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PubMed1999

Retrograde intubation dacryocystorhinostomy for proximal and midcanalicular obstruction.

OBJECTIVE: Retrograde intubation of canaliculi during dacryocystorhinostomy can restore canalicular patency in cases otherwise managed with bypass tubes. The surgical technique and success for this procedure are discussed. DESIGN: A retrospective, noncomparative case series with clinic or telephone interview for long-term follow-up of patients' symptoms. PARTICIPANTS: One hundred two patients who had undergone this particular lacrimal drainage surgery at Moorfields Eye Hospital between 1992 and 1997. INTERVENTION: All patients underwent a dacryocystorhinostomy and retrograde canaliculostomy while under general anesthetic. MAIN OUTCOME MEASURES: Relief or reduction of epiphora and discharge. RESULTS: One hundred twenty-three lacrimal systems of 102 patients were included. There were 53 females and 49 males, with ages at surgery ranging from 6 to 83 years (mean, 49 years). The etiology was idiopathic (30%), herpetic canaliculitis (24%), punctal agenesis (18%), and trauma (11%); less-common causes included dacryocystitis, Stevens-Johnson syndrome, eczema, and prior radiation therapy. Both upper and lower canalicular systems were involved in the majority (73%) of patients, and in 13 (11%) systems a dacryocystorhinostomy had previously been performed. The silicone tube was placed for a mean of 2 months (range, 1 week-9 months), and the mean postoperative follow-up was 8 months (range, 2-24 months). Epiphora subjectively improved in 90 (73%) of 123 systems, of which 27 (22%) of 123 were asymptomatic. In 33 systems (27%) in which epiphora persisted, 14 (11%) have undergone closed placement of a Jones canalicular bypass tube with control of symptoms. CONCLUSIONS: Retrograde canaliculostomy and intubation can spare a significant number of patients the long-term inconvenience of Jones tubes. Failure of this technique does not, however, compromise or complicate the future placement of a bypass tube.

Adolescent↗

PubMed2000

Canine and feline primary ocular bacterial infections.

Bacterial infections are frequently associated with diseases of the eyelids, cornea, and conjunctiva. Animals sustaining KCS commonly have bacterial infections of the external eye owing to a lack of antimicrobial properties present in the normal tearfilm. Infection can occur in the nasolacrimal duct or lacrimal sac, which is referred to as dacryocystitis. Severe corneal ulcers are frequently infected with bacteria, especially Pseudomonas sp. Three new topical ophthalmic antibiotics have recently become commercially available: ciprofloxacin, norfloxacin, and ofloxacin.

Animals↗

PubMed2001

Nasolacrimal polyurethane stent placement for epiphora: technical long-term results.

PURPOSE: To assess technical problems related to implantation of a polyurethane stent to treat obstructive epiphora, and to assess the long-term patency of the nasolacrimal system. MATERIALS AND METHODS: Fluoroscopically guided placement of a polyurethane nasolacrimal stent was performed in 70 obstructed lacrimal systems of 62 patients with grade 3-4 obstructive epiphora. Follow-up was conducted for 1-20 months (average, 11.3 months). The obstruction was at the lacrimal sac in six systems, at the junction between the lacrimal sac and the nasolacrimal duct in 60 systems, and at the nasolacrimal duct in four systems. The cause of the obstruction was idiopathic in all cases but was probably residual to dacryocystitis. RESULTS: Of these 70 procedures, stent placement was technically successful in 61 systems (87%). On long-term follow-up, 41 (67.2%) stents remained in place, with resolution or clinical improvement, and 18 (29.5%) stents were removed (because of occlusion in 17 systems), with stent malpositioning in the duct in six cases. There were seven cases of malpositioning in all. Statistical analysis was performed to evaluate patency, compare patency in properly positioned stents and malpositioned stents, and establish the relationship between malpositioning and the need for irrigation to maintain stent patency. Of the total 70 stents originally placed, 41 (58.6%) were still in place and functional at long-term follow-up. At 1 year, 73% of properly positioned stents remained patent versus 0% of improperly positioned stents. Median stent patency in the former group was 20 months and was 1 month in the latter group (P = .00002). Eleven percent of properly positioned stents required irrigation versus 57% of incorrectly positioned stents (P = .01). CONCLUSION: After follow-up for 1 year, recurrence of epiphora brought on by stent obstruction was 28%. Early stent blockage and the need for periodic irrigation may be indicative of malpositioning of the stent.

Follow-Up Studies↗

PubMed2001

Nasolacrimal stents in the management of epiphora: medium-term results of a multicenter prospective study.

PURPOSE: To evaluate in a prospective multicenter setting the clinical utility of polyurethane stents in the percutaneous management of epiphora. MATERIALS AND METHODS: Patients (N = 163; age range = 22-85 y, mean = 52 y; 29 men, 134 women) with severe epiphora had stents (n = 183) inserted under fluoroscopic guidance in 180 lacrimal systems (unilateral = 146; bilateral = 17) to treat complete (n = 172) or partial (n = 8) obstruction of the nasolacrimal duct or sac. The junction between sac and duct was the most frequent location (n = 102), followed by the sac alone (n = 48), and the duct alone (n = 30). The etiology of the obstruction was idiopathic in 113 cases (63%) and chronic dacryocystitis in 67 (37%). The set designed by Song was used in all patients and the original technique was slightly modified by the authors. All patients were treated on an outpatient basis. Average time of the procedure was 14 minutes (range = 3-70 min). RESULTS: Initial technical success rate of stent placement was 97%. Resolution of epiphora was complete in 175 eyes and partial in five. On follow-up (mean = 450 d; range = 8-730 d), 157 of 183 stents remained patent (85.8%). Of the 24 obstructed, 19 were easily withdrawn and 17 of these patients remained asymptomatic for a mean of 15 months (secondary patency rate = 89.5%). CONCLUSIONS: The procedure is simple and safe. It can be performed on an outpatient basis and the original technique could be improved with some technical modifications. It is well tolerated by patients and may be considered as a valid alternative technique for the resolution of epiphora.

Adult↗

PubMed2000

Respiratory diseases of rabbits.

Respiratory diseases are second only to gastroenteric diseases in importance in rabbits. Pasteurellosis is the primary respiratory disease affecting domestic rabbits, but other bacteria (e.g., Bordetella broniseptica and Staphylococcus spp) are significant opportunistic pathogens. The primary manifestations are upper respiratory disease (e.g., rhinitis, sinusitis, conjunctivitis, and dacryocystitis). Various antimicrobials are effective for treatment.

Animals↗

PubMed2006

Preseptal and orbital cellulitis: a 10-year review of hospitalized patients.

BACKGROUND: Preseptal and orbital cellulitis range in severity from minor to potentially severe complications. The purpose of this study is to describe the clinical features of patients with preseptal or orbital cellulitis in one medical center in Taiwan, and to assess the effectiveness of treatments and the complications. METHODS: Patients admitted between 1996 and 2005 to Taipei Veterans General Hospital under the diagnosis of preseptal or orbital cellulitis were retrospectively reviewed. The demographics, administrative history, past history, clinical presentations, treatments, and complications were analyzed. RESULTS: In total, 94 patients fulfilling the diagnostic criteria for preseptal or orbital cellulitis were identified (67 had preseptal cellulitis, 27 had orbital cellulitis). While paranasal sinus disease was the most common predisposing cause in orbital cases, skin lesions in children and dacryocystitis in adults were the most common in preseptal cases. Microbiologic investigations showed variable results, but the most common pathogen isolated was Staphylococcus aureus. Cultures from eye swabs and local abscesses gave the highest positive yield. Blood cultures were taken in some patients, but the positive rate was extremely low. Treatments included intravenous antibiotics alone, or intravenous antibiotics combined with surgical drainage. Only one case had permanent ocular motility impairment after removal of the orbital foreign body. CONCLUSION: Despite the past history of potential morbidity and even mortality from orbital cellulitis, early diagnosis and prompt treatment with proper antibiotics and/or surgical intervention can achieve a good prognosis.

Adolescent↗

PubMed2002

Results of endoscopic endonasal non-laser dacryocystorhinostomy.

Endoscopic dacryocystorhinostomy (EN-DCR) is a procedure that presents itself as an alternative choice to the conventional external approach. This study describes the results of endoscopic endonasal non-laser lacrimal surgery. We reported the data of 64 procedures of 63 patients with epiphora or chronic dacryocystitis who underwent primary EN-DCR by means of a microdrill or revision EN-DCR. One of these cases had bilateral surgery. There were 42 women and 21 men. Thirty-four cases had primary EN-DCR and 30 cases had revision EN-DCR secondary to previously failed external DCR. Mean follow up time was 11.34 months. The procedure was successful in 79.4% of primary EN-DCR cases and in 80% of revision EN-DCR cases. The overall success rate was 79.6%. Postoperative complications included periorbital edema, eyelid ecchymosis, punctal granuloma, cyst of the punctum, adhesion between the superior and inferior punctum. Tube dislocation occurred in 3 patients. Premature loss of silicone tube was determined in 5 patients and granulation tissue occurred at the internal osteum in 11 cases. EN-DCR, when compared with external dacryocystorhinostomy (EX-DCR), has lower success rate, but provides the potential advantages of better intraoperative hemostasis, and lack of cutaneous scar.

Adolescent↗

PubMed1988

Epidemiology of trachoma in the West Bank and Gaza Strip.

A detailed study was made of the prevalence and associations of trachoma in a prospective, randomised population based study of 9058 Palestinian Arabs living in the West Bank and Gaza Strip, and in a prospective study of 1,000 consecutive unselected ophthalmic outpatients at St John Ophthalmic Hospital, Jerusalem. Trachoma was found to be widely distributed throughout the two regions. This chiefly occurred as a mild, self limited disease, interspersed with discontinuous pockets of blinding disease. The highest prevalence was found in the Hebron and Jericho districts. Sub-populations at increased relative risk included females, older age groups, rural dwellers, patients with pre-disabling or disabling lesions, and patients with moderate to severe active trachoma. An increased recovery of bacteria by culture of the lids and conjunctiva of patients with moderate to severe trachoma was noted. Prevalences of lacrimal disease, dacryocystitis, and acute bacterial ulcer were significantly greater among outpatients with trachoma than among those without trachoma. No difference in prevalence of either mucopurulent conjunctivitis or herpetic dendritic keratitis was demonstrated between patients with and without trachoma. An increased prevalence of trachoma was found in communities without a continuous year-round supply of running water compared with communities with this facility.

Adolescent↗

PubMed2003

An unusual cause of neonatal respiratory distress.

Nasal cysts representing cystic extension of the nasolacrimal duct are a rare cause of nasal obstruction and respiratory distress in neonates. A medial canthal mass, epiphora, dacryocystitis or preseptal/orbital cellulitis are the usual presenting symptoms; however, this case shows that patients may present with eye findings so minimal as to be overlooked.

Cysts↗

PubMedDate not supplied

Isolated sarcoidosis of the lacrimal sac without systemic manifestations.

Sarcoidosis is a systemic chronic granulomatous disease of unknown etiology. Although it most commonly affects African-Americans, Scandinavians, and the Irish, individuals of all races and ethnicities are susceptible. The otolaryngologist will most frequently encounter sarcoidosis involving the sinonasal region; however, other sites in the head and neck may be involved. Head and neck affliction with sarcoidosis most frequently accompanies pulmonary involvement, although, in rare cases, it may present in the absence of any systemic manifestations. We present a patient of Eastern European origin treated for persistent epiphora and recurrent dacryocystitis without any other medical problems. Because medical therapy and canalicular intubation failed, an endoscopic dacryocystorhinostomy (DCR) was performed. Histologic examination of the lacrimal sac showed noncaseating granulomas. Further workup revealed an elevated angiotensin-converting enzyme (ACE) level and hilar adenopathy. At no time did the patient have any other signs or symptoms of sarcoidosis. This unique case highlights 4 important issues for the otolaryngologist: (1) sarcoidosis may occur almost anywhere in the head and neck and is not strictly limited to the upper respiratory tract; (2) sarcoidosis may occur in the head and neck even in the absence of any pulmonary or other systemic involvement; (3) sarcoidosis may affect persons of all races, both sexes, and all ages; and (4) routine histopathologic examination after excision of the nasolacrimal sac is recommended.

Adult↗

PubMed2001

Lacrimal drainage system endoscopic examination and surgery through the lacrimal punctum.

BACKGROUND: To describe an approach to restore the physiological tear passages of an obstructed lacrimal drainage system with instruments introduced through one of the lacrimal punctum. METHOD: In a first step a miniature endoscope (Ø: 0.9, 1.1, 1.3 mm) is introduced in one of the lacrimal punctum to visualize the level, the extent, and the nature of an obstruction along the lacrimal drainage system. In a second step, the miniature endoscope is replaced by a lacrimal trephine (Ø: 0.9, 1.1, 1.3 mm) that holds an optic fiber in its lumen, and the obstruction is removed under endoscopic visual control. The entire procedure is performed under local anesthesia. RESULTS: With this approach it is possible to visualize and remove partial or total fibrous obstructions along the lacrimal drainage system (lacrimal canaliculus, nasolacrimal duct). Lacrimal sac lithiasis can also be fragmented and eliminate in the nose through the nasolacrimal duct. During or after the procedure only minor, and no major, complications can sometime occur, such as hematoma or edema (after lacrimal irrigation) of the surrounding soft tissues. CONCLUSION: The approach described here is straight forward, quick, and can be performed under visual endoscopic control and in local anesthesia. With this approach partial stenosis can easily be diagnosed and cured. This procedure might potentially change our current concepts regarding surgical indications for obstructive epiphora and dacryocystitis. However, the long-term results of this type of surgery need to be challenged.

Dacryocystorhinostomy↗

PubMed2002

[Nasolacrimal duct obstruction caused by a cylindroma. Report of an atypical tumor manifestation and review of the literature].

BACKGROUND: The purpose of this report is to describe the clinical characteristics, management and histological findings in a patient with obstruction of the nasolacrimal duct caused by a cylindroma. About 618 lacrimal sac tumours have been reported previously in reviews and case reports, which were reviewed after searching in medline database. CASE REPORT: A 79-year old man suffered from multiple cylindromas (Spiegler tumour) on his head for about 40 years. He presented with a 6 months' history of left-sided epiphora and a painless medial canthal mass of various size. A tumour which caused nasolacrimal duct obstruction was found during dacryocystorhinostomy. After complete excision histological examination revealed a cylindroma, which had shown expansive growth from dermis to the lacrimal sac area. The patient felt well; there was no longer any epiphora or dacryocystitis after the operation. CONCLUSION: Although very rare, lacrimal sac tumours must be considered in the differential diagnosis of nasolacrimal duct obstruction. To our knowledge this case represents the first report on an atypical manifestation on a Spiegler tumour in the lacrimal sac region.

Aged↗

PubMedDate not supplied

[Experiences using acylureido-penicillins (azlocillin, mezlocillin) in pediatrics].

The acylureidopenicillins azlocillin and mezlocillin cover a broad spectrum of bacteria, including gramnegative and grampositive species as well as anaerobes. Azlocillin is especially active against P. aeruginosa. Mezlocillin has a good activity against Klebsiella. Both antibiotics inhibit Hemophilus, N. meningitidis and D. pneumoniae in low concentrations. Clinical and kinetic studies were made in more than 300 pediatric patients. Elimination-constant halflife, distribution volume and area under the curve were determined to propose dosage recommendations. Concentrations of azlocillin (44) and mezlocillin (77) were measured in the bronchial secretions. Up to hour 5 after i.v. injection a wide range of concentration values were observed. Azlocillin was found in the meconium in different concentrations after a single injection into the newborn. Mezlocillin diffused into the CSF even in uninflamed meninges, 3 h after injection the mean concentrations were 5.5 mg/l. 39 patients, 35 of them infected by P. aeruginosa, were treated by azlocillin. Urinary tract infections, wound infections and dacryocystitis were cured with one exception. Less convincing were the results in complicated bronchopulmonary diseases. The clinical efficacy of mezlocillin was similar. In a group of 59 patients there were only 3 without effect and some with improvement again in complicated pulmonary diseases. Side effects worth to be mentioned were not seen. In 2 patients the azlocillin injection caused nausea. Mezlocillin led to some minor transitory elevations of the transaminases and dyspepsia in some patients.

Adolescent↗

PubMed1998

[Manifestation of Wegener's granulomatosis as lacrimal sac tumor].

HISTORY AND SIGNS: This is a report on a patient, who presented an ulcerated lesion (1.5 x 1.2 cm) in the lacrimal sac area. The lesion had existed for 3 months before the patient went to an ophthalmologist. The lacrimal pathway was rinsable all the time. THERAPY AND OUTCOME: The patient was treated by antibiotics and leukase cones at first. But the lesion showed no tendency to heal under this therapy. The patient was sent to the ETN department for further investigations. At this time the suspicion of a malignant process was discussed. In the meantime the lesion became epithelialized, but no closure could be reached at any time. The CT scans showed a bone defect of 1 cm of the lamina papyracea. Tumorous tissue passed through this defect reaching the ulcer at the medial canthal angle. A biopsy was been taken and revealed granulomatous tissue typical for a Wegener's granulomatosis. The patient was sent to an Internal medicine department, but he died one month later due to systemic disorders of this disease. CONCLUSIONS: Although an acute dacryocystitis is most often the reason for a lacrimal sac swelling and inflammation, in all cases of rinsable lacrimal pathway and long term lacrimal sac ectasy a neoplastic or a granulomatous reason has to be excluded.

Biopsy↗

PubMed1995

[Endonasal implantation of a silicon mold improves the long-term outcome of revision surgery in lacrimal duct stenoses].

BACKGROUND: Uncomplicated dacryocystorhinostomy after dacryocystitis with lacrimal sac obstruction has a success rate of 85%. However therapy of restenosis poses a problem. Vast destruction of lacrimal and nasal mucosa renders the drainage system susceptible for further stenosis. This article presents a new surgical procedure for the treatment of restenosis of the nasolacrimal apparatus. The major difference from other techniques is the endonasal implantation of a silicon foil. This counters the development of synechiae and promotes the epitheliasation of wound surfaces. As a result the nasal mucosa can easier gain access to lacrimal mucosa. A complete mucosal coating of the reconstructed lacrimal drainage system is an important condition for the sufficient drainage of the tear-film. PATIENTS AND METHODS: In 30 patients with restenosis after one or multiple dacryocystorhinostomies a silicon foil was implanted endonasally as part of their surgical revision. After skin incision and removal of scar tissue the bony ostium was enlarged. The canaliculi were intubated with silastic tubing. Afterwards the endonasal synechiae were split and a 0.2-0.4 mm silicon foil was implanted endonasally und fixed. The silastic tubing was brought through a hole in the silicon foil and knotted inside the nose. Then the wound was closed. Postoperative evaluation of the surgical success ranged from 3 to 36 months (mean 16 months). RESULTS: The postoperative result was good in 24 patients. Sixteen patients were without symptoms. 8 had epiphora only on stress. The latter felt their situation to be greatly improved. The long-term results were directly proportional to the amount of reconstructable mucosa and inversely proportional to the severity of canaliculus damage. Adverse reaction to the silicon foil were not noted. CONCLUSION: Endonasal implantation of a silicon foil is a new, easy and successful technique for the treatment of endonasal synechiae and restenosis of the nasolacrimal apparatus.

Adolescent↗

PubMed2000

Comparative external versus endoscopic dacryocystorhinostomy: results in 115 patients (130 eyes).

BACKGROUND: Epiphora is an annoying symptom, embarrassing the patient both socially and functionally. The two widely accepted treatment modalities of epiphora resulting from obstruction of the nasolacrimal ductus are external and endoscopic dacryocystorhinostomy (DCR). OBJECTIVE: The aim was to compare the results, operative time, and complications of external and videoendoscopic endonasal DCR performed between December 1994 and December 1998. METHODS: In group 1, conventional primary external DCR with or without silicone tube intubation was performed in 79 patients (66 women and 13 men) with unilateral dacryocystitis. In group 2, endoscopic primary endonasal DCR with hammer-chisel removal of bone located over the lacrimal sac was performed in 51 eyes of 36 patients, 33 women and 3 men (15 bilateral procedures). RESULTS: The follow-up period was 6 to 48 months (mean 25 months) after surgery. The age range was from 4 to 76 years (mean 38.5 years). The success rates of external and endoscopic hammer-chisel DCR were found to be 89.8% and 88.2%, respectively. A lower complication rate was observed in the endoscopic group, with minimal morbidity and shorter operative time compared with the external approach. CONCLUSIONS: Hammer-chisel endoscopic DCR is practical, less traumatic, less time-consuming, and cosmetically more convenient than the external approach. The success rate of the endoscopic DCR procedure is comparable with that of traditional external DCR, and it also allows simultaneous correction of any intranasal pathology.

Adolescent↗

PubMed2000

Treatment of nasolacrimal duct obstruction in children with trisomy 21.

BACKGROUND: Nasolacrimal duct (NLD) obstruction and tear film abnormalities occur frequently in children with trisomy 21. This study describes the outcomes of treatment for NLD obstruction in this population. METHODS: The records of 15 children with trisomy 21 treated for NLD obstruction were reviewed. Eight patients were initially treated with NLD probing with or without placement of nonfixated lacrimal stents. Because of poor success with this procedure, the initial treatment of children with trisomy 21 and NLD obstruction was changed to balloon catheter dilation in 1997. Outcomes were considered excellent if the patient had complete resolution of epiphora and dacryocystitis, good if the patient had only mild residual symptoms, fair if the patient had significant residual symptoms, and poor if there was no improvement. RESULTS: Of 8 patients treated initially with NLD probing, 5 had fair or poor outcomes. These patients all had good outcomes after placement of nasally fixated lacrimal stents, balloon catheter dilation, or both. Of 7 patients treated initially with balloon catheter dilation, 5 had excellent or good outcomes and 2 had fair or poor outcomes. CONCLUSION: Simple NLD probing is often unsuccessful in treating NLD obstruction in children with trisomy 21. Balloon catheter dilation appears to be a reasonable alternative first treatment in these patients.

Catheterization↗

PubMed1998

The place of transsaccal dacryocystorhinostomy in modern lacrimal surgery.

Despite the advances in transnasal and external dacryocystorhinostomy, transsaccal dacryocystorhinostomy is an excellent addition to the armamentarium in chronic fistulizing dacryocystitis with a dilated tear sac in elderly patients. A large incision with excision of the fistula opens the lacrimal sac, from where a wide dacryocystorhinostomy can be opened into the nose. The skin and tear sac incision can be closed in one layer.

Journal Article↗