Flow Of Tears Research Articles

P.075 Anatomy and pathology of the lacrimal apparatus: from the sac to the nasal fossa. what the neuroradiologist should know!

Background: The aim of our educational exhibit is to review the anatomy and pathology encountered and often overlooked of the excretory lacrimal apparatus from the lacrimal sac to the nasal fossa. Methods: We will provide an anatomical review of the various structures easily identifiable on CT and MRI and suggestions of the best imaging protocols to be used. Results: The lacrimal apparatus includes the various structures related to the production and flow of tears. In this educational exhibit we will focus on the excretory apparatus from the lacrimal sac to the nasal fossa. We will present various pathologies affecting the excretory lacrimal apparatus with attention to the specific features of each condition to facilitate an appropriate differential diagnosis. We will emphasize specific anatomical/imaging findings to help the diagnosis and propose a standardized reporting system for the Neuroradiologist and useful to the ENT surgeon. Conclusions: This educational exhibit offers a unique opportunity to review the anatomy and pathology of sometimes overlooked or forgotten structures which are however always included in our CT and MRI studies.

THE GENRE FEATURES OF THE WORKS OF DIMITRY ROSTOVSKY ABOUT THE ILYA ICON OF THE HOLY MOTHER

The author of the article examines the two earliest works by St. Dimitry Rostovsky — “The Miracles of the Most Holy and Blessed Virgin Mary” (1677) and “The Bedewed Fleece” (first edition 1683), created on the basis of the first work. Both books, in terms of content and genre characteristics, represent a legend about the miraculous icon — the Ilya Icon of the Holy Mother of God. The icon was the main shrine of the Boldinsky Trinity Ilya Monastery. A historical and literary analysis of both books showed that both “The Miracles of the Most Holy and Blessed Virgin Mary” and “The Bedewed Fleece” have a certain set of motifs about its miracles and deeds, which puts them on a par with the texts of other legends about miraculous icons. The heyday of this genre occurred in the 17th — early 18th century. The main miracle and the main motif of the legends created by Dimitry Rostovsky is the flow of tears from the icon, which occurred in 1662: the Ilya Icon of the Holy Mother began myrrh-streaming and praying to the Divine Son for the salvation of the entire human race. The remaining miracles describe healings from illnesses and ailments that occur through prayer in front of the icon. However, the composition and style of these books, which reflect new trends and a new style — the Baroque style, differ significantly from the works of this genre. The main difference is that Dimitry Rostovsky inserts additional narratives into the text. He adds moral teachings to the book “Miracles of the Most Holy and Blessed Virgin Mary” and moral teachings, conversations and attachments to the book “The Bedewed Fleece.” They play an important role in the architectonics of the text and carry a significant semantic load, thereby creating a new literary form in the context of the genre of tales about miraculous icons.

Valvular system of the lacrimal drainage pathway and the valve of Rosenmüller

The valves of the lacrimal drainage system are an enigma with a rich eponymous history. The unidirectional flow of tears along with the ultrastructural demonstration of distinctive mucosal folds on the luminal surface has rekindled an interest in them. The first in vivo direct demonstration of the valve of Rosenmüller and its functions has laid to rest some of the controversies of its existence and that of the valve of Huschke. The dynamic assessment of the valve of Rosenmüller has shown a well-defined functional role in the facilitation of unidirectional tear flow. The present mini review describes the embryological aspects, brief overview of the eponymous valves, techniques for their identification along with recent structural and functional aspects of the valve of Rosenmüller.

Carbofuran pesticide toxicity to the eye

Pesticide exposure to eyes is a major source of ocular morbidities in adults and children all over the world. Carbofuran (CF), N-methyl carbamate, pesticide is most widely used as an insecticide, nematicide, and acaricide in agriculture, forestry, and gardening. Contact or ingestion of carbofuran causes high morbidity and mortality in humans and pets. Pesticides are absorbed in the eye faster than other organs of the body and damage ocular tissues very quickly. Carbofuran exposure to eye causes blurred vision, pain, loss of coordination, anti-cholinesterase activities, weakness, sweating, nausea and vomiting, abdominal pain, endocrine, reproductive, and cytotoxic effects in humans depending on amount and duration of exposure. Pesticide exposure to eye injures cornea, conjunctiva, lens, retina, and optic nerve and leads to abnormal ocular movement and vision impairment. Additionally, anticholinesterase pesticides like carbofuran are known to cause salivation, lacrimation, urination, and defecation (SLUD). Carbofuran and its two major metabolites (3-hydroxycarbofuran and 3-ketocarbofuran) are reversible inhibitors of acetylcholinesterase (AChE) which regulates acetylcholine (ACh), a neurohumoral chemical that plays an important role in corneal wound healing. The corneal epithelium contains high levels of ACh whose accumulation by AChE inhibition after CF exposure overstimulates muscarinic ACh receptors (mAChRs) and nicotinic ACh receptors (nAChRs). Hyper stimulation of mAChRs in the eye causes miosis (excessive constriction of the pupil), dacryorrhea (excessive flow of tears), or chromodacryorrhea (red tears). Recent studies reported alteration of autophagy mechanism in human cornea in vitro and ex vivo post carbofuran exposure. This review describes carbofuran toxicity to the eye with special emphasis on corneal morbidities and blindness.

An elderly patient crying out blood: a case report

Haemolacria is a rare hemorrhagic syndrome characterized by the flow of tears of blood. The etiologies of this pathology are varied, the most frequent being inflammation, infection or lacerations. Other rarer causes are also known to lead to this clinical manifestation. We report the case of a 72-year-old patient who consulted for haemolacria associated with very abundant epistaxis. In his history, the patient had no hemostasis disorders or anticoagulant treatment, on the other hand he was monitored for arterial hypertension. The endoscopic exploration showed that retrograde flow through the lacrimonasal tract was the etiology of his hemorrhagic syndrome. The objective of this case report is to expose a rare phenomenon which is haemolacria whose etiological diagnosis can be difficult to grasp. It is important to consider all the causes potentially involved.

Primary rhegmatogenous retinal detachment: evaluation of a minimally restricted face-down positioning after pars plana vitrectomy and gas tamponade

To evaluate the safety and efficacy of a minimally restricted face-down postoperative positioning following pars plana vitrectomy (PPV) with gas tamponade for primary rhegmatogenous retinal detachment (RRD). Patients with primary RRD treated with PPV and gas tamponade and followed up for at least 6mo were selected for the study. All phakic eyes underwent simultaneous cataract surgery. The patients were required to be in a postoperative position that prevented downward flow of retinal tears. Patients with macular detachment were positioned face-down for only a couple of hours. The patients were assessed for preoperative and postoperative best-corrected visual acuity (BCVA), anatomical retinal reattachment rate, and postoperative complications. In total, 40 eyes of 39 patients with primary RRD were included in the study. A single tear was present in 30 eyes (75.0%), multiple retinal tears were present in nine eyes (22.5%), and oral dialysis was present in one eye (2.5%). The anatomical success rate was 90.0% (36 cases) after the primary surgery, and the final anatomical success rate was 100%. The BCVA improved significantly (P<0.001) from 0.75 logarithm angle of resolution (logMAR) preoperatively to 0.12 logMAR at the final visit. Postoperative complications included intraocular pressure elevation (≥25 mm Hg) in 11 patients (27.5%), fibrin formation in two patients (5.0%), pupillary capture of the intraocular lens in two patients (5.0%), and posterior synechia in one patient (2.5%). A minimally restricted face-down and flexible postoperative positioning after PPV and gas tamponade for primary RRD is effective and safe.

A Comparative Study of External Dacryocystorhinostomy with Stent Versus No Stent in Acquired Nasolacrimal Duct Obstruction

Background: Epiphora is defiened as decreased tear transfusion or defective tear discharge flow. Blockage of the NLD (NLDO) prevents the flow of tears from the eye to the nose, leading to symptoms of obstruction. Dacryocystorhinostomy (DCR) was established as the predominant measure. Objective: To evaluate the effect of intubation on the outcome of external dacryocystorhinostomy. Patients and methods: It was a prospective interventional randomized study. The study was carried on 40 eyes of patients were going to do DCR under general anaethesia. They were divided into 2 groups as follows: Group A (20 participants) were undergoing external dacryocystorhinostomy with silicone intubation and group B (20 participants) were undergoing external dacryocystorhinostomy without intubation. Results: At the final follow up of the patients of the two groups for 6 months, there were 4 cases had persistent epiphora post-operative two cases in group (A) and two cases in group (B). This indicated that there was no significant difference between the use of intubation or not in cases of acquired NLDO and chronic dacryocystitis. Conclusion: External dacryocystorhinostomy is still gold standard surgical treatment in primary nasolacrimal duct obstruction. This study showed that the silicone tube implantation is not necessary in the surgery.

A Comparative Study of External Dacryocystorhinostomy with Stent Versus No Stent in Acquired Nasolacrimal Duct Obstruction

Background: Epiphora is defiened as decreased tear transfusion or defective tear discharge flow. Blockage of the NLD (NLDO) prevents the flow of tears from the eye to the nose, leading to symptoms of obstruction. Dacryocystorhinostomy (DCR) was established as the predominant measure. Objective: To evaluate the effect of intubation on the outcome of external dacryocystorhinostomy. Patients and methods: It was a prospective interventional randomized study. The study was carried on 40 eyes of patients were going to do DCR under general anaethesia. They were divided into 2 groups as follows: Group A (20 participants) were undergoing external dacryocystorhinostomy with silicone intubation and group B (20 participants) were undergoing external dacryocystorhinostomy without intubation. Results: At the final follow up of the patients of the two groups for 6 months, there were 4 cases had persistent epiphora post-operative two cases in group (A) and two cases in group (B). This indicated that there was no significant difference between the use of intubation or not in cases of acquired NLDO and chronic dacryocystitis. Conclusion: External dacryocystorhinostomy is still gold standard surgical treatment in primary nasolacrimal duct obstruction. This study showed that the silicone tube implantation is not necessary in the surgery.

Endoscopic dacryocystorhinostomy: A comparison of double-flap and single-flap techniques.

BackgroundDacryocystorhinostomy (DCR) is a procedure to restore the flow of tears into the nose from the lacrimal sac when the nasolacrimal duct obstructed. This study aimed to compare the success rates of two different techniques in endonasal endoscopic DCR; namely single and double mucosal flap techniques.Material and methodsA nonequivalent quasi-experiment design was used in this study. Retrospectively, patients underwent endoscopic DCR for primary nasolacrimal duct (NLD) obstruction were included. Patients were divided into the single-flap technique and the double-flap technique groups. Success was defined as the achievement of patency of the NLD throughout the period of follow-up with significant improvement in epiphora.ResultsOverall, 77 cases were included in the final analysis. Mean age was 41 years and 60% were female. Forty-six cases underwent the single-flap technique and 31 cases underwent the double-flap technique. Recurrence of NLD obstruction occurred in 11 (23.9%) cases in the single-flap group and in only one case (3.2%) in the double-flap group.ConclusionThe modified double-flap technique for primary NLD obstruction resulted in less recurrence compared to the single-flap technique. Creating double flaps to cover any exposed lacrimal bone may reduce the rate of postoperative adhesions over the nasolacrimal duct ostium.

Non-Surgical Persian Medicine-Based Treatment of Chronic Refractory Congenital Nasolacrimal Duct Obstruction in a Surgical Candidate (Thirteen-month-old) Infant

Congenital or acquired obstruction is the most common anomaly of nasolacrimal duct (NLD). NLD obstruction (NLDO) is one of the most common problems in pediatric ophthalmology. Some symptoms of NLDO are seen in 6-20% of infants. NLDO creates two problems; first is disruption in the flow of tears that is due to epiphora. Another is the infection leading to stasis of fluid in the lacrimal system. Surgery is the choice treatment of chronic congenital NLDO in the refractory infants to massage and antibiotics. Dam-e is a watery discharge of eyes that has different reasons in Persian Medicine (PM). Based on the symptoms which was seen in patients with NLDO, it could be one of the subgroups of Dam-e. Conforming to Persian Medicine, residue of materials that moves from brain to the eyes and sediments in the NLD, can be the main reason of NLDO. Our case is the thirteen-month-old infant with congenital NLDO unresponsive to antibiotics and massage and has been a candidate for surgery. In PM view, to open the lacrimal duct obstruction, we use the properties of Persian Medicine’drugs (including Honey, camphor, vinegar and sesame oil) such as fragmentation of excreta (are Moghatte in PM), anti- obstruction (Mofatteh in PM), cleansing (Monaghi in PM) and descaling (Jali in PM) effects, and the patient’s symptoms were nonsurgically relieved. In the discussion of this paper, the properties of these drugs also check point of view of contemporary medicine’s viewpoints compared to Persian Medicine.

Outcome of External Dacryocysto-Rhinostomy (DCR) Operation Without Silicone Tube Intubation

Background: Dacryocysto-rhinostomy (DCR) is a bypass surgery in which an anastomosis is made between the medial wall of the lacrimal sac &amp; the lateral wall of the nasal mucosa by cutting the intervening bone at the level of middle meatus to restore the flow of tears when the obstruction is beyond the common canaliculus. The aim of this study was to evaluate the surgical intervention of conventional external DCR without silicon tube intubation.Methods: This study was conducted at Jahurul Islam Medical College Hospital, Kishoregonj, from July 2016 to January 2018. Fifty cases with chronic dacryocystitis were selected for the study. The operation was done under local anaesthesia. The patients were followed up for 3 months.Result: The mean age of the patient at the time of surgery was 40.9±13.1 years ranged from 16 to 65 years. Male to female ratio was 1:2.1. There were three patients with reactionary haemorrhage, one wound infection, two with wound gap, one epicanthal fold and one granuloma formation. There were no failed DCR in this series.Conclusion: Conventional DCR is the most common oculoplastic surgery performed for managing epiphora due to nasolacrimal duct obstruction.Anwer Khan Modern Medical College Journal Vol. 9, No. 2: Jul 2018, P 121-123

What makes ocular surface anatomy attractive for a scleral lens?

SummaryThe ocular surface consists of the moist mucosal organs at the anterior eye surface. They are a continuous anatomical unit from the lacrimal gland over conjunctiva &amp; cornea into the lacrimal drainage system. Joined by the flow of tears and governed by regulatory systems, e.g. nerves, hormones &amp; immune system ‐ thus they also form a functional unit as a constant moist chamber (for details please see: WWW.OSCB‐BERLIN.ORG). The main function is to provide the environment for vision by the entrance of light and its refraction.“MOISTURE is KEY” because it keeps the cornea transparent and establishes the pre‐ocular tear film as main refraction unit. At the same time the moist chamber is highly endangered in our humid environment.SCLERAL CONTACT LENSES are large contact lenses that rest on the sclera and vault over the cornea by providing a pool underneath, with the patient′s own tears including all factors for nutrition &amp; regulation. Sclerals are thus a unique medical tool to restore both essential functions when the ocular surface and particularly the cornea is altered: constant moisture and a homogeneous refraction interface. In addition they shield the cornea against the chronic mechanical forces in eye movements and blinking.

Research progress on acupuncture therapy forxerophthalmia

The clinical and experimental publish literatures of the traditional acupuncture treatment for xerophthalmia were review and selected, and the acupoints and outcomes index were analyzed. The clinical studies demonstrated that acupoints around eyes, head and face were mainly coordinated with Zangfu organs and meridians; and the experimental studies showed the effect of acupuncture work through stimulation of the lacrimal gland secretion, repairing lacrimal gland structure, inhibition of apoptosis to increase the flow of tears, extending the breakup time of lacrimal film, and relieving eye related symptoms Key words: Acupuncture; Xerophthalmia; Acupoint; Review

A Study of Conventional Dacryocystorhinostomy Operation without Silicon Tube Intubation in a Secondary Hospital

Dacryocystorhinostomy (DCR) is a bypass surgery in which an anastomosis is made between the medial wall of the lacrimal sac &amp; the lateral wall of the nasal mucosa by cutting the intervening bone at the level of middle meatus to restore the flow of tears when the obstruction is beyond the common canaliculus. The only successful treatment of chronic dacryocystitis is DCR. The aim of this study was to evaluate the surgical intervention of conventional external DCR without silicon tube intubation. This prospective study was conducted at General Hospital, Faridpur from July 2012 to June 2014. Eighty cases with chronic dacryocystitis were selected for the study. We excluded the patients with lacrimal fistula, failed DCR and gross nasal pathology like deviated nasal septum, grossly hypertrophied inferior turbinate, atrophic rhinitis, nasal tumour, and polyp from our study. The patients' mean age at the time of surgery was 41.9±8.1 years ranged from 30 to 60 years. The operation was done under local anaesthesia by applying same technique. Then the patients were followed up for 12 months. In this study, we observed recurrence in five patients (6.25%) and complications from DCR are infrequent and not sight threatening. There were seven patients with reactionary haemorrhage, one wound infection, three wound gap, two epicanthal fold, one granuloma formation and five failed DCR. The success rate is 93.75% who underwent external DCR for the management of epiphora due to nasolacrimal duct obstruction.Faridpur Med. Coll. J. Jan 2015;10(1): 20-22

Diagnosis of Mondor's Disease in the Emergency Department with Bedside Ultrasound.

Mondor's disease is a rare condition characterized by a superficial thrombophlebitis that can occur in the thoracoabdominal and genital areas. Findings with ultrasound in penile Mondor's disease are readily measurable: a noncompressible penile vein without flow and absence of tears of the corpus cavernosum or tunica albuginea, hematoma, or evidence of fracture of the penis. We present a case of Mondor's disease, diagnosed with bedside ultrasound, in the emergency department. Ultrasonography is readily available within the emergency department, and we suggest its use in aiding diagnosis of genitourinary disorders such as Mondor's disease.

Dynamics and function of the tear film in relation to the blink cycle.

Great strides have recently been made in quantitative measurements of tear film thickness and thinning, mathematical modeling thereof and linking these to sensory perception. This paper summarizes recent progress in these areas and reports on new results. The complete blink cycle is used as a framework that attempts to unify the results that are currently available. Understanding of tear film dynamics is aided by combining information from different imaging methods, including fluorescence, retroillumination and a new high-speed stroboscopic imaging system developed for studying the tear film during the blink cycle. During the downstroke of the blink, lipid is compressed as a thick layer just under the upper lid which is often released as a narrow thick band of lipid at the beginning of the upstroke. "Rippling" of the tear film/air interface due to motion of the tear film over the corneal surface, somewhat like the flow of water in a shallow stream over a rocky streambed, was observed during lid motion and treated theoretically here. New mathematical predictions of tear film osmolarity over the exposed ocular surface and in tear breakup are presented; the latter is closely linked to new in vivo observations. Models include the effects of evaporation, osmotic flow through the cornea and conjunctiva, quenching of fluorescence, tangential flow of aqueous tears and diffusion of tear solutes and fluorescein. These and other combinations of experiment and theory increase our understanding of the fluid dynamics of the tear film and its potential impact on the ocular surface.

New method for viewing Krehbiel flow by polymethylmethacrylate particles suspended in fluorescein solution.

To investigate the changes in the tear flow velocities caused by ageing. Ninety-nine subjects (41 men, mean age 48.3 ± 20.7 years) were recruited from the Department of Ophthalmology of the Ehime University Hospital. None of the subjects had serious abnormalities of the external surface of the eye. The Krehbiel flow of tears was determined by 40-μm polymethylmethacrylate (PMMA) beads suspended in a fluorescein sodium solution (PPF). The movement of the beads was video recorded through a slit-lamp during normal blinking. The flow of the beads was determined with a Motion ANALYZER(®) software (KEYENCE Co., Osaka, Japan). The velocity of the beads in young age, 20-40 years, middle age, 41-60 years and old age, ≥61 years, groups was determined. The equation describing the velocity (mm/second) of the PMMA particles as a function of age in the lower tear meniscus measured in the direction of the lacrimal punctum was Y = 2.49-0.04X, where Y = velocity and X = age (r(2) = 0.214; p < 0.0001). For the upper meniscus, the equation was Y = 4.83-0.05X (r(2) = 0.195, p < 0.0001). The average velocity was 0.70 ± 1.66 mm/second in the lower and 2.16 ± 1.93 mm/second in the upper tear meniscus (p < 0.0001). The particle velocity decreased significantly with increasing age, but no significant difference between the male and female groups except for the lower tear meniscus when all subjects were analysed. The PPF technique is a simple method of examining Krehbiel flow of tears and may be used for evaluating functional nasolacrimal duct obstruction quantitatively.

Acute Fulminant Hepatatis in Kidney Transplant Recipient After Repeated Sevoflurane Anesthesia - A Case Report and Literature Review

A liver dysfunction induced by halogenated volatile anaesthetics is considered as a significant diagnostic problem. The aim of our report was to describe the first case of lethal hepatic failure in a female patient undergoing kidney transplantation (KTx) from a living donor after repeated sevoflurane anaesthesia. A 47-year-old hypertensive and diabetic female patient received kidney from her 70-year-old mother. There was an immediate graft function and around 800 ml of blood loss on the abdominal drains, which gradually decreased after the erythrocyte and fresh frozen plasma (FFP) substitution. On the first postoperative (p.o.) day she gradually became anuric and overweighed at the next day undergoing dialysis. Because of prolonged hypotension and somnolence she required reintubation. The second day transaminases increased (AST&ALT>700, LDH>1200 U/L). On the third p.o. day she was urgently reoperated because of a sudden excessive bleeding. However, there was a rather slow flow of tears from the whole operative field that was even more excessive after the operation with signs of a consumptive coagulopathy. She was adequately substituted until the bleeding stopped more than 24 hrs after its onset. The new laboratory results showed further increase in transaminazes (3300 U/L-ALT, 5100-AST, 8900-LDH) and ultrasound investigation confirmed an extensive toxic hepatic lesion. On the fourth p.o. night the patient was stable, diuresis rate was at 100 ml/hour, but in the morning she became hyposaturated because of an increased bronchial secretion. The dialysis could not improve the cardio-respiratory insufficiency and she died 30min later. This case report suggests that sevoflurane can lead to a severe hepatotoxicity in at-risk individuals with repeated sevoflurane anaesthesia, having renal failure, in those with a preoperative known history of cardiovascular disorders, as well as in those with excessive extracellular volume. A particular precaution should be considered in cases of an elective surgery including organ transplantation.

Demodex folliculorum and Demodex brevis in healthy and immunocompromised patients

Purpose: To examine the proportion of Demodex folliculorum and D. brevis in the eyelashes of healthy and immunocompromised patients.Methods: Eyelashes were taken from 95 patients at the Pomeranian Medical University, Clinic of Haematology, and from 1091 healthy controls.Results: Demodex folliculorum and D. brevis were found in 22.9% of controls and in 20% of immunocompromised patients. In neither the control group nor the immunocompromised patients did we observe a correlation between the proportion of symptoms of blepharitis and the presence of Demodex spp. – symptoms including burning sensations, loss of eyelashes, sensitivity to light, smoke and dust, dacryorrhea (excessive flow of tears), and foreign body eye sensation. A correlation between itching eyes and Demodex spp. infection was found only in the control group. A correlation between the proportion of cylindrical dandruff in eyelashes and the occurrence of Demodex spp was found in both the control group and immunocompromised patients.Conclusion: Proportions of D. folliculorum and D. brevis, and also symptoms of blepharitis were similar in the control group and immunocompromised patients. Immunosuppression did not seem to increase the rate of Demodex spp. infection.

The use of Piezosurgery™ for external dacryocystorhinostomy

t l o i T acryocystorhinostomy aims to restore the flow of tears rom the lacrimal sac into the nose when the function of he nasolacrimal duct has been altered. External dacryocysorhinostomy is one of the techniques used in the treatment f obstruction.1 This is the surgical creation of a comunication between the lacrimal sac and the nasal cavity, hich can also be made endoscopically. It consists in an nastomosis between the nasolacrimal duct and the nasal avity, adjacent to the top of the obstacle, by ostectomy f the maxillary ramus. The main difficulty is to preserve he nasal mucosa while the bony window is being made to void postoperative stenosis.1 This is usually achieved using echanical devices, which tend to damage the underlying asal mucosa. The development of piezoelectric instruments Fig. 1), capable of cutting bone while sparing the soft tissues, odified our technique.2 We describe the procedure and the enefits. All external dacryocystorhinostomies were done under ocal or general anaesthesia. All patients were given local naesthetic to the sac in the form of 2% xylocaine with drenaline 1/200 000.