[Causes of failure in lacrimal intubation].
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Humans↗
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Results for “NASOLACRIMAL DUCT”
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[Lacrimal intubation: preliminary note].
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Humans↗
[Surgical treatment of contraction and dislocation of the inferior lacrimal points].
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Humans↗
Dacryocystorhinostomy.
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Dacryocystorhinostomy↗
Gadolinium magnetic resonance imaging dacryocystography.
A 1:100 solution of 48% gadopentolate in liquid tear solution was used in magnetic resonance dacryocystography to image the canaliculi, nasolacrimal sac, and nasolacrimal duct. It was administered as an eyedrop, one drop every minute for five minutes, immediately before scanning in six normal and five abnormal nasolacrimal outflow systems. In cases of nasolacrimal obstruction, the dilute gadolinium solution was injected through the canaliculus immediately before scanning. A three-inch surface coil enhanced the detail of soft-tissue structures such as the canaliculi and lacrimal sac. In the evaluation of complex tearing disorders such as congenital, neoplastic, postsurgical, and posttraumatic nasolacrimal obstruction, gadolinium lacrimal contrast adds useful information to magnetic resonance images of the lacrimal outflow system. Because of the expense of the test, we do not recommend it as a routine examination.
Contrast Media↗
Nasolacrimal obstruction secondary to I(131) therapy.
PURPOSE: To report the finding of nasolacrimal drainage system obstruction associated with I(131) therapy for thyroid carcinoma from an updated and expanded cohort. METHODS: Patients with a history of epithelial derived thyroid carcinoma who had tearing were offered referral for evaluation by an oculoplastic surgeon. Patients underwent nasolacrimal probing and irrigation procedures with localization of their nasolacrimal obstruction. Therapy for the site of obstruction was instituted. RESULTS: Clinically significant tearing was identified in 26 patients, all of whom had previously undergone I(131) therapy (n = 563). Nineteen patients were evaluated and confirmed to have nasolacrimal drainage system obstruction; 7 have yet to be formally evaluated. Areas of obstruction included nasolacrimal duct, common canaliculus, and, rarely, distal upper and lower canaliculi. Patients were treated with a variety of modalities including silicone intubation, balloon dacryoplasty, dacryocystorhinostomy, and conjunctival dacryocystorhinostomy. CONCLUSIONS: The use of I(131) for thyroid carcinoma is associated with a 3.4% incidence of documented nasolacrimal drainage obstruction and an overall 4.6% incidence of documented or suspected obstruction. The true incidence may be higher, since - I(131) treated individuals were neither systematically evaluated nor questioned about tearing. It has yet to be established if the obstructions result from local toxicity caused by the passive flow of radioactive iodine containing tears through these tissues or the active uptake and concentration of I(131) in lacrimal drainage system tissues through the sodium/iodide supporter.
Adolescent↗
Final nasolacrimal ostium after external dacryocystorhinostomy.
OBJECTIVE: To evaluate the nasolacrimal ostium created after successful external dacryocystorhinostomy. METHODS: This prospective study included 41 successful primary external dacryocystorhinostomies performed in 41 patients with nasolacrimal duct obstruction (33 women and 8 men; age range, 19-75 years). The dimensions of osteotomy were measured during surgery. Patients alternately underwent either anterior only or anterior and posterior flap anastomosis between the lacrimal sac and the nasal mucosa. Digital subtraction macrodacryocystography was performed to assess the nasolacrimal ostium 6 months after surgery. RESULTS: Dacryocystography showed that the lacrimal sac had re-formed in 40 (98%) of 41 patients. The nasolacrimal ostium was located at the inferior part of the re-formed sac in 37 patients (90%) and at the middle part of the re-formed sac in 3 patients (7%). Mean ostium heights were 3.8 mm (range, 1.6-6.5 mm) in patients who underwent anterior flap anastomosis and 3.1 mm (range, 1.2-5.2 mm) in those who underwent both anterior and posterior flap anastomosis (P =.22). Ostium height did not correlate with osteotomy size (mean, 183 mm2; range, 132-266 mm2; P =.10). CONCLUSIONS: This study confirms that after successful dacryocystorhinostomy, the nasolacrimal anastomosis contracts into a relatively small ostium. Contrary to common belief, the lacrimal sac often re-forms after surgery. The final ostium frequently develops at the inferior part of the regenerated sac. Suturing the posterior lacrimal and nasal flaps in addition to the anterior flaps does not significantly affect the ultimate ostium size.
Adult↗
Effect of addition of hyaluronic acid to highly concentrated insulin on absorption from the conjunctiva in conscious diabetic dogs.
Insulin absorption from the conjunctiva was investigated in five pancreatectomized diabetic mongrel dogs, with the nasolacrimal ducts occluded by micro plugs to prevent insulin absorption from nasolacrimal membrane. In the anaesthetized state, highly concentrated porcine insulin (1000 units mL-1, pH 7.4) was absorbed rapidly and significantly from the conjunctiva. Plasma immunoreactive insulin concentrations increased significantly up to 3 h after insulin administration to conjunctival membranes. Plasma glucose concentration decreased significantly compared with saline control experiments after insulin administration (10 units kg-1) at 3 h (8.3 +/- 0.1 vs 15.6 +/- 0.6 mmol, P < 0.01). However, in the conscious state, there was no significant increase in the plasma insulin levels after topical insulin administration. To improve insulin absorption in the conscious state, we examined the effect of increasing viscosity of insulin preparation with hyaluronic acid. In anaesthetized experiments, there were no significant changes in the bioavailability of insulin after addition of hyaluronate (0.84 +/- 0.11 vs 0.87 +/- 0.05%). In the conscious state, with addition of hyaluronic acid, the area under the curve of plasma insulin concentration was significantly increased (1842 +/- 383 vs 75 +/- 24 m units min L-1, P < 0.01). The bioavailability of insulin absorption was significantly increased after addition of hyaluronate (0.68 +/- 0.14 vs 0.03 +/- 0.01%, P < 0.01). From this study we could demonstrate that the conjunctiva is a potential route for insulin administration, and increased viscosity by the addition of hyaluronate was found effective in increasing the bioavailability of insulin absorption from conjunctival membrane in the conscious state.
Absorption↗
External dacryocystorhinostomy. Surgical success, patient satisfaction, and economic cost.
BACKGROUND: External dacryocystorhinostomy (DCR) is the standard treatment for nasolacrimal duct obstruction, with success rates consistently above 90%. This study reviews the demographics, success, cost, efficiency, and patient satisfaction in external DCR. This information will be useful as comparison criteria for evaluating new surgical techniques. METHODS: Records of 169 external DCR procedures performed over an 8.7-year period were reviewed. All patients had preoperative symptoms of tearing and/or dacryocystitis with a component of nasolacrimal obstruction. Patient demographics, history, examination findings, surgical and anesthesia information, postoperative success, complications, and follow-up course were recorded. Patient satisfaction and long-term success were evaluated by telephone survey. RESULTS: External DCR often required middle turbinectomy (17%), exposure of ethmoid sinuses (17%), and removal of dacryoliths (14%). Most patients (90%) underwent silicone intubation, with the tubes removed at an average of 3.7 weeks after surgery. A patent system was established in 95% of procedures, whereas 92% remained asymptomatic. Postoperative complications included hemorrhage (3.9%) and scarring (2.6%). Of the surveyed patients, 87% denied continued or recurrent symptoms; 97% rated their incision "good" to "excellent" in appearance; and all patients stated they would recommend the procedure to others. CONCLUSION: External DCR is highly successful, requires limited follow-up, and is a cost-effective procedure. Complications are uncommon, and patient satisfaction is high. New lacrimal surgical techniques must be evaluated against the long-proven success of the external approach.
Adolescent↗
Treatment of complete and partial obstruction of the nasolacrimal system with polyurethane stents: initial experience.
PURPOSE: To present our experience in the treatment of nasolacrimal occlusion by means of polyurethane stents. METHODS: Forty polyurethane stents were placed under fluoroscopic guidance in 35 consecutive patients with epiphora due to total or partial obstruction of the nasolacrimal system. The set designed by Song was used in all patients. The procedure was performed by introducing a guidewire through the superior punctum into the canaliculus and advancing it across the obstruction into the inferior meatus of the nasal cavity. After pulling out the guidewire, the stent was advanced in retrograde fashion and released into the sac and the nasolacrimal duct. RESULTS: The technical success rate was 100%. The average time for the procedure was 25 min (range 10-60 min). Immediate complications were: mild pain (n = 5), severe pain (n = 1), minimal epistaxis (n = 7), and moderate epistaxis (n = 1). No major complications occurred. The last clinical control revealed complete resolution of epiphora in 35 eyes and partial resolution in four; one patient did not improve. CONCLUSION: This technique for treatment of obstruction of the nasolacrimal system is simple and safe, and may obviate the use of more invasive procedures.
Adult↗
The management of punctal agenesis.
BACKGROUND: Agenesis of one or more lacrimal puncta is a rare cause of presentation to ophthalmologists. Where normal canalicular tissue lies within the lid, it may occasionally be successfully exteriorized to the conjunctival surface with relief of symptoms. The pattern of punctal agenesis, its relationship to the presence of underlying canalicular tissue, and its management have not been defined previously in a large cohort. METHODS: The authors reviewed the pattern of agenesis, underlying anatomic abnormalities and patient symptomatology in 57 patients seen over a 10-year period. A management plan was devised for eyes with no puncta and those with a single missing punctum. RESULTS: Both puncta were absent in 53 eyes, and a single punctum was missing in 41 eyes. In 86% of eyes with absence of both puncta, no canalicular tissue was identified when the lacrimal sac was opened at surgery. The underlying canaliculus also was absent in patients with one absent punctum. Nasolacrimal duct obstruction frequently accounted for the onset of symptoms in patients with a single punctum. Fifty-three (93%) of the 57 operated eyes were functionally cured at the completion of this report. CONCLUSION: Punctal agenesis usually is associated with the absence of underlying canalicular tissue. Where both puncta are absent, the authors recommend inspection of the internal opening of the common canaliculus at surgery and, if no canalicular tissue can be identified (86% in this series), insertion of a Lester-Jones tube. Symptomatic patients with a single punctum frequently require surgery to relieve nasolacrimal rather than canalicular obstruction.
Adolescent↗
[Chronic dacryocystitis cured by probing of the duct].
A seven-year-old case with chronic dacryocystitis resulting from congenital obstruction of the nasolacrimal duct was cured not by a dacryocystorhinostomy but by probing of the duct. Our results show that even in case of planned dacryocystorhinostomy, probing of the duct should be performed at least once.
Child↗
Mechanical endonasal dacryocystorhinostomy versus external dacryocystorhinostomy.
PURPOSE: To compare the success rates of a new mechanical endonasal dacryocystorhinostomy (MENDCR) technique and the conventional external dacryocystorhinostomy technique (Ext-DCR). METHODS: A prospective, nonrandomized interventional comparative case series of 31 consecutive MENDCRs and 24 Ext-DCRs performed from January 1999 to December 2000. Patients with anatomic nasolacrimal duct obstruction were included in the study; previous lacrimal surgery and functional nasolacrimal and canalicular obstruction were exclusion criteria. Two surgeons performed the MENDCRs, using a standardized operative technique, which involved creation of a large bony ostium and mucosal flaps between the lacrimal sac mucosa and nasal mucosa. One surgeon performed all Ext-DCRs. RESULTS: Twenty-seven patients (8 men, 19 women) underwent 31 MENDCRs. The average age of the patients was 62.9 years (range, 15 to 86 years; SD, 19.1 years). In 11 cases (35.4%), a septoplasty was required at the time of surgery, and in 6 cases (19%), further endoscopic sinus surgery was performed. In the Ext-DCR group, 23 patients (7 men, 16 women) underwent 24 DCRs. The average age was 59.6 years (range, 22 to 86 years; SD, 18.5 years). No other nasal procedures were performed at the time of surgery in this group. The average follow-up time was 13 months for the MENDCR group and 12.4 months for the Ext-DCR group. Success was defined as relief of symptoms and by anatomic patency, which was assessed by history, fluorescein flow on nasal endoscopy, and lacrimal syringing. In the MENDCR group, surgery was successful in 29 of 31 DCRs (93.5%); 1 of 2 failed cases was anatomically patent but symptomatic, yielding an anatomic patency rate of 96.8%. In the Ext-DCR group, the success rate was 95.8% (23/24 DCRs); the failed case was anatomically patent but symptomatic, giving an anatomic patency rate of 100%. The differences in overall success and anatomic patency were not statistically significant (P = 0.6 and P = 0.56, 1-tailed Fisher exact test). CONCLUSIONS: The success rate of MENDCR (93.5%) compares favorably with that of standard external DCR (95.8% in this study). MENDCR relies on the creation of a large ostium and mucosal flap apposition. A larger, randomized prospective trial is needed to fully assess the efficacy of this new technique.
Adolescent↗
Lacrimal sac dacryoliths: predictive factors and clinical characteristics.
OBJECTIVE: Lacrimal sac dacryoliths are often diagnosed during dacryocystorhinostomy (DCR), although their cause is unclear. Several factors have been suggested to predispose to dacryolith formation. The clinical presentation of nasolacrimal duct obstruction (NLDO) may differ if associated with a dacryolith. Our study evaluated specific risk factors related to dacryolith formation and how the clinical presentation of patients with dacryoliths differs from patients with primary acquired NLDO who undergo DCR. DESIGN: Retrospective, comparative, interventional case series. PARTICIPANTS/INTERVENTION: One hundred thirty-eight consecutive patients with NLDO who underwent DCR (163 total DCR cases) between 1993 and 1998. MAIN OUTCOME MEASURES: We evaluated the frequency of dacryolith formation for all DCR cases. For 115 patients with primary acquired NLDO, we statistically compared the patients with dacryoliths (n = 12) to those without (n = 103) for several variables related to clinical history and presentation. RESULTS: The overall frequency of dacryoliths was 12 of 163 (7.4%) for all DCR cases and 12 of 138 (8.7%) for all patients. All patients with dacryoliths were in the subgroup of 115 patients with primary acquired NLDO, and the frequency in that subgroup was 12 of 115 (10.4%). There was no statistical difference between the group of patients with dacryoliths and those without dacryoliths for age, duration of epiphora, history of acute dacryocystitis, or previous use of antiglaucomatous topical medications. Male gender was more likely to be associated with dacryoliths (P = 0.004), as was initial presentation with lacrimal sac distension (P < 0.001). Partial nasolacrimal obstruction on lacrimal irrigation approached statistical significance for dacryolith formation (P = 0.08), as did a history of cigarette smoking (P = 0.09). CONCLUSIONS: In patients with primary acquired NLDO who require DCR, male gender and presence of sac distension are more frequently associated with dacryoliths. Partial NLDO and history of cigarette smoking may also be relative risk factors for dacryolith formation. These observations may be helpful in the evaluation and surgical planning for patients with lacrimal obstruction.
Dacryocystorhinostomy↗
Miscellaneous conditions of the equine head.
Nutritional secondary hyperparathyroidism is associated with horses that are fed diets with an imbalance of calcium and phosphorus or diets containing oxalates. Clinical signs include a shifting lameness, with tenderness of the joints, reluctance to move, or a stiff, stilted gait. Some horses may have broadening of the nasal bones, enlargement of the maxilla and/or the mandible, or a ridge over the nasal bones. Diagnosis may include physical examination findings; analysis of feed; and clinical pathologic data, which may include normocalcemia, normal to increased serum phosphorus, and increased fractional excretion of phosphorus (normal FxP < 0.5%). The primary objective of therapy is to correct the nutritional calcium to phosphorus imbalance. Sialoliths are calcific concretions that develop in the salivary gland or duct. Therapy generally involves surgical removal, and associated complications are uncommon. Obstruction of the nasolacrimal duct occurs most commonly secondary to intraluminal foreign material, although congenital atresia may occur. Clinical signs include epiphora, conjunctivitis, and mucopurulent discharge. Foreign material is often removed by retrograde saline flush and atresia is resolved by surgery.
Animals↗
The role of accompanying sinonasal abnormalities in the outcome of endonasal dacryocystorhinostomy.
BACKGROUND: Acquired nasolacrimal duct obstruction may occur simultaneously and possibly as a consequence of sinonasal disease, because the nasolacrimal system is anatomically related to important nasal and sinus structures. METHODS: Thirty-seven patients with nasolacrimal canal obstruction (42 eyes) were evaluated with paranasal sinus computerized tomography (CT) to determine the presence of sinonasal abnormalities if any. All of the patients underwent endoscopic dacryocystorhinostomy (end-DCR) and accompanying sinonasal pathology was treated also in the same session. RESULTS: Paranasal sinus CT examinations revealed one or more sinonasal abnormalities in 26 (73.3%) patients. The postoperative success rate of end-DCR procedure in patients with sinonasal abnormalities was 82.8%, whereas this figure increased to 92.3% in patients without additional sinonasal disease. However, additional rhinological surgery did not affect the success rate of end-DCR procedure significantly (p = 0.640). CONCLUSION: These data establish a positive correlation between sinonasal abnormalities and the presence of nasolacrimal outflow obstruction, but the additional rhinological surgery does not significantly affect the results of the end-DCR procedure.
Adolescent↗
[Treatment of therapy resistant congenital postsaccular lacrimal duct stenosis with the flexible indwelling catheter].
A flexible silicone-rubber suturamide retention tube, the procedure of intubation and special instruments for the repair of persistent congenital nasolacrimal duct obstructions are described. The results of the treatment of 8 infants are discussed. With the exception of one functional failure, the very good results are due to the histological compatibility and flexibility of the silicone-rubber suturamide tube and its careful introduction. This technique is not indicated if there are osseous anomalies of the nasolacrimal canal and a functionless ectatic tear sac. Then, and in the case of restenosis, an external dacryocystorhinostomy after Toti ought to be performed.
Catheters, Indwelling↗
[Falk's technic of extranasal dacryocystorhinostomy in cases of tear duct stenoses (author's transl)].
The lacrimal sac is totally sacrificed and rebuilt into an accessory nasal sinus using the extranasal dacryocystorhinostomy in the treatment of nasolacrimal duct stenosis as described by Falk in 1961. Using this method, 62 patients with tear duct stenoses were operated in our clinic since 1959. According to etiology, the stenoses were in 5 cases connatal, in 17 traumatic, in 32 inflammatory and in 8 iatrogenic. In only 4 cases (6,4%) failures were reported. - the operative indication has at present been expanded to include stenosis of the lower tear ducts (presaccal stenosis) or in cases where the lacrimal sac has been obliterated (saccal stenosis). In these cases the stenosis is dissected and a silicon tube (introduced via the tear point into the inferior lacrimal duct and drained into the nose) is left in position.
Age Factors↗