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At least 19 recordsLinked to original sources
PubMed1999

Factors affecting the success of nasolacrimal duct probing for congenital nasolacrimal duct obstruction.

PURPOSE: To ascertain the effect of certain parameters on nasolacrimal duct probing. METHODS: In a retrospective study of 142 infants and children who underwent nasolacrimal duct probing for congenital nasolacrimal duct obstruction, age at time of probing, gender, symptom severity, presence of mucous discharge, and history of probing were correlated with success of nasolacrimal probing. Success of probing was defined as complete resolution of signs and symptoms of nasolacrimal duct obstruction. Chi-square test was used to analyze covariance. RESULTS: Success of nasolacrimal duct probing was negatively correlated with increasing age: 92%, 89%, 80%, 71%, and 42% at age 12, 24, 36, 48, and 60 months, respectively (P = .001 at each interval). Increasing severity of epiphora was correlated with increased failure of nasolacrimal duct probing (P = .05). CONCLUSIONS: Although the success of nasolacrimal duct probing declines with age, probing in older children can remain the first line of treatment. Because increasing frequency of epiphora correlates with failure of nasolacrimal duct probing, children with daily epiphora should undergo early nasolacrimal duct probing.

Age Factors↗
PubMed1985

Inferior turbinate fracture in the treatment of congenital nasolacrimal duct obstruction and congenital nasolacrimal duct anomaly.

A group of 52 pediatric patients with lacrimal obstruction were considered to be high risk since they had been previously probed (27 patients) or were older (average age 23 months). At the time of probe and irrigation, a small, straight hemostat was placed into the nose to grasp the inferior turbinate and rotate it a full 90 degrees inward. All cases of congenital nasolacrimal duct obstruction (49) resolved following this maneuver. A small muscle hook with the tip directed upward was placed underneath the inferior turbinate to identify three patients with congenital nasolacrimal duct anomaly (absence or atresia of the nasolacrimal duct) who would not have benefitted from further probings and responded to dacryocystorhinostomy. Even though the results of our uncontrolled surgical trial cannot be compared to other treatment methods, the data suggest that even very difficult cases of congenital nasolacrimal duct obstruction will respond to a simple turbinate fracture with a hemostat without the necessity of complicated tubes or stents. A small muscle hook can be used to identify those rare cases of congenital nasolacrimal duct anomaly who may require specialized procedures such as dacryocystorhinostomy or inferior turbinectomy.

Child, Preschool↗
PubMed1977

Nasolacrimal duct reconstruction with the nasolacrimal duct prosthesis: an alternative to standard dacryocystorhinostomy.

For many years the standard surgical treatment for chronic dacryocystitis has been the edge-to-edge anastomosis of the lacrimal sac mucosa to nasal mucosa over the margins of a hole made through the lacrimal bone. Failures of this standard procedure have been attributed to many factors and complications frequently require reoperation. The procedure described in this paper was developed as a means of overcoming some of these difficulties. It provides a normal, gravity draining, nasolacrimal duct system without pooling and not requiring destruction of the lacrimal bone or alteration of normal anatomy. It consists of the implantation of a permanent indwelling nasolacrimal duct prosthesis (available from Concept, Inc., Clearwater, FL) from the base of the sac through the interosseous canal into the vault of the inferior nasal meatus. Because it does not involve bypassing the normal lacrimal drainage system, the technique is more simple and less traumatic. This method of reconstruction of the nasolacrimal duct has converted a major hour and a half procedure into a 15 minute operation. Because normal anatomic relationships are retained, the nasolacrimal duct prostheis gives reasonable assurance of permanent drainage and is recommended as a primary procedure of choice.

Dacryocystitis↗
PubMed2002

[Lacrimal duct stent for nasolacrimal duct obstruction].

OBJECTIVE: To introduce a new interventional procedure using lacrimal duct stent for the treatment of nasolacrimal duct obstruction, evaluate the short-term and long-term efficacy and observed its intra- and post-operative complications and management. METHODS: 102 cases (136 eyes) of nasolacrimal duct obstruction underwent the lacrimal duct stent placement, the nasolacrimal duct was dilated and the stent was placed retrograde. Digital subtraction dacryocystography was performed before and after the stent placement. RESULTS: Stent placement was technically successful in 132 eyes, and the technical success rate was 97.1%. Good flow of contrast medium was obtained in all patients after stenting. Three months postoperatively, the success rate was 99.2%. After twelve months of follow-up, the success rate was 91.4%. The intra-and post-operative complications included stenting failure, transient hemorrhage and obstruction of the stent. CONCLUSION: Interventional procedure using lacrimal duct stent is a safe, simple and effective method for nasolacrimal duct obstruction without disturbing the normal anatomy.

Adult↗
PubMed2000

The presence of a local immune system in the upper blind and lower part of the human nasolacrimal duct.

The nasolacrimal duct is exposed to exogenous agents, including potentially harmful microorganisms, coming from the eye surface by the lacrimal sac, and from the nasal cavity by the inferior meatus of the nose. The upper blind and lower part of the human nasolacrimal duct were examined immunohistochemically to ascertain the presence and localization of immunoglobulin-producing cells and the epithelial expression of IgA, IgM, and IgG in order to verify the possible antimicrobial properties of this duct. IgA-, IgM-, and IgG-positive immunocompetent cells were recognizable in the lamina propria of the upper blind and lower part of the human nasolacrimal duct, while an evident immunoreactivity for sIgA, IgM, and IgG was demonstrated in the cytoplasm of the apical epithelial cells. The results suggest that all the effector components of the mucosal immune system are present in that area of the human nasal mucosa next to the opening of the nasolacrimal duct as well as in the human lacrimal sac.

Adolescent↗
PubMed2003

The human nasolacrimal ducts.

The human nasolacrimal ducts are a borderland of the disciplines ophthalmology and otorhinolaryngology, which work close together in the treatment of nasolacrimal disorders. However, little knowledge exists concerning the physiology of the nasolacrimal system and, therefore, its pathophysiology. The aim of the present investigations was to obtain a better understanding of tear flow physiology, microbial defence strategies and pathophysiological processes by analysing the nasolacrimal system, thus opening new perspectives against existing therapeutical concepts of diseases of the nasolacrimal ducts. The human nasolacrimal ducts consist of the upper and the lower lacrimal canaliculus, the lacrimal sac and the nasolacrimal duct. They drain the tear fluid from the ocular surface into the lower meatus of the nose. The lining epithelium of the lacrimal sac and the nasolacrimal duct is faced by microvilli, and animal experiments in rabbits support the hypothesis that tear fluid components are absorbed in the human nasolacrimal system. Evidence of seromucous glands, intraepithelial lipids and a specific mucus layer leads to the conclusion that the normal three-layering of the tear film is also present in the nasolacrimal ducts. Based on its composition, the mucus layer, which is mainly synthesised by goblet cells and intraepithelial mucus glands, functionally serves as a simplified drainage of tear fluid, and it is attributed similar properties to epithelia of the gastrointestinal tract. Further defence mechanisms are represented by antimicrobial peptides IgA and immunocompetent cells (lymphocytes and macrophages) which show intraepithelially and subepithelially a special distribution. Moreover, organised lymphoid tissue is present, which reveals the cytomorphologic and immunophenotypic characteristics of mucosa-associated lymphoid tissue. The wall of the lacrimal sac and the nasolacrimal duct are made up of a helical system of different connective tissue fibres. Wide luminal vascular plexus are embedded in this helical system, which is comparable to a cavernous body. Caudally, the vascular system is connected to the cavernous body of the inferior turbinate. With distension the system may be "wrung out" due to its medial attachment and helically arranged fibrillar structures. Thereby, tear fluid is drained distally. The embedded blood vessels underlie vegetative control. By means of this innervation, the specialised blood vessels permit regulation of blood flow by opening and closing the lumen of the lacrimal passage as effected by the engorgement and subsidence of the cavernous body, at the same time regulating tear outflow. Related functions, such as a role in the occurrence of epiphora related to emotional responses, are relevant. Moreover, malfunctions in the cavernous body and in its innervation may lead to disturbances in the tear outflow cycle, ocular congestion or total occlusion of the lacrimal passage. Thus, the pathophysiology of primary acquired dacryostenosis can be explained: Descending inflammation from the eye or ascending inflammation from the nose initiates swelling of the mucous membrane, remodelling of the helical arrangement of connective tissue fibres, malfunctions in the subepithelial cavernous body with reactive hyperaemia, and temporary occlusion of the lacrimal passage. In the follow-up, repeated isolated occurrence of dacryocystitis leads to structural epithelial and sub-epithelial changes, which may lead either to a total fibrous closure of the lumen of the efferent tear duct or to a non-functional segment in the lacrimal passage that is manifest on syringing. The normally constant absorption of tear fluid components into the blood vessels of the surrounding cavernous body that are connected to the blood vessels of the outer eye could be a feedback signal for tear fluid production, which comes to a halt if these tear components are not absorbed. Thus, dry eye could be initiated. Defective stimulation of tear duct-associated lymphoid tissue (TALT) could result in abnormal immune deviation at the ocular surface leading to an autoimmunologic response that could cause dry eye pathology.

Humans↗
PubMed1998

Monocanalicular intubation with Monoka tubes for the treatment of congenital nasolacrimal duct obstruction.

OBJECTIVE: Nasolacrimal duct intubation with Silastic tubes often is used for the treatment of congenital nasolacrimal duct obstruction. The more established intubation technique uses tubing designed for bicanalicular intubation. A commercial product now is available for monocanalicular intubation (Monoka tube, FCI, Issy-Les-Moulineaux Cedex, France), made possible by a punctal anchor attached to the proximal end of the tubing. The authors evaluated the complications and results of their experience with Silastic tube monocanalicular intubation for treatment of congenital nasolacrimal duct obstruction. DESIGN: The study design was a retrospectively reviewed clinical trial with the results compared to a historic cohort treated with an alternative medical device. PARTICIPANTS: Thirty-nine pediatric patients with 48 obstructed congenital nasolacrimal ducts were available for treatment and postoperative follow-up. The historic cohort included 25 cases of congenital nasolacrimal duct obstruction. INTERVENTION: The participants were treated with monocanalicular Silastic tube intubation. The historic cohort was treated with bicanalicular Silastic tube intubation. The tubes were left in place for 4 to 6 months before planned removal. MAIN OUTCOME MEASURES: Dye disappearance tests were performed before and after surgery after removal of the tube. Intraoperative and postoperative complications were noted. RESULTS: Significant complications of the monocanalicular tubing included 1 case of bilateral preseptal cellulitis, 1 case of migration of the punctal anchor into the canaliculus that required surgical correction, 2 cases of a corneal abrasion, 1 case of a corneal ulcer, and 21 cases of premature removal of the tube. Of the 21 cases with premature tube removal, 13 (62%) of the eyes showed an improvement in the symptoms and results of dye disappearance test. Of the 27 cases that completed the full course of tube placement, all the tubes were removed successfully in an office setting, and 25 (93%) showed an improvement in the symptoms and results of dye disappearance test. Significant complications of the authors' bicanalicular intubation include stretching of the punctum, tube dislodgement, and tube removal requiring general anesthesia to the patient. Of the authors' 25 cases treated with bicanalicular intubation, 17 (68%) showed an improvement in the symptoms and results of dye disappearance test. CONCLUSION: The recently introduced Silastic monocanalicular tubing offers an alternative to bicanalicular tubing for treatment with intubation of congenital nasolacrimal duct obstruction. Complications due to intubation persist with the monocanalicular tube. However, some of the complications the authors encountered may be avoided by a recent change in the design of the tubing and by familiarity with recommended techniques. The overall success rate of 79% with the Monoka tube is lower than that for published reports of bicanalicular intubation.

Child↗
PubMed1993

Respiratory distress associated with bilateral nasolacrimal duct cysts.

Nasolacrimal duct system cysts with intranasal extension is a rarely reported cause of respiratory distress in the newborn. Nine often previously reported patients have demonstrated a paranasal mass on examination. Most of these patients have been female and most have required surgical intervention to relieve the obstruction. We present a case of a male newborn with bilateral NLDS cysts with intranasal extension causing respiratory distress, and no evidence of paranasal mass on examination. Nasal endoscopy is essential in the work-up of all patients with nasal obstruction and respiratory distress. The MRI scan was used in the diagnostic work-up to further evaluate the condition. The NLDS cysts with nasal extension resolved spontaneously.

Cysts↗
PubMed2005

Nasolacrimal duct obstruction classified by dacryoendoscopy and treated with inferior meatal dacryorhinotomy. Part I: Positional diagnosis of primary nasolacrimal duct obstruction with dacryoendoscope.

PURPOSE: To investigate the site of primary nasolacrimal duct obstruction (PNLDO) using a dacryoendoscope and nasal endoscope. DESIGN: Retrospective, observational case series. METHODS: After local anesthesia, dacryoendoscopy and nasal endoscopy were performed in 149 cases (138 Japanese subjects) of PNLDO. Membranous nasolacrimal duct obstruction was termed as lower PNLDO, and occlusion at sac/duct junction termed as higher PNLDO. RESULTS: The incidence of lower PNLDO was 26.8% (40 of 149 cases), and 109 cases (73.2%) were diagnosed with higher PNLDO. CONCLUSIONS: The dacryoendoscope is extremely useful to observe directly and evaluate the site of obstruction with accuracy in PNLDO. The higher and lower PNLDO may have a different etiologies.

Adult↗
PubMedDate not supplied

[Timed retrograde catheterization of the nasolacrimal duct as a method of treatment in congenital dacryocystitis and acquired stenosis of the nasolacrimal duct in children].

The authors propose a procedure of timed catheterization of the nasolacrimal duct for use in children with the duct stenosis and congenital dacryocystitis. The catheter is inserted for 7-10 days. Out of 27 children treated (20 cases of congenital dacryocystitis and 7 cases of the stenosis), a persistent effect was achieved in 24. The authors advocate the method as effective and promising in the above conditions.

Adolescent↗
PubMed2001

Reconstruction of acquired nasolacrimal duct obstruction.

BACKGROUND: Acquired nasolacrimal duct obstruction is a common condition in patients who visit otolaryngologists and ophthalmologists. These patients often complain of epiphora and blurred vision, and sometimes they suffer from acute or chronic dacryocystitis. Other causes of acquired nasolacrimal duct obstruction include trauma, chronic inflammation, post-operative iatrogenic procedures, and tumors. Reconstruction of an acquired nasolacrimal duct obstruction provides great improvement in a patient's quality of life and satisfaction both functionally and cosmetically. In this paper, we report on surgical techniques of endonasal endoscopic dacryocystorhinostomy and traditional external dacryocystorhinostomy. A rare case of mechanical compression of the lacrimal sac by a frontal mucocele is also presented. METHODS: From 1989 through 1999, we treated 26 patients, 10 men and 16 women, with 28 cases of acquired nasolacrimal duct obstruction. Two patients had bilateral involvement. Five cases were complications of sinus surgery. Ten cases were acute dacryocystitis due to chronic nasolacrimal duct obstruction. One case of nasolacrimal duct obstruction was caused by a frontal mucocele. The remaining cases were non-specific nasolacrimal duct obstruction. Of all patients, 26 cases underwent external dacryocystorhinostomy, 1 underwent endonasal endoscopic dacryocystorhinostomy, and 1 case underwent frontal sinus dacryocystorhinostomy. RESULTS: Only 1 patient out of 28 cases that underwent surgery suffered from obstruction after external dacryocystorhinostomy for 3 months; 25 patients attained both anatomical success and clinical improvement. CONCLUSION: The success rates were high for patients undergoing either traditional external dacryocystorhinostomy or endonasal endoscopic dacryocystorhinostomy.

Dacryocystorhinostomy↗
PubMed2000

[Facial dysmorphism due to complicated congenital nasolacrimal duct obstruction].

Congenital nasolacrimal duct obstruction (in the literature also called congenital nasolacrimal mucocele or dacryocystocele) presents either as a simple nasolacrimal obstruction with epiphora or as a complicated obstruction on both sides of the lacrimal sac with midfacial deformation and respiratory insufficiency. Five neonates were treated for such complicated congenital nasolacrimal duct obstruction. Symptoms varied from an inner canthal purple-red swelling in the medial corner of the eye, with epiphora, to a serious midfacial deformation with respiratory insufficiency. The presence of a bilateral nasolacrimal mucocele leads to a broadened nasal bridge, which may be falsely interpreted as a dysmorphic feature of a congenital syndrome. Recognition of the condition allows a quick and efficient diagnosis and prevents unnecessary diagnostic procedures and anxiety. Differential diagnosis mainly includes frontobasal encephalocele and haemangioma. Treatment consists of massage, and catheterization if necessary.

Congenital Abnormalities↗
PubMedDate not supplied

Congenital nasolacrimal duct obstruction.

Congenital nasolacrimal duct obstruction is a common disorder in infants, with up to 20% of all newborns suffering from epiphora during the first year of life. This paper reviews the current evidence regarding the incidence, natural history, and management of congenital nasolacrimal duct obstruction. It highlights the role of nasendoscopy in improving the understanding of the condition, which has resulted in better overall management.

Dacryocystorhinostomy↗
PubMed2001

Review of the diagnosis and management of acquired nasolacrimal duct obstruction.

BACKGROUND: Acquired nasolacrimal duct obstruction is a common cause of epiphora. The absolute or partial blockage of the nasolacrimal duct occurs most frequently in middle-aged and elderly women. In addition to the troublesome symptom of epiphora, acquired nasolacrimal duct obstruction is predominantly the underlying cause of both acute and chronic dacryocystitis. METHODS: The primary eye care provider plays an essential role in the diagnosis and management of the patient with epiphora. The potentially serious ramifications of acquired nasolacrimal duct obstruction demand a thorough understanding of the clinical presentation of this disorder. In addition, it is essential the optometrist be well-acquainted with the surgical treatments often necessary for optimal management. CONCLUSION: Whether treatment is provided or an appropriate referral is made, the optometrist is instrumental in providing care for the patient who experiences an acquired nasolacrimal duct obstruction.

Biocompatible Materials↗
PubMed2006

Acquired nasolacrimal duct obstruction.

Acquired nasolacrimal duct obstruction is a common problem. Although tearing is the usual complaint, the clinical presentation can range from a patient having no symptoms to one with a life-threatening infection. Despite many studies providing useful clues, the exact pathophysiology of the obstructive process is incompletely understood. The clinician must be able to accurately make the diagnosis, which is often a clinical one, because many treatments with excellent success are available.

Humans↗
PubMed2001

Congenital nasolacrimal duct obstruction.

Congenital nasolacrimal duct obstruction is a common problem among infants. Its incidence and natural course are reviewed. Probing techniques and various back-up procedures for failed probings are discussed. Additional suggestions are made about the management of lacrimal duct obstruction with congenital cacryocystocele and nasal dacryocele.

Child, Preschool↗
PubMed2002

Animal model for the absorption of lipophilic substances from tear fluid by the epithelium of the nasolacrimal ducts.

PURPOSE: To compare the nasolacrimal tissues of several species to see how closely they resemble the human and to measure nasolacrimal absorption of a substance, to show that an absorption pathway exists for substances placed in the external eye, other than directly through the cornea or conjunctiva. METHODS: The nasolacrimal systems of six different vertebrates were investigated by light microscopy to find a species with a nasolacrimal system comparable to that of humans, for use in absorption experiments. In addition to primates, rabbits were revealed by histology to have a lacrimal system closely comparable to that of humans. The rabbit lacrimal system had a stratified epithelium consisting of two layers. Subepithelially, the lamina propria was composed of two strata: loose connective tissue containing elastic fibers and lymphatic cells and a rich venous plexus comparable to a cavernous body. Rabbits were therefore chosen for the absorption experiments. (3)H-cortisol was dropped into the eyes of female rabbits. After 21, 43, or 146 minutes, the rabbits were killed, the blood collected, and the nasolacrimal systems prepared and embedded for histologic examination. Serum was obtained from the clotted blood, and radioactivity was counted. Autoradiographs of sections of rabbit nasolacrimal duct were also prepared. RESULTS: Uptake of radioactivity into the serum was high and increased with time. After 21 minutes, maximum incorporation of the applied radioactivity into the blood the level was 7.1%; after 43 minutes, 12.4%; and after 146 minutes, 15.5%. Transport of radioactivity was visualized in autoradiographs of rabbit nasolacrimal systems. CONCLUSIONS: (3)H-cortisol is incorporated from the nasolacrimal ducts into the blood of rabbits. The comparable morphology of rabbits and humans suggests that absorption of cortisol would also take place in humans. Future investigations of the nasolacrimal passage are needed to understand whether absorption of normal tear fluid components in the nasolacrimal ducts is a physiological function that also plays a role in pathologic conditions such as dry eye. The similarities between rabbit and human nasolacrimal ducts support the use of the rabbit for such studies.

Absorption↗