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Microsurgery and lacrimal system.

Where epiphora results from canalicular obstruction, it is usually possible to cure the patient by reconstructing the canaliculi themselves. Resort to artificial bypass tubes is thus not often necessary. This paper discusses the role of the operating microscope in facilitating reconstruction of the lacrimal canaliculi so that longer segment of obstructed canaliculus can be reopened and more accurate reconstitution of the anatomy achieved. The place of fibre optics is outlined. Easier techniques for repairing lacerated canaliculi are described.

Dacryocystorhinostomy↗

[Dacryocystorhinostomy without bone perforation (author's transl)].

Present techniques of dacryocystorhinostomy require perforation of the frontal process of the maxillary bone in order to open a passageway between the conjunctival sac and the nasal fossa. This requires a relatively complex operation and leaves an almost horizontal conduit, flow rarely being perfect. A new technique for dacryocystorhinostomy which obviates the necessity for osseous perforation by passing a tube beneath the soft tissues of the face just superficial to the maxillary bone, between the lacus lacrimalis and the nasal atrium. The external diameter of the tube should not exceed 2 mm to that is produced no visible elevation on the surface of the face. The almost vertical position of the tube and the position of its inferior opening in the zone of maximal respiratory flow assures good drainage of tears. The operation can be performed in a few minutes, under local anesthesia, in the surgeon's office.

Anesthesia, Local↗

Thermographic evaluation of the human lacrimal drainage system.

A new method for evaluating the anatomy and patency of the human lacrimal drainage system is presented. Thermography was used in conjunction with routine lacrimal irrigation to visualize the tear ducts in normal subjects and in a patient with obstructive epiphora. The canaliculi, common canal, and lacrimal sac could be identified, and certain abnormalities detected with this technique. Additional information can be obtained regarding the presence of subclinical inflammation. The authors feel that thermography offers promise as a safe, simple technique for evaluating the lacrimal anatomy in patients with epiphora.

Dacryocystitis↗

The slit canaliculus.

Canalicular stent tubes were inserted in patients at canaliculo-dacryocystorhinostomy, dacryocystorhinostomy with a common internal punctum membrane, or at dacryocystorhinostomy with small mucosal anastomosis. Canalicular slits occurred in 16% of cases, more often with polyethylene than with silicone, and more often with increased duration of implantation. With a large patent mucosal flap anastomosis, slitting did not significantly impair function. The need for adequate mucosal anastomosis is emphasized in the treatment of canalicular disease.

Humans↗

Dacryocystorhinostomy: a review of 119 cases.

One hundred nineteen dacryocystorhinostomies were reviewed and were found to be most commonly performed on females in their seventh decade, with silent epiphora being the most common presenting symptom. Trauma was the single most frequent cause of surgery in males and required complex reconstruction in most cases. Three of the seven dacryocystorhinostomy failures occurred in these traumatic dacryostenosis cases. An unusually high percentage of dacryocystorhinostomy surgery was performed on women who had had previous hysterectomies or serious gynecologic pathology.

Adolescent↗