Sac Massage Research Articles

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

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

EFFECTIVENESS OF PROBING FOR CONGENITAL NASOLACRIMAL DUCT OBSTRUCTION IN INFANTS UNDER TOPICAL ANESTHESIA

Background: Nasolacrimal duct obstruction is the most common abnormality of the lacrimal system in children leading to epiphora. Approximately 20% of newborns are affected by it. It may be complicated by recurrent conjunctivitis, chronic dacryocystitis, and lacrimal abscess formation, if not treated in time. Objectives: To study the outcome and complications of probing for congenital nasolacrimal duct obstruction under topical anesthesia. Materials and Methods: In this hospital based prospective interventional study, probing was done under topical anesthesia (lidocaine 4%) in 50 patients (60 eyes) in the age group of 3 months to 12 months, over a period of 1 year in which conservative treatment with antibiotic drops and sac massage had failed Results: Success rate of this procedure was 91.66% with rst and 93.33% after second probing without any untoward complication. Conclusion: Probing under topical anesthesia is a safe, quick and convenient method of treatment for congenital nasolacrimal duct obstruction.

Age-Specific Outcomes of Conservative Approach and Probing for Congenital Nasolacrimal Duct Obstruction.

PurposeTo evaluate the resolution rate of lacrimal sac massage and the efficacy of primary probing among different age groups of patients with CNLDO in Thai population.Patients and MethodsRetrospectively reviewed the medical records of patients younger than 10 years of age who had been diagnosed with CNLDO, from January 1st, 2011, to October 31st, 2021. Patients were divided into two groups. The conservative treatment group comprised patients who had received Crigler’s maneuver and topical antibiotic when indicated; the intervention group comprised patients who had received probing.ResultsThere were 469 patients in the conservative treatment group and 108 patients in the probing group. In the conservative treatment group; the patients were categorized into five groups according to age: 0 to <6 months, 6 to <12 months, 12 to <18 months, 18 to <24 months, and ≥24 months. The resolution rates for these age groups were 99.25%, 96.23%, 64.71%, 50%, and 62.07%, respectively. The rate of spontaneous resolution was significantly associated with patient age (p <0.01). In the intervention group; the patients were categorized into four age groups according to age: 0 to <12 months, 12 to <24 months, 24 to <36 months, and ≥36 months. The success rates of primary probing for these age groups were 92.86%, 89.29%, 85.71%, and 94.12%, respectively. The success rate of primary probing was not significantly associated with patient age (p >0.05).ConclusionThe Crigler’s maneuver is a safe and highly effective procedure for the management of CNLDO in patients of multiple ages, particularly patients less than 12 months of age. According to the high spontaneous resolution rate and the low rate of complications, the clinicians may delay surgical intervention when desired.

Is surgical intervention avoidable in congenital nasolacrimal duct obstruction (CNLDO)

A prospective, interventional study was conducted to determine whether surgical intervention can be avoided in infants with CNLDO by a proper conservative management.The study was conducted from March 2013 till December 2019. 338 prospective cases presenting with epiphora, eyelid discharge and regurgitation on lacrimal sac compression were included in the study.Out of these, 166 were females (49.11%) and 172 males (50.88%). The age at enrolment was 1-47 weeks (median 23 weeks, mode 21 weeks), with 31 premature babies, (9.2%). The cases were divided into Primary (41 cases, 12.13%), who presented early with no prior therapy &amp; Secondary categories (297, 87.86%), who presented late and had been using topical antibiotics and sac massage. Patients’ care-takers were taught the proper technique of lacrimal sac compression with a cottontip. Topical Tobramycin eyedrops were prescribed 3 times daily for 5 days only to cases with a purulent discharge or eyelid swelling. Regular follow-up was conducted at 1, 3, and at 6 months after the initial visit. 316 cases (93.49%) had a complete resolution of epiphora and discharge on lacrimal sac compression. 22 cases (6.50%) were symptomatic at the end of study and needed surgical probing. A complete resolution of symptoms and signs was significantly higher in unilateral cases than bilateral (p=0.001). There was no significant difference amongst genders (p=0.684), or amongst primary versus secondary cases (p=0.062); they all responded to the correct conservative management. CNLDO can be resolved conservatively by a proper technique of sac compression and eyelid cleaning, which must be performed regularly, and continued till the infant is one year old, in order to avoid recurrent symptoms.

Unilateral congenital dacryocele

We report a case of a healthy, full term, 3 months old boy, with was referred for evaluation a bluish-gray cystic firm mass approximately mesuring 1-cm just below the medial canthal tendon of the right eye, present since birth. Diagnosis of unilateral congenital dacryocele have been made confirmed by CT-scan. In our case the dacryocele resolved after medical treatment wich inclouded: massage ,warm compresses, antibiotics drops. We did not have recur over 10 months of follow-up. Congenital dacryocele, also known as nasolacrimal mucocele, it is a rare form of congenital distension of the naso-lacrimal sac with both proximal and distal obstruction usually unilateral (Approximately 25% are bilateral), It is typically present at birth or in the first three months of life. Dacryoceles occur in 0.08% to 0.1% of newborns with congenital nasolacrimal duct obstruction. And patients may also have respiratory distress secondary to the intranasal cyst. Differential diagnosis includes encephalocele, capillary hemangioma, glioma and dermoid cyst. Nasolacrimal mucocele can resolves spontaneously in majority of cases with medical treatment which includes antibiotics, warm compresses, and sac massage. However, surgical treatment may be necessary when self-resolution fails, to avoid infectious complication such as of dacryocystitis and preseptal cellulitis.

Probing under topical anaesthesia

To assess the practical difficulties and results of probing for Congenital Naso Lacrimal Duct Obstruction under topical anesthesia. 500 infants (650 eyes) were selected. Age ranges from 3-12 months and study was done over a period of 10 years. Probing was done in those children in which medical treatment (antibiotic drops and sac massage) have failed. Topical anesthesia (Lidocaine 4%/ Proparacaine 0.5%) was used for probing. This procedure was successful in 95.2% in first &amp; 98.4% in second sitting without any significant complication. Thus probing under topical anesthesia is a shorter &amp; convenient method.

Conservative management of congenital dacryocystocele: resolution and complications

To investigate the clinical outcomes of initial conservative management in infants with congenital dacryocystocele. Retrospective case series. A total of 30 congenital dacryocystoceles of 28 Korean infants treated between January 2006 and December 2015. All patients were managed conservatively with lacrimal sac massage. Clinical courses and outcomes of the patients were retrospectively reviewed, and rates of resolution of dacryocystoceles and development of dacryocystitis were analyzed. In 27 cases of dacryocystoceles without infection, spontaneous resolution was achieved without any complication in 20 of 27 (74.1%) cases after conservative treatment. The mean duration of treatment was 27.5 days. Lacrimal probing was needed in 5 (18.5%) dacryocystoceles that persisted despite lacrimal sac massage for more than 1 month. Infectious dacryocystitis developed in 2 of 27 (7.4%) cases. Three dacryocystoceles were infected at presentation. Overall, 5 dacryocystoceles were complicated with infection and those cases received prompt systemic antibiotics treatment. External incision and drainage of the lacrimal sac was needed in 3 dacryocystoceles, and all cases were finally resolved without any additional procedures. In this case series, most of the uninfected dacryocystoceles could be successfully managed with conservative treatment alone. In cases with infection, systemic antibiotics were essential and external drainage was sometimes required, but these cases could be conservatively managed after the remission of infection.

Congenital Nasolacrimal Duct Obstruction (CNLDO): A Review.

Congenital nasolacrimal duct obstruction (CNLDO) is a common condition causing excessive tearing or mucoid discharge from the eyes, due to blockage of the nasolacrimal duct system. Nasolacrimal duct obstruction affects as many as 20% children aged <1 year worldwide and is often resolved without surgery. Available treatment options are conservative therapy, including observation, lacrimal sac massage and antibiotics, and invasive therapy. Observation, combined with conservative options, seems to be the best option in infants aged <1 year. Meanwhile, in children aged >1 year, nasolacrimal probing successfully addresses most obstructions. However, the most favorable timing for probing remains controversial. To alleviate persistent epiphora and mucous drainage that is refractory to probing, repeat probing, silicone tube intubation, balloon catheter dilation or dacryocystorhinostomy can be considered as available treatment options. Our review aims to provide an update to CNDO management protocols.

Congenital Dacryocystitis- Clinical Profile and Outcome

Aim: To assess the clinical and epidemiological profile of congenital dacryocystis and its treatment outcome. Material and Methods: A prospective study was conducted for duration of two years, cases with congenital dacryocystitis of age less than 5 years were included. A detailed history was taken giving emphasis to epiphora onset, duration, treatment and resolution. Ocular examination was done along with regurgitation on pressure over lacrimal sac test. The plan for the management was standard stepwise approach according to age groups and clinical condition of the cases. The conservative treatment included sac massage and surgical procedure were probing and syringing and endonasal dacryocystorhinostomy. Follow-up was done for 6 months and final clinical assessment was done to assess the success of procedure. Results: Total 65 eyes of 51 cases were included in the study. Mean age of presentation was- 14.6 ± 2.3 months with 52.9% females. Unilateral involvement was more common. Epiphora was most common complaint with 63% ROPLAS positive. The success rate of sac massage was 81% and the overall success rate for treatment of congenital dacryocystitis was 96%. Conclusion: Congenital dacryocystitis is a common pediatric problem. Treatment of congenital dacryocystitis should be started as early as possible and in stepwise manner initially conservative than surgical.

Comparision of Effect of Lacrimal Sac Massage And Lacrimal Sac Massgae with Topical Antibiotic in Congenital Nasolacrimal Duct Obstruction

Comparision of Effect of Lacrimal Sac Massage And Lacrimal Sac Massgae with Topical Antibiotic in Congenital Nasolacrimal Duct Obstruction

Clinical profile of the patients with pediatric epiphora in a tertiary eye care center

Purpose:To study the clinical profile of children aged <10 years presenting with epiphora at a tertiary eye care center, to compare the clinical profile between the early onset (<3 years) and the late-onset (≥3 years) group, and to study the success of different treatment modalities.Materials and Methods:A prospective nonrandomized observational study was conducted in 209 eyes of 167 patients (42 bilateral cases). The main outcome measure was postoperative relief of presenting symptoms and signs at 3 months follow-up.Results:Fifty-five percent cases (92 of 167) were early-onset cases, and 45% (75 of 167) were late onset. The male:female ratio was 1.9:1. Seventy-five percent cases were unilateral. The etiological profile was –76% cases of congenital nasolacrimal duct obstruction (NLDO), 18% traumatic/surgical, 4% acquired NLDO, and 2% punctal causes. The overall success rate of all the treatment modalities in our study was 80% (167/208) –82% for sac massage, 77% for probing, 79% for intubation dacryocystorhinostomy, and 100% for punctal surgery. A significant association was noted between the treatment outcome and laterality (P = 0.04), presence of infection (P = 0.032), symptom severity (P = 0.027), history of previous treatment (P = 0.024), and age. No significant association was found between the treatment outcome and gender (P = 0.73), socioeconomic status (P = 0.43), etiology (P = 0.45), and treatment modality (P = 0.33).Conclusion:This study describes the complete range of causes and treatment modalities for pediatric epiphora and highlights the etiology, signs and symptoms, treatment, and the comparative outcome between the early versus the late-onset group and analyses the factors predictive of the outcome.

Evaluation of Non Surgical Management in Resolution of Congenital Blockage of Nasolacrimal Duct

Background: Congenital Nasolacrimal Duct Obstruction (NLDO) affects 1% to 20% of infants. The non-surgical treatment includes lacrimal sac massage, whereas some cases need surgical intervention. The present study was conducted to prove that maximum number of cases resolve within six months of non-surgical management in infants aged new born to one year . Methods: This is a prospective and observational study in which 319 infants suffering from Congenital Nasolacrimal Duct Obstruction were treated with lacrimal sac massage and topical antibiotics. The symptoms of the patient were assessed after six months of treatment . Results: In infants new born to 8 months of age (233 eyes), more than 50% with NLDO will resolve within 6 months with non-surgical management. Conclusion: So the experience of rate of NLDO resolution in infancy without surgery will help clinician and parents effectively discuss treatment options.

The natural process of congenital nasolacrimal duct obstruction and effect of lacrimal sac massage.

This study aimed to examine the rate of symptomatic improvement of congenital nasolacrimal duct obstruction (CNLDO) in infants treated with conservative management within the first year of age. Other purpose of the study is to emphasize the relationship between spontaneous resolution time and effective lacrimal sac massage. Thirty-one infants were diagnosed to have CNLDO by an ophthalmologist prior to 3 months of age. In this study, 36 eyes of 31 patients were included with CNLDO. The patients were divided into two groups. Group 1 (28 eyes of 24 patients) was consisted of the patients who were applied effective lacrimal sac massage regularly during the follow-up period, and patients whose parents did not apply a regular lacrimal passage regularly were accepted as group 2 (8 eyes of 7 patients). Thirty-three eyes of 31 patients (18 rights and 15 left) successfully resolved with only conservative management (91.6%). In these thirty-three eyes, one eye (3%) resolved between 0 and 3months, fourteen eyes (42.5%) resolved between 4 and 6months, eleven eyes (33.3%) resolved between 7 and 9months, and seven eyes (21.2%) resolved between 10 and 12months. CNLDO was resolved in 27 (96.2%) of 28 eyes in group 1, and in group 2, six eyes (77.7%) had resolvement. This difference was statistically significant (p=0.001). The mean age of resolution was 6.8±1.88months in group 1, 10.3±1.5months in group 2 (p < 0.001). In light of our study, we believe that conservative management of CNLDO is highly successful. Our study provided a possible objective explanation for the efficacy of lacrimal sac massage. Emphasizing the importance of the massage to parents and describing in detail can reduce the risk of unnecessary surgical interventions.

Current aspects of eyelid, lacrimal and orbital surgery in childhood

During childhood the spectrum of disorders of the eyelid, the lacrimal drainage system and the orbit as well as the subsequent therapeutic management differ from those in adults. This review outlines the clinical picture and treatment of the most common eyelid, lacrimal drainage and orbital diseases in childhood. The study comprises a PubMed literature review and own clinical results. The most common eyelid disorders in childhood include congenital malpositions, such as ptosis or entropium, which may require fast surgical correction in order to prevent amblyopia. For connatal dacryostenosis a step-by-step therapeutic approach is recommended: (1) conservative treatment using lacrimal sac massage, astringent eye and nose drops, (2) irrigation and probing of the nasolacrimal system and (3) irrigation, probing and silastic tube intubation under general anesthesia. Benign orbital lesions such as dermoid cysts can be removed at pre-school age. Using systemic beta blockers is a novel conservative approach in the treatment of capillary hemangioma, which should precede surgical interventions. Eyelid and orbital diseases during childhood may require fast surgical intervention to prevent amblyopia. Initial conservative treatment is recommended for connatal dacryostenosis and capillary hemangioma.

Proximal drainage plus massage of lacrimal sac improves the symptoms of congenital dacryocystoceles.

To examine the effect of proximal drainage plus lacrimal sac massage in patients with congenital dacryocystoceles. A retrospective review of 77 patients was performed. Traditional massage was performed in the traditional treatment group (35 patients) first. Proximal lacrimal sac drainage plus massage of the lacrimal sac using a Bangerter lacrimal cannula (defined as modified massage) was performed in the modified group (42 patients). Probing was undertaken if the treatments failed in both groups. Success rates of decompression of lacrimal sac and recovery rate were observed. The χ2 test was used to compare the groups. Success rates of decompression of lacrimal sac were 100% in the modified group and 31% in the traditional group. In the modified group, 34 patients with 37 dacryocystoceles (80%) recovered with the modified treatment within 14 days. However, in the traditional group, only 11 patients with 12 dacryocystoceles (30%) had resolution after conservative treatment. The recovery rate of the modified massage in the modified group was higher than that of massage alone in the traditional group (p&lt;0.001). As to the individuals receiving probing, 8 patients with 9dacryocystoceles (100%) in the modified group were successful, while 18 patients with 21 dacryocystoceles (78%) in the traditional group had a satisfying effect. Proximal drainage plus massage has the advantage of high efficiency and safety for the treatment of congenital dacryocystoceles.

Factors affecting treatment outcome in congenital nasolacrimal duct obstruction: A retrospective analysis from South India.

Purpose:To investigate outcomes for different treatment modalities in congenital nasolacrimal duct obstruction (CNLDO) in an Indian population.Design:Retrospective, interventional, case series.Materials and Methods:In an institutional setting, case records of patients with CNLDO from January 2008 to 2012, were reviewed, and data on patient demographics, clinical presentation, and treatment details (sac massage, probing, and/or dacryocystorhinostomy) were recorded. Success of treatment was defined as complete resolution of symptoms and negative regurgitation on pressure over lacrimal sac (ROPLAS) area.Results:Two hundred and ninety-eight eyes of 240 patients with a mean age of 22.2 ± 26.14 months (median = 12 months, interquartile range = 17) were analyzed. Sac massage (n = 226) was successful in 67 eyes (30%). Multivariable logistic regression analyses showed that children with mucoid ROPLAS were almost 6 times more likely (odds ratio [OR] = 5.55 vs. clear ROPLAS, 95% confidence interval [CI] = 2.35–13.09, P < 0.001) to experience failure of sac massage. Overall probing (n = 193) was successful for 143 (74%) eyes. Multivariable logistic regression showed that older children were 25% more likely to experience probing failure (OR = 1.25 for every 6 months increment in age, 95%, CI = 1.09–1.42, P = 0.001).Conclusion:Sac massage is successful in only a third of our patients and those with mucoid ROPLAS are more likely to experience failure. Probing is successful in three-quarter of our subjects, and its success declines with a progressive increase in age. Lower socioeconomic status, poor general health, and recurrent respiratory infections are unique to our population and may influence outcomes.

Management of congenital lacrimal (anlage) fistula

Background/aimsTo review management choices and outcomes for congenital lacrimal (anlage duct) fistulae performed by a single ophthalmologist over a 10-year interval.MethodsAll cases of congenital lacrimal fistulae with minimum follow-up of...

Use of Oil as a Lubricant makes Lacrimal Sac Massage Efficient in Congenital NasoLacrimal Duct Obstruction (CNLDO)

Introduction: Congenital NasoLacrimal Duct Obstruction (CNLDO) is a frequent entity in the paediatric age. CNLDO has a 20% to 30% incidence rate out of which only 1% to 6% become symptomatic. 1 The 4% of premature infants are affected with CNLDO. 2 The management of failed Crigler’s Sac massage is probing, secondary probing, external DCR and with or without intubation is well known to all. To avoid the sequelae of CNLDO, cure of CNLDO is mandatory. Hence the aim of the study is primary cure for CNLDO by using specific treatment of Crigler’s Sac massage with Oil is emphasised. Method: This study was about 140 eyes and in each group, 70 eyes were enrolled with lost to follow up considerations. Patients had been selected and randomised alternatively when visited ophthalmology OPD. The CNLDO patients were selected from the age group ranged 1 to 9 months. Follow up of all patients was taken every month up to 15 months of age. Each and every patient from both the groups had to complete the formality of clinical consultation, doctors counselling to parents specially mothers explaining the procedure of sac massage and taking a live demonstration by mother/ parent hence confirming the proper technique to be followed at home. Results: In group A, Standard Crigler’s Method was used only on 54 eyes out of enrolment of 70 eyes. In group B, Standard Method with add on therapy of oil massage had been given to 66 eyes out of 70. In group B, cure rate was found in 60(91%) which was significantly differing from the cure rate of group A 30(56%) by Standard Crigler’s Method at P0.05. Conclusion: The primary need of Crigler’s Sac Massage using Oil has given the importance towards good compliance and success of curing CNLDO.

Use of Oil as a Lubricant makes Lacrimal Sac Massage Efficient in Congenital NasoLacrimal Duct Obstruction (CNLDO)

&lt;strong&gt;Introduction:&lt;/strong&gt; Congenital NasoLacrimal Duct Obstruction (CNLDO) is a frequent entity in the paediatric age. CNLDO has a 20% to 30% incidence rate out of which only 1% to 6% become symptomatic.&lt;sup&gt;1&lt;/sup&gt; The 4% of premature infants are affected with CNLDO.&lt;sup&gt;2&lt;/sup&gt; The management of failed Crigler's Sac massage is probing, secondary probing, external DCR and with or without intubation is well known to all. To avoid the sequelae of CNLDO, cure of CNLDO is mandatory. Hence the aim of the study is primary cure for CNLDO by using specific treatment of Crigler's Sac massage with Oil is emphasised. &lt;strong&gt;Method:&lt;/strong&gt; This study was about 140 eyes and in each group, 70 eyes were enrolled with lost to follow up considerations. Patients had been selected and randomised alternatively when visited ophthalmology OPD. The CNLDO patients were selected from the age group ranged 1 to 9 months. Follow up of all patients was taken every month up to 15 months of age. Each and every patient from both the groups had to complete the formality of clinical consultation, doctors counselling to parents specially mothers explaining the procedure of sac massage and taking a live demonstration by mother/ parent hence confirming the proper technique to be followed at home. &lt;strong&gt;Results:&lt;/strong&gt; In group A, Standard Crigler's Method was used only on 54 eyes out of enrolment of 70 eyes. In group B, Standard Method with add on therapy of oil massage had been given to 66 eyes out of 70. In group B, cure rate was found in 60(91%) which was significantly differing from the cure rate of group A 30(56%) by Standard Crigler's Method at P&amp;lt;0.001. Complications were found in 20 eyes in group A and in group B only one patient showed complication unrelated to the treatment of CNLDO used by the patients in this group. No significant difference was seen in the sex distribution in relation to CNLDO at P&amp;gt;0.05. &lt;strong&gt;Conclusion:&lt;/strong&gt; The primary need of Crigler's Sac Massage using Oil has given the importance towards good compliance and success of curing CNLDO.

Endoscopic Dacryocystorhinostomy: A Study at IPGMER, Kolkata.

Endoscopic sinus surgery has developed a new era in the treatment of chronic dacryocystitis. A prospective study was conducted by taking 67 patients having epiphora. Endo DCR was performed under local anaesthesia. Post operative care was given by means of alkaline nasal douching, lacrimal sac massage and endoscopic examination on 1st, 3rd, 6thweek. Success rate was found to be 95.5% which is comparable to external DCR and with added advantages.