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At least 1,099 records · Page 61Linked to original sources
PubMedDate not supplied

[Micro-endoscopy of the lacrimal apparatus combined with Erbium YAG laser: an anatomical study. New methods of imaging].

PURPOSE: To study the anatomic structure and the endoscopic aspect of the lacrimal drainage system and to evaluate the efficacy of the Erbium laser with microendoscope in lacrimal obstruction. METHODS: Twenty lacrimal ducts from ten fresh cadaver heads were used to lead a special rigid probe of 1.1. mm diameter (Endognost Schwind). This probe combined a flexible endoscopic probe of 500 mu, an Erbium laser fiber of 375 mu and an irrigation. The probe was introduced through the inferior canaliculus. Progressing in the lacrimal system, all the images were analysed. Then, we used the laser fiber to open the lacrimal sac mucosa and the lacrimal bone. RESULTS: The anatomo-endoscopic analysis was performed using endoscopic data. We appreciated essentially the walls of valves and sinuses that appeared only functional when increasing the irrigation flow. The laser could easily open the mucosa and the lacrimal bone but not the maxilla. DISCUSSION: The small size of the cannula allows to use the system for the diagnosis of lacrimal obstructions. The combined laser allows to treat at same time canalicular obstructions and lower obstructions. CONCLUSION: The endocanalicular study of the lacrimal drainage system can diagnose the type of obstruction and can treat it. A clinical study is requested to confirm these results.

Cadaver↗
PubMed1999

[Endonasal dacryocystorhinostomy: a personal experience].

Stenosis of the naso-lachrymal duct as a consequence of acute or chronic inflammation, trauma or congenital malformation is a relatively frequent lachrymal duct pathology. The symptoms include epiphora and intermittent tumefaction of the medial ocular canthus, indicative of a deficiency in lachrymal drainage. If such conditions do not respond to medical treatment, lavage and transcanicular probe, surgery proves necessary. Modern techniques for endonasal surgery place the otologist in the forefront in the surgical treatment of this disorder. Endonasal dacryocystorhinostomy (DCR) is indeed a valid alternative to traditional extra-nasal surgery; once exclusively the domain of the ophthalmologist. However, it does require a certain expertise in micro-endoscopic surgery. In most cases sophisticated equipment is not required and the procedure can be performed with just a few instruments: electric knives, scalpel and Citelli forceps. Endonasal DCR makes skin incisions unnecessary and makes it possible to reveal, and possibly, correct, any sequela subsequent to traditional DCR such as ethmoidal rhino-sinusitis or the presence of adhesions. In the present work 67 patients--24 with recurrence after traditional surgery--underwent endonasal DCR within the last 22 months and with an average follow-up of one year. Surgery was successful in 90% of the cases.

Adult↗
PubMedDate not supplied

The treatment of lacrimal apparatus obstruction with the use of an inner canthal Jones tube insertion via a transcaruncular route.

BACKGROUND AND OBJECTIVE: To evaluate the clinical utility of the lacrimal bypass surgery using Bowman's probe in treatment of obstruction of the lacrimal apparatus. PATIENTS AND METHODS: This study evaluated 124 cases of obstruction of the lacrimal passage systems with mean epiphora of 2.7 years. An incision was made on the side of the caruncle, and the lacrimal bone was penetrated between the lacrimal sac and the nasal mucosa by Bowman #0. Insertion of a Jones tube was made at the new lacrimal pathway, a puctum dilator or scissors was introduced through the caruncle and dilated across the lacrimal bone into the nasal cavity. The Jones tube was introduced over the probe into the nasal cavity, and fixed at the caruncle with nonabsorbable suture material. RESULTS: Complete resolution of epiphora was accomplished in 120 (96.8%) of 124 eyes; only 4 (3.2%) eyes failed during a mean of 17.1 months of follow-up. CONCLUSION: This procedure is simple and safe with no facial scarring, short operation time, high success rate, and can be performed under local anesthesia. Therefore, the clinical utility of this procedure seems to be of value in treatment of complicated obstruction of the lacrimal apparatus.

Adolescent↗
PubMedDate not supplied

Comparison of failed and successful dacryocystorhinostomy by using computed tomographic dacryocystography findings.

PURPOSE: To compare the spiral computed tomographic dacryocystography (CT-DCG) findings of failed and successful dacryocystorhinostomies (DCR) and to detect the possible causes of failure before reoperation. METHODS: Eighteen patients with failed and 15 patients with functional DCR were examined by spiral CT-DCG, a combination of contrast dacryocystography and spiral computed tomography. Radiologists, who were blinded to the clinical status of the patients, measured the diameter of the osteotomy window, evaluated its position relative to the lacrimal sac, and documented any abnormal findings around the osteotomy, which may contribute to the failure of DCR. RESULTS: Location of the osteotomy window was inappropriate in 83% (15/18) of unsuccessful cases and in 7% (1/15) of successful cases and the difference was statistically significant (p < 0.01). Presence of the ethmoid air cells medial to the ostium was detected to have a significantly higher frequency in the unsuccessful DCR group (78%, 14/18) than in the successful group (20%, 3/15) (p < 0.01). The antero-posterior diameter of bony ostium was less than 15 mm in 94% (17/18) of failed DCR cases, but in only 60% (9/15) of successful DCR cases, and the difference was statistically significant (p < 0.05). Some additional findings that may contribute to the failure were noted in failed cases. There were ethmoid sinusitis in three, concha bullosa in two, nasal polyposis in two, mass in medial canthus in one, and extensive granulation tissue around the rhinostomy in one of the failed cases. CONCLUSIONS: CT-DCG is a valuable imaging tool to evaluate DCR failures before reoperation. In this series, CT-DCG showed that small size and inappropriate position of osteotomy, and also extension of ethmoid air cells medial to the lacrimal sac, were frequently seen causative factors of DCR failure.

Adolescent↗
PubMed1977

Epiphora.

Explore the source record for details and available documents.

Dacryocystorhinostomy↗
PubMed1995

[Endonasal dacryocystorhinostomy].

Dacryocystorhinostomy an endonasal approach is a surgical procedure which permits removal of symptoms related to chronic stenosis of the naso-lacrimal duct without leaving external scars and without presenting risk for the orbital structures. The Author describes the surgical technique employed in 12 surgical cases. Use of the frontal loupe and of the operating microscope allows the surgeon's hands to remain free while all the advantages of binocular vision are maintained. Pre-operative investigation must always include a dacryocystography, a CT of the paranasal sinuses and an endoscopic examination of the nasal cavities.

Adult↗
PubMed1996

External dacryocystorhinostomy without mucosal flaps: comparison of petroleum jelly gauze nasal packing with gelatin sponge nasal packing.

BACKGROUND AND OBJECTIVE: This study was designed (1) to determine the overall success of patients who underwent external dacryocystorhinostomy (DCR) using a modified Kasper technique without lacrimal sac and nasal mucosal sutured flaps, and (2) to investigate the possible impact of intraoperative petroleum jelly gauze nasal packing as compared with gelatin sponge nasal packing on the surgical results. PATIENTS AND METHODS: A retrospective review of 122 consecutive patients who underwent external DCR using a modified Kasper technique was performed. Patients were divided into two groups based on use of petroleum jelly gauze packing or gelatin sponge packing. Criteria for successful surgery included resolution of the main symptom(s) of tearing, chronic mucous discharge (chronic dacryocystitis), and/or recurrent acute dacryocystitis; and patency of the reconstructed lacrimal system. RESULTS: Ninety-four of 96 patients who had petroleum jelly gauze packing had successful DCRs, whereas only 21 of 26 patients who had gelatin sponge packing had successful DCRs (P < .005). Soft tissue rather than bony obstruction of the rhinostomy was the most common cause of DCR failure, as confirmed by office probing, endoscopy, and computed tomography. Three patients in the gelatin sponge packing group who experienced failure subsequently had bacterial sinusitis. CONCLUSION: This study strongly suggests that gelatin sponge nasal packing, at least when used for patients who undergo DCR without sutured mucosal flaps, may be associated with an increased number of failures as a result of scar tissue formation at the rhinostomy site, as compared with petroleum jelly packing. Petroleum jelly gauze nasal packing may enhance surgical results by reducing scarring between the lacrimal sac fistula and the nasal structures.

Adolescent↗
PubMed1976

[Dacryocystography. 2. Results of 125 studies].

Results and X-ray findings of 125 dacryocystographies are discussed. Type II obstruction is the commonest pathological finding, Type I is caused often by a trauma. DCG gives a good morphological picture of tear drainage system and represents a very important method for planning surgical therapy.

Adolescent↗
PubMed1998

Lacrimal canalicular obstruction associated with topical ocular medication.

PURPOSE: To describe the association between the use of various types of topical ocular medications and acquired lacrimal canalicular obstruction in 14 patients. METHODS: The records of all patients in the author's practice with either lacrimal canalicular or punctal occlusion associated with the use of topical ocular medication were reviewed. RESULTS: Fourteen cases were identified. The obstructions occurred at any point from the punctum to the common canaliculus, but most commonly occurred 2-5 mm from the lacrimal punctum. There was an association with various degrees of clinically apparent subconjunctival scarring maximal at the inner canthus, rarely to a severe degree, with symblepharon, medial canthal keratinization and cicatricial medial entropion. In some cases, no subconjunctival scarring could be clinically detected. Topical medications used were often multiple and included prednisolone acetate/phenylephrine hydrochloride (n = 5), timolol maleate (n = 5), pilocarpine (n = 3), dipivefrine hydrochloride or adrenaline (n = 3), chloramphenicol (n = 3), tobramycin (n = 3), indomethacin (n = 2), ecothiopate iodide (n = 1), betaxolol (n = 1), dexamethasone (n = 1), tropicamide (n = 1) and the long-term use of naphazoline and various artificial tear preparations (n = 1). The duration of exposure ranged from 3 weeks to 20 years, with seven patients having used drops for 3-6 weeks. Seven patients had surgical repair, three by dacryocystorhinostomy (DCR) and glass by-pass tube (all successful), three by canalicular repairs (one failed) and one by DCR and canalicular repair that restenosed at the puncta, who then had successful punctoplasty and silicone intubation. CONCLUSIONS: Lacrimal canalicular obstruction may occur after relatively short-term exposure to topical ocular medications or as part of a more widespread cicatricial reaction in patients on long-term medication. While a direct causal relationship cannot be confirmed, there appears to be a strong association and the site of the obstructions makes other causes unlikely.

Administration, Topical↗
PubMed2006

Effect of mitomycin C on ostium in dacryocystorhinostomy.

BACKGROUND: To observe the effect of intraoperative mitomycin C of varying concentration on postoperative ostium size after external dacryocystorhinostomy (DCR). METHODS: In this prospective controlled study, 60 cases of DCR were taken up irrespective of age and sex. Cases were divided into three groups. Group 1 was taken as a control group and operated without mitomycin C; in experimental group 2 and group 3, mitomycin C at a concentration of 0.05 mg/mL and 0.4 mg/mL was applied, respectively, for 2 min. Each group consisted of 20 cases. Half of the cases in each group underwent single-flap DCR (SFDCR) and half underwent double-flap DCR (DFDCR) surgery. Nasal endoscopic evaluation was performed on the first postoperative day, at 2 weeks and at 6 months after surgery. A Student's t-test was used to compare the osteotomy size of each group. RESULTS: At the end of the final follow up, average size of the ostium in group 1 was 3.6+/-2.36 mm2 in SFDCR and 4.5+/-3.59 mm2 in DFDCR, in group 2 was 4.8+/-4.82 mm2 in SFDCR and 4.9+/-4.12 mm2 in DFDCR, and in group 3 was 16.6+/-6.80 mm2 in SFDCR and 17.5+/-9.07 mm2 in DFDCR. The ostium size in group 3 was found to be significantly bigger in comparison with group 1 (P=0.0001 in SFDCR, P=0.001 in DFDCR) and with group 2 (P=0.0009 in SFDCR, P=0.001 in DFDCR). No statistically significant difference of ostium size was found in SFDCR and DFDCR. CONCLUSION: Mitomycin C in appropriate dose minimizes postoperative fibrosis and granulations, thereby maintaining a bigger postoperative ostium throughout the postoperative observation period.

Adolescent↗
PubMed2004

Ultrasonic visualization of the effect of blinking on the lacrimal pump mechanism.

BACKGROUND: The role of the lacrimal sac (LS) and the medial canthal tendon in the lacrimal pump mechanism is controversial. This study used ultrasonic visualization to analyze this phenomenon. METHODS: Movements of the LS and the medial canthal tendon during blinking were visualized with sonography. In addition, the maximal profile area of the LS was measured before and after blinking using 15-MHz sonography in 14 individuals with a normal lacrimal drainage system and in six patients with lacrimal duct obstruction. RESULTS: The upper part of the LS could be located as an echolucent structure between the lacrimal bone and the medial canthal tendon. The medial canthal tendon appeared to compress the LS during lid closure and release the LS during lid opening. The measured profile area of the visible normal LS at the compression time decreased by 50%. The dilated LS of patients with obstruction could also be compressed by the orbital muscle on blinking, but the maximum area decrease was only 15.5%. CONCLUSION: The findings imply that the lacrimal part of the orbicularis muscle contracts during blinking, with the medial canthal tendon compressing the LS in a cranial direction. Completion of lid closure then compresses both canaliculi and LS, forcing the intrasacral fluid through the drainage system. The expansion of the LS during the opening phase of the blink causes suction, and after opening of the punctal areas the canaliculi and LS vacuum breaks to reload with tear fluid. These findings demonstrate the importance of the orbicularis muscle and the medial canthal tendon for the lacrimal pump mechanism during blinking.

Adult↗