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PubMed1998

[Anatomical consideration for the injury of dacryocyst and nasolacrimal duct during intranasal sinus surgery].

Based on dissection and measurement on 20 adult head cadavers, there is the close relationship between lacrimal duct and lateral wall of the nasal cavity. The cells of anterior ethmoid sinus were classified into three degrees, according to the relationship between the anterior ethmoid sinus and the lacrimal sac fossa. The average distance is 6.74 +/- 1.72 mm between the nasolacrimal duct and the upper part of the uncinate process, 3.44 +/- 0.75 mm and 5.50 +/- 3.73 mm from the nasolacrimal duct to ethmoidal infundibulum and the maxillary ostium. The orifice of the duct most commonly opens under the insertion of the inferior turbinate anteriorly. To perform intranasal sinus surgery, the safest area and key operation approach were discussed.

Adult↗
PubMed1997

Treatment of congenital nasolacrimal duct obstruction before and after the age of 1 year.

BACKGROUND AND OBJECTIVES: The treatment of congenital nasolacrimal duct (NLD) obstruction continues to be a subject of controversy. Some authors advocate early probing and irrigation in an office setting, whereas others recommend that the procedure be performed under general anesthesia when the child is at least 1 year old. The focus of this study was to compare the results of probing and irrigation of congenital NLD obstruction among children younger than 1 year of age, those 1 to 2 years of age, and those older than 2 years. PATIENTS AND METHODS: The author reviewed the records of 120 patients, ranging in age from 3 weeks to 30 years, with 153 cases of NLD obstruction. Eighty-five patients (110 cases of NLD obstruction) underwent probing and irrigation. RESULTS: Complications of NLD obstruction occurred in 12 patients; 75% of these patients were younger than 1 year of age. In group 1 (patient age < 1 year) there were 37 probings with 1 failure (3%). Group 2 (patient age = 1-2 years) had 43 probings and 5 failures (12%). In group 3 (patient age > 2 years), 30 NLDs were probed with 2 failures (7%). However, these differences were not significant (P = .13 between groups 1 and 2; P = .42 between groups 1 and 3). CONCLUSION: In this study, the postponement of probing and irrigation for congenital NLD obstruction beyond the age of 1 year did not result in an increased rate of failures or complications.

Adolescent↗
PubMed1993

[Transsubmucosal maxilloethmoid sinus surgery through inferior turbinate (swinging of nasolacrimal duct and inferior turbinate)].

We recently devised a new technique for endonasal surgery, which simplifies maxillary antrotomy and ethmoidectomy, and dilates the middle nasal meatus widely enough to allow easier postoperative observation. Surgery is initiated by an incision similar to the one used for submucosal resection of the inferior turbinate. The bony inferior turbinate is resected, and the nasolacrimal duct is freed from the bone. Subsequently, the maxillary and ethmoidal sinuses are excenterated, with swinging of the membranaceous inferior turbinate and the nasolacrimal duct. Postoperative observation confirmed satisfactory results.

Adolescent↗
PubMed2006

Hydrostatic pressure as an office procedure for congenital nasolacrimal duct obstruction.

BACKGROUND: The estimated incidence of congenital nasolacrimal duct obstruction (CNDO) is 5% to 20%. We examined our success rate of treating CNDO with hydrostatic pressure (the Crigler method) as an office procedure. METHODS: A total of 742 children with CNDO initially were treated noninvasively with hydrostatic pressure. The procedure was safely repeated up to 3 times, with an interval of at least 1 week, if the condition persisted. RESULTS: Success was defined as no epiphora or discharge. The success rate for the entire study group was 45% for children up to 1 year of age. The ducts were opened in 46% (343/742) at the first attempt of hydrostatic pressure, in 35% (42/120) at the second attempt, and in 38% (8/21) at the third attempt. When the maneuver was performed in patients younger than 2 months of age, the success rate of the first attempt was 56%, decreasing to 46% in children 2 to 6 months of age and to 28% older than 6 months of age. CONCLUSIONS: Hydrostatic pressure is an effective way of resolving infant CNDO and shortening the duration of the associated morbidity. The success rate is higher when the procedure is conducted in patients up to 2 months of age. Nevertheless, we recommend this approach for every infant presenting with CNDO at the first office visit, even after 6 months of age. Procedures can be repeated safely and successfully.

Female↗
PubMed2005

Canalicular and nasolacrimal duct blockage: an ocular side effect associated with the antineoplastic drug S-1.

PURPOSE: To report canalicular stenosis as a side effect of the new antineoplastic agent S-1. DESIGN: Interventional case series. METHODS: Three patients who received S-1 for treatment of gastrointestinal cancer at a tertiary cancer center were evaluated and treated for epiphora. RESULTS: Two patients were found to have severe canalicular stenosis and nasolacrimal duct blockage after approximately 6 months of S-1 therapy. One patient underwent dacryocystorhinostomy with silicone tube placement on one side and dacryocystorhinostomy and Pyrex glass tube placement on the other side. The other patient declined a surgical intervention. One additional patient with epiphora had punctal stenosis early in the course of S-1 therapy. His epiphora resolved after probing and irrigation and 4 weeks of topical corticosteroid therapy. CONCLUSIONS: Canalicular and nasolacrimal duct blockage is a previously unreported side effect of S-1 and should be recognized and treated at its earliest possible stage so that complete closure of the canaliculi can be avoided.

Aged↗
PubMed1992

Surgical management of nasolacrimal duct obstruction in patients with Wegener's granulomatosis.

The treatment of symptomatic nasolacrimal duct obstruction in patients with Wegener's granulomatosis is controversial. Dacryocystorhinostomy has been effective in patients with long-standing quiescent disease but has been complicated by the formation of nasal-cutaneous fistulas in others. Dacryocystectomy may be an alternative if epiphora is absent. The authors report 13 lacrimal bypass surgeries in 9 patients with Wegener's granulomatosis; there were 10 operations with adequate follow-up and 6 surgical successes. Failure was related to a history of dacryopyocele, localized disease activity in the nose and upper airway, extensive periorbital disease, the use of non-maintenance therapy to contain disease activity, and prior surgical failure. The authors' experience suggests that dacryocystorhinostomy is therapeutically viable in patients with Wegener's granulomatosis; intervention is optimal when the disease is quiescent without medication and is probably reasonable if activity is controlled with maintenance therapy. Anticytoplasmic antibody titers are useful to guide the timing of elective surgery.

Adult↗
PubMedDate not supplied

Congenital nasolacrimal duct obstruction in Japanese infants: its incidence and treatment with massage.

We examined the patency of 670 nasolacrimal ducts in 335 newborn infants--42 patients (62 ducts) had obstructions; the involvement was unilateral in 22 and bilateral in 20. No sexual predilection was noted. All affected patients were treated with hydrostatic massage at the area of the lacrimal sac. About two-thirds of the ducts became patent by 2 months after birth, while the remainder became patent by 9 months. Only one patient who had acute dacryocystitis at age 5 months required a probing of the duct and a regimen of systemic antibiotics to achieve good results.

Female↗
PubMed2005

Localized orbital amyloidosis involving the lacrimal sac and nasolacrimal duct.

PURPOSE: To report the case of a 70-year-old man who presented with tearing in his left eye and a firm palpable lump in the area overlying his left lacrimal sac. DESIGN: Retrospective interventional case report. METHODS: Noninvasive diagnostic evaluation followed by external dacryocystorhinostomy, histopathologic studies, and systemic evaluation. RESULTS: The patient was found to have idiopathic localized amyloidosis limited to the lacrimal sac and nasolacrimal duct. CONCLUSION: The localized form of amyloidosis is rare, typically involves the head and neck without systemic manifestations, and carries an excellent prognosis. Previous reports of orbital amyloidosis have described involvement of the lacrimal gland, extraocular muscles, and the cranial nerves. To our knowledge, this is the first report of a patient with nasolacrimal duct obstruction secondary to amyloid deposition in the lacrimal sac and fossa.

Aged↗
PubMed2004

Nasolacrimal duct obstruction secondary to dermatofibrosarcoma protuberans.

OBJECTIVE: To describe a patient wtih dermatofibrosarcoma protuberans causing a nasolacrimal duct obstruction (NLDO). DESIGN: Case report. PARTICIPANT: A 33-year-old female with an NLDO. RESULTS: We report a patient with NLDO as the presenting sign of a rare tumor of the skin, dermatofibrosarcoma protuberans. The patient presented with epiphora, and after dacryocystorhinostomy was done, histopathology revealed dermatofibrosarcoma protuberans. The clinical course, magnetic resonance imaging, and histopathology are discussed. CONCLUSION: Obstruction of the lacrimal drainage system can be seen with dermatofibrosarcoma protuberans.

Adult↗
PubMed1990

Nasolacrimal duct obstruction after endoscopic sinus surgery.

Intranasal endoscopic sinus surgery has several potential ocular complications, including visual loss, diplopia, retrobulbar hemorrhage, and epiphora. We treated eight patients with persistent nasolacrimal duct obstruction after endoscopic sinus surgery. All patients required dacryocystorhinostomy to achieve a patent lacrimal system drainage. To our knowledge, this is a previously unreported complication in the ophthalmologic literature. The relevant anatomy of the nasolacrimal duct is discussed in addition to surgical procedures for avoidance and treatment of iatrogenic injury to the system. Endoscopic sinus surgery is a highly successful procedure that is rapidly gaining popularity among otolaryngologists. As the number of patients undergoing this type of surgery increases, an increase in the relative number of ocular complications should be anticipated.

Adult↗
PubMed2002

Treatment of nasolacrimal duct obstruction with polyurethane stent placement: long-term results.

OBJECTIVE: The purpose of this study was to evaluate the long-term efficacy of polyurethane stent placement in adults with nasolacrimal duct obstruction. SUBJECTS AND METHODS: Polyurethane stents were placed under fluoroscopic guidance in 52 eyes of 49 patients (mean age, 43 years) with severe epiphora due to idiopathic nasolacrimal duct obstruction. The obstruction was complete in 44 eyes and partial in eight. Clinical success was defined as complete resolution of or great improvement in the symptoms of epiphora and the patency of the lacrimal system to irrigation. Mean follow-up was 23 months (range, 14-44 months). RESULTS: Stent placement was technically successful in 50 eyes (96%). The mean fluoroscopy screening time was 2.2 min (range, 0.2-5.8 min). Two patients were lost to follow-up. Clinical success was obtained in 33 (69%) of 48 eyes. Lacrimal symptoms developed in 23 (70%) of these 33 eyes at least once during the follow-up, but these patients responded well to topical drug treatment and lacrimal irrigation. External dacryocystorhinostomy was performed in 13 eyes after failure of the stents. At surgery, lacrimal sacs were shrunken, hyperemic, and fragile in all eyes, making it difficult to anastomose with nasal mucosa. Histologic examination showed granulation tissue and chronic inflammation of the sac epithelium. CONCLUSION: The success rate of the nasolacrimal stent decreases as follow-up lengthens. After stent treatment, lacrimal symptoms frequently develop, even if the stent remains patent, and require multiple office visits and therapy. The polyurethane stent may induce a chronic inflammatory response in the lacrimal sac, which can interfere with subsequent dacryocystorhinostomy.

Adult↗
PubMed2005

Treatment of congenital nasolacrimal duct obstruction with high-pressure irrigation under topical anesthesia.

PURPOSE: To evaluate the effectiveness, safety, and success rate of high-pressure irrigation (HPI) applied under topical anesthesia in outpatient treatment of congenital nasolacrimal duct obstruction. METHODS: HPI was applied under topical anesthesia to 39 eyes of 32 consecutive patients with congenital nasolacrimal duct obstruction. If obstructive symptoms persisted after the first attempt, treatment was repeated within 1 month. Patients were divided in two age groups: 7 to 12 months and 12 to 18 months. The two groups were compared in terms of the number of attempts needed to resolve the obstruction. RESULTS: Thirty-nine eyes that had failed conservative treatment underwent high-pressure irrigation. The overall success rate was 31 of 39 (79.48%) at the first attempt; complete success (8/8, 100%) was achieved at the second attempt. The success rate in the younger group was 18 of 22 (81.8%) at the first attempt and 4 of 4 (100%) at the second attempt. The success rate in the older group was 13 of 17 (76.5%) at the first attempt and 4 of 4 (100%) at the second attempt. There was no statistically significant difference between the two groups regarding the number of attempts needed to relieve the symptoms (p > 0.05). There was no statistically significant difference in massage times and age between cases resolved at the first and second attempts (p > 0.05). CONCLUSIONS: HPI can be attempted as an alternative second-step treatment or as a transition procedure between conservative and invasive methods. HPI has the advantage of being less invasive than other secondary methods, and its application under topical anesthesia seems to be safe and effective.

Anesthesia, Local↗
PubMedDate not supplied

Outcome of late probing for congenital nasolacrimal duct obstruction in Singapore children.

OBJECTIVE: To evaluate the outcome of late probing in a mixed Asian children population with congenital nasolacrimal duct obstruction (CNLDO) and whether probing was associated with an increased risk of infection. METHOD: A retrospective clinical study was conducted. A clinical diagnosis of CNLDO was defined in an infant who presented with a history of tearing and/or eye discharge up to 1 year of age with no other accompanying ocular pathology. All patients with a presumed diagnosis of CNLDO who had probing after 12 months of age were included in our study. Prior to probing, most patients had a trial of conservative treatment with massage and/or topical antibiotics. Intra-operative patency of probing was determined when metal to metal contact of the probe and forceps was achieved and/or when fluorescein dye was recovered from the nose after syringing. Successful probing was defined as a resolution of symptoms within 1 month after probing. RESULTS: Seventeen patients involving 19 eyes fulfilled our inclusion criteria for this study. Fourteen (82%) infants were Chinese, two Malays (12%) and the remaining one Indian (6%). There were 10 males (59%) and 7 females (41%) and the mean age at probing was 2.2 years (range, 14 months to 5 years 6 months). The subjects were followed-up post-operatively for a mean duration of 21.2 months (range, 2 months to 8 years). Successful probing in our series was 89.5% (17/19 eyes). Of the two eyes with persistent tearing, one resolved with massage about 9 months after the unsuccessful probing; the other was referred to the oculoplastic service for further management. CONCLUSION: Late probing after 13 months old appears to be an effective approach in the management of CNLDO in Asian infants.

Child, Preschool↗
PubMed1997

An anatomical basis for primary acquired nasolacrimal duct obstruction.

OBJECTIVE: To measure any sex size differences in the bony nasolacrimal drainage systems in a normal, age-matched population. METHODS: A retrospective study of axial cut maxillofacial computed tomographic scans was conducted. Three levels of the bony nasolacrimal duct (NLD) system on the right and left sides were measured along the anteroposterior diameter. The data were analyzed using 2-tail t test, analysis of variance, and linear regression methods. RESULTS: Scans from 71 adult patients (36 men and 35 women) were reviewed. Women were found to have a smaller bony diameter at the level of the lower fossa (P = .01) and the middle NLD (P = .06) compared with those of men. The adult inferior bony fossa increased in size with age in both men and women, while the middle NLD increased in size in men only. No significant size difference was found between the right and left side at any level. CONCLUSIONS: Size differences are found in measurements of bony nasolacrimal excretory systems in men vs women. Women have significantly smaller dimensions in the lower nasolacrimal fossa and the middle NLD. The anteroposterior dimension of the bony nasolacrimal canal at the fossa level enlarged in both sexes, with age co-inciding with osteoporotic changes throughout the body. These quantitative anatomical observations provide a contributory factor to explain the increased prevalence of primary acquired NLD obstruction in women.

Adult↗
PubMed2006

A symptom survey and quality of life questionnaire for nasolacrimal duct obstruction in children.

PURPOSE: To develop and validate a new parental questionnaire addressing symptoms and health-related quality of life (HRQL) in childhood nasolacrimal duct obstruction (NLDO). DESIGN: Cross-sectional study. PARTICIPANTS: Children ages 6 to younger than 48 months with and without clinical signs of NLDO. METHODS: A new questionnaire was developed using semistructured interviews with parents of children with NLDO and through discussions with expert clinicians. Questionnaires were completed by parents of children with and without NLDO. Cronbach's alpha was calculated as a measure of internal-consistency reliability. Factor analysis was used to evaluate a priori subscales: symptoms and HRQL. Discriminant construct validity was assessed by comparing questionnaire scores between children with and without NLDO and between affected and unaffected eyes of children with unilateral NLDO. Instrument responsiveness was determined by comparing presurgical and postsurgical intervention scores in a subset of NLDO patients who underwent surgical treatment. MAIN OUTCOME MEASURE: The NLDO questionnaire score. RESULTS: Eighty-seven children were enrolled, 56 with and 31 without NLDO. All but 2 questions on the questionnaire showed a good distribution of responses, a high correlation with the rest of the questionnaire, and excellent discrimination between patients with and without NLDO. Cronbach's alpha values were good for the overall questionnaire (0.95), and for 2 predetermined subscales: symptoms (0.95) and HRQL (0.85). On a 0 to 4 scale, NLDO patients had worse scores compared with non-NLDO patients for both symptoms (mean difference, 2.1; 95% confidence interval [CI], 1.9-2.3) and HRQL (mean difference, 1.2; 95% CI, 0.9-1.5) subscales. The NLDO patients had worse scores before intervention compared with after intervention for both the symptoms (mean difference, 2.2; 95% CI, 1.6-2.9) and HRQL (mean difference, 1.4; 95% CI, 0.8-2.1) subscales. Finally, NLDO patients had worse symptom scores for affected eyes compared with unaffected eyes (mean difference, 2.3; 95% CI, 1.9-2.6). CONCLUSIONS: This novel NLDO questionnaire is useful in quantifying parental perception of symptoms and HRQL in childhood NLDO. The questionnaire may have a role in future clinical studies of NLDO.

Child, Preschool↗
PubMed1989

Obstruction of nasolacrimal ducts closely related to graft-versus-host disease after bone marrow transplantation.

A 2-year-old boy underwent bone marrow transplantation for severe aplastic anemia. Eighteen months later he developed chronic lung disease and dryness of the eyes. Ophthalmologic examination revealed obstruction of the nasolacrimal ducts and marked dilatation of the lacrimal sacs bilaterally. It seems likely that the nasolacrimal duct obstruction was a manifestation of chronic graft-versus-host disease.

Anemia, Aplastic↗
PubMed1990

[Antibiotic therapy in congenital obstruction of the nasolacrimal duct].

Forty-eight children aged from 4 to 11 months, affected by Congenital Nasolacrimal Duct Obstruction (CNDO), treated successfully by local hydrostatic massage, were retrospectively included in two groups: Group A treated by massage and antibiotic eye drops, Group B treated by massage only. The comparison shows a quicker resolution of the CNDO when antibiotic eye drops are administered. The Author stresses the utility of topical antibiotic therapy regardless of the presence of mucopurulent discharge.

Anti-Bacterial Agents↗