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At least 235 records · Page 13Linked to original sources
PubMed2005

Botulinum toxin for palliative treatment of epiphora in a patient with canalicular obstruction.

OBJECTIVE: To describe the use of botulinum toxin injection of the lacrimal gland for palliative treatment of epiphora secondary to canalicular obstruction from docetaxel therapy. DESIGN: Case report. INTERVENTION: A 50-year-old female with bilateral canalicular obstruction secondary to docetaxel therapy received botulinum toxin injections (5 units each) into the lacrimal glands of both eyes. RESULTS: Symptomatic epiphora of the affected eyes was reduced after 2 weeks. No side effects were observed. CONCLUSIONS: Botulinum toxin injection of the lacrimal gland is an effective palliative treatment for epiphora secondary to canalicular obstruction from docetaxel therapy.

Antineoplastic Agents, Phytogenic↗
PubMed1987

Problems of the lacrimal system in children.

The lacrimal system is composed of various glands to produce tears and a drainage system for tear removal. The most common abnormality is a defect or blockage in the drainage system, a blocked nasolacrimal duct. Most of the evidence favors conservative management of this condition, reserving probing for those that fail to resolve by one year of age.

Child↗
PubMed2001

Canalicular stenosis secondary to docetaxel (taxotere): a newly recognized side effect.

OBJECTIVE: To report a newly recognized side effect of a commonly used antineoplastic agent, docetaxel, in three patients with metastatic breast cancer. DESIGN: Observational case reports. PARTICIPANTS: Three patients with metastatic breast cancer who received weekly docetaxel chemotherapy. MAIN OUTCOME MEASURES: Occurrence of epiphora and severity of punctal and canalicular fibrosis secondary to docetaxel. RESULTS: In three patients receiving weekly docetaxel, canalicular stenosis and resultant epiphora developed shortly after start of their treatment. Discontinuation of drug several months after initiation of therapy did not lead to resolution of symptoms in two of the three patients. CONCLUSIONS: Epiphora is a newly recognized side effect of docetaxel and may occur more frequently with weekly cycles of this drug. The mechanism for epiphora seems to be punctal and canalicular stenosis. This side effect, in advanced cases, is not reversible with discontinuation of the drug. Patients being administered weekly cycles of docetaxel should be screened for epiphora and canalicular stenosis, and treatment in the form of silicone intubation or punctoplasty should be considered in early stages to prevent the need for conjunctivodacryocystorhinostomy.

Adult↗
PubMed1997

Clinical and radiologic lacrimal testing in patients with epiphora.

OBJECTIVE: The purpose of the study is to assess the strengths and weaknesses of selected clinical and radiologic lacrimal tests in patients with epiphora. DESIGN: The study design was a prospective clinical trial. PARTICIPANTS: Fifteen patients with epiphora (N = 27 eyes) were studied. METHODS: All patients underwent Jones testing, the dye disappearance test, canalicular probing, lacrimal scintigraphy, and macrodacryocystography. MAIN OUTCOME MEASURES: The dye disappearance test was graded individually by three ophthalmologists. Lacrimal scintigraphy and macrodacryocystography were evaluated by a nuclear medicine specialist and a radiologist, respectively. A panel of three ophthalmologists evaluated the data using a scoring system that relied on the preponderance of evidence to arrive at a final assessment. RESULTS: When the Jones I test results were negative (dye recovered from the nose), the epiphora was always from hypersecretion. When the Jones I test results were positive (no dye recovered from the nose), obstruction was not always present. When the dye disappearance test results were strongly abnormal, obstruction was always present. In contrast, when the dye disappearance test results were normal, the lacrimal drainage system was not always patent. Canalicular probing was more reliable than scintigraphy in identifying canalicular obstruction. Marked stenosis of the sac or duct on dacryocystography essentially confirmed nasolacrimal outflow obstruction; however, with the authors' technique, a normal study was found in some patients with functional or partial obstruction. CONCLUSIONS: More than one lacrimal test may be required for a definitive diagnosis in patients with epiphora due to partial or functional nasolacrimal outflow obstruction.

Aged↗
PubMed1998

Comparison between nasolacrimal syringing/probing, macrodacryocystography and surgical findings in the management of epiphora.

AIMS: Macrodacryocystography (MDCG) has been shown to be highly sensitive in evaluating the lacrimal drainage system. We aimed to compare the results of syringing/ probing with MDCG, and with surgical findings where available. We also aimed to determine whether MDCG is advisable in addition to syringing/probing when investigating epiphora. METHODS: In a retrospective study, we looked at the records of 76 consecutive patients (86 eyes) presenting with epiphora over a period of 2 years (January 1993 to December 1994). All patients underwent syringing/probing and subsequent MDCG to determine the presence and level of nasolacrimal block. The results were then compared with surgical findings where available (46 eyes, 53%). RESULTS: Surgical findings were predicted by MDCG in 95.5% of cases but in only 54% by probing. Probing findings agreed with MDCG in only 51% of cases. The main areas of disagreement were the presence of canalicular blocks and the presence of more than one block at different levels. CONCLUSION: A combination of syringing/ probing and MDCG provides the most accurate pre-operative lacrimal assessment and should predict all the canalicular stenoses requiring intubation. In addition, MDCG can predict physiological duct blocks beyond canalicular blocks and thus alter surgical management.

Humans↗
PubMed1976

[Dacryocystography. 2. Results of 125 studies].

Results and X-ray findings of 125 dacryocystographies are discussed. Type II obstruction is the commonest pathological finding, Type I is caused often by a trauma. DCG gives a good morphological picture of tear drainage system and represents a very important method for planning surgical therapy.

Adolescent↗
PubMed1984

[Echographic diagnosis in diseases of the efferent tear ducts].

We report the results of our echographic examinations of 250 patients with diseases of the lacrimal drainage system. First, normal A- and B-scan pictures are presented. Then the echographic criteria of malformations (persistence of the valve of Hasner, dacryocystocele), dacryocystitis and its complications (fistula, membrane-formation, stenosis) are discussed. The possibility of pre- and postoperative controls with echography is stressed. Tumors of the lacrimal sac can also easily be detected.

Cysts↗
PubMed1982

[Endoscopy of the nose as an aid in lacrimal duct surgery].

Endoscopy of the nose is a recently-adopted supplementary procedure for examining the tear drainage system. This examination is performed under local anesthesia with the patient on the operating table. We use a Hopkins endoscope with 30 degrees and 70 degrees deflections, diameter 2.7 mm and 4 mm. Endoscopy prior to dacryocystorhinostomy enables the examiner to judge whether the nasal cavity is large enough for an osteotomy. The orifice of the nasolacrimal duct is visible directly through the endoscope, so that the dye test can be rendered fairly objective. Endoscopy also enables the course of healing of the nasal ostium after surgery to be studied. We observed complications, such as granular tissue and synechiae developing between the posterior flap of the nasal mucosa, the middle turbinate and the nasal septum. Granulation tissue may be removed under endoscopic control. If an intubation of the lacrimal system is attempted, it may be easier to find the end of the steel probe exiting into the nose under endoscopic observation. If the inferior turbinate is impacted with the nasal floor, it may be impossible to find the probe under the inferior turbinate without endoscopic control. Finally, during lacrimal duct probing in infants, one can check whether the probe is correctly sited. Perforations created by probing can be recognized and avoided.

Dacryocystorhinostomy↗
PubMed2003

Manometric measurement of lacrimal sac pressure after endoscopic and external dacryocystorhinostomy.

OBJECTIVE: To evaluate endoscopic and external dacryocystorhinostomy (DCR) using a quantitative, objective functional tool. MATERIAL AND METHODS: This study comprised 58 cases divided into 4 groups: healthy controls; patients suffering from epiphora due to nasolacrimal duct (NLD) obstruction; patients who had undergone endoscopic DCR; and patients who had undergone external DCR. The lacrimal sac pressure was measured during blinking, forced blinking and the Valsalva maneuver using a polygraph. RESULTS: Negative pressure was detected during blinking and forced blinking in all normal subjects and in most patients who had successfully undergone DCR. In contrast, positive pressure was detected in cases with epiphora and patients in whom DCR had failed. Negative pressure was higher after endoscopic than external DCR. During the Valsalva maneuver there were no pressure changes in normal cases and patients with epiphora. In contrast, positive pressure was detected after all of the successful procedures (being higher after external than endoscopic DCR) and in most of the patients in whom external DCR failed. CONCLUSIONS: In normal subjects, negative pressure is created during blinking. In cases with epiphora due to NLD obstruction, the lacrimal pump is affected but its function is restored after successful DCR. The suction power of the pump mechanism is more effective after endoscopic than external DCR.

Adolescent↗
PubMed1993

Clinical study on the effectiveness of tear drainage with a single canalicular system under environmental stress.

Sixteen asymptomatic volunteers had their right lower puncta occluded with a Freeman silicone plug. They then went about their normal daily activities for approximately 1 week under the stress of a cold Chicago winter. Of the 16 eyes that were plugged, 4 had epiphora. The episodes were of short duration and did not have any effect on the subjects' daily activities. When comparing the incidence of epiphora between the plugged eyes and the control eyes, there was no statistically significant difference (p = 0.082). Also, when comparing the modified Jones I test and Schirmer tests, with and without anesthesia, there was no significant difference in the values between the plugged and the control eyes (p > 0.05). The only difference noted was in the dye disappearance test (p < 0.05). These results support the hypothesis that in selected patients, even under stressful environmental conditions, a single healthy canaliculus may provide sufficient tear drainage from a normal eye to prevent bothersome subjective symptoms.

Adult↗
PubMed2003

Clinicopathologic findings from lacrimal sac biopsy specimens obtained during dacryocystorhinostomy.

PURPOSE: To retrospectively review the pathologic diagnoses and clinical characteristics of patients undergoing dacryocystorhinostomy (DCR). METHODS: Specimens accessioned between 1991 and 2001 in a single ophthalmic pathology laboratory were reviewed. All of the specimens included a lacrimal sac biopsy specimen. The pathologic diagnoses were recorded. The clinical features of the patients with significant pathologic abnormalities were reviewed to determine if the pathology was suspected before or at the time of the DCR. RESULTS: There were 377 DCR specimens from 316 patients representing 1.8% of 21,018 ophthalmic pathology specimens accessioned between 1991 and 2001. Diagnoses, in decreasing order of frequency, were nongranulomatous inflammation (321, 85.1%), granulomatous inflammation consistent with sarcoidosis (8, 2.1%), lymphoma (7, 1.9%), papilloma (4, 1.11%), lymphoplasmacytic infiltrate (4, 1.1%), transitional cell carcinoma (2, 0.5%), and single cases of adenocarcinoma, undifferentiated carcinoma, granular cell tumor, plasmacytoma, and leukemic infiltrate. A total of 31 (8.2%) specimens from 25 (7.9%) of patients demonstrated significant pathology. Among 17 specimens (4.5%) from 14 patients with neoplasms whose clinical histories were available, 8 (2.1%) were not suspected before surgery. CONCLUSIONS: Nongranulomatous inflammation consistent with chronic dacryocystitis is the most common diagnosis in lacrimal sac specimens obtained at DCR. Neoplasms resulting in chronic nasolacrimal duct obstruction occurred in 4.6% of cases and were unsuspected before surgery in 2.1% of patients. We recommend pathologic examination of DCR specimens.

Adolescent↗
PubMed2004

Vasculitis of the lacrimal sac wall in Wegener granulomatosis.

A 35-year-old woman with a 4-year history of generalized Wegener granulomatosis (WG) had clinically controlled disease. She was evaluated for a 6-month history of right lacrimal sac mass. On examination, a right chronic dacryocystitis and mucocele were observed. A right external dacryocystorhinostomy was performed. The surgical biopsy specimen from the lacrimal sac showed leukocytoclastic vasculitis with more aggressive damage to the small vessels in the deeper mucosa and focal microhemorrhages. The patient was free of symptoms 1 year after surgery. We believe this is the first report of generalized WG presenting features of an active vasculitis of the lacrimal sac wall on surgical biopsy specimen. We conclude that the lacrimal drainage system can be affected directly by focal WG vasculitis, suggesting that nasolacrimal duct obstruction is not always due to contiguous paranasal disease.

Adult↗
PubMed2006

Delayed assessment of the nasolacrimal system at naso-orbito-ethmoid fractures and a modified technique of dacryocystorhinostomy.

Nineteen patients between 8 and 65 years of age (mean age 32) who were treated for naso-orbito-ethmoid area traumas and suffering from epiphora were evaluated. The time after the trauma was at least 4 months. The patients were divided into two groups. The first group consisted of 10 (52.7%) patients who have undergone a surgical procedure for the fractures before. The second group has 9 (47.3%) members who have never been surgically treated after trauma. All of the patients were evaluated with dacryocystography. Obstruction was found to be in the bony nasolacrimal canal in 13 (68.4%) patients. The nasolacrimal canal was intact in six (31.6%) of the patients. Dacryocystorhinostomy (DCR) was essential for five (50%) of the patients in the first group and eight (88.8%) of the patients in the second group. No additional surgical intervention was carried out for nasal deformities of the patients resulting from naso-orbito-ethmoid fractures. Palpebral malposition was present in six (32%) patients. Relief in tear flow was supplied in all patients. Our aim is to compare the outcomes of a modified technique of DCR and incidence of nasolacrimal system injury in patients with naso-orbito-ethmoid fractures and epiphora on whom reduction was or was not carried out. In conclusion, early surgical reduction of naso-orbito-ethmoid fractures should be performed to prevent problems and deformities of the nasolacrimal system.

Adolescent↗
PubMed1988

Surgical management of the lacrimal drainage system.

The physiology of normal tear drainage has been better defined in recent years. Some of the refined techniques developed in the fields of anaesthesia and surgery have been applied to the lacrimal drainage system. The combination of these advances has resulted in more rational and successful treatment of lacrimal drainage abnormalities. A review of these advances is presented with a discussion on the treatment of lacrimal drainage abnormalities.

Dacryocystorhinostomy↗