Complaints Of Epiphora Research Articles

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.

Surgical results of endonasal dacrocystorhinostomy

Background: The lacrimal system includes the tear film of the eye and the tear drainage system. Endoscopic dacryocystorhinostomy (DCR) is a safe and effective method of surgical treatment of nasolacrimal duct obstruction. The anatomy of the nasal cavity is better visualized endoscopically and sac is approached under vision and hence the results are decided at the time of surgery. Methods: Present clinical study was conducted in tertiary medical centre from July 2015 to July 2016. Total 50 patients with epiphora as evidenced by nasolacrimal duct blockage on sac syringing were included in the study. Children less than 10 years and revision cases were excluded. These patients underwent DCR without stenting. Results: Out of the 50 patients, 60% were males and 40% were females. Surgical success was defined as anatomical patency and symptomatic relief at the end of the follow up period which was observed in 45 of 50 (90%) patients. Incidence of complications was as low as only 5 patients. These patients were followed up for 6 months with no complaints of epiphora. Conclusions: Endoscopic DCR is a safe and effective method of surgical treatment of nasolacrimal duct obstruction. It gives equivalent symptomatic relief from epiphora when compared to external method. Thus, we can minimize complications, discomfort, cost of stenting and follow up visits after endonasal surgery. Due to higher success rate, minimal invasiveness and high patient satisfaction as compared to other procedures, it has gained more popularity.

Successful management of an unusual extra-ocular foreign body.

A 25 yr old male†, industrial worker by profession, presented to the emergency setting of Government Medical College, Chandigarh, in July 2020, with a rare foreign body impaction. This was after he sustained occupational ocular trauma while cutting iron sheets with a manual work tool machine. He was not wearing any ocular protective gear. Ocular examination revealed impaction of multiple round brass foreign bodies in the right lower lid (Fig. 1A) and closed globe injury to the globe with vitreous haemorrhage and peri-papillary retinal pallor (Fig. 1B). Non-contrast computed tomography orbit showed metallic foreign bodies abutting the globe but not causing globe rupture (Fig. 2A: axial view; Fig. 2B: coronal view; Fig. 2C: sagittal view). The foreign bodies were removed (Fig. 1. inset) and the lid and canalicular repair was done. Pars plana vitrectomy was done to clear the vitreous haemorrhage. During the procedure, fibrogliotic bands with pigmentary alterations and multiple retinal breaks were noticed inferonasally due to coup injury at the site of the impact. Differential diagnoses of chorioretinitis sclopetaria, choroidal rupture and commotio retinae were kept in mind. The breaks in the region of chorioretinitis sclopetaria were lasered using a 532 nm laser. At 12 months of follow up, the visual acuity was 20/40 with attached retina (Fig. 3A and B) and no complaints of epiphora were noted. To the best of our knowledge, the impaction of multiple foreign bodies with stacking in the extra-ocular space has not been reported previously in the spectrum of work-tool related eye injuries. A team approach by oculoplastic and retina surgeons may be required for successful management of complex occupational ocular trauma.Fig. 1: (A) Photograph showing three metallic foreign bodies stacked one above the other in the lower eyelid in the medial aspect. (B) Fundus picture showing diffuse retinal opacification around optic disc and the fundus details are masked by overlying vitreous haemorrhage (inset). Photograph showing three (two are stacked together) 15 mm round smooth disc-shaped brass foreign bodies removed from the orbit.Fig. 2: Computed tomographic scan showing metallic foreign body in the inferior orbit abutting the globe with intact inferior wall of the orbit (A, axial scan, B, coronal scan, C, sagittal scan).Fig. 3: (A) Follow-up facial photograph of the patient showing repaired eyelid after removal of the foreign bodies with puncta well opposed to the globe. (B) Fundus montage of the right eye, after pars plana vitrectomy showing inferonasal chorioretinitis sclopetaria (arrow) with laser done for retinal breaks (arrowheads).Conflicts of Interest: None.

Study of the current pattern of bacterial isolates with nasolacrimal passage obstruction and their antibiotic sensitivity patterns in a teaching hospital

Introduction: An acquired nasolacrimal duct obstruction can occur at any age, and is classified as either primary or secondary. The nasolacrimal obstruction occurring primarily also known as PANDO (Primary acquired nasolacrimal duct obstruction) is observed mainly in conditions occurring due to inflammation or fibrosis. Material and methods: This was a prospective observational study with a sample size of 100 patients. All the patients coming to Ophthalmology OPD with the complaints of epiphora, discharge or both along with regurgitation on pressure over lacrimal sac and mucoid or mucopurulent or clear regurgitant material on sac syringing were taken. Before the beginning of the investigative procedure, informed consent was taken. The Clinical and Laboratory Standards Institute's standardised Kirby-Bauer disc diffusion test was used to determine antibiotic susceptibility. Results: In our study, the distribution of patients according to bacterial isolates was as follows, a maximum of 62% patients were found with no growth while 18% MSSA, 10% CONS, 6% S.pneumoniae, 4% Pseudomonas were observed respectively. In our study, CONS was observed as the predominant bacterial isolate in the diabetics with a Female preponderance followed by MSSA (39%), Pseudomonas (75%) and S.pneumoniae (34%). We found Ciprofloxacin as a broad-spectrum antibiotic that works against most bacterial isolates. Conclusion: A higher female preponderance was observed in our study with the left side being affected in most of the patients. We also observed that most of the patients hailed from rural areas and belonged to lower socio-economic class. This is attributed to a lack of hygiene and awareness among low socioeconomic groups. In all the patients showing positive culture growth, Gram-positive organisms were the dominant species. We conclude, Ciprofloxacin as broad-spectrum antibiotic works against most bacterial isolates.

The use of anterior segment optical coherence tomography in evaluation of punctal stenosis

To evaluate the applicability of anterior segment optical coherence tomography (AS-OCT) for objective diagnosis of punctal stenosis. We report the use of AS-OCT in 3 cases of epiphora related to punctal stenosis. We followed the methodology described in previous studies. The examination was performed by a single technician using a single Spectralis OCT with the AS-OCT module. Three patients with complaints of epiphora (mean age=80 years) were examined. The external punctal diameter was measured on both infrared (IR) and OCT images. The internal diameter was measured on OCT images at a depth of 500μm. The diagnosis was confirmed by clinical examination. The external punctal diameters were 159μm in the right eye (Cases 1 and 2) and 195μm in the left eye (case 2; mean: 171μm). All measurements were lower than cadaveric measurements (200-500μm), as well as previously described average diameters, thus confirming the diagnosis of punctal stenosis. The AS-OCT diameter correlated moderately with the punctal diameter estimate on the IR photos (mean: 183μm). In addition, the mean internal diameter of the punctum at 500μm (cases 1 and 2) was 58μm, which is consistent with the mean diameter at 500μm described in previous studies. Case 3 involved an 88-year-old man who complained of chronic epiphora. Slit lamp examination showed total punctal stenosis associated with cicatricial ectropion in the left eye due to a cutaneous tumor treated with radiotherapy. AS-OCT confirmed the presence of total punctual stenosis and the absence of associated canalicular stenosis. Our study is obviously limited by its small study population. The decision to resort to surgery was made by 2 different surgeons. There was thus no homogeneity in terms of stenosis. There is difficulty in everting the lid without applying pressure to the globe or changing the punctal or canalicular morphology. This maneuver was difficult in the postoperative setting after ectropion repair. Our study shows that AS-OCT can be a rapid, non-invasive method in diagnosing punctal stenosis. Further studies are necessary to assess the use of AS-OCT in punctal stenosis.

Annular intubation with pigtail probe for canalicular lacerations.

Purpose:Pigtail probe as a procedure of choice for canalicular laceration.Methods:Retrospective, consecutive interventional case series of patients with eyelid laceration involving the canaliculus undergoing repair. All patients were subjected to repair with pigtail probe as first choice and only if this was not possible, they were repaired by other method. Outcome was analyzed in terms of cosmetic, functional, and anatomic success.Results:A total of 35 patients (mean age, 10.88 years) underwent eyelid and canaliculus repair by a single surgeon (RM). In all, 32 (91.42%) canalicular lacerations were repaired by annular intubation using a pigtail probe, while the remaining 3 (8.58%) lacerations in which pigtail probe intubation was not possible, were repaired by an alternative method. Upper canaliculus was involved in 6 (17.14%) and lower canaliculus in 29 (82.86%) eyes. Mean follow-up was 8.2 months (range 3–13 months). Intubation tubes were removed after at least 3 months (range 12–20 weeks). None of the patients had complaints of epiphora. All the patients had good cosmesis, anatomic alignment and functional success as assessed by dye disappearance test in younger children and lacrimal irrigation in older children and adults.Conclusion:Bicanalicular annular repair with pigtail probe achieved excellent functional and cosmetic results. The loop minimizes the chances of extrusion of the tube, maintains natural anatomic alignment of the cut ends of the canaliculus and thus retains the integrity of the delicate canalicular system. Pigtail probe intubation can be considered as the first choice in canalicular lacerations.

Transitional Cell Carcinoma of Lacrimal Sac Presenting as a Massive Swelling and Dacryohemorrhea

AbstractTransitional cell carcinomas (TCCs) of lacrimal sac are extremely uncommon neoplasms with high degree of invasiveness, local recurrence, and distant metastasis despite an aggressive treatment. They generally present with epiphora and lacrimal mass lesion but rarely dacryohemorrhea or bloody tears. We hereby report a 50-year-old female who presented with complaints of epiphora, blood in tears, and a progressive swelling measuring 8 cm × 5 cm over left lacrimal sac site. Biopsy from the swelling revealed TCC of lacrimal sac. Radiographic imaging showed a localized mass lesion lacrimal sac eroding adjacent structures, left orbital extension, and left cervical lymphadenopathy without any intracranial extension or distant metastasis. She underwent wide local excision of the primary lesion with left orbital exenteration, left partial maxillectomy, left anterior ethmoidectomy, and left forehead flap reconstruction followed by adjuvant conformal radiotherapy to local site to a dose of 60 Gy and ipsilateral neck to 50 Gy. Combined modality therapy showed satisfactory cosmesis and overall improved functionality on her first review at 6 weeks, however she lost to further follow-up. A thorough review of literature reveals that our case may be one of the largest TCC of lacrimal sac ever reported and the third case to present with dacryohemorrhea in world literature till date.

CORNEAL FINDINGS IN ECTRODACTYLY ECTODERMAL DYSPLASIA CLEFTING SYNDROME: CASE REPORT AND LITERATURE REVIEW

The purpose of this study was to report the ocular findings in an unusual case of ectrodactyly-ectodermal dysplasia-clefting (EEC) syndrome and review the etiology and clinical presentation of similar cases in the literature. Thys study is an observational case report of a 13-year-old woman with complaints of epiphora and red eye. On examination she presented with lacrimal punctal agenesis and neovascularization in both eyes. She was treated medically and without any surgical intervention. Corneal changes in EEC can have variable presentation. The etiology of such keratopathy seems to be due to several factors and limbal stem cell deficiency (LSCD) being the most recent factor involved. Recurrent infection from lacrimal drainage obstruction and tear film instability are other risk factors for disease severity and progression. Since these patients present several anomalies, it is important, to follow an interdisciplinary approach to reduce complications and provide the best possible medical care.

Use of mitomycin c versus gentamicin and dexamethasone in endonasal endoscopic dacrocystorhinostomy

<p class="abstract"><strong>Background:</strong> Dacrocystorhinostomy (DCR) is the procedure done to drain the lacrimal sac in cases of nasolacrimal duct obstruction or in chronic dacrocystitis. New advancements in nasal endoscopic surgeries have given results comparable to external DCR. This is a prospective, case control, randomized, double blinded study to compare efficacy of mitomycin c local application versus gentamicin + dexamethasone local application intraoperatively.</p><p class="abstract"><strong>Methods:</strong> Fifty two patients who underwent endonasal endoscopic DCR at our Tertiary care centre between October 2015 and February 2017. All patients were operated by a single surgeon with double blind method of assigning case. In 26 patients pledgets soaked with 0.4 mg/ml mitomycin C were kept over operative site for 10 min and in other 26 patients pledgets soaked with gentamicin and dexamethasone. Post operatively patients were assessed after 1<sup>st</sup> and 2<sup>nd</sup> week and 1<sup>st</sup> and 3<sup>rd</sup> month after surgery; post-operative complaints of epiphora were graded. </p><p class="abstract"><strong>Results:</strong> Maximum patients belonged to the age group of 31-60 yrs (78%), females constituted the majority with n=36 (69%). At the end of the study Group A had 92% success and Group B had 85% relief in complaints.</p><p><strong>Conclusions:</strong> We have found statistically insignificant difference between the outcome of local application of Mitomycin C and Gentamicin and dexamethasone. Thus it can be used as substitute or adjuvant with mitomycin C in the intraoperative procedure.</p>

Conjunctival cytologic features in patients with unilateral primary acquired nasolacrimal duct obstruction.

To evaluate the cytologic features of conjunctival epithelium in patients with unilateral primary acquired nasolacrimal duct obstruction (PANDO) using impression cytology. Twenty-four patients with unilateral PANDO for at least 1year were enrolled in this study. The healthy eyes of the patients are assessed as control group. All patients were subjected to ophthalmic surface examination with conjunctival impression cytology analysis. Squamous metaplasia and goblet cell density were graded according to Nelson grading system. The mean age was 52.7±16.3 (range 21-70) years. The mean period for complaints of epiphora was 3.2±2.4 (range 1-8) years. The eye with PANDO had a mean squamous metaplasia grade of 2.38±0.59 versus 1.91±0.82 for control eyes (p=0.011). The mean grade of goblet cell density was 2.0±0.51 for eyes with PANDO and 2.38±0.65 for control eyes (p=0.013). There was no statistically significant correlation between conjunctival cytological features in terms of squamous metaplasia and goblet cell density grades and duration of epiphora complaint (r=-0.04, p=0.82; r=0.09, p=0.66, respectively). PANDO may cause alterations in conjunctival impression cytology. Successful dacryocystorhinostomy surgeries will help to protect ocular surface health.

Primary small B cell non-Hodgkin Lymphoma of the Lacrimal Sac Upon Chronic Dacryocystitis

Primary non-Hodgkin lymphoma of the lacrimal sac is an extremely rare tumor. In this article, we report a 44-year-old female who was referred for dacryocystorhinostomy with complaints of epiphora and swelling on the right lacrimal sac region. She had slight epiphora for 8 years, which increased within 6 months, with concomitant swelling between the eye and the nose. A hard and fixed mass was detected on palpation just below the medial canthus. Magnetic resonance imaging showed a 30x35 mm tumoral, lesion which invaded the medial wall of the right orbit and compressed the medial rectus muscle. Histopathologic examination of the tumor revealed a small B cell non-Hodgkin lymphoma. As a conclusion, we suggest that if symptoms of a chronic dacryocystitis patient deteriorates, malignancy should be suspected

Tear-Film Osmolarity Changes Following Dacryocystorhinostomy in Primary Acquired Nasolacrimal Duct Obstruction

ABSTRACTPurpose: To evaluate tear osmolarity (TO) in patients with epiphora caused by primary-acquired nasolacrimal-duct obstruction (PANDO), before and after an external dacryocystorhinostomy (DCR) and to compare with healthy control subjects.Materials and Methods: Twenty eyes of 20 patients (15 women, 5 men) who suffered from epiphora for at least one year due to PANDO, and 20 eyes of 20 healthy subjects (13 women, 7 men), were included in this study. External DCR was applied to all patients with PANDO, and TO measurements were repeated during the first month follow-up visit after surgery.Results: The mean period for complaints of epiphora was 1.7 ± 0.6 years (1–3). Patients had a mean TO of 282.6 ± 10 mOsm/l (range: 269–302) prior to DCR, and this increased to 297.7 ± 7.7 mOsm/l (range: 284–310) one month after DCR (p = 0.0001). Preoperative TO values were significantly lower when compared with the healthy control subjects’ (301.7 ± 10.6 mOsm/l (range: 280–316) (p = 0.0001). No significant differences were detected between postoperative and control group TO values (p = 0.18).Conclusions: Epiphora due to PANDO causes lower TO values. One month after DCR, TO came to similar TO levels when compared to healthy subjects.

Use of optical coherence tomography based lacrimal meniscometry in dacryology

To investigate the significance of OCT based lacrimal meniscometry in determining the extent of insufficiency of lacrimal drainage. A total of 108 measurements of the lower tear meniscus were taken. Of them, 23 measurements were taken in healthy volunteers, who had no complaints of epiphora, 59 - in patients with epiphora of different intensity, and 26 - in patients after surgical intervention. Meniscometry was performed with RTVue-100-2 (Optovue, USA) optical coherence tomograph. The tear meniscus 'height', 'depth', and coefficient were evaluated. Munk's scores for epiphora were also collected. Spearman's correlation was applied to assess the morphometry results and Munk's scores. A separate analysis was performed for patients who were examined before and after dacryological treatment. Differences were evaluated with the Kruskal-Wallis H test. Statistically reliable differences were found between the meniscus 'height' and 'depth' values at different epiphora intensities (p<0.001 for both parameters; H=25.35 and 22.01, respectively), however, the meniscus coefficients showed no significant difference in these patients (p=0.8, H=1.57). Moreover, there was a highly reliable (p<0.001) medium strength direct correlation between the meniscus 'height' and 'depth' and the Munk's scores (R=0.46 and R=0,48, respectively), while the correlation between the meniscus coefficient and the Munk's scores appeared weak and lowly reliable (p=0.20, R=0.14). Lower meniscus morphometry with 'depth' measurement is a comprehensive method to assess the state of lacrimal drainage system. However, it should not be used alone due to significant variations in morphometric parameters, particularly in patients with intensive epiphora.

Endoscopic Dacrocystorhinostomy: Our Experience

The endoscopic Dacrocystorhinostomy (DCR) has distinct advantage over external DCR. Scar on the face is avoided, there is less intraoperativebleed, surgery is done under direct vision, it is a day care procedure. Patient satisfaction and success rate is as good as external DCR. The endoscopic DCR surgery is being performed more by the ENT surgeons rather thanophthalmologists. The aim of this paper was to describe and assess the efficacy of endonasal dacryocystorhinostomy. The study involved a prospective case series with short preoperative follow up with 50 patients attending Santhiram medical college, Nandyal with complaints of epiphora. We have achieved 96% success rate.

English

The objective of present study was to compare the results of endonasal endoscopic dacryocystorhinostomy and external dacryocystorhinostomy. It was a prospective study. Forty two consecutive patients having complaints of epiphora, swelling near medial canthus, angular conjunctival congestion, with naso lacrimal duct obstruction were selected for the study. Selection of type of operation was left to the patient's choice. All patients had preoperative counseling and both the procedures were explained in detail with their advantages and disadvantages. Twenty two patients underwent endonasal dacryocystorhinostomy and twenty had external dacryocystorhinostomy .The follow-up was done at 7 th , 21, st & 3 months after surgery. The patency of lacrimal passage was confirmed by syringing and patients were questioned about their symptoms. There was no significant difference in the results of both surgeries. The complication rate in both groups was almost equal. Thus we came to the conclusion that these two different dacryocystorhinostomy techniques are acceptable alternative. Success of external DCR & endonasal DCR based on patency of passage on 3 rd month was 85% & 81.8% respectively.

Comparison of the results in external dacryocystorhinostomy with single flap and double flap techniques

The aim of this study was to compare the success rate of single and double flaps anastomosis technique in the course of external dacriyocystorhinostomy (DCR) operation. Between December 2009 and June 2012, 168 patients operated for chronic dacryocystocystit by external DCR. All of these patients lacrimal canals were entubated with slicone tube after flaps were prepared . Patients were classified by their age, gender, complication and success rate of the surgery. Free nasal passage in lacrimal irrigation and relief from complaints of epiphora were determined as surgical success criteria. Of 168 patients who take part in the study, 97 were female, 71 was male. 86 of these patients operated by single flap technique, 82 of them operated double flaps anastomosis technique by external DCR. Out of 82 patients who operated double flap anastomosis, 31 of them were male and 51 were female. Median was 45.6 ±18.4. Out of 86 patients operated by single flap technique 40 of them were male and 46 of them were female median was 43.5 ±20.6. Median follow up time of double flap group was 20.4 ±4.3 months, single flap group was 19 ±9.7 months. Surgical success rate of double flap group was 95.2%, and 95.4% on the single flap group. The success rates were not found to be statistically different between two groups of patients (p>0,05). Our study suggests that external DCR with double flaps anastomosis has no difference from external DCR with single flap in terms of the surgical success rates. Single flap technique is much easier to perform and preferable.

Extraintestinal Crohn Disease Causing Bilateral Nasolacrimal Duct Obstruction

A 16-year-old boy presented with complaints of epiphora and bilateral palpably distended lacrimal sacs. He had a history of Crohn disease involving the small and large intestines, and a history of granulomatous cheilitis. Bilateral dacryocystorhinostomies were performed through an external approach and revealed multiple nodular masses in both lacrimal sacs, which on biopsy, contained granulomatous inflammation consistent with extraintestinal Crohn disease. A literature search from 1966 to the present using the PubMed database revealed three previous publications describing nasolacrimal duct obstruction associated with Crohn disease, but these cases did not show pathologic evidence of granulomatous inflammation. To our knowledge, this is the first reported case of extraintestinal Crohn disease with granulomatous inflammation affecting the lacrimal-outflow system.

A New Modification in the Porous Polyethylene-Coated Lester Jones Tube

Purpose: Conjunctivodacryocystorhinostomy (CDCR) is the gold standard for the treatment of many cases of canalicular obstruction since 1965 (). With a proper CDCR and a well-placed Jones tube, the success rate in our experience is almost 100%. The most frequent complication is extrusion and dislocation. Rates as high as 49% have been reported in some studies (). Various modifications have been introduced in the tube design in order to minimize extrusion, including tubes with suture holes, the frosted Jones tubes, and regular porous polyethylene-coated tubes. The regular porous polyethylene-coated tubes are covered by a long sleeve of porous polyethylene, which irritates the conjunctiva causing discharge and sometimes granuloma formation. We describe here a modification of this tube with a much shorter porous polyethylene sleeve to minimize the ocular irritation and discharge. Methods: Ten patients, age 29–50 years, with complete canalicular obstruction and excessive tearing after failed DCR with canaliculoplasty were included in this study. All patients underwent CDCR with anastomoses of the sac mucosa with that of the nasal mucosa via posterior and anterior flaps. Subsequent placement of porous polyethylene-coated Lester Jones tubes were done at the site of carunculectomy. The regular porous polyethylene coat was shortened using a surgical blade to correspond to the fistula opening, only without extension to the caruncle. The average length of the coat in the 10 cases was about 5 mm. Results: Postoperatively, all patients had surgically successful outcomes, with no complaints of epiphora or discomfort. All tubes are still in proper position and functioning well. Our follow-up has been limited to an 18-month period. Conclusion: CDCR with the modified porous polyethylene-coated Lester Jones tube has the same advantages of the traditional porous polyethylene-coated tube. Moreover, it reduces the discharge and ocular irritation, which are the main complications of the CDCR with the current porous polyethylene-coated Jones tube.

Dacryoendoscopy: feasibility and value as diagnostic tool

Abstract Purpose: To access the feasibility and value of endoscopy of the lacrimal duct as a diagnostic method in setnoses of the lacrimal drainage system. Methods: In this prospective study 50 patients with prolonged complaints of epiphora or history of recurrent dacryocystitis were included. All patients underwent clinical examinations including syringation, digital dacryocystography and dacryoendoscopy before a decision for appropriate surgical treatment was made. Findings of clinical examinations, dacryocystography and dacryoendoskopy were compared in regard of feasibility, localization of the obstruction, particular informations provided and correlation between the three methods. Results: Dacryoendoscopy could be performed in all patients included in the study. Concerning the localization of stenoses, 48% of the patients were found to have complete post‐saccal stenosis, 20% stenoses of the canaliculus, 10% combined complete post‐saccal stenosis and partial stenosis of the canaliculus and 2% a partial stenosis of the distal lacrimal duct. In 18% of the patients no definitive location could be found using dacryoendoscopy. The localization of the stenosis determined with dacryoendoskopy correlated in 66,67% with the clinical diagnosis according to syringation, and in 70% with the localization of the stenosis as determined by dacryocystography. Endoscopy could provide additional information about pathologies of the lacrimal system, like lithiasis or polyposis. Conclusions: Dacryoendoscopy can provide valuable information under direct visualization of the lacrimal system. However it must be doubted whether the benefits of this method may justify to subsitute the other well established methods in the diagnostics of dacryostenoses.

Frosted Jones Pyrex Tubes

To describe the use of a new, frosted Jones Pyrex tube in the treatment of obstructed canaliculi of the upper lacrimal system. The frosted Jones tube retains the advantages of the traditional smooth Pyrex tube yet appears to improve the positional stability in the surgically created fistula. Ten patients of a single surgeon who had previously undergone external conjunctivodacryocystorhinostomy and placement of a Jones Pyrex tube, with subsequent Pyrex tube extrusion, were included in the study. All had previous success with Pyrex tubes, with follow-up ranging from 1 month to 14 years. In each case, when the patient presented with an extruded tube, it was replaced with a frosted Jones tube (Weiss Scientific Glass Blowing Company, Portland, OR, U.S.A.). In this preliminary study, none of the 10 patients fitted with a frosted Jones Pyrex tube had a recurrence of extrusion. All patients reported proper functioning of the tubes, with no complaints of epiphora or discomfort. Compared with a standard Jones Pyrex tube, a frosted tube functions equally well and reduces the possibility of extrusion, which is the main complication of traditional conjunctivodacryocystorhinostomy. We have exchanged smooth tubes for frosted tubes in patients who have had extrusion of the original tube, and we are currently investigating primary placement of the frosted Jones Pyrex tube.