Nasolacrimal Duct Research Articles

Effects of Topical Anti-Glaucoma Medications on Outcomes of Endoscopic Dacryocystorhinostomy: Comparison with Age- and Sex-Matched Controls.

This study analyzed the effects of topical anti-glaucoma medications on the surgical outcomes of endoscopic dacryocystorhinostomy (EDCR) in nasolacrimal duct obstruction (NLDO). This retrospective study included patients who underwent EDCR for NLDO between September 2012 and April 2021. Thirty patients with topical anti-glaucoma medications and 90 age- and sex-matched controls were included. The success rate of EDCR was higher in the control group than in the anti-glaucoma group (97.8% vs. 86.7%, p = 0.034). Univariate and multivariate logistic regression analyses identified prostaglandin analogs as the most influential risk factor for EDCR success among anti-glaucoma medication ingredients (p = 0.005). The success rate of the group containing all four anti-glaucoma medication ingredients was statistically significant (p = 0.010). The success rate was significantly different in the group of patients who used anti-glaucoma medication for >24 months (p = 0.019). When multiplying the number of drug ingredients by the duration in months, the group > 69 showed a significantly decreased success rate (p = 0.022). Multivariate logistic regression analysis identified the number of anti-glaucoma medications as the most significant risk factor for EDCR success (odds ratio, 0.437; 95% confidence interval, 0.247 to 0.772; p = 0.004). The authors suggest that the anti-glaucoma medications might cause NLDO and increase the failure rate after EDCR. Therefore, when performing EDCR in patients using topical anti-glaucoma medications, surgeons should consider the possibility of increased recurrence after EDCR in clinical outcomes.

Lacrimal sac massage for congenital nasolacrimal duct obstruction: a multicentre randomised controlled trial

AimCongenital nasolacrimal duct obstruction (CNLDO) is the most common cause of epiphora and mucous discharge in the newborn. We conducted a multicentre randomised controlled trial to determine whether Crigler massage...

Unilateral Idiopathic Hemolacria: A Case Report

Purpose: To present a case of a patient diagnosed with idiopathic hemolacria.Case Summary: A healthy 19-year-old man without pre-existing medical conditions presented to the hospital for treatment of intermittent bloody tears from his right eye. The patient reported experiencing bloody tears in his right eye approximately once per month during stressful events for the preceding 6 years. These episodes were associated with ocular pain, right-eye hyperemia, headaches, and nausea. However, these symptoms of bloody tears spontaneously resolved without intervention. Corrected visual acuity in the right eye was 1.0, and the intraocular pressure was 16 mmHg. There were no abnormalities in the ocular appendages, anterior chamber, or eyelids. Nasolacrimal duct probing and irrigation, as well as fundus examination, revealed normal findings. Brain and orbital magnetic resonance imaging did not show abnormalities in the brain or the orbital region, although slight mucosal thickening was present around the right lacrimal gland. Other examinations, including an electrocardiogram, chest X-ray, blood test, and nasal endoscopy, all revealed normal findings.Conclusions: Recurrent bloody tears (hemolacria) occurred in the right eye of a 19-year-old man with no history of trauma, intraocular surgery, or underlying medical conditions. Comprehensive ophthalmic examination and brain and orbital magnetic resonance imaging failed to identify any specific abnormalities leading to a diagnosis of idiopathic hemolacria.

How does ocular graft-versus-host disease fit under the dry eye umbrella? A review.

Graft-versus-host disease (GVHD) is a systemic disease that can affect multiple organs as a consequence of an allogeneic haematopoietic stem cell transplant. One organ system that is often affected in GVHD is the eyes. Ocular GVHD (oGVHD) may involve various structures within the eye including the lacrimal glands, eyelids, conjunctiva, cornea, and nasolacrimal ducts, and is a source of morbidity in patients with GVHD. Common presenting features of GVHD overlap with dry eye disease (DED), including decreased tear production, epithelial disruption, and Meibomian gland dysfunction (MGD). In this review, we aim to compare oGVHD and DED to better understand the similarities and differences between the conditions, with a focus on pathophysiology, risk factors, clinical features, and treatments.

Prickle1-driven basement membrane deposition of the iPSC-derived embryoid bodies is separable from the establishment of apicobasal polarity.

Basement membrane (BM) component deposition is closely linked to the establishment of cell polarity. Previously, we showed that Prickle1 is crucial for BM deposition and cell polarity events in tear duct elongation. To gain a deeper understanding of the intimate relationship between BM formation and cell polarity, we generated induced pluripotent stem cells (iPSCs)-derived embryoid bodies (EBs) with a basement membrane separating the visceral endoderm (VE) and inner EB cell mass. We found that Prickle1 was highly expressed in VE of the normal EBs, and the Prickle1 mutant EBs displayed severely impaired BM. Notably, the formation of the basement membrane appeared to rely on the proper microtubule network of the VE cells, which was disrupted in the Prickle1 mutant EBs. Moreover, disruption of vesicle trafficking in the VE hindered BM secretion. Furthermore, reintroducing Prickle1 in the mutant EBs completely rescued BM formation but not the apicobasal cell polarity of the VE. Our data, in conjunction with studies by others, highlight the conserved role of Prickle1 in directing the secretion of BM components of the VE cells during embryonic germ layer differentiation, even in the absence of established general polarity machinery. Our study introduces a novel system based on iPSCs-derived EBs for investigating cellular and molecular events associated with cell polarity.

Ayurvedic Management of Puyalasa (Chronic Dacryocystitis)

Puyalasa is one of the Sandhigata Vyadhi described by Acharya Sushruta and Vagbhata. It is presented with symptoms of discharge of Puya (pus), Pakwa shopha (swelling), Vrana (wound), Vedana (pain) with Tridosha dushti. Puyaalasa can be co-related with chronic dacryocystitis. It is an infection of the lacrimal sac, secondary to obstruction of the nasolacrimal duct at the junction of lacrimal sac, followed by stasis in the lacrimal sac, causing pain, redness, and swelling over the inner aspect of the lower eyelid and epiphora. In this case study 62-year-old female complaining of pus discharge, watering of eyes associated with swelling over the lacrimal sac in left eye for 3 weeks was treated with application of Jaloukavacharana, along with internally Gandhaka rasayana, Nimbadi guggulu, for 45 days. The results proved to be significant, on the basis of clinical assessment that Ayurvedic management with Jaloukavacharana, and internal medication on the lacrimal sac area offers effective result in the treatment of chronic dacryocystitis.

Long-term results of nasolacrimal duct and inferior turbinate swing technique for inverted papilloma of the maxillary sinus.

We developed a technique to preserve the entire nasolacrimal duct and inferior turbinate, by swinging the nasolacrimal duct upward and the inferior turbinate backward; that is, a nasolacrimal duct and inferior turbinate swing technique for sinonasal inverted papilloma of the maxillary sinus. In this study, we evaluated the long-term results of this technique. A retrospective analysis was performed on the data for 53 consecutive pathologically confirmed inverted papilloma patients who were treated using nasolacrimal duct and inferior turbinate swing technique. The frequency of recurrence, the degree of nasolacrimal duct and inferior turbinate preservation, and the frequency of adverse events were assessed. The median follow-up period was 51 months (mean 62.5 months; range 10-187 months). No cases of recurrence within the maxillary sinus were observed among the cases treated using this technique, whereas three (5.7%) of the 53 cases experienced recurrence in areas other than the maxillary sinus. We could preserve the nasolacrimal duct in all cases. On the other hand, the inferior turbinate was resected during surgery in one case. No epiphora, dacryocystiits, numbness of the cheek, or collapse of the ala of the nose was observed. This nasolacrimal duct and inferior turbinate swing technique method is a safe and effective method for the excision of primary or recurrent inverted papilloma and demonstrates low rates of recurrence and complications.

Two-electron oxidized polyphenol chemistry-inspired superhydrophilic drug-carrying coatings for the construction of multifunctional nasolacrimal duct stents.

Nasolacrimal duct obstruction due to infection, inflammation, or excessive fibroblast proliferation may result in persistent tearing, intraocular inflammation, or even blindness. In this study, surface engineering techniques are applied to nasolacrimal duct stents for the first time. Based on the functioning of marine mussels, "one-pot" and "stepwise" methods were employed to construct a novel multifunctional superhydrophilic PDA/RAP coating using dopamine and rapamycin. Micron-sized rapamycin crystals combined with nano-sized polydopamine particles form a micro-nano topographical structure. Therefore, acting synergistically with in situ-generated hydrophilic groups (amino, carboxyl, and phenolic hydroxyl), they impart excellent and long-lasting superhydrophilicity to the nasolacrimal duct stent. The PDA/RAP coating effectively maintained the stability of the initial microenvironment during stent implantation by inhibiting the onset of acute inflammation and infection during the early stages of implantation. Meanwhile, the rapamycin crystals, supported by the superhydrophilic platform, exhibited a sustained-release capability that helped them to better exert their anti-inflammatory, antibacterial, and anti-fibroblast proliferative properties, ensuring conducive conditions for the rapid repair of nasolacrimal duct epithelial cells, verified by a series of experiments. In conclusion, the PDA/RAP hydrophilic coating has anti-inflammatory, antifibrotic, antibacterial, and antithrombotic properties, offering a new strategy to address restenosis following clinical nasolacrimal duct stent implantation.

Anatomical structure and morphometric parameters of the distal segment of the lacrimal drainage system

The article analyzes the literature data concerning the anatomical structure of the tear ducts with a focus on morphometric studies of individual structures. It is noted that, despite the high information content of cadaveric studies, most of the information to date has been obtained with the use of intravital radiation visualization methods. It is shown that the lacrimal drainage system has age, gender, and racial characteristics. Most studies focus on features of the bone nasolacrimal canal, while there is a relative shortage of research devoted to soft-tissue nasolacrimal duct. The analysis showed that most of the studies are devoted to particular morphometric indicators, which makes it difficult to obtain a complete objective picture of the size of the tear duct. Information about its volume can be found only in a couple of studies. The numerical values of the obtained data vary, which can be explained by a different approach to the selection of research subjects, sample sizes, anatomical criteria and the calculation method of morphometric parameters. There are only a few studies on morphometric parameters of the nasolacrimal duct in healthy humans, which is extremely important for determining the pathogenesis of disorders of the patency of the lacrimal drainage system.

Dacryocystorhinostomy with a counteropening in the treatment of secondary nasolacrimal duct obstruction after radioiodine therapy

This study analyzes the clinical effectiveness of dacryocystorinostomy with a counteropening. The outcomes of 49 surgeries (49 patients) with secondary acquired nasolacrimal duct obstruction due to radioactive iodine therapy were analyzed, including 34 DCR and 15 DCR with a counteropening. The clinical outcomes were analyzed over the longest possible period after surgery. The analysis included the severity of tearing on the Munk scale, the characteristic of the formed ostium on the M. Ali scale and the height of the tear meniscus. Differences were considered significant at a confidence level of 95% (p≤0.05). Analysis of the results of the performed surgeries showed that DCR was clinically effective in 30 (88%) cases, DCR with a counteropening - in 15 (100%) cases. The differences were not statistically significant in the total sample, but were statistically significant when comparing the results of surgeries in patients with distal obliteration. The developed and clinically tested method of DCR with a counteropening in the area of the Hasner's valve was completely effective in 15 patients with secondary nasolacrimal duct obstruction caused by radioiodine therapy.

Surgical Outcomes in Congenital Nasolacrimal Duct Obstruction After Probing Failure: A One-Stage Approach.

This study evaluates the outcomes of a one-stage obstruction-based strategy for congenital nasolacrimal duct obstruction (CNLDO) in children who have prior probing failure. The objective is to assess the success rates of probing, balloon dacrioplasty (BDP), monocanalicular intubation (MCI), and external dacryocystorhinostomy (external DCR) performed in the same anesthesia session. A retrospective analysis included 55 eyes (45 patients, aged 12-120 months) with initial probing at another center. Procedures involved probing, probing plus BDP, MCI, and external DCR. For membranous obstruction (MO), the procedure concludes after probing; for incomplete complex obstruction (ICO) it includes BDP or MCI; and for complete complex obstruction (CCO), external DCR is performed. Success rates were assessed based on obstruction types and age groups, with improvement in symptoms and signs as the measure of success. Statistical analysis utilized Kruskal-Wallis, Fisher's exact test, and logistic regression. The overall success rate for all procedures was 72.7%. Success rates were 77.8% for MO, 66.7% for ICO, and 100% for CCO, introducing a promising perspective for the management of different CNLDO types. External DCR exhibited a 100% success rate, highlighting its effectiveness in cases of CCO. Success rates for interventions were 77.8% for probing, 61.5% for probing plus BDP, and 73.1% for MCI, emphasizing the feasibility and success of one-stage obstruction-based treatments. Age did not significantly correlate with success rates. The one-stage obstruction-based approach, which demonstrated favorable success rates in treating CNLDO and introduced a paradigm shift in the treatment strategy after probing failure, underscores the importance of tailoring interventions to the specific obstruction type. The study also highlights the feasibility and cost-effectiveness of performing multiple BDP, MCI, or external DCR procedures concurrently during the same anesthesia session, further emphasizing the crucial role of customizing treatments based on the nature of the obstruction.

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.

Dacryocystitis – A Study of its Microbiological Spectrum at a Tertiary Eye Care Hospital in Hyderabad, India

Abstract Objectives: Dacryocystitis is the infection of the lacrimal sac due to obstruction within the nasolacrimal duct leading to inflammation resulting in several symptoms such as pain, redness, and swelling in the lacrimal sac area, persistent watering from the eye (epiphora), and if untreated may lead to many devastating complications. This study was undertaken to evaluate and understand the microbiological profile of dacryocystitis and its antibiotic susceptibility pattern for the choice of better and effective treatment, among the patients attending a tertiary eye care hospital. Materials and Methods: This was a study done from January 2022 to December 2022 wherein a total of 98 samples were collected from all those cases fulfilling the inclusion criteria and diagnosed as acute and chronic dacryocystitis by the ophthalmologists and processed as per the Clinical and Laboratory Standards Institute guidelines for the bacterial and fungal culture and their antibiotic susceptibility pattern in the microbiological laboratory. Results: Among the 98 patients diagnosed with dacryocystitis, the incidence of chronic cases, 76 (77.55%), was higher when compared to acute cases, 22 (22.45%), with females, 74 (75.51%), being dominant. Most isolated bacteria were the Gram-positive cocci, followed by Pseudomonas among the Gram-negative organisms, while Aspergillus, Candida, and Fusarium were the isolated fungi. Most of the Gram-positive cocci were susceptible to fourth-generation fluoroquinolone like gatifloxacin and aminoglycoside antibiotics like amikacin, and the Gram-negative organisms were highly susceptible to fluoroquinolones, aminoglycosides, and cephalosporins. Conclusions: Dacryocystitis with its destructive complications such as lacrimal sac abscesses, lacrimal fistulas, meningitis, cavernous sinus thrombosis, vision loss, and sometimes death have to be dealt with seriously by the ophthalmologist. There must be prompt referral to the microbiological laboratory for culture and sensitivity. This aids in understanding the microbial organisms responsible in a particular geographical area and in selecting the appropriate antibiotic and also aids in prompt improvement of the patient’s condition and reduces the risk of secondary ocular infections and other complications.

Long-term outcomes of modified transcanalicular diode laser dacryocystorhinostomy.

The purpose of this study is to assess the long-term outcomes of modified transcanalicular diode laser dacryocystorhinostomy in a large cohort of patients affected by primary acquired nasolacrimal duct obstruction. This study, conducted from January 17 to June 2022, encompassed 141 patients (159 procedures) who underwent modified transcanalicular diode laser dacryocystorhinostomy (MT-DCR). The procedure employed an 810-nm diode laser. Patients were monitored for at least a year after the intervention. Anatomical success was determined by ostium patency upon irrigation, while functional success referred to epiphora resolution. Parameters studied included patient demographics, procedure duration, complications, and both anatomical and functional success. Statistical analysis was performed using the Statistical Package for the Social Sciences software, with results considered significant at a 95% confidence interval (p≤0.05). A total of 159 lacrimal drainage systems (141 patients: 112 women and 29 men) were included in this study. Among them, 18 underwent bilateral procedures. The average patient age was 58 years (range: 34-91 years), and the average surgical duration was 24 minutes (range: 18-35 minutes). One year after the surgery, MT-DCR exhibited anatomical and functional success rates of 84.9% (135/159) and 83% (132/159), respectively. MT-DCR achieved an anatomical success rate of 84.9%, reflecting an excellent outcome. However, further extensive studies with larger sample sizes and longer follow-up periods are necessary to substantiate these findings.

Pharmacological prevention of fibrosis in dacryosurgery

Chronic inflammatory process in the lacrimal drainage system is the main etiological factor leading to dacryostenosis and consequent obliteration - partial and total nasolacrimal duct obstruction. Prevention of this process is an urgent problem in dacryology. Currently, there is very little research on the development and use of conservative methods for treating dacryostenosis using anti-inflammatory, as well as anti-fibrotic drugs. In this regard, the main method of treating lacrimal drainage obstruction is dacryocystorhinostomy. However, the problem of recurrence after this operation has not been resolved. The causes of recurrence can be cicatricial healing of dacryocystorhinostomy ostium, canalicular obstruction, formation of granulations and synechiae in its area. Surgical methods of recurrence prevention are associated with possible complications, and there is conflicting data on the feasibility of their use. Based on this, the development of pharmacological methods for the prevention of fibrosis in dacryology is promising, among which the antitumor antibiotic Mitomycin C is the most studied. However, there are no specific scientifically substantiated recommendations for the use of this drug, and the data on its effectiveness vary. This has prompted researchers to look for and study alternative anti-fibrotic agents, such as antitumor drugs, glucocorticoids, hyaluronic acid, small molecule, biological, immunological and genetically engineered drugs, as well as nanoparticles. This review presents the current data on the efficacy and prospects of the use of these drugs in dacryology.

Formulation and Evaluation of Ocusert Embeded with Ciprofloxacin Loaded Nanoparticles

Formulation and Evaluation of Ocusert Embeded with Ciprofloxacin Loaded Nanoparticles

The evaluation of nasolacrimal duct injury in Le Fort I osteotomy patients.

Although Le Fort I surgeries are safe and successful procedures; nasolacrimal duct injuries may be observed due to these surgeries. The study aimed to investigate the prevalence of nasolacrimal duct injury in Le Fort I osteotomy patients. The authors conducted a retrospective cohort study consisting of patients who underwent Le Fort I osteotomies between 2017 and 2021 in the Erciyes University Faculty of Dentistry. The primary predictor variables were the distance of the nasolacrimal canal to the outer cortex of the maxilla and the nasal floor, as well as the superior-inferior level of the superiorly positioned screw inserted in the maxilla aperture region relative to the nasolacrimal canal. The outcome variable was the presence of a nasolacrimal duct injury. Mann Whitney U test was used for quantitative variables between the two groups. A Pearson chi-squared analysis was used to compare categorical data. A p-value <0.05 was considered statistically significant. A total of 290 nasolacrimal canals were evaluated in 145 patients, 87 females, and 58 males. The mean age was 23.47± 6.67. There was a statistically significant relationship between screw level and nasolacrimal canal perforation (p<0,001). The distance between the most anterior border of the nasolacrimal canal and the outer cortical of the maxilla was significantly less in the perforation group (p<0,001). The fixation screw was significantly closer to the nasolacrimal canal in the perforation group (p<0,001). In Le Fort I surgery, nasolacrimal duct injury may occur during screw fixation to the aperture region. Superiorly positioned fixation screws in the aperture region may damage the nasolacrimal canal. In patients where the nasolacrimal canal is close to the outer cortex, care should be taken when applying the fixation screws to the aperture region to avoid damaging the canal.

Morphometric Assessment of the Bony Nasolacrimal Canal in Patients with Primary Acquired Nasolacrimal Duct Obstruction by Cone Beam Computed Tomography

Morphometric Assessment of the Bony Nasolacrimal Canal in Patients with Primary Acquired Nasolacrimal Duct Obstruction by Cone Beam Computed Tomography

Outcomes of external and endonasal dacryocystorhinostomy according to a modified Lacrimal Symptom Questionnaire (Lac-Q).

Nasolacrimal duct obstruction is usually treated using endoscopic or external dacryocystorhinostomy (DCR). The anatomic outcomes of both the endoscopic and external approaches are considered excellent. However, anatomic success does not translate into patient satisfaction. The current study assessed pre- and postoperative lacrimal problems using the symptom-based Lacrimal Symptom Questionnaire (Lac-Q) and investigated patient satisfaction depending on the choice of surgical technique. A total of 112 eligible patients with lacrimal problems treated using external or endonasal DCR at the ophthalmology and ear, nose, and throat clinics at Skane University Hospital, Scania, Sweden, over a four-year period, were enrolled in this retrospective study. Patients were considered eligible if they experienced preoperative epiphora and had lacrimal duct stenosis. They were offered treatment using either external or endonasal DCR and were allowed to freely choose the technique. Exclusion criteria consisted of previous ipsilateral DCR, congenital NLDO, age < 18 years, presence of cancer, previous orbital trauma, or noncompliance with postoperative follow-up. After surgery, the patients were sent the Lac-Q to evaluate their lacrimal symptoms pre- and postoperatively. Complementary questions were added pertaining to the operative scar and the patients' overall satisfaction with the operation. In total, 67 (60%) patients with ages ranging from 18 to 88 years completed the questionnaire, 33 (49%) of whom underwent external DCR and 34 (51%) endonasal DCR. Of the 67 respondents, 51 (76%) were women and 16 (24%) were men. Patients scored preoperative lacrimal problems highly on the Lac-Q, reporting both symptomatic and social problems due to epiphora. Following surgery, the group that underwent external DCR remained home from work for 2 - 14 days (median, 3.5 days). However, 17 (52%) were retired. After the endonasal DCR, the patients remained home for 0 - 7 days (median, 2 days). Most patients were satisfied after DCR surgery, with both techniques significantly improving total, lacrimal symptom, and social impact scores (all P < 0.001). No differences in postoperative satisfaction were observed between the external DCR and endonasal DCR groups (P > 0.05). A small number of patients expressed scar-related concerns after external DCR. The patients perceived lacrimal problems as a significant symptomatic and social burden. Postoperative satisfaction and symptom relief were good regardless of the surgical approach. Further prospective studies assessing patient satisfaction and its correlation with anatomical and functional success rates after external and endonasal DCR could provide robust, practical, real-world implications.

Thickness of the nasolacrimal duct and the adjacent maxillary bone in different skeletal patterns using MSCT: A retrospective study

Objectives: To evaluate the anatomy of the nasolacrimal duct and the adjacent maxillary bone thickness using multislice computed tomography. Methods: Tomographic images of 92 individuals (184 sides) were analyzed according to sex, side, and sagittal (Class I, II, and III) and vertical (mesocephalic, brachycephalic, and dolichocephalic) skeletal patterns. The largest diameters of the nasolacrimal duct and the thickness of the adjacent maxillary bone were measured when the lacrimomaxillary suture was completely visible. In addition, the measurements were performed 2 mm above and below the midpoint. The maxillary bone and nasolacrimal duct measurements were analyzed by one-way ANOVA with Tukey’s post-hoc test. Results: Females had a significantly narrower lacrimal duct at the midpoint (p=0.026) and 2 mm above it (p=0.025). Maxillary bone thickness was greater in Class II individuals compared to Class I at the midpoint (p=0.012) and 2 mm above it (p=0.027). The dolichocephalic group had greater maxillary bone thickness at the midpoint (p=0.014) and 2 mm below it (p=0.005) compared to the brachycephalic group. Maxillary bone thickness was greater in mesocephalic individuals compared to dolichocephalic individuals (p=0.04). Conclusions: Brachycephalic Class I individuals have lower maxillary bone thickness adjacent to the nasolacrimal duct, which increases the risk of injury during the bone fixation process.