Stenosis of the lacrimal canals and puncta; caused by the Stevens-Johnson syndrome.
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BACKGROUND: Patients with tuberous sclerosis (Morbus Bourneville-Pringle) may show hamartomatous tumors of different organ systems. 50% of patients display astrocytic hamartomas of the retina. The skeletal system is affected in 40%: peri-, en- or exostoses, or cysts may occur. To the best of our knowledge, there are only three descriptions of an involvement of the facial skeleton in the literature. PATIENT: A 54-year-old man presented with recurrent dacryocystitis and lacrimal duct obstruction. Tuberous sclerosis and epilepsy were present since childhood. Besides typical skin lesions and intracranial calcified astrocytomas a retinal astrocytoma was detected in his left eye. Coronal CT scan revealed endonasal bone thickening involving the nasal floor, conchae and lateral walls. Evidence of maxillary and ethmoidal sinusitis was also present. CONCLUSION: The endonasal findings in our patient are most likely a manifestation of tuberous sclerosis of the facial skeleton. They may have favored the development of marked sinusitis and lacrimal duct obstruction.
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INTRODUCTION: Diagnostic and rhinosurgical problems relevant to surgical treatment of lacrimal duct stenosis are discussed. MATERIAL AND METHODS: A group of 418 patients suffering from lacrimal duct stenosis were subjected at the same time to 455 procedures of endonasal dacryocystorhinostomy combined with other intranasal interventions, such as septoplasty, ethmoidectomy, mucotomy. Rhino-ophtalmologic evaluation included: micro-endoscopic examination, CT of paranasal sinuses, dacryocystography or dacryoscintygraphy. RESULTS: In the most of the patients we noted at least some anatomical alterations of the nasal cavity. Most common were septal deviations (85.9%), followed by hypertrophy of the inferior turbinates (78,0%), pathology of ostio-meatal complex (24.8%), concha bullosa (15.0%) or various combinations of these. Chronic rhinosinusitis was noted among 23.2% of patients. Radiological examinations showed the predominance of postsaccal stenosis in 15.3-17.0% cases (respectively to the right or left side), saccal stenosis in 12.7-11.7% cases and presaccal in 4.3-3.6% cases. CONCLUSIONS: This combined procedure makes easy not only the operation on lacrimal duct but removes the pathologic changes and has a good influence on healing.
Conjunctivo-dacryocystorhinostomy with a Jones glass tube serving as a conduit for tear flow is used in patients with epiphora resulting from obstructed canaliculi. The glass tube runs from the medial canthus into the nose. The author describes the use of an extended Jones tube in a patient without a nose.
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We went through papers on lacrimal duct disorders published in 1991 seeking new information which could be directly applied. Practical clinical information was given priority over academic results. 1. New strategies were adopted in particular in the surgical treatment of lacrimal duct obstructions. The most important progress in this context was in the use of various types of laser in combination with improved video endoscopes, e.g. in laser dacryocystorhinostomy or laser conjunctivodacryocystorhinostomy. 2. A special instrument, the "Reiss punctal punch", was developed for treatment of punctal stenosis. It enhances and facilitates punctoplasty. 3. With regard to the lacrimal gland and tear secretion, it was shown that epidermal growth factor (EGF) is a natural component of human tears and is formed in the lacrimal gland. It is not yet known whether corneal wound healing can be influenced by administering drugs which alter EGF production.
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