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PubMed1991

Use of ultrasound diagnostics in lacrimal sac diseases.

Ultrasonographic examinations of the lacrimal drainage system demonstrated that the Ultrascan System IV apparatus used was not able to represent the normal-size lacrimal canaliculi, the common canaliculus, the lower part of the nasolacrimal duct and the lacrimal ostium. It can be used routinely, however, in the diagnostics of diseases of the lacrimal sac and its surrounding tissue, for surgical indication and in order to examine the postoperative condition, in most cases without other expensive diagnostic methods. The advantages over dacryocystography are that it is simple, quick, and inexpensive, it can be used post-operatively immediately, the patient is not exposed to radiation, it can be used without any contrast medium, and it is useful when the common canaliculus is occluded.

Humans↗
PubMed1986

The postsaccal, idiopathic dacryostenosis--experimental and clinical aspects.

The 'idiopathic' dacryostenosis has not yet been cleared up in its aetiological aspects. For further explanation of aetiology and pathomechanisms an experimental, anatomical study was made. Its object was to define the angles and measurements within the bony lacrimal structures and to establish possible connections between the development of the postsaccal stenosis and certain bony constellations of the lacrimal system. The main goal of these examinations was to determine the angle between the lacrimal fossa and the main direction of the nasolacrimal canal, as well as the angles which are found in the course of the nasolacrimal canal. Macerated half skulls obtained from anatomical dissection courses were used for this study. After cleaning the bony lacrimal passages, the distal orifice of the nasolacrimal canal was closed with bone wax. The canal and the lacrimal fossa were filled with epoxy resin. After hardening the preparations were radiographed in order to make sure that the whole system was completely filled with resin. Then the surrounding bone was removed chemically and the resin casts were laid free. They were photographed and the photographs were traced and measured. A trigonometric method was then used for constructing the maximum angle between the lacrimal fossa and nasolacrimal canal. This angle was mainly directed dorsomedially and showed a considerable amount of variation. A bony system with a large angle increases the possibility of acquiring a postsaccal dacryostenosis. The bony angle is one of many factors facilitating an ascending inflammation in the lacrimal mucosa. Clinically we have to differentiate the acute, fresh dacryocystitis from the chronic, recurrent dacryocystitis. The main symptoms are epiphora, pain and inflammation in the medial canthal area and headache. The most important diagnostic examinations are the slitlamp examination of the eyelids, of the lacrimal puncta and of the anterior segment of the globe, the 'lacrimal punctum excursion test', the diagnostic rinse of the lacrimal passages, the dacryocystography and the rhinological examination. The result of a successful treatment of the acute, beginning dacryocystitis is to open the incomplete, transitory, distal stenosis of the nasolacrimal duct. The stenosis is caused by an ascending inflammation from the nose and by the swelling of the lacrimal mucosa. The blockage can be solved by massage after application of vasoconstrictory drops. The therapy of a complete, postsaccal lacrimal stenosis always has to be a dacryocystorhinostomia externa ('Toti-operation'). The Kaleff-Hollwich modification proved successful and is extended by a fibrin sealing method.(ABSTRACT TRUNCATED AT 400 WORDS)

Acute Disease↗
PubMed1985

Lacrimal gland enlargement as one of the ocular manifestations of Wegener's granulomatosis.

Wegener's granulomatosis is characterized by chronic, focal, necrotizing and granulomatous vasculitis. The localized form involves mainly the upper or lower respiratory tracts, or both. In the commoner generalized form, the kidneys are also affected. Literature findings suggest that ocular manifestations are a predominating sign in about 30% of cases. Ocular findings may include conjunctivitis, keratitis and sclerouveitis, pseudotumor of the orbit or proptosis. We report on a patient who showed bilateral episcleritis, keratitis, nasolacrimal duct obstruction and enlargement of the lacrimal gland. The latter finding was confirmed by CT scan.

Adult↗
PubMed1992

Spread of herpes simplex virus to the cerebrospinal fluid and the meninges in experimental mouse encephalitis.

The development of the inflammatory response within the brain, meninges and cerebrospinal fluid (CSF) compartment has been studied for the first time simultaneously in experimental herpes simplex virus (HSV) encephalitis after inoculation via the cornea. Two major viral pathways were found from the eye to the brain: one through the trigeminal nerve to the brain stem and one through the nasolacrimal duct to the olfactory system. Viral antigen was found to be present in the CNS before there were clinical signs or cellular infiltration of brain tissue. Subsequently, the virus spread to all parts of the trigeminal brain stem complex. This phenomenon was accompanied by severe inflammation of the meninges covering the trigeminal root near its entry into the brain stem. The meninges near the entry of the olfactory fila also contained antigen. However, HSV-1 did not spread along meningeal rami of the trigeminal nerve and, consequently, is--at least in this experimental model--not a route to reach the inferior frontal and temporal lobes. The development of CSF changes followed the histopathological development of meningitis and encephalitis closely. HSV-DNA could be detected in the CSF from day 4 post inoculation (p.i.) and HSV-1-specific immunofluorescence in CSF cells was convincingly present on day 5 p.i.; on the same days (4 and 5 p.i.) inflammatory cells were found in apposition to infected cells in the brain. We postulate that HSV is carried to the CSF by infected leukocytes rather than a direct spread to the CSF by simple extension of the encephalitic process to the meningeal surface.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2000

Unilateral mydriasis after nasal reconstruction surgery.

PURPOSE: To present a case of iatrogenic, unilateral pupillary dilatation after general anesthesia for nasal surgery. Unilateral pupillary dilatation after general anesthesia has sinister implications, which might prompt further investigations. However, in patients undergoing nasal surgery, it might be caused by the action of drugs injected intranasally. Consideration of iatrogenic causes of pupillary dilatation might help clinicians to avoid time-consuming and costly investigations. CLINICAL FEATURES: A 24-yr-old healthy woman underwent a general anesthetic for septoplasty and bilateral turbinectomy. She was hemodynamically stable and did not suffer any hypoxia intraoperatively. At the end of the operation her right pupil was dilated (8 mm diameter). Her left pupil was normal. No other abnormality was detected. After she woke up, her vision was grossly normal. Neurological examination did not show any other abnormality. Six to eight hours later, both pupils were equal (2 mm in diameter) and reacting normally to light and accommodation. CONCLUSION: The patient was a healthy 24-yr-old who underwent an operation in which there was no incident of hypoxia or hemodynamic instability. Since the patient recovered completely within six to eight hours, the pupillary dilatation was probably caused by epinephrine, which could have entered the eye through the nasolacrimal duct. Although pupillary dilatation after general anesthesia has been described, this is the first case report where the most likely causative agent was epinephrine, injected into the nasal submucosa.

Adult↗
PubMed2002

[Mucins in otorhinolaryngology].

BACKGROUND: Mucins are glycoproteins of high-polymer structure. They are an important component of the mucous layer covering the epithelia of the upper aerodigestive tract. Until now there has been little interest with regard to mucins in otorhinolaryngology. METHODS: The present knowledge about mucins of the upper aerodigestive tract is presented. A MEDLINE search was conducted for English- and German-language articles published from 1966 to the present. RESULTS: Thirteen different mucins named MUC 1-13 have been subdivided based on the classification system used by the Human Gene Mapping Committee. Besides mucins, small mucin-associated peptides, called trefoil factor peptides, have attracted much interest. CONCLUSIONS: Classification and attribution of the mucins found in the middle ear, larynx, oropharynx, esophagus, and nasolacrimal ducts has yet to be done. Also, little is known about the distribution of trefoil factor peptides in the upper aerodigestive tract.

Carcinoma, Squamous Cell↗
PubMed2005

[Balloon dilatation of the canaliculus communis for chronic epiphora].

PURPOSE: To examine the clinical outcome of the balloon dilatation in stenosis of the canaliculus communis. METHOD: 18 nasolacrimal ducts with epiphora and proven obstruction of the canaliculus communis by dacryocystography (DCG) were treated with balloon dilatation in local anaesthesia. All patients were treated electively. RESULTS: In 16/18 cases the balloon dilatation was technically successful, in 2 patients the guide wire failed to pass the obstruction and the wire could not be placed in the nasal cavity. There were no complications. Over a mean follow-up of 6 months there were 2 reobstructions, one of these led to an occlusion of the canaliculus communis. 14/18 (77,8%) cases after DCP were treated successful, 11/18 cases were free of symptoms after DCP, in 4/18 cases the epiphora improved. CONCLUSIONS: Until recently in stenosis of the canaliculus communis the only therapeutic option was surgical procedure followed by silicone tube intubation. The results were often disappointing. In contrast to this balloon dacryocystoplasty is a minimally-invasive alternative in the therapy of stenosis of the canaliculus communis resulting in good clinical outcome during follow up.

Adult↗
PubMed1999

[Endoscopic laser dacryoplasty. Methodology and outcome after 3 months].

BACKGROUND: After performing endoscopy of the lacrimal passage, the endoscopic system can be connected to an erbium-YAG laser if the indications are appropriate. MATERIALS AND METHODS: In a bi-center study we performed laser dacryoplasty in 53 cases out of 261 endoscopy procedures (18 stenoses of the canaliculi, 19 stenoses of the sac, 9 stenoses of the nasolacrimal duct, 9 restenoses following DCR). In 35 cases an examination was done and in all 53 cases the results were obtained by means of a questionnaire. RESULTS: Epiphora and irrigation were improved in more than 75%. CONCLUSION: Suitable indications are small stenoses in the sac or duct membranes following DCR. Laser dacryoplasty is a promising method, but more studies still need to be conducted to obtain long-term results. The technical system must also still be improved to make it easier to handle.

Adult↗
PubMed2001

[Laser-assisted transcanalicular dacryocystorhinostomy. Initial results].

BACKGROUND: Endoscopes for direct examination of the mucosa and disorders of the lacrimal drainage system have been available for four years. This had led to the wish to be able to treat lacrimal disorders by endoscopes and laser. PATIENTS AND METHODS: Since September 1997 we have treated 48 patients by laser-assisted transcanalicular dacryocystorhinostomy (DCR) using a KTP laser, including all those with stenosis to the nasolacrimal duct and all those with postsaccal stenosis. A bony window with diameter of 5 x 5 mm was created. Bicanalicular intubation into the nose was performed and was left for 3-6 months. RESULTS: We found 40 patients to have patent lacrimal pathway and no symptoms, 4 watering in cold weather, and 4 a restenosis. CONCLUSIONS: The KTP-laser is sufficiently powerful to create bony windows at least 5 mm in diameter, and a transcanalicular laser-assisted DCR is therefore possible.

Dacryocystorhinostomy↗
PubMed1999

46, XY, del (3) (pter-->p25) syndrome: further delineation of the clinical phenotype.

A boy with monosomy for the distal part of the short arm of chromosome 3 is described. The clinical features this patient has in common with the previously reported cases include pre- and post-natal growth delay, microcephaly, craniofacial dysmorphism and mental retardation. In addition, minor abnormalities not previously reported were observed, such as snapping thumbs, dorsiflected big toes, connecting anterior and posterior fontanelles at birth, nasolacrimal duct stenosis and double urethral meatus. Conclusion These five new clinical findings may help in further delineation of the syndrome and allow its early recognition. A complete revision of clinical findings published in literature is reported.

Abnormalities, Multiple↗
PubMed1975

Modifications of the conjunctivodacryocystostomy procedure.

I modified the conjunctivodacryocystostomy procedure in 36 patients (43 eyes) by directly threading the pre-flanged PE-190 polyethylene tubing over a No. 3 or 4 Bowman probe into and through the nasolacrimal duct, contrary to the original intranasal maneuvers. This simplified the procedure but caused minor amenable complications such as shortening the tubing postoperatively. In eight of 43 eyes, replacement or shortening the tubing was easily done in the office over a handleless Bowman probe. In three of the 43 eyes, polyethylene tubing was occasionally plugged, requiring cleansing or replacement. Of the 43 tubes inserted, 42 are still in place and functioning.

Adolescent↗
PubMed1976

Lacrimal obstruction after migration of orbital floor implant.

A 7-year-old girl developed epiphora, recurrent purulent conjunctivitis, and dacryocystitis 32 months after the repair of a traumatic orbital floor fracture. Dacryocystography and surgical exploration revealed that migration of the orbital floor implant had caused obstruction of the nasolacrimal duct at the sac. Migration of the implant was probably due to a failure to anchor the implant properly to bone.

Bone Plates↗
PubMed1976

Fluorescein oropharyngoscopy.

To evaluate patency of the lacrimal system, fluorescein was instilled in the conjunctival cul-de-sac and the posterior oropharynx was examined with ultraviolet light. In 20 normal patients fluorescein was evident in one to 30 minutes. In cases of complete nasolacrimal duct blockage no fluorescein appeared after two hours.

Adolescent↗
PubMed1981

Rapid recurrence of papillary squamous cell carcinoma of the canaliculus.

We treated a 76-year-old man who had an epithelial carcinoma that involved the canaliculus and extended into the lacrimal sac. Despite what appeared to be adequate resection (the surgical margins were completely free of tumor on both frozen and paraffin section), the tumor recurred less than one month later. The patient underwent wide local incision, including en bloc removal of the medial third of both eyelids and inner canthi, canaliculi, lacrimal sac, and nasolacrimal duct, and resection of the anterior lacrimal crest, lacrimal bone, anterior portion of the ethmoid bone, anterior medial wall of the maxilla, and subjacent periosteum and mucous membranes. Sixteen months later, the tumor has not recurred. This infiltrating papillary squamous cell carcinoma histologically demonstrated the most rapid and destructive recurrence of any such tumor originating in the lacrimal system.

Aged↗
PubMed1988

Infantile glaucoma in Down's syndrome (trisomy 21).

We examined five patients with Down's syndrome and bilateral infantile glaucoma. In the first few months of life four patients had large cloudy corneas, breaks in Descemet's membrane, increased intraocular pressure, photophobia, and tearing. In one patient the diagnosis was delayed until 3 1/2 years of age because of concomitant nasolacrimal duct obstruction. Two patients developed cataracts and retinal detachment and have undergone multiple surgical procedures. The clinical course in these two older patients suggests that coexistence of congenital glaucoma, severe myopia, and cataracts in patients with trisomy 21 strongly predisposes for the development of retinal detachment and poor visual outcome.

Adolescent↗
PubMed1990

Nasolacrimal abnormalities in oblique facial clefts.

A patient with a Tessier No. 4 cleft and an associated bifid nasolacrimal system is presented and considered within the Tessier classification of craniofacial clefting. Previous accounts of nasolacrimal abnormalities associated with facial clefts are reviewed together with the accepted developmental embryology. It is proposed that the bifid nasolacrimal duct system described constitutes a new addition to the literature.

Abnormalities, Multiple↗
PubMed1982

Inferior dacryocystorhinostomy in severe congenital dacryostenosis.

Inferior dacryocystorhinostomy is a simple and effective method in the treatment of such cases of congenital dacryostenosis in which conservative treatment and probing have failed and in which the atresia is located at the level of the nasolacrimal duct. The operative technique is described in detail. The series treated by this method consists of 8 patients, 3 of whom showed bilateral stenosis. On 2 patients adenoidectomy was performed in connection with the dacryocystorhinostomy. The follow-up time ranged from 2 to 34 months, and a good result was obtained in 7 cases. In one case the passage produced closed soon after the operation. Endonasal dacryocystorhinostomy was then successfully carried out by West's method. The operative technique described is well suited for patients under two years of age.

Adenoidectomy↗