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PubMed2006

Changes in lumen width of nasolacrimal drainage system after adrenergic and cholinergic stimulation.

PURPOSE: To determine the effect of an adrenergic agonist and a cholinergic agonist on the lumen width of the nasolacrimal drainage system. DESIGN: Prospective, nonrandomized, clinical trial. METHODS: The asymptomatic sides of 33 patients (23 women, 10 men) with unilateral stenosis/obstruction of the nasolacrimal drainage system were studied. The tear meniscus height of the asymptomatic side was normal, with a patent lacrimal system as revealed by dacryocystography. The nasolacrimal drainage system of the asymptomatic side was infused with 100 microL of 5% phenylephrine hydrochloride (an alpha-1 adrenoceptor agonist) or 100 microL of 2% pilocarpine hydrochloride (a cholinergic agonist), and dacryocystography was performed to determine the lumen width of the nasolacrimal drainage system. RESULTS: Phenylephrine caused a significant increase of the lumen width of the nasolacrimal drainage system, and the changes were more marked in the nasolacrimal duct (NLD), especially the upper and middle regions, than in the lacrimal sac. In contrast, pilocarpine reduced the lumen width of the NLD significantly, especially in the middle and lower regions, and the lumen width of the lacrimal sac was not significantly changed. CONCLUSION: The alterations of the lumen width of the nasolacrimal drainage system, especially the lumen width of the NLD by adrenergic and cholinergic agonists, suggest that the lumen width can be changed by the autonomic nervous system.

Adrenergic alpha-Agonists↗

PubMed1978

[A new lacrimal intubation set (author's transl)].

The authors report a new lacrimal intubation set made with two very malleable metal probes and with a silicone tube. The system can be used during the repair of the nasolacrimal duct injuries, during dacryorhinocystostomy, and also for the repair of canaliculus injuries with the little set.

Adult↗

PubMed1978

[Rare causes for epistaxis (author's transl)].

Rare causes for nosebleeding are different benigne and malignant tumors of the nose and aneurism of the internal carotid artery. Two cases of rupture of an aneurism of the internal carotid artery are reported. One case with a hemangioma of the nasolacrimal duct and the problematic therapy of epistaxis are discussed in cases with Osler's disease.

Aneurysm↗

PubMedDate not supplied

Neonatal respiratory distress caused by cryptic dacryoceles.

Two cases of neonatal respiratory distress responded with treatment of bilateral dacryocele. In one case, no visible or palpable external evidence of dacryocele was present until mucopurulent discharge commenced more than a week after birth. While the incidence of typical congenital nasolacrimal duct obstruction is about 6%, dacryocele is 200 times less common.

Anatomy, Cross-Sectional↗

PubMedDate not supplied

[Endonasal dacryocystorhinostomy. A comparative study of microscopic and endoscopic techniques].

A comparative study was made of endonasal dacryorhinostomy using either a 0 degree or 30 degrees rigid endoscope or a Zeiss operating microscope in 25 patients with chronic epiphora and complete stenosis of the nasolacrimal duct confirmed by dacryocystography. The success rate in both groups was similar (80%). Computed tomography is useful in post-traumatic cases.

Dacryocystitis↗

PubMed1980

[Ultrastructural aspect of the different levels of the lacrimal system (author's transl)].

Using the transmission electron microscope and the scanning electron microscope, we have found a different ultrastructure at the different levels of the lacrimal system: 1) tarsal conjonctiva: numerous microvilli on a relief of small valleys; 2) lacrimal punctum: the surface of the cell is flat with sparse microvillosti, sparse cilia and strong intercellular junction; 3) external part of the canaliculus: pavement epithelium with numerous microvillositi and pinocytosis, absence of cilia; 4) internal part of the canaliculus: the microvillositi are very small or absent; 5) lacrimal sac: the cilia are arranged by tufts scattered on this malpighian epithelium; 6) nasolacrimal duct: the cilia are numerous; 7) in the nose the cilia are extremely numerous.

Cilia↗

PubMed2004

Pediatric canaliculitis and stone formation.

A 5-year-old girl with a remote history of idiopathic thrombocytopenic purpura presented with a history of partial nasolacrimal duct obstruction unresolved with standard treatments of probing, irrigation, and lacrimal system intubation. Surgical exploration revealed canaliculitis with dacryolith formation within the inferior canalicular system. After punctoplasty and removal of the dacryoliths, the patient had full resolution of symptoms. Although the diagnosis is uncommon in this age group, it should be included in the differential diagnosis of chronic or recurrent pediatric nasolacrimal obstruction.

Bacterial Infections↗

PubMedDate not supplied

Long-term follow-up of patients with microscopic endonasal dacryocystorhinostomy.

BACKGROUND: Stenosis of the nasolacrimal drainage system is a relatively frequent complication of acute or chronic inflammation, trauma, tumor, or congenital malformation. Symptoms include epiphora, intermittent purulent secretion, and swelling of the nasolacrimal sac. The principle of dacryocystorhinostomy (DCR) is to create an artificial opening of the lacrimal sac into the nasal cavity. This can be done via an external as well as an endonasal route. METHODS: In this retrospective study, we examined 74 microscopic endonasal DCRs. which were performed on 70 patients between 1990 and 2000. All of the 74 DCR operations had no major complications intraoperatively. RESULTS: Sixty DCR procedures (81.1%) were successful after a mean follow-up time of 3.18 years. This success rate is lower than those rates reported in the literature for the external approach, which range between 85 and 99%, although follow-up times were shorter in most of these studies. CONCLUSIONS: Advantages of the endonasal approach such as saving the medial palpebral ligament, the lacrimal pump mechanism, and the horizontal apparatus are obvious. If necessary, additional management of sinus, septal, and conchal disease can be performed simultaneously. Our results reveal that the microscopic endonasal approach is a safe and reliable procedure in the management of postsaccular or saccular nasolacrimal duct obstruction and is an alternative to the traditional external route.

Adolescent↗

PubMed1983

Brief clinical report: a new syndrome of hemangiomatous branchial clefts, lip pseudoclefts, and unusual facial appearance.

Two unrelated children (one male, the other female) had unusual craniofacial anomalies consisting of hemangiomatous branchial clefts, lip pseudoclefts, and identical unusual facial appearance. One also had unilateral microphthalmia and both had congenital nasolacrimal duct obstruction. Two similar, sporadic cases from the literature were also identified. These four cases form the basis of a new, distinctly recognizable pattern of malformation.

Branchioma↗

PubMed1988

Levy-Hollister syndrome.

The Levy-Hollister syndrome is an autosomal dominant disorder characterized by lacrimal malformations, simple cup-shaped ears, hearing loss, hypodontia and enamel dysplasia, and upper limb malformations. Renal anomalies have been noted variably. Two families with this disorder have been described previously. Recently, a third family with the Levy-Hollister syndrome was evaluated. Unusual features present in this family included bilateral nasolacrimal duct fistulas, radial aplasia, and unusual dermal ridge patterns. Early recognition of this disorder should prompt investigation for renal anomalies and/or hearing loss. It should also lead to consideration of surgical attempts to correct the lacrimal abnormalities or conductive hearing loss, thereby reducing the long-term morbidity in affected patients.

Abnormalities, Multiple↗

PubMedDate not supplied

Ambulatory pediatric ophthalmic surgery.

A retrospective analysis of 100 consecutive cases of ambulatory pediatric ophthalmic surgery was performed. The diagnoses included strabismus surgery, nasolacrimal duct probing, and excision of chalazion. The hospital stay was extended in only two cases and that was due to vomiting. This is a known side effect of halothane anesthesia and falls well within the known incidence of this occurrence. Ambulatory surgery appears to be a very viable method for short-stay surgery in children.

Adolescent↗

PubMed1998

[Basic study of MR-dacryocystography].

We developed MR-dacryocystography as a non-invasive, safer imaging technique for canaliculi, the nasolacrimal duct and lacrimal sac by dropping saline solution and diluted Gd-DTPA solution into the eye. The diluted Gd-DTPA solution was found to create no local irritation in the eyes of rabbits and normal volunteers. Lacrimal sacs and ducts were well visualized in all of 10 normal volunteers by using the saline solution or the diluted Gd-DTPA solution. Canaliculi were visualized in 4-7 cases on thin-slice axial images. MR-dacryocystography was suggested to be a useful screening examination for lacrimal outflow disorders.

Adult↗

PubMed1978

Morphological changes in the human conjunctival epithelium. II. In keratoconjunctivitis sicca.

A clinicopathological correlation was performed on 24 patients suffering from keratoconjunctivitis sicca (KCS). Examination of conjunctival biopsies by light and transmission electron microscopy revealed stratification of the conjunctival epithelium with separation of the superficial cell layers, and this was directly proportional to the clinical severity of the disease. Counts of goblet cells were found to be inversely proportional to the degree of stratification. The goblet cells were morphologically identical to, but significantly fewer in number than, those found in normal conjunctival tissue. A reduction in epithelial cell stratification and separation and an increase in goblet cell density were closely related to nasolacrimal duct occlusion--an operation performed only in the severe examples of KCS in this series. The possible causes of 'mucous' plaques and 'filaments' are discussed in relation to these phenomena. Moreover, there is a dramatic reduction and deformation in the microplicae on the surface of the conjunctival epithelium. The significance of this was considered in relation to tear film stability.

Adult↗

PubMed2005

Endocanalicular laser dacryocystorhinostomy analysis of 118 consecutive surgeries.

PURPOSE: To describe the outcomes of endocanalicular laser dacryocystorhinostomy (ECL DCR) for patients with nasolacrimal duct obstruction (NLDO). DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: One hundred eight consecutive patients who underwent ECL DCR. METHODS: The records of the patients who underwent ECL DCR at 1 of 2 academic centers were reviewed and the data analyzed. MAIN OUTCOME MEASURES: Success was defined as the resolution of symptoms or unobstructed lacrimal irrigation. RESULTS: One hundred eighteen consecutive ECL DCR surgeries performed on 108 patients between June 1997 and June 2003 were reviewed, excluding 6 lost to follow-up. Endocanalicular laser DCR was the initial surgical intervention for all cases except 6 that had previously undergone surgery (external or endonasal DCR) at outside hospitals. Twenty-seven of the surgeries were considered failures on the basis of recurrent epiphora or discharge, or reflux on nasolacrimal irrigation. One of the failures was permanently corrected with balloon dacryoplasty. Nine of the other failures had a repeat procedure, with 7 remaining patent after one repeat procedure and an additional one remaining patent after a third procedure. All 6 ECL DCR procedures that were performed after external or endonasal DCR at an outside institution remained patent. Among the 102 initial lacrimal surgeries in this series, there was a 73.6% success rate. The overall success, including repeat procedures, was 81.5%. The success of this technique as a repeat procedure after previous external, endonasal, or ECL DCRs was 87.5%. CONCLUSIONS: Endocanalicular laser DCR offers a minimally invasive alternative procedure for the treatment of NLDO. In our series, the success rates are comparable to those previously reported. The technique had a high success rate when used to treat recurrent NLDO after previous lacrimal surgery.

Adolescent↗

PubMed1985

Visualization of the probe tip during lacrimal outflow system probing and intubation.

Probing of the lacrimal outflow system is commonly performed by ophthalmologists for treating nasolacrimal duct obstruction in infants or for intubating the lacrimal system. Visualization of the probe tip in the inferior meatus during probing insures the surgeon of reaching the nose with the probe. Similarly, visualization of the probe is the key to success in intubation irrespective of the retrieval system used. Rotation of a curved metal probe plus infracturing of the inferior turbinate after shrinking the nasal mucosa with cocaine allows such visualization in most instances.

Adult↗

PubMed1988

Absence of Chlamydia in trachomatous lacrimal sacs.

We performed lacrimal sac biopsies in 35 patients who underwent dacryocystohinostomies in Saudi Arabia. The nasolacrimal duct obstructions were presumably secondary to trachoma in 22 cases and unknown in the remaining 13 cases. Lacrimal sac specimens were submitted for routine histopathologic examination and the direct-smear fluorescent antibody test. All specimens were negative for chlamydia. Possible reasons for the low detection rate of chlamydia in the trachomatous group were the frequent finding of clinically inactive disease, common canalicular obstruction, and loss of the epithelial lining in the lacrimal sac.

Adult↗

PubMedDate not supplied

Early and late assessment of internal drainage of chronic dacryocystitis.

To evaluate the efficacy of internal drainage of a lacrimal abscess, we treated 10 patients with pyocele of the lacrimal sac, who did not want to undergo operative intervention. A temporary nasolacrimal stent was placed in the nasolacrimal duct, and the pussy material was collected for microbiological examination to adjust the preliminary antibiotic treatment which was given systemically and locally. The stents were removed after the infection had subsided clinically. Three years later, there was a recurrence of the infection in only 1 patient. This internal drainage of the lacrimal sac, combined with systemic and local antibiotics, was successful in 90% of the patients.

Abscess↗

PubMed1993

[Long-term follow up of dacryorhinostomy in 14 cases with fibroendoscopy].

The orifice of anastomosis and the lower aperture of the nasolacrimal duct in 14 cases (16 eyes) after dacryorhinostomy were followed up with the fibroendoscope. It was found that the size of the office and positioning of the bony window were key factors for a successful operation. Postsurgical management was advised to continue for at least 3 months or preferably 6 months. Deviation of the nasal septum toward the affected side was not regarded as contraindication for the operation, and the authors recommended fibroendoscopy in the diagnosis and postsurgical examination of lacrimal passage diseases.

Adolescent↗