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PubMed1995

[Tuberculous dacryocystitis].

BACKGROUND: Acute infection and inflammation of the nasolacrimal sac may complicate congenital obstruction of the nasolacrimal duct. Acute dacryocystitis is uncommon later and tuberculosis is exceptionally responsible for it. CASE REPORT: A 4 1/2 year-old boy was admitted because he suffered from acute left dacryocystitis with fever and cervical adenitis. Involvement of both lacrymal gland and lymph node persisted despite antibiotic and corticosteroid therapy. Needle biopsy of the lymph node showed presence of Mycobacterium tuberculosis and excision revealed caseating granulomas. The tuberculin skin test was positive while pulmonary tuberculosis was discovered in the patient's father. The patient was successfully given izoniazid, rifampin for 9 months and pyrazinamide for 2. Drainage of the sac area was necessary after 1 month of treatment followed by dacryocystorhinostomy. CONCLUSION: This rare case of tuberculous dacryocystitis permits to delineate the difficulties of ophthalmologic therapy.

Acute Disease↗

PubMedDate not supplied

Recurrent bilateral dacryocystoceles in Wegener's granulomatosis: a rhinologic perspective.

Wegener's granulomatosis (WG) is a rare, idiopathic, systemic vasculitis of small vessels that manifests in multiple organ systems. Otorhinolaryngic manifestations of this disease include recurrent sinusitis and relapsing polychondritis. Periocular involvement is also a well-documented location of Wegener's disease. We present the case of a 13-year-old girl with severe WG who developed multiple recurrent orbital infections. She underwent multiple incision and drainage surgeries of each orbit and multiple courses of intravenous antibiotics. The patient persistently reaccumulated purulence in her nasolacrimal duct system and was referred to an oculoplastic surgeon for evaluation of these recurrent infections. The diagnosis of dacryocystitis as a complication of WG was made. This unique case represents a patient with severe WG developing bilateral dacryocystitis requiring bilateral dacryocystorhinostomies.

Adolescent↗

PubMed2005

Management of neck and head injuries.

The horse, a flight animal that is used extensively by man, frequently receives injuries to its neck or head that result mostly from its management and handling. Better facilities, training of the horse, and horsemanship skills of the handler could prevent many of these injuries. Because many body systems can be involved, with potentially major consequences regarding health, performance, and appearance, early recognition of trauma and competent treatment are crucial. Progress has been made in the treatment of some tracheal and esophageal injuries. Severe tracheal trauma and rupture of the esophagus still represent major challenges for the attending veterinarian, however. Lacerations of the head generally heal well, likely because of an abundant blood supply. Thorough yet conservative debridement is necessary, as is accurate reconstruction of the tissues to maintain normal function and an acceptable cosmetic appearance. Fractures of the facial bones can result in complications, such as sequestrum formation, sinusitis, nasolacrimal duct injury,facial deformity, and injury to or entrapment of the globe. An awareness of the treatment methods available can help to diminish the complication rate and to restore a normal or acceptable appearance.

Animals↗

PubMed2006

Common procedures in rabbits.

Rabbits are popular companion animals that present to veterinary clinics for routine and emergency care. Clinics equipped for treat-ing dogs and cats may be easily adapted to accommodate rabbits. This article reviews common procedures performed by the clinician specific to rabbits. Topics include handling and restraint, triage and patient assessment, sample collection, and supportive care techniques. Miscellaneous procedures, including anesthetic delivery, nasolacrimal duct flushing, and ear cleaning, are also discussed.

Animal Diseases↗

PubMed2004

Proboscis lateralis: a report of two cases.

Proboscis Lateralis (PL) is one of the congenital anomalies of the nose which presents as obvious deformity. This is a report of two cases of the rare anomaly PL. One presented with right PL and the second presented with left PL. In this rare anomaly, the nasal cavity on one side is completely normal while on the affected side, the nasal cavity is replaced by a tube of skin and soft tissue attached to the inner canthus of the eye. This anomaly occurs sporadic as an isolated defect or in association with other anomalies. It is usually associated with failure of the paranasal sinuses and the nasolacrimal duct development. Embryologically, this anomaly is a result of imperfect fusion of the lateral nasal wall and maxillary processes (Int. J. Pediatr. Otorhinolaryngol. 23 (1992) 275).

Eyelids↗

PubMed2006

Bilateral congenital lacrimal sac fistulae in a patient with ectrodactyly-ectodermal dysplasia-clefting syndrome.

We describe a case of bilateral congenital lacrimal sac fistulas, associated with ectrodactyly-ectodermal dysplasia-clefting syndrome. The embryologic basis for this condition is discussed, as well as the epidemiology, typical presentation, and possible treatment modalities. After we excised the fistulas and intubated the nasolacrimal ducts in this patient, he experienced improvement in symptoms by report.

Abnormalities, Multiple↗

PubMed2006

Ocular phenotype correlations in patients with TWIST versus FGFR3 genetic mutations.

BACKGROUND/PURPOSE: Despite the similar clinical phenotype of the Saethre-Chotzen and Muenke craniosynostoses, the 2 syndromes are now genotypically distinct. Patients with Saethre-Chotzen and Muenke syndromes carry mutations in the TWIST and fibroblast growth factor receptor (FGFR) 3 genes, respectively. We sought to assess possible ocular phenotypic differences in patients with mutations of either gene previously grouped according to phenotype only. METHODS: A retrospective chart review was performed for 21 children with known mutations of the TWIST (n=10) or the FGFR3 (n=11) genes. Data gathered included patient sex, age, family craniofacial history, craniofacial and ophthalmic surgeries, type of strabismus, ptosis, cycloplegic refraction, visual acuity, the presence of amblyopia, nasolacrimal duct obstruction (NLDO), nystagmus, hypertelorism, epicanthal fold anomalies, and any ocular structural abnormalities. RESULTS: In the TWIST group, ptosis was present in 90%, amblyopia in 70%, horizontal strabismus in 70%, vertical strabismus in 60%, NLDO in 60%, astigmatism in 50%, inferior oblique overaction (IOOA) in 40%, hyperopia in 40%, myopia in 30%, nystagmus in 30%, and optic nerve findings in 30%. In the FGFR3 group, ptosis was present in 36%, amblyopia in 18%, horizontal strabismus in 55%, vertical strabismus in 36%, NLDO in 0%, astigmatism in 9%, IOOA in 45%, hyperopia in 27%, myopia in 18%, nystagmus in 18%, and optic nerve findings in 27%. CONCLUSIONS: Patients with TWIST gene mutations may have more ophthalmic abnormalities, including more strabismus, ptosis, NLDO, astigmatism, vertical deviations, and amblyopia compared with patients with FGFR3 gene mutations.

Abnormalities, Multiple↗

PubMed2004

Inferior meatal antrostomy: is it necessary after radical sinus surgery through the Caldwell-Luc approach?

PURPOSE: In the Caldwell-Luc (CWL) operation, an antrostomy at the inferior meatus is created surgically to promote sinus drainage. This inferior meatal antrostomy (IMA) has been criticized because of the need for an additional time, early loss of the sinusotomy, injury to the nasolacrimal duct, epistaxis from the sphenopalatine artery, and deviation from the normal sinus physiology. This trial was undertaken with specific attention to the question: Is it necessary to perform antrostomy at the inferior meatus after radical sinus surgery through the CWL approach? MATERIALS AND METHODS: Thirty-three patients with a dental origin of sinus disease indicating the CWL operation were entered into this trial. They were treated in blocks of 3, in which IMA was not performed in the first and second patients of each successive block. Only the third patient of each block had IMA performed. Cheek swelling, infection, and failure to relieve the patient's symptoms were the criteria for comparison between patient groups. Cheek swelling was measured by the eye-mouth line and the ear-nose line on the second and fourth day after surgery. RESULTS: At no time was there a statistically significant difference in cheek swelling between the treated groups (P >.05). No infection or failure of treatment was encountered. However, some patients in both groups had numbness or paresthesias of the cheek, upper lip, upper front gingiva, and teeth. These complaints were transient and lasted for several weeks. CONCLUSION: Based on our findings, it does not seem necessary to perform antrostomy at the inferior meatus, provided the patient has a patent osteomeatal complex and no anatomic abnormalities.

Adult↗

PubMed2005

Systemic reactions associated with ophthalmic medications.

Although most medications for ophthalmic disease are administered locally, systemic absorption occurs as the drug passes into the nasopharynx by way of the nasolacrimal duct and may lead to a significant exposure. Knowledge of the mechanism of action of the drug, extent of systemic exposure, and its corresponding risks are important factors that must be considered before prescription of any ophthalmic agent. The relative risk in turn depends on the agent prescribed, plasma levels achieved, and individual susceptibility factors. Judicious use of pharmacotherapy in the management of ophthalmic disease should minimize the risk-benefit ratio.

Animals↗

PubMed2004

Orbitotemporal neurofibromatosis. Clinical features and surgical management.

PURPOSE: To classify the periorbital deformities of adult orbitotemporal neurofibromatosis (NF) and describe new clinical findings, and to recommend guidelines for surgical treatment and management of surgical complications. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Thirty-three patients over age 16 with orbitotemporal NF. METHODS: Retrospective surgical case record and serial photographic review recording the laterality and the severity of periorbital involvement, the presence of complications from previous surgery, the surgical techniques undertaken, and the surgical outcome and complications. MAIN OUTCOME MEASURES: Comparison of preoperative and postoperative level of deformities. RESULTS: New classification of periorbital deformities: (1) brow ptosis, (2) upper lid infiltration with ptosis, (3) lower lid infiltration, (4) lateral canthal disinsertion, and (5) conjunctival and lacrimal gland infiltration. Two patients had bilateral and 31 patients (94%) had unilateral orbitotemporal NF. All patients had upper and 19 patients (58%) had lower lid involvement. Six (18%) patients had significant brow infiltration. Fourteen (42%) patients had a dropped lateral canthus requiring surgical reattachment, 28 (85%) required anterior levator resection for ptosis, and 28 (85%) had lid-debulking surgery. New findings included severe brow infiltration, lacrimal gland involvement, and functional nasolacrimal duct obstruction. Complications from previous surgery included residual ptosis, ptosis overcorrection, poor lid contour, dry eye, corneal exposure, and upper and lower lid entropion/ectropion. CONCLUSIONS: The periorbital appearance and comfort of patients with NF type 1 who have orbitotemporal NF can be significantly improved through oculoplastic surgery.

Adolescent↗

PubMed2006

Endoscopic management of sinonasal malignancy.

The advent of rigid telescopes has revolutionized the management of rhinologic disease. These instruments have been used as a diagnostic and therapeutic tool for paranasal sinus inflammatory diseases since the 1970s. Endoscopic techniques have been used for treating increasingly complex intranasal pathology, including nasolacrimal duct obstruction, cerebrospinal fluid leaks/encephaloceles, dysthyroid orbitopathy, and optic neuropathy. Recently, endoscopic techniques have also been used successfully to manage selected tumors, including inverted papilloma, angiofibromas, and hypophyseal tumors. This article reviews patient evaluation strategies, surgical techniques, and outcomes data for the minimally invasive endoscopic resection.

Craniotomy↗

PubMed2006

Visual outcome of accelerated fractionated radiation for advanced sinonasal malignancies employing photons/protons.

PURPOSE: To investigate the visual outcomes of patients with advanced sinonasal malignancies treated with proton/photon accelerated fractionated radiation (AFR). PATIENTS AND METHODS: Between 1991 and 2001, AFR was used to treat 36 patients with advanced stage primary (n=33) or recurrent (n=3) nasal or paranasal malignant tumors. Full ophthalmologic follow-up was documented. The median dose to the gross tumor volume (GTV) was 69.6 CGE (range 60.8-77). Visual complications were graded according to the National Cancer Institute Common Toxicity Criteria (CTC) and the late effects of normal tissue (LENT) scoring systems. The median follow-up was 52.4 months (range 17-122.8). RESULTS: Thirteen patients developed late visual/ocular toxicity. Cataracts were LENT grade 1 and 3 in 2 patients and 1 patient, respectively. One LENT grade 1 vascular retinopathy and 1 optic neuropathy were also observed. Three and five patients presented with nasolacrimal duct stenosis (CTC grade 2, 2 patients; CTC grade 3, 1 patient) and dry-eye syndrome (CTC grade 1, 1 patient; CTC grade 2, 4 patients), respectively. The 3- and 5-year probability of LENT/CTC grade > or =2 visual toxicity were 15.8+/-6.7% and 20.7+/-7.8%, respectively. CONCLUSIONS: AFR for locally advanced nasal cavity and paranasal sinus tumors enables delivery of 70 CGE to the tumor with acceptable ophthalmologic complications.

Adult↗

PubMed2006

Wegener's granulomatosis: ophthalmic manifestations and management.

OBJECTIVES: To provide an up-to-date and comprehensive review of Wegener's granulomatosis (WG) as a disease entity, focusing on the ophthalmic manifestations and management options. METHODS: A search of Medline was undertaken between 1966 and 2005 regarding WG, systemic vasculitis, and the ocular manifestations of WG. Major ophthalmic and medical textbooks also were reviewed for content, as well as original references. RESULTS: Involvement of ocular and orbital structures in patients with WG is common and may be a presenting feature. The ocular manifestations range from mild conjunctivitis and episcleritis to more severe inflammation with keratitis, scleritis, uveitis, and retinal vasculitis. Involvement of the nasolacrimal system and orbital tissues also can occur. Except for some cases of anterior segment inflammation, the ocular involvement will not respond to topical agents, but rather to systemic antiinflammatory and immunosuppressive regimens. Surgical intervention may be of value for obtaining tissue diagnosis, in achieving orbital decompression in cases of significant orbital disease with optic nerve compromise, or in cases of nasolacrimal duct obstruction. CONCLUSION: WG is an important clinical entity that needs to be recognized early and treated appropriately. Ophthalmic manifestations are frequently encountered and can result in significant morbidity and even blindness. The management is challenging and often requires a multidisciplinary approach.

Diagnosis, Differential↗

PubMed1997

Surgical treatment of dacryocystitis.

Dacryocystitis is a common infection of the lacrimal sac. In adults, dacryocystitis results from an obstruction (ie, dacryostenosis) of the nasolacrimal duct. Dacryocystitis can be either an acute or chronic infection, and both forms usually are unilateral in nature. The hallmark symptom of both forms of dacryocystitis is epiphora (ie, excessive tearing). An obstruction of the lacrimal duct also can cause dacryocystitis. This article discusses the surgical treatment of dacryocystitis and provides a case study that illustrates perioperative nursing care of a patient who required surgical treatment of this lacrimal duct disorder.

Adult↗

PubMed2004

[Endonasal and endocanalicular dacryocystorhinostomy by diode laser. Preliminary results].

AIM OF THE STUDY: To describe the surgical technique and to evaluate the clinical results after having performed the transcanalicular and endocanalicular dacryocystorhinostomies by diode laser, including the advantages and limits of this technique. METHODS: 34 were performed by diode laser in patients with clinical history of epiphora, with or without mucopurulent secretion, for nasolacrimal duct obstruction. The study was prospective, interventional, non randomized and non comparative. Diode laser was used to realize vaporization of lacrimal sac, osteotomy and vaporization with coagulation of nasal mucosa. The mean of surgical time was 15 minutes (range 7 to 29 minutes). Bicanalicular intubation was performed with a silicone tube and prolene filament for two months in all cases. Postsurgical follow-up was between 4 and 11 months. The degree of epiphora was evaluated by the Munk scale and lacrimal permeability was evaluated by endoscopic functional staining test in all cases. RESULTS: Out of the 34 DCR-EDN+ENC that were performed, 32 cases (94.11%) remain asymptomatic. Two of them (5.88%) required endonasal dacryocystorhinostomies by drilling, because the bony perforation was impossible to achieve by laser fiber. Two cases (5.88%) presented fibrosis and lacrimal and lower canaliculi obstruction, without epiphora because the superior canaliculi was permeable. CONCLUSION: Endonasal and endocanalicular dacryocystorhinostomy technique performed by diode laser is a valid method. It does not cause cutaneous scarring, it decreases thermic canalicular damage, it respects the lacrimal pump, it minimizes pain and bleeding, it needs less surgical time and it has turned into an out-patient procedure with a minimal surgical and postsurgical morbility.

Adult↗

PubMed1990

Lacrimal drainage anomalies in mandibulofacial dysostosis.

Seven patients who had the complete form of mandibulofacial dysostosis were examined to determine the prevalence of nasolacrimal abnormalities. Bilateral inferior punctal atresia (and, by implication, accompanying inferior canalicular atresia) was identified in all seven patients; a 95% confidence interval for the true underlying rate of this finding in mandibulofacial dysostosis is 59% to 100%. Lacrimal surgery was required in only one patient who had coexistent bilateral nasolacrimal duct obstruction and chronic dacryocystitis and who responded well to bilateral dacryocystorhinostomy.

Adolescent↗

PubMed1993

Ocular manifestations of the lacrimo-auriculo-dento-digital syndrome.

We studied a mother and daughter with an extremely rare constellation of signs and symptoms. One or both had absent lacrimal puncta, nasolacrimal duct obstruction, chronic dacryocystitis, dry eyes, and epiphora. Systemic findings included salivary gland hyposecretion, dental hypoplasia and dysplasia, cup-shaped ears with hearing loss, and digital anomalies. These findings are consistent with those of the lacrimo-auriculo-dento-digital syndrome, a genetic disorder. Our study supports the autosomal dominant inheritance of this syndrome, delineates the ophthalmic manifestations, and provides evidence that renal anomalies are part of the disorder.

Abnormalities, Multiple↗

PubMed1985

Lacrimal surgery in children.

Of 142 children who underwent major lacrimal surgery (160 dacryocystorhinostomies, one congenital fistula excision, one dacryocystectomy, and one canaliculostomy), 49 had congenital nasolacrimal duct obstruction (34%). Lacrimal obstruction was also associated with canaliculitis, punctal agenesis, trauma, congenital fistula, dacryocystitis, craniofacial defects, and functional eyelid abnormalities. Although the timing and technique of the surgery varied according to the abnormalities, an overall functional success rate of 90% (144 of 160 procedures) was achieved.

Adolescent↗