Lacrimal Obstruction Research Articles

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.

Polypropylene in Endoscopic Dacryocystorhinostomy: A Novel Stent.

Endoscopic dacryocystorhinostomy (DCR) is usually done in cases of lacrimal apparatus obstruction. The common causes of failure are that of obstruction in the common canaliculus and closure of the rhinostomy site. To overcome these problems we use stents. Stents most commonly used are that of silicon which are expensive and not readily available. As an alternative, polypropylene (Prolene; Ethicon) is used as a stent which is cheaper and readily available. This study is done to evaluate the clinical efficacy and results of stenting with polypropylene suture material in endoscopic dacryocystorhinostomy. Fifty one endoscopic DCR operations were performed between July 2013 to December 2014. After creating an aperture in the medial wall of the lacrimal sac, 3/0 prolene was inserted from lower punctum to neo ostium. The prolene was left in the lacrimal sac for 3weeks. The patients were followed up for 3months. In our study, most of the patients belonged to the age group of 41-60years (47%). There was female preponderance as 64.7% were females. 47 patients (92.2%) showed very good results. Two patients (3.9%) developed granuloma for which revision surgery was done. We lost 2 patients during follow up. This modification enables an easy, safe, effective and low-cost form of DCR. Prolene is cheaper and readily available. It might be used successfully in endoscopic dacryocystorhinostomy and is promising alternative to silicone stent intubations, especially in settings with limited resources.

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.

Postoperative long-term morbidity of extended endoscopic maxillectomy for inverted papilloma.

Extended endoscopic maxillectomy (Sturmann-Canfield procedure) allows full visualization of the maxillary sinus by sectioning the lacrimal duct and removing the medial part of the anterior maxillary wall. The aim of this study is to evaluate the morbidity of Sturmann-Canfield procedure in patients treated for inverted papilloma. The clinical records of all patients treated with a Sturmann-Canfield procedure for inverted papilloma from October 2000 to September 2015 at two teaching hospitals were reviewed. All patients were evaluated by nasal endoscopy and lacrimal system patency was assessed. Pre-maxillary cutaneous sensitivity was tested with a Semmes-Weinstein aesthesiometer and thermic stimulation. The SNOT-22 questionnaire was administered. Patients were also asked to report any other post-surgical complaints. Fifty-nine patients were identified. Mean follow-up after surgery was 66.3 months. Mean SNOT-22 score was 5.94 (range 0-20); the majority of patients (86%) had a SNOT-22 symptom score of 3 or lower. Mucocoele occurred in 3 (5%) cases. Lacrimal pathway obstruction was observed in 7 (12%) patients. Fourteen (24%) patients complained of paraesthesia in the malar area; hypoesthesia was present in only 5 (8%) cases. Hypoesthesia in the region innervated by the anterior superior alveolar nerve was detected in 17 (29%) patients. One patient reported a slight depression of paralateronasal soft tissues. Although nasal function outcomes and the results from SNOT-22 questionnaires were favourable, a high rate of neurologic and lacrimal complications was observed. Potential morbidity of the intervention, including the possibility of negative aesthetic sequelae, should be discussed during preoperative counselling.

Etiology, diagnosis, management and outcomes of epiphora referrals to an oculoplastic practice.

To investigate the etiology, diagnosis, management and outcome of epiphora referrals to an oculoplastic practice. Retrospective chart review of patients referred for epiphora to an oculoplastic clinic between 2005 and 2009. Patient demographics, past history, ophthalmic examination, treatment and outcome were analyzed. There were 237 subjects with a primary complaint of epiphora. They included 130 (55%) females and 107 (45%) males with an average age of 55.9±25.9y. The most common cause of epiphora was lacrimal obstruction (46%); followed by multifactorial epiphora (22%), reflex tearing (22%) and eyelid malposition (11%). Differences in prevalence of etiology were noted in terms of age and gender distribution. Of the 182 (77%) patients who returned for follow up, 41 (23%) reported a complete resolution and 102 (56%) reported a significant improvement in their symptoms. Epiphora is a common condition with many causes. A thorough history and examination are required to provide the appropriate treatment tailored to the underlying cause.

Management of Lacrimal Pathway Obstructions: A Deliberation

Management of Lacrimal Pathway Obstructions: A Deliberation

Endoscopic Transretracaruncular-Middle Meteas Tract for Insertion of a Porous Polyethylene-Coated Jones Tube.

The purpose of this article is to describe a modified lacrimal bypass with a porous polyethylene-coated Jones tube. A total of 180 patients (180 eyes) with a nonreconstructable lacrimal obstruction underwent lacrimal bypass with a porous polyethylene-coated Jones tube through a retrocaruncular-middle meatus tract approach with endoscopic assistance. All patients were followed up at least for 24 months. Success rate of lacrimal bypass was analyzed and complications were recorded. A total of 174 patients were finally included. Duration of surgery ranged from 28 to 47 minutes (mean 37.2 ± 4.2 minutes). The mean duration of follow-up was 30.0 ± 6.4 months (range 24-48 months). The mean tube length was 23.2 ± 1.9 mm (range 20-28 mm). At the final review, complete success was achieved in 138 (79.3%) patients. Moderate success was achieved in 23 (13.2%) patients, and 13 (7.5%) patients failed. Of the 161 patients successfully treated, 24 patients underwent revision surgery to excise granulomas (15 patients) or adjust tube position (9 patients). The complications included granuloma proliferation around the openings of the tube (28 eyes), downward displacement of the tube (17 eyes), and ocular discomfort (15 eyes). The majority of downward tube migration occurred in patients who had a prior history of dacryocystorhinostomy. The treatment failed for 5 patients because of repeated granulomas covering the nasal tube openings, and the treatment failed for 8 patients because of downward displacement of the tube. Our procedure appears to be an effective method for closed insertion of a porous polyethylene-coated Jones.

Conjunctivodacryocystorhinostomy with Jones tube: a history and update.

Current opinions and trends in the management of upper lacrimal obstruction include design variations on the original Lester Jones tube and updated awareness and management of the problems associated with the tubes. This article includes a brief review of the fascinating history of the development of the Jones tube, which sets the perspective for the current scientific dialog. First, many design modifications have been proposed to reduce the risk of tube migration and extrusion, with no consensus on the best tube. Second, the issue of retrograde airflow through the Jones tube with the use of continuous positive airway pressure is an increasingly common and challenging problem. Third, bacterial biofilms on the surface of the Jones tube can play a role in recalcitrant infections. Jones tubes can be cleaned or replaced in the office setting with topical anesthesia. Conjunctivodacryocystorhinostomy (CDCR) with placement of a Jones tube remains the gold standard for management of upper lacrimal obstruction. This article provides an updated perspective on issues with extrusion or migration of the tube, bothersome retrograde airflow with the use of a continuous positive airway pressure device, and management of crusting and possible infectious biofilms on the tube.

Resection of anterior canalicular wall and lacrimal stent intubation for lacrimal canaliculitis

Objective To study the clinical efficacy of resection of anterior canalicular wall and lacrimal stent intubation for lacrimal canaliculitis. Methods A paralleling eyelid incision about 3 mm away from the margin was performed to expose the bulgy canaliculus. The canaliculus was cut parallelly and the purulent secretion, calculus and granulation tissue were removed.The two ends of a soft silicone stent were implanted via the superior and inferior punctum and were pulled out from nasal cavity where they were tied. The redundant dilated anterior wall canaliculus was resected and the posterior wall was sutured with 8-0 absorbable suture for wrapping up the stent. The follow-up time was 6-12 months. Results The suture of the skin was removed 1 week after the operation, and the stent was taken out 3 months after the operation. After follow-up of 6-12 months, the lacrimal passages were irrigated successfully on 32 cases (32 eyes) among the total 34 cases(34 eyes), accounting for 94.12%. Two patients had recurrent lacrimal passage obstruction, and it caused by stent falling off one week after the operation in one patient. The canaliculus had no purulence with open puncta and resetting eyelid. Conclusion Canaliculus hemisection combined with lacrimal stent intubation is an effective way with low recurrent rate for treating canaliculitis and reconstructing the canaliculus, especially for inferior canaliculitis. Key words: Canaliculitis; Canalicular hemisection; Lacrimal stent intubation

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.

Clinical observation of laser ablation combined with lacrimal duct intubation for the treatment of chronic dacryocystitis

Objective To observe the clinical efficacy of laser ablation combined with lacrimal duct intubation for the treatment of chronic dacryocystitis with other lacrimal passage diseases. Methods A total of 310 eyes of 264 cases diagnosed as chronic dacryocystitis with lacrimal duct stenosis or obstruction who received laser lacryocystoplasty and silicone stent intubation in our hospital were retrospectively analysed. The follow-up time was 6-12 months. The patient's symptoms and lacrimal passage irrigation condition after extubation were analysed. Results There were 272 eyes recovered(87.74%), 27 eyes improved (8.71%) and 11 eyes invalid(3.55%). Conclusion Laser ablation combined with lacrimal duct intubation has good curative effect, few damage, low cost and doesn't change the normal lacrimal duct structure and affect the appearance, which can be considered as the preferred treatment for chronic dacryocystitis with other lacrimal passage diseases. Key words: Dacryocystitis, chronic; Diseases, lacrimal passage; Laser ablation; Intubation, stent

Use of the Crawford tube for symptomatic epiphora without nasolacrimal obstruction.

To evaluate the effectiveness of the Crawford tube in treating symptomatic epiphora without nasolacrimal obstruction. A protocol was adopted for the management of symptomatic epiphora without nasolacrimal obstruction. Patients who suffered symptomatic epiphora without nasolacrimal obstruction in both eyes were included in the study. One eye was treated with Crawford tube intubation and the other eye was treated with medication therapy. Degree of watering, patient satisfaction, and symptomatic improvement were carefully evaluated by one of the authors at the end of the follow-up period, after Crawford tube removal, to ascertain functional results. Thirty-seven adult patients (37 eyes) underwent Crawford tube intubation for functional epiphora. The mean follow-up time after removal of the tube was 14.8±4.8mo. The procedure was an overall success in 28 eyes (75.7%), with symptoms improving significantly. Two eyes (5.4%) were relieved of indoor epiphora, two (5.4%) had minimal epiphora outdoors, but only with wind or cold, and five (13.5%) continued to experience tearing both indoors and outdoors. Thirty of the patients (81%) expressed satisfaction with the procedure. Crawford tube insertion is an effective, safe, simple, and relatively noninvasive treatment strategy for functional lacrimal system obstruction.

Treatment choice in dacryostenosis based on single-photon emission computed tomography and X-ray computed tomography findings

To develop surgical indications in dacryostenosis within the vertical portion of lacrimal pathways that would consider findings of single-photon emission computed tomography (SPECT) combined with X-ray computed tomography (CT). A total of 96 patients with isolated vertical-portion dacryostenosis (127 cases) were enrolled. The examination included collecting Munk's scores for epiphora, optical coherence tomography of the lower tear meniscus, lacrimal scintigraphy, and SPECT/CT. Group 1 (40 cases) was composed of patients with lacrimal obstruction on CT, group 2 (87 cases) - of those whose lacrimal pathways proved passable. There were also 3 patients (4 cases) from group 1, whose lacrimal pathways, despite being blocked on CT, were still passable on SPECT. Surgeries performed in group 1 were endoscopic endonasal dacryocystorhinostomy (DCR) (36 cases) and pathways recanalization with bicanalicular intubation and balloon dacryoplasty (DCP) (4 cases). In group 2, all patients (87 cases) underwent recanalization with bicanalicular intubation (supplemented with balloon DCP in 32 cases). Surgical results were evaluated 8-12 months after the treatment. In group 2, particular attention was paid to the concordance in locations of dacryostenosis provided by CT and SPECT scans. Favorable outcomes of endoscopic endonasal DCR were obtained in as many as 32 cases from group 1 (88.9%), while in 4 cases (12.1%) the condition relapsed. Of those patients whose stenosis was not complete on SPECT, 3 cases (75.0%) improved, 1 (25.0%) - relapsed. In group 2, favorable outcomes were obtained in 65 cases (74.7%), relapses were 22 (25.3%). A high concordance in stenosis locations by CT and SPECT was noted in 60 cases of those who improved (92.3%) and 3 cases of those who relapsed (13.6%). The value of information provided by SPECT/CT has proved high in patients with nasolacrimal duct stenosis or obstruction. A combined scan allows to establish causal relationships between anatomical changes and functional failure of lacrimal pathways and to make an optimal treatment choice.

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

Congenital lacrimal obstruction: case series of probing and intubation

Objective: To evaluate the relationship between age at surgery in patients with congenital lacrimal obstruction and success achieved by them. Methods: We studied 94 medical records of patients diagnosed with congenital lacrimal obstructions, assisted at the oculoplastic sector of the Hospital de Olhos do Parana, in the period january 2006 to december 2012. For diagnosis and inclusion in the study, the clinical history were made, overall and specific ophthalmologic examination, with the tests: Milder and Observation Test of Fluorescein in the Oropharynx. To determine the type of intervention (probing or intubation) service criteria were used. In the statistical analysis, the chi-square and Student’s t test were used. Significance level of 5 % was adopted. Results: When comparing the results by age, regardless of treatment, there was no significant association (p = 0.223) between the rate of improvement and age. Conclusions: In the present study shows, there is no significant difference between the surgical interventions within the age groups addressed.

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

Nasolacrimal System Fractures: A Description of Radiologic Findings and Associated Outcomes.

Fractures of the bony nasolacrimal system (NLS), including the lacrimal sac fossa and nasolacrimal canal, have not been comprehensively described in patients with facial trauma. Characterization of these injuries may help facial trauma surgeons better predict which patients will develop lacrimal outflow obstruction symptoms including epiphora and dacryocystitis and who may eventually need lacrimal surgery. CT images for all patients seen at the University of Wisconsin Hospital and Clinics for craniofacial trauma were reviewed from January 2001 to December 2005. Patients were included if they had a NLS fracture and at least 1 year of follow-up. Fracture patterns were described and correlated with clinical outcomes documented in the medical record. Outcomes, including the development of epiphora or dacryocystitis and the need for lacrimal surgery, were analyzed using Fisher exact test. We identified 104 patients with NLS fractures among 1980 patients with craniofacial trauma who had at least 1 year of follow-up. Eleven patients (10.6%) developed epiphora or dacryocystitis, and 2 patients (1.9%) required dacryocystorhinostomy (DCR). Ten radiographic injury patterns were characterized. Avulsion of the lacrimal crest, bone fragment in the lacrimal sac fossa or duct, duct compression greater than 50%, and nasomaxillary buttress displacement were significantly associated with the development of epiphora or dacryocystitis (P < 0.05). Nasomaxillary buttress displacement was significantly associated with the eventual need for DCR (P = 0.03). Patients with radiographic evidence of NLS fracture have an approximately 10% risk of developing epiphora or dacryocystitis. We describe 5 NLS fracture findings that are significantly associated with the development of lacrimal outflow obstruction. The presence of nasomaxillary buttress fracture and displacement suggests a significantly higher risk of eventually needing lacrimal surgery.