as about ten years for spontaneous loss and five years for all causes. Despite complications and the need for further surgery in many patients, most patients (91%) were pleased with the functional result of surgery. The principles, techniques and complications of lacrimal canalicular bypass surgery are presented and the long-term care of bypass prostheses is discussed.
Adolescent↗
The EEC syndrome and its ocular manifestations.
The EEC syndrome (ectrodactyly or lobster-claw deformity, ectodermal dysplasia, and cleft lip and palate) is a rare disorder with autosomal dominant inheritance, variable expression, and in some families lack of penetrance. We present the findings in five cases with emphasis on the ocular findings. Lacrimal surgery was performed on three patients with good results in each case. We also report the occurrence of spontaneous corneal perforation in two cases, a complication not previously recognised. The ophthalmic care of these patients must be pursued long-term, as progressive visual impairment may be the most disabling feature of the syndrome.
Abnormalities, Multiple↗
Congenital double lacrimal fistula.
A case of congenital double lacrimal fistula is herein reported. Both fistulae were noted at the time of surgery to connect to the common canaliculus. To the best of our knowledge, this is the only case of a double fistula that has been reported.
Child, Preschool↗
Management of unsuccessful lacrimal surgery.
Two hundred and eight cases of failed dacryocystorhinostomy presenting to the Lacrimal Clinic at Moorfields Eye Hospital between 1970 and 1985 were reviewed. All cases underwent a further operation. The reasons for failure were usually apparent on reoperation. The surgical technique is described. A second dacryocystorhinostomy is a highly successful technique that spares both patient and surgeon the lifelong commitment to a bypass tube.
Adult↗
Lacrimal surgery in children.
Of 142 children who underwent major lacrimal surgery (160 dacryocystorhinostomies, one congenital fistula excision, one dacryocystectomy, and one canaliculostomy), 49 had congenital nasolacrimal duct obstruction (34%). Lacrimal obstruction was also associated with canaliculitis, punctal agenesis, trauma, congenital fistula, dacryocystitis, craniofacial defects, and functional eyelid abnormalities. Although the timing and technique of the surgery varied according to the abnormalities, an overall functional success rate of 90% (144 of 160 procedures) was achieved.
Adolescent↗
Congenital lacrimal fistulas.
Twenty-one patients had surgical procedures for symptomatic cogenital lacrimal fistulas. The symptoms were epiphora from birth in 18 patients and late-onset epiphora in three cases. Thirteen patients had nasolacrimal obstruction at the upper duct or sac level. There were 21 dacryocystorhinostomies with fistula excision and canalicular intubation, and one patient had excision of the fistula tract only. The fistulas originated from the tear sac in only four cases and from the common canaliculus in 17; in one, the upper and lower canaliculus and the lacrimal fistula each had a separate opening into the lateral sac wall. The functional success rate was 95%. We recommend dacryocystorhinostomy with common canalicular dissection, fistula excision, and canalicular intubation for all patients with symptomatic congenital lacrimal fistulas to facilitate outflow and to avoid common canalicular obstruction.
Adolescent↗
The Lester-Jones tube: a 15-year follow-up.
The indications for and long-term results of about 200 Lester-Jones tube insertions are reported. Follow-up was possible in 165 patients, of which 83% ended up with a comfortable dry eye. Reimplantations had been necessary in a certain percentage, dependent upon the primary cause of epiphora. The best results were achieved after herpetic canalicular obstructions, and the highest ratio of complications occurred when unsuccessful lacrimal surgery had been the indication for bypass surgery.
Dacryocystorhinostomy↗
Lacrimal canalicular papillomatosis.
Three new cases of lacrimal canalicular papillomatosis are reported and the total of 12 cases in the literature reviewed. They present with epiphora or a local mass. Multiple recurrences over many years is characteristic. A minority have papillomata of the conjunctiva or lacrimal sac. Histopathological examination shows a benign papilloma with a fibrovascular stalk. Treatment was either multiple excision or cryotherapy, but neither affected the rate of occurrence. A viral aetiology is postulated in some cases.
Adult↗
Lacrimal canalicular obstruction following chickenpox.
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Chickenpox↗
The immediate management of injuries to the lacrimal drainage apparatus.
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Humans↗
Epiphora after irradiation of medial eyelid tumors.
Thirteen patients had severe epiphora after undergoing radiation therapy for medially located basal cell epitheliomas. All 13 had obstructions of both upper and lower canalicular systems, usually in the lateral one-third. Twelve of the patients became symptom-free after dacryocystorhinostomy with the insertion of a Jones tube. The symptoms of one patient who had a medial obstruction were relieved after a canaliculodacryocystorhinostomy.
Adult↗
Herpetic canalicular obstruction.
Viral infection is a common cause of acquired obstruction of the lacrimal canalicular system. A series of 20 patients with canalicular obstruction attributable to infection with herpes simplex is reported, and 1 case is described in detail.
Adolescent↗
Quantitative lacrimal scintillography.
In a study of 100 asymptomatic lacrimal systems, we have found that quantitative lacrimal scintillography provided a sensitive and reproduceable test of canalicular function. This technique, at the present time, appears to have no role in the clinical evaluation of tear passage through the nasolacrimal duct to the nose. A revision of the currently accepted theory of lacrimal drainage is proposed. Lacrimal drainage is best approached as a bimodel system. The first part, from conjunctiva to lacrimal sac, is dependent upon the "lacrimal pump." The second part, by which tears drain from the sac to the inferior meatus of the nose at basal tearflow levels, is dependent on gravity and the resistance of the nasolacrimal duct.
Adolescent↗