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PubMedDate not supplied

Evaluation of polyurethane nasolacrimal duct stents: in vivo studies in New Zealand rabbits.

The purpose of this study was to evaluate the radiographic and biological effects of different polyurethane nasolacrimal duct stents in an animal model. Fifteen polyurethane nasolacrimal duct stents (n = 5 mushroom-type stents, n = 5 newly designed S-shaped TearLeader stents without hydrophilic coating, and n = 5 S-shaped TearLeader stents with hydrophilic coating) were implanted in the nasolacrimal ducts of eight unaffected New Zealand rabbits. One nasolacrimal system served as control. Clinical and radiographic follow-up was performed at 1-, 2-, and 4-week intervals, then after a 3-month interval, after which the animals were euthanized. All stents were implanted without major periprocedural complications. The stents proved to be patent by the end of the procedure. During follow-up, all mushroom-type stents were occluded at 4 weeks. None of these stents opened to forced irrigation. Clinically, all rabbits demonstrated severe dacryocystitis. Three out of five TearLeader stents without hydrophilic coating were blocked at 4 weeks; one out of five was open to irrigation. Best results were observed in the stent group with hydrophilic coating. Follow-up dacryocystography demonstrated patent stents in nasolacrimal ducts of all animals after 4 weeks. In only one of five cases, the coated stent became partially occluded after 2 months. These animals were free of clinical symptoms. After 3 months, at least three out of five stents still opened to forced irrigation and only one stent was completely blocked. Dislocation of the stents was not observed. Refinement of the stent surface and stent design improves the results of nasolacrimal duct stenting in this animal model. Implantation of hydrophilic-coated S-shaped stents is highly superior to conventional mushroom-type stents and noncoated stent types. Hydrophilic coating seems to prevent foreign-body reactions, resulting in maximized stent patency.

Animals↗

PubMed1992

Clinicopathologic study of lacrimal sac and nasal mucosa in 44 patients with complete acquired nasolacrimal duct obstruction.

We studied 44 patients who had dacryocystorhinostomy for primary acquired complete nasolacrimal duct obstruction. The lacrimal sac and nasal mucosa adjacent to the osteotomy were examined histologically. The lacrimal sac had chronic inflammatory changes in 33 of 37 patients with varying degrees of fibrosis in 34 of 37. Focal ulceration of the lacrimal sac epithelium was present in 15 cases. Goblet cells, present in 11 specimens, were not identified in 26 specimens. Moderate or severe chronic inflammation was found in 14 of 44 nasal mucosal specimens and marked fibrosis in 22. The pathology of the lacrimal sac and nasal mucosa is similar to that of the nasolacrimal duct in complete nasolacrimal duct obstruction. The nasal inflammation may have resulted from dacryocystitis or alternatively contributed to the dacryocystitis.

Adolescent↗

PubMed1990

Postnatal transformation of the epithelium lining the nasolacrimal duct of the mouse.

The nasolacrimal duct of the newborn mouse was lined with the stratified cuboidal epithelium, while in the mouse after 15 days of age the epithelium was stratified squamous. Further, in the adult mouse the epithelium could not be classified definitely as typical stratified squamous epithelium, but was somewhat modified. It is suggested that the stratified cuboidal epithelium corresponds to the "intermediate epithelium (NAKANO 1986)", and transforms into the modified stratified squamous epithelium with passing through the typical stratified squamous epithelium.

Animals↗

PubMed2004

Comparison of monocanalicular stenting and balloon dacryoplasty in secondary treatment of congenital nasolacrimal duct obstruction after failed primary probing.

PURPOSE: To determine the success of monocanalicular stenting and balloon dacryoplasty as secondary treatment options for congenital nasolacrimal duct obstruction after failed probing surgery. METHODS: An interventional case series of consecutive secondary balloon dacryoplasty and monocanalicular stenting for congenital nasolacrimal duct obstruction was reviewed. These secondary treatments were used in cases in which a bicanalicular stent would have been used in the past. Seventy-seven nasolacrimal systems in children with epiphora after probing and irrigation surgery were treated with a monocanalicular stent or balloon dacryoplasty. The patients were then evaluated at least 3 months after surgery or after stent removal by using a dye disappearance test. Cases in which there was no significant dye at 5 minutes were considered a success. Cases with residual dye or history of persistent tearing were considered failures. RESULTS: The monocanalicular stent was used in 35 nasolacrimal systems, whereas balloon dacryoplasty was used in 42 nasolacrimal ducts. The mean age of treatment was 25.2 months for the monocanalicular stent group and 25.8 months for the balloon group. Overall, 32 of 35 (91%) nasolacrimal ducts responded to monocanalicular stenting, whereas 36 of 42 (86%) responded to balloon treatment. When the patient group was further stratified by age, the monocanalicular stenting was 94% successful in children younger than age 2 years and 89% successful for children older than 2 years. The balloon treatment had a success rate of 91% in the younger group and 79% in the older group. Chi-square statistical analysis showed no significant difference between the two treatments or on the basis of age stratification within each treatment group. CONCLUSIONS: Monocanalicular stenting and balloon dacryoplasty are excellent secondary therapies for congenital nasolacrimal duct obstruction after initial probing and irrigation surgery has failed. These two treatment options are now our procedures of choice for secondary surgery.

Catheterization↗

PubMed1994

Adult nasolacrimal duct obstruction.

Tear production resulting from obstruction of the nasolacrimal duct is a common ophthalmic problem. The diagnosis and treatment of this condition require a thorough understanding of the lacrimal apparatus and its ocular and nasal relationships. Idiopathic or primary acquired nasolacrimal duct obstruction is a syndrome of unknown etiology. Of all nontraumatic forms, it accounts for the vast majority of cases found in adults. The authors discuss a number of potential causes, some of them iatrogenic and discuss the technique of dacryocystorhinostomy, the standard surgical treatment, in detail.

Adult↗

PubMedDate not supplied

Congenital nasolacrimal duct obstruction: therapeutic management.

PURPOSE: Congenital nasolacrimal duct obstruction is a common condition, and its diagnosis must be based more on regular in-time epiphora than mattering. The purpose of this study is to better define the diagnostic criteria and therapeutic strategy. METHODS: We have retrospectively evaluated 1563 subjects treated from 1990-1997 at the Pediatric Ophthalmological Service of Modena University Eye Clinic. The mean age at first examination was 5.7 months. According to symptoms and age, patients were treated with antibiotic therapy, office probing, or general anesthesia probing. Recovery was confirmed only after a 3-month symptom-free period. RESULTS: More than 29% of patients recovered spontaneously or with topical antibiotic therapy. Office probing reduced the number of patients who needed a general anesthesia probing (from 62.97% from 1990-1993 to 33.61% from 1994-1997). In the period from 1994-1997, we changed the technique and especially the age of patients, obtaining a clearing of the obstruction in about 86% of cases compared with a 39% rate in the earlier period. Since 1994, in cases of general anesthesia probing, we have used a midazolam and ketamine anesthesiologic technique that has reduced risks and increased parental satisfaction and cost-effectiveness. Also, our data show that age at first attempt highly influenced probing failure rate. CONCLUSION: If the first ophthalmologic examination is precocious and correctly timed, the possibility of curing the patient using the simplest method is increased. Better results can be obtained with cooperation among pediatricians, ophthalmologists, and anesthesiologists.

Anesthesia, Local↗

PubMed1989

[The inheritance of congenital nasolacrimal duct stenosis].

The incidence of congenital nasolacrimal duct stenosis in 587 neonates surveyed was found to be 0.17%, while a familial investigation of 100 consecutive patients revealed the incidence of the first, second and third degree relatives were respectively 2.32%, 0.95%, and 0.45%; the obvious differences of incidence (P less than 0.05) indicated an apparent genetic involvement. 86 of the 100 patients were sporadic, and the pedigree study of 14 patients with positive family history did not produce sufficient evidence of autosomal dominant, recessive, or sex-linked inheritance. In conclusion, the mode of inheritance of the disease was thought to be multigenic and the inheritability calculated to be 58%.

Female↗

PubMed1983

A useful alternative to silicone intubation in congenital nasolacrimal duct obstructions.

Initial treatment of congenital nasolacrimal duct obstructions, by a variety of methods, is highly successful. However, a small percentage of obstructions either are not cleared or recur. Silicone intubation has been reported highly successful in treatment of these obstructions. This paper describes our experience with infracturing the inferior turbinate (described originally by Jones and Wobig) as being at least as highly successful, safe, and easy to perform.

Child, Preschool↗

PubMedDate not supplied

Congenital nasolacrimal duct obstruction in Kayseri, Turkey.

Congenital nasolacrimal duct obstruction was diagnosed in 170 patients between 1982 and 1991 in Kayseri, Turkey, and 111 patients were treated with massage plus topical antibiotics (MBC), pressure irrigation (PI), probing (PRB) or infracturing of the inferior turbinate (INF). The ages of the patients ranged from one week to 15 years. The obstruction was bilateral in 38 patients. Among the 149 obstructed lacrimal drainage systems of 111 patients, 101 were cleared by MBC (67.8%), 30 by PI (20.1%), eight by PRB (5.3%) and two by INF (1.3%). Eight cases were unsuccessful (5.3%), and the overall success rate was 94.6%. The efficacy of four interventions was correlated to the patients' ages and to the presenting pathology. MBC carried out at the serofibrinous stage and at 7-13 months was more effective than other interventions, with a statistical significance (p < 0.01). The effectiveness of four interventions is discussed, with an emphasis on the importance of early MBC. The importance of fluoroscopy during PI or PRB is also emphasized.

Adolescent↗

PubMed2002

[A new probe for congenital nasolacrimal duct obstruction].

OBJECTIVE: To investigate the therapeutic effect of a new probe for congenital nasolacrimal duct obstruction. METHODS: The probe was designed and manufactured by ourselves. We observed 158 cases (172 eyes) with congenital nasolacrimal duct obstruction and treated them with the probe 1-3 times. RESULTS: The mean period of postoperative follow-up was 17.8 (range 12-24 months) months. The success rate was 98.2%. Common complications included a slight blood-stained nasal discharge. CONCLUSION: Our newly designed and manufactured probe provides a new probe for congenital nasolacrimal duct obstruction. The probe is a safe, simple and effective treatment method for congenital nasolacrimal duct obstruction.

Adolescent↗

PubMed2000

Congenital nasolacrimal duct obstruction: irrigation or probing?

The authors investigated the efficacy of antibiotic irrigation as the therapeutic option in congenital nasolacrimal duct obstruction. We retrospectively reviewed the medical record of 76 patients' eyes in whom congenital nasolacrimal duct obstruction had been diagnosed. In 50 of these patients, the colonizing microorganism was identified and, irrigation through canaliculi was performed using antibiotics of suitable sensitivity. Nasolacrimal system probing was performed on 26 patients as the control group. Treatment was regarded successful when over a 4 week period epiphora or mucous discharge disappeared and when saline passed without resistance on irrigation. 96.0% of patients in the irrigation group and 84.6% of patients in probing group were treated successfully. There was no statistical difference in the success rate between the two groups (P = 0.173). The recovery period based on culture results was 3.22 +/- 0.37 months in the group in which microorganisms were isolated and 2.39 +/- 0.35 months in the group in which no organisms were isolated. There were no statistically significant differences in the success rates between the group in which there was growth and the group in which there was no growth (P = 0.1308). Thus a similar result was obtained using nasolacrimal probing and canaliculus antibiotic irrigation in congenital nasolacrimal duct obstruction. Antibiotic irrigation is a safe and simple therapeutic option in congenital nasolacrimal duct obstruction.

Anti-Bacterial Agents↗

PubMed2002

Dilation probing as primary treatment for congenital nasolacrimal duct obstruction.

PURPOSE: Recent studies have suggested that simple nasolacrimal duct (NLD) probing can be an effective primary surgery for congenital NLD obstruction regardless of age. The success of balloon dilation after failed NLD probing suggests that maximally enlarging the passage through the NLD system may enhance the success of simple NLD probing. This study used sequential probing with modified, taper-tip probes to evaluate whether maximally enlarging the nasolacrimal duct can effectively treat congenital NLD obstructions in all age groups. METHODS: Under general anesthesia, each obstructed NLD system was sequentially probed with larger diameter NLD probes until firm resistance prevented the passage of any larger probe size. Successful treatment was defined as a negative dye-disappearance test 2 weeks after probing and the absence of tearing symptoms at last contact. RESULTS: A retrospective chart review identified 40 patients ages 6 to 32 months (average, 17.7 months) who underwent the sequential probing procedure. Sequential NLD probing was successful in 66 (92%) of 72 eyes. Of the failures, both eyes in a 15-month-old patient with Down's syndrome had tight, anomalous NLD systems. In the remaining 4 eyes, 2 had resolution of symptoms but partially positive dye-disappearance tests, and 2 underwent successful repeat sequential NLD probing. Subdividing by age, 27 (100%) of 27 obstructed NLD systems were treated successfully in patients older than 18 months compared with 39 (87%) of 45 in younger patients. CONCLUSIONS: Sequential NLD probing to maximally enlarge the NLD system has a high rate of success in all children. Age does not appear to have an impact on success of probing.

Child, Preschool↗

PubMed1998

Identification of the lower end of the nasolacrimal duct with a fibre-optic light 'pipe'.

PURPOSE: To report a method of identifying the lower end of the nasolacrimal duct when more usual methods have failed. METHODS: A vitreoretinal fibre-optic light pipe was used to identify the lower end of the nasolacrimal duct in a child with unusual congenital nasolacrimal duct obstruction. RESULTS: This intraluminal light source enabled easy cut down onto the 'blind' end of the lacrimal drainage apparatus and subsequent intubation with silicone tubing to overcome the obstruction. CONCLUSION: This technique may prove useful in the rare cases in which it is not possible to identify the lower end of the nasolacrimal duct with a probe and nasal endoscope alone.

Dacryocystorhinostomy↗

PubMed1996

Simultaneous silicone intubation through the osteotomy and the nasolacrimal duct during dacryocystorhinostomy.

PURPOSE: To determine whether simultaneous silicone intubation of the osteotomy and the nasolacrimal duct is advantageous in some dacryocystorhinostomy procedures. METHODS: Silicone tubing was placed through both the osteotomy and the nasolacrimal duct in two patients who underwent dacryocystorhinostomy for dacryolithiasis. RESULTS: Postoperatively, signs and symptoms of nasolacrimal obstruction were relieved, and lacrimal irrigation confirmed anatomic patency of the tear drainage canals in both cases. CONCLUSIONS: Simultaneous intubation of the osteotomy and the nasolacrimal duct prevents prolapse of the silicone stent and may decrease the frequency of postoperative scarring.

Dacryocystorhinostomy↗

PubMedDate not supplied

Nasolacrimal duct foreign body--endoscopic removal.

Foreign body in the nasolacrimal duct is extremely rare. We present a case of foreign body of nasolacrimal duct responsible for recurrent dacryocystitis which was removed with the help of an endoscope.

Adolescent↗

PubMed2004

Double silicone intubation as treatment for persistent congenital nasolacrimal duct obstruction.

PURPOSE: The great majority of children with nasolacrimal duct (NLD) obstruction are successfully treated with probing or conventional silicone tube intubation. A small percentage of patients fail to have their NLD obstruction resolved with these procedures and require dacryocystorhinostomy (DCR). This study was conducted to assess the effectiveness of double bicanalicular silicone intubation with placement of two loops of silicone tubing through the NLD for treatment of persistent NLD obstruction in children as an alternative to DCR. METHODS: Ten eyes of 9 patients with nasolacrimal duct obstruction who had failed conventional therapies and were to otherwise undergo DCR were instead treated with double bicanalicular silicone tube intubation. Resolution of preoperative symptoms and signs of NLD obstruction were assessed. RESULTS: At an average follow-up of 40 +/- 5.6 months, all patients had improvement in symptoms and signs. The mean patient age was 31 +/- 3.2 months. The average duration of intubation was 15 +/- 0.73 months. Eight of 10 eyes had complete resolution of NLD obstruction symptoms. Two of 10 treated eyes had occasional symptoms of mattering with upper respiratory infection and exposure to wind or cold but required no further treatment. Nine of 10 eyes were treated for congenital NLD obstruction. The remaining patient had failed conventional bicanalicular intubation after repair of a traumatic common canalicular avulsion. CONCLUSIONS: Double bicanalicular silicone tube intubation is an effective alternative to DCR in selected children who have failed conventional therapies for NLD obstruction. This treatment obviated DCR in all patients in this study.

Biocompatible Materials↗

PubMed1999

Nasolacrimal duct obstruction and orbital cellulitis associated with chronic intranasal cocaine abuse.

OBJECTIVE: To report the association of acquired nasolacrimal duct obstruction and orbital cellulitis in patients with a history of chronic intranasal cocaine abuse. METHODS: Retrospective, consecutive case series. Results of imaging, histopathologic examinations, and clinical courses of these patients were studied. RESULTS: Five women and 2 men (mean age, 41 years) with a history of chronic intranasal cocaine abuse (mean, 11 years; range, 5-20 years) presented with epiphora and in some cases acute onset of periorbital pain, edema, and erythema associated with fever. The suspicion of intranasal cocaine abuse was made on anterior rhinoscopy with the detection of an absent nasal septum and inferior turbinate. Computed tomographic and magnetic resonance imaging findings in 4 patients included extensive bony destruction of the normal orbital wall architecture, opacification of the sinuses, and the presence of an intraorbital tissue mass. Histopathologic examination of the nasolacrimal duct in 2 patients and of the orbital mass in a third patient revealed marked chronic inflammation with fibrosis causing secondary nasolacrimal duct obstruction. Six patients were treated with systemic antibiotics followed by dacryocystorhinostomy in 3 patients, and a pericranial flap to insulate the exposed orbit in 1 patient. CONCLUSIONS: Chronic intranasal cocaine abuse can result in extensive bony destruction of the orbital walls with associated orbital cellulitis, and should be included in the differential diagnosis of acquired nasolacrimal duct obstruction. Anterior rhinoscopy is very helpful in establishing the correct diagnosis in these patients.

Administration, Intranasal↗

PubMed1988

Histopathology of nasolacrimal duct obstruction compatible with localized sarcoidosis.

We report a case of nasolacrimal duct obstruction with histopathology compatible with localized sarcoidosis, in a patient with no evidence of systemic disease. Excisional biopsy of the nasolacrimal duct revealed multiple noncaseating granulomas. Previously reported cases of sarcoidosis involving the lacrimal drainage system all had systemic disease, and these case are reviewed. Our case illustrates the potential value of nasolacrimal duct biopsy during dacryocystorhinostomy.

Dacryocystorhinostomy↗