Lacrimal Drainage Obstruction Research Articles

Evaluation of the results endonasal dacrocystorhinostomy in patients with DCR

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Dacrocystitis refers to a series of clinical entities characterized by inflammation of lacrimal sac which leads to obstruction at the level of drainage of lacrimal system. Owing to the initial encouraging results and simplicity of the operation, it is decided that all symptomatic patients with lacrimal drainage obstruction would be treated initially by endoscopic endonasal dacrocystorhinostomy method, irrespective of the level of obstruction. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">A total 50 patients were included in the study over a period of 3-4 months. They were subjected to endonasal dacrocystorhinostomy and were evaluated for postoperative complications. </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Very few complications were seen postoperatively suggesting that this newer technique may be useful. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Endonasal dacrocystorhinostomy may prove better in coming years.</span></p>

Cancer-associated epiphora: a retrospective analysis of referrals to a tertiary oculoplastic practice

AimTo report the underlying causes and treatment outcome of lacrimal drainage obstruction in patients with cancer-associated epiphora.MethodsA single-centre retrospective review was performed for consecutive referrals to an oculoplastic surgeon for...

Image-guided lacrimal drainage surgery in congenital arhinia-microphthalmia syndrome

ABSTRACTThe aim of this study was to illustrate the surgical techniques and utility of stereotactic or image-guided navigation in the management of lacrimal drainage obstruction in congenital arhinia-microphtalmia syndrome and review the relevant literature. Image-guided combined external and endoscopic dacryocystorhinostomy was performed in a female, aged 16 years with congenital partial arhinia and ipsilateral microphthalmus. The lacrimal sac was bypassed to the contra lateral nasal cavity through a septal window. The surgical procedure was performed using the intra-operative optical image-guided Nav 1 PicoTM ENT navigation system with real-time intra-operative instrument geometry. Different phases of the surgical technique, adjunctive endoscopic procedures, intra-operative anatomical guidance, and utility at crucial phases of surgery were noted. A review of the literature was performed pertinent to arhinia and navigation guided lacrimal surgeries. Lacrimal bypass into the contra lateral nasal cavity even through a malformed septum is possible in partial arhinia syndromes. Detailed preoperative evaluation including 3D imaging studies, navigation guided planning of risk structures with intra-operative distance control and construction of meticulous surgical roadmaps were found to be essential factors in successful outcomes. At six months follow up after surgery, there was a complete and contiguous healed mucosal anastomosis with lacrimal system patent on irrigation and resolution of epiphora. Combined external and endoscopic approach is useful in partial arhinia syndromes. Image guidance is a very useful adjunctive tool that facilitates safe and precise surgery in the management of such complex lacrimal surgeries.

Meibomian Gland Dysfunction in Patients With Chemotherapy-Induced Lacrimal Drainage Obstruction.

To investigate the relationship between chemotherapy-induced lacrimal drainage (LD) obstruction and obstructive meibomian gland dysfunction. Twenty patients who had received chemotherapy were divided into 2 groups, according to the presence of LD obstruction: the LD obstruction group (n = 10) and control group (n = 10). Upper and lower meibomian gland loss was evaluated using noncontact meibography, and tear film lipid layer thickness was measured using an interferometer. The mean values of the right and left eyes of each patient were used to compare parameters between both groups. The LD obstruction group had higher levels of meibomian gland loss in both upper (42.9% ± 16.4%) and lower meibomian glands (80.1% ± 16.7%) than did the control group (17.3% ± 6.7% and 22.8% ± 13.0%, respectively) (P < 0.001 and P < 0.001, respectively). In the LD obstruction group, meibomian gland loss in the lower eyelid was significantly higher than that in the upper eyelid (P < 0.001). The lipid layer was significantly thinner in the LD obstruction group (28.4 ± 9.7 nm) than it was in the control group (72.9 ± 22.5 nm) (P < 0.001). Patients with chemotherapy-induced LD obstruction had greater meibomian gland loss and thinner lipid layers than did patients without LD obstruction. Chemotherapeutic agents that induce LD obstruction can also block the meibomian gland orifice, resulting in obstructive meibomian gland dysfunction through the same mechanism.

S-1-Induced Lacrimal Drainage Obstruction and Its Association with Ingredients/Metabolites of S-1 in Tears and Plasma: A Prospective Multi-institutional Study.

PurposeThis prospective study was conducted to determine the incidence of lacrimal drainage obstruction (LDO) during S-1 chemotherapy and evaluate the association between the development of LDO and the concentrations of ingredients/metabolites of S-1 in tears and plasma.Materials and MethodsA total of 145 patients with gastric cancer who received adjuvant S-1 therapy were enrolled. Ophthalmologic examinations were performed regularly during S-1 chemotherapy. Concentrations of tegafur, 5-chloro-2,4-dihydroxypyridine (CDHP), and 5-fluorouracil at steady-state trough level were measured in both tears and plasma.ResultsFifty-three patients (37%) developed LDO. The median time to the onset of LDO was 10.9 weeks, and LDO developed most frequently in the nasolacrimal duct. Univariable analyses revealed that an older age (≥ 70 years), creatinine clearance rate (Ccr) < 80 mL/min, 5-fluorouracil concentration in plasma ≥ 22.3 ng/mL (median), CDHP concentration in plasma ≥ 42.0 ng/mL (median), and tegafur concentration in tears ≥ 479.2 ng/mL (median) were related to increased development of LDO. Multivariable analysis indicated that a high plasma 5-fluorouracil concentration was predictive of increased development of LDO (hazard ratio, 2.02; p=0.040), along with older age and decreased Ccr. Patients with LDO also developed S-1–related non-hematologic toxicity more frequently than those without LDO (p=0.016).ConclusionLDO is a frequent adverse event during S-1 chemotherapy. An older age, decreased Ccr, and high plasma 5-fluorouracil concentration were found to be independent risk factors for LDO. The high incidence of LDO warrants regular ophthalmologic examination and early intervention in patients receiving S-1 therapy.

Surgical outcomes of external dacryocystorhinostomy and risk factors for functional failure: a 10-year experience

To analyze the surgical outcomes of external dacryocystorhinostomy (DCR) and the risk factors associated with functional failure. We reviewed the medical records of 769 patients who underwent external DCR for primary lacrimal drainage obstruction between 2005 and 2014. Recorded data included intraoperative anatomical findings, postoperative diagnosis, and surgical outcomes. We performed univariate and multivariate analyses to identify risk factors for functional failure. Of the 769 cases, primary nasolacrimal duct obstruction (NLDO) was diagnosed in 457 cases; common canalicular obstruction in 228 cases; and canalicular obstruction in 84 cases. Anatomical success was achieved in 98.8% (760/769) and functional success in 81.9% (630/769) of the cases. An analysis of 760 anatomically successful DCRs showed that common canalicular obstruction (OR=1.752, P=0.014) and canalicular obstruction (OR=2.058, P=0.015) were independent risk factors for functional failure. In a subgroup analysis of patients with primary NLDO, patients with a small lacrimal sac had a significantly higher risk of functional failure (OR=2.500, P=0.018). The overall surgical outcomes of external DCR were favorable in this case series. Site of obstruction was an important risk factor for functional failure in cases with primary lacrimal drainage obstruction. A small lacrimal sac was also found to be a risk factor for functional failure in cases with primary NLDO.

Intraoperatively Observed Lacrimal Obstructive Features and Surgical Outcomes in External Dacryocystorhinostomy.

PurposeTo analyze the features of lacrimal drainage system obstruction confirmed during external dacryocystorhinostomy surgeries and report the surgical outcomes.MethodsWe reviewed the medical records of a total of 769 cases who underwent external dacryocystorhinostomy for primary lacrimal drainage obstruction between 2005 and 2014. Data about detailed location and extent of obstruction were collected intraoperatively. The sites of obstruction were classified into nasolacrimal duct obstruction (NLDO), common canalicular obstruction (CCO), and canalicular obstruction. Lacrimal sac mucosa and lumen were grossly inspected, and the frequency of lacrimal sac changes, such as significant inflammation or fibrosis, was analyzed in cases of CCO or canalicular obstruction. The surgical success rate was also evaluated including effect of lacrimal sac status in the CCO and canalicular obstruction groups.ResultsOf 769 cases, primary NLDO with patent canaliculi was diagnosed intraoperatively in 432 cases (56.2%), CCO in 253 (32.9%), and canalicular obstruction in 84 (10.9%). Of 253 cases with CCO, 122 (48.2%) showed clear lacrimal sac lumen, and the other 131 (51.8%) showed significant inflammation or fibrosis of the lacrimal sac. In cases with canalicular obstruction, 35 of 84 (41.7%) showed a clear lacrimal sac, and the other 49 cases (58.3%) cases revealed mucosal changes of the lacrimal sac. The functional success rate was 87.5% for primary NLDO, 75.5% for CCO, and 72.6% for canalicular obstruction. In the CCO group, the functional success rate was lower in cases with significant lacrimal sac change (p = 0.044).ConclusionsEven in patients with CCO or canalicular obstruction, a large number of cases have lacrimal sac changes, and those changes were associated with lower functional success rate.

Evaluation of granulation tissue formation in lacrimal duct post silicone intubation and its successful management by injection of prednisolone acetate ointment into the lacrimal duct.

To evaluate the clinical findings and original treatment method of granulation tissue formation post silicone intubation (SI) for primary acquired lacrimal drainage obstruction (PALDO). This retrospective, consecutive, comparative, interventional case series study involved 85 consecutive PALDO patients treated by SI and followed by dacryoendoscopy for 12 months post surgery. Patients in whom complication by granulation tissue formation occurred were treated every 2weeks until it disappeared with an injection of prednisolone acetate ophthalmic ointment into the lacrimal duct without removing the tube. The frequency of granulation tissue formation post SI, relationship between the locations where the primary obstruction and granulation tissue formation occurred, and impact of the complication on the surgical outcome were evaluated. Granulation tissue formation occurred in 9 of the 85 cases (10.6%) at 2-8weeks post surgery, yet disappeared via treatment during that same period. No relationship was found between the location of the primary obstruction and the granulation tissue formation, and no statistical difference was found when comparing the success rate of our surgical treatment in patients with or without the complication (P=0.46, Fisher's exact test). Complication by granulation tissue formation occurred in 10.6% of the patients who underwent SI for PALDO, yet the injection of prednisolone acetate ophthalmic ointment into the lacrimal passage may have successfully treated the complication without removal of the silicone tube.

Tear Film, Lacrimal Drainage System, and Eyelid Findings in Subjects With Anophthalmic Socket Discharge

To compare the results of tear film and lacrimal drainage system tests between anophthalmic socket and normal eye and assess discharge characteristics and frequency of prosthesis removal (questionnaire), eyelid function, and meibomian glad dysfunction (MGD). Prospective masked case control. Subjects (≥6 years and ≥6months of wearing prosthesis) with unilateral acquired anophthalmic socket discharge were included. Excluded was ocular adnexal abnormality of any reason and incomplete tests. The subjective questionnaire was completed. Blinking rate, lagophthalmos, eyelid laxity, MGD, Schirmer test, tear meniscus height, and dye disappearance test were assessed by a masked examiner. Another masked examiner performed an irrigation test 1week later and interpreted the scintigraphy images at the end of the study. Included were 50 subjects (mean age: 31.3 years, mean prosthesis wear: 96.1months). Discharge was frequent or very frequent in 85%, mucoid or mucopurulent in 90%, and moderate to severe in 86% of the subjects. MGD in 58%, lagophthalmos in 80%, and eyelid laxity in 46% were observed. Anophthalmic socket sides showed a significantly lower tear production and higher tear drainage obstruction. Subjects with frequent prosthesis removal had a significantly (P= .02) greater lagophthalmos and blinking rate (P= .04). The blinking rate was also significantly greater in subjects with higher frequency of discharge (P= .04). Tear film impairment (aqueous and lipid) and lacrimal drainage obstruction should be considered in subjects with anophthalmic socket discharge. A significantly higher blinking rate and lagophthalmos were found in subjects with higher frequency of prosthesis removal.

Surgical Outcomes of Dacryocystorhinostomy in Lacrimal Drainage Obstruction after Systemic Chemotherapy or Radioactive Iodine Therapy

Surgical Outcomes of Dacryocystorhinostomy in Lacrimal Drainage Obstruction after Systemic Chemotherapy or Radioactive Iodine Therapy

Effects of Cataract Surgery on Lacrimal Drainage System

Introduction: Complaining of tearing was found in some of the patients after cataract surgery (both Phacoemulsification and Small Incision Cataract Surgery) for age related cataract, among male and female patients with an increased incidence among female and more elderly patients. Secondary acquired lacrimal drainage obstruction has been proposed to develop due to different causes like infections and inflammation of the lacrimal drainage system. Watering eyes are observed after cataract surgery may be due to surgical trauma, inflammation of the anterior segment of the operated eye, frequent use of topical medications during the post operative periods and less forceful blinking by the patients in early postoperative days.Objective: To determine the effects of cataract surgery (both Phacoemulsification and Small Incision Cataract Surgery) on lacrimal drainage system in eyes with age related cataract.Methods: This cross-sectional study was performed on 100 eyes of 100 patients with age related cataract. Among the patients, 64 were male and 36 were female. All the patients were Armed Forces personnels (both serving, retired and civilians) and their parents. The average age of the patients were 61.6±8.92 years ranging from 51 to 80 years. According to age, the patients were divided in three age-group (51-60 years; 61-70 years; 71-80 years). The patients were equally divided in two groups. In group-I(n=50), patients were done Phacoemulsification and posterior chamber intraocular lens (PCIOL) implantation and in group-II(n=50), patients were done Small Incision Cataract Surgery (SICS) and PCIOL implantation in one eye. All the patients were operated under peribulbar anesthesia. Included patients had Fluorescein Disappearance Test (FDT) and Taste test duration of ?5.7 minutes in both eyes before operation. Tear drainage function tests were repeated for one week and one month after surgery in both eyes and obtained data were compared.Results: The incidence of watering eyes after phacoemulsification surgery in eyes treated for age related cataract was 17% at the end of first week and 09% after one month. The mean taste test duration time was 3.83±0.76 minutes before surgery, 5.33±2.45 minutes after a week and 4.27±1.53 minutes one month after surgery. After SICS the incidence of lacrimal drainage impairment was 19% at the end of first week and 12% after one month. The mean Taste test duration time was 3.83±0.76 minutes before surgery, 5.62±2.84 minutes after a week and 4.36±1.85 minutes one month after surgery. However, more number of elderly patients developed watering eyes than the lower age group. Among the patients, from 71-80 years age group, 05 patients (19.23%) developed watering eyes. There was slight difference between male and female in complaining of tearing after operation. Out of 64 male, 11 patients (approximately 17.18%) were observed watering eyes in first week follow up. Among 36 female, 07 patients (approximately 19.44%) complained of watering in first week follow up. No difference of watering was observed in respect of socio-economic conditions. No post operation complains of watering eyes was observed in the sound eyes (non-operated) of the patients.Conclusion: Watering eyes may develop cataract surgery (both Phacoemulsification and SICS) in eyes with age related cataract, among male and female patients with an increased incidence among female and more elderly patients.Journal of Armed Forces Medical College Bangladesh Vol.10(2) 2014

Management of acquired punctal stenosis with perforated punctal plugs

PurposeTo evaluate the efficiency of perforated punctal plug in acquired punctal stenosis. Materials and methodsForty-five eyes of 33 patients who had epiphora due to punctal stenosis were included in this study. After biomicroscopic examination and lacrimal dilatation punctal stenosis was managed with the perforated punctal plugs in all patients. In the following period epiphora, plug tolerance, lacrimal drainage were evaluated and graded. Lacrimal drainage was evaluated with fluorescein dye disappearing test. ResultsThe age of the patients ranged between 31 and 80 (mean 55.78±13.11). Preoperatively punctal dilatation and lacrimal system irrigations were performed on all patients. Lacrimal system irrigation was positive in all patients. Perforated punctal plugs were placed in the inferior puncti in all patients. The plugs were explanted 6months after operation. The follow-up period ranged between 6 and 24months. Plug tolerance was good in 97.8% of the eyes in the 1st month visit. Epiphora decreased remarkably in 88.9% of the patients 1month after plug implantation, except one whose plug dropped off spontaneously in 2weeks. Fluorescein disappearing times were found under 3min in 97.8% of the eyes after plug explanations. ConclusionPunctum stenosis is one of the several disorders that cause lacrimal drainage obstruction. Perforated punctal plugs are found convenient and effective in managing punctal stenosis.

Indications for and effects of Nunchaku-style silicone tube intubation for primary acquired lacrimal drainage obstruction.

To study the indications for and effectiveness of Nunchaku-style silicone tube intubation (NSTI) in treating primary acquired lacrimal drainage obstruction (PALDO). In this interventional cohort study, 235 consecutive patients in 1 institution who had complete lacrimal obstruction were investigated. Of those, 212 PALDO patients were enrolled, and 156 of the PALDO patients ultimately satisfied our treatment protocol and were then followed up for 12 months postsurgery. Patients without dacryocystitis underwent NSTI, while those with dacryocystitis underwent NSTI or endonasal dacryocystorhinostomy (EN-DCR) using the NST as a stent. The tubes were left in place for 8 weeks, and all patients received identical postoperative care. Resolution was deemed as patency assessed by irrigation. Logistic regression analyses were performed to compare the success of NSTI for upper (puncta and canaliculus) and lower (lacrimal sac and nasolacrimal duct) obstruction, NSTI for lower obstruction with and without dacryocystitis, and NSTI and EN-DCR for lower obstruction with dacryocystitis. Comparison of the success rates at 12 months postsurgery showed significance as follows: treatment with NSTI was more successful for upper obstruction (94.6%) than for lower obstruction (71.4%) [odds ratio (OR) 8.23; P < 0.01]; treatment with NSTI was more successful for lower obstruction without dacryocystitis (82.9%) than for dacryocystitis (52.4%) (OR 4.96; P < 0.05); and treatment with EN-DCR (95.5%) was more successful than NSTI (52.4%) for treating lower obstruction with dacryocystitis (OR 16.99; P < 0.001). NSTI is effective for treating PALDO; however, EN-DCR is more effective for treating PALDO cases complicated by dacryocystitis.

Significance of transcanalicular laser assisted dacryocystorhinostomy in modern lacrimal drainage surgery

For the treatment of postsaccal lacrimal drainage obstructions transcanalicular laser dacryocystorhinostomy (TCL-DCR) represents a less invasive alternative to external Toti procedures. Herein, a diode laser optical fiber is inserted into the lacrimal sac via the canaliculi. Under visual control with a nasal endoscope laser energy is applied until a patent osteotomy between the sac and nasal mucosa has been created. Published success rates of 70-90% get close to the excellent results of Toti procedures. Besides describing therapy planning and surgical technique, pros and cons of TCL-DCR are discussed.

Bilateral Lacrimal Drainage Obstruction and Its Association With Secondary Causes

Etiologies of lacrimal obstruction requiring a dacryocystorhinostomy (DCR) have been reviewed previously but most commonly are thought to result from "primary acquired" nasolacrimal duct obstruction, a process of chronic inflammation in a narrowed duct. The authors have observed that secondary causes are frequently associated with bilateral lacrimal outflow disease. The purpose of this study is to investigate this relationship to help the clinician prioritize which patients to evaluate for secondary causes. This is a retrospective case-controlled review of patients who underwent bilateral DCR from 1986 to 2012 at this institution. They are compared with an age and gender-matched control group who underwent unilateral DCR. Statistical analysis was undertaken using the Pearson chi-square test for p value, except for age, which used the Wilcoxon rank sum test. Logistic regression was used for comparing prevalence of secondary issues in bilateral disease versus unilateral disease, with age as covariate. Two hundred thirty-five patients underwent bilateral (91) or unilateral DCR (144). Twice as many patients undergoing bilateral DCR had an underlying secondary cause compared with the patients undergoing unilateral DCR. (38%, 19%, p= 0.001, odds ratio 2.59). In patients <50, the odds ratio of a secondary cause in bilateral disease would be 5.34 compared with patients older than 80. (p = 0.0002) Patients in the bilateral DCR group underwent revisions at more than twice the rate as patients in the unilateral DCR group (26%, 12%, p = 0.007). Ophthalmologists should have a high index of suspicion for secondary conditions underlying bilateral lacrimal outflow obstruction, especially in patients <50. These patients should undergo laboratory workup and intraoperative biopsy. They should also be counseled regarding a higher failure rate.

Lacrimal drainage obstruction in gastric cancer patients receiving S-1 chemotherapy

This study was conducted to determine the incidence and clinical characteristics of lacrimal drainage obstruction (LDO) in patients receiving S-1 chemotherapy. Consecutive 170 patients with gastric cancer who underwent curative surgery and received adjuvant S-1 chemotherapy were enrolled. S-1 was administered orally (40 mg/m2 b.i.d. on days 1-28 every 6 weeks) for 1 year. Ophthalmologic examinations were carried out on patients complaining of epiphora. Thirty-one patients (18%) developed epiphora. Among 31 patients, 25 underwent ophthalmologic examinations and 22 (88%) were diagnosed with LDO. The median time to the onset of LDO was 2.9 months. The most common site of obstruction was the nasolacrimal duct [86% (19/22)]; punctal [23% (5/22)] and canalicular obstruction [14% (3/22)] were also noted. In multivariate analysis, total gastrectomy [versus partial gastrectomy: hazard ratio (HR), 2.9; P=0.014] and creatinine clearance<50 ml/min (versus ≥50 ml/min: HR, 2.9; P=0.038) were independent risk factors for the development of LDO. Considering the high incidence of LDO in patients receiving S-1 chemotherapy, oncologists should be alert to epiphora and cooperate with ophthalmologists in the early stages to improve the quality of life of patients and avoid more complicated ophthalmologic procedures.

Corneal changes in ectrodactyly–ectodermal dysplasia–cleft lip and palate syndrome: case series and literature review

The aim of this study is to describe the corneal changes in three unrelated patients with ectrodactyly-ectodermal dysplasia-cleft lip and palate (EEC) syndrome and review the literature on the possible etiology and clinical presentation of similar cases. Case 1 is an 18-year-old female with cleft lip and palate, syndactyly, and bilateral corneal pannus superiorly and inferiorly. She was initially diagnosed and treated as herpes simplex virus keratitis. Case 2 is a 3-year-old female born with cleft lip and palate, absent radial digits in both hands, and bilateral lacrimal stenosis. She developed progressive stromal scarring and neovascularization in both eyes. Her cornea perforated after developing infectious ulceration. Case 3 is a 49-year-old male with cleft palate, claw-hand deformities, absent meibomian glands and lacrimal duct, right ankyloblepharon, and a superior wedge-shaped opacity in the left cornea. The clinical findings demonstrated the different spectrum of keratopathy seen in patients with EEC. All patients were treated medically and without any surgical intervention. Limbal stem cell deficiency (LSCD) is presumed to be the cause in all three cases. Corneal changes in EEC can have variable presentation. LSCD seems to be the etiology of such keratopathy. Recurrent infection from lacrimal drainage obstruction and tear film instability are other risk factors for disease severity and progression.

Obstrução de vias lacrimais associada ao tratamento radioiodoterápico de carcinoma de tireoide

To report the finding of nasolacrimal drainage system obstruction associated with radio iodine therapy and to review clinical data and the surgical treatment outcome of this rare complication. We retrospectively analyzed ophthalmological data of patients with history of thyroid carcinoma that underwent radioactive iodine I-131 therapy and were referred to lacrimal surgery. 17 patients with thyroid cancer treated with thyroidectomy and radioactive iodine I-131 therapy presented symptomatic nasolacrimal duct obstruction after 13.2 months following cancer treatment. 11 patients presented bilateral epiphora, 8 had lacrimal sac mucocele. Age range was 30 to 80 years, 10 patients had less than or equal to 49 years. The mean cumulative dose of radioiodine was 571 mCi (range: 200-1200 mCi). Nasal obstruction symptoms and increased salivary glands were also present in 53% of patients. All subjects underwent dacryocystorhinostomy. Dilation of the lacrimal sac and increased intraoperative bleeding was also observed in 3 younger patients. Complete epiphora and dacryocystitis resolution after surgery occurred in 82.4%, and partial in 17.6% (3 patients that still presented unilateral relapse after correction of bilateral obstruction). Mean follow-up was 6 months (range: 2-24 months). Cumulative high dose of radioiodine, nasal and salivary gland dysfunction are associated with lacrimal drainage obstruction. We observed a great percentage of younger patients presenting dacryocystitis when compared to the idiopathic dacryostenosis. Radioactive iodine uptake by nasolacrimal duct mucosa with subsequent inflammation, edema and fibrosis seems to have a relationship to lacrimal duct obstruction. The knowledge of this complication is important for the study and proper management of these patients.

Dacryoscintigraphy

Dacryoscintigraphy is a grossly underutilized nuclear medicine procedure for assessing the patency of nasolacrimal ducts. It is an alternate noninvasive modality requiring no added expertise when compared with dacryocystography, an invasive radiological counterpart. Dacryocystorhinostomy (DCR) is a surgical procedure in which a patent rhinostomy is made so that a low-pressure lacrimal bypass system is created, thus relieving epiphora, dacryocystitis or mucocele. DCR has been accepted as a highly successful procedure in the management of epiphora from nasolacrimal duct obstruction; however, adverse local effects can reproduce epiphora. This study highlights the utility and simplicity of dacryoscintigraphy in the postoperative setting of DCR, apart from showcasing its high sensitivity and accuracy in localizing the sites of lacrimal drainage obstruction. Fifty-five postoperative patients of DCR were screened. Ten volunteers constituted the control group. One drop (10 μl) of technetium pertechnetate (TcO4) was instilled simultaneously in the outer canthus of both eyes (50-100 μCi). Upright dynamic (8 min) and anterior static images of the eyes (up to 20 min) were acquired on a gamma camera fitted with a high-resolution collimator. Physiological interventions that were used in this study were eye blinking, saline intervention, and lacrimal sac massaging. Out of 40 symptomatic DCR patients, 22 had complete obstruction at the presac level and 18 patients had partial obstruction. Quantitative parameters like tear transit time and lacrimal sac half-life were also calculated. After massage of the lacrimal sac, progression of the tracer was observed in five patients. Premassage and postmassage tear column measurements showed a relative increase of 30.1%. Massage of eight clinically normal ducts showed a relative increase of 2.4% (P=0.06). Statistical analysis using the Fisher test shows very significant concordance between clinical symptoms and dacryoscintigraphy findings in postoperative DCR patients (P<0.0001). The modified McNemar's pair test did not show statistically significant differences between dacryoscintigraphy and the syringing irrigation test. Dacryoscintigraphy is a simple and easy-to-perform investigation providing high sensitivity in epiphora detection in patients after DCR. Interventions play a role in further enhancing the sensitivity of the technique. This study demonstrates the utility of dacryoscintigraphy in detecting subclinical and partial lacrimal duct obstruction with good patient compliance. It provides an easy and effective way of screening families, enabling an early diagnosis. During imaging, a high-resolution collimator is found to be an efficient substitute for the conventional pinhole collimator.

A Review of Bypass Tubes for Proximal Lacrimal Drainage Obstruction

Proximal obstruction of the lacrimal drainage system is typically managed with conjunctivodacryocystorhinostomy and lacrimal bypass tubes, a technique first described in 1962 by Lester Jones. This initial approach utilizes a temporary stent to allow epithelialization of the fistula. Over the last 49 years numerous alterations to this technique have been described, including permanent intubation of the lacrimal bypass fistula, now the most common approach. We review the range of available lacrimal bypass tubes, indications for their use, and surgical techniques for their insertion and focus on improving success rates and minimising short and long-term complications.