Cause Of Nasolacrimal Duct Obstruction Research Articles

Leprosy as a cause of nasolacrimal duct obstruction.

Leprosy, also known as Hansen disease, is an airborne spread disease caused by Mycobacterium leprae (M. leprae) which commonly presents with skin lesions, peripheral neuropathy, and ocular involvement. This report describes a patient who presented with epiphora secondary to chronic nasolacrimal duct obstruction four years after completing antimicrobial treatment for tuberculoid leprosy. At the time of endoscopic dacryocystorhinostomy (DCR), the lacrimal sac demonstrated chronic dacryocystitis with granulomatous inflammation and a Fite positive staining bacterial rod-like structure. Pathological examination of the surgical specimen demonstrated numerous non-necrotizing granulomas in a perivascular and neural distribution, compatible with sequelae of previously treated M. leprae infection. The patient has remained symptom free six months after surgery.

Lacrimal sac dacryolith treated with endoscopic dacryocystorhinostomy: A case report and literature review

Dacryolith is a concretion within the nasolacrimal systemthat may calcify and cause further obstruction of the nasolacrimal pathway. It may cause intermittent epiphora without inflammation or recurrent dacryocystitis and is often diagnosed during dacryocystorhinostomy (DCR). We report the case of a lacrimal sac dacryolith in a 37-year-old man who was referred to our hospital from the eye clinic with complaints of epiphora that were not relieved by medication. He had no history of epiphora. During endoscopic DCR, the presence of dacryolith in the lacrimal sac was detected and completely removed while the pus was drained. The patient was discharged on the second postoperative day with systemic and topical antibiotics. During routine follow-up, the patient was in good condition and had no complaints. We aim to raise awareness among clinicians of this unusual cause of nasolacrimal duct obstruction, which can be successfully managed with endoscopic DCR rather than an open external approach.

Case Report on Right Chronic Dacryocystitis with Lacrimal Sac Abscess

Background: Dacryocystitis of the lacrimal sac, can be acute or chronic. Chronic dacryocystitis is prevalent, but acute dacryocystitis is uncommon, and it's usually caused by a nasolacrimal duct obstruction. Traumatic injury, infections, inflammations, and neoplasms are all possible causes of nasolacrimal duct obstruction (NLDO). Whatever causes NLDO, it leads to the stalling of tears, the accumulation of mucoid secretions, and the desquamation of cells, providing an ideal environment for bacterial infections and the development of dacryocystitis. Case presentation: A 23 years old male came to the ENT department with the chief complaint of right eye watery discharge for 1 year, and right lower eyelid swelling with pain over the right side of the face for 1 month. The patient had a history of road traffic accidents one year ago. For that, he underwent open reduction and internal fixation. But after 9 months, he was having a history of right frontozygomatic suture region infected plate for which he underwent surgery of infected Removal with right orbital volume correction. He had a history of 2 units of blood transfusion with no allergic reaction. On arrival, a physical examination of the eye was carried out which shows swelling over the right eyelids along with tenderness. The Contrast Enhanced Computed Tomography of paranasal sinuses was done along with the dacryocystography under local anesthesia after that he has undergone through Dacryocystorhinostomy under general anesthesia and later he was treated with antibiotics, analgesics, and antacids.Conclusion: It is an inflammation of the tear-producing gland. Chronic dacryocystitis has 2 types namely, primary and secondary types. The primary variety, which affects 80% or more of women, is widespread and distinguished by a strong sex preference. The most significant contributing component to its cause appears to be heredity. The prevalence of the second variant is uncommon and roughly equal in both sexes. It is brought on by an illness or injury to the nearby parts. An external dacryocystorhinostomy is the best method of treatment for this condition.

The predictive value of nasolacrimal sac biopsy in endoscopic dacryocystorhinostomy

BackgroundDuring dacryocystorhinostomy (DCR), the lacrimal sac wall biopsy is not routinely performed in our hospital, but it is recommended if there is a suspicion of underlying disease other than preoperatively or intraoperatively chronic inflammation. ObjectiveMost of patients with epiphora have different causes of nasolacrimal duct obstruction (NLDO). This study aims to examine how important routine lacrimal sac biopsy is during endoscopic DCR surgery. Patients & methodsThe study included 50 patients with chronic unilateral epiphora. All patients underwent endoscopic DCR with NLD biopsy. Histopathologic analysis was performed for each specimen. ResultsThe findings of NLD biopsy showed chronic inflammation in 33 cases (66%), chronic dacryocystitis in 9 cases (18%), dacryolith with dacryocystitis in one case, granuloma in 4 cases (8%), rhinoscleroma in 2 cases (4%), and one case had a neoplasm. Histopathologic findings were inflammatory cellular infiltrates in 56%, 30% and 14% in mild, moderate and severe chronic inflammatory state (CIS) score, respectively. Fibrosis in 18%, 20% and 62% in mild, moderate and severe CIS score, respectively. Capillary proliferation in 64%, 32% and 4% in mild, moderate and severe CIS score, respectively. Chronic inflammatory signs in 64%, 32% and 4% in mild, moderate and severe CIS score, respectively. ConclusionAlthough neoplasm and granuloma are rare cause of lacrimal sac or duct obstruction requiring DCR, they were detected through nasolacrimal assessment and routine intraoperative lacrimal sac biopsy.

Incidence of neoplasia in patients with unilateral epiphora.

Nasolacrimal duct obstruction is common and is usually a result of benign stricture formation.Although neoplasia near or around the lacrimal system may produce epiphora, the incidence of neoplasia from within the lacrimal system as a cause of nasolacrimal duct obstruction is not well documented. A retrospective study was performed on all patients undergoing dacryocystorhinostomy with a history of epiphora. The incidence of patients with operative findings of intra-lacrimal neoplasm was sought. Histopathologically confirmed cases were included. The study comprised 537 patients, who underwent a total of 631 endoscopic dacryocystorhinostomy procedures between January 1998 and July 2013. Non-stenotic causes of nasolacrimal duct obstruction were encountered in 3.01 per cent of dacryocystorhinostomy procedures, and included neoplastic, inflammatory and infectious pathologies. Inverted papilloma was the most common cause, encountered in 0.79 per cent of dacryocystorhinostomy operations. These findings suggest that neoplasia is an uncommon but not a rare cause of nasolacrimal duct obstruction. Surgical teams performing high numbers of dacryocystorhinostomy procedures should be aware of such pathology and patients counselled appropriately.

Clinical Effectiveness of Monocanalicular Silicone Intubation for Congenital Nasolacrimal Duct Obstruction Under Nasal Endoscopic Visualization of the Terminal End of the Obstructed Nasolacrimal Duct.

To evaluate the cause of nasolacrimal duct obstruction through confirmation by nasal endoscopic findings of Hasner's valve and to report the success rate of monocanalicular silicone intubation (MCI) for the management of congenital nasolacrimal duct obstruction (CNLDO). Seventy-seven eyes of 56 patients with CNLDO underwent MCI under nasal endoscopic visualization of the terminal end of the obstructed nasolacrimal duct at the Korea University Ansan Hospital and Guro Hospital from October 2008 to March 2013. The following demographic information was analyzed: age, sex, endoscopic findings of Hasner's valve during operation, complications, and outcomes. The main outcome measures were disappearance of epiphora symptoms beginning the first 2 months after removal of the silicone tube. The silicone tube was removed under topical anesthesia in the office between 2 and 3 months, postoperatively. The mean (± SD) age of the study population was 29.8 (± 26.9) months (range: 6 months to 12 years). Under nasal endoscopic view, 45 ducts (58.4%) had a thin membranous obstruction or had a simple stenotic opening of Hasner's valve. Seven ducts (9.1%) had thick obstructing membranes with probe passage under the lateral nasal mucosa. Twenty-three ducts (29.9%) showed the probe tip protruding through balloon-like nasal mucosa. Two ducts (2.6%) appeared to have probe protrusion through a stretchable valve. The overall success rate was 89.6% (69/77). The incidence of tube prolapse and tube loss was 18.2% (14 eyes) and 13.0% (10 eyes), respectively. No other complications were observed. Monocanalicular silicone intubation under nasal endoscopic visualization of the terminal end of the obstructed nasolacrimal duct can be an effective procedure for the management of CNLDO.

Fibrous dysplasia as a rare cause of nasolacrimal duct obstruction

Fibrous dysplasia of the paranasal sinuses is mostly asymptomatic, but sometimes may cause signs and symptoms de- pending on its location. We report two cases of maxillary fibrous dysplasia obstructing the lacrimal drainage system as a reason of chronic dacryocystitis, and reviewed the related literature. The first case underwent an endonasal endoscopic approach combined with external dacryocystorhinostomy. He had a patent lacrimal system at one-year follow-up. The le- sion was completely removed via an endonasal endoscopic approach in the second case, wherein the patient was asymp- tomatic of the six-month follow-up period.

Chronic, Recurrent Dacryocystitis From a BB in the Lacrimal Sac

Metallic foreign bodies in the lacrimal outflow tract are a rarely reported cause of nasolacrimal duct obstruction. Among the few cases in the literature, 1 consisted of a BB in the nasolacrimal duct. This case report presents a second case of chronic, recurrent dacryocystitis in a child, which occurred secondary to a BB that had become lodged in the lacrimal sac. The metallic foreign body was identified on CT and successfully removed surgically. Exogenous sources of lacrimal sac foreign bodies should be considered in patients with a history of periorbital trauma and signs of chronic nasolacrimal duct obstruction. Evaluation with CT is recommended. Removal of the foreign body, with dacryocystorhinstomy as needed, is curative.

Osteoma of the medial wall of the maxillary sinus: a primary cause of nasolacrimal duct obstruction and review of the literature.

A 74-year-old male patient presented to the outpatient department with left-sided epiphora and chronic dacryocystitis, without any history of head trauma or previous nasal or paranasal sinuses surgery. No abnormalities were noted at the time with the use of nasal endoscopy. The computed tomography scan however revealed an osteoma of the medial wall of the left maxillary sinus. An endonasal endoscopic dacryocystorhinostomy (DCR) with osteoma removal by using a drill with temporary silicone stenting of the nasolacrimal duct system was performed. Due to a granuloma formation at the DCR-window site 2 months postoperatively a revision-DCR was performed and the new window remained patent at control 6 months after surgery.

Nasolacrimal Duct Obstruction Secondary to Dental Impaction

To describe a patient with nasolacrimal duct obstruction (NLDO) caused by dental impaction. This is an interventional case report of an 18-year-old man presenting epiphora of the right eye. Previous surgical management was unsuccessful. Computed tomography (CT) of the orbits and sinuses was performed. Dacryocystorhinostomy (DCR) on the right lacrimal sac resulted in complete remission of symptoms. The DCR surgical outcome at last follow-up was recorded. The CT imaging showed ankylosis of deciduous canines and impaction of persistent canines. The root of the right impacted dental element was involved with the nasolacrimal duct, leading to NLDO. Endoscopic DCR resulted in complete remission of symptoms. The patient was symptom-free at last follow-up. Our case adds NLDO to the long list of complications arising from dental impactions, highlighting the importance of correct early management of the latter condition. This case also shows that dental impaction can be included among the secondary mechanical causes of NLDO.

Dacryolith in an unusual case of epiphora: open or endoscopic approach?

Dacryoliths are concretions formed in the lacrimal sac from cellular debris and proteins, which may calcify and cause further obstruction of the nasolacrimal pathway. Dacryoliths are often underlying contributors in cases of intermittent or chronic dacryocystitis (i.e. nasolacrimal sac inflammation, characterised by epiphora, pain, erythema, sac dilation and lacrimal punctum swelling). We report an unusual case of dacryolith resulting in obstructive epiphora, managed via an endonasal endoscopic approach. Case report and literature review pertaining to dacryolith. A 54-year-old man attended the multidisciplinary nasolacrimal clinic due to recurrent epiphora. Obstructive epiphora secondary to chronic dacryocystitis was diagnosed. He underwent endonasal endoscopic dacryocystorhinostomy. Intra-operatively, a large dacryolith was found to be the cause of epiphora. Dacryolith is an unusual cause of nasolacrimal duct obstruction. This case highlights this unusual cause, and the relevant diagnostic investigations. This case also illustrates successful endonasal endoscopic management, rather than an external, open approach.

Analysis of Functional and Anatomic Success following Endonasal Dacryocystorhinostomy

The aim of this study was to assess the concomitant perioperative procedures, the causes of nasolacrimal duct obstruction, the success rate, and the complications associated with endonasal dacryocystorhinostomy (ENDCR). In this single-center retrospective study, 98 patients underwent 104 ENDCRs between January 1994 and February 2006. There were 78 patients with 84 nasolacrimal duct obstructions who were included in this study. The overall functional success rate with improvement in symptoms was 94.9% for primary surgery (59 of 84 obstructions) and 63.6% for salvage surgery after failure of primary surgery performed in another hospital (25 of 84 obstructions). The mean follow-up time was 36.8 +/- 17.11 months. Primary surgery showed better results, with a complete success rate of 93.2%, than did salvage surgery, with a success rate of only 68%. Persistent symptoms, despite an open rhinostomy, were found in 1.7% of patients with primary surgery and in 12% of those with salvage surgery. Failure of ENDCR was observed in 3.4% of patients after primary surgery and in 20% after salvage surgery. We encountered only minimal perioperative complications, and these were essentially related to lacrimal intubation. Because of the possibility of treating concomitant sinonasal disorders, the cosmetic advantages, and the excellent results, ENDCR represents the procedure of choice for treating nasolacrimal duct obstructions. The main challenge lies in the exact preoperative assessment, as well as postoperative evaluation in case of failure.

A rare cause of nasolacrimal duct obstruction: Dentigerous cyst in the maxillary sinus

The most common abnormality of the lacrimal drainage system is congenital or acquired nasolacrimal duct obstruction. The causes of acquired nasolacrimal duct obstruction may be primary or secondary. The secondary acquired obstructions may result from infection, inflammation, neoplasm, trauma or mechanical causes. The maxillary sinus cysts usually obstruct the nasolacrimal duct mechanically. Dentigerous cysts are one of the main types of maxillary cysts. These cysts are benign odontogenic cysts which are associated with the crowns of unerupted teeth. The clinical documentations of mechanical nasolacrimal duct obstructions due to a dentigerous cyst in the maxillary sinus are very rare in literature. In this case report, we describe a dentigerous cyst with a supernumerary tooth in the maxillary sinus in an 11-year-old male child causing an obstruction to the nasolacrimal duct. The case was successfully managed surgically by Caldwell Luc approach.

Endoscopic dacryocystorhinostomy for acquired nasolacrimal duct obstruction: creating a window with a drill without use of mucosal flaps

Conclusion. Success and complication rates of endoscopic dacrycystorhinostomy (DCR) creating a window with a drill and without using mucosal flaps are similar to those of external DCR. Moreover, any intranasal or paranasal disease can be treated simultaneously and a superior cosmetic result is achieved. Objectives. To present success and complication rates of a case series of patients treated with the same technique of endoscopic DCR for acquired nasolacrimal duct obstruction (NLDO). Patients and methods. This was a retrospective case review of 46 patients (25 female, 21 male; mean age 57 years). All patients had acquired NLDO with epiphora. Additionally, chronic dacryocystitis was evident at presentation in five patients. The cause of NLDO was primary acquired NLDO in 35 patients and lacrimal sac mucocele in 11 patients. An endonasal endoscopic approach using a drill was performed. Temporary silicone stenting of the nasolacrimal duct system was applied. In 19 patients additional surgery (11 FESS, 3 septoplasties, 5 FESS and septoplasty) was necessary. Patient follow-up ranged between 3 and 27 months. Results. A successful functional result was obtained in 97.8% of patients. No major complications were observed. Minor complications (acute dacryocystitis or periorbital ecchymosis) occurred in four patients and were treated with antibiotics or resolved spontaneously.

Solitary Sclerotic Fibroma as a Rare Cause of Nasolacrimal Duct Obstruction

Purpose: To report a case of solitary sclerotic fibroma (SF) as a rare cause of nasolacrimal duct obstruction. Methods: A 47-year-old female presented with a mass in the right lacrimal sac region that was associated with intermittent watering, pain and itching, and showed delayed fluorescein clearance. CT scan showed a soft tissue density in the lacrimal sac region. The mass was completely excised and on histopathology showed a well-circumscribed fibrous nodule with eosinophilic collagen bundles arranged in an interweaving “plywood” pattern with elongated clefts between them, characteristic of SF. Conclusions: SF should be included in the differential diagnosis of nodular masses in the lacrimal sac region. Although most of SFs occur in the dermis and are asymptomatic, this case suggests that SF can produce symptoms and signs of clinical significance by virtue of its anatomic location in a confined space in proximity to other structures.

Obstruction of the Nasolacrimal Duct by Ascaris lumbricoides

Although Ascaris lumbricoides infestation is extremely prevalent in some populations, the nematode is an extremely rare cause of nasolacrimal duct obstruction. Obstruction of the nasolacrimal duct in a 4-year-old Brazilian girl by a young adult A. lumbricoides is reported. In contrast to previously reported cases, the nematode involved the inferior, rather than superior, canaliculus and punctum.