Dacryocystorhinostomy For Nasolacrimal Duct Obstruction Research Articles

Dry Eye Assessment of Patients Undergoing Endoscopic Dacryocystorhinostomy for Nasolacrimal Duct Obstruction Combined with Dry Eye Syndrome.

To evaluate the prevalence of dry eye symptoms after endoscopic dacryocystorhinostomy (EDCR) for patients with primary acquired nasolacrimal duct obstruction (PANDO) combined with dry eye syndrome. The patients diagnosed with PANDO combined with dry eye syndrome who underwent EDCR were divided into two groups according to the questionnaire about dry eye symptoms after surgery. The medical records were retrospectively analyzed. Before and after surgery, we compared the tear meniscus height, tear breakup time, and the presence of corneal punctuate epithelial erosion. The level of dry eyes of patients after surgery was assessed by using the Korean guidelines for the diagnosis of dry eye. At 6 months after EDCR, the proportion of patients with dry eye symptoms was 30% in a total of 80 patients. The duration of epiphora and tear breakup time after EDCR were higher in the group without dry eye symptoms and the proportion of eyes with corneal punctuate epithelial erosion after EDCR was higher in the group with dry eye symptoms. About 15% of total patients started treatment with a dry eye of level 2 or higher. About 15% of patients who underwent EDCR for PANDO combined with dry eye syndrome developed significant dry eye syndrome after surgery. The short onset of epiphora was associated with the development of the dry eye symptoms. Therefore, it is necessary to evaluate dry eye syndrome before surgery, and surgeons should be careful about this.

Antimetabolites as an adjunct to dacryocystorhinostomy for nasolacrimal duct obstruction.

Antimetabolites as an adjunct to dacryocystorhinostomy for nasolacrimal duct obstruction.

External Dacryocystorhinostomy in Patients with Systemic Sarcoidosis

Sarcoidosis is an idiopathic systemic disorder characterized by noncaseating granulomas 1 Avisar I. McNab A.A. Dolman P.J. et al. Endonasal dacryocystorhinostomy for nasolacrimal duct obstruction in patients with sarcoidosis. Orbit. 2013; 32: 225-230 Crossref PubMed Scopus (13) Google Scholar that affects the nose and sinuses in up to 2%. 2 Lee B.J. Nelson C.C. Lewis C.D. Perry J.D. External dacryocystorhinostomy outcomes in sarcoidosis patients. Ophthalmic Plast Reconstr Surg. 2012; 28: 47-49 Crossref PubMed Scopus (14) Google Scholar Published outcomes for lacrimal drainage surgery in such patients are limited to small series from multiple centers using various techniques. 1 Avisar I. McNab A.A. Dolman P.J. et al. Endonasal dacryocystorhinostomy for nasolacrimal duct obstruction in patients with sarcoidosis. Orbit. 2013; 32: 225-230 Crossref PubMed Scopus (13) Google Scholar , 2 Lee B.J. Nelson C.C. Lewis C.D. Perry J.D. External dacryocystorhinostomy outcomes in sarcoidosis patients. Ophthalmic Plast Reconstr Surg. 2012; 28: 47-49 Crossref PubMed Scopus (14) Google Scholar , 3 Chapman K.L. Bartley G.B. Garrity J.A. Gonnering R.S. Lacrimal bypass surgery in patients with sarcoidosis. Am J Ophthalmol. 1999; 127: 443-446 Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar We present a retrospective review of the clinical outcome for 75 external dacryocystorhinostomy procedures performed in 47 patients with systemic sarcoidosis in whom pulmonary disease was the most common manifestation (Table S1, available at www.aaojournal.org). Fifteen of 47 patients had been referred with failed prior dacryocystorhinostomy. Surgery was performed at Moorfields Eye Hospital, largely by a single surgeon (G.E.R.) using a uniform external dacryocystorhinostomy, with a large osteotomy, sutured posterior and anterior mucosal anastomoses, and placement of silicone intubation. 4 Verity D.H. Rose G.E. External dacryocystorhinostomy. in: Albert D.M. Lucarelli M.J. Clinical Atlas of Procedures in Ophthalmic and Oculofacial Surgery. Oxford University Press, Oxford2012: 1021-1032 Google Scholar Some of the patients underwent biopsy of nasal or sac tissues. These results were reported elsewhere, with granulomas present in 60% of sac biopsy samples and 87% nasal tissues. 5 Stewart C.M. Luthert P.J. Rose G.E. Nasal and lacrimal sac histopathology in patients with systemic sarcoidosis undergoing external lacrimal drainage surgery. Ophthalmic Plast Reconstr Surg. 2018 Sep 18; ([Epub ahead of print])https://doi.org/10.1097/IOP.0000000000001217 Google Scholar Systemic immunosuppression was unchanged, and all patients received postoperative steroid antibiotic eyedrops for a month; no nasal medication or douching was used. Sutures were removed at 7 to 10 days after surgery, intubation removed at between 4 and 6 weeks after surgery, and success was defined as resolution of epiphora. The study received institutional research board approval (identifier, CA17/AD/13) from Moorfields Eye Hospital. All research adhered to tenets of the Declaration of Helsinki, and all subjects consented to surgery and clinical follow-up.

A COMPARATIVE STUDY IN DACRYOCYSTORHINOSTOMY WITH VERSUS WITHOUT SILICON TUBE INTUBATION IN NASOLACRIMAL DUCT OBSTRUCTION IN ADULTS

Background: Dacryocystorhinostomy (DCR) has been touted as the standard procedure fortreatment of acquired nasolacrimal duct obstruction; it can be performed through a cutaneousincision referred to as external DCR, or via a transnasal approach. Intubation with silicone tubes hasbeen widely used in lacrimal duct surgery. Objective: Toevaluate the role of silicon tube intubation inthe clinical outcomes of external and endonasal dacryocystorhinostomy in nasolacrimal ductobstruction in adults. Patients and Methods: This is a prospective, randomized; comparative studyincluded 80 cases of 74 patients who were diagnosed with postsaccal obstruction of the lacrimalpathway. The studied sample was randomly grouped into two main groups (n=40), group (I)undergoneexternal dacryocystorhinostomy (EX_DCR) and group (I) undergoneendonasaldacryocystorhinostomy (EN_DCR), then each group was subdivided into two subgroups (n=20)according to with or without silicon tube intubation. From all patients, full history was taken andthey received a complete ophthalmologic examination, ENT and systemic assessment. Afterundergoing the surgical procedure, patients were followed up at1stpostoperative day, 1week, 1, 3 &6 months, complications and outcome were assessed. Results: The overall success rate in externalDCR was 82.5% (33 cases), however, the overall success rate in endonasal DCR was 77.5% (31cases) with no significant difference between groups. The success rate was 85% for external DCRwith intubation, 80% for external DCR without intubation, 80% forendonasal DCR with intubation andwas 75% for endonasal DCR without intubation, with non significant differences among thesesubgroups (P=0.89). The results showed that DCRs without intubation recorded significantly loweroperative time compared to with indubation DCRs. Conclusion: The results of endoscopic andexternal DCR with silicone intubation were comparable to these result without intubation with nonsignificant differences. Using of silicone tube has no significant beneficial effect in the surgicalsuccess of primary DCR, while, it is associated with increasing cost, operative time and complicationrate, there is no need for its routine use. Further studies with larger sample size are warranted.

Laser-assisted dacryocystorhinostomy in nasolacrimal duct obstruction: 5-year follow-up.

To evaluate the long-term sucess rate of laser-assisted dacryocystorhinostomy (L-DCR) in patients with nasolacrimal duct obstruction (NDO). Forty-one eyes of forty patients aged between 21-85y (mean 56.7y) who underwent L-DCR for the treatment of NDO were included in this retrospective, non-randomized study. The follow-up time was 72mo. Functional sucess was defined as the disappearance of epiphora under normal conditions and the presence of a patent ostium on lacrimal irrigation. Anatomical success was defined as a patent lacrimal passage on syringing besides continuing epiphora. Surgical failure was defined as persistent epiphora and closed ostium. Twenty-seven of 40 patients (67.5%) were female and 13 of 40 patients (32.5%) were male. The NDO was right-sided in 17 (42.5%) patients and left-sided in 22 (55%) patients whereas 1 (2.5%) patient had undergone bilateral surgery. In 11 (27.5%) patients there were additional nasal abnormalities requiring simultaneous surgical approach. The average time for L-DCR was 26.50±4.9min (16-39min) and the average total amount of laser energy used was 287±27.9 J (239-367 J). At the 5y follow-up, anatomical sucess rate was 75.0% (30 patients) and functional success rate was 65.0% (26 patients), whereas surgical failure was seen in 25% (10 patients). Revision of surgery was performed in 10 cases (25.0%); failure of revision surgery was seen in 2 cases (5.0%). Transcanalicular L-DCR is a reliable and fast procedure in the treatment of NDO. It can be alternative to external DCR which is accepted as the gold standard currently. The functional and anatomical success rate is higher in the first months and years, but still satisfactory at fifth year.

Primary nonendoscopic endonasal versus external dacryocystorhinostomy in nasolacrimal duct obstruction in children

Purpose:The aim is to compare the outcome of nonendoscopic endonasal dacryocystorhinostomy (NEN DCR) with external DCR (EXT-DCR) in the treatment of nasolacrimal duct obstruction (NLDO) in children.Methods:A retrospective, comparative chart analysis of all consecutive children <16 years after EXT-DCR or NEN-DCR between June 2012 and February 2016.Results:Seventy-one children (79 eyes) underwent DCR in the study, of which 37 children (40 eyes) underwent EXT-DCR and 34 (39 eyes) NEN-DCR. Mean age of both groups (8.7 vs. 7.7 years) was comparable. Etiologically, persistent congenital NLDO was the most common indication (50% vs. 72%), followed by acquired and secondary NLDO. Mean duration was shorter for NEN-DCR (47 vs. 37 min; P = 0.0021). Mitomycin C 0.04% was used more often in NEN-DCR (10% vs. 56.41%). Success after primary EXT-DCR was 100% as compared to 75% for primary NEN-DCR at median follow-up of 12 and 16 months respectively. At revision, the main cause of failure was granuloma (60%). After revision, all eyes were symptom-free at a median follow-up of 9.5 months.Conclusion:Primary NEN-DCR has a poorer outcome than EXT-DCR in the treatment of NLDO in children and is more likely to need a revision procedure.

Effectiveness of sodium hyaluronate (Protad) application in endoscopic endonasal dacryocystorhinostomy

ObjectiveTo evaluate the effects of applying sodium hyaluronate solution (Protad) intraoperatively during endonasal dacryocystorhinostomy. MethodsA retrospective medical record review of all 254 patients (254 eyes) who underwent endonasal dacryocystorhinostomy for nasolacrimal duct obstruction was performed. The success rates and postoperative complications of the Protad application group (105 eyes) and the control group (149 eyes) were compared. ResultsThe Protad group had better anatomical (96.2% vs 86.6%, p = 0.010) and functional (93.3% vs 85.2%, p = 0.046) surgical success rates. Granuloma developed less frequently in the Protad group (11.4% vs 32.9%, p < 0.001). Regarding secondary outcomes, synechia was less frequent in the Protad group, but the difference was not statistically significant (p = 0.283). Crust and infection rates were also lower in the Protad group (6.7% vs 11.4% for crust, 7.6% vs 8.1% for infection), but the difference was not statistically significant (p = 0.203 and p = 0.899, respectively). The rate of revision surgery was significantly lower in the Protad group compared to the control group (1.9% vs 14.1%, p < 0.001). Granuloma had the largest effects on anatomical and functional surgical success (odds ratio, 72.221 for anatomical and 19.915 for functional). ConclusionsThe application of Protad effectively reduced postoperative granulation and enhanced surgical success rate after endonasal dacryocystorhinostomy. We suggest that Protad is a good nasal dressing material, especially for beginners in endoscopic surgery who work on Asian patients with narrow nasal cavities.

Antimetabolites as an adjunct to dacryocystorhinostomy for nasolacrimal duct obstruction

Antimetabolites as an adjunct to dacryocystorhinostomy for nasolacrimal duct obstruction

Study of primary endoscopic dacryocystorhinostomy without lacrimal stent

OBJECTIVES/HYPOTHESIS: To evaluate the surgical outcome of primary endoscopic dacryocystorhinostomy (DCR) in nasolacrimal duct obstruction (NLDO) in our set up. STUDY DESIGN: Retrospective non randomized study of consecutive 571 DCR performed in MIMER Medical College, Talegaon-Dabhade, Pune, India during January 2006 to December 2013 with a follow up period of minimum 1 year. METHODS: Retrospective analysis of 571 consecutive primary endoscopic DCR procedures performed without stenting was done. Nasolacrimal system irrigation was used for preoperative assessment. Success was defined as absence of symptoms and patent nasolacrimal system. RESULTS: The overall success rate was 87.39% (499/571). CONCLUSIONS: Our study suggests that the surgical outcomes of primary endoscopic DCR in nasolacrimal duct obstruction are good.

Comparison of the extrusion rate of Crawford tubes.

To compare the outcomes of dacryocystorhinostomy (DCR) using traditional Crawford tubes (TCT) and Crawford tubes with suture (CTS) in the lumen. Retrospective case series consisting of patients who underwent DCR between 2008 and 2013. A total of 61 DCRs were performed on 50 patients. Patients who underwent DCR using CTS had higher rates of prolapse compared to the TCT group (50% vs 9.4%; P=0.003). Stent removal occurred earlier in patients who received CTS (3.3mo vs 5.1mo; P=0.004). Success rates were equivalent between the two groups (75% vs 81.1%; P=0.684). CTS in the lumen increases the risk of prolapse, prompting earlier tube removal in patients following DCR for nasolacrimal duct obstruction (NLDO). Earlier removal of tubes does not appear to significantly decrease success rates.

Safety and efficacy of adjunctive intranasal mitomycin C and triamcinolone in endonasal endoscopic dacryocystorhinostomy.

One of the common causes of failure in dacryocystorhinostomy for nasolacrimal duct obstruction (NLDO) is mucosal scarring and fibrosis around the ostium. Steroid and mitomycin C (MMC) can potentially reduce scarring by their action on the inflammatory and proliferative phase of wound healing, respectively. The purpose of this study is to evaluate the safety and efficacy of combined usage of adjunctive MMC and intranasal triamcinolone (TA) in endonasal endoscopic dacryocystorhinostomy (EE-DCR). This is a retrospective interventional case series. All patients underwent mechanical EE-DCR in two regional hospitals in Hong Kong from January 2005 to December 2006 were included. All received intraoperative MMC application for 5 min and gelfoam soaked with TA onto the ostium. Main outcome measures include the anatomical and functional success rate at follow-up at least 6 months after operation. Other outcomes include complications occurred during and after operation. A total of 73 EE-DCR were performed in 69 patients. Three patients had simultaneous bilateral DCR; one had sequential DCRs for both sides. At the last follow-up, anatomical success was achieved in 68 cases (93 %) and both anatomical with functional success in 67 cases (92 %). No major complication was observed. Minor complications included asymptomatic mucosal adhesion between the nasal septum and lateral nasal wall in one patient and moderate secondary hemorrhage in another. EE-DCR with adjunctive MMC and TA is a safe and successful procedure for the treatment of NLDO.

Endoscopic dacryocystorhinostomy and obstructive sleep apnoea: the effects and outcomes of continuous positive airway pressure therapy.

This study aims to assess the effects and outcomes of continuous positive airway pressure (CPAP) therapy for obstructive sleep apnoea (OSA) in patients who have undergone endoscopic dacryocystorhinostomy (DCR). Retrospective series in a university setting. A total of 205 consecutive patients were included in this study. A 10-year retrospective review was performed of 205 consecutive patients who had undergone powered endoscopic DCR for nasolacrimal duct obstruction. Patient notes were reviewed for demographic, clinical and surgical information. In addition, all patients were contacted and asked to complete a standardized telephone survey relating to OSA, CPAP use and associated symptoms. Effects of CPAP following DCR. Ten of the 205 patients undergoing DCR were identified to use CPAP for obstructive sleep apnoea. Eight patients were initiated on a nasal device, while two used a full-face mask. The mean CPAP pressures were 8 cm H20 (range: 6-10 cm H20). Eighty percent (8/10) of patients complained of symptoms from the use of their CPAP following DCR. The most commonly described symptom was that of air regurgitation in 70% of patients followed by ophthalmic symptoms in 60% (6/10). 50% (5/10) of patients discontinued their CPAP as a consequence of their symptoms with 20% (2/10) discontinuing because of intolerable ophthalmic symptoms. Symptoms from CPAP use post-endoscopic DCR are a common occurrence and may contribute to poor compliance with CPAP therapy. Detailed preoperative counseling with regards to CPAP use and its effects should be mandatory in known or at risk OSA patients undergoing DCR.

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

Management of functional epiphora in patients with an anatomically patent dacryocystorhinostomy.

Approximately 5% to 10% of patients continue to experience persistent epiphora following an anatomically successful dacryocystorhinostomy (DCR) for nasolacrimal duct obstruction or stenosis. To investigate the management and success rate of so-called "functional failure" of DCR for nasolacrimal duct obstruction by experienced lacrimal surgeons. Multicenter retrospective case series including 5 Australian and New Zealand centers. Participants included 61 patients (71% women [n = 46]; mean age, 66 years) with functional epiphora after 65 DCRs (69% transnasal) who were recruited over a mean of 7.6 years. Inclusion criteria included confirmed preoperative diagnosis of nasolacrimal duct obstruction or stenosis, age greater than 18 years, recurrent or persistent epiphora after DCR, an anatomically successful DCR, and follow-up longer than 6 months. Exclusion criteria included evidence of lacrimal hypersecretion, eyelid malposition, and punctal or canalicular abnormalities. The number, type, timing, and success of all clinical interventions performed for the management of functional epiphora after DCR. Epiphora recurred a mean of 8.9 months after primary DCR; 89% of the cases (n = 58) had evidence of a patent ostium and 100% were patent on lacrimal irrigation. Intubation with a lacrimal stent was performed in 82% of the cases at the time of surgery, and all stents were removed a mean of 8 weeks postoperatively. Epiphora was reported immediately following DCR in 32% (n = 21) of the cases and within 6 weeks after removal of the stent in 31% (n = 20); late recurrence (>12 months after DCR) developed in 37% (n = 24) of the cases. In a total of 15% of the cases, participants declined any treatment following DCR. The remainder underwent a mean of 1.3 interventions (range, 1-3) during a mean of 23 to 41 months after primary DCR, following which 72% (n = 47) of the cases had a successful outcome; 12% (n = 8) failed to achieve improvement, and the patients declined further intervention. Thirty-nine interventions (60%) were intubation with a silicone stent with a 54% success rate. Almost half of those undergoing intubation elected to keep the stent permanently; 34% (n = 22) had an eyelid-tightening procedure with 50% success, and 15% (n = 10) required a Lester-Jones tube despite patent canaliculi, with a success rate of 90%. Functional epiphora after DCR among patients with preoperative nasolacrimal duct obstruction or stenosis appears to be uncommon. Benefits can be achieved in most patients with intubation (transient or permanent) or eyelid tightening. More than one procedure is often required.

Post-external dacryocystorhinostomy lagophthalmos.

To describe lagophthalmos and eyelid closure abnormality after external dacryocystorhinostomy (DCR). A retrospective review of medical records and postoperative photographs of 79 patients who underwent external DCR for nasolacrimal duct obstruction and developed eyelid closure abnormality and lagophthalmos with or without exposure keratopathy was conducted. Collected data included age, sex, indication for surgery, laterality, length and type of incision, length of follow-up duration, presence of punctate epithelial keratopathy, and time for resolution of eyelid closure abnormalities. Twenty-seven patients with 28 external dacryocystorhinostomy had postoperative eyelid closure abnormalities. Male to female ratio was 1:6. The mean age was 40.1 years (range 9-80 years). All surgeries were performed through diagonal skin incision. Lagophthalmos involving the medial third of the palpebral fissure was noticed in 28.6 % of cases. All patients had hypometric blink mainly of the upper eyelid. One patient had punctate epithelial keratopathy. Resolution of lagophthalmos was noticed over a period of 1-5 weeks with an average of 3 weeks. None of the patients continued to have residual hypometric blink or punctate keratopathy at the last follow-up time. The mean follow-up period was 4.2 months (range 3-6 months). Eyelid closure abnormality and lagophthalmos after external DCR are underestimated problems. Spontaneous resolution is seen in all cases weeks to months after surgery.

DACRYOCYSTORHINOSTOMY FOR NASOLACRIMAL DUCT OBSTRUCTION SECONDARY TO SARCOIDOSIS

DACRYOCYSTORHINOSTOMY FOR NASOLACRIMAL DUCT OBSTRUCTION SECONDARY TO SARCOIDOSIS

内視鏡下鼻内涙囊鼻腔吻合術を要したサルコイドーシス例

内視鏡下鼻内涙囊鼻腔吻合術を要したサルコイドーシス例

Lacrimal System Endoscopy Assisted Endonasal Dacryocystorhinostomy

Objective: To assess the potential benefit of intra-operative lacrimal system endoscopy during endonasal dacryocystorhinostomy.Methods: Eight patients (10 cases) underwent lacrimal system endoscopy assisted endonasal dacryocystorhinostomy for nasolacrimal duct obstruction between May 2010 and July 2012 at the New York Presbyterian Hospital/Weill Cornell Medical College. All patients were subsequently followed post-operatively for at least 6 months. Primary outcome measures included post-operative epiphora and infection.Results: Lacrimal system endoscopy assisted endonasal dacryocystorhinostomy was successful in identifying the level of nasolacrimal duct obstruction in all 10 cases. Endoscopy revealed obstruction at the valve of Hasner in 2 cases, while the remaining cases involved obstruction at more proximal locations within the nasolacrimal duct. The location of the rhinostomy created during dacryocystorhinostomy was tailored to the specific level of obstruction. No intra-operative complications were encountered. The majority of patients (6 of 8) experienced complete resolution of epiphora within 1 month of surgery, with all patients achieving resolution by 6 months. None of the patients in the study exhibited any signs of post-operative dacryocystitis.Conclusion: The evaluation and management of nasolacrimal duct obstruction may be greatly enhanced through the use of intra-operative lacrimal system endoscopy by specifically localizing and identifying the underlying cause of obstruction, while maintaining the excellent success rate of endonasal dacryocystorhinostomy.

Endonasal Dacryocystorhinostomy for Nasolacrimal Duct Obstruction in Patients with Sarcoidosis

Purpose: To evaluate the outcomes of endonasal dacryocystorhinostomy (EN-DCR) surgery in patients with sarcoidosis.Methods: Retrospective chart review of all patients with sarcoidosis undergoing EN-DCR in 6 practices from 1999–2011.Results: We included 18 procedures in 14 patients (8 female, 6 male) who underwent EN-DCR for acquired NLDO secondary to sarcoidosis. The mean age was 53.7 (range 38–82). The presenting symptom in all cases was epiphora. Eight patients (57%) complained of having additional nasal congestion. Surgery was performed using endoscopic powered-type DCR with flaps in 12/18 (67%) and non-endoscopic mechanical EN-DCR in 6/18 (33%). In 15 (83%) cases the lacrimal sac and nasal mucosa appeared abnormally yellowish, crusty, oedematous and friable. Five patients were treated with pre-operative oral steroid and overall 8 patients had oral prednisolone post operatively, 30–60 mg tapered within 10 days–8 weeks. One patient had difficulties in tapering down the oral steroids at 6 months of follow-up. All patients were free of epiphora and patent to syringing, with nasal endoscopy revealing free flow of fluorescein through the ostium at a mean follow-up of 11.3 months (median follow-up 9 months).Conclusions: All 18 cases of acquired nasolacrimal duct obstruction secondary to sarcoidosis were treated successfully with EN-DCR. An abnormal appearance of the nasal mucosa is an important sign. Nasal congestion is a frequent sign. A successful outcome may not depend on intensive long-term therapy with local or systemic steroids. Mechanical or powered EN-DCR for nasolacrimal duct obstruction secondary to sarcoidosis achieves encouraging medium-term outcomes.

Inverted Papilloma of the Nasolacrimal System Invading the Orbit

A 73-year-old man with a history of epiphora, discharge from the left eye, and left-sided nasal congestion underwent external dacryocystorhinostomy for nasolacrimal duct obstruction. The procedure revealed bony erosion of the majority of the lacrimal sac fossa and a large papillomatous mass filling the lacrimal sac and nasolacrimal duct. Inverted papilloma was diagnosed via biopsy. A subsequent orbitotomy with combined endoscopic medial maxillectomy was performed to remove the mass. This case illustrates the importance of including inverted papilloma, a benign but invasive neoplasm, in the differential diagnosis of nasolacrimal duct obstruction.