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PubMed1984

Nasolabial cyst: presentation of a case with a review of the literature.

This report presents the clinical and histologic features and treatment of a classic nasolabial (nasoalveolar) cyst. Review of the literature confirms the fact that this lesion is a benign developmental cyst that may arise from epithelium of the nasolacrimal duct. The lesion is usually unilateral, but may be bilateral, is located beneath the ala of the nose, and occurs more frequently in females. Histologically, it is most frequently lined by a pseudostratified columnar epithelium, although both stratified squamous and cuboidal epithelium and goblet cells may be found. The cyst responds well to conservative enucleation.

Female↗

PubMed2002

Correlation between presumed sinusitis-induced pain and paranasal sinus computed tomographic findings.

BACKGROUND: The correlation between facial and/or head pain in patients clinically suspected of having sinusitis and actual localized findings on sinus computed tomographic (CT) imaging are poorly understood. OBJECTIVE: To prospectively evaluate the relationship of paranasal sinus pain symptoms with CT imaging. METHODS: Two hundred consecutive patients referred by otolaryngologists and internists for CT of the paranasal sinuses participated by completing a questionnaire immediately before undergoing CT. Three radiologists blinded to the patients' responses scored the degree of air/fluid level, mucosal thickening, bony reaction, and mucus retention cysts using a graded scale of severity (0 to 3 points). The osteomeatal complexes and nasolacrimal ducts were also evaluated for patency. Bivariate analysis was performed to evaluate the relationship between patients' localized symptoms and CT findings in the respective sinus. RESULTS: One hundred sixty-three patients (82%) reported having some form of facial pain or headache. The right temple/forehead was the most frequently reported region of maximal pain. On CT imaging the maxillary sinus was the most frequently involved sinus. Bivariate analysis failed to show any relationship between patient symptoms and findings on CT. Patients with a normal CT reported a mean 5.88 sites of facial or head pain versus 5.45 sites for patients with an abnormal CT. CONCLUSIONS: Patient-based responses of sinonasal pain symptoms fail to correlate with findings in the respective sinuses. CT should therefore be reserved for delineating the anatomy and degree of sinus disease before surgical intervention.

Facial Pain↗

PubMed2003

Distribution of refractive error in healthy infants.

PURPOSE: Few data exist regarding the upper limits of refractive error distributions in healthy infants; the data that do exist are biased because they were selected from the records of pediatric ophthalmology practices. We sought to obtain these data to validate examination failure criteria for vision screening. METHODS: We reviewed records from all children age birth to 5 years seen at the Tennessee Lions Eye Center at Vanderbilt Children's Hospital with a billing diagnosis of nasolacrimal duct obstruction and no comorbid ocular diagnoses except for refractive error. This was to avoid referral bias for any condition that could have influenced refractive error. All patients received a complete eye examination and cycloplegic refraction. Cumulative probability distribution (CPD) plots and means for spherical and cylindrical refractive error and anisometropia were prepared. RESULTS: One hundred thirty patients were studied; mean age was 15.5 +/- 9.9 months (range, 2 days to 66 months). The mean refractive error (spherical equivalent) was +1.4 D +/- 1.1 D. CPD plot analysis showed 95% of hyperopia to be < +3.25 D. Two children had myopia </=-1.00 D. The mean astigmatism was +0.2 D +/- 0.4 D, and 74% of patients had no astigmatism. Seven children had astigmatism > +1.00 D in one eye. CPD plot analysis showed 95% of astigmatism to be < +1.50 D and 95% of meridional anisometropia to be < 1.50 D. Six children had anisometropia >/=1.50 D, and 3 children had anisometropia > 3.00 D. CONCLUSIONS: At least 95% of children have hyperopia < +3.25 D, astigmatism < +1.50 D, and anisometropia < 1.50 D. This information will prove useful in identifying the natural history and prevalence of amblyogenic factors identified during preschool vision screening.

Age Distribution↗

PubMed1997

Endoscopic holmium:YAG laser dacryocystorhinostomy-safe and effective as a day-case procedure.

Endoscopic holmium laser dacryocystorhinostomy can be used safely and efficiently to relieve symptoms of distal nasolacrimal duct obstruction. It has great advantages over the conventional external approach as it can be done as a day-case procedure under local anaesthesia. The excellent ablation of bone and soft tissue using this type of laser contribute to the fact that the procedure can be performed in a mean time of 20 minutes. We report on the results of our first 50 patients and review the literature on the subject.

Aged↗

PubMed2003

Adenoidectomy during early life and the risk of asthma.

The objective of the study was to evaluate the risk of asthma in children who had undergone an adenoidectomy, an operation frequently performed on children with glue ear or recurrent otitis media. Two surveys were carried out, a nation-wide questionnaire returned by 483 individuals (survey A) and a survey of hospital discharge records involving 1616 children who had undergone an adenoidectomy and 161 control children who had undergone probing of the nasolacrimal duct due to congenital obstruction (survey B). The questionnaire (survey A) showed that an adenoidectomy before the age of 4 years was associated with asthma (OR 3.19, 95% CI 1.25; 8.13) and with allergy to animal dust (OR 2.50, 95% CI 1.27; 4.95). In survey B, asthma diagnosis was retrieved from the national asthma register. It showed also that adenoidectomy at an early age was associated with an increased risk of asthma (OR 6.74, 95% CI 2.99; 15.2). There was an association between asthma and adenoidectomy, even before adenoidectomy had actually been performed. The risk of asthma was highest among children who had had adenoidectomy because of recurrent otitis media. The observed association between an adenoidectomy and asthma may be explained by an underlying factor predisposing to both recurrent otitis media and asthma.

Adenoidectomy↗

PubMed1993

The treatment of epiphora with balloon dacryocystoplasty.

We examine a new treatment for epiphora: balloon dilatation of the nasolacrimal duct, or dacryocystoplasty. The procedure, which was performed as an out-patient procedure under local anaesthetic, was carried out on 20 patients with epiphora, 17 due to anatomical and 3 due to functional obstruction. There was an overall success rate of 60%, with complete relief of symptoms in 4 patients and a symptomatic improvement in another 8 (follow-up 2-9 months, mean 4.2 months). All patients tolerated the procedure well with minimal per-operative and post-operative discomfort. A higher success rate was seen in those patients with either a low anatomical or a functional obstruction. The procedure can be easily repeated and, if unsuccessful, still allows a dacryocystorhinostomy to be performed at a later date.

Adolescent↗

PubMed2001

Balloon dacryocystoplasty study in the management of adult epiphora.

PURPOSE: To determine the efficacy of dacryocystoplasty with balloon dilation in the treatment of acquired obstruction of the nasolacrimal system in adults. METHODS: Balloon dacryocystoplasty was performed in 52 eyes of 42 patients under general anaesthetic. A Teflon-coated guidewire was introduced through the canaliculus and manipulated through the nasolacrimal system and out of the nasal aperture. A 4 mm wide 3 cm coronary angioplasty balloon catheter was threaded over the guidewire in a retrograde fashion and dilated at the site of obstruction. RESULTS: There was complete obstruction in 30% of cases and partial obstruction in 70%. The most common site of obstruction was the nasolacrimal duct. The procedure was technically successful in 94% of cases. The overall re-obstruction rate was 29% within 1 year of the procedure. There was an anatomical failure rate of 17% for partial obstruction and 69% for complete obstruction within 1 year. CONCLUSIONS: Balloon dacryocystoplasty has a high recurrence rate. There may be a limited role for this procedure in partial obstructions. Further refinements of the procedure are necessary before it can be offered as a comparable alternative to a standard surgical dacryocystorhinostomy.

Adolescent↗

PubMed2002

Local anaesthetic endonasal endoscopic laser dacryocystorhinostomy: analysis of patients' acceptability and various factors affecting the success of this procedure.

BACKGROUND AND OBJECTIVES: Endonasal endoscopic laser dacryocystorhinostomy is now a well established, effective approach to relieve nasolacrimal duct obstruction. Whereas attempts have been made to comment on the efficacy of the procedure, no study has been conducted to evaluate the acceptability of this procedure by those at the receiving end, ie, the patients. An attempt has been made in the present study to critically evaluate the procedure from the point of view of patients' acceptability and also to evaluate certain factors which may influence the success rate of this procedure. PATIENTS AND METHODS: Forty-six eyes from 40 patients underwent endonasal endoscopic laser dacryocystorhinostomy, performed by the same surgeon, over a period of 15 months. Various aspects of the procedure were evaluated by patients by filling out a simple questionnaire (Figure 1). In addition to recording patients' views, success of the procedure was confirmed by performing a postoperative sac washout in the clinic. Patients were also subdivided according to their age, duration of symptoms and history of previous surgical intervention. The data were statistically analysed using chi-square tests with the Yates correction. RESULTS: The percentage of patients who declared themselves completely cured was 65.22%. A partial resolution was felt by 23.91% of patients and no improvement was reported by 10.87% of patients. Forty-two out of the 46 eyes (91.3%) achieved anatomical success by the procedure, as shown by a postoperative sac washout performed in the clinic. Some of them, however, did not have complete resolution of their symptoms perhaps due to an additional factor of lacrimal pump dysfunction in these patients. During the procedure 60.86% of eyes felt no discomfort at all whereas 39.14% of eyes felt some discomfort at some point of time during the procedure (Table 1). When directly asked 86.12% of patients recommended the procedure (implying that the procedure had some good effect on their quality of life), 8.33% of patients did not recommend it and 5.55% of patients made no comments. Various factors affecting the success of this procedure were analysed (Table 2) and it was found that eyes which had no previous surgical intervention showed a complete cure rate which was significantly higher than that seen in eyes which had some sort of previous intervention (P = 0.0003); eyes with a short (<6 mths) duration of symptoms showed significantly higher success rates (P = 0.0098) in comparison to that shown by eyes with longer (>6 mths) duration of symptoms; and younger patients (<50 yrs) had a complete resolution rate much higher than patients over 50 yrs of age (P = 0.0309). CONCLUSION: The present study clearly shows that endonasal endoscopic laser DCR is an effective procedure, well tolerated and recommended by the patients. Discomfort during the procedure is not a major problem. Younger patients, with no previous surgical intervention and with short duration of symptoms are likely to be benefited the most. Though success rates are higher with external DCR, endonasal endoscopic laser DCR offers certain advantages over the external approach while keeping the option of external DCR open, if needed at a later date.

Administration, Topical↗

PubMed2002

Characteristic ocular findings in Asian children with Down syndrome.

AIMS/PURPOSE: To identify the characteristic ocular findings in Asian children with Down syndrome. METHODS: A total of 123 Korean children with Down's syndrome between 6 months and 14 years of age were examined for ocular findings from March 1999 to April 2000. Ocular examinations including visual acuity assessment, slit-lamp biomicroscopy, ocular motility, cycloplegic refraction, and ophthalmoscopy were performed. RESULTS: The ocular findings in decreasing prevalence were the following: upward slanting of the palpebral fissure (78 patients, 63%), epicanthus (75 patients, 61%), epiblepharon (66 patients, 54%), astigmatism (38 patients, 31%), hyperopia (35 patients, 28%), myopia (31 patients, 25%), strabismus (31 patients, 25%, 18 esotropia and 13 exotropia), nystagmus (27 patients, 22%), nasolacrimal duct obstruction (21 patients, 17%), blepharoconjunctivitis (20 patients, 16%), retinal abnormalities (18 patients, 15%), cataract (four patients, 13%), and glaucoma (one patient, 0.8%). Brushfield spots and keratoconus were not found. CONCLUSIONS: Asian children with Down syndrome demonstrate unreported, high incidence of epiblepharon, the high rate of exotropia, and essentially no notable Brushfield spots, which are in contrast to the ocular findings in Caucasian patients with Down syndrome.

Adolescent↗

PubMed2003

A consideration of the time taken to do dacryo-cystorhinostomy (DCR) surgery.

PURPOSE: Comparison of surgical times for dacryocystorhinostomy (DCR) by three different approaches: (1) external, (2) endoscopic endonasal surgical (EES), and (3) endoscopic endonasal laser (EEL) using the holmium:YAG laser. The merits and limitations of each approach are considered and surgical throughput predicted. METHODS: Prospective study of adult patients undergoing primary DCR surgery for nasolacrimal duct obstruction. Surgical times were recorded. Subjective and objective outcomes were assessed at a minimum of 6 months. RESULTS: A total of 48 patients undergoing 51 DCR procedures were studied. The mean surgical time for primary external (n=20), EES-DCR (n=16), and EEL-DCR (n=15) was 41.1+/-10.3, 39.6+/-13.8, and 20.9+/-7.8 min, with symptomatic success achieved in 95, 88, and 60%, respectively. Follow-up was 6-36 months, mean 8 months. It was calculated that if six EEL-DCR, four EES-DCR, or three external DCRs are performed per list for 45 lists per annum, this equals a total of 270 EEL-DCR, 180 EES-DCR, and 135 external DCRs. Of these, 108 EEL-DCR, 22 EES-DCR, and seven external DCRs will fail. If 75% of these have redo surgery using the same technique, an extra 13.5 (EEL-DCR), four (EES-DCR), and two (external DCR) lists are needed. CONCLUSIONS: There was no significant difference between the time taken to do EES-DCR compared to external DCR, and their clinical outcomes. Only EEL-DCR was significantly faster (P<0.001). However, its lower success rate negates the apparent benefit from the greater surgical throughput.

Adolescent↗

PubMed2003

An unusual cause of neonatal respiratory distress.

Nasal cysts representing cystic extension of the nasolacrimal duct are a rare cause of nasal obstruction and respiratory distress in neonates. A medial canthal mass, epiphora, dacryocystitis or preseptal/orbital cellulitis are the usual presenting symptoms; however, this case shows that patients may present with eye findings so minimal as to be overlooked.

Cysts↗

PubMed2004

[Lacrimal system injuries -- primary and secondary surgical care].

BACKGROUND: Canalicular lacerations can be the result of sharp or blunt trauma as well as burns of the facial region. The nasolacrimal duct may become obstructed as an after-effect of naso-orbital trauma. MATERIAL AND METHODS: Main principles of surgical repair of the lacrimal system are reviewed with regard to the outcome of our own patients compared with the literature. RESULTS: Success rates in the primary repair of traumatic injuries of canalicular system are about 70 to 82 %. 14 of 20 patients who were managed between 1976 and 1980 in our department were cured permanently. 55 of 272 secondary reconstructions of canalicular obstructions (1976 - 1997) were caused by trauma. Conjunctivodacryocystorhinostomy with polyethylene or silicone tubes (1978 - 1999, n = 37, 21 traumatic) had success rates of 61 % and 72 %, respectively. 11 (4.8 %) of 228 dacryocystorhinostomies (1991 - 2000) were necessary as a result of traumatic injuries and achieved a success rate of 87.5 %. CONCLUSIONS: Canalicular lacerations need urgent primary repair with silicone intubation and special heed to the medial canthal tendon. The success rate of secondary reconstructions of traumatically caused tear-duct system obstructions depends on the microsurgical techniques that were used.

Eye Injuries↗

PubMed1999

[Value of external dacryocystorhinostomy].

Present surgical techniques to distal obstruction of the nasolacrimal duct system are the external dacryocystorhinostomy (DCR) and alternatively the endonasal laser-assisted DCR and the transcanalicular laser-assisted DCR. Combining the own experiences and the overview of bibliography the different surgical techniques are compared. As criteria are used the success rate (long term patency rate), the perioperative conditions and the patient selection. The conclusion is that the success rates for conventional external lacrimal surgery are better than those for endonasal and transcanalicular laser-assisted DCR. Therefore at present the external DCR still remains the gold standard by which other methods are measured.

Dacryocystorhinostomy↗

PubMed1987

[Congenital fistula of the lacrimal sac].

Fistulas of the lacrimal sac are visible as small openings in the skin of the medial canthus. They can cause inflammations and serous or mucous secretions. Additional canaliculi of this type can be demonstrated by dacryocystographic techniques. Under the operating microscope the fistula is exposed as far as the lacrimal sac and then excised. The lacrimal sac and the nasolacrimal duct are examined. If there is no further stenosis a dacryocystorhinostomy is not necessary. After bicanalicular silicone intubation the wound is closed layer by layer. If primary healing occurs without complications dense closure results and there is no danger of fistulas of the lacrimal sac redeveloping.

Child↗

PubMed1982

[Wegener's granulomatosis: ocular manifestations, diagnosis and therapy].

As a chronic, focal, necrotizing granulomatous angiitis Wegener's granulomatosis mainly affects the upper respiratory tract, the lungs and kidneys. Various other organs may be affected including te eyes. Ocular manifestation of Wegener's granulomatosis may result from granulomatous sinusitis that has proceeded into the orbit causing nasolacrimal duct obstruction and proptosis, and affecting eye muscles as well as the optic nerve. Another possible picture is presented by focal vasculitis in the form of conjunctivitis, episcleritis, scleritis, uveitis and granulomatous vasculitis of the retina and optic nerve. In 13 patients out of 26 examined the eyes were found to be involved. The etiology of Wegener's granulomatosis is unknown. The prognosis of this generally lethal disease could definitely be improved by early treatment with cyclophosphamide in combination with glucocorticosteroids.

Adult↗

PubMed1999

The value of nasal endoscopy after dacryocystorhinostomy.

PURPOSE To determine the value of office nasal endoscopy after dacryocystorhinostomy (DCR). METHODS A prospective clinical observational study of consecutive adult patients after primary external or endonasal surgical DCR, both with intubation for nasolacrimal duct obstruction. Nasal endoscopy was used at the time of tube retrieval and six months after surgery to evaluate nasal pathology and ostium function. RESULTS Sixteen patients were examined. 5/16 (31%) had surgically induced nasal synaechiae; in 2/5 patients transnasal synaechiae occluded the ostium. Granuloma adjacent to the ostia in 2/16 (12.5%) did not impair function. There was no difference in the incidence of synaechiae or granuloma after endonasal compared to external DCR. In 3/16 (19%) endoscopy aided retrieval of tubes concealed by transnasal synaechiae or a narrow nasal space. Six months after surgery ostium function was positive in 12/16 (75%) using the functional endoscopic dye test; 13/16 (81%) patients had relief of epiphora with patent syringing; one had an alternative drainage route. CONCLUSIONS Nasal endoscopy after DCR i) identifies surgically induced nasal mucosal pathology, ii) assists in difficult retrieval of tubes and iii) assesses ostium function using the functional endoscopic dye test. The information obtained is adding much to our understanding of the effects of DCR at the lacrimal / sinus / nasal interface.

Journal Article↗

PubMed1999

Use of mitomycin C and 5-fluorouracil in external dacryocystorhinostomy.

PURPOSE. To evaluate the effects of antiproliferative agents on the fibrous tissue responsible for the failure of external dacryocystorhinostomy at the site of surgical rhinostomy. METHODS. The study group consisted of 60 cases. Patients with primary acquired idiopathic nasolacrimal duct obstruction were divided into three groups according to the agent used. Each group consisted of 20 patients. Mitomycin C was applied to the first group (0.5 mg/ml to 10, 1 mg/ml to 10 cases) and 5-flourouracil to the second group (2.5 mg/ml to 10, 5 mg/ml to 10 cases). The third group consisted of 20 control cases. The mean follow-up period was 15.3 +/- 2.60 (12-18) months. The tissues obtained during the revision of the cases with failure were evaluated by light and electron microscopic examination. RESULTS. External dacryocystorhinostomy failed in four cases. Of these, one was in the first group (0.5 mg/ml mitomycin C), one in the second group (2.5 mg/ml 5-flourouracil), and two were in the control group. Light microscopic examination of the tissues revealed an increase in fibroblastic activity in the control group whereas hypo- and acellular areas were found to be dominant in the groups given antifibroblastic agents. The control group revealed more active fibroblasts with cytoplasms containing numerous organelles in electron microscopic examination. Electron microscopic examination of the cases given antifibroblastic agents revealed fibroblastic cells with nuclear fragmentation, necrosis or pyknosis, while some others had scanty cytoplasms poor in organelles. CONCLUSION. We can conclude that intraoperative antiproliferative agents improve the success rate of external dacryocystorhinostomy.

Journal Article↗

PubMed2003

Factors affecting the success of external dacryocystorhinostomy.

PURPOSE: To assess the success rate of external dacryocystorhinostomy (Ext-DCR) and factors affecting it in a university hospital. MATERIALS AND METHODS: In a retrospective interventional non-comparative case series, records of 276 Ext-DCRs in 274 patients in a 9-year period were reviewed. 'Complete success' was defined as patent system on irrigation (objective) and absence of symptoms (subjective). Patent system on irrigation with minimal postoperative symptoms was considered as partial success. The chi-square and Fisher's exact tests with 95% confidence interval (CI) were used to analyze the data (SPSS release version 9.0, Chicago). RESULTS: The age range was 3-84 years (mean: 41.5, SD: 17.7). The majority of the patients (66.7%) were female. The most common presumed etiology was primary acquired nasolacrimal duct obstruction (PANLDO) (227/276, 82.2%). A silicone tube was inserted in 111 patients (40.2%). Follow-up was from 6 to 89 months (mean: 11.5, SD: 10.4). Overall complete success rate was 89.1% (246/276). It was 92% (209/227) in PANLDO, 72.7% (16/22) in congenital NLDO (P: 0.01, 95% CI: 0.024-0.030), 71.4% (10/14) in traumatic NLDO (P: 0.001, 95% CI: 0.012-0.017), 90% (9/10) in previous failed DCR (P: 0.6, 95% CI: 1), and two out of three patients with previous nasal/sinus surgery. Gender, type of presenting symptoms, duration of preoperative symptoms, silicone tube insertion in PANLDO, and associated canalicular stenosis did not have a significant effect on the success. CONCLUSION: Ext-DCR is an effective and highly successful procedure for the treatment of NLDO regardless of the etiology.

Adolescent↗