Nasolacrimal Drainage System Research Articles

Clinical characteristics and cytological changes in mucinous obstruction diagnosed by dacryoendoscopy

To analyze the clinical characteristics of mucinous obstruction diagnosed by dacryoendoscopy and compared the cytological changes with membranous obstruction using a modified liquid-based thin prep cytology method. A retrospective chart review was conducted on 53 eyes of 51 patients with mucus obstruction based on dacryoendoscopic findings from January 2022 to October 2022. Liquid-based thin-prep cytology was performed by irrigating the inside of the nasolacrimal drainage system with saline during dacryoendoscopy-guided silicone tube intubation. Pathological findings were analyzed through a comparison of mucinous obstruction with membranous obstruction as determined by dacryoendoscopic findings. The modified liquid-based thin prep cytology technique had a higher cytology detection rate across all cases. Mucinous obstruction exhibited a significantly higher number of successful canalicular irrigation test cases compared to membranous obstruction. In mucinous obstruction, epithelial squamous cells were more frequently detected in pre-sac obstruction, whereas columnar epithelial cells were predominant in post-sac obstruction. Inflammatory cells showed a stronger correlation with primary change and post-sac obstruction. Bacterial colonies were observed exclusively in cases of mucinous obstruction. The use of a modified liquid-based thin prep cytology method enables the examination of histopathological changes in the lacrimal passage in primary acquired nasolacrimal duct obstruction (PANDO), particularly in cases of mucinous obstruction, without the need for invasive biopsies. These findings enhance the understanding of the etiopathogenesis of mucinous obstruction, complementing knowledge of membranous obstruction in PANDO.

Clinical outcomes of endoscopic dacryocystorhinostomy without preserving mucosal flaps in combination with silicone stent and steroid-soaked gelfoam

To report clinical outcomes of endoscopic dacryocystorhinostomy (En-DCR) combined with stenting and without preserving the nasal and lacrimal mucosal flaps. In this prospective interventional case series, patients with primary acquired nasolacrimal duct obstruction who were candidates for En-DCR were enrolled. Patients with a known history of previous DCR, sinus surgery, rhinoplasty, nasal trauma, nasal anomaly, canalicular or punctal occlusion, or less than one year of follow-up were excluded. All patients underwent En-DCR and stenting followed by ostial packing using Gelfoam soaked with dexamethasone. The patients were assessed preoperatively, on the first postoperative day, after 2 weeks, 3 months, and 1 year. Postoperative outcomes were anatomical and functional success, defined as patent irrigation test and resolution of epiphora, respectively. The nasolacrimal drainage system was evaluated anatomically and functionally during the follow-up period. Eighty-three patients with a mean age of 54.36±15.27 years were enrolled. Of these, 61 patients (73.5%) were women. The mean duration of follow-up was 20.7±6.9 months. Anatomical success was achieved in all patients and remained stable during the study duration and at 1 year. Functional failure leading to epiphora was observed in 1 patient 3 months after surgery and resolved after re-DCR at year 1. Preoperative tenderness and purulent reflux were observed in 12%, 33.7% of which completely resolved postoperatively. Moderate and severe hemorrhage was observed in 12 (14.5%) and 2 (2.4%) patients, respectively. En-DCR without mucosal flap preservation in combination with silicone stent and steroid-soaked Gelfoam is a safe and highly successful procedure in patients with primary acquired nasolacrimal duct obstruction.

A Novel Snake-chain Metal Probed Silicon Intubation Set for Nasolacrimal Duct Intubation: A Cadaveric Feasibility Study.

A fresh-frozen human cadaveric feasibility study to investigate the feasibility of probing and stenting the nasolacrimal ducts (NLDs) of human cadavers with a novel flexible bicanalicular nasolacrimal stent. A custom-designed bicanalicular nasolacrimal stent was made by connecting a 250 mm long, 0.9 mm diameter silicone tube to a 200 mm long stainless-steel, snake-chain probe at each end. The punctum was dilated, and the snake-chain stent fed into the nasolacrimal drainage system. The emergence of the stents from the terminal end of the NLD and retrieval with a ball probe was conducted under endoscopic guidance. Bicanalicular nasolacrimal stenting with intranasal retrieval under endoscopic guidance was successfully achieved in six NLDs of three adult cadaveric nasolacrimal drainage systems. Despite being soft and flexible, the snake-chain silicon stent passes smoothly and freely through cadaveric human NLD and is easily retrieved from the nasal cavity. This novel NLD stent design may make stenting of the NLD easier and less traumatic.

Development of Ciprofloxacin-Loaded Bilosomes In-Situ Gel for Ocular Delivery: Optimization, In-Vitro Characterization, Ex-Vivo Permeation, and Antimicrobial Study.

Conventional eye drops are most commonly employed topically in the eye for the management of bacterial conjunctivitis. Eye drops have a low corneal residence time and 90-95% of the administered dose is eliminated from the eye by blinking and the nasolacrimal drainage system. This problem can be minimized by formulating a mucoadhesive ocular in-situ gel system that undergoes sol-gel transition upon stimulation by temperature, pH, and ions. The goal of this study was to develop ciprofloxacin (CIP) loaded bilosomes (BLO) in-situ gel for the improvement of therapeutic efficacy. The BLO was prepared by the thin-film hydration method and optimized by the Box-Behnken design. Cholesterol (CHO), surfactant (Span 60), and bile salt (sodium deoxycholate/SDC) were used as formulation factors. The vesicle size (nm) and entrapment efficiency (%) were selected as responses (dependent factors). The optimized CIP-BLO (CIP-BLO-opt) formulation displayed a vesicle size of 182.4 ± 9.2 nm, a polydispersity index of 0.274, a zeta potential of -34,461.51 mV, and an entrapment efficiency of 90.14 ± 1.24%. Both x-ray diffraction and differential scanning calorimetry spectra did not exhibit extensive peaks of CIP in CIP-BLO-opt, revealing that CIP is encapsulated in the BLO matrix. The CIP-BLO-opt formulation was successfully incorporated into an in-situ gel system using a gelling agent, i.e., Carbopol 934P and hydroxyl propyl methyl cellulose (HPMC K100 M). CIP-BLO-opt in-situ gel formulation (CIP-BLO-opt-IG3) was evaluated for gelling capacity, clarity, pH, viscosity, in-vitro CIP release, bio-adhesive, ex-vivo permeation, toxicity, and antimicrobial study. The CIP-BLO-opt-IG3 exhibited satisfactory gelling properties with a viscosity of 145.85 ± 9.48 cP in the gelling state. CIP-BLO-opt-IG3 displayed sustained CIP release (83.87 ± 5.24%) with Korsmeyer-Peppas kinetic as a best-fitted model (R2 = 0.9667). CIP-BLO-opt-IG3 exhibited a 1.16-fold than CIP-IG and a 2.08-fold higher permeability than pure CIP. CIP-BLO-opt-IG3 displayed a significantly greater bio-adhesion property (924.52 ± 12.37 dyne/cm2) than tear film. Further, CIP-BLO-opt-IG3 does not display any toxicity as confirmed by corneal hydration (76.15%), histology, and the HET-CAM test (zero scores). CIP-BLO-opt-IG3 shows significantly higher (p < 0.05) antimicrobial activity against P. aeruginosa and S. aureus than pure CIP. From all these findings, it could be concluded that CIP-BLO-opt-IG3 might be an effective strategy for the increment of corneal residence time and therapeutic activity of CIP.

Blood-stained tears-a red flag for malignancy?

Blood-stained tears can indicate occult malignancy of the lacrimal drainage apparatus. This study reviews data on patients presenting with blood in their tears and the underlying cause for this rare symptom. Patients presenting with blood in their tears, identified over a 20-year period, were retrospectively collected from a single tertiary ophthalmic hospital's database and analysed. 51 patients were identified, the majority female (58%) with a mean age of 55 years. Most cases were unilateral (96%) with blood originating from the nasolacrimal drainage system in 53%. The most common diagnosis for blood-stained tears was a lacrimal sac mucocele (n = 16) followed by a conjunctival vascular lesion (n = 4). Three patients had systemic haematological disorders. The rate of malignancy was 8% (n = 4), with 2 patients having lacrimal sac transitional cell carcinomas, one with a lacrimal sac plasmacytoma and the other with chronic lymphocytic leukaemia and bilateral orbital infiltration (with bilateral bloody tears). One patient had a lacrimal sac inverted papilloma, a premalignant lesion. Four patients had benign papillomas (of the lacrimal sac, conjunctiva and caruncle). Haemolacria was a red flag for malignancy in 8% of patients (and tumours in 18% of patients). A thorough clinical examination including lid eversion identified a conjunctival, caruncle, eyelid or canalicular cause in 27% of cases.

Evaluation of epiphora by topical contrast-enhanced CT and MR dacryocystography: which one to choose?

Our study aims to compare non-invasive imaging such as topical computed tomography dacryocystography (CTD) and topical magnetic resonance dacryocystography (MRD) in patients with epiphora. To evaluate the practicability of topical contrast media during helical CTD and topical saline during MRD to reveal obstruction in the nasolacrimal drainage system (NLDS). Twenty participants with nasolacrimal duct obstruction were observed for two years. Ten participants underwent CTD and the other 10 participants underwent MRD. Images were analyzed by two radiologists. Participants were also asked about the level of discomfort of the contrast material versus the saline solution. The NLDS was seen on both CTD and MRD. Very good agreement between the two observers (κ value > 0.81) was seen according to the κ statistics. CTD multiplanar and 3D images allowed for precise diagnosis of the point of obstruction whereas, the MRD did not require any contrast material and showed the point of obstruction. Saline was more comfortable for the patients than topical contrast (P < 0.05). Topical CTD and MRD are non-invasive techniques that can visualize the degree and level of obstruction in the NLDS than conventional invasive cannulation dacryocystography. CTD is useful in visualizing the point of obstruction and smaller drainage structures. However, it is a source of ionizing radiation to the lens. The benefit of MRD is that it requires no contrast or radiation; however, it is poor in depicting the bone anatomy and smaller drainage structures. Finally, saline was better tolerated by patients than topical contrast.

Anatomy of the nasolacrimal duct in Persian cats determined by computed tomographic dacryocystography.

This study sought to describe the anatomical characteristics of the nasolacrimal duct of Persian cats as observed by computed tomographic dacryocystography. Ten cats weighing 3-6kg (three live cats and seven cadaveric specimens). The animals were submitted to bilateral computed tomographic dacryocystography, totaling 20 nasolacrimal ducts. Dorsal, sagittal, and transverse planes were studied. Two additional skulls were also dissected following latex injection into the nasolacrimal duct. The length and width of the nasolacrimal duct and lacrimal canaliculi, and the distance between the nasolacrimal duct and the root of the upper canine tooth at the point of closest proximity were measured. The nasolacrimal duct followed a convoluted course, particularly in the middle and rostral portions. Duct stenosis (width reduction equal to or >75%) and dilations (width increase equal to or >50%) were also detected, particularly in the rostral portion. Nasolacrimal duct length and width ranged from 1.3 to 1.5cm and 1.5 to 2.3mm, respectively. Mean lacrimal canaliculus length and width corresponded to 3.1mm and 0.4mm, respectively. Mean distance from the nasolacrimal duct to the canine tooth was 2.4mm. The root of this tooth interfered with the course of the nasolacrimal duct. This study provided anatomical information for clinical assessment of the nasolacrimal drainage system in Persian cats.

Evaluating malformations of the lacrimal drainage system in brachycephalic dog breeds: A comparative computed tomography analysis.

ObjectivesThis study aimed to investigate and compare the anatomical features of the nasolacrimal drainage system (NDS) in three brachycephalic dog breeds with those of normocephalic dogs, taking into account how the NDS was related to the malformed brachycephalic head.AnimalsFifty-one brachycephalic dogs were examined, comprising 23 Pugs, 18 French Bulldogs, and 10 English Bulldogs. Six normocephalic dogs of different breeds served as a comparison.MethodsComputed tomographic dacryocystography was performed. Parameters such as length, angulation, and gradient were determined. Crossing of the nasolacrimal duct (NLD) beneath the maxillary canine root, as well as the incidence of an accessory opening, were also analyzed.Results and conclusionsIn all three brachycephalic breeds, the NDS was grossly malformed. We regard this as a further consequence of exaggerated breeding for a short head conformation. While the length of the NLD was substantially reduced by 41 to 57 percent in brachycephalic dogs, their lacrimal canaliculi were two to three times as long as those of normocephalic dogs. Varying parts of the nasolacrimal drainage system followed an inverse direction in short-headed dogs, giving the entire nasolacrimal apparatus an anomalous U- or V-shaped appearance. The NLD exhibited a three to five times steeper alignment in brachycephalic dogs than in normocephalic ones. Obviously, this strong slope did not cause clinical symptoms only because there was an aberrant outflow pathway. The brachycephalic dogs consistently exhibited an accessory opening, through which most of fluid escaped into the posterior nasal cavity instead of through the common route into the nasal vestibule via the nasolacrimal ostia.

Helical computed tomographic-dacryocystography in adult pet dwarf rabbits: procedure and normal appearance

Partial or complete nasolacrimal drainage system (NLDS) occlusion is a common clinical concern in rabbits. It can be assumed that computed tomographic-dacryocystography (CTDCG) might be an efficient technique in this indication. In this prospective study, the technique of CT-DCG and the appearance of the NLDS in eight healthy rabbits on CT-DCG images are described. The quality of visualization of bony structures adjacent to the NLDS was good on pre-contrast computed tomographic images. The bony lacrimal canal had a smooth contour, a regular diameter, and its mean dimensions are provided. CT-DCG technique was easy to perform and offered a good visualization of the NLDS including anatomical narrowings and bendings. CT-DCG is a minimally invasive and informative technique for evaluating the NLDS in rabbits. Its diagnostic usefulness in exploring nasolacrimal diseases remains to be specified in this species.

A Case of Primary Tuberculosis of the Lacrimal Sac Presenting as Epiphora

Extra-pulmonary tuberculosis usually progresses as a secondary infection from pulmonary tuberculosis, and tuberculosis of the head and neck region. Tuberculosis of ocular and periocular areas, however, is a rare disease. Among ocular tuberculosis involving the adnexal structures, a few lacrimal sac tuberculosis has been reported. We recently experienced a case of lacrimal sac tuberculosis presenting as epiphora. Examination revealed bilateral nasolacrimal duct obstruction and the patient underwent endoscopic endonasal dacryocystorhinostomy. During the operation, a biopsy taken from the unhealthy looking lacrimal sac filled with caseous necrotic tissue was suggestive of tuberculosis. Histopathological features and further systemic evaluation confirmed tuberculosis. She was treated medically with anti-tubercular agents. The new opening of the lacrimal sac was patent and epiphora was resolved successfully at a year follow up. This report highlights the requirement of high suspicion of tuberculosis, even in the nasolacrimal drainage system.

Lacrimal Drainage System Obstruction Following Inferior Turbinate Surgery

Objective: To provide information on the clinical characteristics and management of an uncommon acquired nasolacrimal drainage system obstruction (NLDSO).Methods: A patient was treated with microdebrider-assisted endoscopic marsupialization for a cystic lesion located in the synechiae between the inferior turbinate and the lateral wall of the inferior meatus.Results: A 21-year-old woman suffered from epiphora and purulent discharge 1 week after inferior turbinate surgery. Endoscopy reveled synechiae between the inferior turbinate and the lateral wall of the inferior meatus. Computed tomography-dacrocystography (CT-DCG) showed enlargement of the nasolacrimal duct and cystic accumulation of contrast medium from the lacrimal orifice posteriorly. The patient was treated with nasal endoscopic marsupialization of the cyst and then powered inferior turbinoplasty. Six months after the operation, both endoscopy and CT scan showed a widely patent left inferior meatus and nasolacrimal orifice.Conclusions: We report the first case of post-operative NLDSO following inferior turbinate surgery. Nasal endoscopy and CT-DCG are useful to diagnose the location of a NLDSO. Otorhinolaryngologists should be aware that surgery may lead to the formation of a NLDSO and that endoscopic marsupialization is a curative treatment for these distal-end NLDSO. NLDSOs are caused by synechiae, which are a complication of inferior turbinate surgery.

Hydrogel Biomaterials for Application in Ocular Drug Delivery.

There are many challenges involved in ocular drug delivery. These are a result of the many tissue barriers and defense mechanisms that are present with the eye; such as the cornea, conjunctiva, the blinking reflex, and nasolacrimal drainage system. This leads to many of the conventional ophthalmic preparations, such as eye drops, having low bioavailability profiles, rapid removal from the administration site, and thus ineffective delivery of drugs. Hydrogels have been investigated as a delivery system which is able to overcome some of these challenges. These have been formulated as standalone systems or with the incorporation of other technologies such as nanoparticles. Hydrogels are able to be formulated in such a way that they are able to change from a liquid to gel as a response to a stimulus; known as “smart” or stimuli-responsive biotechnology platforms. Various different stimuli-responsive hydrogel systems are discussed in this article. Hydrogel drug delivery systems are able to be formulated from both synthetic and natural polymers, known as biopolymers. This review focuses on the formulations which incorporate biopolymers. These polymers have a number of benefits such as the fact that they are biodegradable, biocompatible, and non-cytotoxic. The biocompatibility of the polymers is essential for ocular drug delivery systems because the eye is an extremely sensitive organ which is known as an immune privileged site.

Ponto lacrimal duplo pode ter apresentações clínicas diferentes

In this paper, we describe two adult patients who presented with double lacrimal puncta: one of them was asymptomatic and incidentally diagnosed, and the other complained of epiphora. In both patients, unilaterality, preference for the lower lid, and location medial to the normal punctum were common features of the accessory punctum. In the asymptomatic patient, irrigation revealed no obstruction in the punctum or the nasolacrimal drainage system. By contrast, the other patient's nasolacrimal drainage system exhibited obstruction. Therefore, dacryocystorhinostomy surgery and silicone tube intubation were successfully performed. Double lacrimal puncta may be associated with epiphora or dry eye. These manifestations can easily be missed in a routine examination. This report was written to emphasize that unilateral epiphora of dry eye symptoms may be related to supernumerary punctum or canalicular systems and can easily be diagnosed with lid eversion.

Patency of the nasolacrimal drainage system after power-assisted medial flap turbinoplasty.

ObjectiveTurbinoplasty is a common procedure for the management of nasal blockage resulting from inferior turbinate hypertrophy. There are many ways to perform turbinoplasty; however, power‐assisted medial flap turbinoplasty provides reliable reduction and long‐lasting results compared to other techniques. The aim of this study was to assess the patency of the nasolacrimal drainage system after power‐assisted medial flap turbinoplasty and to investigate the safety of this procedure with regard to drainage of the nasolacrimal ducts.MethodsThis prospective study included 31 patients (62 turbinates) who underwent power‐assisted medial flap turbinoplasty in the period between January 2017 and December 2017 and had a normal nasolacrimal drainage system as confirmed by endoscopic fluorescein dye test preoperatively. The test was repeated 3 months postoperatively to test for patency.ResultsAll the patients showed normal drainage of the fluorescein dye from the inferior meatus preoperatively and postoperatively as well. No other major complications resulting from the power‐assisted medial flap turbinoplasty procedure were reported.ConclusionPower‐assisted medial flap turbinoplasty is a safe and effective procedure. There was no nasolacrimal duct injury among our patients and we did not observe any major complications.Level of EvidenceIIb

Lacrimal Apparatus Procurement in Face Transplantation.

The aesthetic outcome of a well-planned and executed vascularized composite tissue face allotransplant is unquestionable; however, complete functional restoration is necessary. The authors studied the possibility of restoring tear duct function in face transplant recipients. They also examined the technical specifics and feasibility of incorporating a lacrimal drainage apparatus into facial allografting. The authors performed a standardized face vascularized composite allograft on 4 hemi-faces (2 fresh cadavers). On one side of the face, a soft tissue myocutaneous alloflap was raised. They attempted to incorporate the nasolacrimal apparatus into the allograft to develop and describe an efficient harvest method. On the contralateral side, an osteocutaneous alloflap was raised with the midface and mandible. The authors describe 2 techniques to incorporate the lacrimal drainage system. The authors retrieved the graft in a consistent and replicable fashion within conventional alloflap retrieval times. The authors successfully incorporated the entire nasolacrimal drainage system into the conventional soft tissue-only myocutaneous alloflap by transforming it into a modified mini-osteomyocutaneous alloflap. They demonstrated that the contralateral conventional bi-maxillary osteocutaneous alloflap procedure, as an alternative comparative technique, provided another means to restore lacrimal drainage. In conclusion, surgically harvesting the nasolacrimal apparatus is technically feasible in vascularized composite tissue allotransplantation. Before translating this to a clinical setting, further dissections are necessary to explore the technical specifics of how to insert the harvested nasolacrimal apparatus into the recipient to restore a conduit for tear drainage. This study is the first step towards a fully functioning lacrimal drainage system in face transplant recipients.

Incidence of acquired lacrimal drainage system obstruction in epiphoric patients in Thailand

Background: There were few reports regarding the incidence of the acquired nasolacrimal duct obstruction , and the incidence in different geography or countries might be alike. Since the nasolacrimal drainage system obstruction is a common problem in Thailand, knowledge of the incidence may disclose the burden of the disease that has never been reported. Objectives: Evaluate the incidence of acquired lacrimal drainage system obstruction (ALDO) in Thailand. Methods: This study was conducted in multi-centers. It was based on prospective and descriptive design. All patients with epiphoric symptoms visiting the outpatient departments of five tertiary eyecare centers were recruited between 2004 and 2007. Features of epiphoric symptoms and medical history were recorded, and complete ophthalmic examinations were performed. Results: Epiphoric patients were enrolled from all medical centers with 245 eligible patients, female:male ratio was 4.2:1. Ninety-nine patients (40%) had duration of epiphoric symptoms between one-five years. ALDO was found in 111 patients (45%) with female preponderance (6.9:1). Seventy-one patients (64%) had pre-sac obstruction and 40 patients (36%) had post-sac obstruction. Among other causes of epiphora, dry eye was the most common. Conclusion: The most common cause of epiphora was ALDO. The four-year incidence rate of ALDO among epiphoric patients was 45%.

Long-term outcomes of punch punctoplasty with Kelly punch and review of literature.

PurposeTo report long-term outcomes of punch punctoplasty utilizing the Kelly punch and to compare the results with other described methods of punctoplasty in literature.Patients and methodsA retrospective, non-comparative interventional case series of patients who underwent punch punctoplasty at the Hong Kong Eye Hospital over an 8-year period. A standard Kelly Descemet's membrane punch was utilized for punctal enlargement in all cases. Patient records and their operative records were reviewed. Anatomical success was defined by well-patent puncta on follow-up. Functional success was considered complete if tearing resolved completely postop and partial if residual tearing remained despite patent puncta and nasolacrimal drainage system. An OVID MEDLINE review was performed to compare success rates of various punctoplasty surgeries in literature.ResultsIn all, 101 punch punctoplasties from 50 patients were performed between January 2008 to January 2016. At a mean follow-up of 34 months (range: 6-86 months), the anatomical success rate was 94% (95 out of 101 puncta), whereas functional success was 92% (54 out of 59 eyes). Two cases experienced postop dry eyes; otherwise no major complication was observed.ConclusionPunch punctoplasty via the readily available Kelly punch is a simple, minimally invasive procedure that demonstrates high anatomical and functional success as a sole primary treatment for simple punctal stenosis.

Anatomical and subjective success rates of endonasal dacryocystorhinostomy over a seven-year period.

PurposeEndonasal dacryocystorhinostomy (END-DCR) is a relatively novel approach that has recently been shown in some studies to provide similar success rates to the more traditional external approach for the treatment of nasolacrimal duct obstruction (NLDO). However, a range of success rates using this approach are reported within the literature and the majority of oculoplastic surgeons are still favouring the external approach. The purpose of this study was to review the anatomical and subjective success rates of END-DCRs performed over a 7-year period.Patients and methodsWe provide a review of the success rates of 288 END-DCRs for the treatment of acquired NLDO performed over a 7-year period by a single oculoplastic surgeon in Sydney, Australia. We describe the operative technique used and define anatomical success as demonstrated patency of the nasolacrimal drainage system at 10 weeks postoperatively while subjective success is defined as complete resolution or significant improvement of symptoms as reported by patients at the same time point.ResultsIn our study, we were able to demonstrate that out of 288 END-DCRs, an average anatomical success rate of 89.6% and an average subjective success rate of 81.3% were achievable.ConclusionsWe conclude that the success rates using our endonasal approach remain similar to those obtained using the external approach, as reported within the literature, and may be considered as a primary treatment option for acquired NLDO.

Nasolacrimal System Aeration on Computed Tomographic Imaging: Sex and Age Variation.

To investigate variation in aeration of the nasolacrimal drainage system between age groups and genders, and to report the reliability of repeated aeration grading and nasolacrimal canal measurements on CT. Retrospective review of CT images from 92 individuals, 60 female and 32 male, was conducted by 3 independent reviewers for the presence of air within the nasolacrimal drainage system. Diameter and area measurements were also obtained at the smallest identifiable portion of the nasolacrimal canal by 2 independent reviewers. When air is present on CT, it is seen more fully throughout the nasolacrimal system in men as compared to women. Age data demonstrate that patients from the third and fourth decade have significantly more aeration than older patients. Diameter and area of the nasolacrimal duct within the canal at its narrowest point revealed no correlation with sex, age, or nasolacrimal system aeration. Inter-reviewer reliability shows strong repeatability of aeration grading and nasolacrimal duct measurements between multiple reviewers. The results suggest CT is reliable and repeatable modality to assess nasolacrimal system aeration and nasolacrimal duct diameter. Decreased aeration of the nasolacrimal system in females and the elderly mirrors epidemiologic trends for those at risk to develop primary acquired nasolacrimal duct obstruction. Variables in nasolacrimal drainage system anatomy, specifically nasolacrimal duct diameter and area, did not vary between sexes or age groups, suggesting aeration may be an overlooked variable in nasolacrimal system function.

Preoperative Computed Tomography Findings for Patients with Nasolacrimal Duct Obstruction or Stenosis.

PurposeTo identify and analyze the role of preoperative computed tomography (CT) in patients with tearing symptoms with nasolacrimal duct obstruction (NLDO).MethodsWe retrospectively reviewed the medical records and CT results on 218 patients who complained of tearing symptoms with NLDO between January 2014 and December 2014. All patients were recruited from Kim's Eye Hospital's outpatient clinic and assessed by clinical history, examination, and CT to evaluate periocular pathology and nasolacrimal drainage system. Patients with abnormal findings assessed by preoperative CT were further reviewed.ResultsCT was performed on 218 patients (average age, 58.2 ± 11.9 years). Of these, 196 (89.9%) had endonasal dacryocystorhinostomy, 14 (6.4%) declined surgery, and 8 (3.7%) were inoperable due to abnormal CT findings. Soft tissue opacity was the most common finding which 243 cases (85.9%) of 283 obstructed nasolacrimal duct and 89 cases (81.7%) of 109 non-obstructed nasolacrimal duct showed it. Thirty-nine (17.8%) of 218 patients showed either maxillary sinusitis or ethmoidal sinusitis and 32 (14.7%) of 218 patients presented with periocular inflammation. Other abnormal CT findings included septal deviations, previous fractures, masses, and structural abnormalities of nasal cavity.ConclusionsPreoperative CT imaging is useful in the assessment of both nasolacrimal drainage and nearby anatomical structures. This information will be helpful in planning surgical interventions and management of NLDO.