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PubMed1995

Measurement of the resistance to fluid flow within the lacrimal outflow system.

BACKGROUND: Although the presence of complete obstruction within the human lacrimal drainage system can be easily determined with diagnostic techniques currently available, it is not possible to quantitate degrees of partial obstruction. The authors have developed a new instrument that directly measures pressures associated with fluid flow, allowing the calculation (pressure : flow) of resistance within the tear drainage system. The authors believe that the ability to measure the degree of partial lacrimal stenosis quantitatively will be clinically useful, allowing the diagnosis of lacrimal disease before complete obstruction. Of course, it is first necessary to establish normal values, which was the goal of the study. METHODS: A constant flow rate of distilled water was irrigated into the lacrimal system through the lower canaliculus, and pressure was measured continuously. Resistance then was calculated as the differential of pressure to flow rate (pressure : flow). In the first stage of a two-part study the authors determined the resistance to fluid flow in 43 tear ducts of 24 healthy patients. In this group, the resistance within the entire lacrimal system was obtained. In the second stage of this study, the authors measured the resistance in 28 tear ducts of 26 patients after successful lacrimal bypass surgery (dacryocystorhinostomy). Because dacryocystorhinostomy byasses the lower drainage system (sac and nasolacrimal duct), the resistance measured in this group of patients was determined only by the upper (canalicular) system. RESULTS: The mean resistance within the normal lacrimal system is 49.5 +/- 17.0 mmHg.seconds/ml. Just more than half of the resistance, 26.8 +/- 13.1 mmHg.seconds/ ml (54%), comes from the canaliculi, leaving 22.7 mmHg.seconds/ml (46%) attributable to the lower system. The authors comment on comparisons between these values and theoretical values calculated using information on average dimensions obtained from casts of the lacrimal drainage system. CONCLUSION: The authors have developed a new instrument to measure the resistance to fluid flow within the human lacrimal outflow system, and resistance values in control subjects have been documented.

Adult↗

PubMed2005

[Congenital lacrimal obstruction: outcome and factors associated with therapeutic probing].

PURPOSE: To determine the success rate of probing for congenital nasolacrimal duct obstruction and the factors related to probe failure. METHOD: A retrospective observational study was conducted, involving 80 children with congenital nasolacrimal obstruction who underwent nasolacrimal probing. The subjects were evaluated according to sex, age and probing outcome. The data were evaluated according to the descriptive method, Goodman test and Mann-Whitney test adopting a significance of 5%. RESULTS: The possibility of cure was the same in both sexes. The mean age at cure was 19.95+/-11.44 months and on failure was 23.67+/-15.21 months. The analysis showed no significant change in cure rate when over 6 months old. Nasal alterations such as rhinitis, mucosal or turbinate bone hypertrophy, septum deviation and sinusitis were associated with probe failure. CONCLUSION: The cure rate does not vary significantly at intervals of increasing ages even it over 12 months old. Nasal alterations might be included in the causes of failure.

Age Factors↗

PubMed2001

The pathogenesis and treatment of lacrimal obstruction: The value of lacrimal sac and bone analysis.

INTRODUCTION. The cause of primary acquired nasolacrimal duct obstruction (NLDO) has not been fully elucidated. In an attempt to determine the role of an inflammatory etiology, the pathology of nasolacrimal sac and bone specimens was assessed and correlated with clinical lacrimal variables. MATERIALS AND METHODS. Lacrimal sac and bone tissues from patients with known NLDO were sampled at the time of external dacryocystorhinostomy (DCR). Histopathological analysis was carried out to determine the presence and degree of inflammatory changes present in the tissues, and to correlate them with the clinical presentation. RESULTS. Of 104 cases analyzed, bony inflammatory changes were seen in 14% and lacrimal sac inflammatory changes in 94%. All cases of bony inflammation had accompanying lacrimal sac inflammation. The inflammatory changes were independent of the following variables: gender, duration of symptoms, a history of dacryocystitis, the presence of a lacrimal sac mucocele, the location of obstruction, and the presence of lacrimal sac calculi. CONCLUSIONS. Inflammatory changes are almost invariably present in all patients with NLDO. Its occurrence in bone is probably secondary to lacrimal sac inflammation. Although attempts are made to perform DCR surgery only in the absence of lacrimal sac inflammation, almost all cases exhibit subclinical inflammation. This may suggest that bypassing this 'critical area' of the sac-duct junction, as in a dacryocystorhinostomy, would be more reasonable than to re-canalize through an inflammatory obstruction.

Journal Article↗

PubMed1999

High-resolution conjunctival contrast-enhanced MRI dacryocystography.

We assessed high-resolution MRI of the lacrimal system with conjunctival contrast enhancement in patients with suspected stenosis. We studied 18 patients with epiphora affecting 22 eyes, using a surface coil, before and after conjunctival and intravenous Gd-DTPA. Stenosis or obstruction of the ducts was found in 18 of 22 cases: at canalicular level in 3 cases, at the sac in 7 cases, and in the nasolacrimal duct in 8 cases. Periductal pathology following surgery to the maxillary sinus or dacryocystorhinostomy was seen in three cases. In conjunction with the findings on syringing and/or conventional dacryocystography, the narrowing was classified as stenosis or obstruction.

Adult↗

PubMed1988

Nasolacrimal evaluation and surgery.

The lacrimal drainage system is a very important functional and anatomic assembly in the orbit and midface. For surgeons who intend to become involved in its repair or reconstruction, it is mandatory to understand the full range of anatomic, physiologic, and diagnostic considerations prior to embarking upon a surgical course. Proper eyelid function depends upon the integrity of its constituent parts, including the margin, tarsus, muscle, and globe apposition. The lacrimal pump mechanism is produced by proper eyelid function and structure, and must be adequately assessed. The puncta and canaliculi are delicate structures and must be manipulated with care and gentleness. The lacrimal sac is a static structure that serves as a collecting sphere but also may be forced to evacuate its contents into the nasolacrimal duct by the "squeezing" action of the investing tendons. Proper tendon position must be maintained after surgery or trauma to facilitate this action. The nasolacrimal sac may be damaged after facial fractures or blocked from intranasal conditions. If the blockage cannot be relieved, it must be bypassed by performing a dacryocystorhinostomy. The use of long-term, indwelling silicone intubation catheters greatly facilitates the successful reconstruction of the lacrimal drainage system. Proper attention to all of these points will be appreciated by the patient.

Dacryocystitis↗

PubMed1996

Quantitative histomorphology of the blind mole rat harderian gland.

Anatomical, histological and morphometric studies have been performed on the harderian gland and its surroundings in the blind mole rat (Spalax ehrenbergi). The gland is tubuloalveolar with no true duct system. All ducts within the gland are formed by a single epithelial cell type and drain into a wide secretory duct. This opens into the conjunctival sac which serves as a reservoir for harderian secretions. Drainage from the conjunctival sac follows 2 possible routes: one through the nasolacrimal duct to the external nasal cavity, the other through a unique excretory duct that emerges from the anteromedial part of the conjunctival sac and runs through the dermis to the skin, opening at the base of a hair follicle. The function of this newly described duct is discussed. Morphometric studies revealed that the lumen volume fraction in the female, slightly smaller than that of the male during the summer, becomes significantly greater during the winter breeding season. The dimorphism and seasonal variations found in the gland acini suggests that the gland may be implicated in pheromone production.

Animals↗

PubMed1988

Silicone intubation for the treatment of congenital lacrimal duct obstruction: successful results removing the tubes after six weeks.

There is little agreement in the ophthalmic literature on the optimum length of time that silicone tubes should be left in place after lacrimal intubation for the treatment of congenital nasolacrimal duct obstruction. Various authors have recommended leaving the tubes in for 3 to 6 months. The authors of this article believe this to be an excessive amount of time. Lacrimal probing, inferior turbinate fracture, and silicone intubation were performed in children ranging in age from 3 months to 5 years. The tubes were removed after 6 weeks in all cases. Resolution of epiphora and dacryocystitis was achieved in all cases. Follow-up ranged from 4 to 81 months. The authors recommend that the silicone tubes be removed after 6 weeks. They also believe that fracture of the inferior turbinate should be performed along with silicone intubation.

Child, Preschool↗

PubMed2002

[CT dacryography without selective lacrimal duct catheterization: review of 39 patients].

OBJECTIVES: Dacryographies and CT dacryographies are usually performed after catheterization of a lacrimal canaliculus. We evaluated the quality of opacification on CT scan after simple instillation of contrast medium, without any catheterization. PATIENTS AND METHODS: 39 patients (78 nasolacrimal ducts) were examined for lacrimal pathways obstruction by CT scan after instillation of diluted contrast medium. Additional CT scan imaging was performed after catheterization when the first study did not provide adequate opacification. RESULTS: CT dacryography after instillation is a well tolerated technique. In our study, it allowed detection of all pathologic lacrimal ducts; 7 normal lacrimal pathways (after catheterization) were not opacified after instillation (false positives). The sensitivity of the method was 100%, its specificity 84%. CONCLUSION: CT dacryography after instillation is a physiologic, simple and sensitive method to evaluate lacrimal obstruction. We propose it as a first step, catheterization being used only in the absence of opacification after instillation.

Adolescent↗

PubMed1997

[Cannulation of congenital lacrimal duct obstruction].

During the development of a Czechoslovak silicone cannula for reconstructive surgery of the lacrimal passage-ways was elaborated the modification for the congenital obstruction. The surgical method imoles the probing and cannulation at the same time. probe with fixed cannula passed delicately through nasolacrimal duct via the upper or lower canaliculus to saccus lacrimalis. This probe overcomes the lateral part of the nose on the inspection of otorhinolaryngologist. The end of cannula was fixed by the stitch to skin near lacrimal punctum. The silicone tubing is left in situ for about three months.

Humans↗

PubMed1993

[Cysts of the lacrimal tracts in the newborn infant].

At birth, a thin membrane often remains at the distal end of the nasolacrimal duct in the inferior meatus. The rupture is spontaneous during the first month of life. Sometimes this impatency can lead to a symptomatology usually limited to an uni or bilateral dacryocystitis. Exceptionally a cyst can develop in the nasolacrimal passageways. The authors describe three cases of intranasal occurrences, two of which brought about an obstructive dyspnea. Twelve cases have been described in the literature. This affliction predominantly occurs in young girls. Whenever the nasal obstruction is isolated, it is important to eliminate any other cause of intranasal tumor, especially an encephalocele, before any surgical intervention. Computerized tomographic scan is indispensable in order to eliminate any connection with the intracranial space. Magnetic resonance imaging appears promising. For the authors, the treatment must be surgical and must be kept simple. It consists in a cyst excision.

Cysts↗

PubMed2000

Ocular features in Rubinstein-Taybi syndrome: investigation of 24 patients and review of the literature.

AIMS: To delineate the nature and frequency of ocular pathology in Rubinstein-Taybi syndrome (RTs). METHODS: Literature was searched for reports describing ocular symptoms in patients with RTs. 24 RTs patients (out of a total of 73 Dutch known RTs individuals) were selected for ophthalmological and electrophysiological examination, selection being based only on the distance between a patient's residence and the place of investigation. RESULTS: Most frequently reported eye anomalies in the literature were lacrimal duct obstruction, corneal abnormalities, congenital glaucoma, congenital cataract, and colobomata. Abnormalities of almost any eye segment have been published in case reports. Ophthalmological examination of 24 Dutch RTs patients showed a visual acuity </=0.3 in five patients. The most frequently found eye anomalies were nasolacrimal duct problems (six patients), cataract (six patients, four congenital), and retinal abnormalities (18 patients). VEPs showed an abnormal waveform in 15 patients. It was possible to perform an ERG in 18 patients, of whom 14 were abnormal (eight showed cone dysfunction, six cone-rod dysfunction). CONCLUSIONS: Ocular abnormalities occur in the majority of RTs patients and can be remarkably diverse. The high frequency of retinal dysfunction (78%) has not been described before. With age, retinal as well as electrophysiological abnormalities occur more frequently. In four patients no signs of retinal dysfunction were observed, indicating phenotypic heterogeneity. Further cytogenetic and molecular examination of the patients is needed before it becomes clear if this also represents genetic heterogeneity. Because of the high frequency of ocular abnormalities, visual function tests and electrophysiological investigations should be performed in every RTs patient at regular intervals.

Adult↗

PubMed2002

[Estimation dacryocystorhinostomy with temporary intubation of lacrimal canaliculi].

UNLABELLED: The purpose of the study was to present the results of treatment of lacrimal ducts obstruction. The authors describe the advantages of temporary intubation of lacrimal canaliculi with simultaneous dacryocystorhinostomy. The findings have been based on 38 operations within a sixteen-year period. Obstruction of the lacrimal drainage pathway was due to: trauma, postinflammatory stenosis of the nasolacrimal duct, tumors and jatrogenic injuries of the naso-lacrimal drainage system often following operations of the maxillary sinus. Treatment was based on clinical examination by: slit lamp exam, probing and irrigation of the lacrimal system, X-ray picture of the maxillary sinus, laryngology examination and bacteriological culture from conjunctival sac. CONCLUSION: Anatomical and functional results indicate the necessity of this surgery method in selected cases.

Adolescent↗

PubMedDate not supplied

Endoscopic dacryocystrhinostomy.

UNLABELLED: Endonasal endoscopic dacryocystorhinostomy (EN-DCR) is now a well-established procedure to relieve nasolacrimal duct obstruction, becoming its domain for the ENT surgeons indispensable. AIM: The aim of the present study is to report the experience of the Otorhinolaryngology Department of the University of São Paulo Medical School in the management of the obstruction of the drainage of the nasolacrimal system by EN-DCR, comparing with the results in literature. STUDY DESIGN: clinical retrospective. MATERIAL AND METHOD: We reviewed the medical records of 17 patients (17 eyes) that were submitted to EN-DCR between april 2001 and july 2004. We analysed: sex, age at the time of diagnosis, etiology, clinical findings, surgical technique, use of silicone tubes, follow-up and complications. RESULTS: Eight men and nine women, the age range was from 29 to 79 years (mean 42.6413.1 years), mean follow-up time: 15 months, presented a lacrimal clinic with epiphora. Powered DCR was performed in 06 cases and YAG LASER in 01 patient. Silicone tubes were used in all cases and left in place mean 7.9 weeks. The surgical success rate was 82,3%. CONCLUSION: EN-DCR showed one safe technique, with advantages in relation to the external technique. So ophthalmologists and ENT physicians must work in harmony to offer more benefits to its patients.

Adult↗

PubMed1982

[Endoscopy of the nose as an aid in lacrimal duct surgery].

Endoscopy of the nose is a recently-adopted supplementary procedure for examining the tear drainage system. This examination is performed under local anesthesia with the patient on the operating table. We use a Hopkins endoscope with 30 degrees and 70 degrees deflections, diameter 2.7 mm and 4 mm. Endoscopy prior to dacryocystorhinostomy enables the examiner to judge whether the nasal cavity is large enough for an osteotomy. The orifice of the nasolacrimal duct is visible directly through the endoscope, so that the dye test can be rendered fairly objective. Endoscopy also enables the course of healing of the nasal ostium after surgery to be studied. We observed complications, such as granular tissue and synechiae developing between the posterior flap of the nasal mucosa, the middle turbinate and the nasal septum. Granulation tissue may be removed under endoscopic control. If an intubation of the lacrimal system is attempted, it may be easier to find the end of the steel probe exiting into the nose under endoscopic observation. If the inferior turbinate is impacted with the nasal floor, it may be impossible to find the probe under the inferior turbinate without endoscopic control. Finally, during lacrimal duct probing in infants, one can check whether the probe is correctly sited. Perforations created by probing can be recognized and avoided.

Dacryocystorhinostomy↗

PubMed2004

Carbonic anhydrase VI in the mouse nasal gland.

Western blotting analysis of mouse nasal tissue using a specific anti-mouse secreted carbonic anhydrase (CA VI) antibody has shown that CA VI is present in this tissue. A single immunoreactive band of 42 kD was observed, as has been found previously for salivary tissues. RT-PCR analysis has shown that nasal mucosa expressed CA VI mRNA. By immunohistochemistry (IHC), CA VI was observed in acinar cells, in duct contents of the anterior gland of the nasal septum, and in the lateral nasal gland. The Bowman's gland, the posterior gland of the nasal septum, and the maxillary sinus gland were negative. Immunoreactivity was also observed in the mucus covering the respiratory and olfactory mucosa and in the lumen of the nasolacrimal duct. In contrast, an anti-rat CA II antibody (that crossreacts with the mouse enzyme) stained only known CA II-positive cells and an occasional olfactory receptor neuron. These results indicate that CA VI is produced by the nasal gland and is secreted over the nasal mucosa. By reversible hydration of CO(2), CA VI is presumed to play a role in mucosal functions such as CO(2) sensation and acid-base balance. It may also play a role in olfactory function as a growth factor in maturation of the olfactory epithelial cells.

Animals↗

PubMed2006

Eosinophilic angiocentric fibrosis: an unusual entity producing complete lacrimal duct obstruction.

Eosinophilic angiocentric fibrosis is an unusual fibrotic condition of unknown aetiology that tends to affect the upper respiratory tract. Twenty-one cases have been reported in the literature and only three have had ocular adnexal involvement. Despite characteristic histopathological and clinical findings, the diagnosis remains a challenge. Furthermore, its progressive nature with potential to invade adjacent structures and the lack of response to current treatment modalities make management difficult. We describe a case of sinonasal eosinophilic angiocentric fibrosis that presented with bilateral nasolacrimal duct obstruction.

Adult↗

PubMed2000

[Endoscopically controlled surgery with the micro-drill and intubation of the lacrimal ducts].

PURPOSE: Operative procedures to manage lacrimal outflow obstruction were made traditionally without endoscopic assistance. For dacryoendoscopy we previously used a 0.5-mm endoscope with a special wash cannula. We now use the microendoscope Vitroptic T for dacryoendoscopy and for endoscopically controlled surgery with a microdrill. METHODS: In an attempt to perform microinvasive lacrimal surgery we use a 1.1-mm endoscope (Vitroptik T) with a wash cannula, a channel for the microoptic and a channel for a microdrill. We report on our initial experiences and on the results of eight patients with stenosis of the lacrimal outflow system who were treated with an endoscopic microdrill and silicone tubing. One patient had lacrimal stenosis after external dacryocystorhinostomy (DCR), and seven patients showed punctual stenosis in the nasolacrimal duct. RESULTS: Using the dacryoendoscope (Vitroptic T) we were able to visualize pathologic changes of the lacrimal outflow system. Intraoperative situations during dacryoendoscopy are demonstrated. The Vitroptic T allows dacryoendoscopy and endoscopically controlled surgery of the lacrimal drainage system. Three months after surgery in six patients (75%) the lacrimal outflow system was patent with the silicone tube in place, and these patients had no epiphora. The patient with re-stenosis after external DCR showed patency. CONCLUSIONS: Dacryoendoscopy and endoscopic controlled surgery of the lacrimal drainage system enables atraumatic and minimally invasive surgery. The Vitroptik T with the microdrill allows endoscopically controlled microsurgery. Possible indications for the microdrill are punctual stenosis and re-stenosis after external DCR.

Dacryocystorhinostomy↗

PubMed1999

Endoscopy of the lacrimal system.

BACKGROUND/AIM: Until recently, diagnosis of disorders of the lacrimal system has depended on digital dacryocystography and on clinical examinations such as the fluorescein dye test, lacrimal probing, and irrigation. The lacrimal system and its mucous membranes can now 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. METHODS: 132 patients ranging in age from 8 months to 73 years with nasolacrimal obstruction were referred to the lacrimal department. Diagnostic lacrimal imaging utilising various small calibre endoscopes less than 0.5 mm in external diameter was performed. The endoscopes are coupled to specially designed lacrimal probes as well as a CCD camera and a video recorder. The imaging was performed during standard lacrimal probing and irrigation in an outpatient clinic setting in 120 of 132 patients RESULTS: All patients reported the pain of endoscopy as being similar to that of standard lacrimal probing and irrigation. No adverse effects such as bleeding or lacrimal perforation were noted. Endoscopic manipulation was not too difficult and the picture quality, depth of focus, and illumination were satisfactory in all cases. The most common site of stenosis was the nasolacrimal duct (59 patients), followed by the lacrimal sac (39 patients) and the canaliculi (34 patients). In 25 patients, partial obstruction, rather than complete stenosis, was visualised as a narrow lumen, which widened during irrigation. In 14 of 28 patients, obstruction was due to canalicular submucosal folds and was removed with laser. In addition, the colour and consistency of the lining mucosa correlated with type of obstruction. Normal mucosa is smooth and light pink in colour. Inflammatory changes manifest as thickened and reddish grey mucosa. More complete stenosis is shown as fibrotic plaques with grey white inelastic membranes. CONCLUSION: Lacrimal endoscopy is a new, non-invasive method used to view directly and localise obstructions precisely. It allows differentiation between inflammatory, partial, and complete stenosis. Endoscopy enables one to choose the appropriate surgical therapy for patients. Patients tolerated the procedure well without any adverse reactions or effects. While it may not replace standard probing and irrigation, this technique is an extremely useful adjunct in determining the proper surgical modality, ease, and tolerance of the endoscopic manipulation by patients, and obtaining sharp and clear images of the nasolacrimal outflow system anatomy and pathology. Differentiation of various types of obstruction by precise location and severity can be achieved.

Adolescent↗