Lacrimal Fistula Research Articles

Neonatal Lacrimal System Anomalies

Abnormalities of the neonatal lacrimal system result from incomplete or abnormal embryologic formation of the structures that drain tears from the eye into the nose. The most common of these, nasolacrimal duct obstruction, often resolves spontaneously. Less common abnormalities, including neonatal dacryocystitis associated with nasolacrimal duct cysts, atresia of the lacrimal canaliculi and puncta, and lacrimal fistulae, usually require surgical intervention. The developmental origin, clinical signs and symptoms, and management of these entities are discussed.

Paediatric dacryocystorhinostomy

Of 258 cases of dacryocystorhinostomy performed on children in the period September 1981 to September 1991, 130 were for simple, unresolved congenital nasolacrimal duct obstruction. Other indications for surgery included punctal agenesis, lacrimal fistula, post-traumatic and post-inflammatory canalicular obstruction. Of 177 children without canalicular pathology, 171 (96%) were relieved of symptoms with one operation, without canalicular intubation. Of 81 cases with canalicular disease, 55 of 70 (79%) who underwent DCR plus canalicular intubation, and 10 of 11 who underwent DCR plus Lester-Jones tube, were substantially improved with one operation. No child required peroperative or postoperative blood transfusion. Dacryocystorhinostomy in childhood, in experienced surgical hands, is a safe procedure, achieving relief of symptoms in most cases, particularly in the absence of canalicular disease.

The use of fibrin tissue adhesive as an aid to dacryocystectomy

The procedure of dacryocystectomy is described in a child with craniodiaphyseal dysplasia. Fibrin tissue adhesive is used to distend and delineate the lacrimal sac and fistula to aid complete dissection.

The surgical management of congenital lacrimal fistulae.

Congenital lacrimal fistulae are developmental anomalies of the lacrimal apparatus that are usually symptomatic, frequently causing epiphora and occasionally causing fistulitis or dacryocystitis. They may be associated with other abnormalities of the lacrimal system or with systemic anomalies. Complete excision alone, or in combination with nasolacrimal intubation and/or dacryocystorhinostomy is recommended for treatment.

Congenital lacrimal fistula

Congenital lacrimal fistula is a rare developmental condition. Patients may be asymptomatic or have tearing from the fistula, the eye or both. The clinical features of 60 patients are reviewed, including presenting symptoms, presence of other lacrimal or systemic anomalies and morphology of the fistula. A detailed description is given of the surgical technique utilised in patients whose symptoms warrant surgical intervention. The results of this technique are presented and alternative treatment strategies are discussed. Theories of the aetiology of the condition are reviewed and morphological and histological evidence is presented to support our belief that congenital lacrimal fistulae represent aberrant canaliculi.

Management of Epiphora in the Presence of Congenital Punctal and Canalicular Atresia

We treated ten eyes in six pediatric patients with epiphora and punctal and canalicular atresia in one or both lids. Attempted probing and irrigation had failed to improve the epiphora. Nine out of ten of the lacrimal systems had additional anomalies, such as cutaneous lacrimal fistulas (anlage ducts), small sacs, and nasolacrimal duct stenosis or obstruction. A surgical plan is described for the exploration and reconstruction of these markedly abnormal nasolacrimal drainage systems, including a new method of performing bicanalicular intubation. Four of the five eyes with at least part of one canaliculus present have had resolution of epiphora.

CT Scan of Cutaneous Lacrimal (Anlage) Fistula

We report CT visualization of both a rare congenital lacrimal fistula and a large mucocele of the lacrimal sac on the opposite side of the same patient. CT scan visualization of a patent anlage fistula has not been reported previously. CT scans can demonstrate extensive orbital abnormalities not detectable by routine clinical or radiologic evaluation.

Congenital lacrimal fistulas.

Twenty-one patients had surgical procedures for symptomatic cogenital lacrimal fistulas. The symptoms were epiphora from birth in 18 patients and late-onset epiphora in three cases. Thirteen patients had nasolacrimal obstruction at the upper duct or sac level. There were 21 dacryocystorhinostomies with fistula excision and canalicular intubation, and one patient had excision of the fistula tract only. The fistulas originated from the tear sac in only four cases and from the common canaliculus in 17; in one, the upper and lower canaliculus and the lacrimal fistula each had a separate opening into the lateral sac wall. The functional success rate was 95%. We recommend dacryocystorhinostomy with common canalicular dissection, fistula excision, and canalicular intubation for all patients with symptomatic congenital lacrimal fistulas to facilitate outflow and to avoid common canalicular obstruction.

Accessory Lacrimal Gland Fistula Secondary to Ptosis Surgery

This is a case report of the development of a lacrimal fistula following repeated anterior levator resections for severe ptosis. The fistula was excised and pathologically traced to an accessory lacrimal gland. This patient represented the first documented case following an accessory lacrimal gland as the source for a fistula following levator resections for ptosis.

A new technique for dacryocystorhinostomy.

In 1836, Montain 1 first described the use of a perforating trephine in the treatment of lacrimal fistula. He dilated the fistula and, introducing a trephine into the lacrimal fossa, perforated the bone with the trephine. He then packed the newly created opening with a gut suture and irrigated this twice daily. After ten to fifteen days, when the patient was discharged, the skin was healed. In 1897, Kyle 2 described a procedure for chronic dacryocystitis. The lower canaliculus was slit and dissected to the opening of the nasolacrimal duct. A trocar was then placed through the newly created fistula. The cannula was allowed to remain in place until the fistulous opening had epithelized, after which it was removed. This type of procedure was replaced by the type of external dacryocystorhinostomy first described by Toti 3 in 1904. An external skin incision was made over the anterior lacrimal crest. The

Lacrimal Fistula : A Surgical Technique Based on Dacryocystography

Lacrimal Fistula : A Surgical Technique Based on Dacryocystography

WHY DO LACRIMAL FISTULAS, PHLEGMONS AND MUCOCELES ALWAYS APPEAR BELOW THE HORIZONTAL AXIS OF THE EYE?

It is a well known fact that when progressive inflammatory conditions of the tear sac advance sufficiently to change the normal contour of the region of the internal canthus, the swelling (phlegmon or mucocele) or fistula is always to be found below the horizontal axis of the eye (fig. 1). Even in phlegmonous cases in which the inflammation may extend above the eye the greater part of the swelling is always distinctly beneath the horizontal axis. In the literature, however, I find no exact explanation of this clinical fact, although it is constantly made use of in differentiating fistulas of the ethmoid and frontal sinuses from those of the lacrimal sac. Lacrimal fistulas perforate below the horizontal orbital axis, while fistulas of the frontal and ethmoid sinuses appear above this axis. An abscess always advances along the path of least resistance, and just as a psoas abscess follows the lumbar muscles, so there is a definite anatomic reason for inflammations of the lacrimal sac pointing below the horizontal axis of the eye.

Stereoskopischer Atlas der ausseren Erkrankungen des Auges nach forbigen Photographien fur Studium und arztliche Fortbildung mit begleitendem Text.

The fourth part of this "Stereoscopic Atlas" presents the following conditions : pterygium, epithelial tumor of the limbus, lacrimal fistula following injury to the skull, xerophthalmia following trachoma, melanosarcoma of the choroid, tuberculous iritis, zonular cataract, luxation of a calcified lens into the anterior chamber, metallic foreign body in the anterior chamber and vaccinia of the lids. The excellence of the colored photographs is maintained, and the new series shows many interesting pictures.