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PubMed1991

[Lacrimal duct intubation as an alternative to dacryocystorhinostomy].

A series of 52 patients, aged 60-85 and suffering from chronic obstruction of the nasolacrimal duct with no other complication of the lacrimal mechanism or of the eyelids (e.g. ectropium), were treated by means of silicon tube intubation instead of dacryocystorhinotomy. The tubes remained in place for 10-12 months and the patients were observed a 3-year postoperative period. In 37 cases (71%) the nasolacrimal duct remained patient after 3 years. In 7 cases, although the drainage was not opened, the patients ceased to show evidence of secretion of mucus or pus. We consider that intubation of the nasolacrimal duct is an alternative to dacryocystorhinotomy, but only if the patient knows that the tubes are to remain in place for a lengthy period of time. This does not disturb a cooperative patient since the tubes are essential and do not create any irritation. Furthermore, tears are partially eliminated around them and, thus, improvement of the symptoms is apparent from the first day onward.

Aged↗

PubMed2000

Management and complications of congenital dacryocele with concurrent intranasal mucocele.

INTRODUCTION: The association of dacryocele and intranasal mucocele has been previously reported. Its incidence and optimal treatment are unknown. PATIENTS AND METHODS: A retrospective review of 22 patients with 30 dacryoceles was performed to determine the mean age at presentation, sex distribution, and prevalence of associated intranasal mucocele, associated dacryocystitis, and respiratory distress. The components of the examination, ancillary tests, treatment modalities, and treatment outcomes were then summarized. RESULTS: Unilateral dacryoceles were seen in 16 (73%) of the infants, and bilateral dacryoceles were seen in 6 (27%) of the infants. Four (25%) of the 16 patients who initially had unilateral dacryoceles later developed bilateral dacryoceles. Dacryocystitis, preseptal cellulitis, or both were present on presentation or developed in 18 (60%) of 30 dacryoceles. Nasal endoscopy was performed on 13 (59%) of 22 patients. Nasal examination with nasal speculum and headlight was performed on 7 patients (32%). A concurrent intranasal mucocele was diagnosed in 23 (77%) of 30 dacryoceles. Respiratory distress arose in 5 (71%) of 7 patients with bilateral intranasal mucoceles and in 2 (22%) of 9 patients with a unilateral intranasal mucocele. Thirty-four procedures were performed. Seven dacryoceles (21%) were treated with nasolacrimal duct probing under topical anesthesia. Another one (3%) was treated with needle aspiration with later definitive therapy. All other procedures were managed under general anesthesia. These included 2 nasolacrimal duct probings (6%), 2 probings with silicone tube placement (6%), 10 probings with intranasal mucocele marsupialization and silicone tube placement (29%), and 12 probings with marsupialization alone (35%). Two (29%) of the 7 probings performed under topical anesthesia failed, whereas all other procedures were successful. One dacryocele spontaneously resolved. CONCLUSIONS: Congenital dacryoceles are commonly associated with intranasal mucoceles, dacryocystitis, and preseptal cellulitis. Respiratory distress is common in bilateral cases. Bilateral nasolacrimal duct probing should be considered in unilateral cases because of the high incidence of occult contralateral involvement.

Endoscopy↗

PubMed2001

Dacryocystosclerotherapy.

PURPOSE: To introduce a less invasive therapeutic method in selected patients with primary nasolacrimal duct obstruction. METHODS: Noncomparative interventional case series. Seven patients with primary acquired nasolacrimal duct obstruction who were poor candidates for dacryocystorhinostomy because of underlying medical conditions and two symptomatic patients with previous incomplete dacryocystectomy were included. Ethanolamine oleate 5% was slowly injected through the puncta into the patent portion of the lacrimal drainage apparatus. RESULTS: After a mean follow-up period of 26 months, the lacrimal pathway was permanently obliterated in 6 cases (66.7%). In two cases, the procedure was repeated successfully and in one case, the patient refused to repeat the procedure after the initial failure. CONCLUSIONS: In selected patients, ethanolamine oleate dacryocystosclerotherapy appears to offer a simple, low-cost, less invasive alternative to dacryocystectomy.

Aged↗

PubMed1989

Recognition and management of acute noninfectious dacryocystic retention.

Eleven female and 4 male patients presented with 20 documented episodes of acute noninfectious dacryocystic retention. This syndrome complex consists of severe pain and tearing with minimal but tender distention of the lacrimal sac, without signs of inflammation. It is caused by impaction of a dacryolith in the nasolacrimal duct. In our group of patients, the mean age when seen was 39 +/- 14 years, and the mean onset of symptoms occurred at age 35 +/- 13 years. Six episodes resolved spontaneously, and the rest responded to interventional therapy. In six, irrigation relieved the symptoms. One patient each responded to probing, lacrimal intubation, and primary dacryocystorhinostomy (DCR). In three patients, a new technique of percutaneous nasolacrimal duct dilatation using angiographic techniques relieved symptoms. One patient each failed irrigation and percutaneous dilatation and required secondary DCR. Recognition of this presentation permits differentiation of this syndrome from infectious lacrimal obstruction and allows appropriate therapy. In at least some patients, percutaneous nasolacrimal duct dilatation may offer both a method of accurate diagnosis and an initial alternative to more extensive surgery.

Acute Disease↗

PubMed2005

Outcomes of dacryocystorhinostomy in patients with head and neck tumors.

BACKGROUND: The purpose of this study was to evaluate the outcomes of dacryocystorhinostomy (DCR) in patients with head and neck tumors. METHODS: The clinical records of all 31 patients with head and neck tumors who underwent DCR for nasolacrimal duct blockage at The University of Texas M. D. Anderson Cancer Center between 1999 and 2003 were retrospectively reviewed. RESULTS: The tumor diagnoses were squamous cell carcinoma (n = 18), chondrosarcoma (n = 3), sinonasal carcinoma (n = 2), adenoid cystic carcinoma (n = 2), sinonasal papilloma (n = 2), esthesioneuroblastoma (n = 1); hemangiopericytoma (n = 1); ameloblastoma (n = 1), and osteosarcoma (n = 1). Twenty-eight patients had a maxillectomy or other sinus surgeries, 10 had radiotherapy, and 14 had chemotherapy and radiotherapy before DCR. All 31 patients (35 eyes) experienced improvement of epiphora after DCR, but five patients (six eyes) had recurrent nasolacrimal duct blockage develop during the study period. Two patients had mild wound infections; none had osteoradionecrosis. CONCLUSIONS: DCR alleviates nasolacrimal duct blockage in most patients with head and neck tumors and is not associated with unusual complications in this setting.

Adult↗

PubMed1991

Distribution of cytochrome P-450 monoxygenase enzymes in the nasal mucosa of hamster and rat.

Deposition of inhaled particulates onto the respiratory mucosa is relatively great in that portion of the nasal cavity unprotected by ciliated, goblet, or keratinized superficial cells. The cytochrome P-450 system is an important enzyme system involved in the biotransformation of xenobiotics into metabolites that are more readily absorbed. To examine the transitional region caudal to the nasal vestibule, nasal tissues of hamster and rat were prepared for immunocytochemistry. Blocks of tissue representing four levels along the long axis of the nasal cavity were examined. Paraffin sections were processed through the avidin-biotin peroxidase procedure, with diaminobenzidine tetrahydrochloride as the chromagen. Enzyme localization was accomplished through the use of antibodies for three rabbit cytochrome P-450 isozymes; 2, 5, and 6 (subfamilies IIB, IVB, and IA, respectively); and for rabbit NADPH-cytochrome P-450 reductase. Enzyme distribution was similar in both hamster and rat nasal tissues except in cells of striated and intercalated ducts of nasal glands and in cells of the nasolacrimal duct where immunoreactivity was greater in the hamster. Immunoreactivity for reductase and isozyme 2 was intense in nonciliated cells lining the nonolfactory epithelium, in sustentacular cells of the olfactory epithelium, and in acinar cells of olfactory glands. Distribution of reaction products to isozyme 5 and 6 were similar to but not so intense as those of reductase and isozyme 2. Reaction products for reductase and isozyme 2 occurred generally in the same cellular and intracellular regions with the following exceptions: isozyme 2 was more concentrated in cells of striated ducts and of the nasolacrimal duct, and reductase was more abundant in intercalated ducts of nasal glands.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed2000

Paediatric laser DCR.

PURPOSE: Endoscopic laser dacrocystorhinostomy is an alternative procedure to external approach DCR in children. We report our results with 5 patients (6 eyes) with congenital nasolacrimal duct obstruction. METHODS: Six endonasal DCR's were carried out using the KTP laser in patients with congenital nasolacrimal duct obstruction resistant to probing and intubation. RESULTS: The follow-up ranged from 3-8 months. All patients experienced a recurrence of their symptoms postoperatively. CONCLUSION: Endoscopic laser assisted DCR is not a successful procedure in children.

Child↗

PubMed2003

Nasal endoscopy in the treatment of congenital lacrimal sac mucoceles.

PURPOSE: To determine the incidence of intranasal cysts associated with lacrimal sac mucoceles and the cure rate with nasal endoscopic cyst marsupialization. DESIGN: Interventional case series. METHODS SETTING: University-affiliated teaching hospital. PATIENT POPULATION: Twenty-five infants with non infected or infected lacrimal sac mucoceles or dacrocystitis without obvious mucocele were consecutively enrolled. INTERVENTION PROCEDURES: Management included local lacrimal massage, parenteral antibiotics, and when still symptomatic, nasolacrimal duct probing with concomitant nasal endoscopy. Intranasal cysts identified were marsupialized until the distal end of the nasolacrimal duct probe was visualized. MAIN OUTCOME MEASURES: Presence of intranasal cyst identification and cure rate. RESULTS: Infants were 4 days to 10 weeks old (mean 19 days). Forty-eight percent had a bluish cutaneous mass inferior and lateral to the lacrimal sac. Twenty percent were bilateral. At presentation, 76 percent had dacrocystitis. Fourteen percent had respiratory distress. Only one child responded to medical management. At endoscopy, 23 of 24 infants had ipsilateral intranasal cysts. The one child without nasal cyst had recurrent dacrocystitis and no mucocele. All children with mucocele were cured except one child with residual nasolacrimal duct obstruction. CONCLUSIONS: Lacrimal sac mucoceles were almost always associated with intranasal cysts. Nasal endoscopy is a valuable addition to the treatment plan for lacrimal sac mucoceles not responding to a brief trial of massage or infantile dacrocystitis. To avoid potential complications, we recommend against waiting until infection occurs before proceeding with surgery.

Dacryocystitis↗

PubMed2005

The clinical value of dacryoscintigraphy in the selection of surgical approach for patients with functional lacrimal duct obstruction.

PURPOSE: Dacryoscintigraphy is widely known to be an effective modality in diagnosing abnormalities of the lacrimal system that cause epiphora (pathological overflow of tear). However, dacryoscintigraphy rarely serves beyond the simple diagnostic use for lacrimal duct obstruction. In our study, dacryoscintigraphy results of patients with functional lacrimal duct obstruction are newly classified into three types, the effects and prognoses of silicone tube intubation are noted according to each type, and the role of dacryoscintigraphy in determining appropriate surgical approaches is evaluated. METHODS: Subjects were 36 eyes of 29 patients complaining of epiphora who had increased tear meniscus, but showed no sign of obstruction on duct syringing. Impression of functional lacrimal duct obstruction was made through dacryoscintigraphy, and silicone tubes were inserted. RESULTS: Patients were classified according to the results of dacryoscintigraphy; those with delayed secretion in the distal nasolacrimal duct were typed as class I; those with delays in the proximal nasolacrimal duct class II; and delayed secretion from the pre-lacrimal sac to the lacrimal sac as class III. All patients had silicone tube intubations together with selective punctoplasty. Symptomatic improvement was observed in all 6 cases of distal nasolacrimal duct obstruction (100%), 14 of 18 proximal obstruction cases (77.8%), and 8 of 12 pre-lacrimal obstructions (66.7%). CONCLUSIONS: Functional lacrimal duct obstruction is easily diagnosed with dacryoscintigraphy. Furthermore, its may be classified by types of obstruction to predict post-operative results of silicone tube insertion. Cases suspicious of pre-lacrimal sac obstructions in particular may achieve better operative results with adjuvant treatments in addition to silicone tube insertion.

Adult↗

PubMed1991

Dacryocystorhinostomy in osteopetrosis.

Osteopetrosis is a rare congenital disorder of bone metabolism characterized by generalized sclerotic bone resulting from osteoclast dysfunction. There are several ocular manifestations, one of which is nasolacrimal duct obstruction from osteosclerosis of the nasolacrimal foramen. The surgeon must anticipate and prepare for the difficulties of working with marbleized, ultra-dense bone, alternating technique accordingly. In nasolacrimal duct obstruction, surgical management produces seemingly stable long-term results. However, if ossification recurs at the operative site, reoperation may become necessary for either optic nerve decompression or dacryocystorhinostomy.

Adult↗

PubMed2005

Four-year experience with intranasal transilluminating dacryocystorhinostomy using ultrasound.

BACKGROUND: The aim of this study was to investigate the results obtained by intranasal dacryocystorhinostomy. METHODS: This was a prospective, non-randomised, non-comparative case series study of 150 patients with epiphora due to nasolacrimal duct obstruction. The same team of ophthalmic and otorhinologic surgeons performed the transilluminating intranasal dacryocystorhinostomy using ultrasound. The main outcome measures were subjective improvement of epiphora, dye testing, lacrimal probing, lacrimal irrigation, and endoscopic nasal examination. RESULTS: Symptomatic relief and patency of the lacrimal apparatus was achieved in 92% (138) of the patients at the 3-month follow-up and 89% (134) at the 6-month follow-up. At 1 year, only 2 patients of the 134 initial successes showed obstruction of the nasolacrimal duct. All 16 successful patients that we have followed for 4 years have sustained their improvement. INTERPRETATION: Transilluminating intranasal dacryocystorhinostomy is a quick and safe option for the treatment of nasolacrimal duct obstruction. The main advantages over external dacryocystorhinostomy are avoidance of skin incision, reduced haemorrhage, shorter duration of the operation, and quicker recovery of the patient.

Adult↗

PubMedDate not supplied

Measurement of pH, electrolytes and electrophoretic studies of tear proteins in tears of patients with dacryoliths: a novel concept for dacryoliths.

Dacryolithiasis is one of the causes of acquired nasolacrimal duct obstruction, although its origin is unclear. The purpose of this study was to investigate the differences in tear constituents between patients with nasolacrimal duct obstruction with dacryoliths and those without dacryoliths. In a prospective case-control study, undiluted tears were collected from 30 eyes from 30 patients with partial acquired nasolacrimal duct obstruction (PANDO) consisting of 17 PANDO patients with dacryoliths and 13 PANDO patients without dacryoliths. The pH, and the Na(+), K(+), Cl(-), total calcium and total protein concentrations were determined. The composition of the tear proteins was assessed by cellulose acetate electrophoresis. In the tear samples from 17 eyes with PANDO/dacryoliths, the mean +/- SD K(+) level was 15.6 +/- 3.1 mEq/l. In the tear samples from 13 PANDO controls, the mean +/- SD K(+) level was 19.8 +/- 4.9 mEq/l. The difference between the two groups was statistically significant (p = 0.02). In the tear samples from PANDO/dacryolith patients, the mean +/- SD total protein level was 129.0 +/- 72.9 mg/dl. In the tear samples from the PANDO controls the mean +/- SD total protein level was 261.6 +/- 132.5 mg/dl. The difference between the two groups was statistically significant (p = 0.00). In the tear protein fractions from electrophoresis, a low level of lysozyme was observed in the PANDO/dacryolith samples compared with the PANDO control samples (p = 0.03). The tears from patients with PANDO due to dacryoliths showed a change in the concentrations of electrolytes and protein, particularly lysozyme, compared with that of the patients with PANDO without dacryoliths, which may be related to the pathogenesis of dacryoliths.

Adult↗

PubMed1988

Dacryocystorhinostomy without flaps.

In a series of 50 consecutive cases, a modification of the Kasper technique of dacryocystorhinostomy without flaps resulted in a success rate of 90%. The success rate was 92.5% in patients with nasolacrimal duct obstruction alone, but only 80% in those with both nasolacrimal duct obstruction and canalicular disease. The results of this study indicate that equivalent results are achieved with or without the use of flaps. The elimination of flaps shortens and simplifies the procedure.

Adolescent↗

PubMedDate not supplied

Combined external-endonasal approach for complete excision of the lacrimal drainage apparatus.

PURPOSE: The purpose of this study was to describe a new surgical technique for the complete excision of the lacrimal drainage apparatus (LDA) that combines external and endoscopic approaches. METHODS: This study involved a noncomparative, retrospective chart review of the clinical and pathological findings of four patients presenting with LDA papillomas who underwent a combined open and endonasal excision of the lacrimal system. RESULTS: Of the four patients, three were male. The mean age at referral was 41 years, and all cases were unilateral. Histopathology revealed two transitional cell papillomas, one squamous cell papilloma, and one combined transitional/squamous papilloma. Epiphora and an external lesion were the main complaints at presentation. Nasolacrimal duct obstruction was present in all four patients. Papilloma virus infection was suggested in two cases and was confirmed in the only patient who had recurrence. CT identified a solid enhancing mass in two cases. The surgical approach in all cases was performed with the patient under general anesthetic supplemented with infiltration of local anesthesia with vasoconstriction. The lacrimal sac was exposed as per an external dacryocystorhinostomy with biopsy collection from the lacrimal sac lumen to confirm the diagnosis prior LDA excision. The superior aspect of the LDA was isolated by using lacrimal probes in each canaliculus to stabilized parallel incisions and careful dissection toward the common canaliculus until they met the medial aspect of the lacrimal sac. The sac was then separated from the periosteum from the medial orbital wall, using sharp dissection. Finally, an endoscopic dissection of the lower end of the nasolacrimal duct released the most inferior aspect of the LDA, allowing the surgeon to pull and excise the complete system from the external wound. CONCLUSIONS: Extensive LDA papillomas required complete excision of the drainage system to prevent recurrence and/or malignant transformation. The use of a combined approach through an open excision of the superior part of the LDA in conjunction with the direct manipulation of the nasolacrimal duct guided by the nasal endoscope facilitates the complete excision of the system for extensive benign lesions.

Adult↗

PubMed2001

[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↗

PubMed2006

Ocular abnormalities in Apert syndrome: genotype/phenotype correlations with fibroblast growth factor receptor type 2 mutations.

BACKGROUND/PURPOSE: Apert syndrome, a disorder of craniosynostosis, syndactyly, and other craniofacial malformations, is caused by point mutations (Ser252Trp or Pro253Arg) in the fibroblast growth factor receptor 2 gene. This study's goal was to determine ophthalmic phenotype/genotype correlations in patients with either mutation. METHODS: A retrospective chart review of demographic and ophthalmologic data was performed for 18 children carrying either the S252W (11) or the P253R (7) mutation. Fisher exact tests were performed to determine significance of variable phenotypes between the two mutation groups. RESULTS: In the P253R group, 85% had strabismus (14% required surgery), 71% had ptosis, 43% had amblyopia, 14% had nasolacrimal duct obstruction, 14% had myopia, 14% had hyperopia, and 14% had astigmatism. In the S252W group, 91% had strabismus (64% required surgery), 73% had ptosis, 73% had amblyopia, 100% had nasolacrimal duct obstruction, 36% had myopia, 9% had hyperopia, and 82% had astigmatism. Overall, S252W and P253R groups showed significantly different numbers of patients with strabismus requiring surgery (p = 0.039), superior rectus muscle underaction (p = 0.024), nasolacrimal duct obstruction (p = 0.0002), and astigmatism (p = 0.005). CONCLUSIONS: Compared with patients with the P253R mutation, Apert syndrome patients with the S252W mutation may have more severe ocular phenotypes with a higher likelihood of developing strabismus, especially vertical deviation. They also are more likely to develop astigmatic refractive errors and tearing secondary to nasolacrimal system anomalies.

Acrocephalosyndactylia↗

PubMed2000

[Significance of preoperative digital subtraction dacryocystography for nasolacrimal stent].

Digital subtraction dacryocystography were performed prior to placement of a nasolacrimal stent. Among the 107 eyes, the sites of obstruction were in the common canaliculus in 9 eyes, above the neck of the lacrimal sac in 12 eyes and under the neck of the lacrimal sac in 86 eyes. The placement of a nasolacrimal stent may become the treatment of choice for epiphora due to obstruction of the nasolacrimal duct at the saccular or subsaccular level. After operation, these nasolacrimal ducts after stenting were patent and epiphora was resolved completely or partially. The results suggest that the preoperative digital subtraction dacryocystography is helpful in selective indication of placement of a nasolacrimal stent and prognostic assessment of the postoperative outcome.

Adolescent↗

PubMed2005

[Adenocarcinoma in the tear sack after endonasal dacryocystorhinostomy].

Primary adenocarcinoma of the nasolacrimal drainage system is a highly uncommon diagnosis, which is presumably derived from malignantly transformed glandular cells that are interspersed amongst the epithelium of the nasolacrimal duct. The patients usually present with unspecific orbital or sinus-nasal symptoms. An appropriate therapeutic regime consists of a preferably early, radical resection and local postoperative radiation therapy. This brief contribution deals with an especially uncommon case of a carcinoma of the nasolacrimal drainage system. On his first presentation, the 62-year old patient complained about right sided epiphora which had been present over the last few weeks. Eight years prior to presentation, he had been treated for a nasolacrimal duct stenosis by endoscopic dacryocystorhinostomy on this side. Diagnostic imaging revealed a soft tissue mass in the right nasolacrimal duct which was removed by a combined extra-endonasal approach. The final histopathological evaluation was adenocarcinoma. Following postoperative radiotherapy, the patient has been free of disease for 42 months. The occurrence of adenocarcinoma of the nasolacrimal drainage system in the setting of previous surgery may provide a new insight into the clinical spectrum of the natural history of this disease.

Adenocarcinoma↗