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PubMed2000

Probing for nasolacrimal duct obstruction with intravenous propofol sedation.

BACKGROUND: Nasolacrimal duct obstruction occurs in 5% to 6% of neonates. Many studies advocate the probing of nasolacrimal duct obstruction under general inhalational anesthesia in patients at a late age (12 to 13 months) because a high percentage will resolve spontaneously. Others support early surgical intervention in patients aged younger than 6 to 9 months without anesthesia. We present late nasolacrimal duct probing under intravenous propofol sedation as an alternative approach to the treatment of nasolacrimal duct obstruction with a decrease in cost and time compared with probing under general inhalational anesthesia. METHODS: We made a retrospective review of patient charts of children who underwent nasolacrimal duct probing with intravenous propofol sedation from April 1996 to September 1997. Procedure time and cost of procedure were compared for patients who had probings under propofol sedation to patients who had probings under general anesthesia. RESULTS: A total of 22 patients (31 eyes) underwent nasolacrimal duct probing with propofol sedation; the patients' ages ranged from 11.5 to 39 months (average age, 17.8 months). Twenty-six (84%) of 31 eyes had resolution of the symptoms. The average total time for procedure under propofol sedation was 10.5 minutes, compared with 43.6 minutes under general inhalational anesthesia. The average total recovery time under propofol sedation was 13.6 minutes, compared with 121.1 minutes with general inhalational anesthesia. The cost of probing under propofol sedation was one third less than the cost of probing under general inhalational anesthesia. DISCUSSION: Late probing for nasolacrimal duct obstruction under intravenous propofol sedation is comparable in efficacy to late probing under general inhalational anesthesia with a shorter time for the procedure and decreased expense.

Anesthesia, Intravenous↗

PubMed2003

The course of the nasolacrimal duct in brachycephalic cats.

Casts of the nasolacrimal duct system were obtained from 50 euthanised cats including brachy-, meso- and dolichocephalic breeds. The course of the nasolacrimal duct, which was assessed radiographically and gross-anatomically, was strongly related to the shape of the skull. In meso- and dolichocephalic cats the nasolacrimal duct formed a dorsally opened arch with the descending part being directed rostroventrally. The main part of the duct passed the nasal cavity in a rather horizontal course parallel to the hard palate and was located ventrally to the lacrimal foramen. However, foreshortening of the face was associated with a right-angled or even acute-angled alignment of the duct. In higher degrees of brachycephaly the main part of the duct ascended beyond the level of the lacrimal foramen and passed the nasal cavity dorsal to the level of the lacrimal foramen. This specific course of the nasolacrimal duct in brachycephalic cats was consistent with a steeper alignment and attachment of the maxilloturbinate. Accessory orifices of the nasolacrimal duct opening into the nasal cavity had never been observed. The present results strongly suggest that the specific course of the nasolacrimal duct in brachycephalic cats might hinder the drainage of the lacrimal fluid irrespective of the diameter of the lumen of the nasolacrimal duct system.

Animals↗

PubMed1997

The endoscopic approach for congenital nasolacrimal duct obstruction.

Probing of the nasolacrimal duct is a common procedure in children with congenital stenosis. Although simple probing of the nasolacrimal duct is successful in a majority of patients, a number of failures occur. In those temporary intubation of the nasolacrimal duct with a silicone drain may solve the problem. We performed silicone intubation in 11 infants under nasal endoscopic control. By this improved visualization of the inferior meatus, the procedure was facilitated. In four children the probe was unable to pierce the nasal mucosa and stayed in the submucosal space. An incision of the nasal mucosa was needed before the probe could be passed into the nasal lumen. We believe that this situation, inability to pierce the nasal mucosa, may explain a number of failures of simple probing. It is therefore advisable, especially if initial probing has failed, to repeat the procedure under endoscopic control.

Child, Preschool↗

PubMed2006

[Evaluation of therapy outcome in congenital nasolacrimal duct obstruction in own material].

UNLABELLED: The inborn nasolacrimal duct obstruction is common ocular disease in new-borns and infants. There are still doubts concerning the timing of the operating procedure. Probing of the lacrimal ducts is the therapeutic method for this condition. PURPOSE: To evaluate the therapy outcome in congenital nasolacrimal duct obstruction in authors' own material. MATERIAL AND METHODS: In retrospective study of 3950 medical records of children from our Outpatient's Clinic, we distinguished 192 children with nasolacrimal duct obstruction. Then, we evaluated the outcome of implemented treatment in correlation with their age and timing of the nasolacrimal duct probing. RESULTS: All children with nasolacrimal duct obstruction had mucopurulent discharge in the lacrimal sac and lacrimation. After the conventional treatment, the disease resolved in 23% of our group, whereas, in the rest of the patients probing of the nasolacrimal duct was implemented. The probing was successful in all children, but it was necessary to repeat the procedure twice in 13 children and three times in 5 children. The success rate of single probing was as follows: 91% in the group of children 1 - 3 months old, 83% in both groups: 3 - 6 and 6 - 12 months old and 71% in the oldest group of children - above 1 year of age. CONCLUSIONS: In majority of children the nasolacrimal duct obstruction did not resolve spontaneously. Early probing within first few months of child's life increased the success rate of this procedure.

Age Factors↗

PubMed2002

Endoscopic marsupialization of congenital nasolacrimal duct cyst with dacryocoele.

A congenital nasolacrimal duct cyst is an uncommon condition in the newborn usually treated by ophthalmologists. Prolapse or expansion of the cyst into the nose may lead to respiratory distress and difficulty in feeding as newborns are obligate nose breathers, which needs the involvement of the Otolaryngologist in diagnosis and management. The authors report a series of 8 children presenting with a congenital nasolacrimal duct cyst and dacryocoele and highlight the importance of endoscopic nasal examination of newborns presenting with respiratory problems. Diagnostic studies included intranasal endoscopy and CT scanning of the nasolacrimal system and nose. All the patients were treated by endoscopic marsupialization of the cyst. Nasolacrimal duct abnormality should be considered in the differential diagnosis of neonatal respiratory distress and nasal obstruction. Nasal endoscopy is essential in the work-up of all children with nasal obstruction and respiratory distress. CT scanning is the investigative method of choice. Endoscopic marsupialization followed by lacrimal duct irrigation is effective in the treatment of congenital nasolacrimal duct cyst and results in complete resolution of symptoms.

Cysts↗

PubMed2002

Balloon catheter dilation for treatment of persistent nasolacrimal duct obstruction.

PURPOSE: To report the outcome of balloon catheter dilation of the lacrimal duct for treatment of children with persistent nasolacrimal duct obstruction after previous surgery. DESIGN: Interventional case series. METHODS: Thirty-two consecutive children with a history of persistent nasolacrimal duct obstruction following previous surgery were treated with nasolacrimal duct probing with balloon catheter dilation of the distal nasolacrimal duct. Patients were excluded from this study if they had a history of facial trauma, systemic disorders that involved the lacrimal system, or nasolacrimal duct cysts. Outcomes were considered excellent if the patient had complete symptomatic resolution of epiphora and dacryocystitis and normal tear drainage on examination, good if the patient had only minimal residual symptoms or a minimally delayed dye disappearance test, fair if the patient had moderate residual symptoms or delayed tear drainage, and poor if there was no improvement. RESULTS: Thirty-two children (20 with bilateral nasolacrimal duct obstruction and 12 with unilateral nasolacrimal duct obstruction) underwent balloon catheter dilation. Overall results were excellent in 9 (28%) patients, good in 15 (47%) patients, fair in 7 (22%) patients, and poor in 1 (3%) patient. Seven patients had undergone more than one previous procedure. Of these patients, 3 had excellent outcomes, 2 had good outcomes, 1 had a fair outcome, and 1 had a poor outcome following balloon catheter dilation. CONCLUSIONS: Balloon catheter dilation is a safe and generally effective treatment for children with persistent symptoms of nasolacrimal duct obstruction following previous surgery.

Catheterization↗

PubMed1994

Congenital nasolacrimal duct mucocele: a cause of respiratory distress.

Congenital nasolacrimal duct mucocele is an uncommon condition in the newborn. Prolapse or expansion of the mucocele into the nose may lead to respiratory distress and difficulty in feeding, as newborns are preferential nose breathers. Infants with congenital lacrimal sac distension should be examined for signs of respiratory distress and nasal pathology. In the presence of respiratory distress, nasal examination and imaging studies should be done to ensure the diagnosis of nasolacrimal duct mucocele. If significant respiratory distress exists, endoscopic marsupialization of the nasolacrimal duct mucocele in conjunction with nasolacrimal duct probing by the ophthalmologist and possible insertion of lacrimal drainage tubes should be considered. At our institution the nasolacrimal duct mucocele was expectantly managed in two of three cases. Only one of the three patients manifested a significant degree of respiratory distress and required intervention. Endoscopic marsupialization of the nasolacrimal duct mucocele resulted in complete resolution of the mucocele and improvement in symptoms.

Female↗

PubMed1999

[The applied anatomy and measure of nasolacrimal duct].

OBJECTIVE: To know the anatomy of nasolacrimal duct. METHOD: 80 half-skulls of chinese adult were used to observe shapes of the orifice. RESULT: Five shapes of the orifice were found. Slit-shape was the most in all shapes. 73 nasolacrimal ducts and situation of orifices have been measured with results as follows: (1) The nasolacrimal duct length is 14.14 mm (mean value); (2) The distance from the inferior margin of the anterior nostril to the anterior margin of the orifice (D.N.O.) is 29.00 mm (mean value); (3) The distance from the anterior attachment of the inferior turbinate to the anterior margin of the orifice is 11.70 mm (mean value); (4) The distance from the inferior margin of the anterior nostril to the anterior attachment of the inferior turbinate (D.N.T) is 18.30 mm (mean value). With analysis of linear regression, the relationship between the "D.N.T." and the nasolacrimal duct length, the "D.N.T." and the "D.N.O." is positive linear correlation respectively, "D.N.T." has been able to be measured easily, so the nasolacrimal duct length and the situation of the orifice have been recognized. CONCLUSION: D.N.T. may be used in clinical teaching and researching work.

Adult↗

PubMed2005

Monocanalicular versus bicanalicular silicone intubation for nasolacrimal duct stenosis in adults.

PURPOSE: To compare the success rate of monocanalicular versus bicanalicular silicone intubation of incomplete nasolacrimal duct obstruction (nasolacrimal duct stenosis) in adults. METHODS: In a retrospective, nonrandomized comparative case series, 48 eyes of 44 adult patients with nasolacrimal duct stenosis underwent endoscopic probing and either bicanalicular (BCI; n=22 eyes) or monocanalicular (MCI; n=26 eyes) nasolacrimal duct intubation under general anesthesia. "Complete success" was defined as complete disappearance of the symptoms, "partial success" as improvement with some residual symptoms, and "failure" as absence of improvement or worsening of symptoms at last follow-up. The last follow-up examination included diagnostic probing and irrigation if there was not complete success. RESULTS: Patient ages ranged from 31 to 90 years (mean, 69; SD, 11.5). Forty-five tubes were removed 6 to 17 weeks (mean, 9.1; SD, 3) after surgery. Premature tube dislocation and removal occurred in one eye with BCI and in two eyes with MCI. Follow-up ranged from 6 to 52 months (mean, 14.9; SD, 8.4). The complete success rate was nearly the same in eyes with MCI (16/26, 61.53%) and BCI (13/22, 59.09%). Partial success (MCI: 8/26, 30.76%; BCI: 1/22, 4.54%) and failure (MCI: 2/26, 7.69%; BCI: 8/22, 36.36%) were, however, significantly different (p=0.010). Complications included 3 slit puncta with BCI and 4 temporary superficial punctuate keratopathy after MCI. CONCLUSIONS: MCI had virtually the same complete success rate as BCI, a higher partial success rate than BCI, and a lower failure rate than BCI in treatment of nasolacrimal duct stenosis in adults.

Adult↗

PubMed2001

Nasolacrimal duct injury from microscopic sinus surgery: preliminary report.

Nasolacrimal duct injury is a well established complication of functional endoscopic sinus surgery. In 1992, Bolger reported an incidence of nasolacrimal duct injuries in endoscopic sinus surgery of up to 15 per cent, but there is no documentation in microscopic sinus surgery. Fluorescein instillation into the lacrimal system via the punctum was done to determine the incidence of nasolacrimal duct injuries in 16 patients who underwent 32 microscopic sinus procedures. Only one patient exhibited nasolacrimal duct injury intraoperatively on the left side (0.3%). He had complete healing of the nasolacrimal duct at 2 months and no postoperative epiphora developed.

Adolescent↗

PubMed1992

Office probing of congenital nasolacrimal duct obstruction.

We report the results of office nasolacrimal duct probing under topical anesthesia in 2369 eyes with symptomatic nasolacrimal duct obstruction. The overall success rate for cure by initial probing was 92%. In patients less than 9 months old, a 94% cure rate was achieved with one probing; in patients 9 months and older, the rate decreased to 84%. The decrease in success rate after 9 months was statistically significant (P less than .00001 by chi-square analysis). A majority of 180 parents of these patients surveyed said they were happy with the office procedure and preferred having the probing performed to resolve symptoms, even though they realized that the symptoms most probably would resolve by 1 year of age without it. We conclude that office probing for congenital nasolacrimal duct obstruction is a safe and effective method for treatment of symptomatic nasolacrimal duct obstruction, allowing the cost and risk of general anesthesia as well as the cost and inconvenience of prolonged medical management to be avoided.

Age Factors↗

PubMed2006

The histopathologic effects of balloon dacryoplasty on the rabbit nasolacrimal duct.

PURPOSE: To examine the histopathologic effects of balloon dacryoplasty on the nasolacrimal duct of the rabbit. METHODS: Sixteen nasolacrimal ducts of 8 infant white New Zealand rabbits were divided into 3 treatment groups: a control group, a 2 mm balloon dilation group, and a 3 mm balloon dilation group. The LacriCath balloon catheter (Quest, Medical, Allen, TX) was used for nasolacrimal duct dilation according to the manufacturer's recommended human protocol. The rabbits were euthanized at 1, 3, and 7 days after treatment and the nasolacrimal ducts were harvested for histological examination. RESULTS: There were no significant differences between treatment groups in the number of neutrophils in the lumen, epithelium, and stroma of the duct; the number of monocytes in the stroma of the duct; or in the number of red blood cells in the stroma of the duct. No differences were found in overall cellularity of any type in the nasolacrimal ducts of treated and untreated rabbits. Finally, no histopathologic signs of crush injury were evident. CONCLUSION: Balloon dacryoplasty does not induce significant inflammation or crush injury in the nasolacrimal duct of a rabbit model.

Animals↗

PubMed1995

[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↗

PubMed1999

[Evaluation of nasolacrimal duct function in chronic paranasal sinus infections with 99mTc dacryoscintigraphy].

BACKGROUND: Paranasal sinus infections and nasolacrimal duct obstructions are commonly encountered problems. However the relationship between these two conditions is not yet clear. Trauma, surgery, tumors, and systemic diseases are among the causes of acquired nasolacrimal duct obstructions but most of the cases are idiopathic. In this study patients diagnosed with chronic paranasal sinus infection were examined with 99mTc lacrimal dacryoscintigraphy to assess their nasolacrimal duct function. METHODS: Twenty-four patients diagnosed with chronic paranasal sinus infection are included in the study. These patients were observed for at least three months awaiting surgical treatment following unsuccessful medical treatment. The control group included 16 persons admitted to the ophthalmology department without any nasolacrimal duct disease. Nasal endoscopy and paranasal sinus CT revealed normal findings. The age of the patients with chronic paranasal sinus infection and examined in regard to nasolacrimal duct function was between 15 to 17 with a mean age of 34.2 years. Fourteen patients were male and 10 patients were female. The control group included 9 male and 7 female patients between 18 to 60 years with a mean of 30.5 years. RESULTS: The dacryoscintigraphic examination of 48 nasolacrimal ducts in 24 patients with chronic paranasal sinus infection revealed 7 complete and 18 partial obstructions of the duct, and 23 normal findings. In the control group with 32 nasolacrimal ducts of 16 patients, there was no complete obstruction. Partial obstruction (10.6, 12.0, 14.7 minutes) was be observed in three cases. The statistical workup resulted in a significant difference between paranasal sinus patients and control group (x2 = 15,840 p < 0.001). The paranasal sinus CTs of the patients with paranasal sinus disease were staged using the Lund-Mackay staging system: There is no correlation between the staging score of the paranasal sinus infection and the degree of the obstruction the nasolacrimal duct. CONCLUSION: This study shows that chronic paranasal sinus disease plays an important role in the pathogenesis of nasolacrimal duct obstructions. The presence of infection has an influence on the nasolacrimal drainage system, but the distribution (staging) of the infection does not appear to correlate with the degree of nasolacrimal duct obstruction. Partial obstruction cases that may progress to complete obstruction may be detected by dacryoscintigraphy, and the treatment of chronic paranasal sinus disease may help to overcome the lacrimal drainage problems in these cases.

Adolescent↗

PubMed1998

The management of nasolacrimal duct obstruction in children between 18 months and 4 years old.

PURPOSE: Success with nasolacrimal duct probing has been shown to be inversely correlated with age. Consequently, several authors have suggested that the older child with a previously untreated nasolacrimal duct obstruction should undergo silicone intubation or a balloon catheterization as the primary surgical procedure because older children are more likely to have complicated obstructions that will not respond to simple probing. The purpose of this study was to investigate the hypothesis that older children with uncomplicated nasolacrimal duct obstruction can be successfully managed with simple probing. METHODS: A 14-year prospective study was conducted of consecutive patients older than age 18 months with nasolacrimal duct obstruction. All were treated (subject to certain exclusion criteria) with a simple nasolacrimal duct probing. Careful attention was paid to the type of obstruction encountered at surgery. Outcome evaluation included a standard ophthalmologic examination plus a dye disappearance test at 6 weeks after surgery. A follow-up examination or telephone interview was conducted 1 year after surgery. RESULTS: Of 378 children undergoing nasolacrimal duct probing, 23 met the inclusion criteria of being older than age 18 months (18 to 48 months). Seventy percent of the 23 children had a good outcome from the probing procedure. When analyzed by the type of obstruction, 12 of the 12 children (100%) with a simple membrane at the valve of Hasner had a good outcome. This contrasted with a success rate of 4 of 11 children (36%) who had complicated obstructions (p < 0.01). Complicated nasolacrimal duct obstructions were more prevalent in older children. CONCLUSION: A simple probing of the nasolacrimal duct has an excellent success rate in children up to 4 years old if an uncomplicated obstruction is found at the valve of Hasner.

Child, Preschool↗

PubMed1982

Silicone intubation for obstruction of the nasolacrimal duct in children.

We performed 63 intubations with silicone tubing for nasolacrimal duct obstruction in children in whom nasolacrimal duct probings had failed. Fifty-nine (93.7%) obstructions were congenital and four (6.3%) were acquired. The average length of intubation was 4.3 months. The final results for both congenital and acquired obstructions combined were good in 52 cases (82.5%), fair in three (4.8%), and poor in eight (12.7%). Complications, with the exception of some with infection, were easily treated or minimal and did not affect the outcome significantly. We recommend silicone intubation as the procedure of choice for congenital or acquired nasolacrimal duct obstructions in children after failure of medical therapy and nasolacrimal duct probings.

Child, Preschool↗

PubMed1986

Demonstration of nasolacrimal duct carcinoma by computed tomography.

Nasolacrimal duct neoplasms are unusual; when they do occur, clinical findings and contrast dacryocystography generally are utilized to establish the diagnosis. We report a case of squamous cell carcinoma of the nasolacrimal duct in which computed tomography was used to confirm the diagnosis and define the extent of the tumor.

Aged↗

PubMed2005

[Balloon dilatation and Stentimplantation of the nasolacrimal duct for chronic epiphora].

PURPOSE: To examine the clinical outcome of the ballon dilatation in stenosis and obstruction of the nasolacrimal duct. MATERIAL AND METHODS: 63 patients (69 nasolacrimal duct systems) with epiphora and proven obstruction of the nasolacrimal duct were treated with ballon dilatation, respectively Stentimplantation. In 55 cases there was a pre- or postsaccal stenosis, in 14 cases an occlusion of the nasolacrimal duct system. The diagnosis was established by dacryocystography. RESULTS: Technical success was obtained in 61 cases (n=50/55 stenosis; n=11/14 occlusions). Over a mean follow-up of 6 months patency of the nasolacrimal duct system was achieved in 83,6% (46/55) in stenosis. In occlusion the clinical outcome was 42,9% (6/14). CONCLUSION: Balloon dacryocystoplasty and Stentimplantation are minimal-invasive alternatives, performed in local anesthesia that recover the normal anatomy of the nasolacrimal duct system. They are a good alternative in the treatment of epiphora caused by nasolacrimal duct obstructions.

Adult↗