Lacrimal Drainage System Obstruction Research Articles

Dacryocystorhinostomy for epiphora in the presence of a patent lacrimal system.

To evaluate the success rate of dacryocystorhinostomy (DCR) for epiphora in patients with a clinically patent lacrmal drainage system. A series of 51 patients, 12 men and 39 women, who underwent DCR surgery for epiphora with a clinically patent lacrimal drainage system in the background of normal eyelid examination, were evaluated. All patients underwent fluorescein dye disappearance testing and Jones 1 and 2 testing with dacryocystograms in borderline cases. A standard DCR was performed with bicanalicular silicone tubing inserted in all cases. The average time for the removal of the silicone tubes was 9.6 weeks. In 48 cases (94%) there was improvement in symptoms with minimal or no significant epiphora postoperatively. Epiphora with a patent lacrimal drainage system obstruction can be successfully treated by DCR based on fluorescein dye disappearance tests and Jones 1 and 2 tests, with dacryocystography in borderline cases.

Use of computed tomographic dacryocystography in the evaluation of lacrimal drainage system obstruction

A computed tomograph (CT) scanner was used in the diagnostics of diseases of the lacrimal drainage system. During the past three years, 22 patients with lacrimal disease were examined: 20 patients with dacryocystitis, two of them after maxillo-facial injury, and two with lacrimal sac tumor. Computed tomographic dacryocystography (CTD) was used to diagnose dacryocystitis or other types of obstruction in the lacrimal sac or nasolacrimal duct. In dacryocystitis cases CTD clearly visualized the lacrimal sac, the nasolacrimal duct and its connections with the surrounding bone tissue, and showed the correct anatomical obstruction site, even in complicated cases. In tumor cases, CT with intravenous contrast material was used to detect the extent of the tumor and also the bone defect. Because of the expense, the authors suggest ultrascan diagnostics as the first choice of imaging diagnostic method in simple dacryocystitis cases, and the use of CT and other imaging diagnostic methods in complicated cases.

Lacrimal drainage system obstruction: management and results obtained in 70 patients

Causes and types of acquired obstruction of the lacrimal drainage system are discussed in 70 patients, as well as the results of their surgical treatment. Obstruction of the lacrimal drainage pathway, according to frequency, was due to: trauma (mainly naso-orbital and LeFort II fractures), post-inflammatory stenosis of the nasolacrimal duct, tumours and latrogenic injuries of the naso-lacrimal drainage system often following Caldwell-Luc operations of the maxillary sinus. The ages of patients ranged from 3-70 years. Canalicular obstruction was diagnosed in 9 (12.9%), obstruction of the lacrimal sac in 2 (2.8%), while obstruction of the naso-lacrimal duct in 50 (71.4%) patients, including 3 bilaterally. And in 9 (12.9%) patients, injury to the lacrimal system following excision of tumours of the eyelids and the medial canthal region occurred. In patients with canalicular obstruction intubation of the canaliculi was carried out and both ends of the drain were inserted into the nasal cavity for 6 months via a dacryocystorhinostomy. Total recovery was obtained in 44.5%. In lacrimal sac and nasolacrimal duct obstruction Dupuy-Dutemp's dacryocystorhinostomy was performed and 90.4% of the patients recovered. When fibrosis or extensive damage of the lacrimal sac had occurred, wide anastomosis with the nasal duct was indicated. After tumour excision, the lacrimal pathways were reconstructed by conjunctivo-rhinostomy, conjunctivo-sinusostomy or conjunctivo-dacryocystorhinostomy. In 40% of the patients who underwent conjunctivo-dacryocystorhinostomy a successful outcome ensued.

Stevens-Johnson Syndrome with Associated Nasolacrimal Duct Obstruction Treated with Dacryocystorhinostomy and Crawford Silicone Tube Insertion

Although Stevens-Johnson syndrome (SJS) has long been recognized as a cause of punctal and canalicular obstruction, nasolacrimal duct obstruction secondary to SJS is rare and has not been reported in the ophthalmologic literature. Keratoconjunctivitis sicca, entropion, and trichiasis are well-known complications of SJS that may require measures to supplement or preserve tears. Lacrimal drainage system obstruction may occasionally occur in the face of relatively normal tearing, resulting in clinically significant epiphora. We report two cases of SJS, one associated with epidemic keratoconjunctivitis, that led to nasolacrimal duct obstruction and canalicular obstruction or stenosis. Epiphora and, in one case, dacryocystitis, necessitated dacryocystorhinostomy and Crawford tube insertion.