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PubMedDate not supplied

Intranasal endoscopic diagnosis and treatment in congenital nasolacrimal duct obstruction.

BACKGROUND AND OBJECTIVE: To identify the causes of congenital nasolacrimal duct obstruction using intranasal endoscopy. PATIENTS AND METHODS: Eleven children with symptoms of epiphora since birth were selected for treatment. A silicone tube was inserted after identifying the causes of prior probing failures by observing the probing tip directly with intranasal endoscopy. RESULTS: As confirmed through intranasal endoscopic examination, tearing was caused by mucosal obstruction, submucosal passing of the probe, pus collection, and inferior turbinate impaction. The probe passed into the submucosal space in 5 patients and, by performing probing medially instead in the usual posterolateral direction, probing succeeded in 4 patients. One case was accompanied by a bone abnormality; we bent the probe tip into the nasal cavity to form the lacrimal pathway. CONCLUSION: By using intranasal endoscopy, a silicone tube can be inserted under direct visualization and any causative abnormalities can be identified. This can also minimize the intranasal trauma sometimes caused by blind probing.

Child, Preschool↗
PubMed2003

Nasolacrimal duct obstruction associated with radioactive iodine therapy for thyroid carcinoma.

A 50-year-old woman presented with a 5-year history of unilateral epiphora that began shortly after 131I therapy for thyroid carcinoma. A recent recombinant human thyroid-stimulating hormone (Thyrogen) scan had shown a focus of uptake adjacent to the right eye that was initially thought to be a possible metastasis. Probing and irrigation revealed complete blockage of the right nasolacrimal duct. The patient underwent a right dacryocystorhinostomy (DCR) and biopsy of the lacrimal sac. Histopathologic examination of the lacrimal sac and nasal mucosa revealed foreign-body reaction and fibrosis with no malignant cells. A repeat Thyrogen scan after DCR showed no residual focus of activity in the nose or near the lacrimal sac and confirmed reestablishment of lacrimal drainage on the right side. This case demonstrates that 131I therapy for thyroid carcinoma can be associated with nasolacrimal duct obstruction. The appearance of a focus of uptake near the lacrimal sac on Thyrogen scanning in a patient with a history of thyroid carcinoma may not be due to a new focus of metastasis and may indeed be due to pooling of 131I in the lacrimal sac due to nasolacrimal duct blockage.

Carcinoma, Papillary↗
PubMed2003

Congenital nasolacrimal duct occlusion with clinical anophthalmos: a possible new association.

PURPOSE: To report the association of congenital nasolacrimal duct occlusion and clinical anophthalmos in an eight-year-old girl. METHODS: A case report. The patient suffered from epiphora and clinical anophthalmos on the right side since birth. This paper presents the clinical presentation, workup, and surgical approach of the case. RESULTS: The nasolacrimal system of the patient was occluded on irrigation. Computed tomography showed a blockage at the level of the sac-duct junction, an enlarged nasolacrimal duct below the obstruction, and a sclera-like ball of tissue surrounded by extraocular muscles in the right orbit. Treatment included a right bicanalicular silicon intubation performed under general anesthesia. CONCLUSION: This case may represent a new association that has not been previously reported.

Anophthalmos↗
PubMed2005

Inverted papilloma invading the orbit through the nasolacrimal duct: a case report.

PURPOSE: Inverted papillomas of the nose and paranasal sinuses are uncommon neoplasms, characterized by their tendency to recur and by their association with malignancy and invasive potential to the adjacent structures. The authors report a case of recurrent inverted papilloma of the nasal cavity and sinuses that eventually invaded the orbit through the nasolacrimal duct. METHOD: Assessment and management of a 47-year-old patient who presented with epiphora, left medial canthal area mass, proptosis and lateral displacement of his left eye associated with significant nasal obstruction. RESULTS: Computed tomography and magnetic resonance imaging studies revealed a mass filling the nasal cavities and sinuses, invading the left orbit without destruction of any orbital walls. During excision of the tumor, it was learned that the orbital component of the tumor was connected with the sinonasal tumor through the nasolacrimal duct without any bony defects of the orbit. Histopathology of tumor proved to be inverted papilloma with areas of malignant transformation. CONCLUSION: Athough a rare cause of proptosis, inverted papilloma with orbital invasion must be considered in the differential diagnosis of nasosinus tumors invading the orbit. The case presented demonstrates that these tumors may invade the orbit through the nasolacrimal duct in the absence of orbital wall defects.

Humans↗
PubMed1985

Silicone intubation for partial and total nasolacrimal duct obstruction in adults.

We performed silicone intubation for both partial and total nasolacrimal duct obstructions in adults. Twenty-three cases with partial obstructions and nine patients with total observations were untubated. The final results were good (73.9%), fair (8.7%), and poor (17.4%) in the partial obstruction group; and good (22.2%) and poor (77.8%) in the total obstruction group. Complications were minimal and did not affect the outcome. We recommend silicone intubation for partial nasolacrimal duct obstructions and dacryocystorhinostomy for total obstructions.

Adolescent↗
PubMed2004

Endoscopically assisted balloon dacryoplasty treatment of incomplete nasolacrimal duct obstruction.

PURPOSE: To report the success rate of endoscopically assisted balloon dacryoplasty (EADCP) for treatment of acquired incomplete nasolacrimal duct obstructions (NLDOs). DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Records of patients treated for incomplete NLDOs with EADCP by one of the authors (WLW) were reviewed. Diagnosis of incomplete NLDO was based upon subjective complaints of tearing, dye disappearance testing, clinical evidence of epiphora, and nasolacrimal duct irrigation. Endoscopically assisted balloon dacryoplasty was performed for incomplete obstructions identified. METHODS: One hundred forty-two nasolacrimal systems in 103 patients with incomplete NLDOs underwent EADCP for treatment of incomplete obstructions. A 3x15-mm balloon was utilized in all procedures, with silicone lacrimal tubes placed in 131 systems. Patients received postoperative topical antibiotic-steroid drops for 2 weeks and a 1-week tapering dosage of systemic methylprednisolone. MAIN OUTCOME MEASURES: Patients were assessed at their last postoperative visit by nasolacrimal system irrigation, dye disappearance testing, and subjective complaints of epiphora. RESULTS: Eighty systems (56%) experienced complete resolution of symptoms after surgery. Forty-eight additional systems (34%) showed improvement but still experienced periodic epiphora. Fourteen systems (10%) showed no improvement. The average time before follow-up was 7.5 months. CONCLUSION: Endoscopically assisted balloon dacryoplasty as a treatment for incomplete NLDOs provides complete relief or substantial improvement in a significant percentage of patients. Nasal videoendoscopy adds significantly to the understanding of this procedure and its potential for success. Endoscopically assisted balloon dacryoplasty should be considered an appropriate treatment option for selected patients with incomplete NLDOs.

Adolescent↗
PubMed1996

Nasolacrimal duct opacity on CT.

A retrospective analysis of 100 coronal sinus CT scans was performed to investigate the frequency of opacity of the nasolacrimal duct and determine if there was any correlation between the pattern of duct opacity and the presence of inflammatory sinus disease. The study showed that the nasolacrimal ducts are opaque in the majority of normal people and that there is no relationship to inflammatory sinus disease.

Adolescent↗
PubMed2006

Silicone intubation with the Ritleng method in children with congenital nasolacrimal duct obstruction.

PURPOSE: To evaluate the technical properties and clinical efficacy of bicanalicular silicone intubation with the Ritleng method in children with congenital nasolacrimal duct obstruction. METHODS: The Ritleng method was used for lacrimal intubation in 50 eyes of 42 consecutive patients (mean age, 37.3 months). All procedures were done by or under the supervision of one surgeon. The hollow Ritleng probe was inserted via the canaliculus into the inferior meatus. The polypropylene (Prolene) thread-guide, attached to the silicone tube, was advanced through the probe. Either the Prolene emerged from the nose spontaneously or it was retrieved using a hook without visualization. The tube ends were sutured to the nasal wall. Tube removal was planned for 3 months postoperatively. Resolution of signs and symptoms of lacrimal obstruction was assessed. The mean follow-up time was 18.1 months (range, 3 to 48 months). RESULTS: The silicone tube was placed successfully in all eyes except 1 (98%). The mean procedure time was 26 minutes for each eye (range, 15 to 45 minutes). Both Prolene guides spontaneously emerged from the nose in only 8 eyes (16%). In the others, one or both Prolene guides were retrieved with a hook. Inadvertent tube dislodgement occurred in 21% of the eyes and required early tube removal. Success, ie, relief of signs and symptoms, was achieved in 86% of eyes. CONCLUSIONS: The Ritleng method of intubation for congenital nasolacrimal duct obstruction yields a high rate of success. Contrary to previous reports, our experience suggests that the surgeon must be prepared to retrieve the Prolene guide from the nose.

Child↗
PubMedDate not supplied

Inferior turbinate fracture and congenital nasolacrimal duct obstruction.

PURPOSE: To evaluate the success rate of probing combined with inferior turbinate fracture in comparison with simple probing as a first attempt in the treatment of congenital nasolacrimal duct obstruction in children. METHODS: In a prospective interventional case-control study, 86 eyes from 61 children older than 6 months with congenital nasolacrimal duct obstruction underwent surgical intervention. Forty-two eyes of 33 patients underwent probing combined with infracturing of the inferior turbinate and 44 eyes of 28 patients underwent simple probing. The outcome evaluation included a standard ophthalmologic examination plus a dye disappearance test 2 months after the surgical intervention. RESULTS: In the case group (probing + infracture of the inferior turbinate), the results were good in 22 (66.7%) patients, fair in 8 (24.2%), and poor in 3 (9.1%). In the control group (simple probing), the results were good in 20 (71.4%) patients, fair in 3 (10.7%), and poor in 5 (17.9%) (p=0.9). Success rates were 91% and 82% in the case and control groups, respectively (p=0.4). CONCLUSIONS: Based on the results of this study, infracturing of the inferior turbinate does not increase the success rate of simple probing as a first attempt.

Case-Control Studies↗
PubMed2001

Comparison of balloon dacryocystoplasty to probing as the primary treatment of congenital nasolacrimal duct obstruction.

PURPOSE: In children older than 18 months, primary probing procedures for congenital nasolacrimal duct obstruction (CNLDO) are thought to have lower rates of success. This study compares the results of primary probing to balloon dacryocystoplasty (DCP) in children stratified by age category. METHODS: In a retrospective chart review, 29 eyes with CNLDO that underwent balloon DCP in children older than 18 months were identified and age-matched to 29 eyes that underwent probing. The eyes were divided into 3 age categories: category 1 (18-24 months), category 2 (24-36 months), and category 3 (>36 months). RESULTS: Of the 29 eyes treated with balloon DCP (mean age, 37.1 months), 26 were successfully treated. Twenty-five of the 29 matched probed eyes (mean age, 31.1 months) were successfully treated, resulting in an overall success rate of 90% for balloon DCP and 86% for primary probing. Within each age category, the success rate varied but did not show an advantage to balloon DCP. The presence of crusting and expressible discharge from the puncta during preoperative evaluation predicted a successful probing (OR, 16; 95% CI, 1.3-192). CONCLUSION: Overall, balloon DCP did not appear to present an advantage as compared with primary probing as the initial treatment in these children. Primary probing has an impressive overall success rate that did not diminish in the children older than 36 months.

Catheterization↗
PubMed2000

Otolaryngological findings in congenital nasolacrimal duct obstruction and implications for prognosis.

AIM: To investigate otolaryngological abnormalities associated with congenital nasolacrimal duct obstruction (CNLDO) and their effect on the prognosis. METHODS: 65 consecutive cases of CNLDO were followed up with routine otorhinolaryngological examination with tympanometry. RESULTS: Otitis media with effusion (OME) and uvula bifida were detected in 44.6% and 9.2% of the children, respectively. Medical treatment and probing were less effective in patients with OME (p<0. 05). CONCLUSIONS: OME and uvula bifida are significant anomalies associated with CNLDO and the former has a marked effect on the prognosis. This finding may help to determine the patients who will need further treatment after massage and probing.

Acoustic Impedance Tests↗
PubMedDate not supplied

Value of bacterial culturing in the course of congenital nasolacrimal duct (NLD) obstruction.

The role of infection in the etiology and persistence of congenital nasolacrimal duct (NLD) obstruction is examined in a group of 334 infants who had conjunctival swabs cultured. One hundred and fifty eight (47%) of these had evidence of NLD obstruction and 176 (53%) did not. The types of organism grown from those with and without NLD obstruction were similar and occurred in almost equal proportions in each group. In addition, the rate of spontaneous resolution in those with NLD obstruction was the same, whether pathogenic bacteria were grown or not. There were no cases of orbital cellulitis, dacryocystitis, or ocular infection in those with NLD obstruction and no suggestion that secondary infection was more common in this group.

Bacteria↗
PubMed2006

Spectrum and the susceptibilities of microbial isolates in cases of congenital nasolacrimal duct obstruction.

PURPOSE: To determine the microbial profile of congenital nasolacrimal duct obstruction (CNLDO) and the appropriate antimicrobial agents based on the sensitivity pattern of the isolated microorganisms. METHODS: Two hundred thirty-eight eyes of 187 young children in the age group of 0-5 years with CNLDO were included in the study. A group of 40 children (80 eyes) who had attended the hospital for other ocular disorders was considered a control. Material obtained from the lacrimal sac was cultured, and infectious agents were isolated. Susceptibility testing was done by Kirby-Bauer disk diffusion method for 7 different antibiotics. Fisher's exact test was used to look for statistical associations between the age group, the type of discharge, and the type of microorganisms isolated. RESULTS: Of the 238 samples with a clinical diagnosis of CNLDO, 197 (83%) yielded a positive culture. There was no growth in 41 samples (17%). Altogether, there were 217 isolates. One hundred twenty-four (57%) isolates were Gram-positive bacteria, the most frequent isolate being Streptococcus pneumoniae. Gram-negative bacteria accounted for 93 (43%) of the isolates, the most frequent isolate being Haemophilus influenza. There was one fungal isolate (0.5%) of Candida tropicalis. Gram-positive bacteria were sensitive to chloramphenicol, vancomycin, and ofloxacin and Gram-negative bacteria to ofloxacin and ciprofloxacin. CONCLUSIONS: Chronic dacryocystitis caused by CNLDO is associated with an almost-equal proportion of Gram-positive and Gram-negative bacteria. Ofloxacin topical drops can be used in the treatment of cases with CNLDO.

Anti-Bacterial Agents↗
PubMed2006

Modified laser DCR for paediatric nasolacrimal duct obstruction.

AIMS: To evaluate the efficacy, safety, and long-term outcome of modified laser dacryocystorhinostomy (DCR) for primary nasolacrimal duct obstruction, unresponsive to probing. METHODS: Retrospective, noncomparative case-note review of all paediatric cases operated between September 2000 and November 2003. PROCEDURE: A fibre optic light, inserted through the canaliculi into the lacrimal sac was visualized endonasally. Nasal mucosa was incised using a keratome and a bony ostium was created with the Holmium : YAG laser. Bicanalicular silicone tubes were inserted. RESULTS: Five children with a mean follow-up of 25.6 months (range 21-48 months) and a mean age of 7 years were reviewed. Silicone tubes were used in four patients and were removed at a mean 6.5 months (range 3-9 months). One patient developed a mucocele 6 months after the procedure requiring excision of the membrane covering the ostium. There were no other immediate or late postoperative complications. Complete cure of symptoms was achieved in all patients and was maintained at final follow up. CONCLUSION: Modified paediatric laser DCR appears to be an encouraging technique for primary nasolacrimal duct obstruction unresponsive to probing. This may be attributable to the modification of excision of mucous membrane, which may prevent regrowth.

Child↗
PubMed1989

An unusual complication of nasolacrimal duct probing.

A 4-mm segment of the tip of a 0000 probe broke off inside the nasolacrimal duct of an 11-month-old girl during probing for congenital nasolacrimal duct obstruction. Despite numerous attempts, the tip could not be extracted. Examination of the 000 end of the double-ended probe showed a narrow neck approximately 4 mm from the bulbous tip. Choosing an appropriate probe design, inspecting the probe before use, and selecting the appropriate probe size will help prevent this unusual complication.

Dacryocystorhinostomy↗
PubMed1999

Endoscopic marsupialization of bilateral lacrimal sac mucoceles with nasolacrimal duct cysts.

A lacrimal sac mucocele is an uncommon disease usually treated by ophthalmologists. In rare cases, it is sometimes associated with a nasolacrimal duct cyst presenting as an intranasal cystic mass, which needs the involvement of an otolaryngologist in diagnosis and management. Two cases of lacrimal sac mucoceles with nasolacrimal duct cysts are presented with a brief literature review. Both cases presented with intranasal cystic masses that caused nasal obstruction and were cured with endoscopic marsupialization of the cysts.

Adult↗
PubMed2002

[Nasolacrimal duct obstruction caused by a cylindroma. Report of an atypical tumor manifestation and review of the literature].

BACKGROUND: The purpose of this report is to describe the clinical characteristics, management and histological findings in a patient with obstruction of the nasolacrimal duct caused by a cylindroma. About 618 lacrimal sac tumours have been reported previously in reviews and case reports, which were reviewed after searching in medline database. CASE REPORT: A 79-year old man suffered from multiple cylindromas (Spiegler tumour) on his head for about 40 years. He presented with a 6 months' history of left-sided epiphora and a painless medial canthal mass of various size. A tumour which caused nasolacrimal duct obstruction was found during dacryocystorhinostomy. After complete excision histological examination revealed a cylindroma, which had shown expansive growth from dermis to the lacrimal sac area. The patient felt well; there was no longer any epiphora or dacryocystitis after the operation. CONCLUSION: Although very rare, lacrimal sac tumours must be considered in the differential diagnosis of nasolacrimal duct obstruction. To our knowledge this case represents the first report on an atypical manifestation on a Spiegler tumour in the lacrimal sac region.

Aged↗