Lacrimal Drainage System Obstruction Research Articles

CORRELATION OF THE DURATION OF DOCETAXEL ADMINISTRATION IN BREAST CANCER PATIENTS WITH EPIPHORA DEGREES

Abstract
 Introduction & Objectives : Epiphora is caused by excessive secretion and/or obstruction of lacrimal drainage system, malposition or weakness of the eyelids, failure of the nasolacrimal duct, and reflex tearing. Obstruction of the lacrimal drainage system can be caused by inflammatory processes in the palpebra, the use of certain medications or congenital abnormalities. Some drugs that are at risk of causing epiphora are chemotherapy drugs, especially 5-FU and docetaxel. Most epiphora were foundin weekly therapy than every 3 weeks therapy. Docetaxel causes epiphora, induces obstruction of the lacrimal drainage system and fibrosis of the stroma in the mucous layer of the lacrimal drainage system. According to Erkan et al, cases of recurrent or persistent and symptomatic epiphora had a Munk score of 2 to 4. This study interested in conducting research on the Correlation of the Duration of Docetaxel Administration in Breast Cancer Patients with Epiphora Degrees at RSUP Dr. Mohammad Hoesin Palembang.
 Methods : Cross sectional study with 25 samples suffering from breast cancer and experiencing epiphora at RSUP Dr. Mohammad Hoesin Palembang. The epiphora degree assessment is carried out using the Munk Score.
 Results : The sample was predominantly ≤50 years old as many as 21(84%) samples with a median 45 (23-64) years. The most dose of docetaxel was 70 mg in 20(80%) samples. Somer's D test showed that there was a significant correlation (p=0.021) between the duration of docetaxel administration to epiphora degrees and the strength of the strong correlation (r=0.645).
 Conclusion : The length of the docetaxel cycle is strongly correlated to having an epiphora

Comparison of Systemic Inflammation Markers in Patients with Different Types of Lacrimal Drainage System Obstruction

Amaç: Üst ve alt lakrimal drenaj sistemi (LDS) tıkanıklığı olan olgularda preoperatif kan testlerinden
 sistemik inflamasyon belirteçlerini araştırmak ve gruplar arasında bu inflamatuar belirteçleri ve
 uygulanan cerrahi tedavilerin başarısını karşılaştırmak amaçlandı.
 Gereç ve Yöntemler: Bu retrospektif çalışmada 2021-2023 yılları arasında LDS tıkanıklığı olan olguların
 dosyaları incelendi. Üst LDS tıkanıklığı olan olgular Grup 1'e ve alt LDS tıkanıklığı olan olgular Grup 2'ye
 dahil edildi. Tüm hastaların ameliyat öncesi tam kan sayımından, sistemik inflamatuar belirteçler olan
 nötrofil-lenfosit oranı (NLR), platelet-lenfosit oranı (PLR) ve ortalama platelet hacmi (MPV) elde edildi.
 Nötrofil (N), lenfosit (L) ve platelet (P) sayılarına (NxP/L) dayanan sistemik immün inflamasyon indeksi
 (SII) bir biyobelirteç olarak hesaplandı. Her iki grubun sistemik inflamasyon belirteçleri ve cerrahi tedavi
 başarısı karşılaştırıldı.
 Bulgular: Çalışmaya 46 (Grup 1=26, Grup 2=20) olgunun 57 (Grup 1= 37, Grup 2=20) gözü dahil edildi.
 Grup 1'deki olguların yaş ortalaması 52,3±9,4 yıl iken; Grup 2'de 47,1±9,0 yıl idi (p=0,067). Cinsiyet
 dağılımı Grup 1’de 18 kadın, 8 erkek; Grup 2’de 15 kadın 5 erkek idi (p=0,749). Grup 1'de ortalama nötrofil
 sayısı 4,98±2,36 10^3/uL, NLR 2,25±1,19 ve PLR 114,7±29,2 idi. Bu değerler Grup 2'de sırasıyla
 3,91±0,85 10^3/uL, 1,57±0,48 ve 95,5±27,9 idi (p

The technique and its role of dacryoendoscopy in the management of the false passage of the lacrimal drainage system

This is a retrospective study of patients with primary acquired nasolacrimal duct obstruction (PANDO) who underwent dacryoendoscopy (FT-203F; Fibertech Co., Tokyo, Japan) and sheath-guided silicone intubation for 830 cases with PANDO from March 2016 to December 2020. 19 cases (2.3%) were observed as false passage in the lacrimal drainage system (LDS). Dacryoendoscopic findings revealed that the following factors were associated with LDS obstruction (% cases): structural change of 63.2% (stenosis, 42.1%; fibrotic membrane, 21.1%), and secretory change of 36.8% (mucus, 15.8%; stone, 10.5%; and granulation, 10.5%). The obstruction sites were distributed through LDS. The false passages detected in LDS were managed as follow: usage of fluid irrigation pressure to check the true passage following the previously intubated silicone tube as a reference, and confirmation the end of passage through the inferior meatus with nasal endoscopy. The overall success rate was 73.7% using this management technique. Dacryoendoscopy enables real-time observation of the lumen of the LDS, thus facilitating management of pathological lesions including false passages. With this technique, we are better able to make customized treatment of patients with false passages, with a safer and more effective results leading to the success of dacryoendoscopy guided silicone tube intubation in PANDO patients.

Diagnostic value of lacrimal scintigraphy in the evaluation of lacrimal drainage system obstruction: a systematic review and meta-analysis.

A systematic review and meta-analysis to evaluate the diagnostic performance of lacrimal scintigraphy (LS) versus anatomical methods in the evaluation of the nasolacrimal duct obstruction (NLDO). A systematic search was performed using electronic bibliographic databases until the end of May 2021. Inclusion criteria: (a) used LS as a diagnostic method to evaluate NLDO; (b) used anatomical studies [including syringing, irrigation, probing, and dacryocystography (DCG)] as reference tests; and (c) provided adequate crude data. A hierarchical method was used to pool the sensitivity and specificity. The hierarchical summary receiver-operating characteristic model was performed. Additionally, the studies' heterogeneity and publication bias were analyzed. All analyses were conducted by the 'Midas' module of STATA 16. Twelve articles (with 14 separate populations) were considered eligible to enter the meta-analysis. They were divided into two groups based on the reference standard method, called irrigation and DCG groups. In the irrigation group, the pooled sensitivity and specificity were 89% [95% confidence interval (CI), 72-96%] and 25% (95% CI, 8-56%), respectively. In DCG group, the pooled sensitivity and specificity were 97% (95% CI, 85-100%) and 27% (95% CI, 0.12-0.49), in turn. LS is a sensitive modality to evaluate the anatomical obstruction of NLD. In contrast, it shows low pooled specificity compared with anatomical methods. Thus, LS can be used as the first noninvasive modality for the evaluation of epiphora. However, in case of any abnormality, confirmatory procedures are required.

Evaluation of lacrimal drainage system in Pseudoexfoliation syndrome.

PurposeTo evaluate the prevalence of the obstruction of lacrimal drainage system (LDS) in patients with pseudoexfoliation (PXF) syndrome.Materials and MethodsThis cross-sectional study included 152 eyes of 76 consecutive patients with bilateral PXF syndrome and 170 eyes of 85 age and gender-matched controls. The LDS evaluation was performed based on dye disappearance test, slit-lamp examination, diagnostic probing, and irrigation test. The presence of punctal stenosis and canalicular obstruction were considered as the obstruction of proximal LDS; and complete or incomplete nasolacrimal duct obstruction was considered as obstruction of distal LDS. Demographic characteristics, ophthalmologic findings, and prevalence and site of obstruction of LDS were compared among the groups.ResultsThe prevalence of obstruction of LDS was higher in the PXF syndrome group when compared to controls (21.1% vs 12.2%), but the difference was not statistically significant (p = 0.061). The obstruction of proximal LDS was found to be more frequent in the PXF syndrome (17.7%) group when compared to controls (10.0%), and this difference was statistically significant (p = 0.041). There was significantly more punctal stenosis in the PXF syndrome group when compared to controls (15.1% vs 7.6%, p = 0.033). The prevalence of canalicular stenosis and obstruction of distal LDS was similar in the PXF and the control groups (p = 0.596 and p = 0.741, respectively).ConclusionThe prevalence of punctal stenosis was statistically significantly higher in the PXF syndrome group when compared to the controls. This association is probably related to increased local ocular surface inflammation which is triggered by the accumulation of PXF material.

Case Series of Laser Therapy of Eyelid Peripunctal Benign Tumor.

Objective: This study is the first time to explore the feasibility of CO2 laser treating some eyelid lacrimal puncta benign tumor. Background: Eyelid lacrimal papillae is special anatomy region. Treatment of eyelid peripunctal tumor is relatively intractable and needs reconstruction of the lacrimal passage in most of the time. We use super pulse CO2 laser to treat peripunctal benign tumor and appears to be effective. Materials and methods: It contained 12 participants treated with super pulse CO2 laser photocoagulation without lacrimal duct silicone tube placement. The areas of lesions were as follows: eight cases were located in the upper eyelid lacrimal puncta, four cases in the lower lacrimal puncta. Super pulse CO2 laser was used to treat it. The follow-up period was 4 weeks, 24 weeks, and 3 years after treatment. Histological diagnoses were obtained in all patients. Results: All patients were satisfactory after treatment with their cosmetic outcomes, and the wounds are dry, with no infections. No patient has functional damage, secondary epiphora, and lacrimal drainage system obstruction. Complete epithelialization occurs 2-4 weeks after treatment and forms normal epithelium. It showed no obvious scars or notches after treatment, and only temporarily less hyperpigmentation is in the treated area than the circumambient normal skin. During the follow-up period, there were no complications and no relapses were observed. Conclusions: Super pulse CO2 laser therapy for eyelid peripunctal benign tumors without lacrimal duct silicone tube placement sometime appears to be available, effective, and well-tolerated alternative to traditional surgery in the clinic, especially for selected disease. The IRB proved number is 2016034.

Pulled versus Pushed Monocanalicular Silicone Intubation in Adults with Lacrimal Drainage System Stenosis: A Comparative Case Series.

Purpose To compare the success rate and complications of pulled versus pushed monocanalicular intubation in adults with incomplete lacrimal drainage system obstruction (lacrimal drainage system stenosis). Methods Patients with lacrimal drainage system stenosis (Munk grade ≥3), including both nasolacrimal duct (NLD) stenosis and common canalicular stenosis, were recruited in this prospective comparative case series. Patients underwent probing and either Monoka (51 eyes) or Masterka (48 eyes) intubation under general or local anesthesia. Tubes were removed 4–14 weeks after the procedure. Six months after tube removal, Munk grades 0 and 1 were defined as a complete success, Munk grade 2 was defined as a partial success, and Munk grade ≥3 was defined as failure. All complications were recorded. Results Ninety-nine eyes from 89 patients with lacrimal drainage system stenosis who underwent either Monoka (51 eyes) or Masterka (48 eyes) intubation were included. The mean (SD) age of the patients was 55.4 (12) years in the Monoka group and 53.5 (12.9) in the Masterka group. Groups were matched on demographics. Masterka intubation could not be performed in one eye. Complete and partial successes were observed in 52.9% (27/51) and 17.6% (9/51) of eyes in the Monoka group and 42.6% (20/47) and 12.8% (6/47) of eyes in the Masterka group, respectively (p=0.29). There was a trend toward a higher total success rate in patients with NLD stenosis treated with Monoka 66.7% (26/39) than Masterka 45.5% (15/33) intubation (p=0.07). This trend also existed in patients with common canalicular stenosis (83.3% (10/12) vs. 76.6% (11/14), p=0.75). Age, sex, bilateral involvement, and duration of intubation did not have a significant impact on the success rate. Early tube loss, slit puncta, and temporary superficial punctate keratopathy were observed complications. Conclusion Intubation with the pulled monocanalicular silicone tube was associated with a slightly but not significantly higher success rate in adults with lacrimal drainage system stenosis. Patients with NLD stenosis may achieve better results with pulled silicone tubes.

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.

Multi-Detector CT Instillation Dacryocystography and Its Role in the Diagnosis of Lacrimal Drainage System Blocks.

To assess the use of Multi-detector computed tomography instillation dacryocystography (MDCT-DCG) and its role in the diagnosis of lacrimal drainage system (LDS) blocks. It is a prospective evaluation of Twenty-five cases presenting with symptoms with NLDO (nasolacrimal duct obstruction) assessed by MDCT-DCG. The study was conducted in LN medical college and JK hospital Bhopal (M.P) territory centre between January 2016 and January 2017. Various levels of LDS obstruction were detected, Lower canaliculus 12% common canaliculus in 20% patients, lacrimal sac in 12% junction between lacrimal sac and NLD in 40% and NLD obstruction in 16% patients. The most common CTDCG findings were dilated opacified lacrimal sac with no opacification of the nasolacrimal duct (NLD) in 40% patients. CTDCG is a non-invasive, quick, patient friendly, indispensable in the assessment of NLDO procedure that adds benefit in documentation and preoperative planning.

Diagnosis and Treatment of Lacrimal Drainage System Obstruction

Diagnosis and Treatment of Lacrimal Drainage System Obstruction

Transcanalicular endoscopic dacryoplasty in patients with primary acquired nasolacrimal duct obstruction.

To investigate the lacrimal drainage system (LDS) from the punctum to the inferior meatus and the clinical outcomes of transcanalicular endoscopic dacryoplasty and silicone intubation through dacryoendoscopy in patients with primary acquired nasolacrimal duct obstruction (PANDO). We conducted a retrospective chart review of 203 cases from 156 patients who underwent dacryoendoscopy (FT-203F; Fibertech Co., Tokyo, Japan) and sheath-guided silicone intubation for PANDO from December 2014 to March 2018. Clinical characteristics, tear meniscus height, irrigation test, dacryocystographic findings, and dacryoendoscopic findings related to clinical factors and surgical outcomes were evaluated. The study population consisted of 44 males and 119 females (mean age, 60.4 ± 13.6 years). The mean epiphora duration was 3.8 ± 4.8 years. Dacryoendoscopic findings revealed that the following factors were associated with LDS obstruction (% cases): mucus, 39.9%; fibrotic membrane, 19.2%; stones, 9.4%; granulation, 8.9%; and stenosis, 2.7%. The locations of obstruction were as follows (% cases): nasolacrimal duct, 35.7%; canaliculus, 33.0%; sac, 27.6%; and inferior meatus, 3.5%. The types of LDS obstruction were classified into two groups: secretory group (n = 118) that included mucus, stones, and granulation, and structural group (n = 85) associated with the membrane and stenosis; the pattern of them was divided into focal (n = 134) and diffuse (n = 76). The overall success rate was 86.2%. The success rate of the structural group (95.3%) was significantly higher than that of the secretory group (79.7%) (p = 0.001). All membranous obstruction cases at the inferior meatus were treated successfully, regardless of the irrigation test results. The success rate of the focal group (93.1%) was significantly higher than that of the diffuse group (74.0%) (p = 0.003). Dacryoendoscopic findings were informative regarding the clinical factors leading to LDS in PANDO patients. Mucus and stones in the lacrimal sac were common findings of functional lacrimal duct obstruction. Membranous obstruction and stenosis could be managed by recanalization under direct visualization. Transcanalicular endoscopic dacryoplasty and silicone intubation is considered to be a safe and effective procedure, sparing the patient from bony destruction in selected cases of PANDO.

External dacryocystorhinostomy for patients of chronic dacryocystitis with chronic rhinosinusitis

Introduction: Dacryocystitis is characterized as an inflammatory state of the nasolacrimal sac. It is typically caused by an obstruction within the nasolacrimal duct and subsequent stagnation of tears in the lacrimal sac. Stagnation of tears will provide a favorable environment for infectious organisms to propagate and proteinaceous debris to form. Materials and Methods: In this prospective, observational study conducted over a 5-year period (March 2011 to February 2016) in a tertiary eye care center and department of Ophthalmology and otorhinolaryngology, consecutive subjects (60 chronic sinusitis patients) were recruited with primary obstruction of the lower lacrimal drainage system due to chronic dacryocystitis who underwent external dacryocystorhinostomy (EDCR) by a single surgeon. Results: A total of 60 patients were included in this study, concerning the gender, there was a predominance of the female with 39 out of 60 patients (64.1%) and males were 21 patients. Age groups of 1-20 years are 3 patients (4.61%) and predominant age in the study was elderly more than 61 years old patients 40%. The clinical characteristics of chronic dacryocystitis are shown in table 3, epiphora was found in 51 patients (78.4%) and absent in 14 patients (21.5%). The discharge by the digital expression of the lacrimal sac was attained in 45 patients (69.2%) and not attained in 20 patients (30.8%). The previous history of exacerbation of chronic dacryocystitis identified as purulent discharge occurred in 5 patients (7.7%) and non-occurrence in 60 patients (92.3%). Conclusion: The physiopathology of the CDC is not fully known. This study reveals a possible influence of CRS on the CDC, emphasizing its action on the exacerbation of the symptoms.

Evaluation of efficacy and safety of Botulinum toxin injection in treatment of epiphora

Purpose The aim of this study was to evaluate the efficacy and safety of Botulinum toxin injection in the palpebral lobe of the lacrimal gland for treatment of epiphora.Patients and methods A total of 20 patients with epiphora (crocodile tears syndrome, lower lid laxity, malposition of the lower lid, and obstruction of lacrimal drainage system in which lacrimal surgery was impossible) received intralacrimal gland injection of Botulinum toxin (2.5 IU/0.1 ml). Follow-up was performed on the first day, first week, first month, third month, and sixth month after injection to evaluate the efficacy, safety, and occurrence of any complications and to record the rate of recurrence.Results Cure was successfully achieved in 60% of the patients after the first injection and in 90% of patients after the second injection. There were 15% of recurrent cases after the first injection, and there were no recurrent cases after the second injection. Temporary ptosis occurred in 10% of this study group after the first injection and in 5% after the second injection. There was a highly significant decrease in Schirmer’s test and tear meniscus height among the study group regarding the pre-injection and follow-up values (P<0.01). In addition, there was a highly significant decrease in Munk scale and time of dye disappearance test among the study group regarding the pre-injection and follow-up values (P<0.01).Conclusion The injection of Botulinum toxin in the palpebral lobe of the lacrimal gland was effective and safe as a temporary measure to reduce excessive tearing until a more permanent measure can be taken.

Clinical utility of SPECT/CT and CT-dacryocystography-enhanced dacryoscintigraphy in the imaging of lacrimal drainage system obstruction

PurposeEpiphora is commonly caused by a relative or complete occlusion in the lacrimal drainage system (LDS), principally a nasolacrimal duct obstruction (NLDO). Dacryoscintigraphy (DSG), an extensively assessed imaging technique in diagnosing its abnormalities, can provide only planar images, according to which it needs to be improved. Our aim was to evaluate clinical utility of simultaneous DSG and single-photon emission computed tomography/computed tomography (SPECT/CT) combined with computed tomographic dacryocystography (CT-DCG) in the evaluation of LDS.MethodsDynamic imaging with DSG was performed, and tracer radioactivity was detected by a gamma camera. Successively, SPECT/CT images of the involved region were gained, followed by CT-DCG, during which a contrast medium was syringed into the affected LDS, and finally contrast CT scans were obtained again from the same region.ResultsFifty-seven patients, mean age 54.25 (± 18.26) years all with unilateral NLDO and 32 control subjects, all with patent LDS, mean age 49.88 (± 18.61) years were evaluated in the study. Delayed outflow of tearing eyes was exposed to DSG compared to the fellow and control eyes. The highest value for sensitivity was observed for SPECT/CT, followed by CT-DCG and DSG techniques, while combining DSG with SPECT/CT, DSG with CT-DCG, and SPECT/CT with CT-DCG, the sensitivity increased to 96.49%, 92.98%, and 94.73%, respectively.ConclusionsAlthough DSG is a sensitive nuclear medicine method, it only provides useful clinical data when simultaneously supplemented with SPECT/CT and CT-DCG trials as they jointly can offer valuable information about the localization of an abnormality and verify stenosis or obstruction.

Clinical features and treatment outcomes of patients with tearing after chemotherapy.

To evaluate the clinical features and treatment outcomes of patients complaining of tearing after receiving chemotherapy. The clinical records of patients who complained of tearing between August 2014 and February 2016, and underwent or were undergoing chemotherapy were retrospectively reviewed. Clinical measurements were as follows: LipiView® interferometer (lipid layer thickness and meibography), lacrimal drainage examinations (syringing), and outcomes at 6 months after treatment. This study included 34 eyes of 17 patients with a mean age of 62.4 ± 14.82 years. The mean follow-up period was 9.6 months. On syringing, 10 eyes (29.4%) showed total regurgitation, 19 eyes (55.9%) showed partial regurgitation, and 5 eyes (14.7%) showed no regurgitation. On LipiView®, mean lipid layer thickness was 34.5 nm (range, 20-89 nm). Mean meiboscore was 2.15 ± 0.86 in upper eyelid and 2.53 ± 0.79 in lower eyelid. Patients were treated with silicon tube intubation (STI) (10 eyes, 29.4%), dacryocystorhinostomy (DCR) (4 eyes, 17.6%), conjunctivodacryocystorhinostomy (CDCR) (8 eyes, 11.8%), DCR combined with CDCR (1 eyes, 8.8%), and conservative care (11 eyes, 32.4%). Mean time interval from onset of tearing to first clinic visit was 1.4 months in the conservative care group, 2.9 months in the STI and DCR groups, and 6.0 months in the CDCR group. Because of the high incidence of accompanying meibomian gland loss in cases of lacrimal drainage system (LDS) obstruction, reflex tearing by mebibomian gland dysfunction should also be considered for proper management of tearing. Early recognition and management of LDS stenosis could result in patients undergoing surgery with a lower burden.

Incidence of acquired lacrimal drainage system obstruction in epiphoric patients in Thailand

Background: There were few reports regarding the incidence of the acquired nasolacrimal duct obstruction , and the incidence in different geography or countries might be alike. Since the nasolacrimal drainage system obstruction is a common problem in Thailand, knowledge of the incidence may disclose the burden of the disease that has never been reported. Objectives: Evaluate the incidence of acquired lacrimal drainage system obstruction (ALDO) in Thailand. Methods: This study was conducted in multi-centers. It was based on prospective and descriptive design. All patients with epiphoric symptoms visiting the outpatient departments of five tertiary eyecare centers were recruited between 2004 and 2007. Features of epiphoric symptoms and medical history were recorded, and complete ophthalmic examinations were performed. Results: Epiphoric patients were enrolled from all medical centers with 245 eligible patients, female:male ratio was 4.2:1. Ninety-nine patients (40%) had duration of epiphoric symptoms between one-five years. ALDO was found in 111 patients (45%) with female preponderance (6.9:1). Seventy-one patients (64%) had pre-sac obstruction and 40 patients (36%) had post-sac obstruction. Among other causes of epiphora, dry eye was the most common. Conclusion: The most common cause of epiphora was ALDO. The four-year incidence rate of ALDO among epiphoric patients was 45%.

Intralacrimal migration of Masterka® stents

Tearing and conjunctivitis in children are commonly due to lacrimal drainage system obstruction. Congenital nasolacrimal obstruction is a common pathology treated by probing with or without silicone stent insertion, depending upon the age of the child. The silicone stent is self-retaining and placed for at least one month. Masterka® is a recent version of Monoka®, which may lead to the same surgical complications, such as intralacrimal migration. The medical records of two patients surgically treated with the Masterka® probe for nasolacrimal duct obstruction, who developed intralacrimal migration of the stent, were retrospectively reviewed and analyzed. A 41-month-old child and an 18-month-old child presented with disappearance of the silicone tube after 7 days and 2 years respectively. In the first case, the tube migrated completely within the lacrimal system and became externalized through the nose at 2 years, while in the second case, the Masterka® was retrieved through a canalicular approach. In both cases, infants had no further tearing. The frequency self-retaining stent disappearance is estimated at 15%. Among these cases, intralacrimal migration is only reported in 0.5% of cases. To prevent intralacrimal migration, the surgical technique must follow a certain number of rules. Management, based on residual epiphora, is discussed. Prevention of intralacrimal migration of self-retaining stents involves a rigorous analysis of the relationship between the meatus and the fixation head at the time of placement. After lacrimal intubation, scheduled monitoring is necessary to screen for stent disappearance. Management is based on clinical findings, anterior rhinoscopy and even exploratory canaliculotomy.

The relationship between topical anti-glaucoma medications and the development of lacrimal drainage system obstruction.

To evaluate whether any topical anti-glaucoma medications increase the risk of lacrimal drainage system obstruction or whether the presence of preservatives alone is sufficient to generate obstruction. This nested case-control study compared a group of patients with lacrimal duct obstruction who received topical anti-glaucoma medications to a control group of patients without obstruction. The medical records of 255 patients with glaucoma who consulted the Oculoplastic Section with complaints of watery eyes were reviewed. Among these patients, 59 exhibited lacrimal drainage obstruction. Ninety-four percent of patients with lacrimal drainage obstruction used beta-blockers, and 41% used prostaglandin analogs. A logistic regression model was used to adjust for age, sex, and the use of other medications. No significant differences were observed regarding the topical anti-glaucoma medications used between groups. No single topical anti-glaucoma medication demonstrated a stronger association with the development of lacrimal duct obstruction.

Medial Canthoplasty Combined with Conjunctivodacryocystorhinostomy for the Treatment of Delayed Medial Telecanthal Deformity.

Background:Rupture of the medial canthal ligament can be caused by many events. It remains a challenge to rebuild the drainage system and restore the function. The aim of this study was to evaluate the clinical efficacy of medial canthoplasty combined with conjunctivodacryocystorhinostomy (CDCR) in patients with medial telecanthal deformities and lacrimal drainage system damage.Methods:Twenty-two patients (22 eyes) treated with medial canthoplasty and CDCR during June 2012 to June 2014 were included in this retrospective study. For all patients, a self-tapping, titanium, low-profile head microscrew was drilled into the solid bone on the posterior aspect of the anterior lacrimal crest at the attachment position of the medial canthal ligament. Medpor-coated tear drainage tubes were applied. Distance of patient's lateral displacement before and after operation was recorded and compared. The complications of CDCR were described.Results:Before the surgery, distance of patient's canthal displacement was 4–6 mm. The canthal distance between two eyes of patients with surgery was 1 mm or less. Among patients with CDCR, four patients had proximal obstruction and two patients had distal obstruction. Five patients had tube malposition, for example, tube extrusion 1–3 months after surgery.Conclusions:Medial canthoplasty combined with CDCR is an effective surgical method for treatment of patients with medial telecanthal deformity and lacrimal drainage system obstruction. The study indicates that medial canthoplasty combined with CDCR surgery rebuilds normal appearance of eyelid and contour of the medial canthus and successfully repairs the function of the lacrimal drainage system.

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.