Nasolacrimal Obstruction Research Articles

Prospective Comparison of Conventional External Dacryocystorhinostomy and Endonasal Laser Dacryocystorhinostomy

Background:Epiphora, a common manifestation of chronic dacryocystitis, requires definitive treatment through dacryocystorhinostomy (DCR), a surgical procedure aimed at creating an alternative fluid drainage pathway.This study aimed to assess how effective both external dacryocystorhinostomy (Ex-DCR) and endonasal dacryocystorhinostomy (Endo-DCR) are in managing chronic dacryocystitis, with a specific focus on surgical duration, complication rates, and treatment outcomes. Methods: In this study, sixty participants were prospectively enrolled and evenly divided into two groups. Thirty patients were assigned to the first group and underwent En-DCR surgery, while the second group, also comprising thirty patients, underwent Ex-DCR surgery. Both groups were monitored for a duration of 9 months and assessed for surgical duration, perioperative and postoperative complications, and eventual surgical outcomes. Results: The distribution of patients across age groups and sexes was similar between the two groups (p>0.05). Clinical features such as epiphora, epiphora with discharge, and epiphora with swelling were comparable between groups. En-DCR group demonstrated significantly less intraoperative bleeding (mean:13.5 ml vs 50 ml; p<0.0001) and shorter operative durations (mean: 20 mins vs 37.5 mins; p<0.0001) compared to Ex-DCR group. Complications such as nasal bleeding and hematoma were minimal in both groups, with no significant differences noted. The final outcome, categorized as success (En-DCR vs Ex-DCR: 76.7% vs 83.3%) or failure (23.3% vs 16.7%), did not show a statistically significant difference between the two groups (p>0.05). Conclusion:Both surgical techniques offer feasible alternatives for addressing issues related to nasolacrimal obstruction. J Bangladesh Coll Phys Surg 2024; 42: 355-362

Retrospective cohort study of self-reported outcomes after unilateral dacryocystorhinostomy in patients with bilateral epiphora and suspected nasolacrimal obstruction

ABSTRACT Purpose This study aimed to quantify the proportion of patients with bilateral epiphora and suspected nasolacrimal obstruction who self-reported improved epiphora bilaterally following unilateral dacryocystorhinostomy and investigate predictive factors. Methods A retrospective cohort study of patients from an Australian lacrimal clinic was performed. Eligible patients were at least 18 years of age, complained of bilateral epiphora, underwent unilateral dacryocystorhinostomy between 2012 and 2022 and followed-up. Outcome groups were created by grouping self-reported epiphora improvement levels for each eye. Two-sided confidence intervals were calculated for the proportion of participants in each outcome group. Ordinal elastic net regression identified clinical features associated with outcome groups and estimated their effect sizes. Results Of 243 patients, the median post-operative follow-up duration was 3 months. Fifty-eight percent (95% CI 52–64%, n = 141) reported significant improvement (≥50% ipsilateral and any contralateral improvement), 5% (95% CI 3–9%, n = 13) reported small improvement (<50% ipsilateral and any contralateral improvement) and 26% (95% CI 20–31%, n = 62) reported ipsilateral improvement only. Eleven percent had functional or anatomical failure. Older age (OR 1.01), contralateral nasolacrimal duct narrowing (OR 1.37), contralateral nasolacrimal duct obstruction (OR 0.93) and longer follow-up time (OR 0.85) predicted outcome groups. Conclusions After unilateral DCR, many patients with bilateral epiphora and suspected nasolacrimal obstruction report an improvement of their symptoms bilaterally in the early postoperative period. Contralateral nasolacrimal system diagnosis, patient age and follow-up duration were associated with outcomes. Further study using validated epiphora assessment tools may quantify this observation, and we suggest a potential underlying mechanism of contralateral effects after unilateral treatment.

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.

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

Evaluation of nasolacrimal canal morphology in different facial skeletal relationships

BackgroundAbnormal morphological variations of nasolacrimal canal (NLC) and its lack of understanding contributes to acquired injuries during craniomaxillofacial surgical procedures which leads untoward postoperative complications like nasolacrimal obstruction (NLO) and epiphora. PurposeThe purpose of this study was to determine dimensional and volumetric morphological variations of nasolacrimal canal in various facial skeletal relationships which aid in performing a precise and safe surgery. Materials and methodsThis retrospective cohort study involved dimensional and volumetric analysis of nasolacrimal canal procured from computed tomography scans of 47 individuals grouped as ClassI, Class II and Class III, and unilateral cleft lip and palate (UCLP) groups. The outcome variables included length of NLC, volume of NLC, distance between the inferior orifice of the NLC to nasal floor, distance between inferior orifice of NLC to canine apex and distance between inferior orifice of NLC to central incisor apex. The objectives were to analyse morphological variation of NLC in different facial skeletal relationships and to evaluate the variation with change in facial sides and its relationship with surrounding structures. ResultsVolume of the NLC was found significant in Class I and UCLP population (p < 0.05) with the greatest volume in the UCLP group. The mean linear and volumetric measurements between the right and left sides were found insignificant among all groups. Inferior orifice of NLC from canine apex were farthest in Class III and nearest in the UCLP group (p < 0.05). There was no significant association between outcome variables and skeletal base configuration. ConclusionNLC demonstrates dimensional and anthropometric variations between different skeletal relationships and this study is inevitable in understanding the probability of NLC injury during maxillofacial surgeries.

Reply Re: "Outcome of Primary Monocanalicular Stent Placement in Pediatric Down Syndrome Patients With Congenital Nasolacrimal Obstruction".

Reply Re: "Outcome of Primary Monocanalicular Stent Placement in Pediatric Down Syndrome Patients With Congenital Nasolacrimal Obstruction".

Re: "Outcome of Primary Monocanalicular Stent Placement in Pediatric Down Syndrome Patients with Congenital Nasolacrimal Obstruction".

Re: "Outcome of Primary Monocanalicular Stent Placement in Pediatric Down Syndrome Patients with Congenital Nasolacrimal Obstruction".

Outcomes of Endonasal Dacryocystorhinostomy Performed for Functional Nasolacrimal Obstruction With Delay on Dacryoscintigraphy.

To report the demographics and outcomes of endonasal dacryocystorhinostomy (DCR) following dacryoscintigraphy (DSG) performed for a series of patients with functional epiphora. Case series of endonasal DCR outcomes in patients with symptomatic epiphora with no evidence of lacrimal hypersecretion or lacrimal pump failure, minimal regurgitation noted on syringing, and DSG-confirmed delayed drainage. A successful outcome was defined as 80% subjective improvement or resolution of tearing on the operated side. Patient charts, DSG results, and operative records were examined, and data were collected. Relevant literature was reviewed and discussed. The case series included 15 eyes of 10 patients. The mean age was 61.7 years at the time of surgery. Most cases (n=13) had post-sac obstruction, retention, or delay. One patient had pre and post-sac retention. A total of 12 cases had success after endonasal DCR, and 3 cases had failure. Follow-up for all operated patients was over 6 months. There were no reported complications by the surgeon or patients. Patients with functional epiphora confirmed by DSG seem to have a high success rate after endonasal DCR. In patients with symptomatic epiphora with subjective patency on syringing, the use of DSG in decision-making and outcome prediction may be supported. Further studies, including clinic-based tests, to demonstrate functional obstruction are warranted.

Conjunctival bacterial flora in fellow eyes of patients less than 5 y/o with unilateral nasolacrimal obstruction and its changes after successful probing surgery

Conjunctival bacterial flora in fellow eyes of patients less than 5 y/o with unilateral nasolacrimal obstruction and its changes after successful probing surgery

Use of Mitomycin C in Dacryocystorhinostomy: A Report by the American Academy of Ophthalmology

To review the literature on the adjuvant use of mitomycin C (MMC) during dacryocystorhinostomy (DCR) in adults with primary nasolacrimal duct obstructions (NLDOs) to determine the efficacy in improving functional and anatomic outcomes with an acceptable level of risk. A literature search conducted in November 2020 and updated in November 2022 yielded 137 articles. Twenty-four articles met the inclusion criteria and were rated for level of evidence by the panel methodologist. Inclusion criteria required controlled studies on the effect of MMC on outcomes of external, endoscopic endonasal, or diode laser-assisted transcanalicular DCR in adults with primary acquired nasolacrimal obstruction with 6 months minimum follow-up and at least 10 participants. Six of the 24 articles were rated level I evidence, 15 level II , and 3 level III. In primary external DCR, MMC significantly improved functional outcomes in 3 of 9 series. In primary endoscopic endonasal DCR, MMC significantly improved functional outcomes in 1 of 9 series. In revision endoscopic endonasal DCR, MMC significantly improved functional success in 1 of 3 series. The use of MMC did not improve outcomes statistically in any diode laser-assisted transcanalicular DCR studies. Concentrations of MMC ranged from 0.05 to 1 mg/ml, with 0.2 mg/ml used most frequently in 12 series, with duration of application ranging from 2 to 30 minutes. Ostium size was significantly larger in MMC groups than in control groups at 6 months after surgery in 4 of 5 reporting studies. However, these larger ostia did not confer higher functional success rates. Reporting of adverse events related to MMC were rare, with delayed cutaneous wound healing reported in 1 of 750 patients. Intraoperative use of MMC in external and endoscopic endonasal DCR has been shown to improve functional and anatomic outcomes compared with controls in some series, but there is no agreement on the recommended concentration or application time for MMC in DCR. The data support that MMC use can result in a larger ostium size, decreased granulation tissue formation, and a decreased number of postoperative nasal debridements compared with controls, but this does not translate into improved functional success. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Ocular and systemic features of Rubinstein–Taybi syndrome in a 12-year-old female

Rubinstein–Taybi syndrome (RTS) is an extremely rare congenital neurodevelopmental disorder caused by mutation in the CREBBP and EP300 genes. It is characterized by wide and angulated thumbs and toes, facial dysmorphism, intellectual disabilities, ocular abnormalities, and postnatal growth retardation. Ocular features of the syndrome are diverse, including nasolacrimal obstructions, downslanting palpebral fissures, telecanthus, high-arched eyebrows, strabismus, glaucoma, cataract, and refractive errors. This case report discusses the ocular findings in a 12-year-old patient with the disease.

Eyedrop Instillation Techniques, Difficulties, and Currently Available Solutions: A Literature Review.

To review current eyedrop instillation techniques, common difficulties faced by patients instilling eyedrops, available eyedrop assistive devices, and patient education regarding eyedrop instillation. PubMed, Embase, and Google Scholar were searched from conception until June 2022 for articles on eyedrop instillation difficulties, techniques, tools, and patient education. Instillation involves pulling down the lower eyelids and placing drops on the corneal surface or conjunctival fornix, followed by closing of the eyelids for about 1 min. Examples of techniques include eyelid closure and nasolacrimal obstruction techniques. Patients encounter many difficulties when administering eyedrops, including but not limited to poor visibility, squeezing the dropper bottle, aiming the bottle, and accidentally blinking. However, devices are available that assist with aim and dropper compression-force reduction in eyedrop instillation. These can be particularly useful in patient demographics with diminished manual dexterity or the ability to generate force from their fingers. Furthermore, despite patient education in eyedrop instillation not being a common practice, it has been found that adequate patient education can lead to significant improvement in eyedrop instillation technique. While many factors are associated with poor eyedrop instillation technique, there are many solutions available including assistive devices and proper instillation education.

Outcome of Primary Monocanalicular Stent Placement in Pediatric Down Syndrome Patients with Congenital Nasolacrimal Obstruction.

Congenital Nasolacrimal duct obstruction (CNLDO) is a relatively common problem in children with Down syndrome (DS). Probing and irrigation (PI) with monocanalicular stent intubation may be less successful than in non-DS patients, thus raising some concerns regarding the preferred treatment in this population. We aimed to analyze the surgical outcome of PI along with monocanalicular stent intubation in children with DS compared with non-DS patients. Retrospective cohort study. Thirty-five eyes of 19 children with DS and 1,472 eyes of 1,001 children without DS underwent PI-monocanalicular stent intubation as a primary treatment for CNLDO. All patients were operated on by a single surgeon at the Children's Hospital of Philadelphia between 2009 and 2020. The main outcome measure was a surgical success, defined as the resolution of symptoms after surgery. A total of 1,020 patients were included, 48% females; mean age of 1.9 ± 1.4 years. The mean follow-up time was 35.0 months. The DS patients group consisted of 19 patients. Higher rates of right nasolacrimal duct obstruction and bilateral obstructions were observed in the DS group (100% vs. 73.2%; p = 0.006, and 84.2% vs. 46.8%; p = 0.001, respectively). Patients with DS had a lower success rate (57.1% vs. 92.4%; p < 0 .0001). The median time to failure was 3.1 months in the DS group, and 5.2 months in the group of patients without DS. The hazard ratio comparing DS to the no-DS outcome was 6.6 (95% CI: 3.2-13.7; p < 0.001). CNLDO in DS is more likely to be bilateral and less likely to resolve after primary monocanalicular stent placement.

Functional epiphora: an under-reported entity

PurposeTo determine the etiology of epiphora in a tertiary Australian lacrimal clinic and highlight the high proportion of ‘functional’ cases.MethodsSingle-center retrospective review: Records of adult patients presenting to a tertiary lacrimal clinic from January 2011 to February 2021 with epiphora were reviewed. Patients underwent testing with syringing/probing and lacrimal imaging to reach a diagnosis of functional epiphora. Functional epiphora was diagnosed based on the exclusion of alternate causes of epiphora on clinical examination, patent lacrimal syringing, normal dacryocystography, and delay on dacryoscintigraphy.ResultsFive hundred and seventy-six symptomatic eyes of 372 adult patients (mean 66.2 ± 15.5 years, 63.4% females) with epiphora were evaluated for causes. Post-sac obstruction (stenosis/complete obstruction) and functional epiphora (non-anatomical delay) were the most common causes of presentations to the lacrimal clinic (26% each). Functional epiphora with post-sac delay was substantially more common than functional epiphora with pre-sac delay (89% vs. 11% of functional epiphora cases). In 16% of the cases, no cause for the epiphora was found while more than one cause (multifactorial) was present 11% of the time.ConclusionFunctional epiphora was found to be as common as a nasolacrimal anatomical obstruction when lacrimal imaging is utilized.

A COMPARATIVE STUDY ON INFERIOR BASED FLAP AND POSTERIOR BASED FLAP AND ITS OUTCOME IN ENDOSCOPIC DACROCYSTORHINOSTOMY IN PATIENTS WITH DACROCYSTITIS ATTENDING TO ENT DEPARTMENT AT TERITIARY CARE HOSPITAL

Occlusion of the nasolacrimal duct (NLD) is a frequent condition that is characterized by tearing1 known as Epiphora. The surgical procedure of diversion of lacrimal ow within a nasal cavity through an articial stula made at the level of a lacrimal sac is called Dacryocystorhinostomy (DCR). This includes complete blockages anywhere from the lacrimal punctum to the nasal cavity. The majority of nasolacrimal system obstruction is unknown. Endoscopic DCR can be done by the creation of a different types of mucosal aps like posteriorly based mucosal ap or inferiorly based mucosal ap. In this study, we compare in detail the Chronic Dacryocystitis disease pattern and difference in surgical outcomes of endoscopic surgical outcomes of endoscopic surgical management with its 3 months follow up

Overview of Epiphora Referred to Oculoplastic Surgery Clinic in Adults.

The aim of the study was to evaluate etiological and demographic characteristics of the adult patients referred to the oculoplastic surgery clinic of the tertiary care center with the complaint of epiphora. The medical records of the patients who applied to the oculoplastic surgery clinic with a complaint of epiphora between January 2014 and July 2021 were reviewed retrospectively. Etiology of epiphora, age, gender, duration of symptom, and follow-up period were evaluated. According to the etiological factors, nasolacrimal system disorders such as punctal stenosis, canalicular stenosis, canaliculitis, and acquired nasolacrimal system obstruction, respectively; the causes of epiphora were grouped as eyelid abnormalities such as entropion and ectropion, and hypersecretory tear secretion due to causes such as dry eye, allergy, and inflammation. The patients with epiphora over the age of 18 with at least 6 months of follow-up were included in the study. Patients with congenital or tumor-related nasolacrimal duct obstruction (NLDO) and epiphora due to trauma-related eyelid or canaliculi injury were not included. A total of 595 medical fields were evaluated. Epiphora was present in 747 eyes of 595 patients. Of the patients, 221 (37%) were male and 376 (63%) were female. According to etiological evaluation of frequency, 372 (62.5%, 432 eyes) patients with NLDO, 63 (10.5%, 123 eyes) patients with punctal stenosis, 44 (7.3%) patients with ectropion, 38 (6.3%) patients with entropion, 37 (6.2%, 69 eyes) patients hypersecretory causes (dry eye, allergy, inflammation, etc.), 24 (4%) patients had primary canaliculitis, and 17 (2.8%) patients had epiphora due to canalicular occlusion. Epiphora is an important complaint that may occur due to different etiologies. A detailed examination of the anterior segment, lacrimal system and eyelids, and taking a history are the most important steps in the management of the patient.

SİLİKON TÜP ENTÜBASYONLU EKSTERNAL DAKRİYOSİSTORİNOSTOMİ; UZUN DÖNEM SONUÇLARI

Aim: To present the long-term results of bicanalicular silicone tube intubation combined with external dacryocystorhinostomy (EDRS) in-patient with nasolacrimal duct obstruction (NLDO)&#x0D; Methods: Long-term results of 169 eyes of 169 patients who underwent external dacryocystorhinostomy between January 2010 and December 2020 in our clinic were evaluated, retrospectively. On the postoperative 1st day, 10th day, 1st month, 3rd month, 6th month, 9th month, 12th month, and last visits, the patients were evaluated. Especially on the postoperative 1st day for signs of infection, the position, tension, and placement of the silicone tube, and the presence of epiphora. Silicone tubes of the patients were removed 6 months after surgery. Surgical success; The disappearance of the patient's symptoms was evaluated as the lacrimal drainage open.&#x0D; Results: 102 of our cases were female and 67 were male. The mean age-standard error was 55,48±1,36. Our average follow-up-standard error was 47,83±2,27 months. Surgical failure occurred in two of our patients. These cases were who were severe bleeding occurred during surgery and flaps were formed with difficulty. In these cases, revision surgeries were performed with an internal approach and surgical success were achieved in both of them. In our patients, who underwent bicanalicular silicone tube intubation surgery combined with external dacryocystorhinostomy, the surgical success rate was 98,76% in the first operation and 100% in the second operation.&#x0D; Conclusions: Considering the long-term results of bicanalicular silicon tube intubation combined with dacryocystorhinostomy operations, it is the most effective surgical method with the highest success rate in nasolacrimal canal obstruction.

Применение трансканаликулярной дакриоэндоскопии в практике врача офтальмолога

The peculiarities of the topography of the lacrimal apparatus, as well as the complexity of diagnosis and choice of the method of treatment of the lacrimal pathways prompted the search for methods of their direct visualization. Transcanalicular endoscopy of the lacrimal tracts allows for direct visual examination of their internal surfaces and contents. Keywords: lacrimal tracts, dacryostenosis, Nasolacrimal obstruction, transcanalicular endoscopy

Does Bicanalicular Intubation Improve the Outcome of Endoscopic Dacryocystorhinostomy?

The aim of this study was to compare the success of endoscopic dacryocystorinostomy with and without bicanalicular intubation in the treatment of distal nasolacrimal duct obstruction. Methods: In a prospective, randomized, comparative study, endoscopic dacryocystorinostomy without bicanalicular silicone intubation (Group I) and endoscopic dacryocystorinostomy with intubation (Group II) were performed in patients with distal nasolacrimal duct obstructions. The tubes were removed 3 months after surgery in Group II, and the patients were followed up for 6 months after surgery. Therapeutic success was defined as the fluorescein dye disappearance test grade 0–1 corresponding with a complete resolution of symptoms. Results: Thirty patients, aged 23–86 years, were included in the study. The success rate was 13/15 (86.67%) in Group I and in 14/15 (93.33%) in Group II. The difference between the two groups was not statistically significant (p = 0.483). Most common complications were granulations that occurred in 1/15 (6.67%) patient in Group I and in 2/15 (13.33%) patients in Group II. Adhesions in rhinostomy with epiphora and persistent secretion were observed in 1/15 (6.67%) patient in Group II. Conclusions: Bicanalicular intubation does not significantly increase the success rate of EDCR in distal nasolacrimal obstruction in adults.

Tear instability in the fellow eye of unilateral nasolacrimal obstruction and resolution with dacryocystorhinostomy

ABSTRACT Purpose To determine the effect of unilateral primary acquired nasolacrimal obstruction (PANDO) on ocular surface parameters in PANDOeyes and fellow eyes and changes in these parameters after dacryocystorhinostomy. Methods Tear osmolarity, tear break-up time (TBUT), Schirmer’s test, Meibomian gland score, and Lissamine Green staining of PANDO eyes and fellow eyes were measured preoperatively and postoperatively at Day 15, 1 month, and 3 months. Lacrimal irrigation and epiphora symptomatology were evaluated at all follow-up visits, and patients who did not meet surgical success criteria were excluded from the study. Results Twenty-nine patients who underwent successful dacryocystorhinostomy surgery were included in the study. Preoperative and postoperative Day 15 Schirmer (p = .019, p = .001) and TBUT (p = .039, p = .043) were significantly lower in the fellow eye compared to PANDO eyes. The differences observed between PANDO eyes and fellow eyes in all other parameters were not significant (p > .05). Preoperatively PANDO eye parameters were normal, whereas TBUT (7.59 ± 5.39 s) and tear osmolarity (308.59 ± 17.32 mOsm/L) values of the fellow eye may be indicative of tear film instability. TBUT and tear osmolarity of the fellow eye showed significant improvement 3 months postoperatively compared to preoperative values (p = .010; p = .027 respectively). Conclusion Schirmer and TBUT values of the fellow eye were significantly lower than PANDO eyes preoperatively, one month after surgery there was no significant difference. TBUT and tear osmolarity of the fellow eyes may be indicative of tear instability preoperatively with improvement 3 months after dacryocystorhinostomy.