Valve Of Hasner Research Articles

Long-term Outcomes of a Minimally Invasive Surgical Approach in Paediatric Patients with Congenital Dacryocystoceles.

Congenital dacryocystoceles are a rare condition caused by nasolacrimal duct obstruction. Symptoms include epiphora, nasal obstruction, and swelling in the medial canthus. Treatment usually entails probing Hasner's valve open and, if necessary, intubating the nasolacrimal duct. We present a minimally invasive, endoscopic procedure with marsupialisation of the endonasal portion of the cele. The operation avoids additional manipulation of the lacrimal duct to prevent iatrogenic injury. This retrospective analysis included a total of nineteen infants or young children (21 eyes) aged 3 days to 39 months. Two of the patients were suffering from acute respiratory distress, seven from recurrent infections with persistent epiphora, and twelve from acute dacryocystitis with orbital phlegmon. The endonasal portion of the dacryocele was detected in all cases and resected endonasally using an endoscope. Recurrences required revision surgery involving dacryocystorhinostomy after primary surgery in two patients aged of 22 and 39 months. All other seventeen patients were free of recurrence. Our results show endoscopic endonasal marsupialisation without additional intubation or probing of the lacrimal ducts to be a successful treatment strategy for congenital dacryocystoceles. This avoids iatrogenic scarring, false passages, or postoperative bacteraemia. The surgical technique presented here shows a lower success rate in older children with a history of inflammation.

Dacryocystorhinostomy with a counteropening in the treatment of secondary nasolacrimal duct obstruction after radioiodine therapy

This study analyzes the clinical effectiveness of dacryocystorinostomy with a counteropening. The outcomes of 49 surgeries (49 patients) with secondary acquired nasolacrimal duct obstruction due to radioactive iodine therapy were analyzed, including 34 DCR and 15 DCR with a counteropening. The clinical outcomes were analyzed over the longest possible period after surgery. The analysis included the severity of tearing on the Munk scale, the characteristic of the formed ostium on the M. Ali scale and the height of the tear meniscus. Differences were considered significant at a confidence level of 95% (p≤0.05). Analysis of the results of the performed surgeries showed that DCR was clinically effective in 30 (88%) cases, DCR with a counteropening - in 15 (100%) cases. The differences were not statistically significant in the total sample, but were statistically significant when comparing the results of surgeries in patients with distal obliteration. The developed and clinically tested method of DCR with a counteropening in the area of the Hasner's valve was completely effective in 15 patients with secondary nasolacrimal duct obstruction caused by radioiodine therapy.

Comparison of Outcomes of Silicone Tube Intubation with or without Dacryoendoscopy for the Treatment of Congenital Nasolacrimal Duct Obstruction

In this retrospective study, we compared and analyzed two groups of patients who underwent silicone tube intubation (STI) to treat congenital nasolacrimal duct obstruction (CNDO). We employed dacryoendoscopy to visualize the lacrimal pathways of one group. In total, 85 eyes of 69 patients were included (52 of 41 patients in the non-dacryoendoscopy and 33 eyes of 28 patients in the dacryoendoscopy group). Clinical characteristics, dacryoendoscopic findings, and surgical outcomes were evaluated. The overall STI success rate was 91.8%, and the success rate was significantly higher in the dacryoendoscopy versus non-dacryoendoscopy group (97.0% and 88.5%, respectively). For patients < 36 months of age, the success rate was 100% (23 eyes). All patients with Hasner valve membranous obstructions were younger than 36 months and had structural obstructions of the lacrimal drainage system (LDS) (p = 0.04). However, in patients lacking Hasner valve obstructions, LDS secretory (50.0%) and structural (50%) obstructions occurred at similar rates, which did not vary by age. Dacryoendoscopy-assisted STI enhanced the therapeutic efficacy of CNDO and identified diverse CNDO etiologies beyond Hasner valve obstructions. These findings emphasize the potential advantages of dacryoendoscopy in surgical treatment for CNDO patients.

Minimally Anterior Medial Maxillary Approach (MAMMA): a novel technique for a wide access to the maxillary sinus.

To describe a novel endoscopic technique to approach the maxillary sinus (MS), the Modified Anterior Medial Maxillary Approach (MAMMA), preserving the inferior turbinate (IT) and the nasolacrimal duct (NLD). To perform radiological measurements and describe a case series to study the feasibility and limits of MAMMA. Computed tomography (CT) scans (n = 150 nasal cavities) were used to calculate areas of the MAMMA to define surgical limits and extensions. Measurement of distances to critical anatomy landmarks and total area for the MAMMA were calculated. An instructional case illustrating the surgical technique and outcome was also included. Radiological analysis showed a mean distance from the Piriform Aperture (PA) to the anterior limit of the NLD of 1.03 ± 0.18cm (range 0.59-1.48) and a mean distance from de PA to the posterior limit of the NLD of 1.57 ± 0.22cm (range 1.02-2.11). The mean distance from the nasal floor to the Hasner's valve was 1.61 ± 0.27cm (range 1.06-2.52) and the distance from the nasal floor to the insertion of the IT was 2.20 ± 0.36cm (range 1.70-3.69). Finally, the mean total area for the MAMMA was 4.04 ± 0.52 cm2 (range 3.17-5.53). No complications or recurrence of the pathology were observed in operated patients. The MAMMA provides a wide surgical field of the MS walls comparable to more aggressive techniques, with preservation of the sinonasal and lacrimal function. MAMMA is an effective alternative to treat different MS pathologies including benign recurrent maxillary sinus tumors.

Анализ результатов хирургического лечения пациентов с облитерацией слезоотводящих путей вследствие терапии радиоактивным йодом

Relevance. Nasolacrimal duct obstruction occurs in 9% of patients after radioiodine therapy for thyroid cancer. The surgical interventions used in this case have not been studied enough; indications for certain operations have not been developed. Purpose. To evaluate clinical efficacy of surgical treatment in patients with nasolacrimal duct obstruction due to radioactive iodine therapy. Material and methods. The outcomes of 47 surgeries in patients with secondary acquired nasolacrimal duct obstruction due to radioiodine therapy were analyzed, among them 30 cases of dacryocystorinostomy and 17 cases of recanalization of the tear ducts. In 15 cases, dacryocystorinostomy was supplemented by the formation of an anastomosis in the area of the Hasner's valve. A comparative analysis of the effectiveness of surgical intervention depending on the localization of obstruction was carried out. Results. Dacryocystorinostomy was effective in 90% of cases, recanalization of the tear ducts – in 13% of cases. The analysis revealed that in cases of obstruction at the level of the lacrimal sac, the success of dacryocystorinostomy was 100% (5 observations), with obstruction at the level of the middle part of the nasolacrimal duct – 85.7% (12 observations), with obstruction at the level of the Hasner's valve – 100% (6 observations). Recanalization of the tear ducts was characterized by success in 100% of cases (1 observation) with obstruction of the middle part of the nasolacrimal duct and in 6.3% of cases (1 observation) with obstruction at the level of Hasner's valve. Conclusion. Dacryocystorinostomy is an effective intervention in patients with secondary acquired nasolacrimal duct obstruction due to radioiodine therapy. Recanalization of the tear ducts is characterized by low efficiency. The analysis of the effectiveness of these interventions, considering the localization of obstruction of the tear ducts, showed that the effectiveness of surgical treatment may vary depending on the level of obstruction. In cases of anatomically low obstruction of the tear ducts, dacryocystorinostomy was supplemented by the formation of an anastomosis in the area of the Hasner's valve. Recanalization of the tear ducts was characterized by greater efficiency in cases where the level of obstruction of the tear ducts was higher than the Hasner's valve than directly at Hasner's valve. The choice of treatment tactics for patients with secondary acquired nasolacrimal duct obstruction due to radioiodine therapy should be differentiated depending on the localization of the tear duct obstruction. Key words: tear ducts, radioiodine, dacryocystorhinostomy, nasolacrimal duct intubation

Morphological Characteristics of the Lacrimal Apparatus in its Obstruction of Various Genesis.

Secondary acquired lacrimal duct obstruction (SALDO) is one of the complications of radioiodine therapy. The material was obtained during endoscopic dacryocystorhinostomy with revision of Hasner's valve in patients with PANDO (n = 7) in the distal segments of the nasolacrimal duct and in patients with SALDO (n = 7) after radioactive iodine therapy. The material was stained with hemotoxylin and eosin, alcyan blue, and by Masson method. Morphological and morphometric analyses were performed in semi-automatic mode. The results of histochemical staining of sections were translated into points taking into account the area and optical density (chromogenicity). The differences were considered significant at p < 0.05. It was shown that the nasolacrimal duct sclerosis is significantly lower (p = 0.029) in patients with SALDO than in patients with PANDO while fibrosis in the lacrimal sac is the same in patients of the compared groups.

Endoscopic dacryocystorhinostomy as an option management of syndrome-related congenital dacryocystocele: a case report

Congenital dacryocystocele (CD) is a rare anomaly of the medial region of the orbit, caused by distal at the level of the valve of Hasner and proximal at the level of the valve of Rosenmuller obstruction of the lacrimal system. It may present as isolated abnormalities or maybe associated with syndromes. We described a neonate with a history of bilateral enlarged lacrimal sacs below medial canthal tendon with blue-grayish color and epiphora. Computed tomography (CT) scan resulted in congenital dacryocystocele. She was given topical antibiotics and Crigler massage as conservative treatment. In the first week, the right eye got a complete resolution. Otherwise, the left eye’s lesion was worsening. The patient underwent endoscopic dacryocystorhinostomy (En-DCR) and silicone intubation on the left eye. Epiphora resolved with no recurrence at one month follow up. Conservative treatment and En-DCR have a success rate with no complication and widely used nowadays. In the case of CD associated with a syndrome, multidiscipline workups and treatment are essential.

Usefulness of high definition sialoendoscope for evaluation of lacrimal drainage system in congenital nasolacrimal duct obstruction.

Sialoendoscope was used as a dacryoendoscope, high- definition images of the lacrimal drainage system (LDS) were captured and its performance in congenital nasolacrimal duct obstruction (CNLDO) is reported. Nasal endoscopy was done as the first in all the cases using a 0°, 2.7 mm nasal endoscope (Karl Stroz Tutlingan Germany). This was followed by Dacryoendoscopy (DEN) of the lacrimal drainage system from puncta till the valve of Hasner. DEN was performed under general anaesthesia in 26 children (including 17 primary and 9 failed probing cases). All cases were examined using 0.8 mm sialoendoscope (Karl Storz, Tuttlingen, Germany) with fibreoptic light transmission with a side port for irrigation. We were able to obtain high-definition images of canaliculi, lacrimal sac, sac duct junction, proximal, mid and distal segments of nasolacrimal duct in all the children with CNLDO.In 17 primary cases 16 had distal membranous obstruction and I case had proximal canalicular obstruction. In nine children with history of failed probing, five had membranous obstruction, two had dacryoliths, two had NLD malformation at different levels. An overall success rate of 88.4% was achieved. Sialoendoscope can be used as high-definition dacryoendoscope for diagnostic and therapeutic use in CNLDO. Useful information can be obtained on dacryoendoscopy in complex CNLDO cases.

Endoscopic maxillectomy: anatomo-radiological description of the “double” maxillary sinus window

To present a modified endoscopic medial maxillectomy (MEMM) approach to control maxillary sinus pathologies. MEMM was completed in 13 fresh-frozen specimens. An MEMM includes cutting the nasolacrimal duct, inferior meatus flap, and repositioning the inferior turbinate (IT). The following measurements were obtained: length of IT, height from the nasal floor to valve of Hasner, height of the IT at the level of valve of Hasner, height of the IT at the insertion of the middle turbinate, and distance from the piriform aperture to the posterior wall of maxillary sinus and to the posterior border of palatine bone. Similar measurements were also performed on craniofacial computed tomography (CT) scans (n = 50). The surgical technique was performed in a case series (n = 8). The mean of the specimens was 82 (range 70–95) years old. The average area of the harvested inferior meatus flap area was 9.6 ± 1.0 cm2. In the radiologic study, the mean maximum antrostomy area was 8.8 ± 1.7 cm2 and the IT area overlapping the antral window was 5.8 ± 1.1 cm2, the area allowing a double window control was 3.1 ± 1.9 cm2, the posterior IT insertion length was 0.7 ± 0.4 cm, and the inferior meatus flap covering the inferior meatotomy had an area measuring 6.7 ± 1.7 cm2. Eight patients underwent MEMM for various benign conditions showing no recurrence after 26 month follow-up. The proposed modifications of MEMM provide a “double” window maxillary sinus control with access to all maxillary walls and preservation of the IT.

Comparison of Hasner valvulotomy outcomes in pediatric and adult patients: does age matter?

BackgroundHasner valve incision has been recently introduced as a new treatment for ophthalmic patients with epiphora symptoms. The aim of this study was to examine whether surgical outcomes of Hasner valve incision for inferior nasolacrimal duct obstruction were different between pediatric and adult patients.MethodsA total of 53 eyes of 52 patients who underwent Hasner valve incision in the Beijing Tongren Hospital from October 2016 to November 2019 were retrospectively observed. Patients were divided into two groups, including pediatric group (23 eyes of 22 patients, <18 years old) and adult group (30 eyes of 30 patients, ≥18 years old). Success rate of surgery was determined by both subjective measure (complete resolution of epiphora) and objective measure (lacrimal passage irrigation and tear meniscus height). Fisher exact test was conducted.ResultsBy conducting Fisher exact test and comparing complete resolution of epiphora (P = 0.627), lacrimal passage irrigation (P = 0.663), measurement of Tear Meniscus Height (P = 0.561), and appearance of complication (P = 0.339), there was no statistically significant difference of surgical outcomes between pediatric and adult patients (P > 0.05).ConclusionHasner valve incision was effective for both adult and children with inferior nasolacrimal duct obstruction, with no difference in surgical outcomes between the two groups.

Secondary Acquired Nasolacrimal Duct Obstruction as a Specific Complication of Treatment With Radioactive Iodine (Morphological Study).

To conduct a morphological study of structural changes in the nasolacrimal duct in secondary acquired nasolacrimal duct obstruction (SALDO) as a result of treatment with radioiodine. Twenty patients (20 cases) were involved: 10 cases with secondary acquired nasolacrimal duct obstruction at Hasner's valve level due to the treatment with radioiodine (group 1) and 10 cases with primary acquired nasolacrimal duct obstruction (group 2). During surgery, a biopsy of nasolacrimal duct tissue from Hasner's valve area was taken. A morphological study was performed using semi-fine sections technique. Patients of group 1 showed the following: desquamation of columnar epithelium, pinpoint ulceration of nasolacrimal duct wall, collapse of a significant part of the capillary bed, and absence of blood cells in their lumen. State of secretory cells of mucous glands varied from necrobiotic to the different stages of dystrophic, decreased lumens of acini with abundant microvesicles in cell cytoplasm were revealed. A specific sign noted in patients of group 2 was mixed inflammatory infiltration of the mucosa of the nasolacrimal duct. The picture corresponds to the exacerbation of a chronic inflammatory process. Changes revealed in patients of group 1 include desquamation of nasolacrimal duct epithelium, mucous gland lesion, and moderate fibrosis that indicate a probable primary character of the lesion. In patients of group 2, fibrotic changes were more significant and were due to a chronic inflammatory process. Thus, secondary acquired nasolacrimal duct obstruction after treatment with radioactive iodine has a specific pathogenesis and should be classified as a separate nosological form.

Results of probing guided with soft cannula in children with nasolacrimal duct obstruction

Objectives To compare between the successes of probing using soft cannula (a 22 G) versus conventional probing in children with congenital nasolacrimal duct obstruction. Background Congenital obstruction of the nasolacrimal duct is a common problem in the early years of life. Obstruction can occur in 6–20% of neonates. The usual cause is failure of canalization of the epithelial cells that form the nasolacrimal duct as it enters the valve of Hasner. Patients and methods This prospective, randomized study was conducted on 36 children (48 eyes) having congenital nasolacrimal duct obstruction presented to the outpatient clinic of Menoufia University Hospital and Kafer El-Sheikh Ophthalmology Center from November 2016 to July 2018. The children were divided into two groups: group A, 18 children (24 eyes) operated by conventional probing and group B, 18 children (24 eyes) operated by probing using soft cannula. The patients were monitored for 6 months postoperatively. Results Clinically successful results were achieved in 20 eyes (83.4%) for conventional probing group and 19 eyes (79.2%) for soft cannula group. No significant complication occurred intraoperatively or postoperatively. Conclusion Soft cannula probing is an effective and simple method with no significant complication for the treatment of congenital nasolacrimal duct obstruction. This method allows probing in a more controlled way. However, there was no statistical difference between it and conventional probing.

Outcomes after Endoscopic Dacryocystorhinostomy in the Pediatric Population

Nasolacrimal duct obstruction in the pediatric population can be from a congenital or acquired cause. Congenital nasolacrimal duct obstruction (CNLDO) from the incomplete canalization of the valve of Hasner occurs in up to 6% of newborns. Acquired obstruction can occur from traumatic events, foreign body impaction or sinusitis. This obstruction predisposes children the pediatric acute dacryocystitis (PAD). Signs and symptoms of PAD include rapid edema and erythema over the medial canthal region of the lacrimal sac, epiphora or mucopurulent discharge, tenderness and fever.

Primary nasal rhinosporidiosis - a ten year multicentre experience: what we know?

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Rhinosporidiosis is a disease caused by &lt;em&gt;Rhinosporidium seeberi&lt;/em&gt; that affects the mucous membranes primarily. Nose is the commonest organ to be involved. The authors of this paper with more than ten years of experience across various institutions in Tamil Nadu have analysed their cases and have found out that posterior lip of valve of hasner in the inferior meatus to be the site of attachment in primary nasal rhinosporidiosis irrespective of the endemicity of the region.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a prospective study of seventy eight cases of primary rhinosporidiosis over a period of ten years (February 2009 to December 2019). Recurrent cases, those who did not come for follow up and who were operated under local anesthesia were not included in this study. All the patients (45) were subjected to endoscopic surgery for excision of the rhinosporidiosis under general anesthesia after informed written consent and sent for histopathological examination. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Most common age group being 25 to 50 years with male preponderance and the common site of occurrence is the posterior lip of valve of Hasner in the inferior meatus with seasonal variation with O+ve blood group preponderance. Most common clinical presentation is unilateral nasal obstruction.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Rhinospordiosis is hyperendemic in Tiruvarur and Thiruvannamalai. The posterior lip of valve of hasner is the commonest site of attachment. Correct identification of the site of attachment and surgical excision with cauterisation prevents its recurrence.&lt;/p&gt;

Incision of Hasner's valve under endoscopic intranasal surgery for the treatment of nasolacrimal duct obstruction in children.

To evaluate the effectiveness and safety of a Hasner's valve incision performed under endoscopic intranasal surgery for the management of congenital nasolacrimal duct obstruction. This retrospective study comprised 484 patients with congenital nasolacrimal duct obstruction who underwent incision of Hasner's valve under endoscopic intranasal surgery between April 2000 and October 2016. The primary endpoint was the procedure's functional success rate. The secondary endpoints were Hasner's valve and inferior turbinate anatomical findings, demographic data, complication rate and surgical duration. In patients with no medical history of nasolacrimal duct probing, 91 per cent had a successful result, 5 per cent had a partially successful result, 3.9 per cent showed no change and 0.1 per cent had a worse result following the procedure. Concerning the secondary endpoints, outcomes were more frequently successful in children younger than three years. Only one patient had a post-operative infection. All patients underwent general anaesthesia; no complications related to general anaesthesia were observed. Mean surgical duration was 13.1 ± 5.7 minutes. Incising Hasner's valve after medially displacing the inferior turbinate under nasal endoscopy seems to be an adequate primary surgical treatment for congenital nasolacrimal duct obstruction.

Uncontrolled systemic hypertension and haemolacria.

Haemolacria is a condition caused by a group of disorders resulting in production of tears that are partly composed of blood. It can be unilateral or bilateral. The etiology includes ocular, systemic, psychological, pharmacological, and idiopathic.[123] We present an unusual case scenario of unilateral hemolacria in a 62-year-old previously fit and well gentleman who presented to ER (emergency consultation room) with sudden onset epistaxis from the right nostril. Immediate evaluation included local examination by an ENT (Ear Nose and Throat department) colleague and systemic evaluation by the physician. The Physician diagnosed severe hypertension (BP recorded was 190/110 mm hg) and antihypertensive therapy was initiated. The source of the nasal bleed was identified as the Little's area (Kiesselbach's plexus). An attempt to cauterize the bleed under local anesthesia was made by the ENT colleague, following which anterior nasal packing was done. Within a few minutes of packing the nose, patient started shedding blood mixed tears from the right eye (Haemolacria) [Fig. 1]. The BP continued to stay high at 160/100 mm of Hg. Following this the antihypertensive measures were intensified resulting in complete resolution of the symptoms within the next 6 hours.Figure 1: Shows blood mixed tears coming out of right eye of the patient. It shows right haemolacria and the free end/thread of the anterior nasal pack in the right nostrilPreliminary ophthalmic evaluation revealed no local ocular causes of haemolacria, no previous trauma or lacrimal surgeries. We suspect retrograde blood flow through the Nasolacrimal duct to the conjunctival cul de sac following mechanical attempts at stopping the epistaxis, which alone was apparently ineffective as the underlying primary pathology was uncontrolled systemic hypertension. The authors also suspect a possible congenital absence of the valve of Hasner[4] or iatrogenic damage to the valve of Hasner at the inferior meatus at the time of primary mechanical attempts at haemostasis[5] that resulted in the above presentation. The patient was lost to further follow up thus preventing a further lacrimal outflow reassessment and a formal nasal endoscopic re-assessment. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Acknowledgement Dr. Sujay Siddharthan, TMS Eye hospital.

Eponymous "valves" of the nasolacrimal drainage apparatus. II. Frequency of visualization on dacryocystography.

Developmental remnants may follow segmental canalization of ectodermal epithelial cords forming the nasolacrimal drainage apparatus (NDA). This can result in false luminal "valves" along the path of the NDA, many of which have been named, but most have not been anatomically identified with consistency. By 1908, eight such "valves" were documented, those of: Foltz, Bochdalek, Rosenmüller, Huschke, Aubaret, Béraud or Krause, Taillefer, and Hasner or Cruveilhier or Bianchi. Digital subtraction dacryocystography (DS-DCG) is the highest spatial resolution imaging technique available to outline in vivo NDA anatomy, luminal profile, and pathology. We believe this is the first report of the conspicuousness and frequency of these "valves" on DS-DCG. We retrospectively analyzed routine DS-DCGs with normal findings for the presence and frequency of the eight NDA "valves." We examined 92 normal DS-DCGs on patients aged 14-82 years (71% female, 29% male). We observed "valves" most reliably in the inferior nasolacrimal duct: the inferior valve of Hasner (plica lacrimalis) was present in 98.9% of cases, and more superiorly, the valve of Taillefer (93.5%) and the valve of Krause (79.3%). Contrastingly, we infrequently identified the very superior "valves": Foltz or Bochdalek in 17.1%, Rosenmüller or Huschke in 46.4%, and Auberat in 40% of cases. Therefore, unlike the inferior NDA valves, these more superior "valves" were less consistently identified and are presumed to be simple mural mucosal irregularities rather than true structural valves. These findings will be useful in diagnostic interpretation of DS-DCGs and therapeutic planning for patients undergoing luminal procedures on the NDA. Clin. Anat., 2018. © 2018 Wiley Periodicals, Inc.

Eponymous "valves" of the nasolacrimal drainage apparatus. I. A historical review.

The nasolacrimal drainage apparatus (NDA) is of interest to anatomists, radiologists, and ophthalmologists alike, owing to its intricate luminal contour, complex surrounding structural morphology, and its clinical relevance. Here, we review the history of anatomical descriptions of so-called luminal "valves" of the NDA, including the numerous historical figures whose eponyms adorn the NDA. By 1908, multiple false "valves" that are likely no more than mounds of mucosa along the NDA had been recorded. In the modern era, these have all been largely considered speculative in nature and function aside from the consistently described true valve of Hasner (plica lacrimalis). Back then, eight so-called "valves" were believed to be identifiable. These were the "valves" of Foltz, Bochdalek, Rosenmüller, Huschke, Aubaret, Béraud or Krause, Taillefer, and Hasner or Cruveilhier or Bianchi. With the advent of detailed characterization through modern high-resolution imaging techniques, such as digital subtraction dacryocystography (DS-DCG), many of these valvular folds have come into question owing to their inconsistent identification. This historical review should be useful for greater understanding and accurate contextual interpretation of "valves" encountered on DS-DCG studies, and in clinical management and therapeutic planning of patients prior to undergoing luminal procedures on the NDA. Clin. Anat., 2018. © 2018 Wiley Periodicals, Inc.

Association between congenital nasolacrimal duct obstruction and mode of delivery

Congenital nasolacrimal duct obstruction (CNLDO) is one of the most common ocular disorders in infants and is typically caused by a persistent membrane covering the valve of Hasner. During a vaginal delivery (VD) the mechanical forces of the uterus may have a massage effect on the nasolacrimal system, resulting in the opening of Hasner's valve. This study investigates the association between mode of delivery (VD versus cesarean section [CS]) and CNLDO.

A Comparison between Pulled and Pushed Monocanalicular Silicone Intubation in Management of Congenital Nasolacrimal Duct Obstruction

Background: Congenital nasolacrimal duct obstruction (CNLDO) is usually caused by a membranous block at the valve of Hasner. Symptoms of CNLOD include epiphora, mucous discharge, or mucopurulent discharge. Many CNLDOs can resolve spontaneously by the first year of life. Children who ultimately have unsuccessful responses to canalization will undergo invasive procedures for CNLDO, including probing, silicone intubation, balloon dacryocystoplasty and dacryocystorhinostomy. There are two types of lacrimal intubation, monocanalicular and bicanalicular. Pushed monocanalicular stent is characterized by the probe guide actually placed inside the silicone tube, rather than attached at the end as in conventional ‘‘pulled’’ intubations stents. Aim of the work: was to compare the success rate of pulled monocanalicular (MCI) versus pushed monocanalicular silicone intubation (PMCI) of the nasolacrimal duct for congenital nasolacrimal duct obstruction. Patients and methods: In a prospective randomized clinical trial 67 eyes of 67 patients with CNLDO underwent either pulled monocanalicular silicone intubation (MCI) (=32 eyes) or PMCI ( =35 eyes). Cases were considered successful if reached grade 0 or 1 in fluorescein dye disappearance test -complete or partial resolution of symptoms - after two months after tube removal. Results: This study included only patients with simple obstruction at the level of the Hasner valve and diagnosed intraoperative during the initial probing thus, the surgical outcome was assessed in 30 eyes of 30 patients in the MCI groups. 15 eyes received MCI in the upper punctum and 15 eyes received MCI in the lower punctum. The other 30 eyes 30 patients did PMCI with Masterka tube. 15 eyes received PMCI in the upper punctum and 15 eyes received PMCI in the lower punctum. 33 females (55%) & 27 males (45%) with age ranged from 12 to 46 months with mean of 26 ± 11 months. Follow-up of the patients was done at 1 week, 1 month, 2 and 3 months post-operative. Tube removal was done 3 months post operatively in both types of tube. The overall success rate in the MCI intubation groups was 86.7%, whereas in the PMCI intubation groups was 80%. However, the difference in the success rates between the two groups was statistically insignificant (P= 0.4884) using Chi-square test. Conclusion: Results indicate that MCI has higher success rate in CNLDO treatment compared with PMCI in this small series of patients.