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PubMed2002

Initial nasolacrimal duct probing in children under age 5: cure rate and factors affecting success.

AIMS: To evaluate the success rate of initial probing and the factors affecting the success rate for congenital nasolacrimal duct obstruction (CNLDO)in children under the age of 5 years. METHODS: In a prospective uncontrolled interventional case series, 207 eyes from 161 consecutive patients with CNLDO underwent nasolacrimal duct probing under brief general anesthesia. Based on exclusion criteria, 180 eyes from 139 patients were included in the study. Diagnoses were made according to the patients' histories, clinical examinations, and modified dye disappearance tests. The state of the punctum, the canaliculus, the sac, and the nasolacrimal duct were recorded. The main outcome measure was the complete disappearance of tearing and discharge in the affected eye. The patients were followed at 1 week, 1 month, and 3 months postoperatively. RESULTS: The age range was 5 to 60 months (mean, 19.1 +/- 11.2 months). The cure rates were 92% in the first year, 84.5% in the second year, 65% in the third year, and 63.5 in the fourth and fifth years of age. The patient's age, nonmemberanous CNLDO, and canalicular stenosis were correlated with the success of initial nasolacrimal duct probing (P <.05). CONCLUSIONS: Based on the results, simplicity of probing, and absence of significant complications, initial nasolacrimal duct probing is advised up to the age of 5 years. Increasing age, nonmembranous CNLDO, and canalicular stenosis increase the failure rate (P <.05).

Age Factors↗

PubMed1996

Balloon catheter dilatation for treatment of congenital nasolacrimal duct obstruction.

PURPOSE: To determine the efficacy of balloon catheter dilatation to treat congenital nasolacrimal duct obstruction in children over 12 months of age and in children who had failed lacrimal system probing or silicone intubation. METHODS: We performed a prospective study of balloon catheter dilatation for congenital nasolacrimal duct obstruction in 61 lacrimal systems of 51 patients with an age range of 13 to 73 months (mean, 26 months). Twenty-seven lacrimal systems (44.3%) had no previous procedures, 21 lacrimal system (34.4%) had one or more failed probings, and 13 lacrimal system (21.3%) had failed silicone intubation. Infection was eliminated or suppressed preoperatively with a ten-day course of systemic and topical antibiotics. Oral and topical antibiotics were continued for ten days after surgery. Oral prednisone was administered for five days after surgery. One percent prednisolone acetate eyedrops were for ten days after surgery. Patency was defined as absence of tearing or discharge after the sixth postoperative week, a lack of discharge and a normal tear meniscus on examination, and a normal dye disappearance test. RESULTS: Twenty-six (96%) of the 27 lacrimal drainage systems that had balloon catheter dilatation as a primary procedure were patent after surgery. Thirty-two (94%) of the 34 lacrimal drainage systems that had undergone previous probing or silicone intubation were patent after balloon catheter dilatation. Overall, 58 (95%) of 61 lacrimal drainage systems were patent after balloon catheter dilatation. CONCLUSION: Balloon catheter dilatation is generally effective in the treatment of congenital nasolacrimal duct obstruction as a primary procedure in children over 12 months of age, and as a procedure after failure of lacrimal system probing or silicone intubation.

Anti-Inflammatory Agents↗

PubMed2002

[Nasolacrimal ducts and the dry eye].

BACKGROUND: The knowledge regarding the pathogenesis, diagnosis, and treatment of dry eye has made large advances in recent years. However, many questions are still unanswered. Although the nasolacrimal ducts are part of the tear system they have been paid nearly no attention regarding dry eye. METHODS: The present knowledge about the nasolacrimal ducts is presented and discussed in a context with dry eye. A PubMED search was conducted for articles published from 1966 to the present; in addition, review articles as well as book chapters were considered and discussions with investigators in the field were performed. RESULTS: As a draining and secretory system, the nasolacrimal ducts play a role in tear transport and non-specific immune defense. Moreover, components of tear fluid are absorbed in the nasolacrimal passage and are transported into a vascular system that surrounds the nasolacrimal sac and nasolacrimal duct. This system is comparable to a cavernous body and it is connected to the blood vessels of the outer eye. Also it is subject to vegetative control. Organized mucosa-associated lymphoid tissue (MALT) is present in the nasolacrimal ducts displaying the cytomorphological and immunophenotypic features of MALT. CONCLUSIONS: The normally constant absorption of tear fluid components into the blood vessels of the surrounding cavernous body that are connected to the blood vessels of the outer eye, could be a feedback signal for tear fluid production, which comes to a halt if these tear components are not absorbed. Thus, dry eye could be initiated. Defective stimulation of tear duct-associated lymphoid tissue (TALT) could result in abnormal immune deviation at the ocular surface leading to an autoimmunological response that causes dry eye pathology.

Autoimmune Diseases↗

PubMed1994

Silicone intubation without intranasal fixation for treatment of congenital nasolacrimal duct obstruction.

PURPOSE: We assessed the efficacy and morbidity of silicone intubation without intranasal fixation to treat congenital nasolacrimal duct obstruction. METHODS: Forty eyes of 30 consecutive patients underwent silicone intubation to treat congenital nasolacrimal duct obstruction. The ends of the silicone tubing were tied together with a single square knot and were allowed to retract into the nose without intranasal fixation. Tubing removal was performed in the office via the medial canthus in all patients. No attempt was made to reposition prematurely dislodged tubing. RESULTS: The success rate for this series was 38 (95%) of 40 eyes in 29 (97%) of 30 patients. Of seven eyes that required unplanned early tubing removal for dislocated tubing, five eyes nevertheless showed complete resolution of nasolacrimal duct obstruction. Only one patient underwent a second silicone intubation under general anesthesia. CONCLUSIONS: Silicone intubation without the use of intranasal fixation is an effective strategy for treating congenital nasolacrimal duct obstruction. It spares most patients from a second procedure under general anesthesia and achieves success rates comparable to previous studies in which more complex techniques were used.

Child↗

PubMed2002

[Complications after catheterization of nasolacrimal duct].

THE AIM OF THIS STUDY: Is to identify two severe complications after catheterism of nasolacrimal duct. A boy, 9 months old, was treated in Clinica I Oftalmologie laşi for presptal cellulitis after catheterism of nasolacrimal duct which was performed in other Eye clinic, without general anesthesia. Also, this child presented the rupture of punctal and inferior canalicular duct. CONCLUSION: Catheterism of nasolacrimal duct must be performed by ophthalmopediatric doctors with experience, under general anesthesia, to prevent complications.

Catheterization↗

PubMed2001

The role of nasal endoscopy in repeat pediatric nasolacrimal duct probings.

PURPOSE: To determine whether pediatric nasal endoscopy improves treatment success in recurrent nasolacrimal duct obstruction. METHODS: A retrospective analysis was carried out on 2 nonrandomized cohorts of consecutively treated patients who had one failed nasolacrimal duct probing at the Hospital for Sick Children, University of Toronto. The first cohort of 24 consecutive patients (32 eyes), group A, was treated with Crawford silicone tube intubation by one ophthalmologist (R.C.P.). The second cohort of 23 consecutive patients (33 eyes), group B, was treated with repeat probing by a second ophthalmologist (A.V.L.) in conjunction with nasal endoscopy by one otolaryngologist (V.F.). Abnormalities found on endoscopy were treated accordingly, and no tubes were inserted. Follow-up, through phone interviews or office visits, was conducted to assess the patients' symptoms. RESULTS: Group A patients were older at both the first probing (P = .048) and the second procedure (P = .012). No significant difference in the failure rates was found, with treatment failing in 3 eyes (2 patients) in group A and in 5 eyes (4 patients) in group B (P = .479). Interestingly, 17 of the 32 tubes in group A were extruded in 1 month or less. Also, 28 of 33 eyes in group B had abnormalities on endoscopy-some, multiple. Twenty-two eyes underwent inferior turbinate infracture: 5 had redundant mucosa, which was removed, and 6 had abnormal openings of the inferior meatus. CONCLUSIONS: We were unable to show any benefit of nasal endoscopy over intubation of the nasolacrimal system with silicone tubes in the treatment of failed probings despite the identification and treatment of abnormalities. The study was limited by its low power to detect differences because of the small number of patients and the high success rate of the traditional treatments for congenital nasolacrimal duct obstruction.

Child↗

PubMed2002

Success of balloon catheter dilatation as a primary or secondary procedure for congenital nasolacrimal duct obstruction.

PURPOSE: To determine the efficacy of lacrimal balloon catheter dilatation in treating congenital nasolacrimal duct obstruction (CNLDO) as a primary procedure in children more than 18 months of age and in children who have failed lacrimal probing or silicone intubation. DESIGN: Retrospective, interventional case series. PARTICIPANTS: Fifty-nine patients, ranging in age from 15 months to 9 years (mean, 35.6 months), with 73 lacrimal systems diagnosed with CNLDO who underwent nasolacrimal balloon catheter dilatation. Thirty-four lacrimal systems (46.5%) had no previous procedures, whereas 39 lacrimal systems (53.5%) had failed probing, silicone intubation, or both. INTERVENTION: Balloon catheter dilatation was performed following standard protocol, with a simplified regimen in most patients. MAIN OUTCOME MEASURES: Clinical patency of the nasolacrimal duct after balloon dilatation was the main outcome measure and was defined as complete resolution of signs and symptoms (crusting, discharge, and increased tear meniscus). Age, inferior turbinate infracture, and Downe's syndrome as related to the main outcome measure were also analyzed. RESULTS: Overall, 56 of the 73 lacrimal systems (76.7%) had complete resolution of symptoms. Twenty-seven of all 34 primary balloon catheter dilatations (79.4%) remained clinically patent, whereas 29 of all 39 secondary balloon catheter dilatations (74.4%) remained clinically patent after surgery (P = 0.8165). Thirty-nine of 47 lacrimal systems (82.9%) in children older than 24 months remained clinically patent, whereas 17 of 26 lacrimal systems (65.4%) in children younger than 24 months remained clinically patent (P = 0.1573). The mean age of patients with successful outcomes was 37 months, whereas the mean age of patients with failed balloon catheter dilatations was 32 months (P = 0.3924). In the secondary procedure group, analysis showed that the mean age of success (32 months) was greater than the mean age of failure (18 months; P = 0.0491). Within the secondary group, 16 of 17 lacrimal systems (94.1%) older than 24 months were successful, whereas 13 of 22 lacrimal systems (59.1%) younger than 24 months were successful (P = 0.0344). CONCLUSIONS: Balloon catheter dilatation is an effective treatment for congenital nasolacrimal duct obstruction. In particular, balloon catheter dilatation in older children who failed previous probing is highly successful.

Catheterization↗

PubMed2005

Balloon dacryocystoplasty as the primary treatment in older children with congenital nasolacrimal duct obstruction.

PURPOSE: To report the outcomes of balloon dacryocystoplasty of the lacrimal duct with inferior turbinate infracture as a primary treatment of congenital nasolacrimal duct obstruction in children 18 months of age or older. MATERIALS AND METHODS: This study was a 3-year, prospective, interventional case series, consisting of 83 consecutive patients with congenital nasolacrimal duct obstruction who underwent balloon dacryocystoplasty as their primary treatment modality. Outcome evaluations included an ophthalmologic examination and a dye disappearance test at 3 weeks and 6 months postoperatively. We analyzed the different age groups and the types of obstruction noted at surgery to determine their respective influences on patient outcomes. We used the chi-square test for statistical analysis. RESULTS: Seventy-two patients aged 18 to 112 months (mean 30 months) were included. Overall, 57 patients (79%) had good outcomes from balloon dacryocystoplasty. When analyzed by type of obstruction, 34/42 patients (81%) with simple membranous obstruction at the valve of Hasner had good outcomes and 23/30 patients (77%) with stenosis that extended along the length of the distal NLD had good outcomes (P = 0.60, power 0.62). Age did not significantly affect outcomes (P = 0.66, power 0.72). CONCLUSIONS: Balloon dacryocystoplasty is probably more effective than simple probing in older children with stenosis extending along the distal nasolacrimal duct obstruction.

Catheterization↗

PubMed1996

Treatment of recurrent nasolacrimal duct obstructions with balloon-expandable metallic stents: results of early experience.

PURPOSE: To evaluate the efficacy of Palmaz balloon-expandable metallic stents for the maintenance of luminal patency in the treatment of recurrent nasolacrimal duct, obstructions after failed transluminal balloon dilatation. METHODS: Metallic stents were implanted in the nasolacrimal duct of four patients with recurrent epiphora. All the patients had already undergone transluminal balloon dilatation of the nasolacrimal duct with no or only temporary improvement. In two eyes, 9.5-mm-long Palmaz stents were used; in the other two eyes, 20-mm-long articulated-design Palmaz stents were placed under digital fluoroscopic monitoring. In each case, the upper tip protruded slightly into the lacrimal sac and the lower end was positioned inside the nasolacrimal duct. RESULTS: The stents were placed accurately in all cases, and no complications were observed. After stent placement, all patients had complete resolution of epiphora. During the follow-up period of 10 months, although complete obstruction did not occur in any case, complete resolution of epiphora was maintained only in one of four eyes. In two eyes, improvement was remarkable. In one eye with partial improvement, intrastent balloon dilatation was performed. CONCLUSION: Treatment of recurrent nasolacrimal duct obstructions with balloon-expandable metallic stents is a noninvasive, efficient, and safe outpatient procedure that may be an alternative to surgery as a means for managing epiphora.

Adult↗

PubMed1994

Long-term results after probing for congenital nasolacrimal duct obstruction.

The long term results of probing for congenital nasolacrimal duct obstruction were reviewed using a parental questionnaire issued to both treated and age-matched control groups. On follow up 4-13 years after probing in childhood 30% of patients still had symptoms of epiphora or discharge. Surprisingly, a similar high symptom rate was found in the controls, such that there was no statistically significant difference in the rate of symptoms between the two groups. Probing had therefore apparently reduced the symptom rate to a level close to normal for the age group concerned. All studies on the incidence of congenital nasolacrimal duct obstruction must be interpreted with reference to the known high rate of spontaneous resolution as a clear trend has been demonstrated towards a lower incidence of symptoms the longer the follow up after probing. This finding would support a policy of delay before further intervention in patients with mild residual symptoms after a technically successful probing.

Child↗

PubMed1998

Ritleng intubation system for treatment of congenital nasolacrimal duct obstruction.

Twenty-eight patients (34 eyes) with congenital nasolacrimal duct obstruction underwent silicone intubation with the Ritleng lacrimal intubation system. The technique involves introduction of a Prolene (Ethicon Inc, Somerville, NJ) monofilament guide thread, securely fastened to the silicone tubing, into a tubular metal probe that opens into the inferior meatus. The outcome was evaluated in terms of ease of intubation and objective success rate. Thirty-two (94%) of the 34 lacrimal systems were successfully intubated with the Ritleng system. Difficulty passing the Prolene thread through the probe and out the tip, necessitating conversion to a Crawford intubation system, was encountered in only 2 eyes (6%). The Prolene spontaneously emerged from the nose in 24 (75%) of 32 eyes, making retrieval simple and uncomplicated. The success rate for relieving signs and symptoms of obstruction was 97% (31/32) for the eyes with the Ritleng system and 100% (2/2) for the eyes with the Crawford system. Bicanalicular silicone intubation with the Ritleng intubation system is an easy and effective technique for treatment of congenital nasolacrimal duct obstruction.

Child, Preschool↗

PubMed1996

Microbiologic, radiographic, and anatomic study of the nasolacrimal duct apparatus in the rabbit (Oryctolagus cuniculus).

This study was motivated by the sporadic observation of epiphora in two male rabbits. The epiphora was unilateral and not associated with conjunctivitis or Pasteurella infection. To characterize the cause of epiphora, we studied 15 specific-pathogen-free New Zealand White rabbits. This study group was composed of the two affected males, four unaffected males, and nine unaffected females. Clinical evaluation consisted of bacterial culture of conjunctival specimens, examination of conjunctival scrapings for chlamydial inclusions, culture and cytologic examination of specimens from the nasolacrimal duct, plain and contrast radiography, latex casting, histologic examination, and the Schirmer tear test. Important differences found in the rabbits with epiphora included an opalescent, gritty, nasolacrimal duct flush fluid and marked unilateral dilatation of the duct proximal to a dorsal flexure at the caudal limit of the incisor tooth root. The flush solution from one affected rabbit cleared with ether, suggesting the presence of triglycerides or cholesterol. The organisms most commonly isolated from the conjunctiva were Moraxella sp., Oligella urethralis, Staphylococcus aureus, coagulase-negative Staphylococcus sp., and Streptococcus viridans. The organisms most commonly isolated from the nasolacrimal duct flush fluid were Moraxella sp., S. viridans, and Neisseria sp. Culture of the nasolacrimal duct flush fluid yielded microorganisms more consistently than did culture of the conjunctival specimens. All microorganisms isolated from affected rabbits also were isolated from unaffected rabbits. There was no apparent contribution of microorganisms to the development of epiphora, and Schirmer tear test results for affected animals were within the range seen in unaffected animals. Occlusion of the nasolacrimal duct was presumed to be attributable to fat droplets. This study augments the existing literature and represents the first report of anomalous nasolacrimal duct anatomic features in the rabbit.

Animals↗

PubMedDate not supplied

Conventional or endoscopic probing for congenital nasolacrimal duct obstruction.

PURPOSE: To compare conventional and endoscopic probing for congenital nasolacrimal duct obstruction in infants. METHODS: Conventional probing was performed in 22 eyes of 18 patients, age range 7-14 months (mean 11.4 months). Probing was done with intranasal endoscopic visualization in 18 eyes of 14 patients, age range 7-13 months (mean 11.2 months). All were primary probing cases. RESULTS: After conventional probing 2 of the 22 cases required reprobing. After endoscopic probing only 1 of the 18 cases required reprobing. CONCLUSIONS: In most cases of congenital nasolacrimal duct obstruction endoscopy is not required; however, in failed cases direct visualization of the inferior meatus with endoscopic guidance may be helpful.

Dacryocystorhinostomy↗

PubMed2004

The experience with Ritleng intubation system in patients with congenital nasolacrimal duct obstruction.

BACKGROUND: To report the clinical experience and success rate with Ritleng intubation system in patients with congenital nasolacrimal duct obstruction. METHODS: Twenty-four patients (32 eyes) with congenital nasolacrimal duct obstruction treated with the Ritleng intubation system were enrolled in this study. The mean age was 20.1+/-9.6 months. The technique involved introduction of a Prolene monofilament guide thread, securely fastened to silicone tubing, into a tubular metal probe that opened into the inferior meatus. Success was defined as complete resolution of previous symptoms and a normal result of dye disappearance test in cooperative patients. To establish relationship of success rate with patients' ages, these data were compared and analyzed. RESULTS: All eyes were successfully intubated with the Ritleng system. The Prolene monofilament spontaneously emerged from the nose in 19 (60%) of 32 eyes, making retrieval simple and uncomplicated. The overall success rate (of all aged groups) was 90%. In the group over 24 months of age, there was no significant decrease in the success rate (p > 0.1), but obvious difficulty in intubation and lengthy operation time were noted. CONCLUSIONS: Silicone intubation with the Ritleng system is an effective treatment for patients with congenital nasolacrimal duct obstruction, especially at young age. Comparing with conventional metal probe system, there was minimal nasal bleeding and trauma to the nasal mucosa with Ritleng intubation system. With the advantage of easy retrieval, operation time can be shortened, thereby improving patient care and decreasing potential morbidity.

Age Factors↗

PubMed1988

A simple aid to successful probing of congenitally obstructed nasolacrimal ducts.

For successful probing of congenitally obstructed nasolacrimal ducts in infants, the probe must reach the inferior nasal meatus. Previous methods to determine the position of the probe in the nose require intranasal examination method using two probes of equal length. The first probe is placed inside the lacrimal outflow system and the second probe is placed against the nose. The second probe can be used to measure the distance between the point of the first probe and the anterior narial margin. This method may be particularly valuable in those cases in which the probe point is less than 5 mm below the anterior narial margin.

Evaluation Studies as Topic↗

PubMed1994

Dacryocystoplasty: treatment of epiphora by means of balloon dilation of the obstructed nasolacrimal duct system.

PURPOSE: To evaluate treatment of epiphora due to acquired stenotic obstruction of the nasolacrimal duct system with dacryocystoplasty (DCP), in which balloon dilation is used to alleviate the obstruction. MATERIALS AND METHODS: Twenty patients (21 eyes) with epiphora due to obstructing lesions at the saccular or subsaccular level were treated with DCP. The authors used a catheter with a balloon diameter of only 3 mm to prevent damage to the nasolacrimal duct system and a nontraumatizing guide wire. Stent placement was not considered necessary. Follow-up ranged from 14 to 70 weeks. RESULTS: Cannulation was not possible in one case of complete obstruction. DCP was successfully performed in the other 20 cases. In 18 of these cases (90%), results comparable with those of dacryocystorhinostomy were achieved. No side effects were observed. CONCLUSION: DCP is potentially the treatment of choice for epiphora due to acquired stenotic obstruction of the nasolacrimal duct system.

Adult↗

PubMed2004

Lacrimal intubation with the Ritleng system in recurrent congenital nasolacrimal duct obstruction in children.

PURPOSE: To evaluate the efficacy of the Ritleng lacrimal intubation system in the treatment of congenital nasolacrimal duct obstruction. METHODS: Twenty-six patients (29 eyes) with congenital nasolacrimal duct obstruction, who ranged in age from 2 to 12 years (mean, 4.85 +/- 2.9 years), underwent silicone intubation with the Ritleng lacrimal intubation system. The Ritleng lacrimal intubation system is composed of a Ritleng probe, a monofilament guide thread and a silicone tube. The prolene tip was removed from the inferior meatus with nasal endoscopy in 26 eyes, whereas this was done by using a Ritleng hook in 3. Clinical success was defined by the relief from symptoms and signs of obstruction. The tubes were left in place for an average of 6 months. The patients were followed up between 6 and 25 months (mean, 8.3 months). RESULTS: All cases were successfully intubated with the Ritleng system. Two cases underwent reintubation because of tube dislocation during the first week. Granuloma developed at the edge of the inferior punctum in 1 case. We observed relief from symptoms in all cases. CONCLUSION: The Ritleng lacrimal intubation system is an easy, effective and nontraumatizing procedure for the treatment of congenital nasolacrimal duct obstruction.

Child↗

PubMed1990

Repair of anomalous nasolacrimal duct in a bull by use of conjunctivorhinostomy.

A proximal nasolacrimal duct anomaly, believed to be congenital, in a bull was repaired by use of conjunctivorhinostomy. Initial attempts at correction, using prolonged nasolacrimal duct catheterization, were unsuccessful. Trephination from the medial canthus to the ventral nasal meatus, combined with long-term catheterization of this new passage, was successful in resolving clinical signs of disease.

Animals↗