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PubMed2005

Results and complications of external dacryocystorhinostomy surgery at a teaching hospital in Iran.

OBJECTIVES: To conduct a survey of outcomes, failure frequency rates, and other complications of dacryocystorhinostomy (DCR) at a teaching hospital in Iran. METHODS: In this outcome study, we survey the results of DCR in 187 consecutive chronic dacryocystitis patients operated at the Eye Department of Yazd Medical University, Iran from March 2001 to April 2003. We investigated the results and probable complications of this surgical procedure. RESULTS: Our data shows that the success rate of the operation was 90.4% with a confidence interval of 95% (86.3-94.5). The success rate was 91% in female and 89.3% in males (p=0.543). The failure rate was 9.6%. According to the methods used in this study, the success rate of the external method with silastic intubation was 96.3% and 88% without. These differences, however, were not statistically significant (p=0.08). The most frequent and important complication of DCR was failure and recurrence of epiphora or purulent discharge (9.6%). The less frequent complications included scar formation (8.6%), wound infection (5.3%) and granuloma formation (3.2%). There were no complications during the operation. CONCLUSION: External DCR is an easy technique with a success rate of more than 90%, with few complications.

Adolescent↗

PubMed2005

[Focus on the various techniques of anaesthesia in ophthalmologic surgery].

Ophthalmologic surgery is not a vital one. It mostly concerns patients in extreme ages: children and old people. The risk of anaesthesia mainly depends on the health conditions of the patient. General anaesthesia through use of intravenous drugs alters the balance of the endocrine and sympathetic systems. Tracheal airway intubation constitutes an added constraint and stress especially for the vascular system. Retrobulbar anaesthesia is not devoid of risks: ptosis, diplopic, orbit haematoma, lesion of the optic nerve, eye perforation, vascular occlusion, intra arterial injection, neurologic and cardiovascular toxic effects of local anaesthetics, are all ever present risk Topical anaesthesia with its various variants (single topic or associated with intracameral injection, subconjunctival, circumferential perilimbal, subtenon) represents an interesting alternative for it is simple, less toxic and harless. In our experience, this method is indicated in surgery of eye's anterior segment. We find it safe, efficacisious and economical. Regional anaesthesia is preferred to general anaesthesia especially in the surgery of dacryocystitis and ptosis. General anaesthesia in stell indicated in case of children.

Age Factors↗

PubMed2005

Endonasal treatment of postsaccal stenoses of lacrimal ducts: intranasal retrograde probing in congenital stenosis.

UNLABELLED: Congenital stenosis of nasolacrimal duct is a common medical problem affecting up to 20% of newborn infants. When symptoms persists for more than 5 to 6 months the lacrimal ducts should be subjected to probing and irrigation. Anterograde probing through inferior lacrimal punctum using a rigid Bowman probe is the standard approach to such cases. We could not find reports of a retrograde endonasal probing of the lacrimal ducts in the available literature published in the last five years. MATERIAL AND METHODS: Between 1992 and 2002, we treated 328 children (136 boys and 192 girls) with congenital stenoses of the lacrimal passageways. The mean age of the children was 7.4 (Sx +/- 13) months. Endonasal probing and retrograde irrigation of lacrimal ducts were performed in all children, taking into consideration the individual peculiarities of the obstruction and the anatomical accessibility of the opening of ductus nasolacrimalis in the inferior nasal passageway. RESULTS: Outflow of irrigation fluid from lacrimal puncta was observed at the first probing in 90% out of a total number of 401 primary probings. Because of persistent membranes in the inferior lacrimal punctum in 3 cases (0.8%) we had to repeat the initial dilatation. The repeated probing failed to ensure reliable establishment of lacrimal duct patency only in 1% of the cases. In such children we recommended and performed endonasal dacryocystorhinostomy with balloon intubations placing a catheter and this restored lacrimal drainage to the nasal cavity. CONCLUSION: Endonasal probing and irrigation of lacrimal ducts used in the treatment of congenital stenoses is a highly effective (99%), physiologically consistent and little traumatic method of reestablishing the patency of the tear draining system. If it fails, endonasal dacryocystorhinostomy with stents is the definitive treatment of children's dacryocystitis.

Adolescent↗

PubMed2006

[Endonasal anatomy of lacrimal sac to endoscopic transnasal dacryocystorhinostomy].

OBJECTIVE: To provide clinical guidance for the endoscopic transnasal dacryocystorhinostomy. METHOD: Fifteen adult cadavers (30 sides) were studied on the projection anatomy of lacrimal sac on the lateral wall of nasal cavity and the relationship between lacrimal sac and inner canthal ligament were studied, too. RESULT: A major portion of the sac (2/3) was located above the insertion anterior to the middle turbinate and, quite a part (1/3) of the sac lied above the entry point of the common canaliculus. Inner canthus ligament almost projected on the middle of the sac. The insertion of the front of the middle turbinate could pass the posterior facies (11 sides) even the long axis (1 side) of lacrimal sac. A localization method based on inner canthus ligament showed the degree of accuracy of 80%. CONCLUSION: Dacryocyst iodized oil opacification CT scan should be performed. Surgical stoma location is about 1. 5-2. 0 mm above and slightly anterior to the insertion of the middle turbinate. A localization method based on inner canthus ligament shows a high accuracy. The common canaliculus entry point is comparatively permanent, a laser optical fiber should be used for lacrimal passages exploration on the surgery, and the light spot directed toward lacrimal bone on the nasal lateral wall is exactly as an identification marker.

Adult↗

PubMed2006

Orbital osteoma: three case reports.

INTRODUCTION: Osteoma is the most frequent benign tumor of paranasal sinuses. It is generally asymptomatic and usually discovered by chance during radiological imaging. Three cases with orbital extension are reported and discussed. OBSERVATIONS: 1st observation: Mrs. M.N. is an 18 years-old caucasian female who presented a stony orbital deformity associated with chronical dacryocystitis. Tomography of the orbit revealed a probable ethmoidal osteoma compressing the lacrimal canals. The management consisted in a surgical excision of the whole tumor by external approach, associated with a dacryocystorhinostomy. The patient's follow-up for the last 12 months was normal. 2nd observation: Miss K.A. is a 16 years-old caucasian female who came to consultation for a swelling of the medial angle of the left eye. Computed tomography images showed a fronto-ethmoidal process displaying a bone density consistent with an osteoma. The tumor was removed through an external ethmoidectomy. The patient was free of symptoms at 6 months follow-up. 3rd observation: Mrs. F. Z. is a 45 years-old patient who presented a 5 years history of right painful exophthalmos. The computed tomography was consistent with a fronto-ethmoidal osteoma with intraorbital extension near the optic nerve. The surgical excision was limited to the intraorbital portion. Postoperative complications included ptosis and diplopia. DISCUSSION: Osteomas most commonly affect the fronto-ethmoid sinuses. They rarely show intraorbital extension or cause intracranial complications. They are generally asymptomatic. Symptoms are generally of late onset and are a consequence of tumoral growth and compression of neighbouring organs, as it is the case in our patients. Tumoral exophtalmos is the major ophthalmological sign. The computed tomography is of a great contribution, not only for diagnosis but also for the choice of the surgical approach. The classical surgical technique consists generally in a surgical excision of the osteoma. This surgery may induce ocular or neurochirurgical complications. CONCLUSION: Osteomas of the paranasal sinuses are usually asymptomatic. If they become voluminous, they may cause orbital manifestations and serious complications. The rarity of ethmoidal osteoma with orbital growth made our cases interesting to report.

Adolescent↗

PubMedDate not supplied

Dacryoliths in a series of dacryocystorhinostomies: histologic and chemical analysis.

PURPOSE: To present the clinical and intraoperative characteristics of dacryolith cases, to present their histologic and chemical analysis, and to relate the findings with the probable causes of their formation in a series of dacryocystorhinostomies performed in northern Greece. METHODS: In a series of 242 dacryocystorhinostomies in patients with chronic dacryocystitis, dacryoliths large enough to perform an accurate chemical analysis and a light histologic examination were found in five cases. The chemical analysis was based on atomic absorption spectrophotometry and atomic emission spectrometry. RESULTS: These five cases concerned relatively young patients who presented symptoms of short duration as compared to the other dacryocystorhinostomy cases. In three of them, irregularities of the lacrimal sac wall were observed. The final postoperative results were satisfactory. The histologic examination revealed acellular amorphous organic material and limited areas with characteristics of calcium salt depositions. The chemical analysis showed mainly organic and minimal inorganic material. CONCLUSIONS: The irregularities of the lacrimal sac wall and the consequent flow disorders within the sac and the histologic and chemical analysis of the dacryoliths provide evidence for etiologic consideration.

Adult↗

PubMedDate not supplied

[Diagnosis of Wegener's granulomatosis in patients with ocular inflamatory disease].

OBJECTIVE: Report the ophthalmologic manifestations among patients with Wegener 's Granulomatosis (WG). METHOD: We reviewed the database of the Instituto de Oftalmologia Fundación Conde de Valenciana in order to collect information regarding complete ophthalmic examination, laboratory and cabinet tests, treatment, and disease progression. RESULTS: We included 11 patients with WG (18 eyes). Seven men and four women, mean age 43.7 years (range = 28-55). Three patients had a prior diagnosis of WG and the remaining eight patients were diagnosed by our study team. Seven subjects developed a bilateral affection and four had unilateral involvement. The clinical presentation was necrotizing scleritis with peripheral ulcerative keratitis (PUK) (7/18), diffuse scleritis (3/18), nodular scleritis (1/18), non-granulomatous uveitis (1/18), optic ischemic neuropathy (1/18), retrobulbar neuritis (1/18), serous retinal detachment (2/18), and dacryocystitis (2/18). Final visual acuity was better or equal to 20/40 (13/18), 20/400 (3/18), finger-counting or no-perception of light in 1/18. Currently, seven patients are symptom free. CONCLUSIONS: The most frequent ophthalmic manifestations among our patients with WG were: necrotizing scleritis and PUK. In most cases, WG was diagnosed after ophthalmic manifestations; however, all patients displayed prior systemic or ocular symptoms.

Adult↗

PubMedDate not supplied

Congenital nasolacrimal duct obstruction in Japanese infants: its incidence and treatment with massage.

We examined the patency of 670 nasolacrimal ducts in 335 newborn infants--42 patients (62 ducts) had obstructions; the involvement was unilateral in 22 and bilateral in 20. No sexual predilection was noted. All affected patients were treated with hydrostatic massage at the area of the lacrimal sac. About two-thirds of the ducts became patent by 2 months after birth, while the remainder became patent by 9 months. Only one patient who had acute dacryocystitis at age 5 months required a probing of the duct and a regimen of systemic antibiotics to achieve good results.

Female↗

PubMed1991

Nasolacrimal injuries. Evaluation and management.

The tear drainage system is disrupted in 17% to 21% of nasoethmoidal fractures and, to a lesser degree, other midfacial fractures. When epiphora or dacryocystitis occurs, evaluation should include the Jones dye tests, probing of the ductal system, or dacryography. Dacryocystorhinostomy is the treatment of obstruction distal to the common canaliculus.

Humans↗

PubMed1991

Ocular infections--diagnosis.

The identification and understanding of subtle signs in the ocular and periocular region will usually result in an accurate diagnosis without extensive investigations. The natural history of these diseases makes it possible for general practitioners to manage conjunctivitides, lid infections, and dacryocystitis if the conditions are not complicated by intraocular or corneal involvement. Endophthalmitis or infected corneal ulcers require urgent referral-any delay, even a matter of hours, can result in progression of the disease such that a successful outcome may be impossible. Because of the extreme sensitivity of vision as a monitor of corneal or intraocular changes, and the ease with which pathological processes can actually be seen, the identification and diagnosis of ocular infections and their appropriate treatment are relatively easy and extremely rewarding. The results of treatment are usually observable within 24 hours. All patients with suspected ocular and periocular infections ought to be reviewed in one day, and referred if they are not responding to treatment as expected.

Biopsy↗

PubMedDate not supplied

[Rhinocerebral mucormycosis].

Mucormycosis is unusual in ORL pathology. We present a case of a 53-year-old patient in the dialysis program for the past 6 years for renal insufficiency. Starting with some trouble in the left lacrimal region, he was diagnosed by his ophthalmologist as having deep dacryocystitis, appearing as an ulcero-necrotic lesion on the same side of the nasal dorsum. In the presumption of clinical mucormycosis, a microbiological and histological study was done to confirm the diagnosis, starting treatment with amphotericin B. Because of the rapid extension of the lesion, surgical debridement of the zone was done but his evolution was bad, lapsing into a coma and requiring a neurosurgical operation for intracranial complications. The patient died 12 days after admission. For that reason we did an evaluation of the problem and also a review of the literature.

Amphotericin B↗

PubMed1988

Visual loss following suture removal postkeratoplasty.

Suture removal following penetrating keratoplasty continues to plague surgeons as one of the most unpredictable aspects of this procedure. The patients presented here will detail three cases of endophthalmitis and one case of expulsive hemorrhage following suture removal. These events cannot be predicted. However, certain steps can be taken to minimize these potentially blinding complications. These steps include avoidance of through and through sutures, follow-up examination within 24 h of suture removal to look for signs of would leak, graft dehiscence or infection, use of appropriate antibiotics, elimination of dacryocystitis prior to keratoplasty, and particular vigilance in immunocompromised patients.

Adult↗

PubMed1988

Ocular streptococcal infections.

Streptococcal infections are an important cause of corneal ulcers, endophthalmitis, conjunctivitis, and dacryocystitis. We retrospectively reviewed 53 ocular streptococcal infections diagnosed and followed at Wills Eye Hospital between January 1, 1984, and July 1, 1986. Corneal ulcers (23 of 53; 43%) and endophthalmitis (18 of 53; 34%) constituted a majority of the streptococcal infections in this series. Streptococcal infection was also a common cause of conjunctivitis, but clinical follow-up data were sufficient for inclusion in this series in only a small fraction of conjunctivitis patients (9 of 70; 13%). Streptococcal corneal ulcers and endophthalmitis were frequently associated with a poor visual outcome. When antibiotic sensitivity testing was done, approximately one third of the streptococcal isolates (13 of 38; 34%) were not sensitive to gentamicin. As topical gentamicin is frequently used by ophthalmologists, the possibility of streptococcal infection should be taken into account in the selection of antibiotics for conjunctivitis, corneal ulcers, endophthalmitis, and prophylaxis.

Conjunctivitis↗

PubMed1988

[Digital radiology in the study of the lacrimal ducts].

The authors emphasize the usefulness of digital dacryocystography (DCG), as compared with various current techniques. Utilizing a radiographic unit equipped with a video-fluoroscopic system and interfaced to a digital video-processor, several digitalized images are acquired before, during and after the injection of contrast medium. Final images are obtained by subtraction of suitable pairs of source frames. Twenty-six patients affected by epiphora have been examined so far. In 21 cases digital subtraction DCG allowed an accurate visualization of the lacrimal system; in the other five patients the amount of information was acceptable. This methodology allows the assessment of both the normal anatomy of the lacrimal passages and their pathological patterns, such as obstructions, stenoses, fistulas, chronic dacryocystitis, lacrimal stones. The examination is easy and quick to perform, with no discomfort for the patient. Digital subtraction DCG proves thus to be a very valuable technique thanks to its possible electronic elaboration--i.e. the subtraction and the magnification of images--to its better contrast resolution, and to the possibility it yields of dynamic studies under radioscopic control.

Humans↗

PubMed1987

Complications of orbital trauma surgery.

This article considers the complications of orbital trauma surgery. In addition, ocular as well as nonocular complications of orbital trauma are outlined. Knowledge of the workup of specific types of orbital fractures will help prevent common sequelae of unrecognized orbital fractures: (a) orbital contour abnormalities, and (b) late enophthalmos. Complications of orbital fracture repair that relate directly to the alloplastic implant include (a) orbital cellulitis due to an infected implant, (b) anterior extrusion of the implant, (c) compression of the optic nerve by the implant, (d) dacryocystitis due to obstruction of the lacrimal sac by the implant, and (e) late proptosis due to hemorrhage into the fibrous capsule that surrounds the implant. Surgical techniques that minimize such complications are emphasized.

Adult↗

PubMed1986

An improved method for the delivery of artificial tears using an infusion pump.

Patients with markedly decreased or absent tear duct production require the frequent instillation of artificial tear preparations. Through animal experiments, a new method has been developed for the continuous infusion of these solutions. In this procedure, the canalicular system is intubated with fenestrated silastic tubing, which is subcutaneously tunnelled and then attached to a miniaturized and computerized pumping device. This makes it possible for a predetermined volume of solution to be automatically and continuously delivered. Using this technique, artificial tear solution was instilled at a rate of 1.75 microliter/min, a rate approximately the normal basic tear secretion rate (0.5-2.2 microliters/min). This resulted in a 14% increase in tear flow from preoperative values. This represents a 74% increase in tear secretion rates for patients with keratoconjunctivitis sicca. None of the experimental animals developed subcutaneous infections, dacryocystitis, or corneal ulcers. By utilizing the normal anatomy of the lacrimal drainage system, this new technique: does not compromise the conjunctival cul-de-sac or the salivary system, avoids the inconvenience of previous external devices, and allows for the automatic instillation of predetermined volumes of artificial tear solutions.

Animals↗

PubMed1978

Survey of conjunctival flora in dogs with clinical signs of external eye disease.

Bacteria were isolated 68% of the time from the conjunctival sacs of 120 dogs with conjunctivitis, blepharitis, dacryocystitis, or corneal ulcerations. Coagulase-positive Staphylococcus aureus was the most frequently isolated organism (68%); when both eyes were affected, S aureus was recovered from 29% of the dogs; and in dogs with 1 eye affected, S aureus was isolated from 23% of the affected eyes and in 18% of the nonaffected eyes. Other organisms recovered from eyes were coagulase-negative Staphylococcus epidermidis (27%), beta-hemolytic streptococcus (19%), alpha-hemolytic Streptococcus (17%), Escherichia coli (10%), Bacillus spp (11%), and Proteus spp (7%). It was concluded that S aureus may appear as a primary pathogen in ocular disease. When 1 eye is clinically affected, S aureus can be a potential invader of the normal eye.

Animals↗

PubMed1982

[Clinical evaluation of cefmenoxime in the pediatric infections].

Cefmenoxime (CMX) was evaluated in 25 children with a suspicion of bacterial infection. Of the 20 confirmed bacterial infections, 19 were cured by CMX therapy (effective rate, 95%). The diagnoses included acute pharyngotonsillitis (4), acute bronchitis (1), pneumonia (7), streptococcal dacryocystitis (1), infections accompanied with acute leukemia (4), and acute urinary tract infections (3). The etiologic pathogens were beta-hemolytic Streptococcus group A (1), and F (1), Staphylococcus aureus (4), Haemophilus influenzae (4), Escherichia coli (4), Klebsiella pneumoniae (2), etc. CMX was very effective for 2 children with respiratory infections due to ampicillin resistant H. influenzae type b. The half life of serum concentration of CMX was 0.76 +/- 0.17 hour after an intravenous bolus injection. A cerebrospinal fluid level of CMX was 5.2 mcg/ml 1 hour after intravenous injection of 1 g (23.8 mg/kg) in a child with inflamed meninges. However this level was not as high as those of cefotaxime, latamoxef, or ceftizoxime measured in the same case. No severe adverse reaction was encountered with CMX therapy. The data suggest that CMX is a safe and effective parenteral antibiotic when used in children with susceptible bacterial infections.

Adolescent↗