Complaints Of Epiphora Research Articles

Endoscopically assisted balloon dacryoplasty treatment of incomplete nasolacrimal duct obstruction

Purpose To report the success rate of endoscopically assisted balloon dacryoplasty (EADCP) for treatment of acquired incomplete nasolacrimal duct obstructions (NLDOs). Design Retrospective, noncomparative case series. Participants Records of patients treated for incomplete NLDOs with EADCP by one of the authors (WLW) were reviewed. Diagnosis of incomplete NLDO was based upon subjective complaints of tearing, dye disappearance testing, clinical evidence of epiphora, and nasolacrimal duct irrigation. Endoscopically assisted balloon dacryoplasty was performed for incomplete obstructions identified. Methods One hundred forty-two nasolacrimal systems in 103 patients with incomplete NLDOs underwent EADCP for treatment of incomplete obstructions. A 3×15-mm balloon was utilized in all procedures, with silicone lacrimal tubes placed in 131 systems. Patients received postoperative topical antibiotic–steroid drops for 2 weeks and a 1-week tapering dosage of systemic methylprednisolone. Main outcome measures Patients were assessed at their last postoperative visit by nasolacrimal system irrigation, dye disappearance testing, and subjective complaints of epiphora. Results Eighty systems (56%) experienced complete resolution of symptoms after surgery. Forty-eight additional systems (34%) showed improvement but still experienced periodic epiphora. Fourteen systems (10%) showed no improvement. The average time before follow-up was 7.5 months. Conclusion Endoscopically assisted balloon dacryoplasty as a treatment for incomplete NLDOs provides complete relief or substantial improvement in a significant percentage of patients. Nasal videoendoscopy adds significantly to the understanding of this procedure and its potential for success. Endoscopically assisted balloon dacryoplasty should be considered an appropriate treatment option for selected patients with incomplete NLDOs.

Síndrome de Down e alterações de vias lacrimais

OBJETIVO: Caracterizar as alterações de vias lacrimais em portadores de síndrome de Down. MÉTODOS: Estudo retrospectivo descritivo envolvendo 11 olhos de 8 pacientes com diagnóstico de síndrome de Down, acompanhados no período de 1995 a 2001. RESULTADOS: Todos os pacientes apresentaram quadro de dacriocistite crônica com obstrução no ducto nasolacrimal. Um paciente cursou também com canaliculite por Strepto- coccus sp e outro paciente apresentava ausência do ponto lacrimal inferior. Cinco pacientes foram submetidos à dacriocistorrinostomia, três à sondagem e intubação das vias lacrimais. A epífora foi resolvida em 4 olhos. CONCLUSÕES: Existem poucos relatos acerca do comprometimento das vias lacrimais em pacientes com síndrome de Down. A caracterização e a resolução cirúrgica do mecanismo obstrutivo lacrimal são importantes, uma vez que há interferência na qualidade de vida desses pacientes. No presente estudo, verificou-se que a obstrução da via lacrimal ocorreu no ducto nasolacrimal. O prognóstico cirúrgico foi ruim em 83,4% das intubações e em 57,2% das dacriocistorrinostomias. Causas do insucesso cirúrgico podem estar relacionadas à maior fibrose pós-operatória nesses pacientes e à dificuldade de colaboração dos mesmos no controle pós-cirúrgico. Estudos posteriores são necessários para verificação das presentes observações.

Evaluation of lacrimal system outflow in the newborn by dye tests

PURPOSE : The aim of this study was to evaluate the outflow from the lacrimal excretory system (LES) at birth. METHOD : Two-hundred LES were evaluated by the Milder Test (DDT) and the modified Jones I Test (JIT) in 100 newborns (NBs) from 31 (T1) until 42 (T3) weeks of gestational age. The occurrence of obstruction was related to sex, weight at birth, presence of ocular discharge and the degree of maturity. RESULTS : Both tests were in agreement and showed LES obstruction in 61.5% (DDT) and 78.5% (JIT), respectively, while the LES outflow increased with increasing maturity. CONCLUSION : Evaluation of LES outflow at birth reveals obstruction rates that are much higher than those clinically observed in children with complaints of epiphora.

Punctal and canalicular stenosis associated with systemic fluorouracil therapy

Ocular side effects of systemic fluorouracil include excessive lacrimation, due to punctal and canalicular stenosis and fibrosis. Obstruction of the tear ducts after systemic therapy with fluorouracil is more frequent than is assumed. Five patients with breast cancer and punctal or canalicular stenosis are presented. Although complaints of epiphora usually resolve two weeks after cessation of systemic therapy, local antibiotics and steroids may be indicated. In patients with persisting complaints, and patients treated with fluorouracil for a prolonged period of time, prophylactic intubation of the tear ducts with silastic tubes has been advocated. (Conjunctivo)dacryocystorhinostomy may be unavoidable.

The Pitfall of Dacryostenosis

We examined a 65-year-old woman with complaints of epiphora, which was diagnosed as due to dacryostenosis. After she had undergone dacryocystorhinostomy for this presumed condition, we discovered a large mass protruding through the incision. A biopsy showed anaplastic carcinoma, and a CT scan revealed that the right-side sinuses were filled with tumor. We conclude that the possibility of paranasal sinus tumors should at least be considered before initiating treatment for complaints of epiphora in elderly patients.