Endonasal Dacryocystorhinostomy Research Articles

A comparative study on outcome of endonasal dacryocystorhinostomy with and without silicone intubation-otorhinolaryngology

Background: Epiphora or “tearing eye” is a functionally and socially, bothersome symptom. Dacryocystitis is an inflammatory condition of the nasolacrimal sac caused due to an obstruction within the nasolacrimal duct (NLD). Dacryocystitis can be classified as acute and chronic or acquired and congenital. Chronic dacryocystitis is almost always managed surgically. The present study was undertaken for comparative study of outcomes of endonasal Dacryocystorhinostomy (DCR) done with and without silicone intubation. Methods: The 50 cases dacryocystitis were selected. The patients were divided in group A cases (with intubation) and group B controls (without intubation) randomly. A detailed history was taken followed by general physical and clinical otorhinolaryngological examination. Patients were evaluated with nasal endoscopy, DCG (Dacrocystogram), through which site of obstruction was located. Results: In our study, Among the cases 18 subject presented with right dacryocystitis and 7 with left dacryocystitis. Similarly, among the controls, 20 subjects presented with right dacryocystitis and 5 presented with left dacryocystitis. According to modified Likert’s score, at the end of 6 months when a nasal endoscopy was done along with syringing 96% of the cases had patent rhinostomy while only 80% of the controls showed patency. Post operative epistaxis was evident in 6 cases and 4 controls. Conclusions: Endonasal DCR with and without stenting, had more or less similar results, with equal post op complications. Though, with stenting, success rates were high as shown in our study.

Letter to the editor: Some reflections on 'Endonasal dacryocystorhinostomy in children: Our experience'.

Letter to the editor: Some reflections on 'Endonasal dacryocystorhinostomy in children: Our experience'.

Outcomes of Endoscopic Endonasal Dacryocystorhinostomy in Glaucoma Patients.

Anti-glaucoma eye drops have been investigated due to their production of fibrotic changes on the conjunctival surface, undermining the functioning of the upper lacrimal drainage system. We aimed to assess whether these effects may impair the effectiveness of endoscopic endonasal dacryocystorhinostomy (EE-DCR). This is a single-center observational retrospective study on EE-DCR via a posterior approach. Resolution of epiphora and dacryocystitis were analyzed after 1 (T1) and 6-months (T2) from surgery. Surgical success was defined as anatomical (patency at irrigation, no recurring dacryocystitis) or complete (zeroing of Munk score). Twenty patients (32 sides) were enrolled. Preoperatively, 93.75% (n = 30/32) presented severe (Munk 3-4) epiphora and 68.75% (n = 22/32) recurrent dacryocystitis. At T1, 50.0% (n = 16/32) were referred with residual epiphora (Munk ≥ 1) and 18.75% (n = 6/32) dacryocystitis. At T2, 31.25% (n = 10/32) still complained of epiphora (Munk ≥ 1) and 6.25% (n = 2/32) dacryocystitis. Difference of outcomes at aggregate and paired timepoints (except for T1 versus T2) resulted in statistical significance (p < 0.05). At T2, 22 (68.75%) complete, 8 (25.0%) anatomical successes and 2 (6.25%) surgical failures were observed. Despite the chronic uptake of anti-glaucoma eye drops, EE-DCR guaranteed high rates of clinical relief from epiphora and remarkable decreases in the rates of recurrent dacryocystitis.

Early Endonasal Dacryocystorhinostomy for Acute Dacryocystitis: A Systematic Review and Meta-Analysis.

The aim of this meta-analysis is to compare the outcomes of early endonasal dacryocystorhinostomy (DCR) with delayed DCR in the treatment of acute dacryocystitis (AD). A comprehensive electronic search of PubMed, Embase, Web of Science, and the Cochrane Library databases was conducted up to November 11, 2023. Data synthesis was performed using Review Manager 5.4, and forest plots were generated for each outcome measure. Potential publication bias was assessed using funnel plots and Egger's test. Six studies involving 288 patients were included in the meta-analysis. Overall, the success rate of early endonasal DCR was comparable to that in the delayed DCR group (odds ratio [OR] = 1.52, 95% confidence interval [CI]: 0.81-2.85, P = .19). Furthermore, in comparison with the delayed DCR group, early endonasal DCR significantly reduced the time for medial canthus swelling resolution (mean differences [MD] = -4.92, 95% CI: -5.46 to 4-.37, P < .00001) and complete resolution of symptoms (MD = -17.70, 95% CI: -23.88 to -11.52, P < .00001). Primary early endonasal DCR seems to be a promising and favorable approach for managing AD with comparable efficacy and faster relief of symptoms compared to conventional delayed DCR.

Comparative study of surgical outcomes regarding tear meniscus area and high-order aberrations between two different interventional methods for primary acquired nasolacrimal duct obstruction.

To compare endonasal dacryocystorhinostomy (EN-DCR) with sheath-guided dacryoendoscopic probing and bicanalicular intubation (SG-BCI) by evaluating tear meniscus area (TMA) and total high-order aberrations (HOAs) for primary acquired nasolacrimal duct obstruction (PANDO). We retrospectively reviewed 56 eyes of 42 patients (7 men, 35 women; age, 72.7±13.1 years) who underwent EN-DCR or SG-BCI for PANDO in Toyama University Hospital from February 2020 to June 2022. In the EN-DCR and SG-BCI groups, we measured the patency of the lacrimal passage, preoperative and postoperative TMA, and HOAs of the central 4 mm of the cornea using optical coherence tomography (AS-OCT), six months postoperatively. There was a positive correlation between preoperative TMA and preoperative HOAs in all cases. Postoperative patency of lacrimal passage was 100% in the EN-DCR and 80.8% in the SG-BCI group. There was a significant difference in the number of passages between the two groups (p = 0.01). Preoperative TMA and HOAs showed a significant postoperative decrease in both groups (EN-DCR group: p<0.01, p<0.01, SG-BCI group: p<0.01, p=0.03, respectively). We then calculated the rate of change of preoperative and postoperative TMA and HOAs and compared them between the two groups. The rate of change was significantly higher in the EN-DCR group than that in the SG-BCI group (TMA, p=0.03; HOAs, p=0.02). Although both EN-DCR and SG-BCI are effective for PANDO, our results suggest that EN-DCR is more effective in improving TMA and HOAs.

Surgical outcomes of endoscopic dacryocystorhinostomy for eyes with nasolacrimal duct obstruction via tear meniscus height evaluation.

To evaluate the association of tear meniscus height (TMH) with clinical outcomes of patients who underwent endonasal dacryocystorhinostomy. We recruited 304 patients from two institutes. The TMH was measured using anterior segment optical coherence tomography before surgery. All patients underwent endoscopic DCR with lacrimal intubation stent insertion. The lacrimal stent was removed 2months after surgery. The TMH was measured at 2months and 12months after surgery. Improvements in epiphora were assessed using a visual analogue scale (range, 0-2). Recurrence was determined based on lacrimal irrigation and endoscopic evaluation results. All patients experienced improvements in subjective symptoms 2months after surgery. The mean TMH also decreased significantly compared with that before surgery. During the follow-up period, four patients experienced recurrence. The mean TMH 12months after surgery was significantly lower than that before surgery. The rate of change in the TMH was significantly associated with the use of a dacryoendoscope during sheath-guided lacrimal stent intubation at all time points. Of the 251 patients who were followed up at 12months after surgery, three reported recurrences, and 17 reported mild improvement of epiphora. The rate of change in the TMH was significantly associated with epiphora improvement. Height was also associated with epiphora improvement. Endoscopic DCR is an acceptable surgical procedure for managing nasolacrimal duct obstruction. Sheath-guided lacrimal stent intubation using a dacryoendoscope resulted in a greater reduction in postoperative TMH compared to the blind insertion technique, which may lead to favorable clinical outcomes.

Comparison of success between external and endonasal dacryocystorhinostomy in primary acquired nasolacrimal duct obstruction in South India population

Background: Dacryocystorhinostomy (DCR) has been the standard procedure for primary acquired nasolacrimal duct obstruction (PANDO) for many years. This process can be performed either using an endoscopic or external approach. Aims and Objectives: The aim is to evaluate the results and recurrence rates of external DCR (ExDCR) and endonasal DCR (EDCR) surgery in patients with PANDO in the South Indian population. Materials and Methods: Medical records were reviewed in all patients who underwent surgery for PANDO between December 2021 and August 2023 at Government Medical College Mahabubabad. Results: This study was conducted in 92 patients; 34 males (36.96%) and 58 females (63.04%) were the gender split. ExDCR was used in 52 (56.52%) of the cases, and EDCR was used in 40 (43.487%) of the cases. Operation success rates of these data revealed that 50 (54.34%) cases were recorded as successful, 24 (26.10%) of the cases were accepted as partially successful, and 18 (19.56%) of the cases were deemed unsuccessful. There was no statistically significant difference between success rates and recurrences in both groups (P&gt;0.05). Conclusion: Endoscopic DCR produced simple, minimally invasive, and preferable results compared to ExDCR in the South Indian population. Although the success of ExDCR is higher and the recurrence is lower than endoscopic DCR, with the outcomes of this study, endoscopic DCR can be tried as the first choice to protect the patient from major surgery and anesthesia in PANDO.

The Endoscopic Endonasal Dacryocystorhinostomy in Daraa Tafilat –Sud Est Area of Morocco

Objective: The endoscopic endonasal dacryocystorhinostomy (EE-DCR) surgery is a minimally invasive surgery for lacrimal sac. The aim of our study is to analyze and evaluate our patients undergoing EE-DCR during 12 months. Patients et methods: First retrospective study of 23 EE-DCR in Daraa-Tafilalt, sud est area of Morocco from 01/01/2021 to 30/12/2022. This work is an ananalysis of epidemiological data, operative indications, clinical and radiological findings of intraoperative and postoperative anatomical and functional results. Results: This study included 20 women (86.9%) and 3 men. The median age is 45 years. Surgical indications are divided between failure of DCR externally (7 cases), nose and sinus associated pathology (11 cases), dacryocele (5 cases). Our success rate is 87,5% in first-line DCR (14/16). It is 85,7% in revision of external failure. No major complication is collected. Conclusion: The EE-DCR is becoming increasingly widely adopted and is now the preferred DCR technique in many centres. It remains just as effective and reliable than externally with a success rate almost comparable (85% to 90%). The success of an EE-DCR is conditioned by close multidisciplinary collaboration (ENT/Ophthalmologists/Radiologists), a mastery of technical and finally, and a good post-operative care.

Effects of nasal desmopressin spray versus topical epinephrine on surgical field clarity and hemodynamics in endonasal dacryocystorhinostomy: a randomized clinical study

Background A bloodless surgical field coupled with stable hemodynamics is pivotal for successful surgical intervention, especially in endonasal surgeries. This study investigates the effect of intranasal desmopressin spray in reducing surgical bleeding and on hemodynamics compared with topical epinephrine in patients scheduled for endonasal dacryocystorhinostomy (DCR). Methods Fifty-two patients were randomly allocated into two groups in this double-blind clinical study: Desmopressin group (n=26): patients received two puffs of desmopressin acetate 10 μg/puff in the side of the nasal cavity ipsilateral to the obstructed lacrimal duct (20 µg totally) 60 min before the surgery. Epinephrine group (n=26): patients received topical 1 : 100 000 epinephrine in the nasal cavity ipsilateral to the obstructed lacrimal duct via 3 soaked packs placed in the middle meatus for 5 min after induction of general anesthesia and before the start of surgery. Results The median clarity of the surgical field based on the BOEZAART grading system was significantly clearer in the desmopressin group compared with epinephrine group. The duration of surgery was significantly shorter in the desmopressin group (66.92±5.04 min) compared with epinephrine group (71.73±5.45 min). Mean arterial blood pressure (MABP) and heart rate (HR) were statistically significant higher in epinephrine group compared to the desmopressin group at 2 and 5 min after topical epinephrine compared with desmopressin group. Conclusion Pre-emptive 20 ug single dose of intranasal desmopressin provides a clear surgical field with no hemodynamics effects compared with topical epinephrine in patients undergoing endonasal dacryocystorhinostomy. Clinicaltrial.gov (ref: NCT05507476, date of registration: 18-8–2022).

Outcomes of external and endonasal dacryocystorhinostomy according to a modified Lacrimal Symptom Questionnaire (Lac-Q).

Nasolacrimal duct obstruction is usually treated using endoscopic or external dacryocystorhinostomy (DCR). The anatomic outcomes of both the endoscopic and external approaches are considered excellent. However, anatomic success does not translate into patient satisfaction. The current study assessed pre- and postoperative lacrimal problems using the symptom-based Lacrimal Symptom Questionnaire (Lac-Q) and investigated patient satisfaction depending on the choice of surgical technique. A total of 112 eligible patients with lacrimal problems treated using external or endonasal DCR at the ophthalmology and ear, nose, and throat clinics at Skane University Hospital, Scania, Sweden, over a four-year period, were enrolled in this retrospective study. Patients were considered eligible if they experienced preoperative epiphora and had lacrimal duct stenosis. They were offered treatment using either external or endonasal DCR and were allowed to freely choose the technique. Exclusion criteria consisted of previous ipsilateral DCR, congenital NLDO, age < 18 years, presence of cancer, previous orbital trauma, or noncompliance with postoperative follow-up. After surgery, the patients were sent the Lac-Q to evaluate their lacrimal symptoms pre- and postoperatively. Complementary questions were added pertaining to the operative scar and the patients' overall satisfaction with the operation. In total, 67 (60%) patients with ages ranging from 18 to 88 years completed the questionnaire, 33 (49%) of whom underwent external DCR and 34 (51%) endonasal DCR. Of the 67 respondents, 51 (76%) were women and 16 (24%) were men. Patients scored preoperative lacrimal problems highly on the Lac-Q, reporting both symptomatic and social problems due to epiphora. Following surgery, the group that underwent external DCR remained home from work for 2 - 14 days (median, 3.5 days). However, 17 (52%) were retired. After the endonasal DCR, the patients remained home for 0 - 7 days (median, 2 days). Most patients were satisfied after DCR surgery, with both techniques significantly improving total, lacrimal symptom, and social impact scores (all P < 0.001). No differences in postoperative satisfaction were observed between the external DCR and endonasal DCR groups (P > 0.05). A small number of patients expressed scar-related concerns after external DCR. The patients perceived lacrimal problems as a significant symptomatic and social burden. Postoperative satisfaction and symptom relief were good regardless of the surgical approach. Further prospective studies assessing patient satisfaction and its correlation with anatomical and functional success rates after external and endonasal DCR could provide robust, practical, real-world implications.

Комбинированная техника эндоскопической дакриоцисториностомии. Первый опыт

Purpose. To develop a delicate method of dacryorhinostomy formation during endoscopic dacryocystorhinostomy (DCR) based on modern less traumatic techniques allowing better results with lower complications rate. Material and methods. Surgical treatment of patients suffering from chronic dacryocystitis with nasolacrimal duct obstruction was performed. Nasolacrimal anastomosis formation was performed using modern energy methods during steps of endoscopic DCR. Totally, 16 patients were treated, ten females and six males. Mean age was 67 years. Mean follow-up period was 6 months. Results. In all patients an adequate nasolacrimal anastomosis was formed. During surgery there was no one case of damage to the lateral wall of the lacrimal sac (LS) or significant intra- and postoperative bleeding. Functional success was marked in 93.75% (15/16) of cases. In 6.25% (1/16) there was a postoperative granuloma in the rhinostomy region which prevented tear passage. Conclusion. A combination of controlled low-temperature ablation of nasal mucous, ultrasound bone destruction and laser dissection of the medial wall of the LS allows creation of an adequate nasolacrimal anastomosis, makes surgery significantly quicker and easier, enables better soft tissues healing in shorter terms. Key words: chronic dacryocystitis, endonasal endoscopic dacryocystorhinostomy, coblation, ultrasound, laser

ANALYSIS OF UNSUCCESSFUL EXTERNAL DACRYOCYSTORINOSTOMY IN PATIENTS WITH CHRONIC DACRYOCYSTITIS AND WAYS TO ELIMINATE THEM

The purpose of this study is to analyze the causes of relapses of chronic dacryocystitis. Material and methods. The research included 24 patients who were operated in our clinic from January 2018 to September 2022. All patients had been previously operated on for external dacryocystorhinostomy. 14 patients underwent endonasal dacryocystorhinostomy surgery resulted from traumatic dacryocystitis. All patients received a standard ophthalmologic and dacryologic examination, including functional tests to assess the patency of the lacrimal drainage system. All patients were prescribed endonasal dacryocystorhinostomy. All patients also underwent intraoperative examination and, if necessary, CT scan. The severity of lacrimation was assessed before and after the operation using a point scale from 0 to 4: a score of 0 indicated an absence of lacrimation complaints, 1 denoted mild lacrimation, 2 signified moderate lacrimation, 3 indicated lacrimation occurring solely outdoors, and 4 represented severe lacrimation both indoors and outdoors. All patients underwent examinations 1, 3, 7 days, 1 month, 3 months, and 6 months post-surgery. A successful outcome, defined as a score of 0 points, was achieved in 95.8% of cases. Results. In the majority of patients operated because of traumatic dacryocystitis, a rhinological examination revealed displacement and deformation of the nasal bones, hypertrophic rhinitis and other nasal diseases. Moreover, intraoperative examination revealed a poor-quality anastomosis due to scar tissue, the presence of movable bone fragments in the area of rhinostomy and displacement of the lacrimal sac. Other reasons for relapse included insufficient drainage and incorrectly formed bone hole in the wall of the nose. Conclusions. Drainage of the formed anastomosis is a prerequisite for successful surgery of chronic dacryocystitis. Factors that increase the likelihood of relapses are significant changes in the topography of the tear ducts, as well as scar tissue changes in the rhinostomy area and the nasal mucosa. The correct choice of surgical treatment method (in our case, EDCR) in patients with recurrent chronic dacryocystitis, it allows to increase the effectiveness of surgical treatment of these patients.

CHARACTERISTICS OF ACQUIRED OBSTRUCTION OF LACRIMAL PATHWAYS IN PATIENTS WITH CHRONIC TYPE 2 DIABETES AND COMBINED CONSERVATIVE AND SURGICAL TREATMENT INVOLVING ENT SPECIALISTS

Pathological changes in the lacrimal system such as dry eye syndrome in patients with diabetes are well described in modern literature, but no sufficient attention is paid to the problem of the lacrimal system in this group of patients. Currently, the established protocol for treating chronic dacryocystitis involves collaborative endoscopic endonasal dacryocystorhinostomy conducted by ophthalmic surgeons and ENT specialists. However, in patients with type 2 diabetes, there is a need to investigate the clinical effectiveness of this surgical approach.&#x0D; Purpose of this study is to evaluate the effectiveness of conservative and surgical treatment in patients with chronic dacryocystitis depending on the presence of type 2 diabetes and to determine the features of the postoperative period.&#x0D; Materials and methods. The study included 30 patients with chronic dacryocystitis and type 2 diabetes (main group) and 30 patients with chronic dacryocystitis without diabetes (control group), who underwent endoscopic endonasal dacryocystorhinostomy according to the standard technique. The results of the operation were evaluated in 2 months, 6 months and 2 years following the surgical interventions.&#x0D; Endoscopic endonasal dacryocystorhinostomy was considered as an effective technique for restoring unobstructed lacrimal drainage when it lead to the alleviation of tearing, and preventing re-infection of the lacrimal sac. Alongside conventional ophthalmological examinations, the assessment involved nasopharyngeal and lacrimal suction tests, reflux tests, lacrimal duct lavage, lacrimal canal probing, computer tomography, and endoscopic examination of the nasal cavity.&#x0D; Results and discussion. The effectiveness of surgical treatment in 2 months after the operation in patients of the main group (70% of patients) was 1.3 times, after 6 months (63.3% of patients) was 1.4 times, and in the remote period in 2 years (50% of patients) was 1.6 times lower than in patients of the control group (р&lt;0.05). Analyzing the presence of the main symptoms of chronic dacryocystitis in the dynamics of observation, it was noted that after endoscopic endonasal dacryocystorhinostomy the most frequent symptom was lacrimation, but its frequency in patients of the main group after 2 months (30% of patients) was 4.5 times, after 6 months (36.7% of patients) - 2.8 times, after 2 years (50% of patients) - 2.5 times higher than in patients of the control group (р&lt;0.05 ).&#x0D; The efficacy of surgical treatment's in 2 month following the operation in the main group patients (70%) was 1.3 times, after 6 months (63.3%) was 1.4 times, and in the long-term, 2 years post-operation (50%), was 1.6 times lower than in the control group patients (p&lt;0.05). Analyzing the dynamics of chronic dacryocystitis symptoms during observation, it was observed that following endoscopic endonasal dacryocystorhinostomy, lacrimation emerged as the most common symptom. However, its frequency in the main group patients was notably higher after 2 months (30%), being 4.5 times, after 6 months (36.7%) it was 2.8 times higher, and after 2 years (50%) it was 2.5 times higher compared to the control group (p&lt;0.05).&#x0D; Conclusions. In patients with type 2 diabetes, the clinical effectiveness of conservative and surgical treatment for chronic dacryocystitis is lower than in patients without diabetes, and the postoperative period has its own characteristics.

Evaluation of Tear Stability and Ocular Surface in Patients Undergoing External Endonasal Dacryocystorhinostomy (EE-DCR) for Primary Acquired Nasolacrimal Duct Occlusion (PANDO).

The aim of our study was to show the changes in ocular surface and tear film parameters of patients who underwent external endonasal dacryocystorhinostomy (EE-DCR). For this purpose, tear film break-up time, corneal staining score, ocular surface disease index (OSDI), and Schirmer I test were performed preoperatively and postoperatively. The data obtained were compared with healthy controls. In the preoperative period, ocular surface disease index scores and corneal staining scores were higher, and Schirmer 1 and tear film break-up time were lower in group 1 compared with group 2. The ocular surface parameters were similar between the groups in the first and third postoperative months. External endonasal dacryocystorhinostomy is an important method for the restoration of deteriorated tear stability. Restoration of these disorders may be an important determinant of patient satisfaction and visual quality after surgery.

Comparative Study of Endonasal Endoscopic Dacryocystorhinostomy with or without Preservation of Nasal Mucosal Flap.

To analyse the result of endoscopic endonasal dacryocystrhinostomy with or without preservation of nasal mucosal flap. Randomised prospective cohort design. Tertiary academic centre. 100 patients who presented with epiphora and diagnosed as chronic dacryocystitis after syringing by ophthalmologist, were selected and randomised into two groups. Standard surgical procedure of endoscopic endonasal dacryocystorhinostomy was carried out except for the preservation of flap in group A and without preservation of flap in group B. Additional surgeries were done according to necessity. Postoperatively, patients were followed up on OPD-basis at the end of 1stweek, 2nd week, 1stmonth, and 3rd month. Symptomatic improvement was assessed and patency checked by syringing by the ophthalmologist. Nil intraoperative complications (p < 0.05)and nil postoperative complication noted (p < 0.05). Functional and anatomical patency found to be 100% at the end of 1st week in both groups, 96% at 3rd month in case group A and 98%,92% and 82% respectively at the end of 2nd week, 1st month and 3rd month in group B. Nasal endoscopy of all surgical failures showed restenosis in both groups and synechiae in 2 patients in group B. Preservation of nasal mucosal flap with modification around stoma can be used to cover the bared bone with avoidance of granulation tissue formation reducing the risk of closure of ostium with large rhinostomy and improve success of endoscopic endonasal DCR.

Preoperative Orbital CT Scan Findings in Patients with Nasolacrimal Duct Obstruction and its Impact on Surgical Planning

Background: External dacryocystorhinostomy (DCR) failure is sometimes due to pathologies located within the nasal cavity. Preoperative computerized tomography (CT) scan is useful in the assessment of nasolacrimal drainage and adjacent anatomical structures; however, it is not routinely performed before DCR. The present study evaluates abnormal findings in CT scans of patients with nasolacrimal duct obstruction (NLDO) and its effect on changing treatment approaches. Methods: This prospective descriptive cross-sectional study included 162 patients with NLDO. All the patients underwent a supine axial CT scan. Patients with signs of rhinosinusitis, sinus mucositis, nasal septal deviation, nasal polyps or masses, and turbinate deformities were referred to an otolaryngologist. The rest of the patients underwent external DCR. The demographics and radiologic characteristics of the patients undergoing CT scan and their effect on changing treatment approaches were evaluated. Results: The study participants included 162 patients with a mean±SD age of 62.5±14.0 years (age range of 35-93 years). The percentage of endonasal DCR in cases with an abnormal nasal cavity on CT scan was almost 30% higher compared to those without this problem (59.6% vs. 30.2%). Septum deviation and turbinate deformity led to 3.6-fold and 3.9-fold changes in the surgical approach, respectively. Conclusion: A significant association existed between the sinonasal pathologies in patients with NLDO and changing surgical approaches. It is believed that a preoperative CT scan is necessary to detect such pathologies and manage them appropriately.

Canalicular obstruction associated with dupilumab.

Dupilumab is a novel treatment for severe atopic dermatitis and is associated with a range of ocular complications such as blepharoconjunctivitis, keratitis, cicatricial ectropion and punctal stenosis. We report 4 patients with canalicular obstruction in association with dupilumab therapy, and we describe their treatment and outcomes in each case. Canalicular obstruction was diagnosed by an oculoplastic consultant between 3years and 3months and 4years and 9months after the commencement of dupilumab therapy. Case 1 underwent nasolacrimal intubation, case 2 was treated conservatively, and case 4 underwent endonasal dacryocystorhinostomy and these patients' symptoms resolved. Unfortunately, in case 3 despite endonasal dacryocystorhinostomy with stenting they remained symptomatic. This case series adds to the growing number of ocular complications associated with dupilumab therapy, and there is yet an optimal treatment strategy to mitigate these complications. It is possible that simple conservative measures such as discontinuation of dupilumab and topical treatments with steroids can eventually lead to some form of recovery and recanalisation of the canalicular system. Early referral to an ophthalmologist prior to the development of canalicular obstruction to control the inflammatory ocular surface could reduce the risks of cicatricial sequelae from dupilumab, and temporary stenting of the canalicular system could be attempted as a method to keep the canalicular system patent, whilst the patient remained on treatment.

Outcomes of Endonasal Dacryocystorhinostomy Performed for Functional Nasolacrimal Obstruction With Delay on Dacryoscintigraphy.

To report the demographics and outcomes of endonasal dacryocystorhinostomy (DCR) following dacryoscintigraphy (DSG) performed for a series of patients with functional epiphora. Case series of endonasal DCR outcomes in patients with symptomatic epiphora with no evidence of lacrimal hypersecretion or lacrimal pump failure, minimal regurgitation noted on syringing, and DSG-confirmed delayed drainage. A successful outcome was defined as 80% subjective improvement or resolution of tearing on the operated side. Patient charts, DSG results, and operative records were examined, and data were collected. Relevant literature was reviewed and discussed. The case series included 15 eyes of 10 patients. The mean age was 61.7 years at the time of surgery. Most cases (n=13) had post-sac obstruction, retention, or delay. One patient had pre and post-sac retention. A total of 12 cases had success after endonasal DCR, and 3 cases had failure. Follow-up for all operated patients was over 6 months. There were no reported complications by the surgeon or patients. Patients with functional epiphora confirmed by DSG seem to have a high success rate after endonasal DCR. In patients with symptomatic epiphora with subjective patency on syringing, the use of DSG in decision-making and outcome prediction may be supported. Further studies, including clinic-based tests, to demonstrate functional obstruction are warranted.

Outcomes of Endoscopic Endonasal Dacryocystorhinostomy in Glaucoma Patients

Purpose: Glaucoma has been investigated on producing fibrotic changes on the conjunctival surface, undermining the functioning of the upper lacrimal drainage system. The aim of the study was to assess whether these effects may impair the effectiveness of dacryocystorhinostomy (DCR) in patients affected by both glaucoma and nasolacrimal duct obstructions (NLDO). Methods: Single-center observational retrospective study on endoscopic endonasal-DCR (EE-DCR) via posterior approach. Consecutive patients were enrolled in 2020–2023 and evaluated with proper questionnaires; resolution of epiphora and dacryocystitis were analyzed after 1 (T1) and 6-months (T2) from surgery. Surgical success was defined as anatomical (patency at irrigation, no recurring dacryocystitis) or complete (zeroing of Munk score). Results: 17 patients (29 operated sides) were enrolled. Preoperatively, 92.1% (n = 27/29) presented severe (Munk 3-4) epiphora and 69.0% (n = 20/29) recurrent dacryocystitis. At T1, 51.72% (n = 15/29) referred residual epiphora (Munk  1) and 17.20% (n = 5/29) dacryocystitis. At T2, 34.5% (n = 10/29) still complained epiphora (Munk  1) and 6.9% (n = 2/29) symptoms of dacryocystitis. Difference of outcomes at aggregate and paired timepoints (except for T1 versus T2) resulted statistically significant (p&lt;0.05). At T2, 20 (69.0%) complete, 7 (24.2%) anatomical successes and 2 surgical failures (6.8%) were observed. Conclusion: EE-DCR in patients affected by both glaucoma and NLDO guaranteed high rates of clinical relief from epiphora and remarkable decreases in the rates of recurrent dacryocystitis, appearing as a reasonable therapeutical strategy to improve disease-related quality of life.

Анестезиологическое пособие в дакриохирургии

Operations on the lacrimal pathways at present no longer represent complex orbital-nasal interventions, as it was 15–20 years ago, therefore, there may be an alternative to general anesthesia with reliable airway patency and its protection from aspiration. Aim of the study was to evaluate the advantages and disadvantages of various types of anesthesia and to determine the optimal one when performing various dacryosurgical interventions. Methods. The study group included patients aged 17 to 79 years with various forms of dacryostenosis, who, according to the results of a preoperative examination, were assigned to endonasal endoscopic dacryocystorinostomy and lacrimal recanalization with intubation. The patients were divided into 2 groups, the first of which underwent endonasal coblation dacryocystorhinostomy, the second – lacrimal recanalization with intubation. Each group was divided into 2 subgroups depending on the type of anesthesia chosen (general or local). Results. When performing endonasal endoscopic coblation dacryocystorhinostomy, 83.9 % of patients noted insufficiency of local anesthesia, and when performing recanalizing operations on the lacrimal tract, insufficiency of anesthesia was noted by only 18.5 % of patients. Conclusions. Endonasal dacryocystorhinostomy, despite the innovations that have turned it into a minimally invasive procedure, remains a painful operation, for which general anesthesia is preferable. Flexible laryngeal mask creates optimal conditions during awakening and provides protection of the respiratory tract after performing all types of dacryosurgical interventions. Key words: dacryology, anesthesiology, anesthesia, dacryosurgery, dacryocystorhinostomy, lacrimal recanalization, lacrimal pathways.