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PubMed2006

Powered endoscopic dacryocystorhinostomy.

Over the past ten years the interest in endoscopic dacryocystorhinostomy (DCR) has increased with improved instruments and endoscopic surgery skills. Although endoscopic DCR was first described in 1989, the technique has evolved over the past 15 years as the understanding of the anatomy and ability to achieve reliable and consistent results has improved. Powered endoscopic DCR is a reliable and effective technique for managing primary nasolacrimal duct obstruction in adults and children and for revision DCR.

Dacryocystorhinostomy↗
PubMedDate not supplied

Congenital nasolacrimal sac mucocele associated with respiratory distress.

Two newborn infants with mucoceles of the nasolacrimal sac presented with respiratory distress due to mucocele-induced nasal cavity obstruction. Nasolacrimal duct probings were performed and resulted in immediate and permanent relief of respiratory difficulties. This rare complication should be considered in the evaluation of infants with congenital nasolacrimal sac mucocele.

Female↗
PubMed1995

Nonsurgical placement of a nasolacrimal polyurethane stent.

PURPOSE: To describe the placement of a nasolacrimal polyurethane stent with a new introducer set and hook. MATERIALS AND METHODS: The authors designed a soft polyurethane stent, an introducer that does not require balloon dilation, and a hook that can remove a ball-tipped guide wire from the inferior nasal meatus under fluoroscopic guidance. The stent was placed in 51 lacrimal systems in 44 outpatients who had complete obstruction of the lacrimal sac or nasolacrimal duct. RESULTS: Stent placement was technically successful and well tolerated in 50 of 51 nasolacrimal systems. The procedure lasted an average of 16 minutes (range, 10-33 minutes). After stent placement, 47 of 50 eyes showed complete resolution of epiphora, and the other three showed partial resolution. During follow-up, no stents migrated, and one stent became blocked. The stent was reopened by means of forceful irrigation of saline solution through the superior punctum. CONCLUSION: Placing a polyurethane nasolacrimal stent by use of the new introducer and hook simplifies the technique, shortens operating time, reduces cost, and makes the procedure well tolerated by patients.

Adolescent↗
PubMed2001

Endoscopic-guided trephination dacryocystorhinostomy (Hesham DCR): technique and pilot trial.

OBJECTIVES: (1) Test the feasibility and the safety of guided transnasal trephination in creating a nasolacrimal fistula. (2) Develop an appropriate lacrimal maintainer and test its value in modulating healing at the fistula site. DESIGN: Prospective, noncomparative interventional case series. PARTICIPANTS: Five cadavers and 19 patients. METHOD: A transcanalicular lacrimal probe penetrated the lacrimal fossa to guide the passage of a flexible trephine up the nose, which created the nasolacrimal communication. A special wide-caliber lacrimal maintainer was inserted along lacrimal tubes within the created passage. OUTCOME MEASURES: For cadaveric study, direct inspection after dissection of the facial flap was performed. For the clinical trial, subjective improvement in watery eye, dye testing, lacrimal probing, lacrimal irrigation, and endoscopic nasal examination. RESULTS: The technique resulted in the creation of a regular fistula of reproducible diameter into which a standard-shaped wide caliber maintainer could be inserted. Three months after removal of the maintainer and 6 months after surgery, a patent ostium was achieved in 17 of 18 (94%) patients who had a completed procedure. Relief of symptoms was achieved in 83%. CONCLUSIONS: Guided endoscopic dacryocystorhinostomy provides a simple and safe option for the treatment of nasolacrimal duct obstruction. The lacrimal maintainer is a useful device to achieve a large patent nasolacrimal communication.

Adult↗
PubMed1997

[Lacrimal duct endoscopy. Report of initial experiences].

BACKGROUND: Until recently, we have had to depend on digital dacryocystography and on clinical examinations such as the fluorescein dye test, lacrimal probing and irrigation for diagnosis of disorders of the lacrimal system. Now the lacrimal system and its mucuos membranes can be viewed directly with a lacrimal endoscope. While the first endoscopes were rigid and limited by poor picture quality in axial illuminations, the new generation of endoscopes are a great leap forward for new diagnostic and therapeutic approaches. MATERIALS AND METHODS: A new lacrimal endoscopic system has been in used at the University Eye Clinic in Graz since January 1996. The outer diameter of the endoscopes are 0.5 and 0.3 mm. The endoscope produces high-quality images with 3000 picture fibers and 200 light fibers. The unit consits of xenon light sources, a three-chip videocamera and a monitor. RESULTS: Diagnostic endoscopic lacrimal probing was performed on 38 patients whose ages ranged from 8 months to 73 years. Canaliculus scars and strictures, obstructions at the entrance and exit of the lacrimal sac, and scars and structures of the lacrimal sac and nasolacrimal duct were diagnosed. CONCLUSION: Lacrimal endoscopy offers a new approach to the diagnosis of lacrimal disorders. Scars and relative obstructions can be identified more easily and can be directly opened with a laser or through mechanical probing. Perforations and massive mucosal injuries can be avoided. Further development of various types of lasers could allow for intracanalicular dacryocystorhinostomy, help prevent complications and increase the result.

Adolescent↗
PubMed1976

Dacryocystantrostomy. A preliminary report.

A new operative technique is described in which the lacrimal sac is drained into the maxillary sinus. The advantages of the procedure, especially of avoiding a facial incision, are emphasized. Five patients suffering from long-standing epiphora underwent surgery. Two patients had chronic dacryocystitis. Two other patients presented with a mucocele of the lacrimal sac. In the fifth patient, there was obstruction in the nasolacrimal duct. Short term follow-up results suggest its usefulness as a first line of surgical treatment in cases of epiphora due to obstruction in the lacrimal sac or the naso-lacrimal duct.

Adolescent↗
PubMed1989

Congenital nasolacrimal mucoceles: CT evaluation.

A congenital nasolacrimal mucocele, a lacrimal sac mucocele with intranasal extension, is an uncommon mass arising in the medial canthal region of the orbit. The authors describe four infants who presented with medial canthal masses and nasal airway obstruction. All underwent computed tomographic (CT) evaluation, which revealed the triad of cystic dilatation of the lacrimal sac, dilatation of the nasolacrimal duct, and an intranasal cystic mass. Appropriate therapy was determined following identification of the intranasal cystic component. Relevant discussions of the embryology, clinical presentation, and the characteristic CT findings of infants with congenital nasolacrimal mucoceles are included.

Female↗
PubMed1981

The value, limitations, and applications of nuclear dacryocystography.

Nuclear dacryocystography is simple, relatively harmless method of evaluating patients suspected of having abnormalities of the nasolacrimal drainage system. A group of normal saline containing approximately 100 muCi of 99mTc-pertechnetate is placed on the conjunctiva near the lateral canthus, and serial scintigrams are obtained as the pertechnetate flows along the tear strips, through the nasolacrimal drainage system, into the nasal fossa. By using a pinhole collimator with a very small aperture (1mm), the canaliculi, the nasolacrimal sac, and the nasolacrimal duct are readily visualized. When flow is impaired, the site of obstruction can often be identified. Contrast dacryocystography provides similar information but requires the injection of contrast material directly into a canaliculus. Nuclear dacryocystography provides good functional assessment of nasolacrimal drainage but has serious shortcomings in defining pathologic anatomy. Contrast dacryocystography outlines the anatomy well but often misses minor obstructions. The two studies are complementary and together provide an effective means of evaluating the nasolacrimal drainage system.

Ethiodized Oil↗
PubMed1992

Location of the nasolacrimal canal in relation to the high Le Fort I osteotomy.

The positional relationship between the high-level Le Fort I osteotomy and the nasolacrimal canal was studied in standard posteroanterior and lateral cephalograms made of 100 adult dry skulls after orienting the Frankfort horizontal of each skull to the natural horizontal plane. The simulated high-level Le Fort I osteotomy in all of the 100 skulls was under the level of the inferior orifice of the nasolacrimal canal by a mean distance of 5.2 mm (range, 0.5 to 11.5 mm). The average distance between the canal orifice and a line which extended from the lacrimal fossa to the anterior attachment of the inferior turbinate was 0.7 mm (range, 2.0 mm medially to 3.5 mm laterally). The maxillary height was strongly correlated to the height of the infraorbital foramen (r = .59, P less than .001) and the simulated osteotomy (r = .57, P less than .001). The results indicate that the osteotomy, when made just beneath the infraorbital foramen and extending into the piriform rim at the level of anterior attachment of the inferior turbinate, will usually not jeopardize the nasolacrimal duct within its bony canal. A line drawn from the lacrimal fossa to the anterior attachment of the inferior turbinate on the anterior aspect of the maxilla is a good approximation of the course of the nasolacrimal canal.

Humans↗
PubMed1998

Microsurgical endonasal dacryocystorhinostomy with long-term insertion of bicanalicular silicone tubes.

OBJECTIVE: To assess the results of microsurgical endonasal dacryocystorhinostomy with long-term insertion of single or double bicanalicular silicone tubes in canalicular (presaccal) and ductal (postsaccal) stenosis of the nasolacrimal duct system. DESIGN: Retrospective follow-up of case series between 1992 and 1996. PATIENTS: Thirty-eight patients were included in the study: 19 with ductal stenosis; 28 with canalicular stenosis; and 1 (a 6-month-old girl) with congenital agenesis of the lacrimal duct system. INTERVENTION: Forty-seven endonasal microscopic dacryocystorhinostomies were performed on 38 patients. Bicanalicular silicone tubes were inserted, fixed in the nasal cavity, and left in place as long-term space holders. In patients with canalicular stenosis, a specially designed double bicanalicular tube was inserted for maximal dilatation of the lacrimal canals. The tubes are left in place as long as possible, ie, for months to several years. In cases in which there was recurrent obstruction following accidental tube extrusion, we simply inserted new tubes using a short-acting anesthesia. RESULTS: With 1 procedure, 17 (91%) of the eyes that were surgically treated for ductal stenosis became symptom free. The success rate in the cases of canalicular stenosis was 72%. In the remaining 28% of patients with recurrent obstruction, endonasal revision surgery was performed with new insertion of bicanalicular tubes. With the new tubes in place, these remaining patients have also stayed largely symptom free (length of follow-up, 8 months to 5 years [average, 3 years]). CONCLUSIONS: The routine insertion of bicanalicular tubes as long-term spacers has proved effective and has been tolerated without problems. A new aspect of our study is that in cases of canalicular stenosis or congenital agenesis of the lacrimal duct, which generally have a poor prognosis, the patients also benefit when our specially designed long-term double bicanalicular tubes are inserted in the lacrimal ducts.

Adolescent↗
PubMed1991

Unilateral congenital nasolacrimal mucocele.

A case of a congenital nasolacrimal mucocele is reported. This very uncommon finding presents usually with a diagnostic triad on CT: an intranasal cystic mass, a dilated nasolacrimal duct and lacrimal sac.

Female↗
PubMed2005

Clinical outcome of endonasal KTP laser assisted dacryocystorhinostomy.

BACKGROUND: To evaluate the clinical outcome of primary endonasal laser assisted dacryocystorhinostomy (ENL-DCR) using the potassium-titanyl-phosphate laser. METHODS: We retrospectively reviewed all primary ENL-DCRs performed within a period of twelve months by the same combined Ophthalmology and Otorhinolaringology team in Freeman Hospital, Newcastle upon Tyne, UK. The main outcome measure for success was resolution or significant improvement of epiphora. Details of surgery, intraoperative and postoperative complications, as well as pathology associated with failure were also studied. Patients were followed up for at least 12 months. RESULTS: A total of 41 consecutive ENL-DCRs on 29 patients (22 females, 7 males, mean age 75 years) were analysed. All patients had bicanalicular silicone intubation for at least 4 months. The success rate at 12 months postoperatively was 78.1%. Pathology associated with failure included: intranasal pathology (12.2%), mucocele (7.3%), and systemic sarcoidosis (2.4%). No significant intra-operative complications were recorded. CONCLUSION: The ENL-DCR with potassium-titanyl-phosphate laser can be considered as a safe and efficient primary procedure for the treatment of nasolacrimal duct obstruction.

Aged↗
PubMed1992

Anatomic and radiographic study of the lacrimal apparatus of llamas.

The anatomy of the nasolacrimal duct of llamas was examined grossly and radiographically in 2 llamas. Dacryocystorhinography was performed on cadaver heads, using a radiographic aqueous contrast agent. Anatomic casts of the nasolacrimal apparatus were obtained by cannulation of the duct and use of polyurethane cast material. Dacryocystorhinography accurately revealed the nasolacrimal apparatus and compared favorably with gross dissections and polyurethane casts.

Animals↗
PubMedDate not supplied

Uncommon ocular changes in Down's syndrome (mongolism).

A one-year-old White female mongoloid child was seen with typical palpebral fissures, esotropia, myopic astigmatism, and nystagmus. Additional uncommon ocular findings included ganglionic neuroretinal hypoplasia (hypoplasia of the optic nerve) and bilateral congenital impatency of the nasolacrimal duct. An active search for these ocular changes is recommended in cases of Down's syndrome.

Astigmatism↗
PubMed1989

Lacrimal catheterization.

A new atraumatic technique for identifying the medial cut end of a surgically lacerated canaliculus is described. It offers the advantage of allowing the surgeon to pass a stent through the canaliculus only, without surgically manipulating the lacrimal sac or nasolacrimal duct or damaging the ipsilateral canaliculus.

Basal Cell Carcinoma↗
PubMed1994

Symptomatic lacrimal duct diverticulum associated with closed nasal fracture.

Diverticula of the nasolacrimal collecting system are rare. Their cause may be congenital, inflammatory, or traumatic. A diverticulum of the nasolacrimal duct that presented 26 years after nasal trauma is described. The location of this diverticulum is extremely uncommon, and a case occurring after closed nasal trauma has not yet been presented. Evaluative studies and pertinent anatomy are reviewed. In any patient with recurrent dacryocystitis after nasal fracture, the diagnosis of a lacrimal system diverticulum should be considered. A detailed history and physical examination combined with dacryocystography can be confirmatory. Treatment should consist of surgical exploration with a nasolacrimal system bypass procedure.

Adult↗
PubMed1992

Epistaxis in two horses with dacryohemorrhea.

Unilateral epistaxis in 2 horses was caused by inflammation of the distal portion of the lacrimal system. The origin of epistaxis was identified during physical examination by observing hemorrhage emanating from the nasal opening of the nasolacrimal duct. Dacryohemorrhea caused by bacterial infection was successfully treated with antibacterial drugs administered systemically and instilled into the lacrimal system.

Animals↗