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PubMedDate not supplied

The evolution of endonasal dacryocystorhinostomy.

Dacryocystorhinostomy is an important treatment in the relief of tearing. Through the years, there have been several advances in this procedure. Once performed only from an external approach, the advent of rigid endoscopes and endoscopic instrumentation has made the endonasal approach a reality. Advantages of the endonasal approach include lack of a cutaneous incision and excellent visualization of intranasal pathology, which is often the cause of dacryocystorhinostomy failure. Preoperative evaluation including a detailed medical history, physical examination with office endoscopy, and imaging, as well as postoperative care are important. Surgical technique with detailed knowledge of intranasal anatomy and meticulous attention to hemostasis are critical. Endonasal laser-assisted dacryocystorhinostomy is also performed today, and special preoperative considerations and key features of the lasers available are important in the selection of a laser for tissue or bone ablation during the procedure. Endoscopic conjunctivodacryocystorhinostomy is performed today, and given the critical nature of proper length and placement of the Jones tube intranasally, provides the significant advantage of intranasal visualization. Endoscopic dacryocystorhinostomy in children is also performed today; however, challenges such as small nasal anatomy and maintenance of the intranasal osteomy postoperatively in a child are significant issues.

Conjunctiva↗
PubMed2005

[Endoscopic nasal dacryocystorhinostomy: results and advantages over the external approach].

UNLABELLED: Dacryocystorhinostomy (DCR) is a procedure used to create a lachrymal drainage pathway into the nasal cavity in order to reestablish the permanent drainage of a previously obstructed excretory system. AIM: to report our results obtained with endoscopic DCR technique, describing its advantages and disadvantages STUDY DESIGN: Historic cohort. MATERIAL AND METHOD: we retrospectively analyzed thirty-two dacryocystorhinostomies performed at the Otorhinolaryngology Discipline from March 2002 to January 2004 on patients with post-lachrymal sac obstruction confirmed by dacryocystorhinography (DCG). In all cases, the patients were submitted to probing with Crawford probe. RESULTS: surgery was bilateral in ten of the twenty-two analyzed patients, totaling thirty-two procedures, twenty-nine of which were primary surgeries and three revision procedures after unsuccessful external DCR. Our success rate was 79.12%. CONCLUSIONS: endoscopic DCR proved to be a safe and low morbidity technique, which also avoids facial scars and maintains the mechanism of the lachrymal pump, with results similar to those obtained with external DCR.

Adolescent↗
PubMed2000

[20 MHz ultrasound diagnosis in chronic canaliculitis].

BACKGROUND: High frequency sonography is used with a medium frequency of 50 to 100 MHz for non-invasive examination of the anterior eye segment. 20-MHz probes are considered to be a cost-efficient alternative, with a lower resolution and a higher penetration depth. We examined the value of the 20-MHz probe in diagnosing chronic canaliculitis. CASE REPORT: A 50-year-old woman was evaluated for a chronic canaliculitis. A pathognomonic sign of the chronic canaliculitis was the detection of concrements by high-resolution ultrasound. Grains measuring 1-2 mm in diameter could be shown in an ecstatic canaliculus with 20-MHz sonography. The high-resolution sonography showed the extent of the ectasia of the canaliculus and was therefore useful in planing the operative strategy. CONCLUSION: The spectrum of possibilities in diagnosing chronic canaliculitis is broadened with this diagnostic tool. Specially when characteristic symptoms are missing, the 20-MHz probe may be useful in diagnosing patients with chronic canaliculitis.

Actinomycosis↗
PubMed1992

[Adrenodacryolith].

In a 67-year-old woman a dacrocystorhinostomy had to be performed because of dacryostenoses. At operation a black adrenodacryolith was found from by topical adrenalin treatment for chronic simple glaucoma. The mineralogical and histological examinations revealed that the dacryolith consisted of organic material only.

Aged↗
PubMed1993

Stenotic puncta: microsurgical punctoplasty.

The successful long-term management of epiphora caused by punctal stenosis presents a difficult problem for the ophthalmologist. The purpose of this paper is to describe a successful procedure that respects lacrimal excretory anatomy and provides excellent results in the management of epiphora. Twenty-three patients (32 eyes) with punctal stenosis underwent excision of the stenotic puncta followed by microscopic externalization of the vertical canaliculus. At 6 months and 1 year, only one patient complained of tearing; at 2 years, three eyes experienced tearing and were successfully dilated; no eyes experienced tearing at 4 years. Only one patient experienced a dry eye, which was managed with topical lubricants. Microscopic punctoplasty thus provides excellent long-term management of epiphora from punctal stenosis with minimal disruption of anatomy.

Aged↗
PubMed1995

A rationale for the selection of nasal decongestants in lacrimal drainage surgery.

Adequate hemostasis during lacrimal drainage surgery affects the success of the operation. Nasal decongestants, which are sympathomimetric agents including sympathomimetic amines and imidazoline derivatives, help to decrease bleeding. Certain of the imidazoline derivatives--oxymetazoline and xylometazoline--are potent and long-acting agents that have many of the same adrenergic effects as cocaine. Their use as an alternative to cocaine provide adequate hemostasis with less adverse reactions than cocaine. The authors recommend premedication of the nasal mucosa with oxymetazoline or xylometazoline before lacrimal drainage surgery for obtaining maximal nasal mucosal decongestion.

Amines↗
PubMed1991

Unilateral naso-orbital meningocele and bilateral congenital fistulae of the lacrimal passages.

Orbital meningocele is the protrusion of a sac containing cerebrospinal fluid into the orbit, through a defect called cranium bifidum. Although the occipital and frontal basis of the cranial cavity constitute the two most frequent localizations, this pathology may rarely be located in the naso-orbital region. Other developmental anomalies of the eyes may accompany the anomalies of the bony orbit. The case described in the present paper had a right naso-orbital meningocele associated with bilateral fistulae of the lacrimal passages which represents a very rare condition.

Adult↗
PubMedDate not supplied

Conservative treatment of congenital dacryocele.

PURPOSE: To study prospectively the effectiveness of medical management of congenital dacryoceles. METHODS: All patients presenting with congenital dacryocele that were not infected were treated with warm compresses, massage, and topical antibiotics. Dacryoceles that did not resolve with at least two weeks of medical management were probed. Dacryoceles that were infected were treated with intravenous (IV) antibiotics in addition to warm compresses and massage. RESULTS: Seventeen patients with 21 dacryoceles were studied over a 3 1/2-year period. All patients were examined by the authors and treatment was initiated prior to 3 weeks of age. Sixteen dacryoceles resolved with medical management in 1 to 6 days. Three of these 16 dacryoceles were infected and patients were hospitalized at the time of initial ophthalmic evaluation (2 to 4 days of life). One additional dacryocele became infected after 2 days of medical management (4th day of life), requiring hospital admission and IV antibiotics. All four infected dacryoceles resolved within 24 hours of the initiation of IV antibiotics, warm compresses, and massage. Five dacryoceles were probed after not resolving within 14 to 31 days of medical management. One dacryocele required a repeat probing. CONCLUSIONS: Medical management can be effective in the treatment of congenital dacryoceles; 76% of dacryoceles in this series resolved after 6 days of medical management.

Anti-Bacterial Agents↗
PubMed1980

Diagnosis and incidence of lacrimal calculi.

Lacrimal sac calculi are a common and often unrecognized cause of chronic epiphora. Of 94 consecutive dacryocystorhinostomies, 16 lacrimal calculi were found. Symptoms were consistent with lacrimal obstruction and were unresponsive to previous probings and antibiotics. Dacryoliths may be suspected by their intermittent symptoms and by the inconsistent findings at irrigation. Surgical removal of the stone along with a dacryocystorhinostomy has effected a cure in all nine patients.

Adolescent↗