Contralateral rhinostomy for dacryocystitis due to facial malformation.
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Adult↗
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[Otorhinolaryngologic treatment of dacryocystitis neonatorum].
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Dacryocystorhinostomy↗
Dacryocystectomy: indications and results.
BACKGROUND: After the advent of dacryocystorhinostomy (DCR), dacryocystectomy (DCT) was regarded as mutilant surgery and reserved for lacrimal sac tumors. PURPOSE: To present current indications for dacryocystectomy. METHODS: Eighteen eyes from 11 patients subjected to DCT were reviewed retrospectively. Nine patients had chronic dacryocystitis confirmed by dacryocystography and two patients had lacrimal sac tumors. RESULTS: The indications for DCT were: three patients with systemic medical problems, three patients with dry eye, two cases of lacrimal sac tumors, two cases of traumatic dacryocystitis and one case of cutaneous leishmaniasis. Dacryocystitis was resolved in 17 of 18 eyes; the two cases of tumor evolved without epiphora. One patient (traumatic dacryocystitis) had recurrence of dacryocystitis. CONCLUSIONS: DCT is mainly performed when a lacrimal sac tumor is suspected but, since it avoids the intra- and postoperative complications related to dacryocystorhinostomy, it can be indicated in cases of dacryocystitis with significant lacrimal discharge and an enlarged or altered lacrimal sac.
Adolescent↗
[Indications and prognosis of dacryocystorhinostomy in childhood. A clinical study 1970-2000].
BACKGROUND: Dacryocystitis in infants is a serious complication of congenital, but seldom of acquired nasolacrimal duct obstructions. If conservative treatment fails, dacryocystorhinostomy (DCR) appears to be effective. The indications, special clinical history and results will be reviewed. PATIENTS AND METHODS: From 1/1970 to 2/2000, a total of 72 children (56 male, 16 female) with persistent dacryocystitis (18 bilateral) were treated surgically by DCR and were continuously documented. The patients ranged in age from 10 months to 14 years old (mean age 4.9 years). Included in our study were 66 children (52 male, 14 female) with 84 surgically treated lacrimal ducts (46 right eyes, 38 left eyes) who underwent control examinations. RESULTS: The cause of dacryocystitis was congenital obstruction in 63 children and trauma (maxillary fracture) in 3 children, respectively. Of these, 20 children (30.3%) had additional anomalies of the lacrimal system, 21 (31.8%) systemic malformations and 8 out of the 66 children (12.1%) had a family history of nasolacrimal duct obstruction. Since 1985 the surgical procedures have been performed under microsurgery conditions and since 1998 sometimes with a transcanalicular laser-assisted technique. We found a functional success rate (with complete resolution of symptoms) of 90.4% (76 out of 84 lacrimal ducts) over follow-up periods ranging from 1 month to 12 years (average 1.6 years). CONCLUSION: Patients with persistent dacryocystitis due to congenital nasolacrimal duct obstruction have a prevalence of further nasolacrimal abnormalities and a family history. The dacryocystorhinostomy of infants requires minimal invasive (sometimes laser-assisted) techniques. In the case of persistent dacryocystitis, DCR is indicated after the age of 1 year and has the same success rate in infants as in adults (90-95%).
Adolescent↗
Clinical presentation of patients with dacryolithiasis.
OBJECTIVE: To compare the demographic characteristics and presentation of patients having dacryolithiasis with those who are free of stones at the time of dacryocystorhinostomy. DESIGN: Retrospective, comparative case series. PARTICIPANTS AND INTERVENTION: Patients undergoing treatment in the Lacrimal Service at Moorfields Eye Hospital between 1989 and 1999. Group 1 patients, with lacrimal sac stones found at lacrimal surgery, were compared with three other groups undergoing open lacrimal surgery: a stone-free group with epiphora only (group 2), a stone-free group with dacryocystitis (group 3), and a consecutive cohort of unselected patients operated on over a 5-week period (group 4). MAIN OUTCOME MEASURES: Patient demographic characteristics, duration of epiphora, or a history of preceding dacryocystitis were related to the presence or absence of dacryoliths. RESULTS: Thirty-six patients (22 female; 61%) between the ages of 19 and 85 years (mean, 53.8 years; median, 52.5 years) had either single (22 cases; 61%) or multiple dacryoliths. Half of these patients had previous attacks of dacryocystitis. Group 1 patients (with stones) sought treatment earlier than all of the other groups: 13.5 months compared with 36.5 months (group 2; P = 0.01), 48.7 months (group 3; P = 0.05), and 52.2 months (group 4; P = 0.02). Group 1 patients are much more likely to have prior attacks of dacryocystitis than patients without stones (18/36 in group 1, 10/45 in stone-free patients; P = 0.009). In all groups, there was a slight preponderance of females, but there was no difference in gender or age at presentation. CONCLUSIONS: Patients with dacryolithiasis are likely to have a shorter history of epiphora and previous attacks of dacryocystitis at presentation. There is no gender or age difference between the lacrimal stone and stone-free patients undergoing open lacrimal surgery.
Adult↗
Experience with bicanalicular intubation of the lacrimal drainage apparatus combined with conventional external dacryocystorhinostomy.
AIM: The aim of this study was to assess the success rate of bicanalicular intubation of lacrimal drainage apparatus in chronic dacryocystitis patients who were at high risk of failure of surgery of dacryocystorhinostomy. MATERIAL AND METHODS: A total of 24 patients with chronic dacryocystitis (25 eyes) including 11 males and 13 females (age range 3-80 years) having high risk factors of failure of dacryocystorhinostomy were enrolled. Factors such as previous attacks of acute dacryocystitis, trauma in lacrimal sac region, previously failed dacryocystorhinostomies, formation of false passages in the lacrimal drainage apparatus were considered. Conventional dacryocystorhinostomy followed by bicanalicular intubation of the lacrimal drainage apparatus with Jain metal silicone the lacrimal intubation tube (20-23 gauge) was performed in all these patients. The patients were followed up at weekly intervals for two months, at 6 months and at 1 year post surgery. RESULTS: A total of 25 eyes in 24 patients (including 11 males and 3 females) were operated upon using the technique of bicanalicular intubation of lacrimal drainage apparatus with conventional external dacryocystorhinostomy. The procedure was successfully performed in 22 out of the 25 eyes. Perioperative complications included punctual damage due to recurrent attempts at passing these probes in 2 patients and mild damage to nasal mucosa in 5 patients. The majority of patients did not experience any untoward symptoms from these silicone tubes. However, in three eyes there was felt a mild foreign body sensation and two patients had chronic conjunctival erythema. The tubes could not be retained in two of these three eyes. Additionally, in one eye there was spontaneous extrusion of tubes whilst sneezing 3 months after surgery. All these three eyes had a recurrence of symptoms due to non-retention of the tubes and needed re-operation. On average the tubes were retained for a period of six months before they were spontaneously extruded or removed. Fifteen patients retained the silicone tubes for more than 1 year. The procedure gave a success rate of 76% (19/25 eyes) and these were the eyes in which the tubes had been retained for more than 6 months. The success was not influenced by the age or sex of patient, laterality of eye, aetiology of chronic dacryocystitis, or evidence of bony deformity or abnormality of the sac. CONCLUSIONS: Bicanalicular intubation for lacrimal drainage system is a simple, inexpensive and straight forward adjunct to conventional external dacryocystorhinostomy. The procedure is strongly indicated for patients with chronic dacryocystitis who are at high risk of surgical failure. Carefully performed, it gives a 76% success rate and is not influenced by the different variables examined.
Adolescent↗
Evaluation of the role of syringing prior to cataract surgery.
Patients for cataract surgery in India routinely undergo preoperative syringing to rule out chronic dacryocystitis. We determined the sensitivity and specificity of the clinical test of regurgitation on pressure over the lacrimal sac (ROPLAS) as a screening test for chronic dacryocystitis and compared it to syringing. 621 consecutive outpatients who needed syringing for various reasons (including 318 who had routine syringing prior to cataract surgery) were examined in a masked manner for regurgitation on pressure over the lacrimal sac. They then underwent syringing by a trained (masked) observer. The sensitivity and specificity of ROPLAS were 93.2% and 99.3%, respectively. Using a 6.6% prevalence of chronic dacryocystitis (the prevalence in our cataract population), the negative predictive value of the test was 99.5%. In the presence of regurgitation of pressure over the sac, the high specificity of ROPLAS confirms chronic dacryocystitis. In view of the opportunity costs, when ROPLAS is negative, preoperative syringing in cataract is perhaps unnecessary, unless the findings are equivocal or the index of suspicion for chronic dacryocystitis is very high.
Cataract↗
The treatment of congenital dacryocystocele.
PURPOSE: To determine the proper management of congenital dacryocystocele. DESIGN: Retrospective interventional case series. METHODS SETTINGS: Clinical practice. STUDY POPULATION: Twenty-seven consecutive patients with 29 congenital dacryocystoceles who presented from 1987 through 2006. MAIN OUTCOME MEASURES: The charts were reviewed for the presence and age of onset of infection, methods and age of treatment, and response to treatment. RESULTS: Dacryocystitis and preseptal cellulitis requiring intravenous antibiotic therapy were present in 11 lacrimal systems (37.9%), and dacryocystitis without cellulitis was present in an additional 10 lacrimal systems (34.5%). One or more probings were performed in 26 patients (89.7%). Resolution with conservative therapy occurred in three lacrimal systems. The initial probing was successful in seven of seven lacrimal systems (100%) that did not have infection, but was successful in only 10 of 19 lacrimal systems (53%) that had dacryocystitis with or without cellulitis. The mean age of probing in the surgical patients who did not develop infection was 5.9 days, whereas the mean age at first probing in surgical patients who developed infection was 17.3 days. CONCLUSIONS: Patients with congenital dacryocystocele should have probing on an urgent basis and as early in life as possible, unless the lacrimal sac decompresses into the nose at the time of the initial examination. This approach will reduce the incidence of dacryocystitis and cellulitis, and improve the success rate of surgery.
Age of Onset↗
The dacryolithiasis syndrome.
A syndrome of the typical patient with a dacryolith in the lacrimal sac or nasolacrimal duct is described, based on review of 107 consecutive patients undergoing dacryocystorhinostomy (DCR) and 43 patients with a history of dacryocystitis. The incidence of dacryolithiasis was 14% of all patients having a DCR. The typical patient with a dacryolith was 45 years old, had a 4.8 year history of intermittent epiphora, had at least one episode of acute dacryocystitis, and could be irrigated with some fluid getting into the nasopharynx. Patients undergoing DCR with a history of acute dacryocystitis had a nine times higher likelihood of having a dacryolith than DCR patients without a history of acute dacryocystitis. DCR was curative in all 15 patients with a dacryolith.
Adolescent↗
Lesions of the lacrimal drainage system: a clinicopathological study of 643 biopsy specimens of the lacrimal drainage system in Denmark 1910-1999.
PURPOSE: To determine the frequency of histologically verified lesions of the lacrimal drainage system in Denmark between the years 1910 and 1999. Furthermore, to correlate the clinical diagnosis with the pathology diagnosis. METHODS: Retrospective review of all pathology reports from 1910 to 1999 in the files of the Eye Pathology Institute, University of Copenhagen, describing a lesion of the lacrimal drainage system. In addition, a retrospective review of all reports describing a lesion of the lacrimal drainage system from the Danish Pathology Database. All specimens were re-evaluated, except in cases with a primary diagnosis of dacryocystitis. In these cases a sample of 25% was re-evaluated. RESULTS: A total of 643 lesions were collected. Dacryocystitis was the most frequent lesion, constituting 508 cases (79%). The remaining cases were diagnosed as dacryolithiasis (62 cases; 7.9%), tumour (29 cases; 4.5%), trauma (19 cases; 3.0%), congenital malformation (nine cases; 1.4%), canaliculitis (eight cases; 1.2%) and granulomatous inflammation (eight cases; 1.2%). Seventeen tumours were malignant, of which B-cell lymphoma was the most common (six cases). In 0.6% of cases with a clinical diagnosis of dacryocystitis/lithiasis a non-suspected malignant tumour was diagnosed. Micro-organisms were uncommon in dacryocystitis (9%) but frequent in cases of dacryolithiasis (87%). CONCLUSION: Dacryocystitis was by far the most frequent lesion of the lacrimal drainage system referred for histopathological evaluation. Dacryolithiasis was often associated with micro-organisms, especially Gram positive rods. Histopathology is necessary to confirm suspected tumours, more than half of which were inflammatory lesions, and to detect tumours that sometimes masquerade as inflammation.
Adolescent↗
[Alternatives to recovery of lacrimal duct patency].
Based on his many years' experience in treating patients with lacrimal duct abnormalities and on his familiarity with the latest progress of endoscopic microsurgery of dacryocystitis, the author presents a historic analysis of the development of currently available surgical treatments of dacryocystitis in Russia and foreign countries. He reviews treatments divided into the following groups: 1) operations applying an external approach to the lacrimal sac, such as Toti's-type ones; 2) those applying an intranasal approach to the lacrimal sac, such as West's-type operations; 3) intranasal endoscopic microdacryocystorhinostomies; 4) intranasal laser microdacryocystorhinostomies; 5) transcanalicular endoscopic laser microdacryocystorhinostomies; 6) operations that recanalize the lacrimal duct; 7) medical treatments of dacryocystitis. The author emphases the merits and discloses the prospects of endoscopic microsurgical treatments for impaired lacrimal duct patency and dacryocystitis.
Adolescent↗
Recurrent lacrimal sac papilloma: case report.
Tumors of the lacrimal sac are rare. Benign papillomas comprise approximately 40% of all neoplasms of the lacrimal drainage system. They often present insidiously with symptoms of dacryostenosis or dacryocystitis. Recurrent bouts of dacryocystitis and nasolacrimal duct obstruction were reported in a 35-year-old man over a period of 13 years. A medial canthal mass was noted in the 6th year after the onset of symptoms. A tumor was discovered incidentally during surgical intervention for presumed dacryostenosis. Surgical removal of the tumor and dacryocystorhinostomy were performed. The histopathologic report turned out to be benign papiloma. Local recurrences occurred during the follow-up period. In addition to surgical excision, we applied cryotherapy and CO2 laser to prevent further recurrence. This case we presented the characteristic recurrence of lacrimal sac papilloma and implied the possibility of tumor occurrence in a patient with recurrent dacryocystitis. We must bear in mind that a recurrent dacryocystitis may be a presentation of a lacrimal sac tumor, because early diagnosis and aggressive treatment can prevent recurrence and result in a cure.
Adult↗
Treatment of neonatal conjunctivitis.
The effect of different treatment regimens on clinical and microbiologic cures of neonatal conjunctivitis was evaluated during a 32-day observation period. In 84 infants with mild to moderate conjunctivitis and no signs of dacryocystitis, clinical cures were achieved in more than 50% of the cases with lid hygiene only. Staphylococcus aureus was the most common organism (48%) isolated from these infants. Chlamydia trachomatis could not be isolated from eyes with mild to moderate conjunctivitis. Forty-four infants with severe conjunctivitis, with or without dacryocystitis, were randomly assigned to treatment with either topical chloramphenicol or oral erythromycin for 14 days. Chlamydia trachomatis was isolated from 19 (43%) of these infants. All infants with chlamydial conjunctivitis who were treated with 25 mg/kg of oral erythromycin ethylsuccinate twice daily for 14 days were clinically and microbiologically cured. In contrast, all treatment of chlamydial conjunctivitis with topical chloramphenicol failed clinically as well as microbiologically. Dacryocystitis was a common complication in neonatal conjunctivitis (17%). The clinical failures in neonatal nonchlamydial conjunctivitis were associated with persistent obstruction of the nasolacrimal duct.
Administration, Oral↗
Management of complications after insertion of the SmartPlug punctal plug: a study of 28 patients.
PURPOSE: To characterize and describe the management of complications seen in patients who have undergone insertion of the SmartPlug permanent punctal plug. DESIGN: Retrospective case series. PARTICIPANTS: Patients who experienced complications after SmartPlug insertion and were treated by 1 of 18 ophthalmic plastic and reconstructive surgeons between January 2004 and October 2005. METHODS: Presenting symptoms and signs and the management of complications were analyzed. MAIN OUTCOME MEASURES: Prevalences of canaliculitis and dacryocystitis, tearing at presentation, and outcome of conservative and/or surgical management of the SmartPlug complications. RESULTS: Twenty-eight patients were included in the study; 13 had bilateral involvement. On initial presentation, 18 patients had inflammation, including 17 with canaliculitis and 1 with recurrent acute dacryocystitis. Ten patients had little or no inflammation; all 10 had tearing of the involved eye(s). In 5 patients, complications resolved after office irrigation of the lacrimal drainage system; in a sixth patient, silicone intubation was performed as well. Canaliculotomy was performed in 13 patients (bilateral in 3) and combined with silicone intubation (3 patients). Canaliculotomy was planned in an additional 2 patients. Canaliculitis in 1 patient responded to a course of oral antibiotics; the plug was massaged out of the punctum in a retrograde fashion in another patient. In still another patient, the plugs expressed themselves at the time of planned canaliculotomy. In 4 patients, dacryocystorhinostomy (DCR) with silicone intubation was necessary. Two additional patients refused further treatment including DCR and canaliculotomy; both were lost to follow-up. CONCLUSIONS: Canaliculitis, acute dacryocystitis, and tearing may be seen in patients who have had SmartPlugs and may be managed by removal of the plug. A trial of topical and oral broad-spectrum antibiotics followed by retrograde massage of the plug through the canaliculus may be helpful should plug removal be deemed appropriate. If conservative measures fail, canaliculotomy with removal of the plug may be considered; DCR may be necessary. Although lacrimal irrigation may resolve the problem, irrigation also may dislodge the plug from its canalicular position and cause permanent obstruction of the lacrimal drainage system.
Acute Disease↗
[Preseptal and orbital cellulitis in childhood: response to intravenous antibiotics].
PURPOSE: To evaluate retrospectively the response of preseptal and orbital cellulitis in children to empiric antibiotic treatment. METHOD: We included nine patients (five male and four female) admitted to our hospital between October 2002 and October 2003 because of preseptal or orbital cellulitis. RESULTS: Four patients (44.4%) responded to empiric antibiotic treatment (R); five (55.5%) did not respond (NR) and required a second antibiotic to resolve the infection. The presence of an upper respiratory infection was the most common associated disease in both groups, R and NR. However we also found two cases of acute dacryocystitis in the NR. Four patients (44.4%) were treated with cefotaxime intravenously with the infection resolving in three of these. Five patients (55.6%) were treated with cefuroxime intravenously as first empiric option, however only one patient responded. CONCLUSIONS: We found a high prevalence of acute dacryocystitis as a potential cause of the cellulitis. Children with preseptal and orbital cellulitis responded better to cefotaxime than to cefuroxime. The presence of acute dacryocystitis was associated with a lack of response to cefuroxime.
Acute Disease↗
A review of 120 cases of dacryocystorhinostomies (Dupuy Dutemps and Bourguet technique).
BACKGROUND: The study was conducted at the DHQ hospital Lakki Marwat from Jan, 1999 to Dec, 2002 to assess the intra and postoperative complications and success rate of external dacryocystorhinostomy (DCR) with suturing of the bridge between anterior flaps of nasal mucosa and lacrimal sac with the muscle layer. METHOD: We operated upon 120 patients suffering from chronic dacryocystitis (CDC). Females were 81 (67.5%) and males were 39 (32.5%). Majority of the patients were between the age group 40 to 60 years. Indications for dacryocystorhinostomy (DCR) were epiphora, acute on chronic dacryocystitis and a mucocele. All the cases were operated under local anaesthesia with external approach and only anterior flap suturing and engaging it in the muscle layer. These patients were followed for a period of six months. RESULTS: The overall success rate was 98.33%. The successful outcome was defined as symptomatic relief from epiphora and dacryocystitis and a patent nasolacrimal duct upon syringing. CONCLUSIONS: Dacryocystorhinstomy is a safe procedure under local anaesthesia. It is associated with minimal complications, which can be easily managed. This technique has a very high success rate and a short learning curve.
Adult↗
[Retrograde insertion of a spherical headed silicon tube through nasolacrimal duct].
PURPOSE: Chronic dacryocystitis or obstruction of nasolacrimal duct is one of the common and refractory eye diseases. The present operations have large destruction to lacrimal passage and unsatisfactory effects. The purpose of this research is to explore a simple and easy surgical method that makes small injuries and good curative effects. METHODS: Prob a self-made lumbar puncture needle (No. 7) through the lacrimal drainage system, inject fluid and put a thread into the inferior meatus. Guided by the thread, a special robe is retrogradely pulled through the nasolacrimal duct to dilate the meatus to about 3 mm. Then a silicon tube with a spherical head was inserted in the same may. RESULTS: 37 cases with chronic dacryocystitis or obstruction of nasolacrimal duct were treated by the method and followed up from 6 to 17 months. The result showed that the naso meatus was unobstructed postoperatively. The curative rate was 83.7%, which is better than that of other surgical methods. CONCLUSION: This operation is simple and painless for patients; has good curative effects and no severe complications: seldomly injures the normal lacrimal drainage system; can be done repeatedly or replaced by dacryocystorhinostomy if the procedure fails and will become the primarily elected method th treat the patients with chronic dacryocystitis and obstruction of the nasolacrimal duct.
Adult↗
The postsaccal, idiopathic dacryostenosis--experimental and clinical aspects.
The 'idiopathic' dacryostenosis has not yet been cleared up in its aetiological aspects. For further explanation of aetiology and pathomechanisms an experimental, anatomical study was made. Its object was to define the angles and measurements within the bony lacrimal structures and to establish possible connections between the development of the postsaccal stenosis and certain bony constellations of the lacrimal system. The main goal of these examinations was to determine the angle between the lacrimal fossa and the main direction of the nasolacrimal canal, as well as the angles which are found in the course of the nasolacrimal canal. Macerated half skulls obtained from anatomical dissection courses were used for this study. After cleaning the bony lacrimal passages, the distal orifice of the nasolacrimal canal was closed with bone wax. The canal and the lacrimal fossa were filled with epoxy resin. After hardening the preparations were radiographed in order to make sure that the whole system was completely filled with resin. Then the surrounding bone was removed chemically and the resin casts were laid free. They were photographed and the photographs were traced and measured. A trigonometric method was then used for constructing the maximum angle between the lacrimal fossa and nasolacrimal canal. This angle was mainly directed dorsomedially and showed a considerable amount of variation. A bony system with a large angle increases the possibility of acquiring a postsaccal dacryostenosis. The bony angle is one of many factors facilitating an ascending inflammation in the lacrimal mucosa. Clinically we have to differentiate the acute, fresh dacryocystitis from the chronic, recurrent dacryocystitis. The main symptoms are epiphora, pain and inflammation in the medial canthal area and headache. The most important diagnostic examinations are the slitlamp examination of the eyelids, of the lacrimal puncta and of the anterior segment of the globe, the 'lacrimal punctum excursion test', the diagnostic rinse of the lacrimal passages, the dacryocystography and the rhinological examination. The result of a successful treatment of the acute, beginning dacryocystitis is to open the incomplete, transitory, distal stenosis of the nasolacrimal duct. The stenosis is caused by an ascending inflammation from the nose and by the swelling of the lacrimal mucosa. The blockage can be solved by massage after application of vasoconstrictory drops. The therapy of a complete, postsaccal lacrimal stenosis always has to be a dacryocystorhinostomia externa ('Toti-operation'). The Kaleff-Hollwich modification proved successful and is extended by a fibrin sealing method.(ABSTRACT TRUNCATED AT 400 WORDS)
Acute Disease↗