Primary Nasolacrimal Duct Obstruction Research Articles

Comparison on the clinical efficacy between dacryocystorhinostomy with or without silicone intubation: A Cumulative Meta Analysis

To compare and analyse the efficacy of dacryocystorhinostomy (DCR) with or without stent intubation for the treatment of primary nasolacrimal duct obstruction. The English and Chinese literature of randomized controlled trials (RCTs) about comparison of dacryocystorhinostomy with and without stent intubation for treating primary nasolacrimal duct obstruction are selected. The related grey literature and database are explored. Two reviewers independently screen the studies for eligibility, evaluate the quality and extract the data from the eligible studies with confirmation by cross-checking. Divergences of opinion are resolved by discussion or consensus involving a third reviewer. Meta-analyses are performed by Rev Man 5.3. Ten RCTs involving 887 cases meet the inclusion criteria. The success rate of DCR with stent intubation is significantly better than that of DCR without stent intubation, especially in the external DCR subgroup. Key words: Dacryocystorhinostomy(DCR); Stent intubation; Meta analysis

Increased Concomitant Nasal Procedure Frequency in Bilateral Endoscopic Dacryocystorhinostomy.

The etiology of primary nasolacrimal duct obstruction (NLDO) is unknown, and the disease may exist bilaterally in a small number of patients. Dacryocystorhinostomy (DCR) surgery is the recommended treatment for these patients, but concomitant nasal pathologies are believed to be related to decreased surgical success. The authors aim to assess the concomitant required nasal surgical procedure frequency for endoscopic surgical access retrospectively in bilateral and unilateral NLDO patients. Twenty-eight patients who underwent bilateral endoscopic DCR simultaneously and 30 patients who underwent unilateral endoscopic DCR were enrolled in this retrospective study. Required concomitant nasal procedure frequency was recorded. In the bilaterally applied DCR group, septoplasty, partial midline turbinectomy, and inferior nasal concha submucosal resection rates were 16 (57.1%), 5 (17.8%), and 3 (10.7%) patients, respectively. Septoplasty and concha bullosa resection were performed simultaneously in 2 patients. Also, uncinectomy was performed with septoplasty in 1 patient. The concomitant nasal surgery rate was 22 of 28 patients (78.6%). On the other hand, in the unilaterally applied DCR group, septoplasty, partial midline turbinectomy, and inferior nasal concha submucosal resection rates were 5 (16.7%), 1 (3.3%), and 2 (6.7%) patients, respectively. Both septoplasty and concha bullosa resection were done in 1 patient. Uncinectomy was performed on 1 (3.3%) patient. A concomitant surgery rate was observed in 8 of 30 patients (26.7%). Nasal pathology, which requires surgical intervention, is seen much more frequently in bilateral than in unilateral NLDO patients.

Efficacy of Endo Nasal DCR in Primary Nasolacrimal Duct Obstruction

Efficacy of Endo Nasal DCR in Primary Nasolacrimal Duct Obstruction

Functional Outcome in Primary Nasolacrimal Duct Obstruction after Successful External Dacryocystorhinostomy Surgery

Aim: To assess the functional outcomes of external dacryocystorhinostomy(DCR) surgery in symptomatic patient with primary nasolacrimal duct obstruction .Settings and Design: Prospective, clinical interventional studyMethods: This study was conducted in 50 consecutive (50 eyes) patients of Primary Acquired Nasolacrimal Duct Obstruction admitted in a tertiary eye care centre. Functional outcome comprises of symptom improvement which include absence of epiphora, improvement in vision, routine work, occupational work, mood, embarrassment. Assessment was done by pre and post-operative questionnaires at 2 ,6 and 12 months postoperatively.. Anatomic success was assessed by Lacrimal syringing , Fluorescein dye disappearance test(FDDT) and endoscopic view of osteotomy. Statistical significance between preoperative and postoperative symptoms (Functional outcome assessment) was analysed using McNemars testResults: Postoperatively, marked improvement in subjective symptoms i.e. difficulty in vision (93.5%), routine work (95.6%),occupational work (95.8%),mood(95%) and embarrassment (94%) was seen with anatomic success of 96%.Conclusions: In PANDO population, symptoms bother patient significantly. However, successful DCR surgery has a beneficial effect on the patient physical and social health thus changing the quality of life of patients markedly.

Study of microbial growth on silicone tubes after transcanalicular laser-assisted dacryocystorhinostomy and correlation with patency.

Intubation in primary transcanalicular laser assisted dacryocystorhinostomy (TCLADCR) is performed to increase the success rates. However, the associated inflammation and infection can have adverse effects. To study the microbial infection and drug susceptibility of extubated silicone tubes and final anatomical patency in patients undergoing TCLADCR. A non-randomised prospective interventional study was conducted in a tertiary care eye centre. The study included twenty consecutive adult patients with primary nasolacrimal duct obstruction. They underwent TCLADCR with bicanalicular silicone intubation. The stents were removed at 2 months and subjected to culture sensitivity, followed by administration of appropriate antimicrobial agents. Main outcome measures studied were the microbial spectrum on the cultured tubes, their sensitivity profile and its correlation with final anatomical patency. A positive culture was obtained in 100% cases, comprising of normal commensals and pathogenic organisms. Of the total 24 isolates, 16 (66.6%) Gram positive bacteria (75% Staphylococcus aureus) and 8 (33.3%) Gram negative bacteria (commonest E.coli) were found, with 4 tubes having more than one isolate. No fungal growth was seen. Ninety percent success rate was achieved at one year following appropriate antimicrobial therapy except in 2 patients with gram negative isolates who had failed to take the prescribed antibiotics following sensitivity reports. There was no correlation between multiple infections and success rate. However, by using the Fisher exact test, a positive correlation was obtained between appropriate antibiotic treatment and the final anatomical patency (p less than 0.05). Silicone intubation predisposes to microbial growth, which if neglected, can lead to failure of TCLADCR.

Surgical outcomes of external dacryocystorhinostomy and risk factors for functional failure: a 10-year experience

To analyze the surgical outcomes of external dacryocystorhinostomy (DCR) and the risk factors associated with functional failure. We reviewed the medical records of 769 patients who underwent external DCR for primary lacrimal drainage obstruction between 2005 and 2014. Recorded data included intraoperative anatomical findings, postoperative diagnosis, and surgical outcomes. We performed univariate and multivariate analyses to identify risk factors for functional failure. Of the 769 cases, primary nasolacrimal duct obstruction (NLDO) was diagnosed in 457 cases; common canalicular obstruction in 228 cases; and canalicular obstruction in 84 cases. Anatomical success was achieved in 98.8% (760/769) and functional success in 81.9% (630/769) of the cases. An analysis of 760 anatomically successful DCRs showed that common canalicular obstruction (OR=1.752, P=0.014) and canalicular obstruction (OR=2.058, P=0.015) were independent risk factors for functional failure. In a subgroup analysis of patients with primary NLDO, patients with a small lacrimal sac had a significantly higher risk of functional failure (OR=2.500, P=0.018). The overall surgical outcomes of external DCR were favorable in this case series. Site of obstruction was an important risk factor for functional failure in cases with primary lacrimal drainage obstruction. A small lacrimal sac was also found to be a risk factor for functional failure in cases with primary NLDO.

Epiphora as first presenting sign of primary extranodal NK/T-cell lymphoma of the lacrimal sac

ABSTRACTA 28-year-old Caucasian female presented with a six-month history of epiphora of the right eye. Diagnostic lacrimal syringing revealed obstruction of the right nasolacrimal duct. During external dacryocystorhinostomy (DCR), the lacrimal sac had an unusual papillary appearance. Frozen sections suggested malignant lymphoid cells. Pathologic examination revealed extranodal NK/T-cell lymphoma, nasal type. Imaging revealed a mass lesion centered on the lacrimal sac. The authors describe the youngest Caucasian patient with a primary NK/T-cell lymphoma of the lacrimal sac, as well as the first case presenting with epiphora as the sole presenting symptom, reported in the literature. Extranodal NK/T-cell lymphomas rarely occur in the orbit, and are known to be rapidly growing, aggressive lesions. Despite chemotherapy, the patient succumbed to her disease twelve months after diagnosis. Lacrimal surgeons should maintain a high index of suspicion in all cases of primary nasolacrimal duct obstruction. Pre- or intra-operative clinical suspicion of malignancy in the lacrimal sac necessitates biopsy.

Intraoperatively Observed Lacrimal Obstructive Features and Surgical Outcomes in External Dacryocystorhinostomy.

PurposeTo analyze the features of lacrimal drainage system obstruction confirmed during external dacryocystorhinostomy surgeries and report the surgical outcomes.MethodsWe reviewed the medical records of a total of 769 cases who underwent external dacryocystorhinostomy for primary lacrimal drainage obstruction between 2005 and 2014. Data about detailed location and extent of obstruction were collected intraoperatively. The sites of obstruction were classified into nasolacrimal duct obstruction (NLDO), common canalicular obstruction (CCO), and canalicular obstruction. Lacrimal sac mucosa and lumen were grossly inspected, and the frequency of lacrimal sac changes, such as significant inflammation or fibrosis, was analyzed in cases of CCO or canalicular obstruction. The surgical success rate was also evaluated including effect of lacrimal sac status in the CCO and canalicular obstruction groups.ResultsOf 769 cases, primary NLDO with patent canaliculi was diagnosed intraoperatively in 432 cases (56.2%), CCO in 253 (32.9%), and canalicular obstruction in 84 (10.9%). Of 253 cases with CCO, 122 (48.2%) showed clear lacrimal sac lumen, and the other 131 (51.8%) showed significant inflammation or fibrosis of the lacrimal sac. In cases with canalicular obstruction, 35 of 84 (41.7%) showed a clear lacrimal sac, and the other 49 cases (58.3%) cases revealed mucosal changes of the lacrimal sac. The functional success rate was 87.5% for primary NLDO, 75.5% for CCO, and 72.6% for canalicular obstruction. In the CCO group, the functional success rate was lower in cases with significant lacrimal sac change (p = 0.044).ConclusionsEven in patients with CCO or canalicular obstruction, a large number of cases have lacrimal sac changes, and those changes were associated with lower functional success rate.

Simultaneous Bilateral Endonasal Endoscopic Dacryocystorhinostomy: A Low Cost, Fast, and Successful Method.

The etiology of primary nasolacrimal duct obstruction is largely unknown, and this disease may occur bilaterally in a small percentage of patients. In this retrospective study, the authors aimed to discuss the cost, operation time, complications, and success rate of simultaneous bilateral endonasal endoscopic surgery. Twenty-eight patients (16 female, 12 male) were enrolled in this study, with a mean age of 55 years old (range: 43-76). The success rate was 91% (51/56), and the mean operation time was 44 minutes. Only minor and transient complications were observed in 2 of the patients. Overall, the authors believe that a bilateral endoscopic dacryocystorhinostomy would be useful in a single session, based on its advantages of low morbidity, low cost, and high success.

Aquaporin expression in the lacrimal sac of patients with primary and functional nasolacrimal duct obstruction

PurposeTo compare the expression profile of aquaporins (AQPs), a family of membrane proteins that function as selective pores in the epithelium of the lacrimal sac in patients with primary or...

Nonendoscopic endonasal dacryocystorhinostomy: Outcome in 134 eyes.

Aims:To evaluate the outcome of nonendoscopic endonasal dacryocystorhinostomy (NEN-DCR) in patients with nasolacrimal duct obstruction (NLDO) in India.Methods:Retrospective case series of NEN-DCR between July 2012 and October 2014. All patients had follow-up >3 months. Success was defined anatomically as patency on irrigation and functionally as relief from epiphora.Statistical Analysis Used:Fischer's exact test and Chi-square test.Results:A total of 122 patients (134 eyes; 81 female; mean age 37 ± 18 years) were included. Indications were primary acquired NLDO in 92 (68%) eyes of adults (>18 years), NLDO in children (<18 years) in 22 eyes (16%), acute dacryocystitis in 13 eyes, failed prior DCR in six eyes, and secondary acquired NLDO in one eye. Mean duration of surgery was 36 min (range: 16–92). At a median follow-up of 6 months (range: 3–15), 86% eyes had functional success and 85% had anatomical success. Revision NEN-DCR was successful in 13/16 eyes. All patients with acute dacryocystitis were completely symptom-free at final visit. In children, (17/22) 77% achieved functional success after primary NEN-DCR which improved to 100% after one revision. Tube-related epiphora and granuloma in ten eyes resolved after removal.Conclusion:NEN-DCR gives good outcome in primary NLDO and is also effective in those with acute dacryocystitis and in children with NLDO. The technique obviates the need for an endoscope and has an acceptable safety profile and thus may be particularly suited for the developing nations.

Comparison of Transcanalicular Multidiode Laser Dacryocystorhinostomy with and without Silicon Tube Intubation.

Aim. To compare the surgical outcomes of surgery with and without bicanalicular silicon tube intubation for the treatment of patients who have primary uncomplicated nasolacrimal duct obstruction. Methods. This retrospective study is comprised of 113 patients with uncomplicated primary nasolacrimal duct obstruction. There were 2 groups in the study: Group 1 (n = 58) patients underwent transcanalicular diode laser dacryocystorhinostomy surgery with bicanalicular silicon tube intubation and Group 2 (n = 55) patients underwent transcanalicular diode laser dacryocystorhinostomy surgery without bicanalicular silicon tube intubation. The follow-up period was 18.42 ± 2.8 months for Group 1 and 18.8 ± 2.1 months for Group 2. Results. Success was defined by irrigation of the lacrimal system without regurgitation and by the absence of epiphora. Success rates were 84.4% for Group 1 and 63.6% for Group 2 (P = 0.011). Statistically a significant difference was found between the two groups. Conclusion. The results of the study showed that transcanalicular diode laser dacryocystorhinostomy surgery with bicanalicular silicon tube intubation was more successful than the other method of surgery. Consequently, the application of silicone tube intubation in transcanalicular diode laser dacryocystorhinostomy surgery is recommended.

Efficacy of postoperative mitomycin-C eye drops on the clinical outcome in endoscopic dacryocystorhinostomy.

To evaluate the effect of postoperative topical mitomycin-C (MMC) eye drops in endoscopic (dacryocystorhinostomy) DCR and compare them with intraoperative MMC soaking. Retrospective, nonrandomized, interventional case series. One hundred and sixty cases of endoscopic DCR with a single surgeon for primary nasolacrimal duct obstruction (NLDO) were included. Cases were divided into three groups. Group 1 was treated with intraoperative application of 0.02% MMC for 5min. Group 2 was treated with 0.02% MMC eye drops for 5days after surgery, without intraoperative application of MMC. Group 3 was the control group of cases without the use of MMC. Each group was evaluated for surgical success, presence of complications including granuloma, synechiae, and tube-induced inflammation, and the adverse effect of the MMC at least 6months after the surgery. The success rate showed no significant difference among the three groups (P = .122, chi-square analysis). In the analysis between the two groups, although the success rate of Group 2 appeared not to be statistically different compared with that of Group 1 (P = .419, chi-square analysis), Group 2 had a statistically higher success rate for surgery than Group 3 (P = .041, chi-square analysis). The presence of granuloma was significantly lower in Group 1 than in the other two groups (P = .022, chi-square analysis). Synechiae and silicone tube-induced inflammation were not significantly different (P = .308, P = .881, chi-square analysis). There were no adverse effects associated with intraoperative or postoperative MMC application. Use of postoperative topical 0.02% MMC is a safe and effective adjunctive modality to increase the success rate of endoscopic DCR.

A Possible Cause of Nasolacrimal Duct Obstruction: Narrow Angle Between Inferior Turbinate and Upper Part of the Medial Wall of the Maxillary Sinus

Background: To search the relationships between the primary nasolacrimal duct obstruction and the angle between the bony inferior turbinate and upper part of the medial wall of the maxillary sinus.Design: Retrospective study.Participants and methods: Computed tomography findings of 35 patients with primary nasolacrimal duct obstruction and 100 sides of 50 individuals were reviewed. While the study group was composed of patients who had external dacryocystorhinostomy surgery, the control group was composed of patients who had CT scans due to headache, sinusitis and smell dysfunction. Epiphora complaint was evaluated with the lacrimal syringing. The exclusion criteria were: age less than 20 years, previous nose, sinus, turbinate or lacrimal surgery, prior history of maxillofacial fracture, nasopharyngeal malignancy, reflex hypersecretion, and associated pathology of the lacrimal canaliculi.Main outcome measures: The angle of inferior turbinate.Results: The mean angles were 53.2° (range, 37.9–82.9°) for affected side of the study group, 58.6° (range, 32–85.3°) for the unaffected side of the study group and 56.8° (range, 41.2–76.9°) in the control group. The difference between the angles was statistically significant between the study and the control groups (p < 0.05). The difference between the operated and non-operated sides of the study group was also statistically significant (p < 0.05).Conclusion: Although this study was performed in a small group, we thought that the narrow angle between the bony inferior turbinate and upper part of the medial wall of the maxillary sinus might be a possible causative factor in primary acquired nasolacrimal duct obstructions.

Three-Dimensional Volumetric Assessment of the Nasolacrimal Duct in Patients With Obstruction

The purpose of this study was to determine if a significant difference exists in the nasolacrimal duct volume of subjects with primary nasolacrimal duct obstruction compared with that of controls. This was a retrospective, case-control study of 70 subjects with prior maxillofacial CT scans, including 35 subjects with obstruction and 35 controls. Volume measurements of the nasolacrimal duct were made on a GE Advantage Workstation using volume viewer software, and measurements were compared using an unpaired Student t test. Interrater and intrarater reliabilities were calculated. There was no significant difference in the nasolacrimal duct volume of patients (0.411 ± 0.18 cm) compared with that of controls (0.380 ± 0.13 cm(3)) (p = 0.23). Women had smaller volume ducts (0.356 ± 0.11 cm(3)) than that of men (0.482 ± 0.19 cm(3)) (p < 0.001). Male patients had smaller volume ducts (0.470 ± 0.23 cm(3)) than that of male controls (0.493 ± 0.14 cm(3)) (p = 0.70), while female patients (0.384 ± 0.13 cm(3)) had significantly larger volume ducts than that of female controls (0.328 ± 0.08 cm(3)) (p = 0.01). There was excellent interrater and intrarater reliabilities. CT 3-dimensional volumetric software can be used to accurately measure the nasolacrimal duct volume in patients with obstruction. Both the absence of a significant difference in patient's and control's nasolacrimal duct volumes and the overlap in range between the 2 groups imply that the volume of the tear duct is likely not related to the etiology of obstruction. The increase in volume seen in females with obstruction may be due to expansion of the bony canal during the postmenopausal years. The exact etiology of primary nasolacrimal duct obstruction requires further investigation.

Comparative Study of Endonasal Endoscopic Dacryocystorhinostomy and External Dacryocystorhinostomy

ABSTRACT A prospective study on 50 cases of chronic dacryocystitis was done to see outcome of management by endoscopic dacryocystorhinostomy (DCR) in Indian population and to look for its advantages or disadvantages over external-DCR. Effect of mitomycin-C was also evaluated in endoscopic DCR cases. Dacryocystitis was diagnosed on the basis of clinical examination by doing regurgitation test and lacrimal syringing. These patients were divided into two groups: group I consisted of those 25 subjects who were planned for endonasal endoscopic DCR and group II of those 25 subjects who underwent external-DCR in ophthalmology department. Of all the cases, maximum number of cases was in the age group of 21 to 35 years, 27 (54%) cases, 88% were females and 12% were males. External-DCR required a relatively longer surgical duration of an average 65 minutes as compared to 35 minutes for endonasal DCR. Average hospital stay for patient in group I was 3 days and it was 7 days in group II. There were minimal intraoperative complications in endoscopic procedure as compared to external-DCR group. Average follow-up was 6 months. Primary success rate was 96% in both the groups. Thus, it was concluded that both the procedures represent good alternatives for the treatment of primary nasolacrimal sac or duct obstruction or chronic dacryocystitis, endoscopic DCR having advantage of less complications and less traumatic. Mitomycin-C was found to be helpful in reducing fibrosis. How to cite this article Singh H, Mohindroo NK. Comparative Study of Endonasal Endoscopic Dacryocystorhinostomy and External Dacryocystorhinostomy. Clin Rhinol An Int J 2015;8(1):1-4.

Primer Nazolakrimal Kanal Tıkanıklığında, Endoskopik Transkanaliküler Lazer Dakriyosistorinostomi

Amaç: Primer nazolakrimal kanal tıkanıklıklarının tedavisinde endoskopik transkanaliküler lazer dakriyosistorinostomi ameliyatı ve bikanaliküler silikon tüp entübasyonu etkinliğinin değerlendirilmesidir. Gereç ve Yöntemler: Primer nazolakrimal kanal tıkanıklığı nedeni ile endoskopik transkanaliküler lazer dakriyosistorinostomi ameliyatı ve bikanaliküler silikon tüp entübasyonu uygulanan hastaların bulguları geriye yönelik olarak incelendi. Tüm ameliyatlarda transkanaliküler yaklaşımla multidiod lazer kullanıldı. Ameliyat sonrasında epiforanın yokluğu ve nazolakrimal drenaj sisteminin lavaj ile açıklığının saptanması ''başarı'' kriteri olarak değerlendirildi. Bulgular: Çalışmaya toplam 51 hastanın [kadın/erkek: 28/23, ortalama yaş: 47,5±11,0 (24-67) yıl] 51 gözü dâhil edildi. Çalışmamızda 3 (%5,8) hastada intraoperatif kanama kontrolünde güçlük çekildi, 3 (%5,8) hastada ameliyat sonrası birinci ay kontrolünde, rinostomi bölgesinde granülom oluşumu izlendi. Ameliyat sonrası kontrollerde 2 (%3,9) hastada punktum erozyonu görüldü. Silikon tüpün kaldığı ortalama süre 2,5±0,7 (2-6) ay, ameliyat sonrası ortalama izlem süresi 18,9±5,6 (10-38) ay olarak bulundu. Başarı, ameliyat sonrası 1. hafta kontrolünde %96,0; birinci ay kontrolünde %94,1; ikinci ay kontrolünde %92,1; üçüncü ay kontrolünde ise %88,2; son kontrolde %82,3 olarak saptandı. Sonuç: Primer nazolakrimal kanal tıkanıklıklarının tedavisinde endoskopik transkanaliküler lazer dakriyosistorinostomi ameliyatı ve bikanaliküler silikon tüp entübasyonu etkili bir tedavi yöntemidir.

Endoscopic Dacryocystorhinostomy with Silicone, Polypropylene, and T-tube Stents; Randomized Controlled Trial of Efficacy and Safety

To compare the efficacy and safety of endoscopic dacryocystorhinostomy (En-DCR) with different stent materials for lacrimal sac intubation in primary nasolacrimal ductal obstructions. Randomized controlled study with three parallel groups. Level of evidence is 1b. A total of 91 patients (five bilateral) with primary nasolacrimal duct obstruction (NLDO) at a tertiary referral center scheduled for En-DCR were to allocated into three stent groups with a sealed envelope and were randomized into three treatments: silicone, Prolene (polypropylene), and otologic T-tube. Ophthalmology and otolaryngology clinics evaluated the patients preoperatively and postoperatively with endoscopes, lacrimal system syringing, and dacryocystography. The success of the stents was evaluated 12 months after surgery with symptom relief and ostial patency. Complications were also noted. The overall success rate of the En-DCR in the stent groups was 78.1% (75/96); specifically, 87.5% (28/32) with silicone, 84.4% (27/32) with Prolene, and 62.5% (20/32) with T-tube. The efficacy of the procedures with the T-tube was significantly lower than that of the Prolene and silicone (p = .031, χ(2) test). There were no significant differences between the silicone and Prolene (p = .718, χ(2) test). Prolene was found to be related with orbital complications. Spontaneous loss is a particular complication of otologic T-tube and highly portends to failure. The results of our study suggest that efficacy, defined as anatomic and functional success, is equally high for silicone and Prolene stents and lower for otologic T-tube in En-DCR.

Primary acquired nasolacrimal duct obstruction: is it really related to paranasal abnormalities?

To investigate whether there is an association between primary acquired nasolacrimal duct obstruction and paranasal computed tomography (CT) findings. The study cohort consisted of paranasal CT images from 40 patients being treated for unilateral primary nasolacrimal duct obstruction (PANDO) and the reformatted coronal temporal CT images of 71 control subjects who attended the ENT clinic with the complaint of vertigo and tinnitus. A radiologist masked to the clinical situation of participants, investigated the paranasal CT findings of the PANDO and control patients retrospectively. The side, localization, and angle of the septal deviation as well as the thickness and lateralization angle of the inferior turbinate's were recorded. Additionally maxillary and ethmoid sinusitis, concha bullosa, Agger nasi cell formation, and osteomeatal complex status were evaluated. No significant difference was found between the paranasal abnormality incidence in the PANDO and non-PANDO sides of the patients or the control group. Only the side of the septal deviation correlated with the side of the PANDO (p = 0.008). The incidence of PANDO may not be directly related to paranasal abnormalities. Further large-scale studies should be performed to clarify the relationship between paranasal abnormalities and PANDO.

The efficacy of sleeve technique in primary nasolacrimal duct obstruction with a high lacrimal sac

Purpose:To evaluate the efficacy of a sleeve technique during endoscopic dacryocystorhinostomy (DCR) in primary nasolacrimal duct obstruction (NLDO) patients with a high lacrimal sac.Materials and Methods:The medical records of 45 patients (49 cases) undergoing endoscopic DCR for primary NLDO with a high lacrimal sac were retrospectively reviewed. In 19 patients (21 cases), the thick maxilla covering the common canalicular opening was removed using a drill and a bicanalicular silicone tube was inserted (group 1). In 26 patients (28 cases), instead of removal of the thick maxilla, a sleeve was inserted into the bicanalicular silicone tube (group 2). At 6 months postoperatively, the success rate was evaluated and the size of the intranasal mucosal ostium was measured.Results:The success rates in group 1 and 2 was 90.5% and 96.4%, respectively (P =0.400). The intranasal mucosal ostium in group 1 and 2 measured 1.7 ± 0.7 mm and 3.1 ± 1.0 mm, respectively, and the difference was significant (P =0.042).Conclusions:In primary NLDO patients with a high lacrimal sac, DCR inserting a silicone tube and a sleeve together had a satisfactory success rate without using a drill. In comparison with traditional surgical methods, it helped enlarge the size of the intranasal mucosal ostium.