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PubMedDate not supplied

A controlled study of silver nitrate prophylaxis and the incidence of nasolacrimal duct obstruction.

The caustic property of silver nitrate prompted a double-blind, controlled study of a possible causal relationship between use of the agent for prophylaxis against ophthalmic infection in the newborn and the subsequent development of nasolacrimal duct obstruction. Follow-up of 145 newborns randomized either to 1% silver nitrate prophylaxis or to 1% tetracycline prophylaxis revealed no statistically significant difference in the incidence of nasolacrimal duct obstruction between the two groups at either two weeks or two months of age. It is concluded that silver nitrate prophylaxis does not predispose to nasolacrimal duct obstruction in the newborn.

Chlamydia Infections↗
PubMed2006

Malignant melanomas of the nasolacrimal duct.

Two patients with a history of epistaxis who were both found to have a nasolacrimal duct melanoma are presented. A literature review revealed that no previous cases of primary nasolacrimal duct melanoma have been reported. Current therapeutic modalities are discussed.

Aged↗
PubMedDate not supplied

Balloon dilatation for treatment of congenital nasolacrimal duct obstruction.

PURPOSE: To evaluate the safety and effectiveness of balloon dacryocystoplasty in the treatment of congenital nasolacrimal duct obstructions. METHODS: Balloon dacryocystoplasty was attempted in 25 eyes of 21 patients. The procedure was performed successfully in 24 eyes of 20 patients, age range 21-72 months. Nineteen eyes had no previous procedure. The mean age of this group was 43.9 months (range 36-72 months). Five eyes had failed probing of lacrimal system. The mean age of this group was 22.2 months (range 21-24 months). The authors performed balloon dacryocystoplasty under endoscopic guidance. Clinical success was defined as complete remission of epiphora within follow-up period of 7-34 months (mean 25.2 months). RESULTS: The authors performed balloon dacryocystoplasty in 24 eyes. The first procedure was successful in 20 of them and the clinic success rate was 83.3%. The technique was repeated in the one eye that recurred and as it ended successfully, the clinic success rate increased to 87.5%. In 17 of the 19 eyes (89.4%) in which balloon dacryocystoplasty was performed primarily, and in 4 of 5 eyes (80%) in which balloon dacryocystoplasty was performed secondarily after unsuccessful probing, the procedure was clinically successful. There was intermittent epiphora in 3 eyes (15%) and these were considered as recurrence. CONCLUSIONS: This experience shows that balloon dilatation is a safe and effective treatment of congenital nasolacrimal duct obstruction as a primary procedure in children over 36 months of age and as a secondary procedure after failure of lacrimal system probing. As a result, balloon dacryocystoplasty can be an alternative treatment in older children and can be preferred to silicone intubation and dacryocystorhinostomy performed after unsuccessful probing.

Catheterization↗
PubMed1984

Incontinentia pigmenti associated with nasolacrimal duct obstruction.

A case is reported of a five-month-old female with incontinentia pigmenti associated with nasolacrimal duct obstruction. Ocular manifestations of incontinentia pigmenti have previously been described to include persistent hyperplastic primary vitreous, retinal dysplasia, retrolental fibroplasia, corneal opacities, cataract, optic atrophy, and strabismus. This case is believed to be the first reported instance of incontinentia pigmenti associated with nasolacrimal duct obstruction. The management of this patient is also discussed.

Dacryocystorhinostomy↗
PubMed2006

Comparison of two endoscopically assisted procedures in primary surgical treatment of congenital nasolacrimal duct obstruction in children older than 3 years: balloon dilatation and bicanalicular silicone tube intubation.

OBJECTIVES: To determine the success of two transnasally endoscopic assisted procedures as balloon dilatation and bicanalicular silicone tube intubation for the primary surgical treatment of congenital nasolacrimal duct obstruction in children older than 3 years. STUDY DESIGN: Prospective randomized clinical trial. METHODS: An interventional case series of consecutive primary endoscopic assisted balloon dilatation (BD) and bicanalicular silicone tube intubation (STI) for congenital nasolacrimal duct obstruction in children older than 3 years was reviewed. BD was performed in 20 eyes of 17 patients and STI was performed 24 eyes of 20 patients. Clinical success was defined as a complete remission of epiphora at the end of follow-up period of 12 months and a continuation of the remission at least for 4 months. RESULTS: Eighteen out of 20 eyes (90%) nasolacrimal ducts responded to BD whereas the rate was 15 out of 24 eyes (62.5%) in STI group. No significant complications occured in BD group while the complication rate in STI group was 8 out of 24 eyes (33.3%). chi(2)-Statistical analysis showed significantly better results for BD in clinical success and complication rates than those of STI. CONCLUSIONS: BD should be the first choice therapy instead of invasive approaches with high rate of complications and lower success rates such as silicone intubation, in patients who are older than 3 years.

Catheterization↗
PubMed2001

Intraosseous approach to the nasolacrimal duct for removal of a foreign body in a dog.

A Labrador retriever was evaluated because of chronic mucopurulent discharge from the left eye. A foreign body was identified in the nasolacrimal duct by use of dacryocystorhinography. Attempts to alleviate the inflammation by use of flushing and administration of antimicrobials were unsuccessful. At surgery, the infraorbital foramen was used as a landmark for a skin incision, because the nasolacrimal duct courses dorsal and parallel to the infraorbital canal. An air drill was used to remove the portion of the maxillary bone overlying the nasolacrimal duct, which exposed the intraosseous portion of the duct and allowed removal of a plant-material foreign body. The incision in the duct was allowed to heal by second intention, and the dog recovered without complications.

Animals↗
PubMed2001

Diameter of the bony lacrimal canal: normal values and values related to nasolacrimal duct obstruction: assessment with CT.

BACKGROUND AND PURPOSE: Epiphora, or tearing due to primary acquired nasolacrimal duct obstruction (PANDO), is increasingly being treated with balloon dilatation. The cause of PANDO is unknown, but a small diameter of the bony nasolacrimal canal might be one of the etiologic factors. The purpose of this study was to determine the normal distribution of diameters of the bony canal and to ascertain whether there is an association between the diameter of the bony canal and primary nasolacrimal duct obstruction. METHODS: Using axial CT, we measured the minimum diameter of the bony nasolacrimal canal in a control group of 50 men and 50 women and in 19 patients with PANDO. RESULTS: The mean minimum diameter in the control group was 3.5 mm, which was smaller than expected on the basis of published data. The difference between the mean minimum diameter in men (3.70 mm) and that in women (3.35 mm) was significant. The mean minimum diameter in the patient group was 3.0 mm, which was significantly smaller than that in the control group. There was, however, considerable overlap. CONCLUSION: A small diameter of the bony canal appears to be one of the etiologic factors in PANDO.

Adult↗
PubMed2004

Tear flow dynamics in the human nasolacrimal ducts--a pilot study using dynamic magnetic resonance imaging.

BACKGROUND: Jones's theory of tear drainage suggests that the lacrimal sac fills when the eyelids are closed and empties into the nasolacrimal duct when the eyelids are open. This is aided by the contraction of the orbicularis muscle during each blink. This study was undertaken to ascertain the possibility of seeing the dynamic movement of tears in the nasolacrimal system during blinks using magnetic resonance dacryocystography (MR-DCG). METHODS: The sac was initially localized with a three-plane gradient echo sequence using a 1.5-T MRI platform. Fast, dynamic MR-DCG was carried out after we had instilled topically balanced salt solution (BSS) in five subjects and 0.5% gadolinium in seven subjects. The volunteers were asked to close and open their eyes during the fast imaging. The images were digitized to enable us to see the actual movement of fluid in the system. RESULTS: The tear movement was clearly seen as a bolus in the volunteers where BSS was used. The fluid passed into the nasolacrimal duct after several blinks when patent. The sac was never seen to empty completely. Though differential filling was seen between the upper and lower part of the sac, it was difficult to see the actual fluid movement in the volunteers when topical gadolinium was used. CONCLUSION: The findings of the study are supportive of the notion of fluid travel in the form of a bolus through the sac. Once a threshold volume is reached in the lower end of the sac, the fluid is seen to pass through the nasolacrimal duct. This happens after several blinks.

Acetates↗
PubMed2003

Adenocarcinoma ex-pleomorphic adenoma of the lacrimal sac and nasolacrimal duct: a case report.

OBJECTIVES: To present the clinical presentation, workup, surgical approach, and pathological findings of the first case report of a patient with adenocarcinoma ex-pleomorphic adenoma of the lacrimal sac and nasolacrimal duct. STUDY DESIGN: Retrospective review of the records of a case of adenocarcinoma ex-pleomorphic adenoma of the lacrimal sac and nasolacrimal duct. METHODS: The clinical presentation, workup, surgical approach, and pathological findings were reviewed. RESULTS: A 51-year-old man presented with a 10-year history of recurrent epiphora of the right eye. At dacryocystorhinostomy a small lesion was visualized within the lumen of the lacrimal sac. A biopsy specimen was consistent with adenocarcinoma. En bloc resection was accomplished using a lateral rhinotomy and medial maxillectomy. The final specimen showed adenocarcinoma ex-pleomorphic adenoma. The patient was given postoperative radiation therapy. He was free of disease 16 months after treatment. CONCLUSIONS: Lacrimal sac tumors should be considered in the differential diagnosis of chronic epiphora. Management of nasolacrimal adenocarcinoma requires complete surgical resection. Radiation treatment in and of itself is not curative but may be useful as adjuvant therapy. Carcinoma ex-pleomorphic adenoma can develop in the lacrimal sac and nasolacrimal duct.

Adenoma, Pleomorphic↗
PubMed2006

Apoptosis as a creative agent of embryonic development of bucca, mentum and nasolacrimal duct. An in vivo study in rats.

INTRODUCTION: For embryonal facial development several fusion processes between different facial prominences are necessary. If fusion fails to appear, various facial clefts may occur, known as median (e.g. lower median cleft lip), oblique (e.g. open nasolacrimal duct) or lateral facial clefts (macrostomia, lateral cleft). MATERIAL AND METHODS: The development of 3 different facial regions (bucca, mentum, and nasolacrimal duct) was examined in rats using serial histological sections on day 13.5 after conception. Common procedures were used (staining for active caspase-3 and for Ki-67) for histological assessment about the role of apoptotic and proliferative processes in the fusion zones of buccal, mental and nasolacrimal areas. RESULTS: Multiple apoptotic events were detected in epithelial cells of the respective regions, the proliferative centers were located in the mesenchymal surroundings of fusion zones. CONCLUSION: A substantial precondition for fusion of facial prominences are proliferative and apoptotic processes in epithelial and mesenchymal cells. Apoptosis contributes to the development of bucca, mentum and the nasolacrimal duct. Absence of apoptoses may be responsible for facial clefts.

Animals↗
PubMed1993

Rhabdomyosarcoma manifesting as acquired nasolacrimal duct obstruction.

A 5-month-old boy with acquired epiphora developed a right inferonasal lower eyelid mass, which was shown on computed tomography to involve the inferior and medial recti muscles and the nasolacrimal duct. Orbital exploration and excision of the mass disclosed this to be an embryonal rhabdomyosarcoma. This case illustrates the importance of distinguishing acquired nasolacrimal duct obstruction in infancy from true congenital nasolacrimal duct obstruction.

Diagnosis, Differential↗
PubMed1999

Oral and topical antibiotic therapy of complete, primary acquired nasolacrimal duct obstruction in adults.

PURPOSE: To determine whether patients with complete, acquired nasolacrimal duct obstruction may be treated with broad spectrum oral antibiotics and office lacrimal irrigation. METHODS: In a retrospective review, patients with complete, primary acquired nasolacrimal duct obstruction (NLDO) were divided by predominant symptoms and signs into two main groups: (a) those with tearing and/or mucous discharge and (b) those with previous acute dacryocystitis and/or lacrimal sac mucocele. All patients received a therapeutic trial of oral and topical antibiotics followed by lacrimal irrigation. RESULTS: Five of 55 patients with tearing and/or mucous discharge showed significant improvement after treatment with a mean follow-up of 16.5 months. A sixth patient with mucous and tearing had resolution of the mucous discharge but persistent tearing and blockage of the nasolacrimal system to irrigation. Two of 20 patients with lacrimal sac mucocele or history of acute dacryocystitis avoided surgery while 18 opted for early lacrimal surgical intervention. CONCLUSIONS: Conservative management of complete acquired NLDO consisting of oral and topical antibiotics and appropriately timed office lacrimal drainage system irrigation may be considered in selected patients.

Administration, Oral↗
PubMed2005

Results of probing for congenital nasolacrimal duct obstruction in children older than 13 months of age.

PURPOSE: To determine the success rate of probing for congenital nasolacrimal duct obstruction in children older than 13 months of age. METHODS: In a retrospective study of 84 children, 13 months and older who underwent probing for congenital nasolacrimal duct obstruction, the age at probing was correlated with success of probing. The children were divided into two groups, Group 1(13 - 24 months) and Group 2 (>24 months). Success was defined as complete resolution of signs and symptoms. The chi-square test was used to analyse the result. RESULTS: The success rate was 88.1% in-group 1 and 80.1% in-group 2 (P = 0.84). There was no significant difference in the cure rate with increasing age (P = 0.6). CONCLUSION: Probing is highly successful in the older age group and should remain the first line of treatment in older children.

Chi-Square Distribution↗
PubMedDate not supplied

Repeated probing results in the treatment of congenital nasolacrimal duct obstruction.

PURPOSE: To assess the results of our protocol of repeated probing for the treatment of congenital nasolacrimal duct obstruction in various presentations. METHODS: A total of 1600 patients (1748 eyes) with congenital dacryocystitis (850 boys, 750 girls; age range, 1 month to 48 months [mean 16.54 +/- 12.21 months]) were included. Diagnosis was confirmed by history of tearing, crusting of lids, and a boggy swelling over inner canthal region, which on pressure ejected mucopurulent discharge through punctum. Antibiotic eye drops were instilled five times a day for a week in affected eyes after the mother pressed the sac area and cleaned the discharge. The cases that were not relieved were subjected to sequential probing dilating with an increasing diameter probe repeated in failed cases second and third times at 1-week interval. RESULTS: Medical treatment was effective in only 60 eyes (3.43%). Probing and syringing achieved successful results in 790 eyes (100%) aged 1 month to 12 months; 330 eyes (99.40%) aged 12 months to 18 months; 200 eyes (98%) aged 18 months to 24 months; 150 eyes (95.24%) aged 24 months to 36 months; and 158 eyes (89.87%) aged 36 months to 48 months. The cure rate with first probing was 98.10%, second probing was 99.64%, and third probing was 100%. CONCLUSIONS: Our protocol of medical regime and early probing repeated two to three times was very effective in the treatment of nasolacrimal duct obstruction at all ages. A second and third probing was recommended after 1 week of the first probing with successful results if first probing failed.

Acute Disease↗
PubMed1994

Bilateral nasolacrimal duct obstruction associated with Crohn's disease successfully treated with dacryocystorhinostomy.

A 41-year-old woman developed epiphora due to bilateral nasolacrimal duct obstruction 1 year after a definitive diagnosis of Crohn's disease. Treatment with systemic and topical antibiotic therapy resulted in resolution of the left-sided obstruction but epiphora persisted on the right side. The patient underwent standard dacryocystorhinostomy with insertion of silicone tubes. Six months after surgery, she remains free of symptoms. To our knowledge, this is the first report of bilateral nasolacrimal duct obstruction that occurred in a patient with active Crohn's disease.

Adult↗
PubMed2004

Nasolacrimal duct obstruction in children: outcome of intubation.

BACKGROUND: Nasolacrimal silicone intubation is a treatment for congenital nasolacrimal duct obstruction (NLDO) after failed probing and irrigation. Functional outcome has been previously reported as poorer in children with Down syndrome. METHOD: The outcome of 122 cases of silicone bicanalicular nasolacrimal intubation, performed between 1988 and 2002 on 97 children aged 11 months to 9.5 years, was retrospectively reviewed. In all children, intubation was performed under direct vision using nasal endoscopy. Statistical analysis, including multiple logistic regression analysis, was used to assess the effects of duration of intubation, and age at surgery, on treatment outcome, and to determine potential predictors of treatment failure. RESULTS: The overall success rate was 85%, with 89% success for eyes in children with Down syndrome and 85% success for eyes in children without Down syndrome. Success rates were consistently high (83% to 100%) for children who underwent surgery between 1 and 4 years of age. The average duration of intubation was 5.5 months. Increasing duration of intubation was not associated with increasing chance of success, but with a significantly higher risk of failure if greater than 18 months (P = 0.03). Retention of stents for longer than 12 months was associated with a significantly lower success rate (67%). The presence of Down syndrome, increasing age at surgery, or gender were not predictive factors for treatment failure. Unplanned removal of tubes because of dislodgement was the most common complication, occurring in 25% of eyes, but did not affect functional outcome. CONCLUSIONS: Nasolacrimal silicone intubation, under direct nasal endoscopic visualization, is a consistently successful procedure for the treatment of NLDO among children aged older than 12 months of age. Tubing should be left in place for a maximum of 12 months because the success rate declines after this period and the risk of failure is significantly increased after 18 months of intubation. Prematurely dislodged tubes need not be replaced unless symptoms of nasolacrimal obstruction occur, because this does not lead to an increased risk of treatment failure.

Child↗
PubMed1995

[Management of congenital nasolacrimal duct obstruction. Timing of probing].

In the management of congenital nasolacrimal duct obstruction (CNDO), there is not a well-established agreement about the proper time for probing. Some authors perform it prior to the first year of life, since after this age the relapse frequency would be very high; others prefer conservative management, since they deny this high frequency. In order to evaluate which one of these two opinions has to be considered more appropriate, the present study retrospectively reviewed the frequency of relapses at the 6-month-mark after surgery in 77 patients (40 males, 37 females) probed for CNDO at the Children's Hospital of Trieste in the 1990-1992 period. In our case-record relapses were found in 7.8% of all patients (8.8% of eyes), while the corresponding percentages were 10.8% of patients (14.3% of eyes) in those probed in the first year of life, 5% of patients (3.8% of eyes) in those probed after this time. These results show no worsening for late probing outcome, with respect to early probing. As a consequence of these findings, it can be recommended that for CNDO it is proper to start with a conservative management, represented by lacrimal sac massage and antibiotic eye drops instillation, if mucopurulent discharge is present, for a 4-6 weeks period. If symptoms do not disappear completely after this period, whether probing is the treatment of choice, possibly after the 6th month of life, or, when parents prefer this option, to resume the medical treatment, since also late probing guarantees a good outcome. The choice for probing is mandatory after second year of life.

Female↗