Lacrimal History – Part 109: The Interwoven History of Music and Lacrimal Surgeries

The history and evolution of lacrimal surgeries has been a fascinating journey. And yet, as we move forward on this path in time, it appears not to have attracted students in sufficient numbers. This article provides a comprehensive history of surgical interventions for lacrimal disorders spanning the ancient and medieval eras as well as its snapshot in modern times. The article also acquaints the readers with both lacrimal surgeons of the early days and important treatises on lacrimal surgery that together contributed to its advancement.

Ophthalmic plastic and reconstructive surgery ranks among the newest and smallest of the ophthalmic subspecialties. Therefore, readers may be amused to learn of an entire book devoted exclusively to the history and traditions of oculoplastic surgery. However, for the ophthalmologist who also considers himself or herself a scholar, historian, or oculoplastic surgeon, this book provides rare and unadulterated pleasure. This is a multiauthored text and the chapters offered are diverse. The reader gains insight into the antiquity of medical knowledge as exemplified by Sushruta's fourth century BC illustrations of forehead pedicle flaps, which are still used for nasal reconstruction. The evolution of repair and treatment techniques for ptosis, lacrimal surgery, entropion, ectropion, blepharoplasty, orbit, and reconstructive surgery are traced in various chapters, as is the history of the development of oculoplastic surgery in North America, Australia, and Europe. The discussions concerning the history of lacrimal surgery and ptosis repair are

PurposeTo determine the diagnostic value of 'soft stops' encountered during lacrimal syringing and probing.MethodsSingle-center retrospective review. Adult patients with epiphora attending a tertiary lacrimal clinic from May 2010 to April 2021 were reviewed. Cases with evidence of soft stop encountered during lacrimal syringing/probing were included, and patients with possible canaliculitis or a history of lacrimal surgery were excluded. Findings of syringing/probing consistent with pre-sac obstruction were correlated with dacryocystography (DCG) and surgical findings.Results53 (10.2%) canalicular systems had soft stops on syringing/probing and were included in the analysis. The mean age of the patients was 63.8 ± 15.6 (range 28–87) years, and 27 (65.9%) were females. Intraoperative examination findings were available for 27 of 30 cases that underwent lacrimal surgery and DCG was available for 40 systems. Pre-sac obstruction found on syringing/probing was confirmed in 40% and 37% of cases on DCG and surgery, respectively. The correlation between syringing/probing and DCG was stronger for canalicular than for common canalicular location (p = 0.016). Canalicular stenosis on syringing/probing manifested as pre-sac abnormality on DCG in 5/7 (71.4%) compared to 0/6 common canalicular stenosis cases (p = 0.021). Based on the surgical findings, the false-positive rate of a soft stop on syringing/probing was highest for common canalicular ‘stenosis’ (100%) and lowest for canalicular ‘block’ (45.5%; p = 0.093). Findings of pre-sac obstructions on DCG were confirmed in 85.7% of the cases intraoperatively (p = 0.035 compared to syringing/probing alone).ConclusionsSoft stops on probing showed poor correlation with DCG and surgical findings, particularly in common canalicular location.

Epiphora is the overflow of tear in the lid margin. It can be due to hyper secretion or inadequate tear drainage. Inadequate drainage of tears may be due to mechanical or physiological causes. Physiological cause is due to lacrimal pump failure or weakness of orbicularis muscle. Mechanical causes are due to obstruction in the lacrimal passages. Evaluation of epiphora can be done by lacrimal syringing, fluoresceine dye disappearance test, Jones dye test, contrast dacryocystography, nuclear lacrimal scintigraphy, CT, MRI etc. Fluoresceine dye test is a non invasive method to study tear flow drainage system. Our study evaluate the effectiveness of dye disappearance test to lacrimal syringing which is a invasive test. Aim of this study was to evaluate the accuracy of fluorescein dye disappearance test [FDDT] in evaluating epiphora in comparison to lacrimal syringing.: A prospective observational study was conducted in 90 consecutive patients of age group of 40 to 70 years who presented with epiphora in Department of ophthalmology at tertiary care centre. Any cause like foreign body, trauma, blepharitis, lid disorders like ectropion, entropion, history of lacrimal sac surgeries in the recent past, and allergy to sodium fluorescein excluded from the study.A thorough medical history and comprehensive ophthalmological examination done in all patients. Epiphora evaluated with regurgitation over pressure on the lacrimal sac area, lacrimal syringing, and fluorseceine dye disappearance test.FDDT resulte were graded as grade 1 to 4 according to the quantity of flouorseceine stain in the conjunctival sac, Grade 1 and 2 considered as normal and grade 3 and 4 considered as abnormal.Results of FDDT, syringing, ROPLAS compared in the patients with epiphora.: In the study group, the 90 samples were analysed. The sample population were 62% males and 38% females. There were co-morbidities like diabetes mellitus and cataract noticed in the population. When we examined the diabetes mellitus patients presented with epiphora, showed lacrimal passage obstruction is more common in diabetes patients [67% patients among diabetes patients have FDDT of grade 2-3]. Regurgitation on pressure over lacrimal sac] test were done in all patients presented with epiphora, and the test was positive in 21 patients. FDDT were done in these patients and the results showed only 14 patients were Grade 2-3 [67%]. We compared the FDDT and lacrimal syringing tests in epiphora patients. Among the 90 patients we found that 60 individuals had patent nasolacrimal passages, verified by free flow in Lacrimal syringing test. FDDT showed majority of the patients were under grade 0-1 [patent nasolacrimal passages]. The patients with blocked nasolacrimal passages verified by lacrimal syringing were found grade 2-3 in FDDT [Blocked nasolacrimal passages]. Sensitivity, specificity, and positive and negative predictive value of FDDT were calculated.: FDDT is a safe and effective test for the evaluation of epiphora. It can be done as a screening test in pre operative evaluation of cataract surgery.

Objective:To evaluate the influence risk factors of recurrence and the methods for reducing recurrence of sinonasal inverted papilloma (SNIP). Method:Clinical data of 34 patients with SNIP were analyzed retrospectively. All of them were unilateral onset. The diagnosis was confirmed pathologically and the range of lesions was determined by endoscopic and imaging examination; clinical classification according to Krouse classification method; All operations were performed under nasal endoscope, of which 20 cases were operated by simple nasal endoscope, and 14 cases were operated by endoscopic anterior lacrimal recess approach. The patients were followed up for 12-36 months. The curative effects were observed and the prognostic factors of the patients were analyzed. Result:Thirty-four cases of SNIP patients with postoperative recurrence rate was 17.65% (6/34); simple nasal endoscopic surgery in 20 cases, the recurrence rate was 25.00%(5/20); endoscopic anterior lacrimal recess approach in 14 cases, the recurrence rate was 7.14%(1/14), the difference was statistically insignificant (χ²=1.807, P>0.05). Four cases in stage Ⅰ had no recurrence；20 cases in stage Ⅱ, the recurrence rate was 15.0%(3/20); 9 cases in stage Ⅲ, the recurrence rate was 33.3%(3/9); 1 case in stage Ⅳ had no recurrence, the recurrence rate of the patients with different stages were statistically insignificant (χ²=2.692, P>0.05). Conclusion:Simple endoscopic resection of the tumor and endoscopic anterior lacrimal recess surgery are effective methods for the treatment of SNIP. The nasal surgery history and tumor origin are the risk factors for recurrence. The operation completely tumorresection,detailed preoperative examination and postoperative regular endoscopic examination are the keys to preventing recurrence.

To assess the outcome and complications of simultaneous bilateral external dacryocystorhinostomy (DCR) surgery. The records of all patients who underwent bilateral external DCR in a single session between November 1999 and October 2005 were reviewed. The study cohort comprised 59 patients (50 females, nine males; age range: 6-72 years; mean age: 49 years). Nasolacrimal duct obstruction was acquired primarily in 54 patients, congenitally in three and secondary to sinonasal surgery in two. Thirteen eyes of eight patients had a history of unsuccessful lacrimal surgery. The operation was performed under local anaesthesia plus sedation in 54 patients (92%). Total intraoperative haemorrhage varied from 3 mL to 200 mL (median: 17 mL; mean: 37 mL). Excessive intraoperative haemorrhage (= 100 mL) occurred in five patients (9%). Total duration of surgery varied between 70 and 140 min, with an average of 89 min. Postoperatively, early bleeding requiring intranasal tamponade developed in one patient (2%) and bilateral wound infection in one patient (2%). Surgical success rate was 95%. Mean follow-up time was 8.8 months (range: 3-38 months). This study supports that the simultaneous bilateral external DCR surgery may not adversely affect surgical success and complication rates.

Preloaded Monoka (Lacrijet) and congenital nasolacrimal duct obstruction: Initial results

The subspecialty of ophthalmic plastic surgery was born in the mid-twentieth century in the United States at the conclusion of World War II. The art of oculoplastic surgery, however, is centuries old, bearing its roots in antiquity in India, the Far East, and Europe. The principles and basic techniques that have been improved upon and refined over the years are inherent in the disciplines of ophthalmology and plastic surgery. Thus, a history of ophthalmic plastic surgery is inevitably a history of the development of both fields. The various procedures that have evolved over centuries can be divided into several general categories: reconstructive, restorative, and cosmetic. Each of these categories deals with restoring or enhancing structure as well function to damaged or malfunctioning adnexal structures. Numerous adnexal structures make up the periorbita, and throughout time, oculoplastic surgeons have perfected, refined, and pioneered new techniques of lacrimal surgery, ptosis repair and blepharoplasty, orbital surgery, lid malpositions, and flaps and grafts. Oculoplastic surgery became recognized as a unique subspecialty of ophthalmology at the end of World War II. Numerous orbital and periocular injuries were treated by general ophthalmologists without prior training or exposure to ophthalmic plastic surgery. For these surgeons, review of the existing literature, exchange of experiences with colleagues and across disciplines, and, more often than not, trial and error were keys in developing these procedures. After the war, interest in the subfield of ophthalmic surgery grew, and eventually, an organized association dedicated solely to the field of ophthalmic plastic surgery was formed. This chapter is a testament to those great minds that weaved the broad array of ophthalmic techniques into a quilt of a distinct subspecialty.

The Kaleff-Hollwich technique and results of external dacryocysto-rhinostomy operation

The subspecialty of ophthalmic plastic surgery was born in the mid-twentieth century in the United States at the conclusion of World War II. The art of oculoplastic surgery, however, is centuries old, bearing its roots in antiquity in India, the Far East, and Europe. The principles and basic techniques that have been improved upon and refined over the years are inherent in the disciplines of ophthalmology and plastic surgery. Thus, a history of ophthalmic plastic surgery is inevitably a history of the development of both fields. The various procedures that have evolved over centuries can be divided into several general categories: reconstructive, restorative, and cosmetic. Each of these categories deals with restoring or enhancing structure as well function to damaged or malfunctioning adnexal structures. Numerous adnexal structures make up the periorbita, and throughout time, oculoplastic surgeons have perfected, refined, and pioneered new techniques of lacrimal surgery, ptosis repair and blepharoplasty, orbital surgery, lid malpositions, and flaps and grafts. Oculoplastic surgery became recognized as a unique subspecialty of ophthalmology at the end of World War II. Numerous orbital and periocular injuries were treated by general ophthalmologists without prior training or exposure to ophthalmic plastic surgery. For these surgeons topic literature, exchange of experiences with colleagues and across disciplines, and more often than not, trial and error were keys in developing these procedures. After the war, interest in the subfield of ophthalmic surgery grew, and eventually, an organized association dedicated solely to the field of ophthalmic plastic surgery was formed. This chapter is a testament to those great minds that weaved the broad array of ophthalmic techniques into a quilt of a distinct subspecialty.

Conjunctivodacryocystorhinostomy (CDCR) with Jones tube placement is a standard treatment for symptomatic canalicular obstruction but often complicated by tube extrusion. We report two rare cases where patients maintained a patent, functional ostium following Jones tube loss or removal. Both patients had a history of multiple lacrimal surgeries. After tube extrusion or removal, endoscopic assessments and follow-up confirmed continued tear drainage without recurrent epiphora. These cases demonstrate that, under certain conditions, CDCR tracts can remain stable and functional without stenting.

ABSTRACTObjectives: To evaluate the long-term results of simultaneous bilateral external dacryocystorhinostomy (EX-DCR) in cases with bilateral dacryostenosis. Methods: Thirty-four eyes of 17 consecutive patients with a history of bilateral epiphora were included in the study between 2007 and 2011. Demographic information, etiology of the obstruction, history of lacrimal surgery, type of anesthesia, duration of surgery, incidence of postoperative nasal bleeding and infection, surgical outcomes, and duration of follow-up were recorded. During the lacrimal irrigation, there was not any passage noticed in the patients’ eyes. The post-operative follow-up was 13 to 44 months (mean 33.6 months). Results: Of 17 patients undergoing simultaneous bilateral EX-DCR with a mean age of 42.8 years, one of the patients had a history of bilateral unsuccessful DCR performed in a different center. One patient had previously failed bilateral probing before undergoing bilateral EX-DCR. This latter patient was a four-month-old baby with bilateral dacryoceles. Bicanalicular silicone intubation was performed in 15 eyes of 10 patients that had a canalicular problem or fibrotic lacrimal sac. It has been discerned that complaints about epiphora disappeared in 33 of the eyes (97%) and that the passage was open during the lacrimal irrigation. One eye with a history of unsuccessful dacryocystorhinostomy failed to respond positively to our operation. Conclusions: In our study, high success rates of simultaneous bilateral EX-DCR were found in both children and adult patients with bilateral dacryostenosis during a long-term follow-up. We believe that simultaneous bilateral dacryocystorhinostomy has medical, social, and economic advantages.

Purpose Localization of the lacrimal sac is a critical step during endoscopic dacryocystorhinostomy (endo-DCR). A “light pipe” can be used to transilluminate the lacrimal sac endonasally. We hypothesized that this may misguide the surgeon learning endo-DCR to create an osteotomy mostly posterior to the maxillary line if only the bone overlying the transillumination was to be removed, as the thinner lacrimal bone will transmit light more readily than the thicker maxillary bone of the frontal process of the maxilla that forms the anterior lacrimal sac fossa. Methods The charts of 32 patients with primary acquired nasolacrimal duct obstruction in whom a lighted system was used during endo-DCR at Massachusetts Eye and Ear from April 2015 through October 2016 were reviewed. Patients with prior history of lacrimal surgery or trauma directly to the lacrimal sac fossa were excluded. Location of the maximal point of transillumination in relation to the maxillary line was observed and noted intraoperatively. Results Of a total of 39 endo-DCR surgeries performed, the intraoperative transillumination point was entirely posterior to the maxillary line in 32 instances (82%). Conclusions Use of an endocanalicular light pipe preferentially illuminates posterior to the maxillary line endonasally. The anterior lacrimal sac fossa (maxillary line and anterior as visualized endonasally) is rarely transilluminated, likely due to thicker bone in that region. Surgeons learning how to perform endo-DCR using a light pipe should be aware of this phenomenon.

To evaluate etiologies, demographics, and surgical outcomes in cases of traumatic nasolacrimal duct obstruction (NLDO). Charts of 35 patients with the diagnosis of traumatic NLDO were reviewed retrospectively. Patient demographics, type of trauma, previous lacrimal surgery history, surgical treatment, follow-up time, and anatomical and functional outcomes were evaluated. Forty eyes of 35 patients were included in this study over 12 years. Twenty-four patients were male (68.5%) and the mean age of the patients was 31.52 ± 14.58 years (range 9-68). The most common etiology was motor vehicle accidents (52.5%), followed by high velocity blunt injury (27.5%), accidental fall (7.5%), occupational trauma (5%), iatrogenic surgical trauma (5%), and animal bite (2.5%). A total of 21 eyes (52.5%) were treated with external dacryocystorhinostomy (DCR), 30% with conjunctival DCR, 15% with endoscopic DCR, and 2.5% with diode laser-assisted DCR. Mean follow-up time was 23.02 ± 13.53 months. Functional and anatomical success was recorded in 37 out of 40 eyes (92.5%). Naso-orbitoethmoidal fracture is the main etiology of traumatic NLDO. The majority of the injuries occurred in male participants from motor vehicle accidents and high-velocity blunt injury. Dacryocystorhinostomy provides anatomical and functional success in 92.5% of cases of traumatic NLDO.