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PubMedDate not supplied

Midface anomalies in children.

A variety of congenital midface anomalies occur in children. High-resolution computed tomography (CT) and magnetic resonance (MR) imaging have proved helpful in determining the nature and extent of dysplasia, thereby facilitating treatment planning. A classification system has been developed that groups these anomalies into four categories based on embryogenesis and anatomic location. These categories comprise anomalies that are related to the nasal cavity, nasofrontal region, nasolacrimal apparatus, and craniofacial syndromes. CT is the imaging modality of choice in children with possible choanal atresia, pyriform aperture stenosis, or anomalies of the nasolacrimal duct (eg, nasolacrimal duct stenosis, dacryocystoceles). MR imaging is the modality of choice in patients with congenital midface masses (eg, dermoid and epidermoid cysts, nasal gliomas, encephaloceles) and craniofacial syndromes (eg, Apert syndrome, Crouzon syndrome, Treacher Collins syndrome). In many cases, however, both CT and MR imaging are required to adequately evaluate midface anomalies. Familiarity with the characteristic imaging features of these anomalies along with knowledge of midface embryogenesis and normal developmental anatomy is essential to prevent misinterpretation of anatomic variations that may simulate disease.

Child↗

PubMed2001

[Clinical application of a new nasolacrimal stent].

Seventy-two patients(ninety-one eyes) with epiphore due to obstruction of the nasolacrimal duct underwent nasolacrimal stent of our own disign. The period postoperative follow-up was 6 to 20(mean 14.5) months. Seventy-six eyes demonstrated obvious resolution of epiphore, twelve eyes had partial resolution, and three eyes had no resolution. The success rate were 96.7%. The common complications included occluded stent and a slightly blood-stanied nasal discharge. The placement of the nasolacrimal stent is a safe simple and effective method for treatment of epiphore due to obstruction of the nasolacrimal duct.

Adult↗

PubMed1984

Congenital tear duct obstruction.

Congenital nasolacrimal duct obstruction is a classic condition that has been well investigated and is readily identified. The suggested sequence of treatment includes massage, irrigation, probing, insertion of a silicone stent and, finally, dacryocystorhinostomy. Because of the relatively frequent occurrence of duct obstruction in normal infants, family physicians need to be familiar with its diagnosis and treatment. If problems still exist after an adequate trial of conservative treatment, referral before six months of age is suggested.

Fluoresceins↗

PubMed1996

Nonsurgical placement of a nasolacrimal polyurethane stent: long-term effectiveness.

PURPOSE: To evaluate the long-term effectiveness of a polyurethane stent in the treatment of obstruction of the lacrimal sac and the nasolacrimal duct. MATERIALS AND METHODS: Fluoroscopically guided placement of a polyurethane nasolacrimal stent was evaluated in 283 obstructed lacrimal systems of 236 patients, with a follow-up period of more than 1 year (range, 52-134 weeks). The obstruction was at the junction between the lacrimal sac and the nasolacrimal duct in 192 systems, at the lacrimal sac in 52, and at the nasolacrimal duct in 39. The causes of obstruction were traumatic in 34 and idiopathic in 249 systems. RESULTS: Stent placement was technically successful in 270 systems (95%). At 7 days after stent placement, 235 (87%) of the 270 systems with successful placement demonstrated complete resolution of epiphora, 27 (10%) had partial resolution, and the remaining eight (3%) had no resolution. There was recurrence in 81 systems due to obstruction of the stent (n = 77) or obstruction of the common canaliculus (n = 4). The recurrence rate was much higher in the systems with obstruction at the lacrimal sac (64%) than in the systems with obstruction at the junction (26%) between the lacrimal sac and nasolacrimal duct or at the nasolacrimal duct (15%). CONCLUSION: Stent placement in the obstructed lacrimal system below the junction between the lacrimal sac and the nasolacrimal duct is valuable as an initial therapy.

Adolescent↗

PubMed1994

The effect of fluorescein volume on lacrimal outflow transit time.

The Jones primary dye test is a commonly used test of lacrimal outflow. Some clinicians, however, find it of limited practical significance because of variable outcome and relatively low sensitivity in documenting normal lacrimal excretory function. We hypothesized that an important variable affecting the transit time may be the volume of fluorescein used in the primary dye test. To accurately determine the exact time from insertion of dye into the eye to its appearance in the nose, using a rigid nasal endoscope, we directly visualized the dye as it appeared at the ostium of the nasolacrimal duct. Fifty nasolacrimal outflow systems were examined in 25 normal volunteers. The fluorescein dye transit time was determined using a single drop of fluorescein on one side and multiple drops of fluorescein on the other side. Using a single drop of fluorescein, the median dye transit time was 8 min, compared to 1.4 min using multiple drops. These results suggest that the volume of fluorescein used may be an important factor affecting variability in the outcome of the primary dye test.

Adult↗

PubMed2002

TFF peptides in the human efferent tear ducts.

PURPOSE: To determine whether the lining epithelium of the human lacrimal sac and nasolacrimal duct synthesizes TFF peptides (formerly P-domain peptides, trefoil factors), a family of mucin-associated secretory peptides. METHODS: Expression of TFF peptides in human lacrimal sac and nasolacrimal ducts was monitored by reverse transcription-polymerase chain reaction and Western blot analysis. Antisera specific for TFF peptides were used in immunohistochemical analysis to determine the presence and distribution of all three TFF peptides in epithelia of the lacrimal passage. The samples investigated originated from tissue obtained during surgery (18 patients) and postmortem tissue (10 specimens). RESULTS: mRNA expression of TFF1 and TFF3, but not TFF2, was detected in human lacrimal sac and nasolacrimal duct. TFF1 was detected in only approximately 50% of the investigated probes, whereas TFF3 was present in all samples. Immunohistochemistry revealed TFF1 (if present) to be associated with goblet cells forming intraepithelial mucous glands. TFF3 occurred in epithelial cells of the lacrimal sac and the nasolacrimal duct as well as in the acinar cells of subepithelial serous glands, but appeared to be absent in goblet cells. CONCLUSIONS: The epithelium of the nasolacrimal ducts synthesizes TFF3 and in some cases also TFF1. In contrast to the human conjunctiva, in which TFF3 is detectable only in goblet cells, TFF3 of the lacrimal sac and nasolacrimal duct is produced in large amounts by epithelial cells as well as by serous glands, but not-or in small amounts only-by goblet cells. This is comparable with localization of TFF3 in the major salivary glands. Thus, TFF3 may have a special function in tear transport through the lacrimal passage comparable to its function on the ocular surface, because the peptide, together with TFF1, may contribute to the rheologic properties of the tear film. Moreover, the TFF peptides may also influence epithelial healing with their motogenic properties.

Adolescent↗

PubMed2005

[Balloon dacryocystoplasty: interventional radiological therapy of congenital dacryostenosis].

PURPOSE: To evaluate the results of balloon dacryocystoplasty in the treatment of complicated development of connatal obstructed nasolacrimal duct system. MATERIALS AND METHODS: Dacryocystography under general anaesthesia was performed on 46 children with epiphora from birth and recurrent infection of the nasolacrimal duct system. 54 nasolacrimal ducts (8 children bilaterally) were treated with balloon catheter dilatation and antibiotic irrigation of the nasolacrimal sac. In all cases previous conservative treatment with eye drops and superficial massage of the lacrimal sac had failed. 11 children without clinical improvement were irrigated before catheter dilatation by an ophthalmologist. The ages ranged from 6 weeks to 7.5 years (mean 23.5 months). 39 dilatations were carried out as an out-patient procedure. The clinical results were confirmed by a questionnaire filled in by the parents. RESULTS: 15 incomplete obstructions and 39 occlusions of the Hasner valve (n = 45) or of the nasolacrimal duct system (n = 9) were demonstrated with dacryocystography. Dilatation with a 2.5 mm ballon was successfully performed in all cases and the mean radiation time was 2.1 minutes. No relevant complications occurred. The mean follow up time was 18.4 months (3 - 41 months). 39 of 46 children showed no symptoms, 6 children seldomly experienced onset of epiphora. The symptoms did not improve in only one child. The cumulative clinical success rate is 98 %. CONCLUSION: Following diagnostic dacryocystography, balloon catheter dilatation is a low risk and very successful treatment of complicated connatal obstructed nasolacrimal duct system.

Catheterization↗

PubMed1997

Computed tomography in lacrimal outflow obstruction.

BACKGROUND: Acquired nasolacrimal duct obstruction is a common ophthalmologic problem. Despite widespread understanding of treatments available for nasolacrimal duct obstruction, few authors have commented on its etiology. Because the nasolacrimal system is anatomically related to important nasal and sinus structures, the authors postulated that acquired nasolacrimal duct obstruction and its complications might occur simultaneous to, and possibly as a consequence of, rhinologic or sinus disease. MATERIALS AND METHODS: Twenty-three patients with acquired nasolacrimal duct obstruction and 100 control patients were evaluated by coronal computed tomography for evidence of sinus disease or nasal abnormalities. Specifically, five findings were noted: ostiomeatal complex disease, ethmoidal opacification, agger nasi cell opacification, concha bullosa, and nasal septal deviation. RESULTS: Overall, 20 (87%) patients with acquired nasolacrimal duct obstruction demonstrated one or more radiologic finding of sinus disease or rhinologic abnormality whereas 63 (63%) control subjects exhibited these findings. This difference was determined to be statistically significant (P < 0.05). A statistically significant higher incidence of ethmoidal opacification, agger nasi cell opacification, and nasal septal deviation was observed in patients with nasolacrimal outflow obstruction than in controls. Differences in the incidence of ostiomeatal complex disease and concha bullosa were not found to be statistically significant. CONCLUSION: These data demonstrate a correlation between computed tomography findings of sinus disease or nasal abnormality and the presence of acquired nasolacrimal outflow obstruction. This association between radiologic evidence of sinorhinologic disorders and lacrimal outflow obstruction may imply that dacryocystitis, like sinus disease, may be produced by disease of the lateral nasal wall. When evaluating a patient with acquired nasolacrimal duct obstruction, the physician should consider evaluation for concomitant nasal and sinus disease.

Humans↗

PubMed2003

[The effect of treating obstructive disease of lacrimal passage by lacrimal plastic operation with Nd:YAG laser].

OBJECTIVE: To study the therapeutic effects of Nd:YAG laser on obstructive diseases of the lacrimal passage. METHODS: 693 eyes in 603 cases with obstructive diseases of lacrimal passage, including obstruction of lacrimal puncta (23 eyes), lacrimal duct (192 eyes), nasolacrimal duct (227 eyes), chronic dacryocystitis (231 eyes), and traumatic laceration of lacrimal canaliculus (20 eyes), were treated by lacrimal plastic operation with Nd:YAG laser and the therapeutic effects were compared among the groups. RESULTS: The cure rates and effective rates of the five diseases were 86.9% and 95.7%, 89.1% and 93.8%, 93.0% and 96.0%, 78.4% and 82.7%, 40.0% and 65.0%, respectively. By Ridit analysis, R +/- S(R) values for each group were 0.921 +/- 0.023, 0.914 +/- 0.009, 0.927 +/- 0.007, 0.856 +/- 0.013, 0.749 +/- 0.055. CONCLUSIONS: The therapeutic effect on chronic dacryocystitis is less than those of obstruction of nasolacrimal duct and lacrimal duct (P < 0.05). The therapeutic effect on traumatic laceration of lacrimal canaliculus is less than that of the other four groups (P < 0.05). Therefore, it should be restricted on indication for the cases of chronic dacryocystitis and traumatic laceration of lacrimal canaliculus.

Adolescent↗

PubMed1997

Gravity, blink rate, and lacrimal drainage capacity.

PURPOSE: To investigate the influence of gravity and blink rate on lacrimal drainage capacity and to learn whether lacrimal pump function can be measured with the drop test. METHODS: The drop test for lacrimal drainage capacity was performed in 20 test subjects, aged 12 to 30 years. Drops of a known volume of lukewarm saline solution were repeatedly instilled in the tear film for 3 minutes. Excessive saline solution was then removed, and the volume drained by the lacrimal passages was calculated. The drop test was performed both with the nasolacrimal duct in a 45-degree position and with the nasolacrimal duct in a horizontal position. The drop test was performed two times in each position, with the individual reading and not reading. A lower blink rate was induced by reading. RESULTS: There was a high correlation between blink rate and lacrimal drainage when the nasolacrimal duct was in a horizontal position. The volume drained with each blink was approximately 2 microliters. However, when gravity acted upon the fluid in the lacrimal sac-nasolacrimal duct in the direction of the tear flow, the lacrimal drainage capacity showed a significant but variable increase, and there was no significant correlation between blink rate and lacrimal drainage capacity. CONCLUSIONS: Lacrimal drainage capacity in young individuals was significantly affected by both blink rate and gravity. Lacrimal pump function can be measured quantitatively with the drop test.

Administration, Topical↗

PubMed2005

Clinicopathologic findings after nasolacrimal polyurethane stent implantations.

PURPOSE: To evaluate the results of nasolacrimal polyurethane stent implantations for the treatment of primary acquired nasolacrimal duct obstruction, and to determine the effects of various surgical procedures, including stent removal, in subsequent nasolacrimal duct obstruction. METHODS: This study included 15 patients who had nasolacrimal polyurethane implantations for the treatment of primary acquired nasolacrimal duct obstruction. Occluded stents were removed either by nasal endoscopy or during dacryocystorhinostomy (DCR). Cultures and biopsies were performed on the removed stents, and the results of the secondary DCR were analyzed for a 6-month follow-up period. RESULTS: During stent removal surgery, various degrees of chronic inflammatory reaction and fibrous tissue formation were detected in the lacrimal sac and nasolacrimal duct. Formations of granuloma and fibrous tissue were found in 15 eyes, and culture-positive reaction were found in nine of the 15 eyes. Conventional dacryocystorhinostomy surgery was performed in nine of the 15 eyes and a silicone tube was located at the canaliculi. Subjective and objective outcome were favorable in 13 of the 15 eyes. CONCLUSIONS: The success rate of nasolacrimal polyurethane stent implantation for the treatment of primary acquired nasolacrimal duct obstruction is low. This may result from a chronic inflammatory reaction. Despite the low success rate of nasolacrimal polyurethane stent implantation, the success rate of endonasal DCR as a subsequent surgery is favorable.

Adult↗

PubMed1997

[Lacrimal duct recanalization with balloon catheter].

In dilation of nasolacrimal duct stenosis materials now being used originally were developed for percutaneous transluminal coronary angioplasty (PTCA). Suitable modifications of the angioplasty equipment could improve therapeutic results and thus influence the area of indication of this new technique. In addition to the standard PTCA equipment, we used a cannula designed to fit the guide wire, leading to less traumatic intubation of the lacrimal duct and allowing radiographic control of the recanalization procedure. Five patients showing relative stenosis and ten patients showing complete obstruction of the nasolacrimal duct were treated by dacryocystoplasty. Clinical and radiographic follow-up was done over a period of 6 months. In a total of seven patients, dilation proved successful. Out of these, four showed stenosis (80% recanalization rate) and three complete obstruction (30% recanalization rate) before dilation. Recanalization by dilation using balloon catheters seems to be possible even in cases of complete nasolacrimal duct obstruction. However, the success rate is considerably lower than in relative stenosis.

Aged↗

PubMed1996

[Lacrimal-nasal canal stenosis after intranasal surgery].

The etiology of the nasolacrimal duct obstruction usually reported is: idiopathic, infectious, traumatic, congenital, tumoral and others. The nasolacrimal duct stenosis after intranasal surgery is rarely reported in the literature. We describe 5 cases of iatrogenic nasolacrimal duct stenosis found in our series of 41 patients treated the last 2 years for nasolacrimal duct obstruction and we propose how to avoid this complication of intranasal surgery.

Adolescent↗

PubMed2004

Outcome of patients with nasolacrimal polyurethane stent implantation: do they keep tearing?

PURPOSE: To evaluate the results of nasolacrimal polyurethane stent implantation for the treatment of primary acquired nasolacrimal duct obstruction and the effects of obstructed nasolacrimal stent on subsequent dacryocystorhinostomy (DCR). METHODS: This study was designed as a nonrandomized, prospective clinical trial. Stent implantation was attempted in 53 obstructed lacrimal drainage systems of 47 patients. Stent placement was performed in a retrograde fashion through the external nare over a guide wire, which was introduced from the upper punctum. Occluded stents were removed either with nasal endoscopy or during DCR. External DCR surgery with silicone intubation was performed in cases with stent failure. RESULTS: The mean follow-up period was 23.4 months. The success rate of stent implantation was 60.4%, 37.5%, and 31.2% at 6-, 12-, and 18-month follow-up, respectively. Stent obstruction developed in 33 eyes. Twenty underwent external DCR with silicone intubation. During DCR surgery, varying degrees of chronic inflammatory reaction were detected in the lacrimal sac and nasolacrimal duct. The mean follow-up period after DCR was 10.3 months. Epiphora was relieved with DCR in all but one eye. CONCLUSIONS: The success rate of nasolacrimal polyurethane stent implantation for the treatment of primary acquired nasolacrimal duct obstruction is low and may induce inflammation and fibrous tissue formation. Although this may cause further difficulties in subsequent lacrimal surgery, epiphora could be relieved with meticulous technique.

Adult↗

PubMed1992

Tricompartment model of the lacrimal pump mechanism.

BACKGROUND: The role of the lacrimal sac in the lacrimal pump mechanism is controversial. METHODS: Movements of the lateral wall of the lacrimal sac with blinking were videotaped through an endoscope in eight patients after dacryocystorhinostomy. In addition, movements of an air bubble at the opening of the nasolacrimal duct with blinking were studied in three patients with an incompetent valve of Hasner. RESULTS: The superior half of the lateral wall of the lacrimal sac moved laterally with lid closure and medially with lid opening. The inferior half of the lateral wall of the lacrimal sac moved medially with lid closure and laterally with lid opening. In patients with an incompetent valve of Hasner, the air bubble at the opening of the nasolacrimal duct bulged into the nose with lid closure and retracted into the nasolacrimal duct with lid opening. CONCLUSIONS: A tricompartment model of the lacrimal pump is presented that incorporates these findings. With lid closure, the orbicularis muscle contracts, compressing the canaliculi and pulling the superior half of the lateral wall of the lacrimal sac laterally. This creates a lower pressure in the superior sac, allowing tears to be propelled from the canaliculi into the sac. At the same time, the inferior half of the lateral sac wall moves medially, creating a positive pressure in the inferior sac and nasolacrimal duct, thus forcing tears down the duct into the nose. With lid opening, the orbicularis muscle relaxes, allowing the canaliculi to open and the superior half of the lateral sac wall to move medially. The resulting negative intracanalicular pressure allows tears to flow from the lacrimal lake into the canaliculi, and the higher pressure in the superior sac closes the valve of Rosenmueller and forces tears from the superior to inferior sac and proximal nasolacrimal duct. At the same time, the inferior half of the lateral sac wall moves laterally, resulting in a negative pressure in the inferior sac and nasolacrimal duct.

Blinking↗

PubMedDate not supplied

Spectrum of pediatric dacryocystitis: medical and surgical management of 54 cases.

BACKGROUND: Dacryocystitis in infants and older children is a serious complication of congenital or acquired nasolacrimal duct obstruction. To define the modes of presentation and treatment strategies of this disorder better, we reviewed the clinical courses of 54 children treated for dacryocystitis at St Louis Children's Hospital. METHODS: Clinical, neuroradiologic, and laboratory data were collated for all cases of dacryocystitis treated from 1990 to 1995. Average follow up of the children in this consecutive series was 1.75 years (range, 4 months to 5 years). RESULTS: Of the 54 patients, 36 (67%) had chronic low-grade dacryocystitis, which was treated with nasolacrimal duct probing on an outpatient basis. The remaining 18 patients (33%) had acute dacryocystitis, which was treated with a combined medical/surgical strategy. Medical treatment consisted of hospital admission for administration of intravenous antibiotics followed by inpatient surgery, which varied according to the age of the patient and the clinical history: 1) Acute dacryocystitis in neonates was treated surgically by nasolacrimal duct probing and nasal endoscopy for excision of intranasal duct cyst; 2) Acute dacryocystitis with periorbital cellulitis was treated surgically by nasolacrimal duct probing; 3) Acute dacryocystitis due to facial trauma was treated surgically by dacryocystorhinostomy and stent placement; and 4) Acute dacryocystitis complicated by orbital abscess was treated by inferior orbitotomy for orbital abscess drainage, simultaneous nasolacrimal duct probing, and stent placement. CONCLUSION: Dacryocystitis in the pediatric population may present in either chronic or acute forms. An effective and safe treatment for acute dacryocystitis is hospital admission, both for administering intravenous antibiotics and monitoring to rule out orbital cellulitis or abscess formation. Intravenous antibiotic therapy is followed within a day or two by surgery tailored to the clinical history. In the majority of both chronic and acute cases, nasolacrimal duct probing appears to be an effective treatment strategy.

Abscess↗

PubMedDate not supplied

Dacryostenosis in newborns: probing, or syringing, or both?

PURPOSE: This prospective study was designed to establish whether it is more effective to treat symptomatic congenital nasolacrimal duct obstruction by probing, or high-pressure irrigation, or both. METHODS: During the period February 1991 to January 1999, 228 infants (300 nasolacrimal ducts) were examined (132 males, 96 females, age range 12-13 months). These patients were divided into three groups of 100 ducts each. The first group was probed only; in the second group the nasolacrimal ducts were irrigated under high pressure using methylene blue-stained saline, and the third group was probed and irrigated in the same setting. The procedures were done under light general anesthesia. RESULTS: Ninety-one ducts in the first group improved after probing. In the second group 64 ducts improved after irrigation. In the third group 96 ducts improved after both probing and irrigation. CONCLUSIONS: To treat symptomatic congenital nasolacrimal duct obstruction, it is more effective to combine high-pressure irrigation and probing. This gives a better success rate, first in treatment and secondarily, permitting intraoperative verification of the patency of the excretory lacrimal system.

Dacryocystorhinostomy↗

PubMed2007

MUC16 in the lacrimal apparatus.

The aim of the present study was to determine the possible expression of the mucin MUC16 in the lacrimal apparatus. Expression and distribution of MUC16 in lacrimal gland, accessory lacrimal glands, and nasolacrimal ducts was monitored by RT-PCR and immunohistochemistry. MUC16 was expressed and detected in all tissues investigated. Comparable to conjunctiva and cornea it was membrane-anchored in accessory lacrimal glands whereas in lacrimal gland acinar cells and columnar cells of the nasolacrimal ducts it was stored in intracytoplasmic vesicles without membrane-association. Subepithelial serous glands of the nasolacrimal ducts revealed staining of the secretion product. Intracelluar production of MUC16 is present in lacrimal gland and epithelial cells of the nasolacrimal ducts but it is not clear whether this MUC16 is secreted. MUC16 seems to be shedded or secreted from the epithelial surface of subepithelial serous glands of the nasolacrimal ducts. Our results show that MUC16 is present in the whole lacrimal apparatus. Its distribution pattern suggests different physiological functions with regard to tear film physiology and tear outflow. Moreover, the results demonstrate the existence of so far not recognized qualitative differences in the secretion product of main lacrimal gland and accessory lacrimal glands (glands of Krause).

Aged↗