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At least 127 records · Page 7Linked to original sources

PubMed1998

Success rates of nasolacrimal duct probing at time intervals after 1 year of age.

OBJECTIVE: The purpose of the study was to determine the success rate of probing for congenital nasolacrimal duct obstruction after 1 year of age. DESIGN: A record review. PARTICIPANTS AND INTERVENTION: Two hundred fifty-two patients with 303 obstructed nasolacrimal ducts underwent probing and irrigation by the author between 1971 and 1997 while under brief general anesthesia. MAIN OUTCOME MEASURES: Successful outcome of probing was defined as absence of tearing and discharge in the affected eye. RESULTS: The overall cure rate in all patients was 92%, varying from 88.9% to 96.8% at different age intervals up to and beyond 3 years of age. Chi-square analysis showed no significant change in cure rate with increasing age. CONCLUSION: Probing for congenital nasolacrimal duct obstruction beyond 1 year of age is highly successful, and the cure rate does not vary significantly at intervals of increasing age.

Anesthesia, General↗

PubMed2004

Endoscopic treatment of intranasal abnormalities associated with nasolacrimal duct obstruction.

PURPOSE: To report the incidence of intranasal abnormalities in children with nasolacrimal duct (NLD) obstruction and the results of treatment, which included nasal endoscopic removal of abnormal tissue. METHODS: Nasal endoscopy was performed prospectively in 22 infants with mucoceles; in 97 children > or = 18 months at the time of initial NLD probing; and in 59 children with persistent NLD obstruction after previous probing. Endoscopic removal of abnormal tissue was performed in addition to NLD probing or balloon-catheter dilation. RESULTS: NLD cysts were found in 22 of 22 (100%) infants with mucoceles. Cysts or other abnormalities of the distal duct were found in 6 of 97 (6.2%) children > or = 18 months at the time of initial probing and in 5 of 59 (8.5%) children whose previous NLD probing was unsuccessful. Surgery was successful in 91% of patients. CONCLUSION: Nasal endoscopy identified intranasal anatomic abnormalities of the distal nasolacrimal duct uniformly in infants with mucoceles and in 6% to 9% of older children with complicated NLD obstruction. Treatment, including endoscopic removal of abnormal tissue, was successful in most patients. The use of nasal endoscopy may improve the treatment of patients with these disorders.

Cysts↗

PubMed1993

Silastic intubation in congenital nasolacrimal duct obstruction: a study of 129 eyes.

Congenital nasolacrimal duct (NLD) obstruction, the most common cause of congenital epiphora, occurs in approximately 5% of newborns. Before the advent of canaliculodacryo intubation, management of most cases of partial lacrimal obstruction that failed conservative management and probing necessitated bypass surgery such as dacryocystorhinostomy. Noninvasive closed system lacrimal intubation improved the success rate and provided a non-surgical therapeutic alternative. We present 129 eyes with congenital NLD obstruction managed with silastic lacrimal intubations. Early management is recommended with a minimum of 7 months' retention of the stents. Statistical assessment of results and management of complications is presented.

Child↗

PubMed2007

Late probing for congenital nasolacrimal duct obstruction.

OBJECTIVE: To determine the outcome of late Nasolacrimal Duct (NLD) probing in children 2 years and above and to identify the cause of failure in these children. STUDY DESIGN: Quasi- experimental. PLACE AND DURATION OF STUDY: Shri Ganapati Netralaya, Jalna, India, from January 1999 to June 2003. PATIENTS AND METHODS: Clinical diagnosis of Congenital Nasolacrimal Duct Obstruction (CNLDO) was defined in a child who presented with history of tearing and/or eye discharge. Probing was performed under general anesthesia. Intraoperative patency of probing was determined when fluorescein stained saline was recovered from throat after syringing. The type of obstruction was noted in each case as simple obstruction where the probe could bypass the obstruction and post-probing syringing was patent in these cases, and complex where the probe was snugly fit and/or could not pass the obstruction and syringing was not patent in these patients. Success was the main outcome measure and was defined as complete resolution of tearing and discharges in the affected eye. RESULTS: Forty-nine eyes of 42 children were included in the study. The age range was from 2-7 years (average age 3.7 years). Probing was successful in 39 eyes (79.60%). Success rate was 85% in children less than 5 years and 55.55% in those older than 5 years. Out of the failed 10 cases, 5 (50%) were above 5 years of age. All cases with failed probing had complex type obstruction. CONCLUSION: Probing is a viable option in older children. The success rate for probing depends upon the type of obstruction and children with complex obstruction are at high risk for failure of probing.

Child↗

PubMed2002

Nasolacrimal duct obstruction caused by an oncocytoma.

We report the case of a woman with epiphora and purulent rhinorrhea for which she initially underwent a dacryocystorhinostomy. The unilateral rhinorrhea was persistent and one year later an oncocytoma of the lacrimal sac with extension to the nasolacrimal duct was diagnosed. Surgical excision of the tumour via a medial maxillectomy was accomplished. Long-term follow-up for 10 years was without evidence of recurrence. To our knowledge only 22 oncocytomas of the lacrimal sac but none involving the duct have so far been reported. In patients with acquired nasolacrimal duct obstruction a lacrimal sac or nasolacrimal duct tumour though rare is a possibility and should be kept in mind. The majority of these tumours are malignant and oncocytomas may undergo malignant transformation.

Adenoma, Oxyphilic↗

PubMedDate not supplied

Infected congenital mucocele of the nasolacrimal duct.

The authors report their experience with an infant presenting with an infected nasolacrimal duct mucocele, emphasizing correlation of clinical, CT, and surgical findings. CT is the imaging modality of choice to demonstrate the triad of 1) a cystic medial canthal mass, 2) dilatation of the nasolacrimal duct, and 3) a submucosal nasal cavity mass; findings which are diagnostic of this entity. A brief review of the relevant embryology is also presented.

Humans↗

PubMed2001

Endoscopic laser dacryocystorhinostomy. An unusual post-operative finding: re-opening of the nasolacrimal duct.

Endoscopic laser dacryocystorhinostomy (DCR) is a recognized technique for the surgical treatment of epiphora. Nasolacrimal duct obstruction is surgically bypassed by creating a passage from the lacrimal sac to the nasal cavity (rhinostomy). Some patients have undergone endonasal laser-assisted DCR, and were found to have an obstructed rhinostomy at follow-up. However, they reported a subjective improvement in their symptoms. Five such patients, at six months follow-up, were found to have a non-functioning rhinostomy with fluorescein dye emerging from under the inferior turbinate. These five patients along with four controls had post-operative macrodacryocystograms (MDCG) to delineate the anatomical passage by which tears were entering the nasal cavity. In the control group, clear passage of contrast into the middle meatus was demonstrated in three of the four subjects. In the study group, passage of dye to the inferior meatus, via the nasolacrimal duct was demonstrated in four of the five subjects. It is well recognized that a proportion of patients suffering from epiphora will have a natural resolution of their symptoms. Our results demonstrate that the resolution of epiphora in some operated patients was due to a re-opening of the nasolacrimal duct, and not because of a patent rhinostomy.

Aged↗

PubMed2000

Nasolacrimal duct obstruction and dacryocystocele associated with a concha bullosa mucocele.

PURPOSE: To describe the rare occurrence of a concha bullosa mucocele producing secondary nasolacrimal duct obstruction and dacryocystocele. DESIGN: Case report. PARTICIPANT: Forty-two-year-old man with 6-month history of left medial canthal mass. INTERVENTION: Clinical evaluation with lacrimal testing, computed tomography and surgical exploration, including biopsy, dacryocystorhinostomy, and excision/marsupialization of the middle turbinate concha bullosa mucocele were performed. RESULTS: The medial canthal mass was confirmed to be a dacryocystocele associated with nasolacrimal duct obstruction and bone destruction caused by concha bullosa mucocele. CONCLUSIONS: Concha bullosa mucoceles are uncommon and even more rarely can produce secondary nasolacrimal duct obstruction and dacryocystocele formation. The clinical and radiologic features may mimic a lacrimal sac malignancy.

Adult↗

PubMed1997

Clinically suspected primary acquired nasolacrimal duct obstruction: clinicopathologic review of 150 patients.

PURPOSE: The incidence of lacrimal sac pathology in patients with clinically suspected primary acquired nasolacrimal duct obstruction is unknown. This is an important issue when considering the potential risk of either conservative nonsurgical management or laser dacryocystorhinostomy, neither of which permits direct visualization and biopsy of the lacrimal outflow apparatus. METHODS: A total of 162 lacrimal sac biopsy specimens were obtained in 150 consecutive patients undergoing external or endonasal dacryocystorhinostomy for clinical primary acquired nasolacrimal duct obstruction from January 1992 to October 1994. RESULTS: A total of 147 patients (98%) had histopathologic findings consistent with inflammation or fibrosis of the lacrimal sac or both. In the remaining three patients, abnormalities included sarcoid granuloma (one patient), oncocytoma (one patient), and lymphoma (one patient). CONCLUSIONS: The incidence of significant pathology of the lacrimal sac in clinically suspected primary acquired nasolacrimal duct obstruction is low. However, these cases can be identified correctly only by routine biopsy of the lacrimal sac during dacryocystorhinostomy.

Adult↗

PubMed1997

Balloon dilatation for treatment of resistant nasolacrimal duct obstruction.

PURPOSE: Our purpose was to report our experience with balloon catheter dilatation for resistant nasolacrimal duct obstruction. METHODS: Patients enrolled had symptoms of nasolacrimal duct obstruction and (1) had failed previous probing or (2) were more than 2 years old. Balloon dilatation was performed with a LacriCATH lacrimal catheter (Atrion Medical Products, Birmingham, Ala.). A subset of patients had Silastic silicone rubber (Dow Corning, Midland, Mich.) intubation after balloon dilatation. Success was determined by clinical examination a minimum of 6 weeks later. RESULTS: Twenty-one lacrimal systems of 12 patients were treated (age range 4 months to 7 years). Of the patient subset treated with a LacriCATH lacrimal catheter alone, 9 of 18 systems demonstrated complete resolution of symptoms. Three of the 12 patients underwent balloon dilatation intraoperatively after attempts at Silastic silicone rubber intubation were unsuccessful. In two of these patients, who were younger, Silastic silicone rubber tubes passed easily after balloon treatment; however, in an older patient, age 5 years, intubation still could not be accomplished. CONCLUSION: Common clinical strategy for treatment of resistant nasolacrimal obstruction includes repeat probing, intubation of the nasolacrimal system with Silastic silicone rubber tubes, or dacryocystorhinostomy. Balloon catheter dilatation is an alternative or adjunct to consider. Factors that may affect the success of treatment include the age of the patient, the complexity of the nasolacrimal anatomy, and use of adjunctive systemic antibiotics and steroids.

Catheterization↗

PubMed1999

Comparison of dacryocystography and lacrimal scintigraphy in the diagnosis of functional nasolacrimal duct obstruction.

AIM: It appears from the literature that no standardised examination exists for patients with functional nasolacrimal duct obstruction. The role of dacryocystography and lacrimal scintigraphy was compared in the diagnosis and management of these patients. METHOD: Patients who were clinically diagnosed as having unilateral or bilateral functional nasolacrimal duct obstruction were prospectively entered into the study and data collected over 12 months in Moorfields Eye Hospital and Whipps Cross Hospital, London. All cases had, on separate occasions, a standardised dacryocystogram with delayed erect films and a lacrimal drainage scintigram. RESULTS: 45 lacrimal systems of 32 patients (mean age 62 years; 59% male) fulfilled the inclusion criteria. Abnormalities were detected with dacryocystography in 93% of systems and with lacrimal drainage scintigraphy in 95% of systems. Based on the results of previous quantitative studies, the positive scintigrams were subdivided into those demonstrating prelacrimal sac delay (13%), delay at the lacrimal sac/duct junction (35%), or delay within the duct (47%). Combining the two imaging techniques increased the sensitivity to 98%. CONCLUSIONS: Both investigations are very sensitive at detecting abnormalities in patients with a clinical diagnosis of functional nasolacrimal duct obstruction. Lacrimal drainage scintigraphy is a slightly more sensitive test, but missed an abnormality detected by dacryocystography in two (4%) systems. A combination of the two techniques gives the highest sensitivity with maximum anatomical and physiological information but, in clinical practice, it is reasonable to perform a dacryocystogram initially and proceed to scintigraphy only if contrast radiography is normal.

Adult↗

PubMed1998

Balloon catheter dilation for treatment of adults with partial nasolacrimal duct obstruction: a preliminary report.

PURPOSE: The purpose of this study is to determine the efficacy and morbidity of balloon catheter dilation for treatment of partial acquired nasolacrimal duct obstruction in adults with epiphora. METHODS: We performed balloon dacryocystoplasty prospectively on a series of 15 partial nasolacrimal duct obstructions in 13 adults with epiphora. Partial obstruction was diagnosed by a negative Jones-1 test and canalicular irrigation revealing simultaneous reflux through the opposing punctum and drainage into the nose. Balloon dacryocystoplasty was performed under local anesthesia using an antegrade insertion technique. Silicone intubation of the nasolacrimal system was performed immediately after balloon catheter dilation, and the tubes were removed 2 months postoperatively. RESULTS: Success was measured objectively and subjectively at follow-up examinations 2 months and 6 months after the procedure. At 2 months, 11 (73%) of 15 obstructions were open on irrigation, with subjective success (Munk, grade 0 or grade 1) reported in 13 (87%) of 15 obstructions. At 6 months, 11 (73%) of 15 obstructions were open on irrigation, with subjective success (Munk, grade 0 or grade 1) reported in 9 (60%) of 15 obstructions. CONCLUSIONS: Balloon dacryocystoplasty may be a satisfactory primary treatment for adults with acquired partial nasolacrimal duct obstruction who exhibit no clinical signs of chronic infection. Additional long-term observations following balloon dacryocystoplasty are required.

Adult↗

PubMed2005

The course of epiphora after failure of silicone intubation for congenital nasolacrimal duct obstruction.

BACKGROUND: One of the indications for dacryocystorhinostomy (DCR) in children with congenital nasolacrimal duct obstruction (CNLDO) is failure of silicone intubation. We evaluated the course of epiphora after failure of silicone intubation for CNLDO when DCR was not performed. METHODS: In a comparative cohort study carried out at a tertiary referral center, ten eyes of seven consecutive children who had failure of silicone intubation manifested as persistent epiphora over 2 months and whose parents refused DCR were followed up for an average of 50.4 months (range 33-70 months). Three lacrimal drainage systems of three other children who had failure of silicone intubation underwent uneventful DCR. RESULTS: In eight (80%) of the ten consecutive eyes with congenital nasolacrimal duct obstruction (six of the seven children, 86%), there was spontaneous complete resolution of the epiphora and normal dye disappearance test (DDT) at the end of the follow-up period. One child with Down's syndrome, allergic rhinitis, asthma and multiple site obstructions had improvement of symptoms but abnormal DDT. The epiphora in all three children who underwent DCR had disappeared by 6 months after surgery when the silicone tube was removed. No complications were noted during the follow-up. CONCLUSIONS: Epiphora can spontaneously resolve after failure of silicone intubation in CNLDO, and DCR should no longer considered be compulsory in such cases unless complications evolve.

Child, Preschool↗

PubMed2005

[Identification of bacterial flora of conjunctival sac in congenital nasolacrimal duct obstruction in children].

PURPOSE: The aim of the study was to evaluate the species of the microorganisms and their susceptibility to antibiotics in congenital nasolacrimal duct obstruction in children. MATERIAL AND METHODS: The pus secretion after lacrimal sac massage was obtained from 81 children with congenital nasolacrimal duct obstruction. The laboratory diagnostics was performed using typical microbiological procedures. The modification of these procedures was 24-hour pre-incubation in sugar boullion. RESULTS: The most frequently isolated bacteria were Staphylococcus epidermidis (28%) and Staphylococcus aureus (22%). The isolated staphylococci (only coagulase-negative species MRSE) were resistant to methicillin in 2 cases. Streptococci were obtained in 20% isolations: Streptococcus pneumoniae (14%), Streptococcus viridans (6%). Gram-negative bacilli Pseudomonas aeruginosa and Moraxella spp. and Candida albicans were isolated in a few cases. Negative results of the cultures were obtained in 25% cases. CONCLUSIONS: The microorganisms typically constituting physiological flora of conjunctival sac may become the pathogens in the complications of congenital nasolacrimal duct obstruction in children.

Candida albicans↗

PubMed1994

Nasolacrimal duct obstruction treated nonsurgically with use of plastic stents.

PURPOSE: To evaluate the clinical utility of plastic stents in treatment of complete obstruction of the nasolacrimal duct. MATERIALS AND METHODS: Nineteen plastic stents were successfully placed under fluoroscopic guidance in 16 consecutive patients with epiphora due to complete obstruction of the nasolacrimal duct. After balloon dilation of the obstructed area, the stents were placed in the lacrimal system with the head portion lying in the dilated lacrimal sac and the body in the nasolacrimal duct and projecting into the inferior meatus of the nasal cavity. RESULTS: Complete resolution of epiphora was accomplished in 15 (79%) of 19 eyes and partial resolution in the remaining four (21%) eyes. CONCLUSION: These preliminary results with use of plastic nasolacrimal stents are encouraging.

Adolescent↗

PubMed1997

[Nasolacrimal stent for epiphora caused by obstruction of the nasolacrimal duct].

A 71-year-old patient with severe epiphora due to a subtotal obstruction of the nasolacrimal duct was initially treated with balloon dilatation. After failure of this procedure a nasolacrimal stent was placed under fluoroscopic control in an outpatient setting. After stenting there was complete resolution of the epiphora during a follow-up of six months. Outpatient treatment of complete nasolacrimal duct obstruction or obstruction after failure of balloon dilatation with a nasolacrimal stent appears to be a good alternative to surgery.

Aged↗

PubMedDate not supplied

Congenital nasolacrimal duct obstruction: natural history and the timing of optimal intervention.

Nasolacrimal duct obstruction (NLDO) is a relatively common clinical problem. Debate continues about optimal management. Intervening early and intervening late each have advantages and disadvantages. We reviewed the world literature on NLDO. We assembled information on occurrence, natural history, and results of treatment. Spontaneous remission data were used to derive the probability of continued obstruction versus age. The prevalence a hypothesized treatment-resistant form of NLDO was estimated. Symptomatic NLDO probably occurs in 5 to 6% of infants. Given a symptomatic case under the age of 14 months, the probability of spontaneous remission within the following month appears to be approximately one of three. Probe failure risk increases with age, doubling every 6 months. Increasing probe failure risk may be due to self-selection. Preliminary analysis of management strategies suggests that lacrimal duct probing at age 4 months in the office is the most cost-effective strategy. Further descriptive studies of NLDO remission and treatment are indicated.

Age Factors↗

PubMed1996

Silicone intubation with tissue glue anastomosis in the treatment of congenital nasolacrimal duct obstruction.

BACKGROUND AND OBJECTIVE: To evaluate the advantages of tissue glue application for the anastomosis of silicone intubation in congenital nasolacrimal duct obstruction. PATIENTS AND METHODS: Patients with congenital nasolacrimal duct obstruction were treated with silicone intubation with the aid of tissue glue for end-to-end anastomosis. The recurrence rate, complications, and the need for general anesthesia at tube removal were recorded. RESULTS: The silicone tubes for all 18 eyes studied were removed smoothly on an outpatient basis. Early extrusion was noted in 3 eyes. No recurrence of epiphora was noted in any eye after more than 6 months of follow-up. CONCLUSION: Tissue glue anastomosis is a beneficial modification that avoids the need for general anesthesia during stent removal in children and allows removal to be easily performed in an outpatient clinic.

Anastomosis, Surgical↗