Lacrimal Canalicular Obstruction Research Articles

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

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

Possibility of Pseudo-Obstruction in Lacrimal Canalicular Obstruction Diagnosed with Dacryocystography

Introduction: Endoscopic dacryocystorhinostomy (DCR) is the treatment of choice for patients with lacrimal drainage system obstruction. Dacryocystography (DCG) is one of the most common preoperative studies and considered as a useful test demonstrating the anatomy of lacrimal drainage systems. Objective: This study was designed to evaluate the diagnostic efficacy of DCG for canalicular obstruction and to compare surgical outcomes between true-obstruction versus pseudo-obstruction diagnosed with DCG. Methods: A retrospective study was performed on 45 consecutive patients with lacrimal canalicular obstruction who had underwent endoscopic DCR with silicone tube insertion from January 2009 to December 2014 at a single tertiary hospital. A review of medical records included demographic data, preoperative symptoms and signs, results of intraoperative canalicular probing, and surgical outcomes including the postoperative symptom improvement and endoscopic finding. Results: Of 45 patients, 34 patients (75.6%) had true-canalicular obstructions and 11 patients (24.4%) had pseudo-canalicular obstructions. The success rate of endoscopic DCR was 50% (17 of 34) in cases with true-canalicular obstruction while 90.9% (10 of 11) in pseudo-canalicular obstruction (p value <0.05). No intraoperative or postoperative complications including sinusitis or synechia were found. Conclusions: About a quarter of lacrimal canalicular obstruction cases diagnosed with DCG seem to be pseudo-obstruction. The success rate of endoscopic DCR in pseudo-canalicular obstruction is similar to that of saccal and nasolacrimal ductal obstruction.

Idiopathic Acquired Lacrimal Canalicular Obstruction.

Acquired lacrimal canalicular obstruction has a variety of causes. In a small proportion of patients, no cause can be identified. This article describes a cohort of 27 patients with idiopathic acquired lacrimal canalicular obstruction encountered over a 28-year period. The diagnostic database of the senior author was analyzed to identify all cases of idiopathic acquired lacrimal canalicular obstruction seen from 1990 to 2017. Demographic, clinical, and treatment details were analyzed. Patients with primary lacrimal punctal stenosis or closure were excluded from the analysis. The authors encountered 27 patients with idiopathic acquired lacrimal canalicular obstruction (17 female, 63%) aged 34 to 91 years (median: 65 years). The level of canalicular obstruction ranged from 1 to 10 mm from the punctum. Canalicular obstruction involved 1 canaliculus in 4 patients, 2 in 14 (ipsilateral in all except one), 3 in 3, and all 4 in 6. One patient who presented with ipsilateral upper and lower canalicular obstructions developed contralateral upper and lower obstructions several years later, and another patient redeveloped obstructions after initial successful surgical repair. In all cases, there were no features on history or examination to suggest a cause for the canalicular obstruction. Follow up ranged from 1 to 260 months (mean: 39 months). Sixteen patients underwent surgical repair, 11 with a dacryocystorhinostomy and placement of a Lester Jones glass bypass tube, 2 had a canaliculo-dacryocystorhinostomy (anastomosis of the canaliculus to the nose), 2 had dacryocystorhinostomy and trephination of the canalicular obstruction with silicone intubation, and 1 had a dacryocystorhinostomy alone to try and improve drainage through a single patent canaliculus. Idiopathic acquired lacrimal canalicular obstruction is uncommon and occurs more frequently in older women. The condition may be slowly progressive and can affect one or more canaliculi at any level. Treatment is the same as for any other cause of acquired lacrimal canalicular obstruction.

Lacrimal Obstruction in Inflammatory Bowel Disease

To report lacrimal drainage obstruction in association with inflammatory bowel disease (IBD) in 9 patients. The clinical records of 461 consecutive adult patients treated for acquired lacrimal obstruction by dacryocystorhinostomy were reviewed. Patients with IBD were identified. Additional data collected included known secondary causes of lacrimal obstruction, a history of sinonasal disease, complications following lacrimal surgery, and demographic information. Nine patients (7 women, 2 men) with a median presenting age of 61 years (range, 38-70 years) had IBD. Five patients had Crohn disease, and 4 patients had ulcerative colitis. Seven patients had nasolacrimal duct stenosis or obstruction, and 2 patients had lacrimal canalicular obstruction. Six patients (67%) reported symptoms of sinonasal disease. One patient reported intermittent tearing and nasal obstructive symptoms during flare-ups of bowel disease. All 9 patients were being treated with long-term oral 5-aminosalicylate agents prior to the onset of lacrimal symptoms. One patient had recurrent lacrimal obstruction, 1 year after initially successful surgery. No other surgical complications were observed. Excluding 1 patient with herpetic canalicular obstruction and Crohn disease, the proportion of patients undergoing dacryocystorhinostomy surgery identified to have IBD (1.7%) was significantly higher than the estimated prevalence of IBD in the Australian population (0.3%) (p < 0.0001). In a large cohort of patients surgically treated for acquired lacrimal obstruction, the authors found an increased rate of IBD compared with the estimated population prevalence. To investigate this association further, the authors recommend obtaining lacrimal sac biopsies from patients with IBD who undergo dacryocystorhinostomy surgery.

Bicanalicular Obstruction in Lichen Planus: A Characteristic Pattern of Disease

Lichen planus, an idiopathic mucocutaneous inflammatory disease, has only once been reported to cause lacrimal drainage obstruction. The authors present a series of patients with epiphora resulting from systemic lichen planus and describe the characteristic pattern of lacrimal canalicular blockage. Retrospective noninterventional case series. Eight patients (5 women, 3 men) with a median presenting age of 49 years (range, 39-60 years). A retrospective review of case notes for patients attending the lacrimal clinic between 1998 and 2005 was performed to identify patients with nontraumatic lacrimal canalicular obstruction. In addition to demographic information, the data collected included a history of periocular herpetic infection, administration of systemic 5-fluorouracil, other causes of canalicular obstruction, the extent of proximal and distal canalicular obstruction (noted during surgery), the type of surgery, and the surgical outcomes. Identification of patients with biopsy-proven systemic lichen planus who had conjunctival and canalicular disease and documentation of the extent and severity of canalicular obstruction. Of the 184 patients with canalicular obstruction identified during the study period, 8 had lichen planus. Bilateral, bicanalicular involvement was present in 7 of 8 lichen planus patients, with 3 of 8 patients having completely obstructed canaliculi. Primary dacryocystorhinostomy (DCR) with retrograde canaliculostomy was performed in 4 of 8 patients, but all required secondary placement of Lester Jones canalicular bypass tubes. The other 4 patients had either primary DCR alone (both eyes in 1 patient, with solely canalicular stenosis) or DCR with primary placement of Jones tubes (6 eyes in 3 patients). Histologic examination of pericanalicular tissues in 2 patients showed features consistent with lichen planus. Lacrimal involvement in lichen planus is characterized by severe bilateral bicanalicular occlusion involving most of the length of affected canaliculi, and placement of a Jones canalicular bypass tube is generally required to control symptoms.

Lacrimal Canalicular Obstruction by Cysticercus Cellulosae

Ocular adnexal infestation in cysticercosis is unusual. A case of lacrimal canalicular obstruction by cysticercus cellulosae in a 35-year-old female is reported. The diagnosis was established by histopathological examination of the cyst, surgically removed from the above patient with a suspected benign neoplasm in the lacrimal passage. To our knowledge, this is the first case report of lacrimal canalicular obstruction by cysticercus cellulosae.

A Case of Suspected Drug-induced Ocular Pemphigoid

Lacrimal obstruction can occur as a complication of ocular cicatricial pemphigoid. We report a patient who was diagnosed as having drug-induced ocular cicatricial pemphigoid associated with acquired lacrimal canalicular obstruction in spite of relatively mild subconjunctival scar formation. The patient was a 69-year-old woman. She had been treated for glaucoma, blepharoconjunctivitis, dacryocystitis, and lacrimal canalicular obstruction for two years with topical administration including 0.5% timolol maleate, 0.1% dipivefrine hydrocholoride, 0.1% fluorometholone, and 0.3% ofloxacin. The patient had moderate conjunctival hyperemia without shortening of the inferior conjunctival sac, corneal ulceration, neovascularization, and keratinization. Lacrimal canalicular obstruction progressed further as topical ocular medications were continued. Topical anti-glaucoma medications were stopped after dacryocystorhinostomy. Although the blepharoconjunctivitis was improved, left inferior conjunctival symblepharon, and medical canthal keratinization was progressive despite the use of topical corticosteroids. The conjunctival biopsy specimen showed the lacrimal punctum covered with proliferated conjunctival epithelium. There was a moderate stromal infiltration of small lymphocytes and plasma cells. We diagnosed this patient as having drug-induced ocular cicatricial pemphigoid caused by topical anti-glaucoma medications. Lacrimal canalicular obstructions may occur with the topical anti-glaucoma medications even when subconjunctival scarring is mild.

Lacrimal canalicular obstruction associated with topical ocular medication.

To describe the association between the use of various types of topical ocular medications and acquired lacrimal canalicular obstruction in 14 patients. The records of all patients in the author's practice with either lacrimal canalicular or punctal occlusion associated with the use of topical ocular medication were reviewed. Fourteen cases were identified. The obstructions occurred at any point from the punctum to the common canaliculus, but most commonly occurred 2-5 mm from the lacrimal punctum. There was an association with various degrees of clinically apparent subconjunctival scarring maximal at the inner canthus, rarely to a severe degree, with symblepharon, medial canthal keratinization and cicatricial medial entropion. In some cases, no subconjunctival scarring could be clinically detected. Topical medications used were often multiple and included prednisolone acetate/phenylephrine hydrochloride (n = 5), timolol maleate (n = 5), pilocarpine (n = 3), dipivefrine hydrochloride or adrenaline (n = 3), chloramphenicol (n = 3), tobramycin (n = 3), indomethacin (n = 2), ecothiopate iodide (n = 1), betaxolol (n = 1), dexamethasone (n = 1), tropicamide (n = 1) and the long-term use of naphazoline and various artificial tear preparations (n = 1). The duration of exposure ranged from 3 weeks to 20 years, with seven patients having used drops for 3-6 weeks. Seven patients had surgical repair, three by dacryocystorhinostomy (DCR) and glass by-pass tube (all successful), three by canalicular repairs (one failed) and one by DCR and canalicular repair that restenosed at the puncta, who then had successful punctoplasty and silicone intubation. Lacrimal canalicular obstruction may occur after relatively short-term exposure to topical ocular medications or as part of a more widespread cicatricial reaction in patients on long-term medication. While a direct causal relationship cannot be confirmed, there appears to be a strong association and the site of the obstructions makes other causes unlikely.

Lacrimal canalicular obstruction in lichen planus

PURPOSE To report, for the first time, proximal canalicular obstruction in all four canaliculi of a patient with lichen planus. METHODS The patient file and examination findings were reviewed, along with relevant literature on lichen planus and the eye. RESULTS A 67-year-old woman with lichen planus had bilateral epiphora. All four canaliculi were totally obstructed within 2-3 mm of the puncta, and there was mild medial subconjunctival scarring. CONCLUSIONS Lichen planus is an immune-mediated skin and mucosal disease similar to pemphigoid and lacrimal canalicular obstruction may occur as part of the disease.

Lacrimal Canalicular Obstructions: Safety and Effectiveness of Balloon Dilation

Balloon dilation of the lacrimal canaliculi has been considered contraindicated because of possible damage to the canaliculi. The purpose of this study was to assess the safety and effectiveness of balloon dilation in treatment of obstruction of the lacrimal canaliculus. Fluoroscopically guided balloon dilation was performed in 26 eyes of 21 consecutive patients with epiphora due to lacrimal canalicular obstruction confirmed at dacryocystography. Nine of 26 eyes had complete obstruction and 17 eyes had incomplete obstruction. Technical failure occurred in one eye. Only one acute complication (punctal slitting) and no late complications occurred. At 7 days after balloon dilation, 14 of 17 eyes (82%) with incomplete obstruction and five of nine eyes (56%) with complete obstruction showed complete or partial resolution of epiphora with patency of the lacrimal drainage system. At 6-month follow-up, that improvement was maintained in seven of 17 eyes (41%) with incomplete obstruction and three of nine eyes (33%) with complete obstruction. Although the 6-month recurrence rate is rather high, balloon dilation seems to be safe and valuable as an initial therapy for patients with obstruction of the lacrimal canaliculus.

Problems Associated With Conjunctivodacryocystorhinostomy

Fifty-eight patients (69 eyes) underwent conjunctivodacryocystorhinostomy for lacrimal canalicular obstruction. The cause of lacrimal obstruction and the results and complications of the operation were analyzed. Trauma and idiopathic disease were the most common causes of lacrimal canalicular obstruction in 24 of 69 (34.8%) eyes each. Relief of epiphora was achieved in 68 of the 69 eyes (98.5%). The complications included tube displacement in 40 of the 69 eyes (57.9%), tube obstruction in 19 of the 69 eyes (27.5%), and infection of the lacrimal sac in four of the 69 eyes (5.8%). Despite frequent complications, most Jones tubes can be made to function satisfactorily. Conjunctivodacryocystorhinostomy remains the best surgical treatment at this time for permanent loss of canalicular function.

Lacrimal canalicular obstruction following chickenpox.

Lacrimal canalicular obstruction following chickenpox.