Patency Of Nasolacrimal Duct Research Articles

Assessment of the vision-related quality of life (VR-QOL) in patients with watery eyes

Watering from the eyes is one of the common ocular complaints which leads to blurred vision. It has an impact on daily activities and the social life of the individual which is not studied much. Hence, we did this study with the aim to estimate the proportion of watery eye patients in whom the vision-related quality of life (VR-QOL) is affected. We conducted a cross-sectional questionnaire-based study. Patients who complained of watering for more than one month were included. All the patients were asked to fill a VR-QOL questionnaire. We considered VR-QOL status to be affected if the score for any of the activity listed in the questionnaire was more than or equal to one. We assessed the association of this VR-QOL status with various factors like age, gender, laterality, patency of nasolacrimal duct and Munk score. A total of 59 patients participated in our study. The mean age of study participants was 52.6 ± 13.8 years and 31 were males. VR-QOL was affected in 89.8% and blurring of vision was the most common impairment. The effect of gender and age on VR-QOL due to watering was not significant. We found that watering of eyes causes a significant blurring of vision (p value=0.031) and discomfort during outdoor activities (p-value 0.045). : Epiphora has a significant impact on VR-QOL. The lacrimal drainage system is the major cause of watery eyes. It is important to include the functional component in the outcome assessment of epiphora treatment.

Effect of Topical 5-Fluorouracil on Lacrimal Drainage System: Histopathological Evidence From Animal Experiments and Potential Clinical Implications.

The purpose of this study is to investigate the histopathological changes in the lacrimal drainage system of rabbits following the application of 1% topical 5-fluorouracil (5-FU) for 4 weeks. Ten eyes of 10 healthy New Zealand white rabbits were subjected to topical instillation of 1% (10 mg/mL) 5-FU, 1 drop 4 times a day for 4 weeks. Rabbits underwent a detailed ocular examination including eyelids, ocular surface, punctal, peri-punctal changes, and nasolacrimal duct patency at baseline and after 4 weeks of 5-FU. The rabbits were then sacrificed, and the eyelid, conjunctiva, lacrimal gland, and the entire lacrimal drainage system were retrieved for histopathological analysis as per standard protocols. Clinically demonstrable peripunctal changes and canalicular stenosis were noted in 6 (60%, 6/10) rabbits. Two of these (20%, 2/10) had additional complete regurgitation of clear fluid, indicating a nasolacrimal duct obstruction. The remaining 4 (40%, 4/10) clinically did not demonstrate lacrimal drainage changes and were patent on irrigation. The conjunctiva showed focal loss of goblet cells in several areas. Significant changes were noted in the canalicular, lacrimal sac, and the nasolacrimal duct tissues in the form of epithelial hyperplasia, subepithelial inflammation, edema, dilated and congested vessels, and fibrosis. The lacrimal gland, eyelid tissue (excluding tarsal conjunctiva), and cornea showed no significant histopathological changes. Clinical and histopathological changes were noted in the lacrimal drainage system of rabbits subjected to topical 5-FU application. These findings can have potential clinical implications for patients receiving 5-FU therapy.

Tear film breakup time and Schirmer tear test in normal dogs: Effects of age, sex, reproductive status, skull type, and nasolacrimal duct patency.

The present study aimed to determine the effects of age, sex, reproductive status, skull type, and nasolacrimal duct (NLD) patency on tear production and tear film breakup time (TBUT) in normal dogs. The ophthalmic data of 82 healthy adult dogs were evaluated in this study. Age, sex, breed, and reproductive status were recorded. Schirmer tear test (STT) and TBUT were assessed in all dogs, and interferometry was available for the selected dogs. The Jones test was used to evaluate NLD patency. The cephalic index (CI) was calculated for each dog (skull width/skull length ×100). Mean (SD) values for the STT results for the right (OD) and left (OS) eyes were 20.6 (2.7) and 20.2 (2.7) mm/min, respectively. Mean (SD) TBUT values for OD and OS were 6.5 (2.5) and 6.1 (2.3) mm/min in all dogs, respectively. Sex and reproductive status had no significant effect on STT and TBUT (P[OU] > 0.05). Skull type significantly affected TBUT in both eyes (P(OD) =0.01, P(OS) =0.003), but had no effect on STT (P[OU] > 0.3). Age had no correlation with STT and TBUT in either eye (P[OU] > 0.05). STT and TBUT had no correlation in either eye (P[OU] > 0.2). NLD patency had no significant effect on STT or TBUT (P[OU] > 0.1). The results of this study showed lower TBUT values in brachycephalic breeds than in non-brachycephalic breeds. A compensatory increase in STT values was observed in dogs with low TBUT values.

Ophthalmology of clinically normal alpacas (Vicugna pacos) in the United Kingdom: a cross-sectional study.

BackgroundAlpacas are being more frequently presented to veterinarians in the UK. It is important to validate whether published normal ocular parameters are consistent with the alpaca population in the UK.MethodsOphthalmic examinations were performed on healthy alpacas (Vicugna pacos) from three farms in East Anglia, UK.ResultsOn direct ophthalmoscopy of 35 alpacas, there was a 50 per cent prevalence of opacities within the lens in alpacas older than two years old (n=8/16). There was a 36.8 per cent prevalence of persistent hyaloid arteries in alpacas under two years old (n=7/19). The mean Schirmer tear test-1 value was 20.0 ±6 mm/minute (n=40). The mean intraocular pressure measured by rebound tonometry was 17.2 ±5.5 mmHg (n=46), and applanation tonometry resulted in statistically similar values (P=0.30; n=25). There was a significant variation in intraocular pressure throughout a 24-hour period (n=8). Fluorescein dye was not detected at the nostrils of any of the alpacas which underwent a Jones test to assess nasolacrimal duct patency (n=8).ConclusionThe ophthalmic findings appear largely consistent with previously published values from North America and continental Europe. Variations include the large range of measurements obtained and evidence of diurnal variation in intraocular pressure.

Acute dacryocystitis in pediatric patients and frequency of nasolacrimal duct patency

ABSTRACT Purpose: To study acute dacryocystitis in a pediatric age group, focusing on patients’ demographic profiles, clinical presentation, and management outcome. Methods: A retrospective case series of all acute dacryocystitis in pediatric patients (0–17 years) from two tertiary-care eye centres in Riyadh, Saudi Arabia was conducted. Demographic profile, risk factors, initial clinical presentation, management regimens, and final outcome were analysed. Results: A total of 51 patients were included in the study. The mean age of presentation was 3.9 ± 4 years (1 month–13 years). Thirty-eight patients (74.5%) reported symptoms of congenital nasolacrimal duct obstruction (NLDO) prior to presentation, four patients (7.8%) had congenital dacryocystocele, two (3.9%) had a history of traumatic NLDO, and ten (19.6%) had an attack of acute dacryocystitis in the absence of NLDO or any other known risk factors. Four patients (7.8%) progressed to orbital cellulitis while another three (5.8%) had lacrimal sac fistula secondary to acute dacryocystitis. Systemic antibiotics were the initial management in all 51 patients. Twenty-five (49%) underwent probing after the resolution of the acute attack while 12 (23.5%) patients underwent dacryocystorhinostomy (DCR). Conclusions: Early recognition and urgent management for acute dacryocystitis are required to prevent further potential complications and achieve excellent outcomes. Congenital NLDO is the main risk factor for the development of acute dacryocystitis in the pediatric age group. In a small set of patients, acute dacryocystitis can develop despite the presence of a patent lacrimal drainage system on clinical evaluation with lack of tearing and discharge before and after the attack of acute dacryocystitis.

A Simple Surgical Approach for the Management of Acquired Severe Lower Punctal Stenosis.

Purpose Evaluation of using pigtail probe to detect and open severely stenosed lower lacrimal punctum followed by self-retaining bicanalicular intubation. Study design A prospective nonrandomized clinical study. Methods The study included 24 patients with severe lower punctal stenosis (grade 0 according to Kashkouli scale) attending at Menoufia University Hospitals. The upper punctum and canaliculus were patent. All patients were complaining of epiphora and had a thorough ophthalmological examination including dye disappearance test and slit-lamp examination. Pigtail probe was used from patent upper punctum to detect the lower stenosed punctum which was opened with a scalpel. Syringing of the lower lacrimal passages was done to confirm its patency, and self-retaining silicone bicanalicular stent was inserted. The silicone tube was left in place for 6 months before it was removed. Patients were then followed-up for 1 year after the surgery. Results One year after surgery, epiphora was absent (grade 0) in 16 eyes (66.7%) and was present only occasionally (grade 1) in 4 eyes (16.7%). The difference from preoperative epiphora was statistically significant. One year after surgery, fluorescein dye disappearance time was grade 1 (<3 minutes) in 20 cases (83.3%), and grade 2 (3–5 minutes) in 4 cases (16.7%). There was a statistically significant difference compared with preoperative results. Conclusion Using the pigtail probe is effective in treatment of severe punctal stenosis. Maintaining the punctal opening and prevention of restenosis can be achieved by using self-retaining bicanalicular stent after confirmation of nasolacrimal duct patency. This trial is registered with NCT03731143.

Novel taste test for nasolacrimal duct obstruction using denatonium benzoate: a randomized controlled pilot study

ObjectiveTo evaluate a novel, simple, noninvasive method (known as the “bitter taste test”) of establishing nasolacrimal duct patency in healthy asymptomatic eyes. DesignDouble-blind, randomized controlled pilot study. ParticipantsHealthy asymptomatic medical students, residents, and allied health staff at our institution. MethodsParticipants, aged 18–35 years (n = 28) with assumed normal lacrimal function, were randomized to the interventional group (100 parts per million denatonium benzoate in sterile water, n = 14) or to the control group (sterile water only, n = 14). All participants were pretreated with topical tetracaine in their right conjunctival cul-de sac, followed by 3 drops of the experimental solution spaced 1 minute apart. The primary outcome was whether participants reported a strong, persistent bitter taste. The secondary outcome was the time-to-taste. All participants received lacrimal irrigation. The Fisher’s exact test was done using GraphPad online software. ResultsAll participants in the interventional group reported the presence of the bitter solution. None of the participants in the control group reported bitterness (p < 0.001, Fisher’s exact test). Time-to-taste was within 15 minutes for 71% of the intervention group (n = 10); within 30 minutes for 79% (n = 11); and within 2 hours for 100% (n = 14). The bitterness typically persisted for 1–2 hours. All participants had normal lacrimal systems to irrigation. No adverse events were reported. ConclusionsThe bitter taste test demonstrates a promising ability to assess nasolacrimal duct patency under physiologic conditions in healthy participants. Further research is needed to validate this method in a clinical sample of patients with nasolacrimal duct obstruction.

Indian survey on practice patterns of lacrimal & eyelid disorders (iSUPPLE): Report 3 – Cataract and nasolacrimal duct obstruction

AimTo assess the practice patterns pertaining to pre-cataract screening for nasolacrimal duct obstruction (NLDO) among oculoplastic surgeons in India. The survey was aimed at obtaining data on the current screening and treatment strategies for NLDO and the interval between lacrimal surgery and subsequent cataract surgery. MethodsAn online survey was sent to all members of Oculoplastic Association of India. All valid responses were tabulated and analyzed. ResultsMajority of the respondents (92%) felt that nasolacrimal duct patency should be checked prior to performing cataract surgery: 59.6% felt that checking for regurgitation on pressure over the lacrimal sac (ROPLAS) was sufficient and 32.6% preferred to perform lacrimal irrigation to check for NLD patency. Dacryocystorhinostomy (DCR) was the preferred surgery for NLDO thus detected. The preferred interval between a DCR and subsequent cataract surgery was 4weeks (48.9%). A small minority (7.9%) of the respondents felt that pre-cataract screening for NLDO was not required. Also, a small but significant number (12.6%) felt that no treatment was required for NLDO in such patients and that to could go ahead with cataract surgery even in the presence of coexisting NLDO. ConclusionsThere is a general agreement on the need for pre-cataract screening for NLDO and a majority indicated that checking for ROPLAS was sufficient. Most surgeons prefer to perform a DCR in cases of NLDO and wait for 4weeks before intraocular surgery. There is however, a lacuna in the literature on guidelines regarding the optimal interval between lacrimal surgery and subsequent intraocular surgery.

Lacrimal syringing versus combined lacrimal probing and syringing for treatment of congenital nasolacrimal duct obstruction in children

Introduction: Congenital nasolacrimal duct obstruction (CNLDO) is the most common abnormality of the lacrimal system in the early years of life. Aims and Objectives: To rationalize the applicability of lacrimal syringing alone in comparison to combined lacrimal probing and syringing for the treatment of congenital nasolacrimal duct obstruction in children. Material and Methods: The study was conducted on fifty patients suffering from congenital nasolacrimal duct obstruction randomly selected from the outpatient department of Regional Institute of Ophthalmology, Government Medical College, Amritsar. Results: Majority of cases could be cured by single attempt of combined probing and syringing and cure rate could be enhanced by repeated attempts within 1st two years of life. Conclusion: The overall assessment of the study indicates that although the success rate of gentle lacrimal syringing alone is low yet it is worthwhile to try this least traumatic procedure in each and every child reporting with congenital nasolacrimal duct obstruction under 1 year of age. If lacrimal syringing as a first hand procedure fails, then lacrimal probing along with syringing should preferentially be attempted and may be repeated 2-3 times at a minimum interval of 2 weeks each till the patency of nasolacrimal duct is restored.

Endoscopic Ultrasonic Dacryocystorhinostomy for Recurrent Dacryocystitis Following Rhinoplasty

The lacrimal sac is the structure most vulnerable to injury when performing rhinoplastic osteotomies. When performed in a low lateral position or along the frontal process of the frontal-maxillary suture, osteotomies can potentially tear the medial canthal tendon and injure the underlying lacrimal sac, possibly resulting in dacryocystitis. In this case report, the authors discuss a case of dacryocystitis following primary rhinoplasty; this injury was repaired with endoscopic dacryocystorhinostomy (DCR) using a Sonopet ultrasonic bone aspirator (Stryker, Kalamazoo, Michigan) at a single institution. This method achieved nasolacrimal duct patency, and the patient continued to be symptom-free at an 18-month follow-up. This is the first reported case of recurrent dacryocystitis following rhinoplasty as treated by endoscopic DCR. 5.

Analysis of 104 Cases of Endonasal Dacryocystorhinostomy in a Tertiary Care Hospital: A Prospective Study

To evaluate the results of endoscopic endonasal dacryocystorhinostomy performed in a tertiary care hospital. Prospective, nonrandomized, interventional clinical study. A prospective interventional study was performed on 104 patients presenting with epiphora between January 2006 and January 2010. All patients were operated by one surgeon. Out of 104 cases, 08 cases were of revision endonasal dacryocystorhinostomy (DCR). Bicanalicular silicon intubation was performed in all cases of revision endonasal DCR. Twelve patients had concomitant sinonasal disease for which septoplasty or FESS was done. The patency of nasolacrimal duct was assessed by doing syringing of lacrimal passage weekly for 1month, monthly for 3month, then at 6month and 1year. Out of 104 patients 10 patients lost follow up after surgery. Ninety four patients were followed for 1year. On syringing, rhinostomy site was found patent in 80 patients (85.10%), therefore they were fully satisfied. In 6 cases (6.38%) minimal block was seen with clear fluid regurgitation, were to some extent symptomatically relieved and were found to be satisfied, whereas in 08 cases (8.51%) syringing showed complete block. They required further management. Success rate of our study is comparable to other studies on endonasal DCR as well as external DCR, with advantages of less intra-operative bleeding, shorter operative time, better cosmesis, preservation of lacrimal pump mechanism. Other nasal pathology can be treated at the same time. Our results are clinically as well as statistically highly significant (P value<0.0001).

Can Lacrimal Sac Washout Predict Outcomes of Endoscopic DCR?

Objective: High success rates for endoscopic dacryocystorhinostomy (END-DCR) in partial nasolacrimal duct obstruction (NLDO) have been reported, but comparisons with complete NLDO are lacking. This study compares the success of primary END-DCR with respect to the preoperative nasolacrimal duct patency and reviews factors associated with failure. Method: Retrospective review of END-DCRs performed at a tertiary referral center. Partial and complete NLDO were defined by the presence or absence of flow into the nose with lacrimal sac washout (SWO), respectively. Intraoperative findings including thickness of bone, level and state of the common canaliculus, state of inflammation, and contents of the lacrimal sac during END-DCR were recorded. For patients with at least 3 months follow-up, the outcome of resolution of epiphora (none/partial/complete), postop Jones 1 (J1; positive/ negative) and endoscopy of the neo-ostium (closed/partially or fully-open) were defined. Results: A total of 245 primary END-DCRs were reviewed (mean age, 63.6 ± 5.3 years, 70% women). Based on SWO, the groups were defined as 39.6% and 60.4% complete NLDO. Overall improvement in epiphora was 95.5%. In cases where symptoms improved, absence of flow into nose on SWO was associated with a higher rate of complete resolution (93.6% vs 84.9%, RR 1.102 [1.001, 1.213]). The ostia were fully open in 93.9% and postop J1 was positive in 97.1% of patients and were not different between groups. Conclusion: END-DCR is highly successful for both types of NLDO. Preoperative absence of flow into nose on SWO was associated with slightly higher chance of complete resolution.

Allergic Conjunctivitis and the Impact of Allergic Rhinitis

Although nasal allergy has been prominent in allergy research, ocular allergy is increasingly recognized as a distinct symptom complex that imposes its own disease burden and reduction in patients' quality of life. In the past year, knowledge of the relationships between allergic conjunctivitis and allergic rhinitis has increased. Allergic conjunctivitis is highly prevalent and has a close epidemiologic relationship with allergic rhinitis. Both conditions also exhibit similar pathophysiologic mechanisms. Pathways of communication are thought to increase the likelihood of an inflammatory reaction at both sites following allergen exposure of nasal or ocular tissue. Clinical trials of intranasal therapies have demonstrated efficacy in allergic conjunctivitis and rhinitis. Newer intranasal steroids decrease ocular symptoms, potentially achieving efficacy by suppressing the naso-ocular reflex, downregulation of inflammatory cell expression, or restoration of nasolacrimal duct patency. Proposed pathophysiologic interactions between allergic rhinitis and ocular allergy underscore the need for therapies with efficacy in both symptom sets.

Randomized Trial of Silver Nitrate, Erythromycin, and No Eye Prophylaxis for the Prevention of Conjunctivitis Among Newborns Not at Risk for Gonococcal Ophthalmitis

Objective. To compare the efficacy of commonly used forms of eye prophylaxis for newborns with no prophylaxis in the prevention of nongonococcal conjunctivitis. Design. Randomized doubly masked clinical trial. Setting. University of Washington Hospital and affiliated clinics, Seattle, between 1985 and 1990. Subjects. The medical records of 8499 women were evaluated for possible participation; 2577 were eligible. Of the 758 enrolled, the infants of 630 were evaluable. Intervention. Comparison of silver nitrate, erythromycin, and no eye prophylaxis given at birth for the prevention of conjunctivitis. Main outcome measures. Conjunctivitis during the first 60 days of life and nasolacrimal duct patency in the first 2 days of life. Results. The frequency of impatent tear ducts at the 30- to 48-hour examination did not differ significantly by prophylaxis group. Among the 630 infants randomized and observed, 109 (17%) developed mild conjunctivitis. Sixty-nine (63%) of the cases appeared during the first 2 weeks of life. After 2 months of observation, infants allocated to silver nitrate eye prophylaxis at birth had a 39% lower rate of conjunctivitis (hazard ratio = 0.61, 95% confidence interval = 0.39 to 0.97), and those allocated to erythromycin had a 31% lower rate of conjunctivitis (hazaid ratio = 0.69, 95% confidence interval = 0.44 to 1.07), than did those allocated to no prophylaxis. Conclusion. Silver nitrate eye prophylaxis caused no sustained deleterious effects and even provided some benefit to infants born to women without Neisseria gonorrhoeae. However, the effect was modest and against microorganisms of low virulence. The results suggest that parental choice of a prophylaxis agent including no prophylaxis is reasonable for women receiving prenatal care and who are screened for sexually transmitted diseases during pregnancy.