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Results for “LACRIMAL APPARATUS”

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At least 901 records · Page 50Linked to original sources
PubMed1994

Severe dry-eye syndrome following external beam irradiation.

PURPOSE: There are limited data in the literature on the probability of dry-eye complications according to radiotherapy dose. This study investigates the risk of radiation-induced severe dry-eye syndrome in patients in whom an entire orbit was exposed to fractionated external beam irradiation. METHODS AND MATERIALS: Between October 1964 and May 1989, 33 patients with extracranial head and neck tumors received irradiation of an entire orbit. Most patients were treated with 60Co. The dose to the lacrimal apparatus was calculated at a depth of 1 cm from the anterior skin surface, the approximate depth of the major lacrimal gland. The end point of the study was severe dry-eye syndrome sufficient to produce visual loss secondary to corneal opacification, ulceration, or vascularization. RESULTS: Twenty patients developed severe dry-eye syndrome. All 17 patients who received doses > or = 57 Gy developed severe dry-eye syndrome. Three (19%) of 16 patients who received doses < or = 45 Gy developed severe dry-eye syndrome; injuries in the latter group were much slower to develop (4 to 11 years) than in the higher dose group, in whom corneal vascularization and opacification were usually pronounced within 9-10 months. There were no data for the range of doses between 45.01 and 56.99 Gy. The data did not suggest an increased risk of severe dry-eye syndrome with increasing age. CONCLUSION: Data from the current series and the literature are combined to construct a sigmoid dose response curve. The incidence of injury increases from 0% reported after doses < or = 30 Gy to 100% after doses > or = 57 Gy.

Adolescent↗
PubMed2000

Endoscopic dacryocystorhinostomy: anatomical approach.

Dacryocystorhinostomy is the surgical treatment for nasolacrimal blockage. In recent years, the endoscopic approach has become more popular due to the development of nasal endoscopes and the ease of surgery in comparison to the external approach. In order to identify the lacrimal duct during surgery, surgeons insert a light pipe into the lacrimal duct and then drill or chisel the hard bone of the frontal process of the maxilla to remove the bony covering of the sac and duct. It is obvious that knowledge of the anatomy of the lacrimal sac/duct within the nose is essential for the surgeon. The lacrimal apparatus in the nose was studied using 10 cadaveric half-heads (5 males and 5 females) to establish the anatomical landmarks and most accessible part of the lacrimal duct from within the nose. Although there was solid bone covering the whole length of the sac and the duct, the posteromedial aspect of the lower sac and upper duct was covered by the ultra thin lacrimal bone (average thickness 0.057 mm) which was consistently found to be lying immediately anterior to the uncinate process in the middle meatus, thus constituting a "surgical window" (average size 2.5 mm x 7.2 mm) whereby surgical entry into the lacrimal duct becomes relatively easy. The lower part of the lacrimal sac and the upper part of the lacrimal duct can therefore be easily accessed from within the nose by following this anatomical approach, thus avoiding the need to drill or chisel the dense frontal process of the maxilla.

Aged↗
PubMed2003

Punctal-canalicular stenosis associated with mitomycin-C for corneal epithelial dysplasia.

PURPOSE: To report a case of punctal-canalicular stenosis after topical mitomycin C use for corneal dysplasia. To the authors' knowledge, this association has not previously been described. DESIGN: Observational case report. METHOD: A 62-year-old woman was noted to have a right inferotemporal corneal dysplastic lesion. She received a topical course of mitomycin-C 0.04% four times a day, which subsequently invoked a toxoallergic reaction. One month later, the patient developed right-sided epiphora. RESULTS: Probing demonstrated complete stenosis of the right lower canaliculus, 5 mm from the punctum. CONCLUSION: Mitomycin-C use may lead to lacrimal apparatus fibrosis and symptomatic epiphora when inciting a toxoallergic reaction.

Administration, Topical↗
PubMed2005

[Dacryocystography in adult lacrimal system evaluation].

PURPOSE: To evaluate dacrycystographic examination in patients with suspicion of lacrimal apparatus obstruction. METHODS: A retrospective study was performed to evaluate dacryocystographies of 100 adults suspected of nasolacrimal duct obstruction at the "Faculdade de Medicina de Botucatu-UNESP". The data were submitted to descriptive statistical analysis and chi-square test. RESULTS: The patients were mainly female, over 60 years old, presenting a low obstruction located at Arlt's sinus, with a grade 2 or 3 lacrimal sac. Lacrimal pathways with normal tear drainage, with or without dilatation and nasal alterations such as concha hypertrophy were also observed. CONCLUSION: Dacryocystographic evaluation was important to show the level of obstruction, the presence of dilatation of the lacrimal sac, as well as alterations in nearby structure. This information might influence the adopted surgical technique and the final treatment results.

Adult↗
PubMed1998

The 'swing-door' technique for uncinectomy in endoscopic sinus surgery.

Uncinectomy is an important step in endoscopic sinus surgery. The traditional method of performing uncinectomy has the risk of penetration of the lamina papyracea with orbital fat exposure. If the orbital penetration is not recognized, major complications may follow. In this study the authors used historical consecutive controls to compare the incidence of orbital penetration, identification of the natural ostium and lacrimal apparatus injury by the traditional surgical technique and a new technique of uncinectomy. Six hundred and thirty-six uncinectomies have been performed using the 'swing-door' technique. The 636 uncinectomies performed prior to changing techniques were used as historical controls. The incidence of orbital penetration (six compared to 0; p < 0.05) and ostium non-identification (42 not identified as compared to 0; p < 0.001) was significantly less with the new technique. One lacrimal injury occurred with the 'swing-door' technique compared to zero with the standard technique (p > 0.05). The techniques are described and the complications discussed. The authors recommend this technique as it is easy to learn, allows removal of the uncinate flush with the lateral nasal wall and allows easy identification of the natural ostium of the maxillary sinus.

Endoscopy↗
PubMed1982

[Direct canthorhinostomy--contribution to the surgery of the tear pathways (author's transl)].

The method of choice in the obstruction of the tear pathways is dacryocystorhinostomy (DCR). It is indicated in cases of an obstruction of the lower segment of the lacrimal apparatus. It cannot be applied in cases of the obstruction of the upper segment of the tear pathways. In such pathologic conditions, the new tear pathway is formed from a part of the mucous membrane of the lateral nose wall and from a part of the mucous membrane of the septum. In a form similar to a tube, the mucous membrane of the nose will be sewn up with the mucous membrane of the conjuctiva. Direct suture is made possible by canthotomy, and, therefore, this surgery is called "Direct Cantorhinostomy".

Conjunctiva↗
PubMed2003

Endonasal dacryocystorhinostomy with mucosal flaps.

PURPOSE: To describe a new endonasal dacryocystorhinostomy (DCR) technique and assess its efficacy. DESIGN: Prospective nonrandomized interventional case series. METHODS: A prospective series of 44 consecutive endonasal DCRs performed from January 1999 to December 2000 was entered into the study. The new technique involved creation of a large bony ostium and mucosal flaps to create an anastamosis between the lacrimal sac mucosa and nasal mucosa. Patients presenting with naso-lacrimal duct obstruction based on symptomatic, clinical, and radiologic grounds were included in the study. Patients who had undergone previous lacrimal surgery were excluded. Surgery was performed by two surgeons (A.T., P.J.W.) using a standardized operative technique. Patient demographics, presentation, examination findings, surgical and anesthetic data, postoperative success, complications, and follow-up were evaluated. Success was defined as anatomic patency as well as relief of symptoms as assessed by fluorescein flow on nasendoscopy, lacrimal syringing, and patient examination. Intubation of the lacrimal apparatus was performed in all operations and the tubes usually removed at 4 to 6 weeks postoperatively. After removal of the tubes follow-up was 13 months (mean, 12.9 months; range, 9-28 months; standard deviation [SD], 6.1 months). RESULTS: There were 36 patients (12 male/24 female) who underwent 44 endonasal DCRs. The average age of the patients was 62.9 years old (range, 15-86 years old; SD, 19.1 years) and the main presentation was with epiphora (93%) and/or mucocoele (33%). In 13 operations (30%) a septoplasty was required at the time of surgery, and in 10 operations (23%) further endoscopic sinus surgery was performed in conjunction with the DCR. Anatomic success with a patent nasolacrimal system was achieved in 40 of 44 operations (91%). Symptomatic and anatomic success was seen in 39 of 44 operations (89%). Five of the DCRs were classified as failures. In one DCR the patient was symptomatic despite a patent nasolacrimal system and well-healed ostium. In two DCRs preoperative medial canalicular problems were noted. In two DCRs scarring and fibrosis of ostium were noted. CONCLUSIONS: This new technique of endonasal DCR involves creation of a large ostium and construction of nasal and lacrimal sac mucosal flaps. Its anatomic success rate (91% or 40 of 44 DCRs) compares favorably with the success rate of other techniques for endonasal DCR and is also similar to the success of external DCR. Experience in endoscopic nasal surgery is important in endonasal DCR surgery, as other ancillary procedures may be required within the nose at the time of surgery.

Adolescent↗
PubMed2000

Frequency of the common canaliculus: a radiological study.

BACKGROUND: It is frequently stated in the literature that there is a common canaliculus (CC) in the lacrimal drainage system in about 90% of individuals; in the remaining 10%, the upper and lower canaliculi enter the lacrimal sac separately. To our knowledge, there is no quantitative study supporting this assumption. OBJECTIVE: To investigate the frequency of the CC and other anatomical types connecting the upper and lower canaliculi to the lacrimal sac. MATERIALS AND METHODS: We presumed that there might be 3 different types of anatomical connection between the lacrimal sac and the canaliculi. Digital subtraction macrodacryocystograms obtained from 281 patients with obstructive epiphora were reviewed, and those of 247 patients were included in the study. These patients were grouped according to the anatomical types. RESULTS: Dacryocystographies were performed on 153 patients unilaterally and 94 bilaterally. We observed a CC in 321 (94.1%) of 341 lacrimal drainage systems. In 13 lacrimal drainage systems (3.8%), the CC was absent, but the upper and lower canaliculi joined at the wall of the lacrimal sac. In only 7 lacrimal drainage systems (2.0%) did the upper and lower canaliculi enter the sac separately. In 2 patients with bilateral dacryocystograms, a CC was seen on one side but not on the other side. CONCLUSIONS: The frequency of separate drainage of the upper and lower canaliculi into the lacrimal sac is only 2.0%. The CC might not be present bilaterally in all individuals.

Adolescent↗
PubMed1977

A new simple method for canalicular intubation.

A series of ten patients had canalicular intubation with Teflon and Silastic tubing. Our experience has shown that Silastic tubing appears to be more pliable, has good capillary action, and causes less irritation within the canalicular system than polyethylene or Teflon tubing. Five patients had very good results, three patients were improved, and there were two failures. We believe that this technique is useful in selected cases where there is an obstructed canaliculus near its junction with the sac. There should be only minimal scarring in the medial canthal area for the greatest chance of success with this method.

Dacryocystorhinostomy↗