Nasolacrimal Duct Research Articles

Sustained Delivery of Olopatadine from Vitamin-E Loaded Contact Lenses.

Purpose: Topical antihistamines, such as olopatadine hydrochloride, an H1 receptor antagonist, are commonly prescribed for treating allergic conjunctivitis. Drug delivery via eye drops has many deficiencies including a short residence time due to tear drainage via the nasolacrimal duct, which results in a low bioavailability and potential for side effects. These deficiencies could be mitigated by a drug-eluting contact lens such as the recently approved ACUVUE® THERAVISION™ WITH KETOTIFEN which is a daily disposable etafilcon, a drug-eluting contact lens with ketotifen (19 μg per lens). Here, we investigate the feasibility of designing a drug-eluting lens with sustained release of olopatadine for treating allergies using an extended wear lens. Methods: Nanobarrier depots composed of vitamin-E (VE) are formed through direct entrapment by ethanol-driven swelling. The drug-loaded lenses are characterized for transparency and water content. In vitro release is measured under sink conditions and fitted to a diffusion control release model to determine diffusivity and partition coefficient. Results: In vitro studies indicate that ACUVUE OASYS® and ACUVUE TruEye™ lenses loaded with ∼0.3 g of VE/g of hydrogel effectively prolong olopatadine dynamics by 7-fold and 375-fold, respectively. Incorporation of VE into the lenses retains visible light transmission and other properties. Conclusion: The VE incorporation in commercial lenses significantly increases the release duration offering the possibility of antiallergy extended wear lenses.

Topical Application of Perchlorate: A Toxicity Study in Rats.

To investigate the ocular safety profile of topical perchlorate as a potential preventive treatment for nasolacrimal obstruction associated with excessive use of radioactive iodine therapy. Nine Wistar male rats (18 eyes) were randomly assigned to receive an ocular application (topical eye drop on the OD, 3 times a day for 5 days) consisting of either: 1) sterile saline solution, 2) 30 mg/ml NaClO4 or 3) 30 mg/ml KClO4. The rat eyes were examined daily for corneal cloudiness/clarity, discharge, mucous secretions, conjunctival injection, eyelid erythema, and/or changes in behavior. Seven days after the first dose, the rats were euthanized and OU were harvested, fixed, embedded in paraffin, and stained with H&E and Masson's trichrome using standard techniques. The data collected over the 7 days revealed no behavior changes or ocular complications in any of the 3 study groups. Pathologic analysis of the corneas revealed normal findings on all groups without signs of inflammation, fibrosis, or any other abnormality, and no difference between the treated and control eyes. The findings of this study suggest that the use of topical perchlorate is safe to use on eyes in high concentrations. The efficacy of this compound in minimizing fibrosis of the nasolacrimal sac and duct warrants further study.

Comparative study of surgical outcomes regarding tear meniscus area and high-order aberrations between two different interventional methods for primary acquired nasolacrimal duct obstruction.

To compare endonasal dacryocystorhinostomy (EN-DCR) with sheath-guided dacryoendoscopic probing and bicanalicular intubation (SG-BCI) by evaluating tear meniscus area (TMA) and total high-order aberrations (HOAs) for primary acquired nasolacrimal duct obstruction (PANDO). We retrospectively reviewed 56 eyes of 42 patients (7 men, 35 women; age, 72.7±13.1 years) who underwent EN-DCR or SG-BCI for PANDO in Toyama University Hospital from February 2020 to June 2022. In the EN-DCR and SG-BCI groups, we measured the patency of the lacrimal passage, preoperative and postoperative TMA, and HOAs of the central 4 mm of the cornea using optical coherence tomography (AS-OCT), six months postoperatively. There was a positive correlation between preoperative TMA and preoperative HOAs in all cases. Postoperative patency of lacrimal passage was 100% in the EN-DCR and 80.8% in the SG-BCI group. There was a significant difference in the number of passages between the two groups (p = 0.01). Preoperative TMA and HOAs showed a significant postoperative decrease in both groups (EN-DCR group: p<0.01, p<0.01, SG-BCI group: p<0.01, p=0.03, respectively). We then calculated the rate of change of preoperative and postoperative TMA and HOAs and compared them between the two groups. The rate of change was significantly higher in the EN-DCR group than that in the SG-BCI group (TMA, p=0.03; HOAs, p=0.02). Although both EN-DCR and SG-BCI are effective for PANDO, our results suggest that EN-DCR is more effective in improving TMA and HOAs.

The lacrimal apparatus as an organ at risk during radionuclide therapy

Within the framework of the article, the authors analyzed the available information about the damage to the lacrimal apparatus during radionuclide therapy. In focus of article lesions of the lacrimal production system, the main and accessory lacrimal glands, as well as lacrimal drainage are considered. It was found that damage to the lacrimal apparatus is characteristic of 131I therapy for thyroid cancer, as well as for radioligand therapy using anti-PSMA antibodies labeled with 177Lu and 225Ac. 177Lu-PSMA and 225Ac-PSMA may damage the lacrimal gland with the formation of a clinically pronounced "dry eye syndrome". The pathogenesis of such lesions is associated with the accumulation of a radioisotope in the tissues of the lacrimal apparatus, while during therapy with 131I, accumulation is realized due to the expression of the sodium-iodine symporter in the nasolacrimal duct, and during therapy with 177Lu-PSMA and 225Ac-PSMA, the radiobiological effect is realized in connection with the expression PSMA by lacrimal tissue. An analysis of the available sources showed that to date there are no results of systematic studies on the problem, there is a lack of knowledge regarding the individual risks of developing these complications, methods for their prevention that have proven effectiveness have not been developed, and the treatment methods used, having relatively low efficiency, are not specialized. The authors concluded that the strengthening of interdisciplinary interaction, as well as the organization verification methodology and correct studies, can contribute to solving problems related to the study of the complications under consideration.

An atypical medial canthal mass: a case of lacrimal sac inverted papilloma with literature review

Lacrimal sac localization of an Inverted Papilloma is extremely rare and no risk factors are reported in literature. A chemical trauma was followed by a painless, growing mass in the medial canthal area associated with epiphora. Rhinoendoscopy, Computed Tomography and Magnetic Resonance showed a well-defined mass in left lacrimal fossa extended to the nasolacrimal duct. An endoscopic resection and a dacryocystorhinostomy were performed. The aim of the present study is to show an atypical presentation of a well-known tumor along with a suspicious risk factor and to lead otolaryngologists to consider an inverted papilloma of the lacrimal system among lesions causing lateral nasal swelling.

Evaluation of the relationship between tear meniscus changes and quality of life outcomes after external dacryocystorhinostomy.

This study aims to investigate the effects of external dacryocystorhinostomy (DCR) surgery on tear meniscus parameters and assess its relationship with improvements in quality of life (QoL) in patients with nasolacrimal duct obstruction (NLDO). This prospective study included 30 patients diagnosed with NLDO who underwent external DCR surgery. Tear meniscus (TM) parameters, including height, depth and area, were measured using anterior segment optical coherence tomography. Lacrimal symptom questionnaire (LacQ), Munk scores and Glasgow benefit inventories (GBI) were collected. Statistical analysis was performed to evaluate the correlation between tear meniscus changes and improvements in QoL. TM height, depth and area decreased from preoperative median measurements (0.09mm2, 0.37mm, 0.56mm) to postoperative median measurements (0.03mm2, 0.21mm, 0.30mm) (p < 0.001). Lacrimal symptom scores and Munk scores showed a significant improvement at 3-month postoperatively (p < 0.001). The GBI scores also demonstrated a significant improvement, indicating a positive impact on the patients' QoL. (p < 0.001). A statistically significant correlation was found between the change in TM parameters and LacQ lacrimal symptom scores. External DCR surgery leads to significant improvements in tear meniscus parameters and quality of life outcomes in patients with NLDO. The decreased in TM height and TM area indicates improved tear film dynamics and decreased tear volume, which positively impact the patients' ocular comfort and overall well-being. This study highlights the importance of tear meniscus evaluation as a potential market for assessing the success of DCR surgery and its impact on patients' QoL.

Development and characterization of niosomes loaded mucoadhesive biodegradable ocular inserts for extended release of pilocarpine HCl

Abstract Background Pilocarpine HCl is a non-selective muscarinic receptor agonist that is prescribed for the treatment of glaucoma. The use of pilocarpine conventional eye drops is associated with several side effects, such as loss of visual acuity, and the need for several applications due to rapid drainage away via the nasolacrimal duct, especially for elderly people. Such adverse effects can lead to low patient compliance and poor clinical outcomes. Therefore, the aim of this project was to develop, optimise and characterise a biodegradable pilocarpine HCl ocular insert using niosomes as a drug delivery vehicle. To achieve that, various polymers such as hydroxypropyl methylcellulose (HPMC), polyvinyl alcohol (PVA), and a blend of both were investigated to prepare the ocular inserts using solvent casting technique. The niosomes of pilocarpine HCl were prepared using span-60 and cholesterol by thin film hydration method. The produced noisome-loaded ocular inserts were characterised using various analytical techniques, including Fourier Transform Infrared (FTIR), X-ray Diffractions (XRD), thermal analysis, particle size analysis, weight and content uniformity, surface pH and drug release profile, among others. Results The results indicated that drug-free ocular inserts of the two polymers (HPMC + PVA) were better than single polymer-based ocular inserts (HPMC or PVA alone). The formed niosomes demonstrated good entrapment efficiency of 49.7% ± 7.0, with an average particle size of 325.7 ± 3.5 nm. The FTIR analysis showed no interaction between the compositions of niosomes. Four optimal formulations with various co-polymer ratios and pilocarpine content were further evaluated. Pilocarpine-containing niosomes-loaded ocular inserts provided uniformity in pilocarpine content (89–96%), with 34.8% moisture content and an average pH of 7. The release profile of niosomes-loaded inserts demonstrated an initial burst release within 2 h ranging from 26.54% (T4) to 41.22% (T2), and continuous sustained release for the next 24 h (68.32 ± 5.11% (T4) to 82.11 ± 6.01% (T2)). Conclusions This work successfully optimised biodegradable ocular inserts containing slow-release pilocarpine HCl encapsulated in niosomes for the treatment of glaucoma without dose dumping, resulting in a user-friendly drug delivery system. Graphical abstract

Higher incidence of meibomian gland dysfunction in postmenopausal women with primary acquired nasolacrimal duct obstruction

PurposeThis study aimed to investigate the incidence of meibomian gland dysfunction (MGD) in postmenopausal women with primary acquired nasolacrimal duct obstruction (PANDO) and enables ophthalmologists to pay attention to ocular surface damage before surgery.Methods165 postmenopausal women with PANDO and 115 postmenopausal women with a normal lacrimal drainage system were enrolled in this prospective study. Based on the results of lacrimal duct irrigation and age, the participants were further subdivided. The incidence of different severities of MGD in different groups was calculated and analyzed by the chi-squared test.ResultsThe incidence of MGD in the PANDO group was 81.21%, and in the control group, it was 46.96%, which was significantly higher in the presence of PANDO (p < 0.001). The incidence of severe MGD in the complete and incomplete PANDO groups was higher than that in the control group (all p < 0.05), and no significant differences were observed between the complete and incomplete PANDO groups. The incidence of moderate MGD was significantly higher in the complete PANDO group than in the control group (p < 0.001). When age was considered an independent variable, the results revealed a significant value for patients aged < 70 years (p < 0.001).ConclusionsOur study revealed a prodominantly high incidence of MGD in postmenopausal women with PANDO, especially in a complete PANDO or aged < 70 years. Ophthalmologists need to pay close attention to MGD in postmenopausal women with PANDO.

Successful probing of Congenital Nasolacrimal Duct Obstruction on 11 years old child: A case report

Introduction : Congenital nasolacrimal duct obstruction (CNLDO) is a common cause of epiphora in infants; its prevalence rate of 5% to 20%, although only 2–6% will need intervention. The pathogenesis involves an imperforate membrane of the nasolacrimal duct but it may involve bony abnormalities and narrowing of the lacrimal drainage system.&#x0D; Case Illustration : An 11-year-old boy came to the hospital with complaints of a watery and excreted eye since he was born. On the dye disappearance test the result is +4. The patient was decided to have probing procedures. There was positive dye flow in the nasolacrimal duct after probing and irrigation with saline and dye. One week after the probing procedure, dye disappearance test was performed and the result is negative. Patients also no longer complain of watery and sticky eyes.&#x0D; Discussion : The management of CNLDO remains controversial. Probing can be used as a primary treatment for children &lt;36 months of age, where success rate of 78–93% can be achieved. For older children success rate is even less. Studies on older children between 25 and 60 months have shown failure rates as high as 28%. The prevalence of complex obstruction in children between 49 and 60 months was 43% with a success rate of only 33% on probing.&#x0D; Conclusion : Appropriate time for probing the CNLDO is still under debate. The high success rate of probing in patients older than 2 years old confirm that the first intervention could be probing before considering complex intervention.

Successful probing of Congenital Nasolacrimal Duct Obstruction on 11 years old child: A case report

Introduction : Congenital nasolacrimal duct obstruction (CNLDO) is a common cause of epiphora in infants; its prevalence rate of 5% to 20%, although only 2–6% will need intervention. The pathogenesis involves an imperforate membrane of the nasolacrimal duct but it may involve bony abnormalities and narrowing of the lacrimal drainage system.&#x0D; Case Illustration : An 11-year-old boy came to the hospital with complaints of a watery and excreted eye since he was born. On the dye disappearance test the result is +4. The patient was decided to have probing procedures. There was positive dye flow in the nasolacrimal duct after probing and irrigation with saline and dye. One week after the probing procedure, dye disappearance test was performed and the result is negative. Patients also no longer complain of watery and sticky eyes.&#x0D; Discussion : The management of CNLDO remains controversial. Probing can be used as a primary treatment for children &lt;36 months of age, where success rate of 78–93% can be achieved. For older children success rate is even less. Studies on older children between 25 and 60 months have shown failure rates as high as 28%. The prevalence of complex obstruction in children between 49 and 60 months was 43% with a success rate of only 33% on probing.&#x0D; Conclusion : Appropriate time for probing the CNLDO is still under debate. The high success rate of probing in patients older than 2 years old confirm that the first intervention could be probing before considering complex intervention.

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Introduction : Cyclopentolate eye drops 1% are frequently used during the cycloplegic refraction test. Cyclopentolate 1% side effects that are neurotoxic have the potential to be fatal but are extremely rare.&#x0D; Case Illustration : Thirty minutes after first drop of the cycloplegic refraction preparation, a 4-year-old kid had neurotoxic effects in the form of anxiety, disrupted communicative interactions, and hallucinations after receiving 3 drops of 1% cyclopentolate. Drug administration was stopped, and the patient was observed in the ER. After stopping the eye drops and being monitored in the ED for two hours, the condition improved.&#x0D; Discussion : &#x0D; Conclusion : Discussion: A cycloplegic medication that affects muscarinic receptors is cyclopentolate 1%. Administering eye drops is supposed to have a local effect on the eyes only, but frequently systemic effects can happen if there is absorption via the mucosa of the throat, nose, and stomach due to the eye drops' flow through the nasolacrimal duct when the medicine is instilled. One of Cyclopentolate's 1% uncommon adverse effects is neurotoxic impact, which can be fatal. When cyclopentolate interacts with the central nervous system's muscarinic receptors, this syndrome may result. The severity of the side effects increases with dosage and administration frequency, age and BMI, and dose. Focusing on the Lacrimal Canal during delivery and using the lowest dose of cyclopentolate are recommended to minimize side effects. Conclusion: Cyclopentolate 1% has a rare but potentially catastrophic side effect called neurotoxicity. Reduce the dosage of cyclopentolate, administer it properly dan using it combination with other cycloplegic can reduce adverse effects.

Effectiveness and Timing of Congenital Nasolacrimal Duct Obstruction Probing: a Systematic Review

Abstract&#x0D; Introduction &amp; Objectives : Most congenital nasolacrimal duct obstruction (NLDO) cases could resolve spontaneously or only require minimal conservative treatment. In unresolved cases, lacrimal probing is considered a primary treatment; however, no consensus on the best timing to perform probing is available. Therefore, this study aims to compare the effectiveness of immediate probing with deferred probing and to assess the best time to perform primary probing.&#x0D; Methods : A search for relevant literature was performed on four electronic databases: PubMed, Cochrane Library, EMBASE, and Scopus with predetermined keywords. The inclusion criteria consist of systematic reviews, RCTs, and prospective/retrospective studies published between 2013-2023 regarding lacrimal probing as an intervention for congenital NLDO.&#x0D; Results : We included seven studies. Three studies compared immediate and deferred probing, while four focused on the success rate of probing for NLDO at various age groups. Studies suggest immediate and deferred probing had a comparable effectivity in treating NLDO; however, one systematic review suggests immediate probing was superior to deferred probing. Studies also demonstrate that the success rate of probing declines with age. Lacrimal probing performed on NLDO patients under 12 months old had a success rate of more than 80%.&#x0D; Conclusion : Despite findings of comparable effectiveness between immediate and deferred probing, probing performed at a younger age yielded a higher success rate. This suggests that doctors should consider the patient's age at diagnosis to decide between immediate and deferred probing. Further evidence is needed to determine cut-offs for the best time to perform primary probing.

CORRELATION OF THE DURATION OF DOCETAXEL ADMINISTRATION IN BREAST CANCER PATIENTS WITH EPIPHORA DEGREES

Abstract&#x0D; Introduction &amp; Objectives : Epiphora is caused by excessive secretion and/or obstruction of lacrimal drainage system, malposition or weakness of the eyelids, failure of the nasolacrimal duct, and reflex tearing. Obstruction of the lacrimal drainage system can be caused by inflammatory processes in the palpebra, the use of certain medications or congenital abnormalities. Some drugs that are at risk of causing epiphora are chemotherapy drugs, especially 5-FU and docetaxel. Most epiphora were foundin weekly therapy than every 3 weeks therapy. Docetaxel causes epiphora, induces obstruction of the lacrimal drainage system and fibrosis of the stroma in the mucous layer of the lacrimal drainage system. According to Erkan et al, cases of recurrent or persistent and symptomatic epiphora had a Munk score of 2 to 4. This study interested in conducting research on the Correlation of the Duration of Docetaxel Administration in Breast Cancer Patients with Epiphora Degrees at RSUP Dr. Mohammad Hoesin Palembang.&#x0D; Methods : Cross sectional study with 25 samples suffering from breast cancer and experiencing epiphora at RSUP Dr. Mohammad Hoesin Palembang. The epiphora degree assessment is carried out using the Munk Score.&#x0D; Results : The sample was predominantly ≤50 years old as many as 21(84%) samples with a median 45 (23-64) years. The most dose of docetaxel was 70 mg in 20(80%) samples. Somer's D test showed that there was a significant correlation (p=0.021) between the duration of docetaxel administration to epiphora degrees and the strength of the strong correlation (r=0.645).&#x0D; Conclusion : The length of the docetaxel cycle is strongly correlated to having an epiphora

Lacrimal Sac Characteristics in Patients With Punctal and Canalicular Agenesis: Punctum Update (PUP) Study-Paper 3.

To explore the endoscopic and histopathologic characteristics of the lacrimal sac (LS) and the nasolacrimal duct in cases with punctal agenesis presenting with LS swellings. This is a prospective, interventional study of 13 LSs of 8 patients presenting with punctal agenesis and LS swellings over a 5-year study period (June 2018-July 2023). Complete ophthalmic examination was performed along with CT scans of the orbits. The LS was exposed with an anterior lacrimal crest incision and explored. The exterior and interior of the sac swelling were examined and LS flaps were sent for histopathological analysis. The mean age of the patients was 23 years with a male:female ratio of 5:3. All patients presented with swelling in the LS region. Occasional epiphora was the presenting feature in 6 patients. All patients had both upper and lower punctal agenesis on the affected side with associated LS swelling. CT scans showed a hypodense cystic swelling with expansion of the LS fossa and bony nasolacrimal duct ending abruptly short of the inferior meatus. Intraoperatively, the LS had thin, translucent walls with mucoid secretion and an absence of common canalicular opening. Histopathological analysis showed epithelium consistent with LS with less robust development of the sac walls and poorly structured lacrimal drainage-associated lymphoid tissue with scanty stromal inflammation. The development of LS and the nasolacrimal duct is structurally affected in patients with punctal agenesis. Retrograde approaches for epiphora resolution are not logical in such cases but conjunctivodacryocystorhinostomy with Jones tube can be a feasible option.

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.

Leczenie wrodzonej torbieli worka łzowego z użyciem technik endoskopowych – opis przypadku

Congenital lacrimal sac mucocele occurs in approximately 3% of infants with congenital lacrimal duct obstruction. Lacrimal sac mucocele is sometimes associated with a intranasal nasolacrimal duct cyst presenting as an intranasal cystic mass, which needs the involvement of an ophthalmologist and otolaryngologist in diagnosis and management. Bilateral cysts may cause in the early neonatal varying degrees of nasal obstruction, sleep disturbance, feeding difficulty and even respiratory distress. We present a case of bilateral dacryocystocoele with intranasal extension presenting as respiratory distress in a 7-day-old male newborn. The diagnosis was confirmed clinically and by computed tomography scan.

Surgical outcomes of endoscopic dacryocystorhinostomy for eyes with nasolacrimal duct obstruction via tear meniscus height evaluation.

To evaluate the association of tear meniscus height (TMH) with clinical outcomes of patients who underwent endonasal dacryocystorhinostomy. We recruited 304 patients from two institutes. The TMH was measured using anterior segment optical coherence tomography before surgery. All patients underwent endoscopic DCR with lacrimal intubation stent insertion. The lacrimal stent was removed 2months after surgery. The TMH was measured at 2months and 12months after surgery. Improvements in epiphora were assessed using a visual analogue scale (range, 0-2). Recurrence was determined based on lacrimal irrigation and endoscopic evaluation results. All patients experienced improvements in subjective symptoms 2months after surgery. The mean TMH also decreased significantly compared with that before surgery. During the follow-up period, four patients experienced recurrence. The mean TMH 12months after surgery was significantly lower than that before surgery. The rate of change in the TMH was significantly associated with the use of a dacryoendoscope during sheath-guided lacrimal stent intubation at all time points. Of the 251 patients who were followed up at 12months after surgery, three reported recurrences, and 17 reported mild improvement of epiphora. The rate of change in the TMH was significantly associated with epiphora improvement. Height was also associated with epiphora improvement. Endoscopic DCR is an acceptable surgical procedure for managing nasolacrimal duct obstruction. Sheath-guided lacrimal stent intubation using a dacryoendoscope resulted in a greater reduction in postoperative TMH compared to the blind insertion technique, which may lead to favorable clinical outcomes.

Comparison of success between external and endonasal dacryocystorhinostomy in primary acquired nasolacrimal duct obstruction in South India population

Background: Dacryocystorhinostomy (DCR) has been the standard procedure for primary acquired nasolacrimal duct obstruction (PANDO) for many years. This process can be performed either using an endoscopic or external approach. Aims and Objectives: The aim is to evaluate the results and recurrence rates of external DCR (ExDCR) and endonasal DCR (EDCR) surgery in patients with PANDO in the South Indian population. Materials and Methods: Medical records were reviewed in all patients who underwent surgery for PANDO between December 2021 and August 2023 at Government Medical College Mahabubabad. Results: This study was conducted in 92 patients; 34 males (36.96%) and 58 females (63.04%) were the gender split. ExDCR was used in 52 (56.52%) of the cases, and EDCR was used in 40 (43.487%) of the cases. Operation success rates of these data revealed that 50 (54.34%) cases were recorded as successful, 24 (26.10%) of the cases were accepted as partially successful, and 18 (19.56%) of the cases were deemed unsuccessful. There was no statistically significant difference between success rates and recurrences in both groups (P&gt;0.05). Conclusion: Endoscopic DCR produced simple, minimally invasive, and preferable results compared to ExDCR in the South Indian population. Although the success of ExDCR is higher and the recurrence is lower than endoscopic DCR, with the outcomes of this study, endoscopic DCR can be tried as the first choice to protect the patient from major surgery and anesthesia in PANDO.

385 - Respiratory distress in newborn: an atypical case of nasolacrimal duct cyst obstruction

385 - Respiratory distress in newborn: an atypical case of nasolacrimal duct cyst obstruction

Prelacrimal Recess Approach in Unilateral Maxillary Sinus Lesions: What Is the Impact and Efficacy?

Background and Objectives: Chronic sinusitis is a commonly encountered diagnosis for otorhinolaryngologists. The profound negative effect of rhinosinusitis on patients' quality of life is frequently overlooked, and surgical lines of treatment are numerous. The aim of the study was to assess the comparative efficacy of endoscopic middle meatal antrostomy with the endoscopic prelacrimal recess approach, combined with middle meatal antrostomy in the treatment of unilateral chronic maxillary sinus lesion. Materials and Methods: Thirty patients with unilateral chronic maxillary sinus lesions enrolled in the study at Alahsa hospital. Patients were divided into two groups: 15 treated through a middle meatal antrostomy and 15 treated via a combined middle meatal antrostomy and prelacrimal recess approach. Demographic and clinical information of the patients, including the medical history, CT scan findings, diagnosis, recurrence, and complications, were gathered and analyzed. Pre- and postoperative clinical findings were graded utilizing the Lund-Kennedy Endoscopic Scoring System. Results: The enrolled patients varied in age from 18 to 56, with 60% being male and 40% being female. Antrochoanal polyp, maxillary sinus mucocele, and unilateral allergic fungal sinusitis were among the pathological diagnoses. The follow-up period averaged 14.3 months. Following surgery, two patients in Group II encountered nasal discomfort, which included synechia and epiphora. The success rate for preserving a patient's disease-free condition was 86.7%. A statistically significant difference in disease-free incidence was observed among the patients in group II. In group I, recurrence was identified in 26.7% of the patients. The postoperative symptoms diminished considerably, and the VAS score was reduced substantially. In Group II patients, however, there was no significant difference in scarring. Clinically significant differences were observed in the mean total Lund-Kennedy Endoscopic scores when compared to their preoperative values. Conclusions: Achieving endoscopic access to the sinus's anterior, lateral, inferior, and inferomedial regions is facilitated by operating via the prelacrimal recess, which is the most advantageous approach. This approach facilitates rapid mucosal healing by maintaining the integrity of the nasolacrimal duct and mucosal covering. The specific pathology, surgical objectives, surgeon expertise, and equipment accessibility influence the choice of endoscopic surgical technique.