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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↗
PubMed1981

Herpetic canalicular obstruction.

Primary herpes simplex infection may involve the lining of the lacrimal canaliculi and result in permanent strictures and epiphora. Five cases are reported and analyzed in combination with previously reported cases. Antiviral medication was not responsible for lacrimal drainage obstruction in these cases.

Adolescent↗
PubMedDate not supplied

Conjunctivodacryocystorhinostomy with Jones tube. A 10-year study.

One hundred and eight patients (111 eyes) underwent conjunctivodacryocystorhinostomy with a Jones tube for treatment of epiphora resulting from canalicular obstruction. Sixty-nine patients (63.9%) were females and thirty-nine (36.1%) were males. Their ages ranged from 9 to 64 years, the mean age being 30.1 years. The causes of lacrimal drainage abnormalities included idiopathy (76 cases, 68.5%), trauma (15 cases 13.5%), tumors (8 cases, 7.2%) congenital abnormalities (6 cases, 5.4%) and conjunctival inflammation (6 cases, 5.4%). Twenty-eight (36.8%) eyes in the idiopathic group had previous failed dacryocystorhinostomies. The operation was successful in 90.1% of the eyes with relief of epiphora. Fifty-one out of 111 (45.9%) eyes had complications. Extrusion of the tube was the most frequent complication occurring in 20 (18%) eyes. Malposition (12 eyes 10.8%), infection (12 eyes, 10.8%) and obstruction of the tube (7 eyes, 6.3%) were the other major complications. Of the 20 eyes with tube extrusion, 11 experienced recurrent tube losses. Five of 11 eyes were free of epiphora after tube loss. Four out of five had the tube in place for 2 to 5 years and one had the tube, in place for one year. The remaining 6 eyes which had the tubes for 6 months to 3 years were complicated by epiphora. Our experience confirms the general belief that the tube should stay in place forever. The large majority of our patients could wear their tubes successfully and have done so in our practice for as long as 10 years.

Adolescent↗
PubMed1997

[Endoscopy of the lacrimal ducts].

UNLABELLED: The available picturing methods in the diagnosis of functional and mechanical stenosis of the lacrimal drainage system do not allow direct optical evaluation of the mucosa. With the help of dacryoendoscopy, for the first time there is the possibility of receiving a direct morphological picture of the tissue of the lacrimal drainage system. PATIENTS AND METHODS: In a clinical study in the period January to June 1996, 76 dacryoendoscopies were done before an operative intervention in the lacrimal drainage system to find out what information can be obtained with dacryoendoscopy and what use this extra information is. RESULTS: In all of the dacryoendoscopies performed, direct evaluation of the mucosa was possible. Normal findings could be clearly differentiated from mucosa of acute or chronical inflammatory processes. The choice of the operative strategy changed in part of the planned operations, although in 37 cases where the preoperative diagnosis was stenosis of the lacrimal sac, only in 26 cases was dacryocystorhinostomy performed. Dacryoendoscopy provides an additional means of guaranteeing the quality of operative procedures, e.g., after intubation. CONCLUSIONS: Dacryoendoscopy provides an important additional diagnostic possibility in the diagnosis of diseases of the lacrimal drainage system. Dacryoendoscopy offers the possibility of direct evaluation of the mucosa, the choice of operative strategy is checked and, if necessary, changed, and with the connection of an erbium YAG Laser there is minimal invasive surgery with the aim of rechannelization of the lacrimal drainage system.

Adolescent↗
PubMed2000

[Lacrimal duct endoscopy with the rigid GRIN endoscopy].

BACKGROUND: Endoscopes play a more and more important role in visualizing and treating pathologies of the lacrimal drainage system. The present study analyzes the results obtained during endoscopy of the lacrimal ducts using a gradient-index (GRIN-) endoscope. PATIENTS AND METHODS: 44 patients, 18 to 87 years old (mean 59 years +/- 18.9), with chronic epiphora or symptoms of affection within the lacrimal ducts were examined using a rigid gradient-index (GRIN-) endoscope. Examination was performed ambulatory using drops for local anesthesia. RESULTS: All 44 patients showed pathologic conditions in the lacrimal drainage system. 2 patients had chronic changes. 25 patients had a relative stenosis (16 presaccal, 9 postcanalicular ones). 17 patients had a total stenosis (12 presaccal, 5 postcanalicular ones). 33 patients showed a single-sided pathology while 11 patients showed a bilateral one. The GRIN-endoscope could be used in all patients and gave excellent image quality of the pathologies. CONCLUSIONS: Endoscopy with a GRIN-endoscope can complement the ambulatory diagnostics and therapy of the lacrimal drainage system. In the patient group studied (n = 44), presaccal pathologies (n = 28) were twice more frequent than postcanalicular ones (n = 14). Further developments could enlarge the indications of the GRIN-endoscope.

Adolescent↗
PubMed2005

Clinical value of dacryoscintigraphy using a simplified analysis.

PURPOSE: To study the discriminatory ability of dacryoscintigraphy in differentiating between patients with epiphora and volunteers using a simple method. METHODS: Twenty eyes in ten volunteers and 66 eyes in 55 patients with severe epiphora were studied. Dacryoscintigraphy (15 frames of 1 min) was performed after administration of 4 MBq (99m)Tc-pertechnetate (10 mul) in both eyes. By mapping a single region of interest (ROI) over the conjunctival sac we determined T1 (%dose in first minute) and linear clearance rate (LCR, defined as [see text] from the tracer disappearance curve. Reproducibility was determined in volunteers. Conjunctival resorption was determined from completely obstructed systems. Sensitivity and specificity were calculated and receiver operating characteristics (ROC) analysis was conducted. RESULTS: In volunteers mean T1 was 52.8+/-11.9% (95% CI 47.1-58.4%), and LCR was 74.2+/-11.1% (95% CI 69.0-79.4%). Reproducibility was good (mean difference 4.1+/-13.3% for T1 and 0.7+/-17% for LCR). Epiphora patients had clearly higher T1 (82.1+/-15.2%, P<0.0001) and lower LCR (38.9+/-22.5%, P<0.0001) values. Tracer resorption was 24%. Based on ROC analysis 70% for T1 and 50% for LCR were considered optimal cut-off levels to separate patients from volunteers. Sensitivity/specificity were 77/95% for T1 and 71/100% for LCR. T1 and LCR values did not correlate with symptom scores or Anel test results. CONCLUSION: Dacryoscintigraphy, using LCR and T1 as parameters, is a reliable and objective method to detect tear-flow abnormalities.

Adult↗
PubMed2004

Presurgical and postsurgical ultrasound assessment of lacrimal drainage dysfunction.

PURPOSE: In addition to the obligatory clinical tests, imaging of the lacrimal drainage system (LDS) is useful in its clinical evaluation. The purpose of this study was to examine the usability and reliability of ultrasonography in the evaluation of the lacrimal drainage system. DESIGN: Observational cohort study. METHODS: A prospective study was conducted at a single institution. We performed ultrasound examinations on 17 patients with epiphora before and after surgery, and on 17 asymptomatic volunteers, to visualize and evaluate the anatomic and functional condition or pathologic abnormalities of the LDS. RESULTS: Echographic evaluation of the LDS was possible in all individuals. Pathologic abnormalities (canaliculitis, diverticulitis, concretion, or dilation of the lacrimal sac, and reduced functionality of the orbicular muscle and/or lacrimal sac pump) could be well demonstrated. In the postsurgical course, functional patency of the dacryocystorhinostomy opening could be verified in all cases. CONCLUSIONS: Sonography of the LDS appears to represent a reliable diagnostic technique supplementary to clinical tests in the presurgical and postsurgical examination of patients with epiphora. Pathologic abnormalities that may not be apparent in routine x-ray dacryocystography can be demonstrated with ultrasound techniques. Patients also benefit from the avoidance of exposure to ionizing radiation. However, ultrasound is not suitable for imaging the lower part of the lacrimal sac and the lacrimal duct because of the presence of overlying bony structures.

Adult↗
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↗
PubMed2001

Dacryocystorhinostomy for epiphora in the presence of a patent lacrimal system.

PURPOSE: To evaluate the success rate of dacryocystorhinostomy (DCR) for epiphora in patients with a clinically patent lacrmal drainage system. METHODS: A series of 51 patients, 12 men and 39 women, who underwent DCR surgery for epiphora with a clinically patent lacrimal drainage system in the background of normal eyelid examination, were evaluated. All patients underwent fluorescein dye disappearance testing and Jones 1 and 2 testing with dacryocystograms in borderline cases. A standard DCR was performed with bicanalicular silicone tubing inserted in all cases. The average time for the removal of the silicone tubes was 9.6 weeks. RESULTS: In 48 cases (94%) there was improvement in symptoms with minimal or no significant epiphora postoperatively. CONCLUSIONS: Epiphora with a patent lacrimal drainage system obstruction can be successfully treated by DCR based on fluorescein dye disappearance tests and Jones 1 and 2 tests, with dacryocystography in borderline cases.

Adolescent↗
PubMed2002

Fluorescein transit test time and symptomatic outcomes after external dacryocystorhinostomy.

PURPOSE: To determine the relation between the fluorescein transit test time and postoperative relief of epiphora in patent dacryocystorhinostomies. METHODS: A retrospective study of 40 patients who underwent 42 external dacryocystorhinostomies between January 1994 and January 2000 was performed. Postoperative symptomatic success was assessed by a questionnaire. Intranasal rigid endoscopy was performed to measure the fluorescein transit test time, defined as the time from instillation of fluorescein to its free flow from the osteotomy site. The main outcome measures were symptomatic success, fluorescein transit test time, and anatomic patency to irrigation. Statistical analysis was performed with the use of the Fisher exact test. RESULTS: Of the 42 dacryocystorhinostomies studied, 92.8% were patent to irrigation. There was a statistically significant association between a fluorescein transit test time of < or = 45 seconds and subjective success (P<0.001), with 96% of patients reporting a successful postoperative outcome. A slow fluorescein transit test, with an average time of 138.9 seconds, was associated with symptomatic failure (P<0.001), with 56.2% of this group reporting significant postoperative epiphora. CONCLUSIONS: The fluorescein transit test provides a quantitative measure of lacrimal drainage function after dacryocystorhinostomy, with a fluorescein transit test time of < or = 45 seconds being the relevant parameter to characterize symptomatic success. Postoperative failure in external dacryocystorhinostomy, as evidenced by slow transit times, may result from surgical interference with the lacrimal pump.

Adult↗
PubMed1980

Lacrimal pathology evaluated by dynamic lacrimal scintigraphy.

This study of pathological lacrimal systems demonstrated the usefulness and sensitivity of dynamic lacrimal scintigraphy (dynamic use of computer assisted gamma camera). The method was very sensitive; even small lacrimal obstructions caused a distinct change of the outflow curves. This technique complements other tests in lacrimal assessment especially in patients with epiphora and normal conventional tests.

Adult↗
PubMed1975

Radiography in functional lacrimal testing.

A functional study of the lacrimal drainage apparatus was made in 25 patients. Angiographin was instilled into the conjunctival sac and serial radiographs were taken. The films were interpreted in conjunction with the intubation macro-dacryocystograms. Although this is a useful procedure, the use of angiographin compares unfavourably with ultra-fluid Lipiodol in a similar procedure.

Adolescent↗