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Meniscus level indicator of obstruction.
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Micro-Reflux [correction of Micro-Reflex] Test vs. the Kleenex test.
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Balloon catheter dilatation.
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Lacrimal intubation in the primary repair of midfacial fractures.
Midfacial trauma causes a variety of functional and cosmetic problems that concern many surgical specialties. Fractures of the lacrimal sac fossa and lacrimal canal and compromise of the intrinsic membranous pathways are frequently not addressed, requiring late lacrimal bypass surgery in many cases. Silicone intubation of 11 disrupted distal pathways was performed as part of the primary, interdisciplinary repair of midfacial fractures. Revision of two systems was necessitated by later surgery performed for unrelated problems. In the remaining nine primarily intubated systems, patency was maintained in long-term follow-up. The role of the ophthalmic surgeon in the recognition and primary intubation of fractured distal lacrimal pathways should be stressed among colleagues in otolaryngology, plastic surgery, and maxillofacial surgery.
Congenital lachrymal obstruction.
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Antenatal sonographic diagnosis of dacryocystocele.
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[Foreign body granuloma after lower eyelid avulsion and surgical revision with silicone tube splint].
BACKGROUND: Foreign-body-reactions with granulomas after use of silicone-containing biomaterials are of clinical importance [4]. HISTORY AND SIGNS: A 4-year old patient entered our hospital with a reddish vascularised tumor. The tumor's origin was in the conjunctiva of the nasal lid-angle of the right eye. THERAPY AND OUTCOME: After a traumatic disconnection of the canaliculus lacrimalis inferior, a bicanalicular silicon-tube intubation had been performed with the patient in the age of one year. Only 3 years after this intervention a secondary clinical examination could be performed. At this time, an extended solid conjunctival-tumor appeared at the operated eye. After removal and histological examination it could be classified as a foreign body granuloma. CONCLUSIONS: The blood- and tissue compatibility of silicone is only insufficiently guaranteed on the basis of the hydrophobic material-surface. After reconstructive lacrimal surgery postoperative care and the removal of the stabilizing silicone material is necessary.
[Evidence of lacrimal plugs via high resolution ultrasound].
BACKGROUND: The practical value of high-frequency ultrasound (transducer frequency of 20 MHz) for studying lacrimal plugs positioned into canaliculi was proved. MATERIALS AND METHODS: Twelve patients with twenty intracanalicular plugs and two punctum plugs were examined via high-frequency B-scan ultrasonography using 20 MHz transducer (model I3 Sacramento, USA). Detection and localisation of the intracanalicular plugs was made by a 20 MHz sector scanner. The ultrasound examinations were performed 1 - 24 month after the placement of lacrimal plugs. After patient's head positioning, the high-frequency ultrasound investigation was done via immersion fluid (2 % methylcellulose). RESULTS: All patients with dry eye treated by lacrimal plug implant showed echographic structure in the lacrimal canaliculus. In transversal echograms it was possible to image both canaliculi together when the lids were half-closed. Contrary to the normal state, it was not necessary to inject viscous fluid into the canaliculus. High-resolution ultrasound was able to differentiate the normal canaliculus from the findings after plug placement. The echograms can vary from one plug type to another. Highly reflective structures were found after the placement of silicone intracanalicular plugs, e. g. HERRICK-Plug. In contrast, the ultrasonic image taken through acrylic polymer intracanalicular plugs showed homogeneous small reflective inner structure, e. g. SMART-Plug. However, smooth and flat acoustic interface between acrylic polymer plug and the lacrimal canaliculus produced strong echoes. CONCLUSIONS: 20 MHz ultrasound seems to be well suited for the detection and localisation of intracanalicular plugs. By use of 20 MHz ultrasound scans it is possible to get high-quality images of the intracanalicular plug and around lacrimal canaliculus. Compared with UBM, the depth of penetration is much higher with negligible resolution. On the whole, we believe that 20 MHz ultrasound can become a useful tool for evaluating the placement of intracanalicular plugs after insertion.
[Diaphanoscopic localization of tear ducts in endonasal dacryocystorhinostomy].
BACKGROUND: Endonasal dacryocystorhinostomy is a well established technique in the surgical treatment of stenosis of the lacrimal system. Due to individual anatomic variations it can be difficult and time consuming to localize the stenosis of the lacrimal system intraoperatively. METHODS AND PATIENTS: To simplify the localization of the lacrimal system, a diaphanoscopic technique that has been used in oral surgery was modified for endonasal dacryocystorhinostomy. A sterile optical fiber is passed through the lacrimal canal from the eye into the lacrimal sac or down to the stenosis. Its light can be detected in the nose and marks the sac or the stenosis. To date we have performed twelve operations with this technique. RESULTS: In our experience, endonasal dacryocystorhinostomy is simplified and accelerated by localizing the lacrimal system with diaphanoscopy. CONCLUSIONS: The diaphanoscopic localization of the lacrimal system during endonasal dacryocystorhinostomy is a slight technical modification that is simple and helpful and could therefore be incorporated into the surgical routine.
[Digital subtraction dacryocystography and sialography].
Fourteen examinations of the tear ducts and 21 sialograms were performed using digital subtraction and conventional techniques. In nine of the former and 15 of the latter, digital subtraction produced better results, in the remainder conventional technique was equally good. The advantages of digital subtraction are due to the removal of superimposed structures of the skull. Dose measurements at the level of the lens of the eye showed a greatly reduced radiation dose when using digital subtraction, as compared with conventional dacryocystography. Digital subtraction techniques with pulsed radiation and the ability to perform pixel shift is an optimal method for performing radiological examinations of the tear ducts and salivary glands.
A review of lacrimal drainage surgery.
The advent of improved silicone intubation sets, increased understanding of lacrimal and nasal anatomy and physiology, and refinements in surgical instrumentation and technique have led to higher success rates in lacrimal surgery. Recent clinical studies, combined with new techniques in canalicular reconstruction, have helped identify which patients will benefit from surgical intervention and which techniques are indicated. Fortunately, this has greatly reduced the number of CDCRs necessary.
Intubation of the lacrimal system.
Obstruction of the lacrimal passage in infants and young children can often be overcome by simple probing; however, in some cases, intubation is necessary to maintain patency. This paper describes the instruments needed and the method of insertion and removal of silicone tubes. Placement of the tubes is done under general anesthesia, but removal is accomplished easily in the office.
Valsalva DCR bubble test.
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Complications of lacrimal surgery.
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Evaluation and management of an infant with tearing and eye discharge.
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Paediatric dacryocystorhinostomy.
The results of 95 dacryocystorhinostomy procedures in 78 paediatric patients are reviewed. The success rate was 77%. Factors influencing success and failure are discussed.
Ultrasonic assessment of rhinostomy size following external dacryocystorhinostomy.
AIM: To assess the dimensions and patency of the surgical epithelial fistula after external dacryocystorhinostomy, using B mode ultrasonography to define the postoperative soft tissue anastomosis. METHODS: 12 patients undergoing 16 external dacryocystorhinostomies, with the creation of large osteotomies, were included in a prospective study. The horizontal and vertical dimensions of the bone ostium was recorded during surgery and compared with the ultrasonographic dimensions of the soft tissue anastomosis at 1 day, 2 weeks, and 6 months after surgery. Functional patency was confirmed with dye testing and irrigation. RESULTS: Compared with an osteotomy of between 100 and 380 mm2 (mean 235 mm2), the soft tissue anastomosis on the day after surgery was, in all cases, markedly smaller (72-252 mm2; mean 144 mm2, or 61% of the bone window). The soft tissue anastomosis decreased to between 8 and 208 mm2 (mean 98 mm2; 68% of immediate postoperative value) at 2 weeks and 3-208 mm2 (mean 71 mm2; 49% of immediate postoperative value) at 6 months. 14 of the 16 (88%) dacryocystorhinostomies were functional at the end of the study, the two failures being associated with marked contracture of the soft tissue anastomosis; the outcome of surgery correlated significantly with the area of the anastomosis at 2 weeks (chi 2 = 16.3; p < 0.01) and at 6 months (chi 2 = 16.0, p = 0.01). CONCLUSIONS: B mode ultrasonography provides a simple and effective method for assessing the size of the soft tissue anastomosis after external dacryocystorhinostomy and there is a significant reduction in size after surgery, to which the functional outcome of surgery appears related. As the initial soft tissue anastomosis cannot be larger than (and is, on average, about 60% of) the area of the osteotomy, this emphasises the paramount importance of a large rhinostomy to the success of lacrimal surgery.