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At least 109 records · Page 6Linked to original sources

PubMed2000

Treatment of nasolacrimal duct obstruction in children with trisomy 21.

BACKGROUND: Nasolacrimal duct (NLD) obstruction and tear film abnormalities occur frequently in children with trisomy 21. This study describes the outcomes of treatment for NLD obstruction in this population. METHODS: The records of 15 children with trisomy 21 treated for NLD obstruction were reviewed. Eight patients were initially treated with NLD probing with or without placement of nonfixated lacrimal stents. Because of poor success with this procedure, the initial treatment of children with trisomy 21 and NLD obstruction was changed to balloon catheter dilation in 1997. Outcomes were considered excellent if the patient had complete resolution of epiphora and dacryocystitis, good if the patient had only mild residual symptoms, fair if the patient had significant residual symptoms, and poor if there was no improvement. RESULTS: Of 8 patients treated initially with NLD probing, 5 had fair or poor outcomes. These patients all had good outcomes after placement of nasally fixated lacrimal stents, balloon catheter dilation, or both. Of 7 patients treated initially with balloon catheter dilation, 5 had excellent or good outcomes and 2 had fair or poor outcomes. CONCLUSION: Simple NLD probing is often unsuccessful in treating NLD obstruction in children with trisomy 21. Balloon catheter dilation appears to be a reasonable alternative first treatment in these patients.

Catheterization↗

PubMed2004

Assessment of functional nasolacrimal duct obstruction--a survey of ophthalmologists in the southwest.

The term 'functional nasolacrimal duct obstruction' describes patients with epiphora where the tear duct is partially or completely patent to syringing. Delayed tear drainage is demonstrated with a fluorescein dye disappearance test (FDDT) or lacrimal scintigraphy. A dacrocystogram is also frequently abnormal. Studies show that selected patients with epiphora because of functional nasolacrimal duct obstruction have an 80-90% success rate with open or endonasal dacryocystorhinostomy. To find out if such patients were being considered for surgery, we sent a questionnaire to all ophthalmologists in the southwest. Of the 198 questionnaires, 163 were completed and returned (82%). In the assessment of epiphora, fewer than half those questioned (41%) regularly used an FDDT and only 51% syringe patients themselves. Most did not use lacrimal scintigraphy or dacrocystography if the drainage system was patent on syringing. This survey shows that many patients with epiphora who are patent to syringing are being incompletely assessed, and hence not considered for dacrocystorhinostomy. We recommend that an FDDT is performed on all patients, syringing is carried out by experienced staff, and more radiological investigations are undertaken, so patients with a highly treatable cause of epiphora can be offered dacrocystorhinostomy.

Attitude of Health Personnel↗

PubMed1986

An investigation into the efficacy of probing the nasolacrimal duct as a treatment for epiphora in adults.

An investigation was conducted into the efficacy of probing the nasolacrimal duct as a method for treating epiphora in adults. Probing was performed on patients who had complete obstruction of the nasolacrimal duct. These patients comprised 62 per cent of the total incidence of epiphora observed during the study period. Following a single probing procedure, watering was subjectively improved in 52 per cent of cases. When patients who had a mucocoele or mucous regurgitation were excluded, the improvement rate increased to 75 per cent. A single probing procedure would appear to have been effective in producing some symptomatic improvement when limited in its use to patients who had complete obstruction of the nasolacrimal duct and when watering of the eye was the only symptom. Such patients accounted for 37 per cent of cases of epiphora.

Aged↗

PubMed1986

Probing and irrigation for congenital nasolacrimal duct obstruction.

I reviewed the results of probing for congenital nasolacrimal duct obstruction in a series of 107 patients, with special reference to age at the time of probing. Relief of tearing and discharge was achieved in 90% of patients with the first probing, and an additional 6% were cured after a second probing. Altered nasolacrimal duct anatomy seemed to account for probing failures rather than any delay in probing. Primary probing continued to be an effective treatment well after 2 years of age and was successful in two 5-year-old patients. Unsuccessful probings were usually apparent at the time of the initial probing and were characterized by difficulty passing the probe and subsequent inability to irrigate saline through the nasolacrimal system into the nose. Dacryocystorhinostomy was an effective secondary procedure in the few patients in whom probing was unsuccessful.

Age Factors↗

PubMed1986

Congenital lower nasolacrimal duct anomaly: a case report.

A congenital anomaly of the nasolacrimal system not previously described is reported. The apposition of the distal end of the nasolacrimal duct was not with the nasal cavity as normally occurs prior to birth but to the external skin. As a result the child presented with difficulty with tear drainage and consequent infection--"neonatal conjunctivitis" followed by a facial abscess at the left lower border of the nose. Recent embryological studies suggest that this anomaly is due to failure of complete separation and migration of the epithelial rod most distal from the surface ectoderm to the inferior meatus of the nasal cavity. This distal remnant of the nasolacrimal duct thus remains juxtaposed to the surface ectoderm of the face on the lateral aspect of the alar nares. The modern concept of the embryological development of the nasolacrimal system is reviewed.

Eye Diseases↗

PubMed2000

[Transnasal anchor suture for facilitating silicone tube intubation in deep congenital nasolacrimal duct stenosis].

BACKGROUND: In silicone intubation of the nasolacrimal duct for congenital obstruction, retrieval of the guide thread behind the inferior turbinate can be difficult and time consuming. To facilitate this maneuver a modification of the conventional technique has been developed. PATIENTS AND METHOD: In the conventional technique, a hollow probe was inserted into both lacrimal puncti and pushed downward into the nasal cavity. A guide thread was forwarded into the pharynx. Using the same hollow probe, a third guide thread was inserted transnasally and also forwarded into the pharynx. These three threads were pulled out of the pharynx transorally and tied together. Pulling on the nasal aspect of the transnasal guide brought all guides back into the pharynx and out of the nose. The intubation was completed in the conventional way. RESULTS: The new method was evaluated in 13 children. With the conventional technique the mean duration of the operation was 35 min, but the time required varied greatly among individuals due to retrieval of the guides. In contrast, no guide retrieval problem occurred using the new technique, and the average duration was reduced to 25 min. No adverse effect was observed. CONCLUSION: Using a simple modification, difficulties with the retrieval of the guide thread could be avoided, thus facilitating the procedure of nasolacrimal duct intubation and reducing its duration.

Child↗

PubMed2002

Efficacy of probing the nasolacrimal duct with adjunctive Mitomycin-C for epiphora in adults.

PURPOSE: To investigate the efficacy and safety of adjunctive low-dose mitomycin-C during lacrimal probing for adults with blocked nasolacrimal ducts. DESIGN: Prospective, noncomparative, interventional case series. PARTICIPANTS: From January 1998 to December 2000, a total of 32 adult patients (36 eyes) seen with epiphora caused by primary nasolacrimal duct obstruction was treated and evaluated. INTERVENTION: Lacrimal probing with adjunctive mitomycin-C (0.2 mg/ml). MAIN OUTCOME MEASURES: Objective evaluation of patency with irrigation, as well as patients' subjective assessment of improvement. RESULTS: For 32 of the treated eyes (89%), the nasolacrimal duct remained open 9 months after treatment. Repeat procedure was successful for two of the remaining four eyes with recurrent obstruction during follow-up, yielding an overall patency rate of 94%. Patient satisfaction was assessed after 9 months and indicated that the epiphora was at least mildly improved for 30 (83%) of the treated eyes. Watering was completely absent for nine eyes (25%), rated as moderately improved for 17 (47%), and mildly improved for 4 (11%). No complications were encountered over the 9-month follow-up period. CONCLUSIONS: Our experience suggests good long-term results for probing with adjunctive, topical Mitomycin-C for cases of adult epiphora caused by obstruction of the nasolacrimal duct followed by repeat procedure if necessary. It can be recommended as a simple, effective, and minimally invasive technique, with no significant complications resulting from low-dose use in our study.

Aged↗

PubMed1995

[Value of spiral CT in the diagnosis of nasolacrimal duct stenosis].

PURPOSE: This study was to evaluate postdacryocystographic spiral CT in the diagnosis of stenoses of the nasolacrimal duct system. PATIENTS AND METHODS: Dacryocystography and postdacryocystographic spiral CT were performed in 11 patients with epiphora. RESULTS: Postdacryocystographic spiral CT results in detailed information about the nasolacrimal duct system. Localization, degree, and aetiology of stenoses can be determined more reliably than with dacryocystography alone. CONCLUSION: Postdacryocystographic spiral CT improves planning surgical or radiological interventions such as balloon dacryocystoplasty of the nasolacrimal duct.

Adult↗

PubMed1989

Obstruction of the nasolacrimal duct by Ascaris lumbricoides.

Although Ascaris lumbricoides infestation is extremely prevalent in some populations, the nematode is an extremely rare cause of nasolacrimal duct obstruction. Obstruction of the nasolacrimal duct in a 4-year-old Brazilian girl by a young adult A. lumbricoides is reported. In contrast to previously reported cases, the nematode involved the inferior, rather than superior, canaliculus and punctum.

Ascariasis↗

PubMedDate not supplied

Stepwise treatment paradigm for congenital nasolacrimal duct obstruction.

PURPOSE: To compare the outcomes achieved by a series of patients treated in a stepwise fashion who presented with congenital nasolacrimal duct obstruction. METHODS: In this retrospective interventional case series, 127 patients, ranging in age from 1 month to 81 months, with 173 lacrimal systems diagnosed with congenital nasolacrimal duct obstruction, were treated in a stepwise fashion. A treatment paradigm was evaluated that prescribed probing as an initial procedure regardless of age. Those who failed probing received balloon catheter dilation. Those who failed probing and balloon catheterization received silicone intubation. Dacryocystorhinostomy was reserved for patients failing the above treatments. Clinical success was defined as complete resolution of symptoms. Success rates at each step were evaluated, and a cost analysis was performed. RESULTS: Lacrimal probing was successful in 134 of 173 (76.9%) cases. Of the 39 probing failures, 32 (82.1%) were cured with balloon catheterization. All 7 cases (100%) that failed probing and balloon catheterization were cured with silicone intubation. No patient in this series required dacryocystorhinostomy. CONCLUSIONS: A stepwise approach to the treatment of congenital nasolacrimal duct obstruction is a clinically and financially effective model for treatment.

Catheterization↗

PubMed1990

Silicone intubation for congenital obstruction of nasolacrimal ducts.

In children aged 3 months or older lacrimal probing was performed to cure nasolacrimal duct obstructions. In 56 cases where this procedure failed a silicone tube was inserted. The results were favourable in 47 cases. Children with facial malformations and those with a narrow nasolacrimal duct however proved to be poor candidates for silicone tube insertion.

Child↗

PubMed1997

Intranasal endoscopic silicone intubation for congenital obstruction of the nasolacrimal duct in children.

Aim of the present study was to determine the efficacy of intranasal endoscopic silicone intubation to treat congenital nasolacrimal duct obstruction in children who failed conventional lacrimal system probing. Silicone intubation with intranasal endoscopic visualization was performed in 18 eyes of 16 patients with an age range of 18-48 months (mean, 25 months) to treat congenital nasolacrimal duct obstruction. Out of 16 patients, ten had already undergone previous probings with failure, the other six were primary intubation cases without any previous probings. The tubes were left in place an average of 6 months. Follow-up ranged from 4 months to 2 years (mean, 12 months) following removal of the silicone tubing. Intranasal endoscopic silicone intubation is effective in the treatment of congenital nasolacrimal duct obstruction as a primary procedure in children over 18 months of age and, it is also recommended as the next step in the management of epiphora which fails to resolve after probing.

Child, Preschool↗

PubMed2004

Simple technique for silicone intubation in congenital nasolacrimal duct obstruction.

OBJECTIVE: To propose a simple and low cost technique of using the simple materials in the operating room for silicone intubation in case of nasolacrimal duct obstruction in children after failed probing. METHOD: The study was a consecutive case series. Three patients with congenital nasolacrimal duct obstruction aged 42, 51 and 72 months were referred to the authors. Their symptoms persisted after probing twice with or without infracture inferior turbinate. The authors decided to insert a silicone tubing by using an 18-gauge, intravascular catheter as a channel to place a silicone tubing into the nasolacrimal system. Success was defined as a complete resolution of symptoms and signs (tearing, crusting, discharge, regurgitation on pressure over the lacrimal sac) after silicone intubation. RESULTS: All three patients were free of symptoms and signs after insertion of silicone tubing and an average 5.5 months (9, 6, 1.5 months) after removal of the silicone tubing. There were no intraoperative complications. No unplanned silicone tubing removal was needed and also no complications associated with silicone stent, such as punctal erosion, corneal erosion or granuloma formation occurred. CONCLUSION: This simple and low cost technique using an intravascular catheter as a channel to place the silicone tubing into the nasolacrimal system in case of congenital nasolacrimal duct obstruction in children works well. This new technique is not only inexpensive but also effortless with no complications.

Catheterization↗

PubMedDate not supplied

The natural course of congenital obstruction of the nasolacrimal duct.

In order to establish the rate of spontaneous resolution of congenital obstruction of the nasolacrimal duct, 50 infants, referred from a local pediatric group practice over a period of five years, were followed from the time of first symptoms until 8 to 13 months of age. Among the 50 infants, 65 nasolacrimal ducts were blocked and 58 ducts in 44 patients opened spontaneously. Only seven ducts in six patients required probing for relief of the obstruction. During the same period another seven patients from various referral sources were seen because of noninflammatory swelling of the lacrimal sac at birth. These patients were also found to have nasolacrimal duct obstruction, but early surgical intervention was required in six of the seven patients to relieve the distention of the sac.

Anti-Bacterial Agents↗

PubMed1999

The Micro-Reflux Test: a new test to evaluate nasolacrimal duct obstruction.

OBJECTIVE: The authors describe a new and simple procedure, the Micro-Reflux Test (MRT), to screen for primary acquired nasolacrimal duct obstruction (PANDO). This study sought to determine the reliability of this new test in the diagnosis of complete nasolacrimal duct obstruction. DESIGN: A nonrandomized, prospective, self-controlled, comparative case series. PARTICIPANTS: Two hundred eyes of 100 patients with documented unilateral complete PANDO were examined. INTERVENTION: The MRT was performed by a masked examiner on both eyes of each patient. Two drops of 0.25% sodium fluorescein dye were instilled in the inferior cul-de-sac and the patient made to blink five times to activate the lacrimal pump mechanism. Excess fluorescein dye was blotted away using tissue paper. The patient was positioned at the slit lamp, and observation of the inferior punctum with the cobalt blue filter was done using 5x magnification. The tissue overlying the lacrimal sac was massaged in a counterclockwise direction with moderate pressure using the index finger. The test was considered positive if there was continued observed reflux of fluorescein-stained tears from the inferior punctum after the initial counterclockwise massage to empty the inferior canaliculus. The validity of the MRT was measured by sensitivity and specificity as well as positive- and negative-predictive values. MAIN OUTCOME MEASURE: The MRT was considered positive if there was continued reflux of fluorescein-stained tears from the inferior punctum after the initial digital massage to empty the dye from the inferior canaliculus. RESULTS: The MRT used for the evaluation of complete PANDO has a sensitivity of 97% and a specificity of 95%. It has a positive-predictive value of 95% and a negative-predictive value of 97%. CONCLUSION: The MRT is a reliable screening test for presence of complete nasolacrimal duct obstruction.

Adolescent↗

PubMed2001

Giant cell angiofibroma of the nasolacrimal duct.

PURPOSE: To describe clinical and histologic features of the first case, to our knowledge, of giant cell angiofibroma located in the nasolacrimal duct region in a 28-year-old woman. METHODS: Interventional case report. A left nasolacrimal duct tumor was excised en bloc by lateral rhinotomy. Histopathologic examination was performed with the use of light microscopy. Immunohistochemical staining included S-100 protein, muscle-specific actin, desmin, myoglobin, vimentin, and CD34. RESULTS: The lesion was characterized by haphazardly arranged oval to spindled cells, a myxoid and collagenous stroma, multinucleated giant cells, prominent blood vessels, and pseudovascular spaces. Tumor cells were strongly positive for vimentin and CD34 and were negative for other antigens. After excision, there has been no recurrence over 4 years of follow-up. CONCLUSIONS: Originally described as an orbital tumor, giant cell angiofibroma also may occur in the nasolacrimal duct and lacrimal sac region. This mesenchymal neoplasm should be included in the differential diagnosis of lacrimal drainage system tumors.

Adult↗

PubMed2005

Endoscopic-assisted probing for congenital nasolacrimal duct obstruction.

PURPOSE: To determine the success rate of initial probing in children with congenital nasolacrimal duct obstruction (CNLDO) at different ages using nasal endoscopy, and to identify the anatomical sites of blockage within the drainage system. METHODS: A total of 87 eyes from 67 consecutive children with CNLDO underwent endoscopic nasolacrimal duct (NLD) probing under general anaesthetic. Patients who had had previous probings were excluded from the study. Diagnosis was based on history of epiphora since birth or shortly after, and fluorescein dye disappearance test (FDDT). Cure was judged as complete or near-complete remission of symptoms and signs and a normal FDDT. RESULTS: The age range was 12-91 months (mean 32.3 months). The success rates of probing were: 100% (58/58) for atresia and stenosis at the lower NLD, 100% (13/13) for punctal stenosis, 55.6% (5/9) for functional epiphora, and 0% (0/7) for canalicular and upper NLD obstruction. Age was not found to significantly affect the outcome of probing, whereas site did. Obstruction at canalicular or upper NLD level became more common with increasing age. CONCLUSION: Probing of the nasolacrimal system using the endoscopic approach allows direct visualisation of the distal nasolacrimal duct, which facilitates diagnosis of the anomaly at this site. More complex proximal anomalies became increasingly prevalent in older children, which accounted for the poorer results with increasing age. Site of obstruction has a greater bearing on outcome than patient age.

Age Factors↗

PubMed1998

Efficacy of probing as treatment of epiphora in adults with blocked nasolacrimal ducts.

AIMS: To determine the efficacy of probing in the initial treatment of epiphora and the symptom free period in adults with blocked nasolacrimal ducts. METHODS: The results of probing in 85 eyes with epiphora due to nasolacrimal duct obstruction were studied retrospectively after a mean follow up of 7.4 months (SD 11.6) by a questionnaire and interview survey of patients. RESULTS: 35% of the eyes had an outcome of no watering after probing, 17% mild watering, 35% moderate watering, and 11% severe watering. The patients' satisfaction (watering subjectively improved) after undergoing this procedure was 82%, which is higher than previously reported. The mean symptom free period in eyes with no watering was 11.25 months, in eyes with mild watering 8.20 months, in eyes with moderate watering 5.35 months, and in eyes with severe watering 0.95 months. There was a significant difference (p = 0.001) in the symptom free period between the no watering and severe watering groups. CONCLUSIONS: Probing in adults with confirmed nasolacrimal duct obstruction can be recommended as an initial treatment procedure because of its relatively good efficacy and high patient satisfaction without compromising subsequent surgical treatment if unsuccessful.

Adult↗