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PubMed2003

Manometric measurement of lacrimal sac pressure after endoscopic and external dacryocystorhinostomy.

OBJECTIVE: To evaluate endoscopic and external dacryocystorhinostomy (DCR) using a quantitative, objective functional tool. MATERIAL AND METHODS: This study comprised 58 cases divided into 4 groups: healthy controls; patients suffering from epiphora due to nasolacrimal duct (NLD) obstruction; patients who had undergone endoscopic DCR; and patients who had undergone external DCR. The lacrimal sac pressure was measured during blinking, forced blinking and the Valsalva maneuver using a polygraph. RESULTS: Negative pressure was detected during blinking and forced blinking in all normal subjects and in most patients who had successfully undergone DCR. In contrast, positive pressure was detected in cases with epiphora and patients in whom DCR had failed. Negative pressure was higher after endoscopic than external DCR. During the Valsalva maneuver there were no pressure changes in normal cases and patients with epiphora. In contrast, positive pressure was detected after all of the successful procedures (being higher after external than endoscopic DCR) and in most of the patients in whom external DCR failed. CONCLUSIONS: In normal subjects, negative pressure is created during blinking. In cases with epiphora due to NLD obstruction, the lacrimal pump is affected but its function is restored after successful DCR. The suction power of the pump mechanism is more effective after endoscopic than external DCR.

Adolescent↗

PubMed2005

Acquired external punctal stenosis: surgical management and long-term follow-up.

PURPOSE: To introduce and assess the results of a long-term follow-up of a one-snip punctoplasty with monocanalicular stent (Mini Monoka) for acquired external punctal stenosis (AEPS) with and without associated internal punctal and canalicular stenosis. DESIGN: Prospective non-comparative interventional case series. METHODS: Thirty-five eligible patients (53 eyes) with AEPS underwent a horizontal one-snip punctoplasty and Mini Monoka tube insertion by or under supervision of a consultant Oculoplastic surgeon from June 1999 to May 2002. Diagnostic probing and irrigation were performed before operation and after operation at the last follow-up. Patients with canalicular obstruction, nasolacrimal duct stenosis and obstruction, and those with less than 6 months' follow-up were excluded. The Chi-square (X(2)), Fisher's exact, Pearson correlation, and multiple logistic regression analysis tests, with 95% confidence interval when appropriate, were used for statistical analysis. RESULTS: The age range was 39 to 90 years (mean: 67.2, SD: 11.8, SE: 2). Twenty-seven patients (77.1%) were female. There was a normal canalicular system in 21 (39.6%), lower canalicular stenosis in 10 (18.8%), and internal punctal stenosis in 22 (41.5%) eyes. Postoperative follow-up was from 6 to 41 months (mean: 18.5, SD: 9.2, SE: 1.2). There was a 77.4% complete functional success, 7.5% partial functional success, and 96.2% anatomical success at the last follow-up. The success rate was not significantly different between the eyes with and without preoperative internal punctal and canalicular stenosis (p = 0.4). The lower success rate was significantly correlated with a final abnormal probing and irrigation (p < 0.01). CONCLUSION: The use of a monocanalicular Mini Monoka stent together with a one-snip punctoplasty is helpful to prevent the recurrence of punctal stenosis in the healing phase and addresses the associated internal punctal and canalicular stenosis.

Adult↗

PubMed2005

Long-term follow-up of external dacryocystorhinostomy and the factors affecting its success.

AIM: To evaluate the long-term follow-up results of external dacryocystorhinostomy (Ex-DCR) and to assess the role of some factors in its success. PATIENTS AND METHODS: Between January 1990 and November 2002, 437 nasolacrimal systems of 387 patients were operated on and included in the study. The success rates were determined on the basis of the last examinations of the patients, and the correlations between success rates and factors such as age, gender, the duration of obstruction, history of acute dacryocystitis, the side of obstruction, and the postoperative follow-up period were calculated. RESULTS: The mean follow-up period was 5.9 +/- 2.5 years. Fifty cases (12.9%) were operated bilaterally. The initial success rate was 91.5% and the last success rate was 98.4% after reoperations. We found meaningful correlations between success and duration of obstruction, age of the patient, and the duration of postoperative follow-up (r = 0.18, 0.17 and -0.14, p = 0.036, 0.001 and 0.002, respectively). DISCUSSION: In comparison to newly developed surgical techniques for the treatment of nasolacrimal duct obstruction, Ex-DCR still appears to offer higher success rates, even after long-term follow-up. In addition to being a cost-effective procedure, it requires no sophisticated instruments. In our opinion, the high success rates may be explained by the nature of the operation, which creates a fistula between the sac and the nasal mucosa.

Adolescent↗

PubMedDate not supplied

Ocular drug targeting by liposomes and their corneal interactions.

Topical drug delivery is preferred in the eye to avoid under or over medication and undesired side effects of systemic administration. In order to maintain adequate drug levels in ocular tissues, frequent drug installation is necessary in vision threatening conditions like glaucoma, corneal ulcers due to microbial infections, etc. Only a part of the installed drug reaches the aqueous humor and the rest of it is drained by the nasolacrimal duct. Positively charged liposomes have been found to enhance the penetration of drugs into the cornea. The present study was conducted to visualize the interaction of liposomes with the cornea. Briefly, positively charged liposomes entrapped with Carboxyfluorescein (CF), Propidium iodide (PI), Horseradish peroxidase (HRP), Biotin, Hydroxy benzimide (Hoechst No: 33258), and Ethoxy benzimide (Hoechst No: 33342) were prepared by sonication. Their size and shape were analysed by laser dynamic light spectra and electron microscopy, respectively. The liposome encapsulated and free materials in buffer were instilled, in a volume of 20 microliters, into eyes of anesthetized albino rats. After 30 min and 1 h, the eyes were enucleated and quickly processed for cryosections of 3-5 microns thickness. The interaction of liposome entrapped propidium iodide and HRP was visualized on the outer epithelium of the cornea after specific processing.

Animals↗

PubMed2006

The ocular manifestations of Jacobsen syndrome: a report of four cases and a review of the literature.

PURPOSE: We report ophthalmic manifestations in four Jacobsen syndrome cases, review the literature, and suggest phenotype-genotype correlations. METHODS: Chart review of Ocular Genetics Program patients at The Hospital for Sick Children, Toronto, Canada. RESULTS: Four del11qter cases are presented. Hypertelorism/telecanthus, abnormally slanted palpebral fissures, abnormal retinal findings, nasolacrimal duct obstruction, anomalous extraocular muscles, amblyopia, and microcornea were found. CONCLUSIONS: We report typical findings and novel ocular presentations. Visual prognosis is generally good. Retinal dysplasia and coloboma seem associated with del11q23. ABCG4, NCAM, and Mfrp are candidate genes in this region that theoretically may be disrupted.

ATP Binding Cassette Transporter, Subfamily G↗

PubMed2002

Canalicular stenosis secondary to weekly docetaxel: a potentially preventable side effect.

BACKGROUND: The purpose of this study was to describe canalicular stenosis as a mechanism for epiphora (excessive tearing) secondary to weekly docetaxel. PATIENTS AND METHODS: Fourteen patients with metastatic breast cancer who developed epiphora during weekly docetaxel therapy underwent an ophthalmologic examination, and probing and irrigation of the nasolacrimal ducts. The total duration of docetaxel therapy, the duration of treatment at the time of onset of epiphora, the number of infusions, the cumulative dose of docetaxel and the severity of canalicular stenosis were recorded. RESULTS: All 14 patients had anatomic narrowing of the canaliculi as the underlying mechanism for epiphora. Bicanalicular silicone intubation or dacryocystorhinostomy (DCR) was recommended for all 14 patients. Eleven patients underwent surgery and experienced resolution of their symptoms. The three patients who declined surgery continue to have epiphora at the time of this report. CONCLUSIONS: Canalicular stenosis is an underlying mechanism for epiphora in patients receiving weekly docetaxel. Bicanalicular silicone intubation should be considered early in the course of weekly docetaxel therapy to prevent complete closure of the canaliculi. Once complete or near complete stenosis of the canaliculi occurs, DCR with a permanent pyrex glass tube placement may become necessary to overcome the blockage of tear outflow.

Adult↗

PubMed2006

Switch from antibiotic eye drops to instillation of mother's milk drops as a treatment of infant epiphora.

In a paediatric practice, the management of patients with signs and symptoms of congenital nasolacrimal duct obstruction (CNLO) was switched from topical antibiotic to topical mother's milk (MM) -based regimens. The conservative management of this condition includes frequent cleansing of the lids, digital lacrimal sac massage, and application of topical antibiotic drops when there is a mucopurulent discharge. The method for managing CNLO has evolved in our office of paediatrics during the past 7 years. This change was initiated by some mothers who have applied traditional therapy: MM eye drops. This evolution has been accompanied by a number of articles from the mid 1990s into the 2000s on safety of MM eye drops in case of neonatal conjunctivitis, and on the anti-inflammatory characteristics and antibacterial activity of topical MM.

Anti-Infective Agents↗

PubMed2002

Scalping forehead flap for extranasal reconstructions: total reconstruction of the lower lid.

J. M. Converse described the scalping forehead flap in 1942 with the aim of using it in total nasal reconstruction. A rich net of arterial and venous vessels constitute the basic pattern of its blood supply through three principal pedicles: (1) temporal superficial, (2) supraorbital, and (3) supratrochlear. It was described for nasal reconstruction, but due to its characteristics, such as color of the frontal skin, texture, hairless skin, and reliable irrigation, it can be used in the reconstruction of other facial areas. According to these particularities, the Converse flap was used in the reconstruction of a total left lower lid and adjacent lateral nose and cheek areas in a patient with an extended squamous carcinoma. The tumoral resection included the removal of (1) complete lower lid, (2) lacrimal lower canaliculus, sac, and nasolacrimal duct, (3) lower ocular conjunctiva, (4) intraorbitary fat and both inferior oblique and inferior rectus muscles, and (5) adjacent skin of the nose and cheek. Postoperative controls showed an excellent aesthetic and functional result. A hypochromic frontal skin graft was the only sequela; definitive skin coloration was obtained by a dermopigmentation technique. The versatility of this forehead flap allows it to be successfully used for reconstruction not only in the nasal area but also in other facial ones.

Aged↗

PubMed2004

Posttraumatic obstruction of lacrimal pathways: a retrospective analysis of 58 consecutive naso-orbitoethmoid fractures.

Posttraumatic dacryostenosis represent a troublesome sequela for patients who have sustained centrofacial trauma and can determine complexity in diagnosis and treatment. This article, based on a retrospective analysis of 58 patients with naso-orbitoethmoidal (NOE) trauma, reports the incidence of posttraumatic dacryostenosis and the evolution of such impairments in consideration of fracture type. Experience in diagnosis and treatment is illustrated, and surgical outcomes 6 months after external dacryocystorhinostomy (DCR) are reported. Posttraumatic epiphora was observed in 27 patients with NOE fractures (46.5%). In 10 cases, temporary epiphora was encountered and spontaneous recovery of lacrimal drainage within 5 months was observed. In the remaining 17 cases, permanent epiphora was registered and a frequent association with delayed treatment of facial fracture repair or bone loss in the lacrimal district was found. Surgical reconstruction of lacrimal pathways was performed 6 months after primary surgery, with external DCRs in all 17 patients with epiphora and the presence of nasolacrimal duct obstruction observed with dacryocystorhinography. External DCR with a large rhinostomy achieved a success rate of 94% in the reconstruction of lacrimal drainage. Such a technique proved to be effective in the treatment of posttraumatic dacryostenosis, although patients considered the temporary presence of external scars and stenting material to be a major problem.

Adult↗

PubMed1985

Lacrimal probing complications.

Probing can be accomplished at any age with extreme care. Whenever an individual believes he has developed a false passage, he should stop and come back at a later date to accomplish opening of the obstructed nasolacrimal duct.

Child↗

PubMed1986

Orbital complications of paranasal sinus surgery.

Despite the low complication rate from surgery of the paranasal sinuses, orbital injury may be seen in up to 3% of all procedures. These complications include orbital edema, orbital hemorrhage, enophthalmos, extraocular muscle injury, and nasolacrimal duct obstruction. The most devastating complication is blindness, usually resulting from optic nerve compression with central retinal artery occlusion, or direct injury to the nerve itself. Early recognition of orbital injury during sinus surgery and appropriate intervention may prevent later, more serious ophthalmic complications.

Adult↗

PubMed1986

Intranasal procedures for successful lacrimal surgery.

Successful lacrimal surgery requires specialized knowledge of intranasal surgical anatomy. The clearance of the lower nasolacrimal duct relative to the inferior turbinate and the relationship of dacryocystorhinostomy and conjunctivodac-ryocystorhinostomy sites to upper nasal septum and anterior middle turbinate are not encountered in traditional cosmetic rhinoplasty or procedures for nasal airway obstruction. Intranasal procedures to facilitate lacrimal surgery are described.

Dacryocystorhinostomy↗

PubMed1988

The dacryolithiasis syndrome.

A syndrome of the typical patient with a dacryolith in the lacrimal sac or nasolacrimal duct is described, based on review of 107 consecutive patients undergoing dacryocystorhinostomy (DCR) and 43 patients with a history of dacryocystitis. The incidence of dacryolithiasis was 14% of all patients having a DCR. The typical patient with a dacryolith was 45 years old, had a 4.8 year history of intermittent epiphora, had at least one episode of acute dacryocystitis, and could be irrigated with some fluid getting into the nasopharynx. Patients undergoing DCR with a history of acute dacryocystitis had a nine times higher likelihood of having a dacryolith than DCR patients without a history of acute dacryocystitis. DCR was curative in all 15 patients with a dacryolith.

Adolescent↗

PubMed1989

Correction of vertical retraction of the lower lid with an orbicularis hammock.

Radical maxillectomy is the treatment of choice for malignant tumors of the paranasal sinuses and nasopharynx. Unfortunately, adverse side effects include ectropion, diplopia, and nasolacrimal duct obstruction. We describe a new technique for repair of the cicatricial ectropion and vertical retraction of the lower lid.

Aged↗

PubMed1990

Endoscopic repair of failed dacryocystorhinostomy.

Primary dacryocystorhinostomy (DCR) failure is commonly due to scarring at the rhinostomy site. Nasolacrimal duct obstruction due to scarring may also occur in patients who have had their lacrimal bone removed during maxillary sinus surgery. Five patients following DCR and 3 patients after sinus surgery, all with constant epiphora, underwent endoscopic reconstruction of their lacrimal drainage system. Preoperatively, patency of the bony ostium was determined either by computed tomographic (CT) scan or dacryocystography. Endoscopically, the lacrimal drainage system was reopened then intubated with a silastic stent. Any scar tissue was visualized endoscopically and resected. Seven of the 8 patients have been followed from 3 to 24 months after stent removal, and all have had relief of their epiphora. Endoscopic repair is a useful adjunct in the management of patients with DCR failure or patients with epiphora after removal of the lacrimal bone during sinus surgery. This brief procedure can be performed under local anesthesia, does not require a skin incision, and allows the evaluation and correction of intranasal pathology.

Adolescent↗

PubMed1990

Dacryocystorhinostomy in Wegener's granulomatosis.

Dacryocystorhinostomy was performed on two patients with Wegener's granulomatosis that had been quiescent for many years. Excellent results were attained, with elimination of dacryocystitis, complete relief from epiphora, and maintenance of a patent outflow tract. No wound necrosis occurred postoperatively, in contrast to a previous report in the literature. Our experience suggests that nasolacrimal duct obstruction in the setting of quiescent Wegener's granulomatosis can be treated safely and effectively with dacryocystorhinostomy.

Adult↗

PubMed1991

Nasal catheter use in dacryocystorhinostomy.

A modification of the standard dacryocystorhinostomy (DCR) techniques using a self-retaining nasolacrimal catheter to act as a stent to improve the success rate of nasal ostium patency is described. A series of 21 DCRs performed on 19 patients is presented that includes eight procedures on previously failed DCRs, nine procedures on primary idiopathic obstruction of the nasolacrimal duct, and four procedures where trauma was the etiology. This technique has had no failures except for two procedures that failed because the catheter was too short. This prospective study over 3 years using this technique has resulted in no other cases of closure of the nasal ostium.

Adolescent↗

PubMed1993

Lacrimal sac, conjunctival, and nasal culture results in dacryocystorhinostomy patients.

Chronic dacryocystitis is commonly seen in patients requiring a dacryocystorhinostomy (DCR). The infection may be primary, or may be secondary to an anatomical abnormality that has led to tear flow stasis. It is possible that many cases of primary acquired nasolacrimal duct obstruction are in fact secondary to unrecognized low-grade dacryocystitis. The intent of this study was to determine what organisms grow in the lacrimal sac of patients requiring DCR. It also investigated whether or not there was a correlation between organisms cultured from the sac and from the conjunctiva and/or the nose. The results of the study indicate that there is not a clinically significant correlation. The level of obstruction does not affect whether similar organisms were cultured from the three sites.

Bacteria↗