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PubMedDate not supplied

Conservative management of congenital nasolacrimal duct obstruction.

Fifty-nine children 1 to 24 months of age with congenital nasolacrimal duct obstruction (CNDO) were treated with local hydrostatic massage and antibiotic eye drops. Children 1 to 12 months of age showed a cure rate of 93.3%; only two of them underwent nasolacrimal probing. Children 13 to 24 months of age had a cure rate of 79.3%, and six underwent probing. The initial probings were successful in both age groups. Fifty-one children (86.4%) were thus spared nasolacrimal probing.

Anti-Bacterial Agents↗
PubMed1986

[Concretions in the nasolacrimal duct and lacrimal sac].

Report on six patients with concretions in the lacrimal sac and the nasolacrimal duct. It was possible to remove the concretions in four patients by irrigation of the nasolacrimal sac with cortisone solutions. In one patient a dacryocystostomy was necessary.

Adult↗
PubMed1991

Congenital nasolacrimal duct cysts in dacryocystocele.

Cystic intranasal masses were found in seven newborn infants with congenital dacryocystocele. The cysts were a direct extension of the nasolacrimal duct, located beneath the inferior turbinate. Nasal obstruction was present in three infants and was severe enough to cause respiratory distress in two neonates with bilateral cysts. Using fiberoptic nasal endoscopy, treatment consisting of probing, irrigation, and marsupialization of the cysts was successful in all infants. The authors believe this rarely reported anomaly is a more common finding in dacryocystocele than previously recognized and advocate careful nasal examination in all infants with congenital dacryocystocele. Early diagnosis and treatment of this condition is critical in the infant with nasal obstruction.

Cysts↗
PubMed2006

Nasolacrimal duct lavage in rabbits.

Eye problems are common in both laboratory and pet rabbits. This column reviews the anatomy of the nasolacrimal duct system in rabbits and describes the appropriate techniques for working up a rabbit with an ocular problem related to nasolacrimal drainage.

Animals↗
PubMed2006

Paediatric endoscopic endonasal dacryocystorhinostomy in congenital nasolacrimal duct obstruction.

OBJECTIVES: The objectives of this study were to report a series of paediatric patients who underwent endoscopic endonasal dacryocystorhinostomy (DCR) for primary congenital nasolacrimal duct obstruction (NLDO). METHODS: This is a retrospective, noncomparative review of all consecutive cases in two lacrimal clinics between January 1999 and October 2004. The main outcome measures were patients' demographics, previous treatments, clinical presentation, operative and postoperative complications, postoperative follow-up and resolution of epiphora. RESULTS: Twenty-one patients (15 males) with a mean age of 6+/-3.5 years (range, 2-14 years) underwent 26 endoscopic DCR operations for congenital NLDO. Sixteen cases were unilateral, and five were bilateral. In 13 cases (50.0%), there was a history of epiphora and chronic dacryocystitis with or without a mucocele. Two cases (7.7%) presented with acute dacryocystitis, and 11 (42.3%) had only a history of epiphora. Previous procedures included probing and irrigation in 25 cases (96.2%) and insertion of Crawford tubes in 19 cases 973.1%). During a mean postoperative follow-up period of 18+/-8 months, the anatomical success rate (free flow of fluorescein sodium and patency of ostium on nasal endoscopy) was 100%, and the clinical success rate (resolution of epiphora) was 92.3%. CONCLUSION: Endoscopic endonasal DCR is an effective treatment modality for congenital NLDO that compares favourably with the reported success rates of external DCR.

Adolescent↗
PubMed2004

Modified endoscopic dacryocystorhinostomy with posterior lacrimal sac flap for nasolacrimal duct obstruction.

OBJECTIVES: To evaluate a new technique of modified endoscopic dacryocystorhinostomy involving the creation of a large posterior flap at the lacrimal sac and to compare its success rate with that of the conventional endoscopic method of excising the entire medial lacrimal sac wall as a surgical treatment for epiphora caused by nasolacrimal duct obstruction. DESIGN: Retrospective, interventional, and comparative case series. SETTING: University teaching hospital, Hong Kong. PATIENTS AND METHODS: Only adults with primary nasolacrimal duct obstruction were included. Consecutive endoscopic dacryocystorhinostomy was performed using two different techniques from July 1999 to June 2001. The new technique involved the creation of a large posterior flap at the medial lacrimal sac wall, reflecting it posteriorly, followed by removal of the remaining small anterior flap (the LSF group). Other patients had the entire medial lacrimal sac wall excised (the ELS group). MAIN OUTCOME MEASURES: Surgical success was defined by free fluorescein drainage from the conjunctival sac into the rhinostomy site at least 3 months after silicone stent removal. RESULTS: Ninety-nine procedures were performed in 99 patients. The success rate was 89.1% (41/46) in the LSF group and 71.7% (38/53) in the ELS group. The difference between the two groups was statistically significant (Chi squared test, P=0.031). CONCLUSIONS: Our new and modified technique of endonasal dacryocystorhinostomy has a greater success rate than conventional endonasal dacryocystorhinostomy. A large-scale prospective randomised controlled trial to further evaluate the efficacy and safety of this surgical technique is under way.

Adult↗
PubMed2006

Prospective controlled study of vapor pressure tear osmolality and tear meniscus height in nasolacrimal duct obstruction.

PURPOSE: To determine tear osmolality (TO) and tear meniscus height (TMH) in patients with functional (FNLDO) and primary acquired (PANDO) nasolacrimal duct obstruction. Additionally, to determine the effect of successful dacryocystorhinostomy surgery on these tear parameters. DESIGN: Prospective case-controlled interventional case series. METHODS: Up to 20 microl of basal tears were collected from 20 age- and gender-matched control subjects, 33 patients with FNLDO, 28 patients with PANDO, and 31 patients after successful dacryocystorhinostomy. TMH was measured with videoreflective dacryomeniscometry, and TO was measured with vapor pressure osmometry. RESULTS: Thirty-nine percent of the patients with FNLDO (13/33) elected to undergo dacryocystorhinostomy surgery, compared with 64% of the patients with PANDO (18/28; P = .09). TMH was significantly higher in the disease groups (FNLDO median, 630 +/- 187 microm; PANDO median, 620 +/- 210 microm) compared with the control subjects (median 262 +/- 50 microm; P < .01). In those patients who underwent surgery, TMH was slightly higher in FNLDO than PANDO (P = .08), and TMH reduced significantly after surgery (P < .05). Mean TO in the control subjects was 313 +/- 17 mmol/kg, in FNLDO was 309 +/- 19 mmol/kg, and in PANDO was 315 +/- 24 mmol/kg (P > .05). TO was similar in those patients who progressed to surgery compared with the total group and was unaffected by surgery. CONCLUSION: TO was similar in normal control subjects and in the watery eye group and was unchanged after dacryocystorhinostomy surgery. Despite the slightly higher TMH in patients with FNLDO, a higher proportion of patients PANDO elected to have surgery. Relative to FNLDO, patients with PANDO who progressed to surgery had lower TMH and normal TO, which suggests that a complete lacrimal drainage obstruction induces negative feedback that results in no reduction in TO.

Aged↗
PubMed2005

External versus endoscopic dacryocystorhinostomy for acquired nasolacrimal duct obstruction in a tertiary referral center.

PURPOSE: To compare success rates of external dacryocystorhinostomy (DCR) and endoscopic endonasal DCR for acquired nasolacrimal duct obstruction (NLDO). DESIGN: Retrospective, comparative, nonrandomized clinical study. PARTICIPANTS: One hundred forty-three patients (176 surgeries) operated for acquired NLDO. METHODS: A review of electronic medical records of patients with acquired NLDO who underwent DCR at the Jules Stein Eye Institute from 1999 to 2004 was performed. Data regarding the lacrimal drainage system, comprehensive eye examination, surgical outcome, and postoperative nasal endoscopy were analyzed. MAIN OUTCOME MEASURES: Surgery failure was defined as (1) no marked improvement in tearing or any episode of postoperative dacryocystitis, (2) inability to irrigate the lacrimal system postoperatively, and (3) postoperative nasal endoscopy with scarring in the intranasal osteotomy or no visualization of fluorescein dye. Postoperative nasal endoscopy was performed in all failed cases and in >50% of all patients. RESULTS: One hundred forty-three patients (48 male and 95 female; mean age, 63 years) underwent 176 DCR surgeries for acquired NLDO. Success was achieved in 135 cases (76.7%), and failure in 41 (23.3%). Of the 41 failed cases, anatomical obstruction at the fistula site was found in 20 (49% of failed cases), whereas functional failure with no evidence of obstruction was found in 21 (51%). Surgery revision was performed in 22 cases (12.5%), but it was successful in only 9 (5.1%); patients who failed the first revision were likely to fail additional revisions (P = 0.02). History of facial trauma was associated with surgery failure. In our patients, endoscopic DCR (86 cases) had a significantly higher success rate than external DCR (90 cases), 84% versus 70% (P = 0.03). Complications included 1 patient with nose bleeding on the first postoperative day that resolved with nasal packing and 2 patients with sump syndrome that resolved after endoscopic revision. CONCLUSIONS: The success rate of DCR for acquired NLDO in our group of patients was 77%, lower than reported in previous studies, with endoscopic surgery showing better results. Success rates of revision surgery were relatively low (<50%), and patients who fail the first revision are not likely to benefit from additional revisions.

Dacryocystorhinostomy↗
PubMedDate not supplied

The management of persistent congenital occlusion of the nasolacrimal duct: after unsuccessful probing.

Persistence of congenital occlusion of the nasolacrimal duct in spite of apparently successful probings is usually due to separation of the nasal mucosa in the region of the exit of this duct and failure to rupture the membrane that causes the occlusion. Cutting of this membrane through a nasal speculum is a simple method that often leads to a permanent cure.

Dacryocystorhinostomy↗
PubMedDate not supplied

Electrolytes and electrophoretic studies of tear proteins in tears of patients with nasolacrimal duct obstruction.

This study was performed to determine whether there are differences in tear constituents between normal persons and patients with primary acquired nasolacrimal duct obstruction (PANDO) and to correlate differences in tear composition with the degree of PANDO. We tested 30 normal persons (mean age 42.0 +/- 21.4 years) and 34 PANDO patients (mean age 44.8 +/- 17.9 years) consisting of 18 cases with complete obstruction and 16 cases with partial obstruction. We measured the pH, the concentration of Na(+), K(+), Cl(-), total calcium and total protein of the tears. The composition of tear protein was assessed by cellulose acetate electrophoresis. The data were analyzed by a t test. The pH was more alkaline in patients with PANDO (7.11 +/- 0.38), especially in cases with complete obstruction (7.14 +/- 0.30, p = 0.47) compared with the normal persons (6.94 +/- 0.35). The concentration of Na(+), K(+), Cl(-) and total protein were similar in normal and PANDO cases, while total calcium concentration was significantly higher in PANDO (2.62 +/- 1.70 mg/dl) compared with the normal cases (1.73 +/- 0.97 mg/dl), (p = 0.015). This change was found in both cases with complete obstruction (2.47 +/- 1.25 mg/dl, p = 0.027) and cases with partial obstruction (3.00 +/- 2.16 mg/dl, p = 0.009). PANDO patients had lower levels of tear protein fraction (TPF) 1 (p = 0.006) and higher levels of tear TPF 4 (p = 0.000) than normal persons. Tears in PANDO cases were more alkaline, higher in calcium concentration, and unstable in the proportion of tear proteins compared with normal persons. These results may improve our understanding of tear physiology and the pathogenesis of PANDO.

Adult↗
PubMedDate not supplied

The effect of lateral osteotomy of septorhinoplasty on nasolacrimal duct functions: a radionuclide imaging study.

BACKGROUND: The aim of this study was to evaluate the effects of lateral osteotomy of septorhinoplasty on nasolacrimal duct functions by dacryoscintigraphy. METHODS: The study group comprised 60 nasolacrimal systems of 30 consecutive patients who underwent septorhinoplasty. Dacryoscintigraphy images were taken in the preoperative period and postoperative 1st week and 3rd month. After Tc-99m pertechnetate instillation, dynamic images were obtained every 15 seconds. For cases of normal drainage, the study was terminated after 10 minutes but when obstruction was suspected, external ocular massage and rapid nasal inspiration were applied and the test was extended for an additional 10 minutes. Systems were classified either as passage without massage (normal nasolacrimal test), passage with massage (physiological obstruction), or presac or postsac obstruction (partial or complete obstruction) according to test results. Transit time was determined for cases with normal test or physiological obstruction. RESULTS: In the preoperative period eight systems (two presac and six postsac) had obstruction. There were a total of 11 (18.3%) additional systems with obstruction (4 presac and 7 postsac) in the 1st postoperative week and patient symptoms were not in complete agreement with the test results in this period. By the 3rd month, nine systems (three presac and six post sac) had obstruction. Transit time was prolonged in both the postoperative 1st week and the postoperative 3rd month tests compared with the preoperative tests (p = 0.000 and p = 0.023, respectively). CONCLUSION: We did not encounter any permanent obstructions after lateral osteotomy of rhinoplasty. Temporary obstructions in the 1st postoperative week improved to normal preoperative status by the postoperative 3rd month.

Female↗
PubMed2005

Success of simple probing and irrigation in patients with nasolacrimal duct obstruction and otitis media.

PURPOSE: To examine whether, as has been reported in the literature, a history of otitis media (OM) affects the success of probing and irrigation (P&I) for nasolacrimal duct obstruction (NLDO). METHODS: All patients who underwent P&I at the Saint Louis University Eye Institute between 2001 and 2002 were prospectively studied. A preoperative questionnaire assessed the laterality of NLDO and history and laterality of OM. Intraoperatively, site of NLDO and recovery of fluorescein were recorded. The success of the probing was determined by follow-up interview 6 months postoperatively. RESULTS: Overall success of initial P&I was 86.2%. Patients with OM did not have a statistically significant decrease in success of P&I ( P = 1.00, RR 0.920, 95% CI 0.298-2.736 by Yates-corrected chi-square). The failure rate of initial P&I was not statistically different regardless of fluorescein recovery. NLDO occurred most frequently at the valve of Hasner (45.8%). CONCLUSIONS: OM was not a risk factor for initial P&I failure. Omission of fluorescein irrigation to assess patency may save time and cost.

Administration, Intranasal↗
PubMed2001

Pediatric dacryocystorhinostomy for nasolacrimal duct obstruction.

OBJECTIVE: To determine the outcome of pediatric dacryocystorhinostomy (DCR) for large mucoceles or for primary nasolacrimal duct obstruction unresponsive to multiple probings. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: One hundred thirty-four external dacryocystorhinostomies were performed in 121 children. METHODS: Clinical case notes were reviewed for a series of cases operated on at Moorfields Eye Hospital by specialist lacrimal surgeons between 1987 and 1999. MAIN OUTCOME MEASURES: Postoperative relief of presenting symptoms and signs and complications. RESULTS: Fifty-nine percent of admissions (75 of 127) were day cases, and the other 52 admissions were inpatient. Simultaneous bilateral surgery was performed in 7 of 121 (6%) children, all but one having day case admission, and sequential bilateral surgery in 6 of 121 (5%) cases. Silicone intubation was performed in 20% of operations, these generally being early in the series. Three children had Down syndrome, five had craniofacial anomalies, and two had systemic disorders. Mild postoperative cellulitis occurred in three cases, all of which settled without complication after systemic antibiotic therapy, and there was one case of suture granuloma. There were no cases of immediate postoperative complication in either the day case or the inpatient groups. Complete cure of symptoms was achieved in 96% and an improvement of symptoms (with mild persistence of epiphora under challenge) in five cases (4%). CONCLUSION: For surgeons experienced in pediatric lacrimal surgery, external DCR with sutured mucosal flaps can be accomplished through an 8-mm incision with no surface sutures and minimal scarring. Symptoms are improved in all cases and complete cure achieved in 96%, with no immediate postoperative complications and only few (3%) short-term complications. The surgery is amenable to day case management, without significant morbidity, and may be performed as a simultaneous bilateral procedure.

Adolescent↗
PubMed1985

Medical management of congenital nasolacrimal duct obstruction.

A consecutive series of 113 infants seen with congenital nasolacrimal duct obstruction were treated with local massage and topical antibiotic ointment. In 107 of the infants the obstruction was resolved within 8 months of initiation of this form of management. Nearly all of the infants were spared a surgical procedure that probably would have been performed if early probing of the nasolacrimal system had been advocated.

Combined Modality Therapy↗
PubMed1996

Results of dacryoscintigraphy in massage of the congenitally blocked nasolacrimal duct.

Between November 1990 and November 1993, 580 children with lacrimal outflow obstruction were examined at the Children's Hospital of Philadelphia. After excluding patients previously treated for nasolacrimal duct obstruction, we obtained a prospectively selected series of 20 children for this study. These patients underwent dacryoscintigraphy before and immediately after lacrimal sac massage to investigate the effect of external compression on fluid movement within the lacrimal outflow system. In 12 patients, tracer did not enter the lacrimal outflow system on the side(s) of obstruction. The absence of radiopharmaceutical correlated with clinical obstruction. In eight patients, tracer was noted to enter the lacrimal sac. After massage of the lacrimal sac, we observed progression of the tracer in five of the eight subjects. In these eight subjects, the pre- and postmassage tear column measurements showed a relative increase of 34.3%. Massage of eight clinically normal ducts showed a relative increase of 2.4% (p = 0.06). We conclude that progression of the tear column after lacrimal massage can be demonstrated on dacryoscintigraphy.

Child, Preschool↗
PubMed1995

[Lymphoepithelial carcinoma of the nasolacrimal duct--a case report].

PATIENT: A 59-year-old patient with an extremely rare lymphoepithelioma of the nasolacrimal duct was treated with radiation therapy and chemotherapy. RESULTS: A complete remission was achieved. Serious side effects and late effects have, until now, not been observed. The patient has been free of tumor for two and a half years. CONCLUSIONS: With this case report, the authors wish to draw the attention of otorhinolaryngologists to this unusual tumorsite. They emphasize that good results can be achieved with a combination of radiation therapy and chemotherapy, if surgery is not possible.

Carcinoma, Squamous Cell↗