Small Lacrimal Sac Research Articles

Predictors of nasolacrimal duct intubation failure for primary acquired nasolacrimal duct obstruction: a computed tomography-dacryocystography (CT-DCG) study.

Making a choice between nasolacrimal duct intubation and dacryocystorhinostomy (DCR) for primary acquired nasolacrimal duct obstruction (PANDO) is an important issue in clinical practice. This study aimed to determine the potential lacrimal sac characteristics that could be used as predictors of unsuccessful intubation for PANDO based on computed tomography-dacryocystography (CT-DCG). In this retrospective comparative observational study, we included PANDO patients with a history of failed intubation for nasolacrimal duct obstruction as the intubation failure group and PANDO patients without a history of intubation as the control group. We analyzed the lacrimal sac height, lacrimal sac width, and obstruction site based on CT-DCG, all measured based on several reference levels on axial sections (upper, intermediate, lower level, common canaliculus level, and lowermost contrast level), which were defined according to the contrast and the bony structure. A total of 114 sides of the PANDO were studied, including 36 in the intubation failure group and 78 in the control group. The intubation failure group showed a smaller lacrimal sac height (11.69±4.59 mm) and width (2.28±1.97 mm, intermediate level) than the control group (14.13±2.92, 3.32±2.02 mm, P=0.005 and 0.012, respectively). The intubation failure group had a higher obstruction site than the control group (P=0.009). A small lacrimal sac and high obstruction site are predictors of nasolacrimal duct intubation failure in PANDO. For PANDO patients with a small lacrimal sac or a high obstruction position, DCR is recommended as opposed to intubation.

Endoscopic dacryocystorhinostomy with and without bicanalicular silicone tube in patients with a small lacrimal sac: a comparative study.

To establish whether bicanalicular silicone tube intubation is required during endoscopic dacryocystorhinostomy (En-DCR) for treating chronic dacryocystitis with a small lacrimal sac. In total, this study enrolled 264 patients diagnosed with unilateral chronic dacryocystitis with small lacrimal sacs via computed tomography-dacryocystography that underwent En-DCR from March 2016-September 2020. Patients were randomized into two treatment groups, with those in group A undergoing tubes intubation and those in group B not undergoing this procedure. The tubes were removed 3 months post-operation in group A. Surgical outcomes and related complication rates were then compared. This study included 242 patients, including124 and 118 in groups A and B, respectively. At the three-month follow-up time point, 12.90% of patients in group A exhibited ostial granulation tissue, with this frequency with no differences observed in group B (11.86%). At 6 months post-surgery, 80.65% of patients in group A and 72.88% of patients in group B exhibited successful surgical outcomes, with no significant differences between groups. At 9 months postoperatively, the overall effective success rate was 60.74%, and the success rate was significantlyhigher in group A relative to group B (group A: 75.81%; group B: 44.92%). There were no failed patient outcomes observed as of the 12-month follow-up time point. While En-DCR-based treatment of chronic dacryocystitis in those with smalllacrimal sacs did not yield satisfactory outcomes with respect to the overall effective success rate, these results suggest that intraoperative intubation may improve success rates in long-term follow-up.

Clinical utility of digital radiography dacryocystography for preoperative assessment in nasolacrimal duct obstruction prior to endoscopic dacryocystorhinostomy

PurposeTo evaluate the clinical usefulness of digital radiography dacryocystography in patients with primary acquired nasolacrimal duct obstruction prior to endoscopic dacryocystorhinostomy. MethodsAll dacryocystography images from 129 patients with primary acquired nasolacrimal duct obstruction were analyzed. Each group was assessed for postoperative epiphora severity using Munk's score via telephone follow-up three years post-surgery. Receiver operating characteristic (ROC) curve was plotted to obtain a suitable cutoff value of the transverse diameter of the lacrimal sac (LS), used to categorize LS size into small (≤4.350 mm) and large (>4.350 mm). ResultsAnalysis of the transverse diameter of the LS among 129 patients showed a negative correlation between it and Munk's score (r = -0.282, p = 0.001). There was a statistical difference between the surgical outcomes and the sizes of the LS (p = 0.041). The ROC curve analysis showed that the transverse diameter of the LS at 4.350 mm was the ideal cutoff value for the outcome of endoscopic dacryocystorhinostomy, with a sensitivity of 42.2 %, and specificity of 92.3 %. After adjusting for the age and sex, the small LS was associated with an increased risk of postoperative failed outcome (adjusted odds ratio [95 % CI]: 8.628 [1.074, 69.335]). ConclusionThe small LS was independently associated with the failed surgical outcome. Furthermore, the preoperative measurement of the LS transverse diameter serves as one of the reliable predictors for postoperative epiphora severity.

Silicone nasolacrimal intubation: our experience in long term cases

Purpose: To evaluate the bicanalicular tube structural integrity and the anatomical and functional post operative results of cases of long and very long bicanalicular intubation (from 2 to 13 years). Methods: We studied all the patients of our Department with long-lasting intubation (greater than one year), from 2000 to 2021. We obtained an histocytological evaluation of the material of intubation and a nasal endoscopy. We investigated the causes of the long permanency and the patient tolerability. Results: In our study, 6 eyes from 5 patients (4 women and 1 man) underwent a nasolacrimal duct intubation. The mean intubation permanency time was 6.8 years and the median value was 7 years (minimum 2 years, maximum 13 years). The bicanalicular tube examinations found traces of mucus made of amorphous protein material, sporadic leukocytes and histiocytes. In all the patients the nasal endoscopy showed good conditions of the middle meatus mucosa. Conclusions: In complex cases, such as multiple re-operations, inflamed and small lacrimal sac, fibrotic sac, inflamed nasal mucosa for previous nasal pathologies, a permanent silicone tube could be a reasonable choice as it appears to be well tolerated and without major complication risks.

Effect of endonasal endoscopic dacryocystorhinostomy combined with lacrimal duct drainage tube implantation in treating lacrimal duct obstruction

Objective:To investigate the clinical effect of endonasal endoscopic dacryocystorhinostomy（EES-DCR） combined with lacrimal duct drainage tube implantation in treating the patients with lacrimal duct obstruction. Methods: 32 patients （37 eyes） with lacrimal duct obstruction were included into this study, including 1 patient （2 eyes） of functional nasal lacrimal duct obstruction,2 patients （2 eyes） of recurrence after EES-DCR,17 patients （19 eyes） of nasal lacrimal duct obstruction,6 patients （8 eyes） of small lacrimal sac, and 6 patients （6 eyes） of lacrimal duct obstruction. Intraoperative EES-DCR was performed, and lacrimal drainage tubes were implanted from the upper and lower lacrimal points. Septoplasty was performed in 3 patients with nasal septum deviation, and endoscopic sinus surgery was performed in 1 patient with chronic sinusitis.After operation, nasal hormone spraying was performed. During follow-up, the operation effect was evaluated according to the degree of symptom improvement, the patency of lacrimal passage irrigation and the opening state of dacryocystorhinostomy under nasal endoscope. Results:After 3-30 months of follow-up, 29 cases（34 eyes） were cured, 2 cases（2 eyes） were improved, and 1 case（1 eye） was ineffective. The total effective rate was 97.3%（36/37）. No intraorbital, intracranial or nasal complications occurred in all patients. Conclusion:EES-DCR combined with lacrimal duct drainage tube implantation is safe and effective in treating lacrimal duct obstruction. Implantation of lacrimal duct drainage tube can effectively avoid stoma blockage, prevent the adhesion of lacrimal duct, and significantly improve the success rate of surgery.

Endoscopic dacryocystorhinostomy for refractory nasolacrimal duct obstruction with asmall lacrimal sac (≤ 5mm in diameter).

Although endoscopic dacryocystorhinostomy (DCR) is a standard procedure for nasolacrimal duct obstruction (NLDO), the failure rate remains approximately 10%. A small lacrimal sac is considered the main reason for surgical failure. We explored the efficacy of endoscopic DCR for the treatment of NLDO with a small lacrimal sac. The clinical data of 72 patients (88 eyes) diagnosed with NLDO and undergoing endoscopic DCR from 2012 to 2020, with at least 24months of follow-up were retrospectively collected. Intraoperatively, the Rosenmüller valves were fully exposed, mucosal flaps were preserved to cover the naked bone, and a silicone tube was implanted if necessary. Postoperative intervention was performed if necessary. The main outcome measures were symptomatic improvement and objective ostium patency. Eighty-eight eyes of 72 patients were divided into two groups: the refractory group (34 patients, 47 eyes), with a small lacrimal sac (≤ 5mm in diameter), and the simple group (38 patients, 41 eyes). Patients with small lacrimal sacs were more prone to bilateral eye disease than those in the simple group (P = 0.014) and required a longer postoperative follow-up (P < 0.001). Refractory NLDO and simple NLDO had a success rate of 91.5% and 95.1%, respectively, with no significant difference. Endoscopic DCR for refractory NLDO with a small lacrimal sac could achieve a beneficial result by exposing the Rosenmüller valves, preserving mucosal flaps, implanting necessary intubation, and intervening postoperatively. Thus, a small lacrimal sac should not be regarded as a contraindication to surgery.

Endoscopic Endonasal Dacryocystorhinostomy With a Novel Lacrimal Ostium Stent in Chronic Dacryocystitis Cases With Small Lacrimal Sac.

To investigate feasibility of endoscopic endonasal dacryocystorhinostomy (EE-DCR) with an novel lacrimal ostium stent (LOS) intubation for patients with chronic dacryocystitis with small lacrimal sac. Patients diagnosed as chronic dacryocystitis with small lacrimal sac who preferred to surgery treatment between March 1st, 2012 and May 1st, 2015. All included subjects were randomly divided into 2 groups (Group A and Group B). Cases in group A were performed EE-DCR with LOS intubation while cases in group B were underwent EE-DCR without LOS intubation. Demographic data of each cases were collected. The success rate and the surgical outcomes of 2 groups were compared. The success rate was much higher in group A than group B. At 3 months follow up, 61.6% of patients in group A exhibited scarring and/or granulation tissues around the ostium, which was significantly higher than the 36.4% of patients in group B. Of these patients with scars and/or granulation tissues, no statistical difference was found between 2 groups. Granuloma alone and scars with granuloma were observed in 10 patients and 2 patients, in group A and group B, respectively, resulting in a statistical significant difference for this outcome between the groups. At 9 months follow up and 12 months follow up, no significant statistical difference were found in the rate of scarring and/or granulation tissues, scars alone, granuloma alone and scars with granuloma between 2 groups. EE-DCR with novel LOS may be an effective procedure to manage chronic dacryocystitis with small lacrimal sac.

Relationship between lacrimal sac size and duration of tearing in nasolacrimal duct obstruction

ObjectiveTo analyze the relationship among the presence of lacrimal sac mucus retention, the vertical size of the lacrimal sac, and the duration of tearing symptom in patients with nasolacrimal duct obstruction (NLDO). DesignRetrospective case series. ParticipantsWe reviewed the medical records of 473 patients (664 eyes) who underwent external dacryocystorhinostomy for primary NLDO. MethodsThe information about the presence of lacrimal sac mucus retention and vertical size of the lacrimal sac lumen was collected intraoperatively. The vertical size of the lacrimal sac was classified into 3 groups: small (<5 mm), medium (5–10 mm), and large (>10 mm). The relationship between the lacrimal sac size, presence of mucus retention, and duration of tearing was analyzed. ResultsOf the 664 eyes, 138 had a small lacrimal sac, 199 had a medium lacrimal sac, and 327 had a large lacrimal sac. The distribution of the lacrimal sac size groups differed significantly between the eyes with (n = 245) and without (n = 419) mucus retention (p < 0.001). Among all the subjects of each lacrimal sac size group, there was no significant difference in the duration of symptoms (p = 0.176). However, in patients without mucus retention, the symptom duration in the small lacrimal sac group was significantly longer than that in the large lacrimal sac group (p = 0.017). ConclusionsIn cases with mucus retention, a small lacrimal sac is rare. In cases without mucus retention, the duration of tearing symptom was significantly longer in small lacrimal sac group.

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.

Rosenmüller valve during endoscopic dacryocystorhinostomy in treating refractory nasolacrimal duct obstruction

The objective of this study was to assess the efficacy of exposing Rosenmüller valve during endonasal endoscopic dacryocystorhinostomy (EES-DCR) in treating refractory nasolacrimal duct obstruction. Thirty six patients (47 eyes) with refractory nasolacrimal duct obstruction were entered into this study, including 13 patients (15 eyes) underwent nasal lacrimal duct intubation before, 18 patients (26 eyes) with small lacrimal sac, 2 patients underwent DCR before, 1 patient with functional nasal lacrimal duct obstruction, 1 patient with lacrimal mucocele, 1 patient with nasal trauma. During the DCR, the bone window was enlarged as wide as possible and the valve of Rosenmüller was exposed. The intubation of the lacrimal apparatus was performed if the lacrimal sac was very small and the Rosenmüller valve was tight. Functional endoscopic sinus surgery and septoplasty were performed simultaneously if necessary. Postoperatively, each patient was assessed by the symptom and nasal endoscopy. The postoperative follow-up period ranged from 3 to 36 months. Thirty two patients(89.4%, 42/47 eyes) were cured, which presented as the disappearance of symptoms, the patency of the lacrimal ostium and the lacrimal duct irrigation was clear. One patient (2.1%, 1/47 eyes) was improved, which presented as the improvement of symptoms, a few hypertrophic scar around the lacrimal ostium and the lacrimal duct irrigation was clear. Four cases failed (8.5%, 4/47), which presented as symptomatic and obstruction of the lacrimal ostium. The total effective rate reached to 91.5%. No serious postoperative complications were found in all cases. To expose Rosenmüller valve during endoscopic DCR in treating patients with refractory nasolacrimal duct obstruction could obviously increase the operative success rate, fewer complications, with no facial surgical scar. It is an ideal way to treat the refractory nasolacrimal duct obstruction.

The clinical study of endoscopic dacryocystorhinostomy by suture

Objective To investigate the clinical value of endoscopic transnasal dacryocystorhinostomy （ET-DCR） by suture techniques.Methods 85 patients of 98 eyes with chronic dacryocystifis were randomly divided into the two groups：control group （without suture） and observation group （by suture） .All cases were followed up for more than 12 months.The cure rates and occurrence of granulation tissue were compared between the two groups. Results The cure rate of the observation group （96.00%, 48/50）was higher than that in the control group （81.25%,39/48） （χ^2 =5.35,P〈0.05）. During process of following up,the occurrence of granulation tissue at the ostium margins accounted for 14.00%（7/50） in the observation group and 31.25%（15/48） in the control group （χ^2 =4.19,P〈0.05）.Conclusion ET-DCR by suture techniques reduces the formation of granulation tissue and improves the cure rate.Especially, ET-DCR by suture techniques for the small lacrimal sac of patients may have special advantages. Key words: Endoscopic surgery; Dacryocystorhinostomy; Dacryocystitis,chronic; Suture techniques

Endonasal Endoscopic Treatment of Recurrent Dacryocystitis

This report assessed clinical conditions leading to recurrent dacryocystitis and success rates of its treatment by endonasal endoscopic dacryocystorhinostomy. Forty-eight patients with recurrent dacryocystitis underwent endonasal endoscopic surgery and were followed up for at least 6 months. High bone windows, small bone window openings, small lacrimal sac stomas, scar tissues, and organic diseases of the nasal cavity led to fistula closure. Out of 48 patients, 45 (93.8%) patients were cured by endonasal endoscopic surgery. Endonasal endoscopic dacryocystorhinostomy is beneficial for recurrent dacryocystitis.

Pediatric Endoscopic Dacryocystorhinostomy

This is a case series with chart review from 1997 to 2010 to determine results of endoscopic dacryocystorhinostomy in children. Thirty-seven children underwent removal of the medial wall (RMW) of the lacrimal sac (LS) and 2 had lacrimal stents inserted because they had external fistulae and small cicatrized LS. Parameters of success were (1) resolution of epiphora, (2) no further attacks of dacryocystitis, and (3) patency of neofistula. Of the 37 (95%) children who had RMW of the LS, 34 (92%) were patent after 12 weeks and were considered successful. Three (8%) neofistulae obstructed within 2 weeks and needed revision, and 2 (5%) patients had small cicatrized LS along with fistula and were stented. The fistulae closed down in 4 weeks. However, when the stents were removed 6 weeks later, epiphora returned. The authors' experience reveals that removal of the medial wall of the LS is effective in stopping chronic epiphora.

Factors Associated With Outcome of Endonasal Dacryocystorhinostomy

To identify factors associated with outcome of endonasal dacryocystorhinostomy. One hundred thirty-four cases of endonasal dacryocystorhinostomy in 111 patients performed for primary acquired nasolacrimal duct obstruction by a single surgeon between March 12, 2002 and November 10, 2008 were included in a retrospective, noncomparative case series. Variables assessed during the surgery included intranasal view, difficulty of bone removal, size of the lacrimal sac, presence of lacrimal sac stones, orbital fat prolapse and degree of bleeding. Successful outcome was defined as patency to lacrimal irrigation at final follow up. One hundred twenty-one of the 134 cases (90%) were patent to irrigation at final follow up (mean 8.8 ± 8.6 months). A small lacrimal sac opening intraoperatively was associated with higher risk of failure (odds ratio [95% confidence interval] of 5.7 [1.6, 20] [p = 0.0072]). Orbital fat prolapse had a trend toward higher risk of failure that approached statistical significance (odds ratio [95% confidence interval] of 5.3 [0.87, 32] [p = 0.0698]). A narrow intranasal view, difficult bony opening, lacrimal sac stones, and bleeding were not associated with outcome. A small lacrimal sac opening intraoperatively was associated with failure of endonasal dacryocystorhinostomy.

The discussion on the anastomosis methods of dacryoeystorhinostomy

Objective To discuss the anastomosis methods of dacryocystorhinostomy and the operation techniques. Methods Through the 135 cases (152 eyes) for the chronic dacryocystitis and nasolacrimal duct obstruction patients, according to the size for the lacrimal sac and the lacrimal sac to the nasal mucosa, do dacryocystorhinostomy by 3 kinds of the anastomosis methods:Follow-up 6 months to 12 months after operation. Results 126 eyes(82.9%) were cured; 21 eyes (13.8%) were improved; and 5 eyes (3.3%) were invalid. Conclusion It is more reasonable and effective to choose the anastomosis methods of dacryocystorhinostomy,according to the size for the lacrimal sac and the lacrimal sac to the nasalmucosa. Key words: obstruction of naso-lacrimal duct; chronic dacryocystitis; dacryocystorhinostomy; small lacrimal sac

Dacriocistorrinostomia endonasal em crianças

OBJETIVO: Nosso objetivo foi verificar se os resultados com a dacriocistorrinostomia endonasal endoscópica em crianças com obstrução do canal nasolacrimal permitem considerá-la uma alternativa de tratamento aceitável para crianças. FORMA DE ESTUDO: clínico com coorte transversal. MATERIAL E MÉTODO: Vinte e sete dacriocistorrinostomias endonasais endoscópicas foram realizadas em crianças de 2 a 12 anos com obstrução do canal nasolacrimal. Todas as crianças haviam sido tratadas por sondagem lacrimal, sem resultado. A técnica utilizou uncinectomia e uma abertura do saco lacrimal pequena. O seguimento foi de 3 meses. RESULTADOS: Bom resultado foi verificado após 21 cirurgias (77,8% de sucesso). A única complicação verificada foi prolapso da intubação com silicone em 1 caso. CONCLUSÃO: Nossos resultados permitem confirmar a dacriocistorrinostomia endonasal endoscópica como alternativa válida e segura para o tratamento de crianças com obstrução nasolacrimal resistente a sondagens.

Endonasal dacryocystorhinostomy in children

SummaryAimTo verify whether our results with endonasal endoscopic dacryocystorhinostomy in children with nasolacrimal duct obstruction allow us to consider this technique a valid treatment alternative for children.Study designclinical with transversal cohort.Material and MethodTwenty-seven endoscopic endonasal dacryocystorhinostomies were performed in children 2 to 12 years of age for nasolacrimal duct obstruction. Previous probings in all patients were unsuccessful. The technique employed uncinectomy and a small lacrimal sac opening. Follow-up time was 3 months.ResultsTwenty-one surgeries (77,8%) were successful. The only complication was silicone prolapse in one case.ConclusionOur results confirm endoscopic endonasal dacryocystorhinostomy as an acceptable and safe method for treating children with nasolacrimal duct obstructions that are resistant to probings.