Dye Disappearance Test Research Articles

Higher Order Aberrations in Patients with Unilateral Nasolacrimal Duct Obstruction.

To compare corneal higher order aberrations (HOAs) in patients with epiphora caused by unilateral primary acquired nasolacrimal duct obstruction (PANDO) and their fellow eyes. A total of 122 eyes of 61 patients with unilateral PANDO were included. Affected eyes were named as group 1 and contralateral eyes as group 2. The Munk score and fluorescein dye disappearance test (FDDT) were assessed. Corneal topographic and HOAs measurements were taken by Sirius topography. There were 47 female and 14 male patients. The mean keratometry was 43.84 ± 1.4 in group 1 and 43.96 ± 1.4 in group 2 (p = 0.73). The mean corneal topographic astigmatism was 0.81 ± 0.7 in group 1 and 0.78 ± 0.5 in group 2 (p = 0.57). The mean coma-like aberration was 0.19 ± 0.2 in group 1 and 0.10 ± 0.1 in group 2 (p = 0.03). The mean spherical-like aberration was 0.16 ± 0.1 in group 1 and 0.11 ± 0.1 in group 2 (p = 0.04). The mean total corneal HOA was 0.30 ± 0.5 in group 1 and 0.23 ± 0.2 in group 2 (p = 0.04). The mean Munk score was 3.47 ± 1.0 in group 1. There was a positive correlation between the Munk score and both coma-like aberration (r = 0.53, p = 0.003) and total corneal HOAs (r = 0.44, p = 0.010). The mean FDDT grade was 2.60 ± 0.1 in group 1. A positive correlation was observed between the FDDT grade and both coma-like aberration (r = 0.48, p = 0.001) and total corneal HOAs (r = 0.33, p = 0.001). Epiphora in patients with PANDO can affect corneal HOAs. As patients' symptoms and tear pooling were increased as corneal HOA levels increased.

Functional outcome and quality of life index after endonasal versus external dacryocystorhinostomy

Abstract Purpose: To compare the functional outcome and quality of life (QOL) index following non-endoscopic endonasal dacryocystorhinostomy (NEN-DCR) and external dacryocystorhinostomy (EXT-DCR). Methods: Patients were prospectively allocated to two groups. All adult patients presenting with primary nasolacrimal duct obstruction (PANDO) undergoing EXT-DCR and NEN-DCR at a tertiary eye care center were included. Patients in one group underwent EXT-DCR and others NEN-DCR. Functional outcomes were measured by Munk Score and fluorescein dye disappearance test (FDDT). A validated quality of life questionnaire (EQ-5D-3L) in the local language (Odiya) was used to measure health status (social impact score) before and 1 day, 2 weeks, 6 weeks, and 3 months after surgery. The primary outcome measure was the functional outcome–Munk Score and secondary outcome measures included the QOL index and the FDDT. Results: A total of 110 patients were recruited and equally distributed (n = 55) in both groups. The mean age of the population was 47.6 years (SD = 14.02; range 20–79 years). The majority (71%, 79/110) were female. When longitudinally followed over time, functional outcome and QOL index showed reasonably rapid and marked improvement in both groups after surgery compared to baseline scores. The Munk score (P = 0.037) and QOL index (P = 0.007) were marginally better on the first postoperative day for the NEN-DCR group compared to EXT-DCR but comparable at all subsequent visits. At a median follow-up of 9 weeks (range: 0.5–24 weeks), the anatomical outcome was comparable between both groups. Conclusion: Our results demonstrate that functional outcome and QOL index show rapid and marked improvement in both NEN-DCR and EXT-DCR after surgery. NEN-DCR outcomes were marginally better on the first postoperative day but comparable to EXT-DCR thereafter.

Comparative efficacy of probing with or without intubation, and/or inferior turbinate fracture in simple congenital nasolacrimal duct obstruction: a randomized clinical trial

To compare the success rates of probing with or without monocanalicular intubation, and/or inferior turbinate fracture in resolving simple congenital nasolacrimal duct obstruction (CNLDO). A randomized, double-blind clinical trial was conducted on children aged 12–36 months exhibiting symptoms of epiphora and/or mucous discharge along with a positive fluorescein dye disappearance test (DDT). Patients were randomly assigned to one of the following interventions: (1) probing; (2) probing and monocanalicular intubation; (3) probing and inferior turbinate fracture; (4) probing, inferior turbinate fracture, and monocanalicular intubation. Participants were categorized into two age groups (12–24 months and 24–36 months) and assessed for resolution of CNLDO three months post-surgery. Success was defined as the absence of epiphora or mucopurulent discharge and a negative DDT. Among the 201 participants, 51 underwent probing alone, 53 underwent probing with intubation, 47 underwent probing with turbinate fracture, and 50 underwent probing with turbinate fracture and intubation. No significant differences were observed in age, gender, or laterality of the disease between the groups (Ps > 0.05). While there was no significant difference in success rates among interventions in both age groups (Ps > 0.05), patients aged 24–36 months who underwent interventions involving intubation exhibited a significantly higher success rate compared to those without intubation (93.0% vs. 76.2%; P = 0.018). However, this difference was not observed in patients aged 12–24 months (95.7% vs. 92.9%; P = 0.551). Incorporating interventions such as intubation and/or turbinate fracture alongside conventional probing does not significantly alter the success rate of simple CNLDO resolution in children aged 12–24 months. However, older patients (24–36 months) may derive greater benefits from interventions involving intubation.

Functional inferior canalicular reconstruction using a monocanalicular probe after tumor resection of the medial third of the lower eyelid

Purpose: To describe a surgical technique for functionally reconstructing a lacrimal drainage duct and to assess its long-term functionality.Methods: This observational review includes six cases involving reconstruction of the inferior canaliculus after surgical resection of lower eyelid carcinoma. Following lesion excision with safety margins, the epithelium of the distal portion of the inferior canaliculus is located and intubated with a monocanalicular probe. Subsequently, the eyelid lamellae are reconstructed without displacing the probe. The Monoka collarette is then sutured using a 10/0 nylon suture. Data collection included anatomic pathology of the lesion and data from ophthalmic examinations at each visit (including epiphora, inferior canalicular irrigation, and fluorescein dye disappearance test (FDDT)), as well as stent extrusion or other complications.Results: No complications were observed during the surgeries. The stents remained in place for an average of 4 months, with no extrusions prior to removal. The mean follow-up period was 4.8 years (SD=2.0), during which no other complications were noted. Only one patient experienced intermittent epiphora, also present in the fellow eye. At the final visit, FDDT was normal in all eyes, and all patients demonstrated patency of the inferior canaliculus upon irrigation.Conclusion: Primary reconstruction of an inferior lacrimal drainage duct following tumor resection can be successfully performed, resulting in favorable functional recovery.

Successful probing of Congenital Nasolacrimal Duct Obstruction on 11 years old child: A case report

Introduction : Congenital nasolacrimal duct obstruction (CNLDO) is a common cause of epiphora in infants; its prevalence rate of 5% to 20%, although only 2–6% will need intervention. The pathogenesis involves an imperforate membrane of the nasolacrimal duct but it may involve bony abnormalities and narrowing of the lacrimal drainage system.
 Case Illustration : An 11-year-old boy came to the hospital with complaints of a watery and excreted eye since he was born. On the dye disappearance test the result is +4. The patient was decided to have probing procedures. There was positive dye flow in the nasolacrimal duct after probing and irrigation with saline and dye. One week after the probing procedure, dye disappearance test was performed and the result is negative. Patients also no longer complain of watery and sticky eyes.
 Discussion : The management of CNLDO remains controversial. Probing can be used as a primary treatment for children <36 months of age, where success rate of 78–93% can be achieved. For older children success rate is even less. Studies on older children between 25 and 60 months have shown failure rates as high as 28%. The prevalence of complex obstruction in children between 49 and 60 months was 43% with a success rate of only 33% on probing.
 Conclusion : Appropriate time for probing the CNLDO is still under debate. The high success rate of probing in patients older than 2 years old confirm that the first intervention could be probing before considering complex intervention.

Successful probing of Congenital Nasolacrimal Duct Obstruction on 11 years old child: A case report

Introduction : Congenital nasolacrimal duct obstruction (CNLDO) is a common cause of epiphora in infants; its prevalence rate of 5% to 20%, although only 2–6% will need intervention. The pathogenesis involves an imperforate membrane of the nasolacrimal duct but it may involve bony abnormalities and narrowing of the lacrimal drainage system.
 Case Illustration : An 11-year-old boy came to the hospital with complaints of a watery and excreted eye since he was born. On the dye disappearance test the result is +4. The patient was decided to have probing procedures. There was positive dye flow in the nasolacrimal duct after probing and irrigation with saline and dye. One week after the probing procedure, dye disappearance test was performed and the result is negative. Patients also no longer complain of watery and sticky eyes.
 Discussion : The management of CNLDO remains controversial. Probing can be used as a primary treatment for children <36 months of age, where success rate of 78–93% can be achieved. For older children success rate is even less. Studies on older children between 25 and 60 months have shown failure rates as high as 28%. The prevalence of complex obstruction in children between 49 and 60 months was 43% with a success rate of only 33% on probing.
 Conclusion : Appropriate time for probing the CNLDO is still under debate. The high success rate of probing in patients older than 2 years old confirm that the first intervention could be probing before considering complex intervention.

Assessment of Office-Based Probing with Dacryoendoscopy for Treatment of Congenital Nasolacrimal Duct Obstruction: A Retrospective Study.

We aimed to evaluate the safety and efficacy of office-based probing with dacryoendoscopy under local anesthesia for congenital nasolacrimal duct obstruction (CNLDO). This single-institution study retrospectively reviewed data on 72 eyes of 64 consecutive children (38 boys, 43 eyes; 26 girls, 29 eyes), aged between 6 and 17 (mean age: 10.0 ± 2.7) months with suspected CNLDO, from July 2016 to February 2022. These patients underwent probing with dacryoendoscopy under local anesthesia. CNLDO was diagnosed clinically based on the presence of epiphora and sticky eyes due to mucous discharge commencing within the first 3 months of life, increased tear meniscus height, and fluorescein dye disappearance test results. A total of 63 of the 72 eyes had narrowly defined CNLDO, and 9 eyes had other types of obstructions. The intervention success rate was 100% (63/63 eyes) for patients with typical CNLDO and 97.2% (70/72 eyes) for the entire study cohort. Moreover, CNLDO was classified into five types based on the features of the distal end of the nasolacrimal duct. Probing with dacryoendoscopy is safe and yields a high success rate in pediatric patients with CNLDO. This is the first study to assess the safety and efficacy of probing with dacryoendoscopy under local anesthesia in pediatric patients with CNLDO.

Monocanalicular versus bicanalicular annular intubation for treatment of lacrimal canalicular laceration

Purpose The aim of this study was to compare the safety and efficacy of monocanalicular and bicanalicular annular intubation for treatment of lacrimal canalicular laceration. Patients and methods This is a retrospective review of the medical records of 52 patients for whom primary repair of lacrimal canalicular laceration was done. The patients were allocated into two groups. Group I included 26 patients who underwent primary repair with monocanalicular intubation while group II included 26 patients who underwent primary repair with bicanalicular annular intubation. Three months after removal of the stent, negative fluorescein dye disappearance test and patency of the canaliculus on lacrimal irrigation were defined as anatomical success, while functional success was defined as absence of epiphora. Complications like stent prolapse, granuloma formation, and medial canthal deformity were recorded. Results Complete anatomical success was achieved in 18 (69.2%) patients in group I and in 21 (80.8%) patients in group II, with no statistically significant difference (P=0.594). Complete functional success was achieved in 20 (76.9%) patients in group I and in 22 (84.6%) patients in group II, with no statistically significant difference (P=0.683). In addition, there was no statistically significant difference between the two groups regarding the postoperative complications including punctum granuloma, punctum slitting, and medial canthal region deformities (P>0.05). Conclusion Both monocanalicular intubation and bicanalicular annular intubation were safe and effective for treatment of lacrimal canalicular laceration with no statistically significant difference regarding the anatomical and functional outcomes as well as postoperative complications.

Tear Film and Drainage after Selective Punctal Occlusion Using Polydioxanone Plugs in Dry Eye Patients

Purpose: To assess changes in the tear film and delayed tear drainage after upper or lower, or combined upper and lower, punctal occlusion using dissolvable polydioxanone plugs in patients with dry eye.Methods: In total, 40 dry eye patients (80 eyes) were enrolled: four groups of 10 (20 eyes) with no, lower, upper, and lower and upper punctal occlusions. Dissolvable polydioxanone plugs were placed. The tear break-up time (tBUT) and the tear meniscus height (TMH) were measured, and the Schirmer I test and dye disappearance test (DDT) were performed at baseline and 2 weeks after the procedure.Results: Compared to the control group, all three test groups exhibited significant changes in the tBUT, the DDT test, and the TMH after polydioxanone plug placement (all <i>p</i> < 0.05). The group with both upper and lower punctal occlusions exhibited more delayed tear drainage than the other test groups. A lower punctal occlusion significantly delayed tear drainage to a greater extent than did an upper punctal occlusion (<i>p</i> = 0.010).Conclusions: In dry eye patients, a polydioxanone plug improved the tBUT and TMH, and the DDT score. The tear drainage delay increased in the order: both, lower, and upper punctal occlusion(s).

Diagnostic accuracy of fluorescein dye disappearance test in comparison with lacrimal syringing in evaluation of epiphora

Epiphora is the overflow of tear in the lid margin. It can be due to hyper secretion or inadequate tear drainage. Inadequate drainage of tears may be due to mechanical or physiological causes. Physiological cause is due to lacrimal pump failure or weakness of orbicularis muscle. Mechanical causes are due to obstruction in the lacrimal passages. Evaluation of epiphora can be done by lacrimal syringing, fluoresceine dye disappearance test, Jones dye test, contrast dacryocystography, nuclear lacrimal scintigraphy, CT, MRI etc. Fluoresceine dye test is a non invasive method to study tear flow drainage system. Our study evaluate the effectiveness of dye disappearance test to lacrimal syringing which is a invasive test. Aim of this study was to evaluate the accuracy of fluorescein dye disappearance test [FDDT] in evaluating epiphora in comparison to lacrimal syringing.: A prospective observational study was conducted in 90 consecutive patients of age group of 40 to 70 years who presented with epiphora in Department of ophthalmology at tertiary care centre. Any cause like foreign body, trauma, blepharitis, lid disorders like ectropion, entropion, history of lacrimal sac surgeries in the recent past, and allergy to sodium fluorescein excluded from the study.A thorough medical history and comprehensive ophthalmological examination done in all patients. Epiphora evaluated with regurgitation over pressure on the lacrimal sac area, lacrimal syringing, and fluorseceine dye disappearance test.FDDT resulte were graded as grade 1 to 4 according to the quantity of flouorseceine stain in the conjunctival sac, Grade 1 and 2 considered as normal and grade 3 and 4 considered as abnormal.Results of FDDT, syringing, ROPLAS compared in the patients with epiphora.: In the study group, the 90 samples were analysed. The sample population were 62% males and 38% females. There were co-morbidities like diabetes mellitus and cataract noticed in the population. When we examined the diabetes mellitus patients presented with epiphora, showed lacrimal passage obstruction is more common in diabetes patients [67% patients among diabetes patients have FDDT of grade 2-3]. Regurgitation on pressure over lacrimal sac] test were done in all patients presented with epiphora, and the test was positive in 21 patients. FDDT were done in these patients and the results showed only 14 patients were Grade 2-3 [67%]. We compared the FDDT and lacrimal syringing tests in epiphora patients. Among the 90 patients we found that 60 individuals had patent nasolacrimal passages, verified by free flow in Lacrimal syringing test. FDDT showed majority of the patients were under grade 0-1 [patent nasolacrimal passages]. The patients with blocked nasolacrimal passages verified by lacrimal syringing were found grade 2-3 in FDDT [Blocked nasolacrimal passages]. Sensitivity, specificity, and positive and negative predictive value of FDDT were calculated.: FDDT is a safe and effective test for the evaluation of epiphora. It can be done as a screening test in pre operative evaluation of cataract surgery.

Effect of intubation in patients with functional epiphora after endoscopic dacryocystorhinostomy.

To investigate the effect of bicanalicular silicone tube intubation (BSTI) in the treatment of functional epiphora after endoscopic dacryocystorhinostomy (En-DCR). Clinical data of 84 patients (95 eyes) with functional epiphora after En-DCR were retrospectively analyzed. Functional epiphora was confirmed as persistent or recurrent epiphora by fluorescein dye disappearance test (FDDT), lacrimal irrigation test, as well as endoscopic examination. Secondary BSTIs were recommended for patients with functional epiphora. These tubes were removed 1mo after surgery. Functional success and associated complications were assessed after 2y of follow-up. Seven patients (9 eyes) refused intervention, 5 patients (6 eyes) did not complete postoperative follow-up, and 1 patient (1 eye) developed tube prolapse within 1mo after surgery. Seventy-one patients (79 eyes) were included at last. Functional success ratios at six months, one year, as well as two years post-operation were 94.9% (75/79), 92.4% (73/79), and 91.1% (72/79), respectively. Three eyes presented with punctal slitting (2 eyes without epiphora), 1 eye with proximal canaliculus slitting, 1 eye with canaliculus stenosis and 4 eyes with still present functional epiphora without detectable abnormal at the last follow-up. Secondary intubation is an effective procedure with low recurrence probability for functional epiphora after En-DCR. Punctal and canaliculus injury are the main tube-associated complications after secondary intubation.

A Comparative Study of Endoscopic Endonasal Dacryocystorhinostomy with and without Stenting

Introduction: The definitive management of complete nasolacrimal duct obstruction from chronic dacryocystitis is surgical. The surgery of choice is dacryocystorhinostomy (DCR), which can be done external or endonasal with or without stenting. We aim to compare the anatomical and functional outcomes of endoscopic endonasal DCR with and without stenting. Materials and Methods: This prospective study was carried out involving 30 patients of either sex randomly divided into two groups of 15 patients each. Group A underwent endoscopic DCR with stenting of the canaliculi, whereas Group B underwent endoscopic DCR without stenting. These patients were followed up at week 1, 6, and 12. The success of surgery in each group was determined by the absence of epiphora (Munk scale grades: 0 and 1), patent ostium on irrigation, positive Jones test, and decrease in the marginal tear film volume as seen on dye disappearance test (grade: 0 and 1) at week 12. Final data were analyzed using SPSS 21 version. Results: About 86.6% success rate was noted in the group where stenting was done (Group A) compared to 100% success in the group without stenting (Group B). This difference was, however, not statistically significant (P = 0.143). Failures in the study were attributed to the closure of rhinostomy ostium at week 12 follow-up. The most common complication noted was postoperative pain around the bridge of nose. Stent-related complications such as conjunctivitis and difficulty in removal of the stent were also noted. Conclusion: In our study, the surgical results of endoscopic endonasal DCR without stenting were better than endoscopic dacryocystorhinostomy with stenting both anatomically as well as functionally.

Modified Horner-Duverney's muscle plication in the treatment of functional epiphora.

The orbicularis oculi muscle, especially its part (Horner-Duverney's muscle), which is surrounded by the pericanalicular and located deep in the lacrimal sac, is of primary importance in all stages of tear fluid flow. This study aimed to demonstrate that tightening the pretarsal-preseptal orbicularis oculi and Horner-Duverney muscles may improve the function of the lacrimal pump and may be a surgical alternative for treating functional epiphora. This was a prospective interventional case series of 28 patients with functional epiphora. During surgery, sutures were used to perform the intervention, and these were first passed through the upper and lower eyelid pretarsal-preseptal orbicular muscles, through the Horner-Duverney's muscle, and finally, through the dacriocystorhinostomy incision and tightened. Each patient completed the Lac-Q questionnaire and Munk scale prior to surgery, as well as six weeks and six months later. Before surgery, a fluorescein dye disappearance test was performed, which was repeated at follow-up appointments. Pre- and post-operative data were analyzed and compared at the most recent visit. Twenty-eight patients (10 males and 18 females) with a mean age of 59 ± 35 years were included in this study. The severity of epiphora and its tearing effect on daily life significantly improved following the operation. The fluorescein dye disappearance test result was significantly improved after 6 weeks of followup in %89.3 of eyes and at 6 months followup in 92.9% of eyes. The Lac-Q questionnaire's mean social impact scores improved significantly postoperatively, from 3.76 to 0.77 (p < 0.001). The changes in total scores (7.29 before surgery to 1.71 after 6 months) were statistically significant (p < 0.001). The Munk score success rate was 64.3% and 85.7%, respectively. No significant complications or adverse effects were observed. Our findings suggest that a beneficial and seemingly simple, safe, and easy procedure to reduce functional epiphora is to tighten the preseptal-pretarsal orbicularis and Horner-Duverney's muscles.

Preliminary study on the efficacy of lacrimal duct reconstruction with pedicled conjunctival flap in the treatment of severe lacrimal canalicular obstruction with conjunctivochalasis.

To determine the efficacy and safety of pedicled conjunctival lacrimal duct reconstruction in the treatment of severe obstruction of superior and inferior lacrimal canaliculi with conjunctivochalasis. This study was performed as a retrospective analysis of patients who received conjunctival dacryocystorhinostomy with pedicled conjunctival flap reconstruction combined with tube intubation due to severe superior and inferior lacrimal canalicular obstruction with conjunctivochalasis from January 2019 to October 2019. The clinical data included the degree of preoperative epiphora and postoperative relief, preoperative examination of lacrimal duct computed tomography and ultrasound biomicroscopy, postoperative evaluation of lacrimal duct function by chloramphenicol taste and fluorescein dye disappearance test, etc. Syringing was carried out to determine the reconstruction and patency of the lacrimal duct. All 9 patients (9 eyes) had severe canalicular obstruction with conjunctivochalasis. The patients included 4 males and 5 females aged between 47-65y with an average age of 52.2±6.7y. At 3mo follow-up, the tube was removed and the patients were followed for a further 3mo. After tube removal, 6 patients showed no epiphora. These patients also had positive chloramphenicol tastes and normal fluorescein dye disappearance test results. Two patientshad epiphora. Also, syringing showed partial patency of the reconstructed lacrimal duct. One patient had no improvement in epiphora with negative chloramphenicol taste and fluorescein dye disappearance test results and obstruction of the reconstructed lacrimal duct. The total effective rate of the operation was 8/9, with no serious complications. Pedicled conjunctival lacrimal duct reconstruction conjunctival dacryocystorhinostomy is safe and effective for superior and inferior canalicular obstruction with conjunctivochalasis.

Comparison of success rates of probing surgery in congenital nasolacrimal duct obstruction by age range

Purpose: To evaluate the effectiveness of probing surgery in patients with congenital nasolacrimal duct obstruction (CNLDO) according to application time and age groups. Materials and Methods: In this retrospective study, patients with CNLDO who were followed up at Cukurova University Faculty of Medicine between 2012 and 2022 were evaluated. One hundred thirteen eyes of 90 patients with CNLDO were included in the study. The fluorescein dye disappearance test was used to evaluate the diagnosis and treatment success. The demographic characteristics of the patients and the success of the surgeries were recorded. Results: Considering the first probing surgical time, our success rates according to age groups were as follows: 0-12 months (n=10) 100%, 12-18 months (n=29) 86.2%, 18-24 months (n=24) 87.5%, 24-36 months (n=24) 79.2%, 36-48 months (n=14) 57.1%, and 66.7% in patients aged 48 months and older (n=12). When our entire patient group was evaluated regarding success before and after age 2 years, the rate was 88.9% in patients younger than 24 months (n=63), and 70% in patients aged 24 months and older (n=50). Conclusion: In our study, the most successful age ranges for probing surgery were found as 0-12 months, 12-18 months, and 18-24 months. Probing surgery should be performed for patients with congenital nasolacrimal duct obstruction before the age of 2 years because the success rates decreased in patients older than 2 years in our study.

Efficacy of pyridostigmine (Mestinon) in the relief of patients with epiphora.

Although the mechanism is not clear, the inability of the orbicularis oculi muscle, especially the deeper segment (Horner muscle), is thought to be responsible in epiphora. This study evaluates the effect of the anticholinergic drug pyridostigmine (Mestinon) in patients with patent but dysfunctional lacrimal drainage system. Twenty patients with bilateral epiphora (mean age:60.78±6.49 yrs) were included in this study. Patients with a patent lacrimal irrigation test based on persistent and symptomatic epiphora, wiping >10 times daily or continuous tearing and grade 4-5 epiphora according to Munk scale, showing neuropathic involvement in the orbicularis oculi muscle by the quantitative motor unit potential (MUP) analysis method were evaluated prospectively. Fluorescein dye disappearance test (a semi-quantitative assessment of delayed tear outflow) together with a Schirmer test reading were performed in order to detect dry eye. The patients were evaluated for tear meniscus measurements by anterior segment optical coherence topography (OCT) and non-invasive tear break-up time (NI-BUT) was measured by Oculus Keratograph 5 M. Those with a NI-BUT value above 10s, without eyelid laxity, previous ocular surgery or ocular surface disease, or nasolacrimal duct obstruction, and who agreed to use the drug were included in the study. Each subject underwent OCT measurements of the lower tear meniscus of both eyes before and 15mins after taking Mestinon (1×60mg tablet). Upon measurement of the positive effect of the drug on tear meniscus height (TMH), the patients were asked to continue this regime daily for 1 month and then evaluated for relief in their epiphora complaints and any systemic drug side effects. A total of 20 patients (40 eyes) with bilateral epiphora were included in the study. All eyes had grade 4 Munk-score epiphora, Schirmer's test was within the normal range in all eyes (mean, 14±4mm), and patent lacrimal irrigation test. The lower mean TMH reductions 15min after Mestinon in the right and left eyes were 135.41±85.47 and 55.44±61.56mm, respectively, a statistically significant decrease in both eyes (p=0.001, p<0.01). The mean tear meniscus area (TMA) in the right and left eyes was 131.83±68.27mm2 and 62.72±50.57mm2, respectively; 15 mins after administration of Mestinon, the mean TMA in the right and left eyes was 77.27±48.34 and 59.18±44.74mm2, respectively (p=0.001, p<0.01). The mean decreases of 54.56±39.34mm2 in the right eye area and 3.53±42.32mm2 in the left eye area were statistically significant (p=0.041, p<0.05). Symptomatic relief for epiphora cannot be achieved with known treatment options due to lacrimal pump dysfunction. We found that pyridostigmine (Mestinon) provided relief in patients' complaints of epiphora consistent with a significant reduction in TMH levels.

Causes of Tearing in Patients With Chemotherapy: Meibomian Gland Dysfunction Versus Lacrimal Drainage Obstruction.

Numerous ocular toxicities that have been associated with the use of chemotherapeutic agents present as problems with the ocular surface, ocular adnexa, and lacrimal system, and many chemotherapeutic agents have tearing as a side effect. In this study, 34 eyes from 17 patients with a mean age of 62.4±14.8 years were analyzed. Chemotherapy was administered for a mean of 13.8±7.6 months. Chemotherapeutic agents of the following types were included: titanium silicate-1 (58.8%), Docetaxel (23.5%), Paclitaxel (11.8%), and 5-fluorouracil (5.9%). Tearing began 9.1 to 10.9 months after chemotherapy treatment. Within 3 months of beginning chemotherapy, tearing occurred in 9 patients (52.9%), and within 6 months, it occurred in 11 patients (64.7%). Mean tear break-up time was 5.4±2.6 sec. Ten eyes (29.4%) had normal fluorescein dye disappearance test findings (within grade 1), and the mean fluorescein dye disappearance test was 1.91±0.87. Among the 34 eyes, 24 (70.6%) had normal puncta and 9 (26.5%) and 1 (2.9%) had stenosis and blockage, respectively. Ten eyes (29.4%) showed total regurgitation, 19 eyes (55.9%) showed partial regurgitation, and 5 eyes (14.7%) showed no regurgitation upon syringing. Four eyes (11.8%) and 30 eyes (88.2%), respectively, showed soft and hard stops upon probing. Dacryoscintigraphy confirmed that 6 eyes (17.6%) were normal, 8 eyes (23.5%) showed post-sac delay or obstruction, and 20 eyes (58.8%) showed pre-sac delay or obstruction. The mean meiboscores for the upper and lower eyelids on LipiView were 2.15±0.86 and 2.53±0.79, respectively. The difference in meiboscores between the upper and lower eyelids was significant ( P=0.004 ). Obstruction of the lacrimal drainage system is a significant contributing factor to tearing in chemotherapy patients. However, reflex tearing because of meibomian gland dysfunction should also be fully considered to effectively manage the tearing because of the high incidence of accompanying meibomian glands loss when the lacrimal drainage system is obstructed.

CONGENITAL NASOLACRIMAL DUCT OBSTRUCTION AND ITS MANAGEMENT PROTOCOL

PURPOSE: To determine management protocol in congenital nasolacrimal duct obstruction in age group of 3 months to 6 yrs . METHOD:A prospective interventional study was conducted on 30 patients with CNLDO within the age group 3 months to 6 yrs from September 2020 to April 2022. The diagnosis was made based on a history of epiphora since birth, or shortly after birth, in one or both eyes supported by objective evidence of reduced lacrimal outflow using a fluorescein dye disappearance test (FDDT). Ocular examination was carried out to exclude punctal stenosis or other abnormality. Patients with positive FDDT test were considered for various treatment modalities. Patients with age &lt; 1 year considered for criggler massage 8-10 times a day. Patients with persistent epiphora and mucous discharge were considered for endoscopic assisted probing or DCR with intubation under general anaesthesia. RESULTS: The study group comprised of 30 patients, out of which 40 % were male and 60 % were female. On the basis of age of representation 60 % were between 12 months, 26 % between 1 year – 4 year and 14 % more than 4 years. In this study all patients were prescribed crigler massage but the patients not improved on massage and, 12 months - 4 years and more than 4 years were prescribed with endoscopic assisted probing, and DCR with intubation respectively. In this study out of 30 patients of CNLDO 16 patients were improved by crigler massage (in age group of &lt; 12 months ) ,9 patients were improved with endoscopy assisted probing with 90 % of successful result in age group of 12 months - 4 years and 5 patients improved from DCR with intubation depending upon age of patients . CNLDO is a relative CONCLUSIONcommon disorder in peadiatric population ( 5 - 20 % ) due to failure of canalisation of the distal end of nasolacrimal duct leading to watery and mucoid discharge. Conservative management in the form of crigler massage considered to be safest and effective with higher success rate. Patients with no improvement on crigler massage and persistence of symptoms shows more effective outcome with endoscopic assisted probing or DCR with intubation.

Bicanalicular-nasal silicone stent for deep canalicular laceration management

We evaluated the efficacy and clinical outcomes of bicanalicular-nasal silicone stents for deep canalicular lacerations and their anatomical restoration advantages. This retrospective case series study included patients with deep canalicular lacerations who underwent bicanalicular-nasal silicone stent intubation between January 2010 and June 2021 at a Chinese tertiary hospital and two primary hospitals. Intra- and post-operative complications were recorded. Anatomical, functional, and cosmetic outcomes were evaluated as anatomical restoration assessments at the last follow-up. We defined anatomical success as a free passage with no reflux during irrigation. Functional success was evaluated using the Munk epiphora scale and fluorescein dye disappearance test. Cosmetic outcomes were evaluated by examining the eyelid, lacrimal punctum, and medial canthus for any structural abnormalities and recorded objectively using a grading scale. We evaluated 92 eyes of 92 patients (63 men and 29 women); the mean distance from the lateral lacerated end to the punctum was 7.74 mm (range 7-10 mm). Bicanalicular-nasal silicone stents were successfully used in all 92 eyes with no severe intra- or post-operative complications noted. The stent placement duration ranged from 12 to 16 weeks (mean, 13.18 weeks). The follow-up period after stent removal ranged from 3 to 12 months (mean, 6.04 months). The anatomical and functional restoration success rates were 96.74% (89/92) and 100% (92/92), respectively. Satisfactory eyelid position realignment was achieved in all patients. Bicanalicular-nasal silicone stent placement sufficiently relieved orbicularis muscle tension during deep canalicular laceration repair, providing good functional results and excellent cosmetic realignment and anatomical restoration of the eyelid.

OUTCOME OF DACRYOCYSTECTOMY IN ELDERLY PATIENTS ATTENDING A TERTIARY CARE CENTRE IN KASHMIR

Background: Dacryocystectomy (DCT) is a surgical procedure that involves complete removal of lacrimal sac. It is a less invasive procedure and can be used as an alternative to dacryocystorhinostomy (DCR) in elderly patients. To Aim: determine the surgical outcome of DCT in elderly patients &gt;65 years attending the Department of Ophthalmology, Government Medical College, Srinagar. This was a hospital based prospective study conducted on 35 pat Methods: ients over a period of 2 years from January 2019 to January 2021. Elderly patients &gt;65 years age with presenting complaint of recurrent dacryocystitis, dry eye with no epiphora despite complete nasolacrimal duct obstruction were included in the study. Proper preoperative history was taken with regard to presenting complaints and detailed medical history was recorded. Dry eye was diagnosed using Schirmer-I test and tear lm break-up time. Nasolacrimal duct obstruction was diagnosed by uorescein dye disappearance test and lacrimal irrigation (syringing). Clinical examination was done using slit lamp. Results: In our study, mean age of study population was 75±3 years. Majority of patients were females accounting for 65.7% cases. Main indication of DCT in our study was chronic dacryocystitis accounting for 68.6% cases followed by episodes of acute dacryocystitis in 20% cases and irreducible lacrimal sac swelling accounting for 11.4% cases. Overall surgical outcome was good in our study population with no postoperative complaints at the end of 3 months follow-up in 94.3% cases. Our study indicated that Conclusion: majority of patients who underwent DCT were female with chronic dacryocystitis being the main indication for DCT. DCT is a useful and safe surgical alternative to DCR in elderly patients with recurrent dacryocystitis and in those with underlying systemic comorbidities in whom DCR is associated with a high risk of intraoperative and postoperative complications.