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PubMed1992

Nasal endoscopy in the outpatient clinic.

The introduction of the nasal endoscope has greatly advanced the diagnostic and therapeutic capability of otolaryngologists in the office setting. With continued technologic developments in endoscopic equipment and topical intranasal anesthesia, further advances are expected that undoubtedly will expand endoscopic diagnosis treatment in the office setting. Presently otolaryngologists are beginning to use endoscopes in the evaluation and treatment of nasolacrimal duct obstruction, and we are aware of one case of cerebrospinal fluid leak that has been repaired in the office setting with nasal endoscopic technique. (Lanza D: personal communication, 1991).

Ambulatory Care↗
PubMed1992

Acquired lacrimal drainage obstruction: an etiologic classification system, case reports, and a review of the literature. Part 1.

The cause of acquired lacrimal drainage obstruction may be primary or secondary. Primary acquired nasolacrimal duct obstruction results from inflammation of unknown cause that eventually leads to occlusive fibrosis. Secondary acquired lacrimal drainage obstruction, the theme of this report, may result from a wide variety of infectious, inflammatory, neoplastic, traumatic, or mechanical causes. An etiologic classification system for acquired lacrimal drainage obstruction is proposed, and it is illustrated by representative patients from the author's practice and discussed with reference to published reports.

Adolescent↗
PubMedDate not supplied

A review of 120 cases of dacryocystorhinostomies (Dupuy Dutemps and Bourguet technique).

BACKGROUND: The study was conducted at the DHQ hospital Lakki Marwat from Jan, 1999 to Dec, 2002 to assess the intra and postoperative complications and success rate of external dacryocystorhinostomy (DCR) with suturing of the bridge between anterior flaps of nasal mucosa and lacrimal sac with the muscle layer. METHOD: We operated upon 120 patients suffering from chronic dacryocystitis (CDC). Females were 81 (67.5%) and males were 39 (32.5%). Majority of the patients were between the age group 40 to 60 years. Indications for dacryocystorhinostomy (DCR) were epiphora, acute on chronic dacryocystitis and a mucocele. All the cases were operated under local anaesthesia with external approach and only anterior flap suturing and engaging it in the muscle layer. These patients were followed for a period of six months. RESULTS: The overall success rate was 98.33%. The successful outcome was defined as symptomatic relief from epiphora and dacryocystitis and a patent nasolacrimal duct upon syringing. CONCLUSIONS: Dacryocystorhinstomy is a safe procedure under local anaesthesia. It is associated with minimal complications, which can be easily managed. This technique has a very high success rate and a short learning curve.

Adult↗
PubMed2004

Bilateral congenital dacryocystocele as a cause of respiratory distress in a newborn.

Newborns with respiratory distress and nasal obstruction must be examined for congenital dacryocystocele. This disease is caused by a stenosis in the proximal and distal area of the nasolacrimal duct and leads to a cystic dilatation of this duct. A case of a newborn with bilateral dacryocystocele and dyspnoea is presented. The otorhinolaryngologic as well as the paediatric examination could only reveal in the rhinoscopic examination a tumor of the left nasal cavity that partly obstructed the endonasal space. No other pathologic findings were detected. To clarify the origin and the localization of the tumor as well as to exclude an intracranial relation, a magnetic resonance imaging of the middle face and the frontal skull base was performed. After probe and rinsing of the lacrimal ducts the symptoms improved rapidly. In newborns with nasal obstruction a bilateral rhinoscopy of the lower nasal meatus is required to exclude the existence of a dacryocystocele.

Humans↗
PubMed1992

Bilateral dacryocystitis after punctal occlusion with thermal cautery.

A 61-year-old woman developed acute bilateral dacryocystitis secondary to Staphylococcus aureus 3 weeks after undergoing punctal occlusion with thermal cautery for keratoconjunctivitis sicca. The dacryocystitis resolved with intravenous antibiotics, aspiration of the lacrimal sacs, injection of sulfacetamide into the lacrimal sacs, and bilateral dacryocystorhinostomy. Preexisting bilateral nasolacrimal duct obstruction was postulated as the underlying cause. In these cases, irrigation of the lacrimal system is recommended before proceeding with punctal occlusion.

Anti-Bacterial Agents↗
PubMed2002

[Study of computed tomographic dacryocystography used in endoscopic intranasal dacryocystorhinostomy preoperatively].

OBJECTIVE: To study computed tomographic dacryocystography used in endoscopic intranasal dacryocystorhinostomy preoperatively. METHOD: Ten volunteers and twelve patients with dacryocystitis were undergone the coronary and axial computed tomographic dacryocystography. RESULT: According to the anatomic relationship between anterior ethmoid sinus and fossa of lacrimal sac, the cells of anterior ethmoid sinus were classified into three typies: the result was that type I accounted for 12 sides (27.3%), type II 18 sides (40.9%), type III 14 sides (31.8%) by analysing the data of axial dacryocystographies; the sites of obstruction were connection of the lacrimal sac with nasolacrimal duct, the form of lacrimal sac of 11 patients was normal or enlarged lacrimal sacs, bilateral cricatrized lacrimal sacs were found in one patient by analysing the data of coronary dacryocystographies. CONCLUSION: Computed tomographic dacryocystography preoperatively can provide significant clinical guidance for the endoscopic transnasal dacryocystorhinostomy in locating the site of bone-opening.

Adult↗
PubMed2002

[Semiconductor laser use in endoscopic transnasal dacryocystorhinostomy].

OBJECTIVE: To explore the using and value of semiconductor laser in endoscopic transnasal dacryocystorhinostomy. METHOD: In 8 cases with obstruction of nasolacrimal duct, after being had submucous resection of nasal septum, nasal polypectomy or sinus resection, we used the fiberoptic light probe through the canalis nasolacrimalis to confirmed the location of sacculus lacrimalis and resected the mucosa and bone on lateral wall of nasal cavity that covering the sacculus lacrimalis. RESULT: Six months after operation, the mucous was complete epithelization and ostium without stricture in seven cases. One case was covered with ulo, after reexcised with semiconductor laser and put the silicon through the canalis nasolacrimalis, the ostium without stricture in 6 months. CONCLUSION: Semiconductor laser can obviously reduce bleeding,adhesion and granulation tissue,it is a good, simply and shortcut way for clinic.

Adult↗
PubMed2001

Comparison of external dacryocystorhinostomy and 5-fluorouracil augmented endonasal laser dacryocystorhinostomy. A retrospective review.

PURPOSE: To compare the success rates of external dacryocystorhinostomy (EXT-DCR) with 5-fluorouracil (5-FU) augmented endonasal laser dacryocystorhinostomy (ENL-DCR) and to record the complications associated with 5-FU augmented ENL-DCR MATERIALS AND METHODS: This was a retrospective non-randomised study. Forty-one patients with primary acquired nasolacrimal duct obstruction underwent an EXT-DCR (19 patients) or an ENL-DCR (22 patients) over a 3-year period. A Holmium YAG laser (Ho:YAG) was used in the latter group of patients. Silicone tubes intubated in all patients were removed at three months. 5-FU was applied intraoperatively at the site of the ostium in the ENL-DCR patients. The median follow-up was 12 months (range 3-24 months) for the ENL-DCR group and 22 months (range 6-28 months) for the EXT-DCR group. The patency of the lacrimal system and the severity of epiphora were assessed at a final-review. RESULTS: The median age of the EXT-DCR group was 77 years (range 53-87) and that of the ENL-DCR group was 71 years (range 23 to 84). There were 12 female patients in the former group and 19 in the latter. The percentage of success in the EXT-DCR group was 94.7% (95% confidence interval (CI) = 75.4-99.1) = ), and 63.6% in the ENL-DCR group (95% CI= 43.0-80.3). The confidence interval for the difference of 31.1% was 5.6-52.2. There was a statistically significant difference between the two groups, p=0.024 (Fisher exact test). CONCLUSIONS: These data suggest that EXT-DCR provides better results than 5-FU augmented ENL-DCR. However, ENL-DCR is the procedure of choice in certain circumstances such as in elderly, frail or medically unfit patients. Our results of 5-FU augmented ENL-DCR compare favourably with other published series.

Administration, Topical↗
PubMed1992

Embryology of the eye and its adnexae.

The embryonal and fetal development of the human eye includes a series of sequential events starting with the fertilization of the ovum and culminating in the birth of a normal baby. Three main periods can be distinguished in the prenatal development of the eye. The first period called embryogenesis is characterized by the establishment of the primary organ rudiments and ends at the end of the 3rd week with the appearance of the optic sulci on both sides of the midline at the expanded cranial end of the still open neural folds. The second period called organogenesis includes the development of the primary organ rudiments and extends till the end of the 8th week. The third period involves the differentiation of each of the primitive organs into a fully or partially active organ and is called differentiation. The period of embryogenesis is characterized by the appearance and migration of the neural crest cells and by the formation of the primary brain vesicles. The period of organogenesis extends from the 4th week till the end of the 8th week. The 4th week shows the closure of the neural canal anteriorly with the subsequent evagination of its lateral wall into optic vesicles, the invagination of the lower nasal wall of the optic vesicle causing the formation of the optic cup, and the development of the lens plate, retinal disk and embryonic fissure. The embryonic fissure extends into the optic stalk which connects the cavity of the optic vesicle with the cavity of the neural canal; the hyaloid artery penetrates into the optic cup through the embryonic fissure. During the 5th week, the optic cup is concluded, and the cells of its external layer acquire pigmentation as a result of contact with developing capillaries in the periocular mesenchyme; these capillaries anastomose with each other and form anteriorly the annular vessel. The lens plate develops into a lens pit and later into a lens vesicle which separates soon thereafter from the surface ectoderm. Inside the optic cup, the hyaloid vessels form the capillaries of the posterior tunica vasculosa lentis and through the capillaries of the lateral tunica vasculosa lentis anastomose with the annular vessel. The primary vitreous forms and the surface ectoderm overlying the lens vesicle differentiates into a primitive corneal epithelium. The facial and orbital structures also develop at this stage. The 6th week shows the incipient differentiation of the inner layer of the optic cup into a sensory retina, the formation of the secondary vitreous, the transformation of the posterior cells of the lens vesicle into primary lens fibers, the development of the periocular vasculature and the appearance of the first eyelid folds and of the anlage of the nasolacrimal duct. However, the dominating factor is the closure of the embryonic fissure.(ABSTRACT TRUNCATED AT 400 WORDS)

Cell Differentiation↗
PubMedDate not supplied

Long-term results of external dacryocystorhinostomy.

BACKGROUND AND OBJECTIVE: To evaluate the long-term success following external dacryocystorhinostomy, which is used as a standard in comparing endoscopic or laser techniques. PATIENTS AND METHODS: A chart review of 128 patients (150 procedures) undergoing external dacryocystorhinostomy within a 14-year period was undertaken. Patient demographics, symptoms, examination findings, surgical and anesthesia information, postoperative course, and complications were recorded. Lack of tearing or evidence of dacryocystitis at the final postoperative visit was considered a successful result. RESULTS: External dacryocystorhinostomy was found to be highly successful, with an overall 93% success rate at an average follow-up of 2.7 years. Kaplan-Meier analysis of the data, applied for the first time in this study, predicts a success rate of 90% beyond 4 years. Most important, this demonstrated that most surgical failures were identified in the first 2 years. Postoperative complications were rare and the surgical scar was not a source of patient concern in most cases. CONCLUSIONS: This study confirms that external dacryocystorhinostomy is a highly successful long-term solution to nasolacrimal duct obstruction with low morbidity.

Adolescent↗
PubMed2006

Ocular findings in Malaysian children with Down syndrome.

INTRODUCTION: Down syndrome was first described as Mongoloid children with European parentage. Although their facial features resemble Orientals or Asians, ocular findings have not been well-documented in Asians, especially Malaysians. Our aim was to identify the ocular findings of Malaysian children with Down syndrome. METHODS: A total of 60 children with Down syndrome, aged between one month and 17 years, were examined for ocular findings from January 1995 to January 2004. Ocular examination, which includes visual acuity assessment, slit lamp biomicroscopy, ocular motility, cycloplegic refraction and ophthalmoscopy were performed whenever possible. RESULTS: The ocular findings include epicanthic fold in 96.7 percent (58), nystagmus in 33.3 percent (20), and strabismus in 26.7 percent (16) of children with Down syndrome, all of whom were esotropic. Other findings were bilateral congenital cataract in 13.3 percent (8), blepharoconjunctivitis in 10.0 percent (6), eyelid abnormalities in 6.7 percent (4), glaucoma in 6.7 percent (4), nasolacrimal duct obstruction in 3.3 percent (2), bilateral retinoblastoma in 1.7 percent (1), bilateral retinal detachment in 1.7 percent (1), and chronic uveitis in 1.7 percent (1) of children. Visual assessment showed that 47.3 percent of patients achieved good vision (6/12 to 6/6). Cycloplegic refraction was done in 24 patients (41.7 percent). Out of the 24 patients, 29.2 percent (7) were myopic, 25.0 percent (6) were hyperopic, and astigmatism was observed in 8.3 percent (2). CONCLUSION: Malaysian children with Down syndrome demonstrated high incidences of epicanthic fold, nystagmus, and strabismus, and absence of Brushfield spots or keratoconus, which are in contrast to the ocular findings in Caucasian patients with Down syndrome. Rare ocular findings, such as bilateral retinoblastoma and retinal detachment, were also observed but their association with Down syndrome is not well-established.

Adolescent↗