Compression Of Lacrimal Sac Research Articles

Is surgical intervention avoidable in congenital nasolacrimal duct obstruction (CNLDO)

A prospective, interventional study was conducted to determine whether surgical intervention can be avoided in infants with CNLDO by a proper conservative management.The study was conducted from March 2013 till December 2019. 338 prospective cases presenting with epiphora, eyelid discharge and regurgitation on lacrimal sac compression were included in the study.Out of these, 166 were females (49.11%) and 172 males (50.88%). The age at enrolment was 1-47 weeks (median 23 weeks, mode 21 weeks), with 31 premature babies, (9.2%). The cases were divided into Primary (41 cases, 12.13%), who presented early with no prior therapy & Secondary categories (297, 87.86%), who presented late and had been using topical antibiotics and sac massage. Patients’ care-takers were taught the proper technique of lacrimal sac compression with a cottontip. Topical Tobramycin eyedrops were prescribed 3 times daily for 5 days only to cases with a purulent discharge or eyelid swelling. Regular follow-up was conducted at 1, 3, and at 6 months after the initial visit. 316 cases (93.49%) had a complete resolution of epiphora and discharge on lacrimal sac compression. 22 cases (6.50%) were symptomatic at the end of study and needed surgical probing. A complete resolution of symptoms and signs was significantly higher in unilateral cases than bilateral (p=0.001). There was no significant difference amongst genders (p=0.684), or amongst primary versus secondary cases (p=0.062); they all responded to the correct conservative management. CNLDO can be resolved conservatively by a proper technique of sac compression and eyelid cleaning, which must be performed regularly, and continued till the infant is one year old, in order to avoid recurrent symptoms.

Congenital nasolacrimal duct obstruction update study (CUP study): paper I-role and outcomes of Crigler's lacrimal sac compression.

To assess the exclusive role and outcomes of Crigler's lacrimal sac compression in the management of congenital nasolacrimal duct obstruction (CNLDO). Retrospective interventional case-series was performed on patients diagnosed with CNLDO and who were advised Crigler's lacrimal sac compression (CLSC) at a tertiary care Dacryology Institute from Jan 2016 to June 2019. CNLDO patients who were practicing incorrect techniques of lacrimal sac compression at presentation were separately assessed. All the patients were assigned to four groups (Gr 1: 0-3 months, Gr 2: >3 & <6 months, Gr 3: >6 & <9 months and Gr 4: >9 and <12 months) based on the age at which the CLSC was initiated and followed up quarterly or as needed till at least1 year of age. The parameters studied include patient demographics, clinical presentation, age of initiation of CLSC, success rate with CLSC, and need for additional interventions. Success was defined as the subjective resolution of epiphora and discharge with objective measures of normal tear meniscus height and dye clearance on fluorescein dye disappearance test. A total number of 1240 patients with CNLDO were assessed. Of these, 1037 patients were advised correct techniques of CLSC from the beginning, and the remaining 203 patients were referred but performing it incorrectly at presentation. Of the 1037 patients, 236 were lost to follow-up; hence, a total of 1004 patients (801 + 203) were included for final analysis. CLSC was found to be an effective conservative strategy in the management of CNLDO. The rate of resolution of CNLDO in Gr 1 to Gr 4 was 87.3%, 78.9%, 77.9%, and 76.8%, respectively. There were no statistically significant differences in the outcomes based on the age of CLSC initiation. The referred patients whose techniques were rectified following the initial incorrect techniques showed a resolution of 61.2% (79/129). The correct techniques of CLSC appeared to influence the outcomes. However, the age of its initiation did not substantially impact the outcomes. Significantly high resolution was noted even beyond nine months of ageand encouraging results beyond 12 months of age. It is crucial to initiate the correct techniques of Crigler's lacrimal sac compression to achieve favourable outcomes. Age of initiation of CLSC in infancy does not appear to influence the outcomes.The resolution rate continued to be significantly high up to 1 year of age. There is a need to assess the role of CLSC beyond 12 months of age.

Indian survey on practice patterns of lacrimal and eyelid disorders (iSUPPLE) report 1: Congenital nasolacrimal duct obstruction

BackgroundTo assess the preferred practice patterns in the management of congenital nasolacrimal duct obstruction (CNLDO) among oculoplastic surgeons in India. The survey was aimed at obtaining data on the timing of intervention, procedure of choice, and the use of adjunctive techniques such as silicone intubation and nasal endoscopy. MethodsAn anonymized survey that included questions on the management of lacrimal disorders was sent in April 2015 to members of the Oculoplastic Association of India (OPAI), through an e-mail communication. The results were tabulated and analyzed. ResultsA large proportion (84%) of respondents indicated that they advise lacrimal sac compression up to 1 year of age. Fourteen percent (12/87) indicated 2 years as their upper age limit for advising sac compression. One year is the preferred minimum age for advising primary nasolacrimal duct (NLD) probing by majority (45%) of respondents and the upper age limit being 5 years for 62% of respondents. Based on experience, younger surgeons (<10 years experience) when compared to more experienced surgeons are more likely to offer a trial of primary probing in children between 8 and 12 years age (29% versus 8%). Nasal endoscope is used by 50% (44/88) respondents during primary NLD probing. Nearly a third of the respondents (29/88) use intubation in all cases of NLD probing. Eighty one percent (71/88) of the surgeons would rather repeat NLD probing with adjunctive procedures over dacryocystorhinostomy (17%). Balloon Dacryoplasty is rarely used for CNLDO amongst our respondents. ConclusionsThis study highlights the variation in practice pattern in the management of CNLDO across India. While there are certain trends that are global phenomena, such as the shift towards the use of a nasal endoscope; use of silicone intubation in repeated procedures and time of performing primary NLD probing; issues like the use of balloon dacryoplasty showed lesser degree of agreement.

The Treatment of Dacryostenosis

<h3>To the Editor.—</h3> I am responding to the answer by Drs Cowden and Bergmann to the question by Dr Dave.¹While I agree that there is a high likelihood that Dr Dave's patient is suffering from recurrent conjunctivitis secondary to congenital dacryostenosis, I do not agree with the recommendations of the authors regarding treatment. The hallmark of treatment in dacryostenosis is hydrostatic nasolacrimal duct massage (lacrimal sac compression), as outlined by Crigler²and Price³and confirmed by Kushner.⁴Drs Cowden and Bergmann stated that antibiotic therapy and lacrimal sac compression would result in resolution of symptoms in 60% to 70% of cases. However, Petersen and Robb⁵reported that 58 (89%) of 65 obstructed nasolacrimal ducts managed with massage had resolution of their dacryostenosis by the 13th month of life. In a related study by Nelson et al,⁶95% of patients had resolution within seven