Lacrimal Pathway Research Articles

Diversity in Lacrimal Pathway Morphology Among Patients with Congenital Nasolacrimal Duct Obstruction.

This prospective observational study aimed to explore the diversity in lacrimal pathway morphology among patients with congenital nasolacrimal duct obstruction (CNLDO) by examining dacryocystography (DCG) images. The study included 64 patients who underwent DCG before undergoing general anesthesia probing for unilateral CNLDO. Several parameters were measured from the lateral view of the DCG images: (1) the lacrimal sac (LS) and the nasolacrimal duct (NLD) angle, (2) the angle formed by the superior orbital rim (SOR), LS, and the NLD, (3) LS length, and (4) bony NLD length. Additionally, frontal views of the DCG images were utilized to measure (5) LS-NLD angle and (6) LS angle concerning the midline. The average age of the patients was 34.3 months. The mean ± standard deviation of the measurements of the above parameters was (1) -1.2° ± 16.5° (range: -44.6° ± 46.6°), (2) -5.0° ± 10.3° (range: -24.0° ± 19.0°), (3) 10.2 ± 2.4 mm (range: 6.5-16.0 mm), (4) 8.0 ± 2.5 mm (range: 3.1-14.8 mm), (5) 15.6° ± 11.2° (range: -16.8° ± 41.0°), and (6) 15.1 ± 5.2° (range: 3.3°-29.8°). All parameters, except for parameter (3), conformed to a normal distribution. This study provides valuable anthropometric data derived from DCG images, highlighting the substantial variability in lacrimal pathway morphology among patients with CNLDO. Furthermore, anatomical constraints made probing with a straight metal bougie anatomically infeasible in 25.0% of the patients included in this study.

Exclusive or combined endoscopic approach to tumours of the lower lacrimal pathway: review of the literature.

Exclusive or combined endoscopic approach to tumours of the lower lacrimal pathway: review of the literature.

Mono-canalicular Lacrimal Stent Intubation for Congenital Nasolacrimal Duct Obstruction Treatment

Background Epiphora, marked by tear overflow at the eyelid margin, is a prevalent condition in ophthalmology, affecting over 20% of infants. The causes involve hypersecretion due to anterior segment diseases or compromised lacrimal drainage systems. While congenital nasolacrimal duct obstruction (CNLDO) in children often resolves spontaneously, persistent cases may necessitate surgical intervention. The management, which includes probing, stent insertion, and dacryocystorhinostomy, remains challenging due to the miniaturized and variable anatomy of the lacrimal pathways. Objective and Aims This study aims to investigate the efficacy of mono-canalicular Lacrijet stent insertion in managing congenital nasolacrimal duct obstruction (CNLDO) in pediatric patients, particularly those aged over 24 months. It focuses on assessing success rates in cases with prior probing or no previous probing. The study aims to contribute valuable insights to the existing literature on the effectiveness of Lacrijet intubation as a management option for CNLDO. Patients and Methods A prospective observational study following 25 pediatric patients diagnosed with epiphora in an ophthalmology hospital. The procedure included using mono-canalicular Lacrijet intubation. Patients were followed for 180 days post-operatively via subjective and objective measures. Independent and paired t-tests were used for numerical variables. Chi-square was applied to check the significant association of variables with outcome. A p-value less than or equal to 5% is considered significant. Results More than half of the sample was 3-6 years of age (56%), males (52%), and had previous probing attempts (56%). Seven (28%) patients were relieved from symptoms within less than 5 days, 12 (48%) recovered within 5-9 days, and 2 (8%) patients were symptom-free after 10 days. The success rate was 84%. Only 4 patients (16%) had unsuccessful outcomes. There was no significant difference in outcome regarding patients’ age, gender, affected eye, previous probing, and site of intubation. Conclusions and Recommendations Mono-canalicular Lacrijet stent insertion appears as a simple, safe, and reliable outpatient procedure for treating CNLDO in children. Age and prior failed probing did not significantly impact success rates. Early and detailed assessments are recommended for children with epiphora, with consideration for mono-canalicular stenting. Future research could compare outcomes between probing and intubation as initial treatments for pediatric epiphora.

Evaluation of primary acquired nasolacrimal duct obstruction: Comparison of CT-DCG and dacryoendoscopy in accurately localizing the lacrimal drainage obstructions.

To correlate and evaluate the power and limitations of CT-DCG in determining the level and type of lacrimal duct obstruction in comparison to dacryoendoscopy in patients clinically suspected to be having partial or complete primary acquired nasolacrimal duct obstruction (PANDO). A retrospective chart review was performed on 1232 lacrimal drainage systems of 957 patients who suffered from primary acquired nasolacrimal duct obstruction (PANDO) at Shanghai Ninth People's Hospital. Patients were examined with CT-DCG and correlated with dacryoendoscopy and the findings of clinical examination. Of the studied patients, 173 were men and 784 were women with an age range of 18-93 years. Of the 1232 lacrimal pathways, good CT-DCG images could be obtained in 980 cases and dacryoendoscopy in 957 cases. Of these complete obstructions were noted in 81% (794/980), and partial obstructions were identified in 19% (186/980) with CT-DCG. CT-DCG and dacryoendoscopy showed 68.4% agreement for the type of the obstruction and 63% for the level of the obstruction. The majority of the obstructions occurred at the sac-duct junction (62.5%) followed by the upper half of the nasolacrimal duct (27.5%). There was a significant difference in the correlation of the obstruction type with age group and with the duration of symptoms. As the duration of symptoms increased, the proportion of complete lacrimal duct obstructions as shown on CT-DCG images increased and the proportion of incomplete obstruction decreased (p = 0.015). The junction of lacrimal sac and nasolacrimal duct was the most common obstruction site. Age and the duration of symptoms influenced the type of obstruction noted. The degree and level of agreement between the investigations was moderate. A combination of CT-DCG and Dacryoendoscopy could together identify the location more accurately.

Bicanalicular silicone intubation versus probing for the treatment of congenital nasolacrimal duct obstruction in children older than 2 years

Background One of the most common conditions presenting to the oculoplastic clinic is congenital nasolacrimal duct obstruction (CNLDO), with an incidence of up to 20% in young children. Early probing as early as 18 months of age is usually associated with very good results. Conversely, the results of probing in older children and the need for intubation, either primary or secondary, are debatable in different studies. Purpose The aim of this study was to compare the outcome of probing versus primary intubation in children older than 2 years having CNLDO. Patients and methods This prospective cohort comparative study was carried out on 40 eyes of 36 children, aged 2–7 years of both sexes, with epiphora due to CNLDO. The eyes were divided into two groups: group A that included 20 eyes that underwent probing, and group B that included 20 eyes that underwent intubation in whom the tube was removed after 3 months. The enrolled children were subjected to local ophthalmological examination, eye lid examination, puncti evaluation, regurge test, nasal evaluation, lacrimal pathway evaluation, and computed tomography dacryocystography before the procedure and 3 months after the procedure. Results The intubation group (group B) was found to have a higher success rate (90%) compared to the probing group (group A) (80%), although the difference was statistically insignificant (P=0.661). On univariate regression analysis, age, contrast volume, and most dilated portion of the lacrimal sac before the procedure were significant predictors for the success rate (P<0.001). In addition, there was a significant relationship between the success rate and age, most dilated portion, and contrast volume after the procedure (P<0.001). Conclusion There was a high success rate for both probing and intubation in older children above 2 years suffering from CNLDO. Although intubation was found to have a higher success rate, the difference was statistically insignificant.

Comparison of Outcomes of Silicone Tube Intubation with or without Dacryoendoscopy for the Treatment of Congenital Nasolacrimal Duct Obstruction

In this retrospective study, we compared and analyzed two groups of patients who underwent silicone tube intubation (STI) to treat congenital nasolacrimal duct obstruction (CNDO). We employed dacryoendoscopy to visualize the lacrimal pathways of one group. In total, 85 eyes of 69 patients were included (52 of 41 patients in the non-dacryoendoscopy and 33 eyes of 28 patients in the dacryoendoscopy group). Clinical characteristics, dacryoendoscopic findings, and surgical outcomes were evaluated. The overall STI success rate was 91.8%, and the success rate was significantly higher in the dacryoendoscopy versus non-dacryoendoscopy group (97.0% and 88.5%, respectively). For patients < 36 months of age, the success rate was 100% (23 eyes). All patients with Hasner valve membranous obstructions were younger than 36 months and had structural obstructions of the lacrimal drainage system (LDS) (p = 0.04). However, in patients lacking Hasner valve obstructions, LDS secretory (50.0%) and structural (50%) obstructions occurred at similar rates, which did not vary by age. Dacryoendoscopy-assisted STI enhanced the therapeutic efficacy of CNDO and identified diverse CNDO etiologies beyond Hasner valve obstructions. These findings emphasize the potential advantages of dacryoendoscopy in surgical treatment for CNDO patients.

Proportion and characteristics of lacrimal drainage pathway disease and keratopathy in non-infectious corneal perforation using lacrimal syringing test

AbstractLacrimal drainage pathway disease-associated keratopathy (LDAK) has been associated with corneal perforation, which arises from both infectious and non-infectious corneal disorders. However, patients with corneal perforation are often not routinely tested for LDAK, and the potential risk posed by LDAK in the development of corneal ulcers has not been investigated in detail. This study aimed to assess the proportion and characteristics of LDAK in patients with non-infectious corneal perforation using lacrimal syringing test. This study enrolled 56 patients with corneal perforation treated at Saitama Medical University Hospital between January 2016 and September 2022. The causes of corneal perforation were trauma (n = 17, 30%), infection (n = 19, 34%), non-infection (n = 16, 29%), and unknown (n = 4, 7%). A lacrimal syringing test was performed on 12 patients with non-infectious corneal perforation and 4 with an unknown diagnosis. Among the 16 patients with non-infectious corneal perforation, 13 (81%) had lacrimal drainage disease, but only 3 (19%) patients had lacrimal puncta, as revealed by slit-lamp examinations. The primary bacterial species identified in lacrimal obstructive disease and lacrimal canaliculitis were Staphylococcus spp. and Actinomycetes spp. respectively. Lower temporal and peripheral corneal perforations were common. All patients underwent lacrimal surgery, and 6 (38%) were treated for corneal perforation without corneal surgery. Interestingly, several patients with LDAK who did not exhibit any lacrimal duct obstruction on slit-lamp examination. The study findings demonstrate the significance of the lacrimal syringing test for assessing LDAK in patients with corneal perforation, indicating LDAK as a potential cause of corneal perforation.

Анестезиологическое пособие в дакриохирургии

Operations on the lacrimal pathways at present no longer represent complex orbital-nasal interventions, as it was 15–20 years ago, therefore, there may be an alternative to general anesthesia with reliable airway patency and its protection from aspiration. Aim of the study was to evaluate the advantages and disadvantages of various types of anesthesia and to determine the optimal one when performing various dacryosurgical interventions. Methods. The study group included patients aged 17 to 79 years with various forms of dacryostenosis, who, according to the results of a preoperative examination, were assigned to endonasal endoscopic dacryocystorinostomy and lacrimal recanalization with intubation. The patients were divided into 2 groups, the first of which underwent endonasal coblation dacryocystorhinostomy, the second – lacrimal recanalization with intubation. Each group was divided into 2 subgroups depending on the type of anesthesia chosen (general or local). Results. When performing endonasal endoscopic coblation dacryocystorhinostomy, 83.9 % of patients noted insufficiency of local anesthesia, and when performing recanalizing operations on the lacrimal tract, insufficiency of anesthesia was noted by only 18.5 % of patients. Conclusions. Endonasal dacryocystorhinostomy, despite the innovations that have turned it into a minimally invasive procedure, remains a painful operation, for which general anesthesia is preferable. Flexible laryngeal mask creates optimal conditions during awakening and provides protection of the respiratory tract after performing all types of dacryosurgical interventions. Key words: dacryology, anesthesiology, anesthesia, dacryosurgery, dacryocystorhinostomy, lacrimal recanalization, lacrimal pathways.

Хирургическое лечение базалиомы внутреннего угла глазной щели с закрытием дефекта свободным лоскутом. Клинический случай

Basal cell carcinoma is a tumor of the basal layer of the skin epithelium. It occupies an intermediate position between benign and malignant tumors. It develops from atypical basal cells of the epidermis and follicular epithelium. It does not metastasize. The occurrence on the lower eyelid is about 65 %, on the medial canthus about 15 %, on the upper eyelid about 15 % and on the lateral canthus 5 % of cases. Usually the neoplasm is painless, but more invasive basal cell carcinomas with perineural germination into the tissues of the eyelid and orbit can cause pain [1, 3]. The choice method of treatment of this disease is surgical. The operation is performed under a microscope, which allows to remove the altered tissues as much as possible and correctly match the edges of the donor material. To replace the surgical defect, a type of plastic was chosen: plastic with local tissues, free skin plastic. The skin flap was taken from the upper eyelid of the fellow eye [2]. There are several types of basal cell carcinomas: nodular, flat, and superficial. The nodular form is most common. A distinctive feature in most cases is pearl shade and waxy or translucent consistency of the tumor, more noticeable on the raised edges of the neoplasm. A characteristic and important symptom is telangiectasis marked at the edges of the neoplasm [1]. Initially, a painless nodule appears on the skin gradually, the nodule spreads over the area, accompanied by formation of ulcers, due to disturbance of blood supply and turns into ulcerative-nodular form. Ulceration can bleed. Further, basal cell carcinoma turns into a flat plaque with a peeling surface, a node protruding above the surface of the skin, or into a deep ulcer that destroys the underlying tissues. With advanced forms or inadequate treatment, the tumor can grow into the lacrimal pathways, the orbit and occasionally into the cranial cavity. The sprouting of orbital tumor causes diplopia and dislocation of the eyeball. Spontaneous regression is rare [3]. There are the following types of treatment: radiation, surgical, combined, medicinal, cryogenic, laser [4, 5]. Radiation, laser, cryogenic methods of treatment are carried out in a specialized cancer center. The surgical method is based on excision within healthy tissues with the least traumatization or destruction of surrounding tissues. Excision of a part of the eyelid weakens its horizontal tension; this circumstance requires special restorative techniques to prevent scarring. The choice method of the defect closure is the method of lateral displacement, plastic with a free flap or pedicle flap [4, 5]. Key words: basal cell carcinoma; surgery of basal cell carcinoma; plastic surgery with a free flap.

Сроки и способы лечения дакриостенозов детского возраста

Congenital dacryostenosis (congenital obstruction of the nasolacrimal duct, or CNLDO) is a congenital obstruction of the lacrimal system structures. Usually, the cause of dacryostenosis is blockage of the duct, less frequently – dysgenesis of the lacrimal pathways, including bone abnormalities, stenosis throughout the lacrimal system. Inconsistency of data on the optimal timing of probing, its impact on efficiency, lack of clear criteria for transition from probing to intubation of the lacrimal ducts and operation to create anastomosis, prompted us to this study. Aim. A retrospective analysis of the results of treatment of patients with childhood dacrystenosis and determination of the optimal tactics of their treatment. Methods.The study included patients from 0 to 15 years old with complaints of lacrimation and purulent discharge from one or both eyes from infancy. The first group consisted of patients who at the initial stage underwent probing of tear ducts according to standard procedure. The second group of the study consisted of patients who applied to the clinic after a number of ineffective probing procedures performed in medical institutions at their place of residence. Patients in this group underwent recanalization of the tear ducts with temporary intubation with a polyurethane stent. Results. The study demonstrated absence of a significant difference in the effectiveness of primary probing of tear ducts in groups of children of different ages. Recanalization of the lacrimal pathways with intubation with a polyurethane stent is a highly effective method of treating congenital dacryostenosis used in absence of recovery after twice repeated probing of the lacrimal pathways. The effectiveness of this method decreases in patients older than 3 years, which is associated with long-existing inflammation of the lacrimal sac walls, extension of the lacrimal tract above the level of stenosis, leading to the formation of foci of restenosis after removal of the stent. Conclusions. Performing primary deep probing is an effective method of treating congenital dacryocystitis in children under 2 years of age. The effectiveness of this procedure does not depend on age at the time of the procedure, however, in case of delayed execution, there is a need for general anesthesia when performing the intervention. Recanalization should be recommended to patients with the ineffectiveness of double probing of the tear ducts. Persistence of complaints of purulent discharge after removal of the stent from the lacrimal tract is an indication for endonasal dacryocystorinostomy. Key words: congenital dacryocystitis; lacrimal pathways probing; recanalization; intubation; endorhinoscopy; lacrimation; epiphora.

Endoscopic dacryocystorhinostomy as treatment for lacrimal pathway obstructions: Serial case reports

Introduction: The lacrimal system is an important system for maintaining the normal condition of the ocular surface. Obstruction of the lacrimal duct can lead to inflammation and accumulation of debris and pathogens such as bacteria or fungi in the lacrimal sac and then cause dacryocystitis. This disease is often found in children or adults over 40 years of age, especially women with a peak incidence at the age of 60 to 70 years. Complaints usually include eye discomfort and redness accompanied by excessive tears. The diagnosis can be made based on physical examination, staining tests, and imaging photographs, such as dacryocystography, computed tomography (CT), and magnetic resonance imaging (MRI). Management of dacryocystitis is conservative, supportive, and surgical with an open or endonasal approach.

Evaluation of Distal Occlusions accompanying Punctal Stenosis using Radionuclide Imaging in patients with Unilateral Epiphora

Objective: Our objective was to evaluate distal occlusions accompanying punctal stenosis, which can lead to impaired nasolacrimal drainage in patients with punctal stenosis, using radionuclide imaging. Material and Methods: Our study enrolled 42 patients who had unilateral punctal stenosis and experienced epiphora on the same side. None of the patients had previously undergone surgical intervention for this condition. Ophthalmological examination results were normal on the unaffected side. Dacryoscintigraphy was performed bilaterally, and specific regions of interest were identified. The scintigraphic images were assessed quantitatively and qualitatively by two nuclear medicine specialists. Evaluation between the nuclear medicine specialists was conducted using the McNemar Bowker test and the Kappa test. Results: Eighty-one percent (34) of the patients were female. The mean age of the patients was 68.23±9.67 years. In patients with punctal stenosis, the punctal area exhibited edematous features. The lacrimal drainage pathway from the punctum was assessed by two nuclear medicine specialists using two different methods. In the visual quantitative evaluation to determine the localization of the stenosis, there was a low to moderate agreement between the two observers (p=0.018, kappa value=0.252). In the quantitative evaluation, there was excellent agreement between the observers (p=0.0001, kappa value=1). Conclusion: Dacryoscintigraphy is preferred as an imaging method due to its non-invasive nature that does not disturb the physiological processes. It offers advantages such as lower radiation exposure and higher patient compliance compared to dacryocystography. However, it should be noted that the anatomical correlation in dacryoscintigraphy is relatively low compared to radiological methods. By incorporating quantitative data into the visual assessment of dacryoscintigraphy, it may be possible to enhance anatomical correlation and improve observer agreement, particularly in patients presenting with a combination of functional and anatomical obstructions.

Ультразвуковая эндоназальная дакриоцисториностомия в лечении рецидивирующего дакриоцистита новорожденного

Purpose. To evaluate early and long-term functional and anatomic results of surgical treatment of lacrimal pathways obstruction (LPO) in children with endonasal dacryocystorhinostomy (EDCR) method using ultrasound bone tissue dissector for the formation of nasolacrimal anastomosis. Material and methods. Surgical treatment of recurrent dacryocystitis of newborn (DN) after repeated unsuccessful «blind»lacrimal pathways probing in children with nasolacrimal duct obstruction, including cases of congenital nasolacrimal duct atresia. Bone «window» of the nasolacrimal anastomosis during endoscopic EDCR was formed using SONOCA 185 piezoelectric ultrasound dissector. In total, 14 children, 8 girls and 6 boys aged from 3 to 11 years (mean, 6 years) were operated with follow-up period of 6 months. Results. It was found that in all the children an adequate nasolacrimal anastomosis was formed without significant bleeding episodes both intraoperatively and in the early post-op period. No cases of destruction of the medial wall of the lacrimal sac were marked. Functional success was achieved in 92.8% (13 of14 cases). In 7.2% (1 of 14cases) there was a postoperative granuloma of the mucous in the rhinostoma region which was a partial obstacle for tear flow. Conclusions. Controlled low temperature process of nasal bones ultrasound dissection during EDCR in children allows formation of an adequate bone «window»and, therefore, a valuable nasolacrimal anastomosis in narrow nasal passages, makes the surgical procedure much easier and quicker, enables better healing of soft tissues in a shorter period. Key words: recurrent dacryocystitis of newborns, endonasal endoscopic dacryocystorhinostomy, ultrasound dissection of bone tissue

Valvular system of the lacrimal drainage pathway and the valve of Rosenmüller

The valves of the lacrimal drainage system are an enigma with a rich eponymous history. The unidirectional flow of tears along with the ultrastructural demonstration of distinctive mucosal folds on the luminal surface has rekindled an interest in them. The first in vivo direct demonstration of the valve of Rosenmüller and its functions has laid to rest some of the controversies of its existence and that of the valve of Huschke. The dynamic assessment of the valve of Rosenmüller has shown a well-defined functional role in the facilitation of unidirectional tear flow. The present mini review describes the embryological aspects, brief overview of the eponymous valves, techniques for their identification along with recent structural and functional aspects of the valve of Rosenmüller.

Accuracy of the Lacrimal Syringing Test in Relation to Dacryocystography and Dacryoendoscopy.

This study aimed to evaluate the accuracy of the lacrimal syringing test (syringing) in relation to dacryocystography (DCG) and dacryoendoscopy (DE) in lacrimal pathway (LP) obstruction. We retrospectively reviewed 101 patients (188 LPs) who underwent syringing, cone-beam computed tomography (CBCT)-DCG, and DE to diagnose the degree and site of LP obstruction. The degree of obstruction was classified into patent, partial obstruction, and complete obstruction. The degree of LP obstruction was determined by combining the findings of DE and CBCT-DCG and was designated as DCG+DE. When differentiating complete or partial obstruction on DE was uncertain, complete or partial obstruction was assigned if the DCG showed evidence of contrast media obstruction or passage, respectively. The consistency between syringing and DCG+DE was evaluated by calculating the weighted kappa coefficient. The sensitivity and specificity of syringing were 94% and 89%, respectively. The weighted Cohen's kappa value of agreement between syringing and DCG+DE was κ = 0.73 (SE = 0.04, 95% confidence interval [CI]: 0.66-0.80,p < 0.01). When divided into presaccal and postsaccal obstruction categories, the kappa values were κ = 0.40 (SE= 0.11, 95% CI: 0.19-0.62,p < 0.01) and 0.55 (SE= 0.09, 95% CI: 0.37-0.73,p < 0.01), respectively. Furthermore, when limited to common canaliculus obstruction (stenoses), which accounted for 78% (46 LPs) of the total presaccal obstructions, the kappa value was κ = 0.29 (SE= 0.12, 95% CI: 0.05-0.54,p = 0.021), which demonstrated the lowest consistency between syringing and DCG+DE. Syringing was "substantially" in agreement with DCG+DE in detecting the degree of LP obstruction. Moreover, syringing was a sufficiently sensitive and specific test when performed by an experienced clinician. However, distinguishing between complete and partial obstructions by syringing was sometimes difficult, particularly in the common canaliculus obstruction (stenosis).

Сases of lacrimal system affection after Coronavirus infection

In the present article, cases of lacrimal apparatus conditions emerging after a new Coronavirus infection COVID-19. The aim of the study is to determine the causes of epiphora in patients after Coronavirus infection.&#x0D; 26 patients (30 eyes) were examined, aged from 28 to 70 years, complaining of tearing, which emerged for the first time ever not earlier than 514 days from the onset of the laboratory-confirmed Coronavirus infection COVID-19, which had a mild or a moderately severe course and was accompanied by anosmia.&#x0D; In patients, following conditions of the lacrimal system were revealed: in 22 patients, there were pathological changes of the horizontal portion of lacrimal pathways; in 6 people dry eye syndrome was diagnosed: in 3 people, it was of mild severity, manifested by hyperlacrimia, 3 people had moderate severity of the dry eye syndrome. As concomitant, following signs were revealed: in 7 patients rhinologic conditions were present, in 2 people neurologic signs.&#x0D; In the examined group of patients with epiphora, we found that in 1.53 month after Coronavirus infection COVID-19 with anosmia, as a common sign of the disease in more than a half of cases, a development of pathological changes of the horizontal portion of lacrimal pathways was revealed.

Endoscopic “retrograde” dacryocystorhinostomy: A fast route to the lacrimal sac

Endoscopic Dacryocystorhinostomy (DCR) is an established surgical technique for the management of peripheral nasolacrimal duct (NLD) obstruction. Its main points are the correct identification of the lacrimal sac and the execution of surgical procedures that allow a rapid and accurate healing of the surgical field. The main endoscopic landmarks used for the identification of the lacrimal sac are the middle turbinate and the maxillary line.However, in some cases, this procedure can be difficult due to several factors (e.g. anatomical variations, former surgery).In the present study, a variation of “classic” endoscopic DCR, named “retrograde” endoscopic endonasal DCR (rDCR), is described. rDCR is performed through the quick identification of the NLD at the level of the most anterior insertion of the inferior turbinate in the lateral nasal wall. In most cases, at this level only a very thin shell of bone is present (crack point), easily fractured by using blunt angled dissector. The duct is then followed upward along its course by removing the overlying bone in order to correctly identify the lacrimal sac and unequivocally drill along the lacrimal pathway. This technique proved to be a safe, quick and effective procedure, even in patients with difficult anatomy.

Idiopathic acquired dacryocystocele in an adult: case report of a rare entity

BackgroundIdiopathic acquired dacryocystocele in adults is a rare disorder of the lacrimal drainage pathway. Only 20 cases have been reported in the literature. It presents with a triad of epiphora, medial canthal swelling, and recurrent dacryocystitis. Patients presenting without recurrent dacryocystitis is quite uncommon. This presentation can be confused with secondary nasolacrimal duct obstruction and other non-inflammatory pathologies. Dacryocystorhinostomy with stenting is the treatment employed in most reported cases.Case presentationA 24-year-old male presented with epiphora and medial canthal swelling for 3 years. Examination revealed features of left nasolacrimal duct obstruction. Imaging was suggestive of a cystic, homogenous, non-enhancing lesion in the left lacrimal sac region without bone destruction. Findings were suggestive of dacryocystocele. Patient underwent endoscopic dacryocystorhinostomy without stenting. Postoperatively, the swelling and epiphora resolved. Patient is symptom-free on follow-up.ConclusionIdiopathic dacryocystocele must be considered in evaluation of a medial canthal mass with epiphora without dacryocystitis. Conservative treatment is ineffective. Endoscopic dacryocystorhinostomy is safe and effective.

Non-contrast MR dacryocystography for the evaluation of epiphora and recurrent dacryocystitis: A preliminary study.

Obstruction of the lacrimal drainage represents a common ophthalmologic issue. The blockage may interest any level of the lacrimal drainage pathway, and it is important to find the site of obstruction to plan the most appropriate treatment. In this study, findings from magnetic resonance (MR) dacryocystography were compared with findings from endoscopic and surgical procedures to evaluate the accuracy of MR dacryocystography in localizing the site of nasolacrimal duct obstruction. We enrolled twenty-one patients with clinical suspicion of nasolacrimal duct obstruction who underwent dacryoendoscopy and surgery. MR dacryocystography was performed with a heavily T2-weighted fast spin echo sequence in the coronal planes. Before the MRI was performed, a sterile 0.9% NaCl solution was administered into both conjunctival sacs. For each examination, two independent readers (with 8 and 10years of experience in head and neck imaging) evaluated both heavily 3D space T2-weighted and STIR sequences. Stenosis/obstruction of nasolacrimal duct or lacrimal sac was diagnosed in all 21 patients who underwent MRI dacryocystography. In particular, the site of the obstruction was classified as lacrimal sac in 12 (57%) patients, nasolacrimal duct in 6 (29%) patients, and canaliculi in 3 (14%) patients by both readers. By comparison with the evidence resulting from the endoscopy, there were differences between MRI dacryocystography and dacryoendoscopy in the evaluation of the obstruction's site in three patients, with an overall accuracy of 85.7%. MR dacryocystography allows a non-invasive evaluation of the lacrimal drainage pathway, valid for the planning of the most appropriate treatment.

Изучение методов оперативного лечения травматических разрывов слезных канальцев

Despite the fact that the injury of the lacrimal canaliculi occupies about 3.5% of the pathology of lacrimal drainage, the problem of restoring them while maintaining patency is a rather urgent problem of dacryology. The use of traditional methods of patency restoration with the use of a «pig tail» type probe can lead to injury to the mucous membrane of the lacrimal canaliculi or the formation of false passages. Sometimes, with successful recanalization after removal of stents from the lacrimal tract in the postoperative period, it is possible to preserve their obstruction and the manifestation of symptoms of lacrimation. The aim of our work was to evaluate various methods of surgical treatment of patients with lacrimal canaliculi ruptures after their injury. The materials and methods of the study were presented variants of surgical aids performed in patients with lacrimal canaliculi damage. In total, we examined 28 patients: 16 in the first and 12 in the second group, respectively. The purpose of the applied surgical aids was the reconstruction of the lacrimal canaliculi and their simultaneous stenting using various techniques. After the surgical aid and prolonged stenting, we differentially evaluated the functional result in the study groups. As a «positive» result of the study, not only anatomical restoration of patency of the lacrimal pathways was accepted, but also the absence of lacrimation in patients. As a result of our work, we concluded about the anatomical and functional effect of the studied methods of surgical treatment in groups of patients with different severity of injury and different methods of treatment in patients with traumatic pathology of lacrimal drainage. As a conclusion of the study, a differentiated approach to choosing a surgical aid for traumatic damage to the lacrimal canaliculi is proposed. Keywords: lacrimal canaliculus injury, lacrimal canaliculi stenting, bicanalicular and bicanaliculonasal intubation, epiphora