Cases Of Nasolacrimal Duct Obstruction Research Articles

A Case of Nasolacrimal Duct Obstruction Caused by a Lacrimal Sac Retention Cyst

Acquired nasolacrimal duct obstruction may result from chronic infection, lacrimal stones, anatomical variations such as aberrant ethmoid cells, facial fractures, or complications following nasal surgery. In Korea, there has been no reported case of secondary nasolacrimal duct obstruction due to a retention cyst in the lacrimal sac. Recently, the authors encountered a 65-year-old female patient who presented with epiphora, was diagnosed with a lacrimal sac retention cyst, and was successfully treated with endoscopic marsupialization.

A Case of Nasolacrimal Duct Obstruction During S-1 Treatment For Breast Cancer

A Case of Nasolacrimal Duct Obstruction During S-1 Treatment For Breast Cancer

Iatrogenic nasolacrimal duct obstruction after adnexal intervention: An avoidable consequence

PURPOSE:Isolated cases of nasolacrimal duct obstruction (NLDO) secondary to rhino-orbito-facial reconstructive surgeries have been reported previously. We report the clinical profiles and management outcomes of a series of patients with iatrogenic INDO.MATERIALS AND METHODS:Case records of all patients who presented with secondary NLDO over 5 years were retrospectively analyzed. The case series included seven patients with NLDO secondary to orbito-facial surgeries.RESULTS:The study included six males and one female patient with a mean age of 29 ± 12.58 years. All the patients had a history of road traffic accidents following which they underwent an open reduction and internal fixation by maxilla-facial surgeons. All of them presented to the Ophthalmology outpatient department with epiphora following the surgical intervention. Imaging revealed the implants were responsible for obstructing the nasolacrimal ducts in all seven cases. Five patients underwent external dacryocystorhinostomy while dacryocystectomy was performed in two. Implant removal was necessary for five patients without any compromise on the structural integrity of the orbital walls.CONCLUSION:Precise knowledge of the orbital anatomy, especially that of the lacrimal drainage system is imperative for surgeons performing surgeries in the midface area. A multidisciplinary approach and inclusion of surgeons trained in lacrimal surgeries can prevent such avoidable complications.

点眼薬が誘因と思われる涙石・涙嚢炎から鼻涙管閉塞をきたした 1 例

点眼薬が誘因と思われる涙石・涙嚢炎から鼻涙管閉塞をきたした 1 例

OUTCOME OF INITIAL 100 CASES OF ENDOSCOPIC DACRYOCYSTORHINOSTOMY IN KIRKUK

This study aimed at determining the effect and safety of endoscopic dacryocystorhinostomy (ENDO-DCR) in initial 100 cases of nasolacrimal duct obstruction. This study was done in Kirkuk general hospital from 2010 to 2017 with a total of 100 cases. A standardized method was applied to all cases through employing an endonasal technique to the lachrymal sac. Then, an operative resection was applied to the mucosa of nose, lacrimal bone and a part of the anterior maxilla. Next, a complete removal of the medial wall of the lacrimal sac was done. A tube of canalicular silicone intubation was placed for 6 months after operation. The key results of such measures were epiphora resolution, lack of discharge and clearness of the ostium. The success of ENDO-DCR method with adjunctive tube of canalicular silicon intubation was demonstrated in 80 cases (80%) and 10 cases represented acceptable improvements. However, there were minor complications faced during or after operation period. Finaly Endoscopic dacryocystorhinostomy is a safe and effective method for treating nasolacrimal duct obstruction in adults and children with nasolacrimal duct obstruction and epiphora.

Newly Designed Universal Trans-punctal Rigid Lacrimal Microendoscope.

To report the development and clinical findings of a universal trans-punctal lacrimal microendoscope design. In this study, we examined a unique and original "2-bend" (i.e., double-angle) rigid lacrimal microendoscope designed for universal applications for anatomical variations. The shape of endoscope was initially evaluated in 6 lacrimal systems of cadavers (4 Caucasian-cadaver lacrimal systems and 2 Asian-cadaver lacrimal systems). Second, a prospective clinical study involving 45 consecutive cases of nasolacrimal duct obstruction in Japanese patients was conducted to compare the facility and ease of use between the conventional single-bend type and our original 2-bend type trans-punctal lacrimal microendoscope for examination of the lacrimal drainage system. The findings in the cadaver study revealed that original 2-bend lacrimal microendoscope, which was designed double-angled 20°-30° at 10 and 30 mm from the tip of the scope, could more easily used to insert and image all lacrimal systems, while the conventional single-bent lacrimal microendoscope was difficult to insert in subset of patients with a prominent nasal process of the frontal bone. In the clinical trial, our findings showed that 26.7% of lacrimal systems could not be passed using the conventional single-bend design, while using the 2-bend design, all cases could successfully be investigated. The original 2-bend-design microendoscope was found to be effective and valuable for universal use in examination and evaluation of the lacrimal passage.

A Case of Successful Endoscopic Dacryocystorhinostomy in Nasolacrimal Duct Obstruction with Wegener Granulomatosis

Purpose: To report a case of nasolacrimal duct obstruction occurring in a patient with Wegener granulomatosis treated successfully with endoscopic dacryocystorhinostomy. Case summary: A 36-year-old female diagnosed with Wegener’s granulomatosis 3 years prior and treated with rituximab and currently taking azathioprine 100 mg presented with a 1-year history of left epiphora and mucus in the left eye. Her left tear meniscus was higher than the right and was a hard stop with lacrimal probe when a lacrimal probing test was performed. Mucus was regurgitated during lacrimal irrigation and middle turbinate was not observed due to granuloma in the nasal cavity. Dacryocystography showed proximal nasolacrimal duct obstruction and a well-defined dacryocystocele 6 x 5 x 6 mm in size was observed on the left lacrimal fossa on facial 3D computed tomography. After synechiolysis for a granuloma in the nasal cavity, endoscopic dacryocystorhinostomy was performed and silastic sheet sutured on the nasal septum to prevent resynechia. After 2 weeks and 4 months, the silastic sheet and silicon tube were removed, respectively. The patient was asymptomatic following surgery and there was no regurgitation during lacrimal irrigation test. The ostium was patent at 5 months after surgery using the endoscopic dye test. Conclusions: Nasolacrimal duct obstruction occurring in a patient with Wegener’s granulomatosis can be treated effectively with endoscopic dacryocystorhinostomy even if the nasal cavity is narrow due to granuloma. J Korean Ophthalmol Soc 2015;56(9):1454-1458

内視鏡下鼻内涙囊鼻腔吻合術を施行した多発顔面骨骨折による鼻涙管閉塞例

内視鏡下鼻内涙囊鼻腔吻合術を施行した多発顔面骨骨折による鼻涙管閉塞例

Endonasal dacryocystorhinostomy (DCR) without flap and stent (A new technique): Our experience in RIMS, Manipur

Endoscopic dacryocystorhinostomy (DCR) has been the preferred treatment in the management of epiphora and many techniques were described by different authors with different success rates. We describe a new technique of endonasal DCR which has given almost 100 % success rates in the management of nasolacrimal duct obstruction. In this new technique, there is no preparation of lacrimal sac flap nor any stenting is required hence avoids the possible concern of flap survival. It is less costly, technically simpler and easier to perform as it avoids the use of stents and fibrin glue yet simple enough to perform. A prospective study on 13 cases of nasolacrimal duct obstruction (NLDO) was done to see the outcome of management by endoscopic transnasal DCR without stenting. All the cases were diagnosed clinically by regurgitation test, lacrimal syringing and radiologically by CT scan of the nose and paranasal sinuses to confirm the site and cause of obstruction. No major complications were noted intra-operatively or post-operatively. Average follow- up was 6 months with primary success rate of 100% irrespective of the etiology. This study is an attempt to justify the safety and effectiveness of endoscopic transnasal DCR without stenting in the management of nasolacrimal duct obstruction. Keyword: dacryocystitis, endonasal dacryocystorhinostomy, nasolacrimal duct obstruction

Nasolacrimal Duct Obstruction After Maxillary Orthognathic Surgery

To report cases of nasolacrimal duct obstruction (NLDO) after maxillary orthognathic surgery. The authors reviewed the clinical manifestations, dacryocystographic images, and orbital computed tomographic scans of 10 patients who were diagnosed with NLDO after undergoing maxillary orthognathic surgery. Six of the 10 patients (60%) complained of epiphora immediately after the surgery. Bilateral (n= 2, 20%) or unilateral (n= 8, 80%) NLDO occurred in all patients involved in the study. Twelve eyes of 10 patients were examined, and dacryocystography showed that the obstruction was present in the distal ostium in 7 eyes (58.3%), the junction between the sac and duct in 3 eyes (25%), and the common canaliculus in 2 eyes (16.7%). Computed tomographic scans of all subjects showed that mucosal swelling and congestion around the distal NLD opening narrowed the space between the lateral nasal wall and the inferior turbinate of the affected side. Dacryocystorhinostomy was performed in 9 eyes (8 patients), with a success rate of 100%. The distal to proximal portion of the NLD can become obstructed after maxillary orthognathic surgery. This obstruction seems to be caused by secondary inflammatory changes associated with an indirect injury of the NLD. Therefore, clinicians should be aware of the possibility of NLDO after orthognathic surgery, which can be treated successfully with dacryocystorhinostomy.

A Case of Nasolacrimal Duct Obstruction after Two-Jaw Surgery

A Case of Nasolacrimal Duct Obstruction after Two-Jaw Surgery

Artificial nasolacrimal duct implantation under the nasal endoscope

Objective To observe the treatment effect of artificial nasolacrimal duct implantation under the nasal endoscope for chronic dacryocystitis and nasolacrimal duct obstruction.Methods 48 cases (54 eyes) including 13 cases of chronic dacryocystitis and 35 cases of nasolacrimal duct obstruction were involved.Artificial nasolacrimal duct implantation under endoscope was done for them.Results The patients were followed up from 0.5 to 2 years.They were cured in 47 eyes (87.04％) ; improved in 5 eyes (9.26％),Failed in2 eyes (3.70％).The total effective rate was96.30％.Conclusion The treatmeut effect of artificial nasolacrimal duct implantation under the nasal endoscope is outstanding,superior to traditional operation. Key words: Endoscope, nasal; Duct, nasolacrimal, artificial; Dacryocystitis, chronic; Nasolacrimal duct obstruction

Endoscopic Dacryocystorhinostomy without Probing: Surgical Outcome

Abstract Ninety-eight cases of nasolacrimal duct obstruction including 6 bilateral cases were included in the study done at Postgraduate Institute of Medical Research, Chandigarh. All the cases had been divided into three groups with Group I including cases in which 12 endoscopic dacryocystorhinostomy (DCR) with dilatation and probing and stent insertion were performed. In Group II, 23 Endo DCR performed with intraoperative dilatation and probing but no stent insertion. Group III included 69 cases of Endo DCR without dilatation and probing and no stent insertion. Overall success rate was found to be 94.3% with Group III cases having a success rate of 97.1% and was found statistically significant on comparing with that of Group II (p value: 0.03).

Inferior Meatus Dacryolith

Symptomatic nasolacrimal duct obstruction (NLDO) is a common problem that has the potential to significantly affect the quality of life of many patients. Referral patterns involving patients who are evaluated and often surgically treated without rhinologic examination have developed in most areas. We describe a patient with a diagnosis of NLDO who was found to have a large dacryolith obstructing the nasolacrimal duct orifice on endoscopic examination of the inferior meatus. The dacryolith was easily removed under endoscopic visualization in the office. The patient has had no recurrence of epiphora and was happy to be spared dacryocystorhinostomy (DCR). We believe that cases of NLDO that can be treated by addressing obstruction in the inferior meatus are more common than was previously recognized, and many of these cases undergo more advanced surgical interventions.

Direct silicone intubation using Nunchaku-style tube (NST-DSI) to treat lacrimal passage obstruction.

To confirm the usefulness of direct silicone intubation using a Nunchaku-style tube (NST-DSI) for the treatment of lacrimal passage obstruction. Included in this retrospective study were 54 cases (45 patients) of adult-onset lacrimal passage obstruction on which NST-DSI was performed. The cases were subdivided into two groups: 29 cases of common canalicular obstruction (the canalicular obstruction group) and 25 cases of nasolacrimal duct obstruction (the duct obstruction group). At the final examination, irrigating fluid passed readily through the lacrimal passage in 39 (72.2%) of the 54 cases. Twenty-two cases (75.9%) were successful in the canalicular obstruction group (29 cases) whereas 17 cases (68.0%) were successful in the duct obstruction group (25 cases). NST-DSI is an effective alternative to treat both common canalicular obstruction and nasolacrimal duct obstruction. We regard NST-DSI as the first choice for the treatment of lacrimal passage obstruction.

Clinical efficacy of the polyurethane stent without fluoroscopic guidance in the treatment of nasolacrimal duct obstruction

Purpose To evaluate the clinical efficacy of the polyurethane (Song) stent in the treatment of nasolacrimal duct obstruction without fluoroscopic guidance, especially at the junction between the lacrimal sac and nasolacrimal duct or at the nasolacrimal duct. Design Retrospective noncomparative case series. Participants This study evaluated 59 cases of nasolacrimal duct obstruction in 53 patients, with mean epiphora of 36 months (range, 2 months–17 years). Methods Without the assistance of a radiologist, a polyurethane nasolacrimal stent was placed by introducing a guidewire through the superior or inferior punctum into the canaliculus and advancing it across the obstruction into the opening of the inferior meatus of the nasal cavity. The mean follow-up period was 22 months (range, 12 months–48 months). Main outcome measures Patency of the lacrimal passage to irrigation and the duration of this procedure. Results Complete resolution of epiphora was accomplished in 55 (93.2%) of the 59 eyes. There was recurrence of epiphora in four cases because of obstruction of the stent in three cases and obstruction of the common canaliculus by recurrent dacryocystitis in one case. Conclusions Polyurethane stenting without fluoroscopic guidance seems to be a valuable technique for primary management of nasolacrimal duct obstruction before dacryocystorhinostomy.

Neonatal respiratory distress: sequela of bilateral nasolacrimal duct obstruction

Neonatal respiratory distress is a commonly seen entity whose causes are legion. Nasal obstruction secondary to intranasal masses is significant because neonates are obligate nasal breathers. Congenital nasolacrimal duct obstruction (NLDO) causing respiratory distress is an extremely rare event since most cases of NLDO do not compromise the nasal airway. We report two cases of neonatal respiratory distress secondary to bilateral NLDO with cystic mucocele formation and intranasal extension; only two similar cases have been previously described. Pertinent embryology and anatomy are reviewed as is a brief discussion of congenital NLDO. MRI and a nasal endoscopic photograph are provided demonstrating the nasolacrimal and nasal pathology. Treatment strategies are outlined. Consideration of nasolacrimal duct pathology in the differential diagnosis of neonatal respiratory distress and nasal obstruction is stressed.

Nasolacrimal Obstruction After Inferior Meatus Nasal Antrostomy

Transient epiphora following rhinoplasty or intranasal procedures is a common occurrence. Permanent nasolacrimal duct obstruction, however, is rare. This article documents four cases of nasolacrimal duct obstruction following intranasal antrostomy. Three patients were cured by dacryocystorhinostomy and a fourth refused surgery. The anatomy of the nasolacrimal duct in the inferior meatus has considerable variation. Although the duct typically opens in the inferior meatus immediately under the insertion of the inferior turbinate, the orifice can be a single hole, a slit, multiple holes, or a trough, and can be located anywhere from 30 to 40 mm dorsal to the anterior nares. We review the embryology and anatomy of the nasolacrimal orifice in the nose and make recommendations for safe surgery in the inferior meatus.