Obstruction of lacrimal pathways in naso-orbital-ethmoid fractures and the relationship between lacrimal obstruction and fracture types

Abstract

To analyze the incidence and pattern of lacrimal pathways obstruction after naso-orbital-ethmoid fractures (NOE), and to investigate the relationship between lacrimal obstruction and fracture types. One hundred and one patients with NOE fractures were analyzed retrospectively. These patients were treated in the Department of Ophthalmology, Ninth People's Hospital, Medical School of Shanghai Jiao Tong University from January 2000 to January 2005. The fractures were grouped in according to the classification of Markowitz. All of the patients were assessed with syringing and probing or dacryocystography. The incidence of obstruction in different NOE fracture types was analyzed to illustrate the relationship between obstructions and fracture types. The incidence of different obstruction parts of lacrimal system was evaluated to find which part was more vulnerable. In 101 NOE cases, 63 cases were accompanied with lacrimal obstruction. The naso-lacrimal system was more vulnerable in its bony canal than in the lacrimal canalicular. Obstruction was found in the bony nasolacrimal canal in 39 patients (61.90%), and in the lacrimal canaliculus in 12 patients (19.48%). The defect of lacrimal sacs was found in 7 cases (11.11%), and lacrimal punctum was lost in 5 cases (7.94%). Three patterns of fracture were defined according to the Markowitz classification. Sixteen patients were classified into type I; 37 into type II; 48 into type III according to the Markowitz standard. The incidence of obstructions were 25% in type INOE fracture, 54.05%% in type II, 81.25% in type III, respectively. NOE fracture can cause lacrimal obstruction. Naso-lacrimal obstruction is the most common type. The incidence of obstruction changes with the severity of injury and the pattern of fracture.