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PubMedDate not supplied

Probing for nasolacrimal duct obstruction using intranasal midazolam sedation as an alternative to general anesthesia.

OBJECTIVE: To investigate the effectiveness of topical anesthesia with sedation using intranasal midazolam in patients with symptomatic congenital nasolacrimal duct obstruction undergoing probing. PATIENTS AND METHODS: In this prospective study, probing was performed with general anesthesia (30 cases) and with topical anesthesia using intranasal midazolam (0.3 mg/kg; 44 cases) in 74 patients who were divided into two groups, those 6 to 36 months old and those older than 36 months. The groups were compared after 12 to 48 months (mean, 18.2 months). RESULTS: For the patients 6 to 36 months old, the success rate was 80% in the group who received general anesthesia and 88.9% in the group who received topical anesthesia with intranasal midazolam; the difference between the two groups was not statistically significant (P > .05). For the patients older than 36 months, the success rate was 20% in the group who received general anesthesia and 25% in the group who received topical anesthesia with intranasal midazolam; there was no statistically significant difference between the two groups (P > .05). CONCLUSIONS: Probing with topical anesthesia in the office setting is usually recommended for patients younger than 8 months. Our results show that this is suitable for children until 4 years of age with the support of intranasal midazolam sedation. Probing under topical anesthesia with intranasal midazolam is cost-effective, safe, and comparable in efficacy to probing under general anesthesia but with less risk.

Administration, Intranasal↗
PubMed2004

Intranasal mucocele of the nasolacrimal duct: an important cause of neonatal nasal obstruction.

Anterior nasal obstruction secondary to cystic or solid masses is believed to be uncommon. Previous single or series case reports of intranasal mucoceles of the nasolacrimal duct have been published in otolaryngology, ophthalmology, or radiology journals but were not found in general pediatric journals. A 5-year retrospective chart review from our children's hospital found 10 previously unreported cases of intranasal mucocele of the lacrimal duct causing neonatal nasal obstruction. The purpose of this report is to familiarize pediatricians with this entity, which was the most common cause of anatomic anterior nasal obstruction at our hospital.

Female↗
PubMed1990

Recurrent conjunctival papilloma causing nasolacrimal duct obstruction.

We treated two patients who had recurrent conjunctival papillomas that invaded the nasolacrimal sac and caused complete canalicular and nasolacrimal duct obstruction. The ophthalmologist should be aware of the possibility of a conjunctival papilloma invading the lacrimal sac when treating patients with conjunctival papillomas. Excision should be complete, and adjunctive therapy such as cryotherapy should be considered to reduce the chance of tumor recurrence.

Adult↗
PubMed1988

Adrenaline dacryolith: detection by ultrasound examination of the nasolacrimal duct.

A 73-year-old woman on topical pilocarpine and adrenaline for chronic simple glaucoma for three years presented with a mass in the medial canthus of the right eye. Although dacryocystography showed a dilated and partially obstructed nasolacrimal system, ultrasound examination was able to demonstrate a mass in the nasolacrimal duct. At operation a black dacryolith was found, of the diameter predicted by ultrasound. Histological examination of the dacryolith suggested its derivation from breakdown products of adrenaline.

Aged↗
PubMed1991

An unknown syndrome of nose deformity, oxycephaly, aplasia of the nasolacrimal ducts, and symmetrical cyst formation on the upper lip in siblings: craniorhiny.

An unknown syndrome of oxycephaly, nose deformity, hair growth on the skin at the base of the nose, symmetrical cyst formation on the upper lip, and aplasia of the nasolacrimal ducts in a mother and her three children is presented. This syndrome showed autosomal dominant inheritance. All three children were operated on. Oxycephaly and lip deformity in two of the children and hypertelorism that existed in addition to the other anomalies in the third were all corrected. All corrective surgery was performed during a single session for each child.

Abnormalities, Multiple↗
PubMed2001

Antegrade balloon dilatation of nasolacrimal duct obstruction in adults.

AIMS: To determine the efficacy of antegrade balloon dilatation of postsaccal lacrimal stenosis in adults. METHODS: Balloon dilatation was performed in a series of 30 patients with complete nasolacrimal duct obstructions and epiphora. Obstruction was diagnosed by canalicular irrigation and transcanalicular endoscopic examination of the lacrimal pathway. Except for four cases in which general anaesthesia was applied, the procedure was performed under local anaesthesia. The Lacricath balloon catheter set was used. Silicone intubation was performed simultaneously. The time at which the tubes were removed depended on the findings at postoperative follow up but was, at the earliest, 3 months postoperatively. RESULTS: Success was objectified by irrigation and was evaluated subjectively at each follow up examination according to Munk's scale. In all cases the procedure could be performed with subsequent silicone intubation. Three months postoperatively 89.9% of all cases were positive on simple irrigation, and subjective success was also registered (Munk's grade 0 or 1). At 6 months 70% of all cases were positive on irrigation, again with subjective success (Munk's grade 0 or 1). One year postoperatively 73.3% of all procedures showed subjective success (two successful redilatations would raise the success rate to 79.9%). CONCLUSION: Retrograde as well as antegrade dilatation has been reported to be more or less successful in partial nasolacrimal obstruction. Although the procedure is used as primary treatment in cases of complete obstruction, it can still be performed under local anaesthesia on an outpatient basis. Long term observation will be required to prove the sustained effect of this procedure.

Adult↗
PubMed1999

Dacryocystorhinostomy in nasolacrimal duct obstruction secondary to sarcoidosis.

Over the past 3 years we have treated 4 patients with nasolacrimal duct obstruction secondary to sarcoidosis. These patients have had mixed outcomes following endonasal laser-assisted dacryocystorhinostomy (DCR). A literature search from 1966 to the present yielded a further 11 cases of patients thought to have sarcoid who underwent DCR. The outcome of these 15 patients indicate that while all were initially successful, the subsequent failure rate is high. These patients are older than the majority of patients with sarcoidosis and there is a female preponderance. Systemic steroids reversed obstruction in one patient. We recommend nasal examination in all patients with nasal symptoms in whom DCR is proposed to help identify sarcoidosis or other intranasal disease and/or to allow treatment of specific diseases prior to surgery.

Journal Article↗
PubMed2001

Detection of natural peptide antibiotics in human nasolacrimal ducts.

PURPOSE: To determine the expression and production of antimicrobial peptides by mucosal cells of the lacrimal passage in healthy and pathologic states. METHODS: Detection of bactericidal-permeability-increasing protein (BPI), heparin-binding protein (CAP37), human cationic antimicrobial protein (LL-37), human alpha-defensin 5 (HD5), human alpha-defensin 6 (HD6), human beta-defensin 1 (HBD-1), and human beta-defensin 2 (HBD-2) was performed by reverse transcription-polymerase chain reaction (RT-PCR). Intracellular deposition of lysozyme, lactoferrin, secretory phospholipase A(2), human neutrophil defensins (HNP-1, -2, and -3), human beta-defensin 1 (HBD-1), and human beta-defensin 2 (HBD-2) was analyzed immunohistochemically. Samples were obtained from 15 patients by surgery and from 10 cadavers. RESULTS: RT-PCR revealed BPI, CAP37, and HBD-1 mRNA in samples of healthy nasolacrimal duct epithelium. Additionally, HBD-2 mRNA was detected in epithelial samples from patients with dacryocystitis. Messenger RNAs for LL-37 and alpha-defensin 5 and 6 were absent in all samples investigated. Immunohistochemistry revealed lysozyme, lactoferrin, secretory phospholipase A(2), and HNP-1, -2, and -3 to be present in all samples, whereas HBD-1 was present only in some of the healthy and inflamed samples. Immunoreactive HBD-2 peptide was visible only in some of the inflamed samples. CONCLUSIONS: The data suggest that the human efferent tear ducts produce a broad spectrum of antimicrobial peptides. Under inflammatory conditions, changes in the expression pattern occurred, revealing induction of the human inducible defensin HBD-2 and in some cases downregulation of HBD-1 and CAP37. Antimicrobial peptides have a therapeutic potential in dacryocystitis, in that they have a broad spectrum of antimicrobial activity and accelerate epithelial healing. However, caution is appropriate, because defensins also promote fibrin formation and cell proliferation, which are key elements in scarring processes, such as dacryostenosis.

Adolescent↗
PubMed1989

Unicanalicular stent for nasolacrimal duct obstruction.

The authors describe a method for silicone intubation of a single patent canaliculus associated with a nasolacrimal duct obstruction. Although bicanalicular intubation is always preferable when possible, unicanalicular stenting is necessary when only one canaliculus is patent. A chief advantage of this technique is that the lacrimal stent is inaccessible to the child and thus cannot be accidentally pulled out.

Child, Preschool↗
PubMed1975

Dacryocystorhinostomy with nasolacrimal duct prostesis.

For many years the standard surgical treatment for chronic dacryocystitis has been the anastomosis of the lacrimal sac mucosa to nasal mucosa over the margins of an ostium through the lacrimal bone. Failures of this standard procedure have been attributed to many factors and complications frequently require reoperation. The procedure described in this paper was developed as one means of overcoming some of these difficulties. It consists of the implantation of a specially shaped nasolacrimal duct prosthesis from the base of the sac through the interosseous canal into the inferior nasal meatus. This procedure gives reasonable assurance of permanent drainage and is recommended as a primary procedure of choice. The operation is described.

Chronic Disease↗
PubMed1996

Congenital nasolacrimal duct obstruction in the second year of life: a multicentre trial of management.

We studied spontaneous resolution of congenital nasolacrimal duct obstruction in the second year of life and compared this with the cure rate after probings undertaken between the ages of 11 and 15 months. Of the 111 eyes of 95 patients studied, 26 eyes were included in a randomised prospective comparison of probing with spontaneous resolution. A further 63 eyes followed a similar management plan to the randomised group and are reported as an observational study. Thirty of the 50 eyes followed up without treatment resolved spontaneously before the age of 2 years, of which 24 resolved before 18 months. The overall cure rate for probing was 74% compared with 60% for spontaneous resolution. At 15 months of age the randomised study confirmed that probing at 12-14 months is an effective intervention compared with spontaneous resolution (p = 0.04). At 24 months of age probing was superior in both randomised and non-randomised studies, but with increased numbers in the spontaneous resolution groups the difference was no longer statistically significant. Up to 18 months of age the frequency of spontaneous resolution makes delay in probing a viable management option to be discussed with the parents. It will also lead to an overestimate of the cure rate in any study of interventional treatment unless controls are included.

Adolescent↗
PubMed1990

Endonasal laser dacryocystorhinostomy. A new approach to nasolacrimal duct obstruction.

A high-powered argon blue-green laser coupled to a 300-microns quartz fiberoptic catheter was used to create intranasal dacryocystorhinostomy fistulas in fresh-frozen cadaver heads. The procedure, which we term endonasal laser dacryocystorhinostomy, is described. Cadaver specimens were examined postoperatively. Laser rhinostomies were found to involve the posteroinferior portion of the lacrimal sac fossa. Tissues surrounding the fistula site showed no signs of damage. We report on the first patient to undergo endonasal laser dacryocystorhinostomy for the treatment of nasolacrimal duct obstruction, with 10 months of follow-up. We believe endonasal laser dacryocystorhinostomy offers the following advantages over standard external dacryocystorhinostomy: (1) Tissue injury is limited to the discrete fistula site. (2) The cutaneous scar and cosmetic blemish of an external dissection are eliminated. (3) Excellent hemostasis is maintained. (4) Minimal operative and postoperative morbidity permits outpatient surgery, with faster resumption of normal daily activities and increased cost-effectiveness. (5) Patients prefer endonasal laser dacryocystorhinostomy to external dacryocystorhinostomy.

Adult↗
PubMed2006

Cell and molecular biology of human lacrimal gland and nasolacrimal duct mucins.

The old concept that the lacrimal gland is only a serous gland has been superseded by the finding that lacrimal acinar cells are able to produce mucins--high-molecular-weight proteins--the major mass being carbohydrates with the common feature of tandem repeats of amino acids rich in serine, threonine, and proline in the central domain of the mucin core peptide. At the ocular surface, maintenance of the tear film, lubrication, and provision of a pathogen barrier on the epithelia, conjunctiva, and cornea have been shown to be facilitated by mucins that are present in membrane-anchored (lining epithelial cells) or secreted (goblet cells) form. Also in the lacrimal gland, both membrane-anchored (MUCs 1, 4, and 16) and secreted (MUCs 5B and 7) mucins have been identified. The lacrimal gland is the main contributor to the aqueous portion of the tear film. It is part of the lacrimal apparatus that comprises, together with the lacrimal gland, the paired lacrimal canaliculi, the lacrimal sac, and the nasolacrimal duct, which collects the tear fluid and conveys it into the nasal cavity. In this review, the latest information regarding mucin function in the human lacrimal gland and the human efferent tear ducts is summarized with regard to mucous epithelia integrity, rheological and antimicrobial properties of the tear film and tear outflow, age-related changes, and certain disease states such as the pathogenesis of dry eye, dacryostenosis, and dacryolith formation.

Humans↗
PubMed1990

Prevention of radiation-induced stenosis of the nasolacrimal duct.

Epiphora is a recognized complication of radiotherapy of medial canthal tumours. We reviewed the records of 36 patients who underwent prophylactic nasolacrimal duct intubation with silicone tubing before superficial x-ray beam therapy and 42 patients who did not undergo intubation before radiotherapy. The mean length of follow-up was 3.4 years in the intubated group and 7.2 years in the nonintubated group. A total of 31% of the patients in the nonintubated group reported chronic epiphora during the follow-up period, compared with 6% in the intubated group (p less than 0.003).

Adult↗