Superior Punctum Research Articles

Prosedur Pemeriksaan Dacryocystografi Pada Kasus Dacryosistitis Kronis Di Instalasi Radiologi RSUP. Dr.Wahidin Sudirohusodo Makassar

Dacryocystography examination is the examination of the radiologist to show the nasolacrimal duct by using a positive contrast medium. The purpose of this examination is to describe the system of tear duct blockage and the level of blockage. This research method is descriptive with aproachcase study conducted in RSUP. Dr. WahidinSudirohusodo Makassar on Juni 2019. The inspection technique is done by using the projection Antero Posterior (AP), which contrast material is inserted throught the tear duct in the lacrimal punctum which empties into the concha nasalis inferior. From the result of the examination has been done, it can be concluded that the contrast as much as 1 cc inserted throught the superior lacrimal punctum, contrast restrained and spilled out. Contrast as much as 1 cc inserted throught the inferior lacrimal punctum, the contrast seems to fill out the inferior palpebra area. From the research, lacrimal duct obstruction impression superior and inferior.

Nasolacrimal sac foreign body extraction using vitreoretinal forceps in 28 dogs.

To describe a novel technique of nasolacrimal foreign body extraction in dogs by using a 20G vitreoretinal forceps introduced through the superior lacrimal punctum. A retrospective review of the medical records of dogs with dacryocystitis due to nasolacrimal foreign bodies between the years 2001 and 2022 was performed. We recorded the breed, age, affected eye, type and number of foreign bodies, concomitant diseases, and the use of imaging techniques. All animals underwent the same procedure of a 20G vitreoretinal forceps insertion through the upper canaliculus reaching the lacrimal sac and retrograde extraction of the foreign bodies. A total of 28 dogs were included, 16 males and 12 females, with a mean (±SD) age of 4.7 (±3.2) years. The most common breeds were Wire-Haired Dachshund (4/28; 14.29%) and Labrador Retriever (3/28; 10.71%). Additional imaging techniques were used, such as orbital ultrasound in 13 cases (13/28; 46.43%) and computed tomography in one case (1/28; 3.57%). The most common type of foreign body retrieved was grass awns, although seeds and plant debris were also found. Dacryocystitis resolved after removal of the foreign body and appropriate medical therapy was ensured in all cases in the 1-month postprocedure follow-up. Extraction of nasolacrimal foreign bodies with vitreoretinal forceps is a novel, noninvasive, and easily applicable technique that, although not successful in all cases, can be attempted before performing more aggressive surgery.

Novel findings on the anatomy of medial canthus in dogs.

Severe entropion of the medial canthus results in ocular surface diseases and tear staining syndrome. However, detailed anatomical structures of the medial canthus and lacrimal ducts in dogs are poorly understood. We aimed to understand the anatomical structures of the medial canthus by analyzing the distances from the medial palpebral commissure to the superior lacrimal punctum (DSP) and to the inferior lacrimal punctum (DIP) and by histological examinations of the medial canthal anatomy. Dogs that underwent modified medial canthoplasty (MMC) between April 2017 and March 2021 were studied. As a reference, non-brachycephalic dogs that underwent other surgeries were also examined. DSP and DIP were measured preoperatively in all dogs in both the non-everted and everted positions. Histological examinations of the medial canthal anatomy were performed in four eyes isolated from beagles. The ratios of DIP to DSP (mean ± SD) at the non-everted and everted positions in 242 MMC eyes of 126 dogs were 2.05 ± 0.46 and 1.05 ± 0.13, respectively (p < .01). The ratios of everted to non-everted positions for DIP and DSP were 0.98 ± 0.21 and 1.93 ± 0.49, respectively (p < .01). Histological findings indicated that the orbicularis oculi muscle (OOM) circumjacent lacrimal canaliculus transformed into collagen fibers and were attached to the lacrimal bone. Histological studies revealed that the OOM circumjacent lacrimal canaliculus transformed into collagen fibers and these collagen fibers may be related to the difference between DSP and DIP.

Prosedur Pemeriksaan Dacryocystografi Pada Kasus Dacryosistitis Kronis Di Instalasi Radiologi RSUP. Dr.Wahidin Sudirohusodo Makassar

Dacryocystography examination is the examination of the radiologist to show the nasolacrimal duct by using a positive contrast medium. The purpose of this examination is to describe the system of tear duct blockage and the level of blockage. This research method is descriptive with aproachcase study conducted in RSUP. Dr. WahidinSudirohusodo Makassar on Juni 2019. The inspection technique is done by using the projection Antero Posterior (AP), which contrast material is inserted throught the tear duct in the lacrimal punctum which empties into the concha nasalis inferior. From the result of the examination has been done, it can be concluded that the contrast as much as 1 cc inserted throught the superior lacrimal punctum, contrast restrained and spilled out. Contrast as much as 1 cc inserted throught the inferior lacrimal punctum, the contrast seems to fill out the inferior palpebra area. From the research, lacrimal duct obstruction impression superior and inferior.

Long-term outcomes of a new anatomy-based method for finding the medial cut end during late canalicular repair

Locating the medial cut end during late repair of canalicular lacerations can be challenging. The aim of this study was to evaluate the effectiveness and long-term outcomes of a new anatomy-based method for solving the problem of locating the medial cut end. This retrospective interventional study included 85 eyes of 85 consecutive adult patients with unilateral inferior canalicular lacerations who underwent late primary (≥2 days after injury) or secondary (≥6 months after initial treatment) surgery. Before surgery, the lacerations were classified as lateral, central, or medial according to the 'distance from the punctum to the distal end' of the lacerated inferior canaliculus. The time spent to locate the proximal lacerated end (TSL) was recorded. All patients were followed up for ≥1 year to evaluate the lacrimal passage patency and the distance between the superior and inferior punctum (DBSIP, to assess cosmesis). There were 16 (18.82%) lateral-type, 55 (64.71%) central-type, and 14 (16.47%) medial-type canalicular lacerations. The TSL was 3.48±1.05 (range 0.9-6.8) min for all patients and differed significantly among the three types of canalicular lacerations (P<0.001). Lacrimal irrigation showed patent lacrimal passages in 69 patients (81.18%) at 3 months and a further 4 patients (4.71%) at 6 months, residual stenosis without obstruction in 5 patients (5.88%), and obstruction in 7 patients (8.24%). The postoperative DBSIP on the affected side was shorter than the preoperative DBSIP (2.66±0.66vs. 3.09±1.72mm, P=0.006) and comparable to that on the unaffected side (2.78±0.40mm). Our new anatomy-based method is efficient and achieves good long-term outcomes for all types of late canalicular repair.

Success rate of Nasolacrimal Duct Probing in children with Congenital Nasolacrimal Duct Obstruction after the age of one year

Introduction: The objective of this study was to determine the success rate of nasolacrimal duct probing for congenital nasolacrimal duct obstruction in children after the age of one year.Materials and Methods: It was a descriptive case series conducted on 145 children presented to Ophthalmology Department, Allied Hospital, Faisalabad with CNLDO. The probing and syringing of the nasolacrimal duct were performed under general anesthesia. The patency of the nasolacrimal system was evaluated by irrigation of saline stained with pyodine through the superior punctum, flow of saline into the nose was confirmed by soaking of throat gauze with pyodine stained fluid and/or oozing of pyodine stained fluid through nose. Patients were advised topical antibiotics and steroids for 3 weeks after the probing and follow-up checkups after 6 weeks. Data were analyzed using SPSS computer software version 17.0. Effect modifier like age and gender was controlled by stratification. The post-stratification chi-square test was applied. P-value &lt;0.05 was considered significant.Results: In our study, the frequency of success of nasolacrimal duct probing for congenital nasolacrimal duct obstruction in children between 1 to 2 years was 80.3%, children between 2 to 3 years of age were 53.1%, and children between 3 to 4 years of age were 32.4%.Conclusion: We concluded that the success rate of nasolacrimal duct probing for congenital nasolacrimal duct obstruction is higher in children after the age of one year and decreases gradually as the age progresses.

Resection of anterior canalicular wall and lacrimal stent intubation for lacrimal canaliculitis

Objective To study the clinical efficacy of resection of anterior canalicular wall and lacrimal stent intubation for lacrimal canaliculitis. Methods A paralleling eyelid incision about 3 mm away from the margin was performed to expose the bulgy canaliculus. The canaliculus was cut parallelly and the purulent secretion, calculus and granulation tissue were removed.The two ends of a soft silicone stent were implanted via the superior and inferior punctum and were pulled out from nasal cavity where they were tied. The redundant dilated anterior wall canaliculus was resected and the posterior wall was sutured with 8-0 absorbable suture for wrapping up the stent. The follow-up time was 6-12 months. Results The suture of the skin was removed 1 week after the operation, and the stent was taken out 3 months after the operation. After follow-up of 6-12 months, the lacrimal passages were irrigated successfully on 32 cases (32 eyes) among the total 34 cases(34 eyes), accounting for 94.12%. Two patients had recurrent lacrimal passage obstruction, and it caused by stent falling off one week after the operation in one patient. The canaliculus had no purulence with open puncta and resetting eyelid. Conclusion Canaliculus hemisection combined with lacrimal stent intubation is an effective way with low recurrent rate for treating canaliculitis and reconstructing the canaliculus, especially for inferior canaliculitis. Key words: Canaliculitis; Canalicular hemisection; Lacrimal stent intubation

Applied Endoscopic Anatomical Evaluation of the Lacrimal Sac.

Dacryocystorhinostomy (DCR), a popular surgical procedure, has been performed using an endoscopic approach over recent years. Excellent anatomical knowledge is required for this endoscopic surgical approach. This study was performed in order to better evaluate the anatomical features of the lacrimal apparatus from cadavers in the Isfahan forensic center as a sample of the Iranian population. DCR was performed using a standard method on 26 cadaver eyes from the forensic center of Isfahan. The lacrimal sac was exposed completely, then the anatomical features of the lacrimal sac and canaliculus were measured using a specified ruler. A total of 26 male cadaveric eyes were used, of which four (16.7%) were probably non-Caucasian. Two (8%) of the eyes needed septoplasty, one (4%) needed uncinectomy, and none needed turbinoplasty. Four (16%) lacrimal sacs were anterior to axilla, one (4%) was posterior and 20 (80%) were at the level of the axilla of the middle turbinate. The mean difference of distance from the nasal sill to the anterior edge of the lacrimal sac (from its mid-height) was 39.04 (±4.92) mm. The mean difference of distance from the nasal sill to the posterior edge of the lacrimal sac (from its mid-height) was 45.50 (±4.47) mm. The mean of width and length of the lacrimal sac was 7.54 (±1.44) mm and 13.16 (±5.37) mm, respectively. The mean difference of distance from the anterior edge of the lacrimal sac to the posterior edge of the uncinate process was 14.06 (±3.00) mm, while the mean difference of distance from the anterior nasal spine to the anterior edge of the lacrimal sac (from its mid-height) was 37.20 (±5.37) mm.The mean height of the fundus was 3.26 (±1.09) mm. The mean difference of distance from the superior punctum to the fundus was 12.70 (±1.45) mm, and from the inferior punctum to the fundus was 11.10 (±2.02) mm. Given the differences between the various studies conducted in order to evaluate the position of the lacrimal sac, studies such as this can help to better identify the position of lacrimal sac during surgery based on ethnic differences. In addition, these studies can help novice surgeons to better navigate in a surgical scenario.

Specific features of endoscopic dacryocystorhinostomy – case report

Abstract OBJECTIVE. The aim of the study was to evaluate the endoscopic dacryocystorhinostomy (DCR) with some particularities and its advantages over external DCR. MATERIAL AND METHODS. We evaluated 3 female patients (age range 35-84 years) diagnosed with chronic dacryocystitis - lacrimal sac abscess (2 cases) and lacrimal sac fistula (1 case). All patients presented a history of repeated episodes of acute dacryocystitis initially treated with broad spectrum antibiotics by the ophthalmologist. The evaluation protocol consisted in cranio-facial CT scan or MRI for the evaluation of the lacrimal sac and nasal structures, an ophthalmologic examination with the catheterization of the superior and inferior lacrimal punctum with a light probe to verify the permeability of the lacrimal pathway, and the Jones test with fluorescein to receive information about the common lacrimal path. Lacrimal syringing with regurgitation of fluid from the opposite punctum was the only criteria to decide the surgery. In all three cases we performed an endoscopic DCR, with stent insertion in two cases and a laco-dacryo-rhinostomy in one case. In only one case a reintervention was needed 12 months later. CONCLUSION. The endoscopic DCR, with its different particularities, is a safe surgical procedure with a low rate of complications, being the treatment of choice for the treatment of nasolacrimal duct obstruction.

Lacrimal sac movement under intrasac pressure changes observed with dacryoendoscopy.

To examine movement of the intrasac cavity under intrasac pressure changes with dacryoendoscopy. The authors examined 10 lacrimal sacs (3 right and 7 left) without lacrimal tract obstruction in 10 Japanese patients (3 men and 7 women) aged 35 to 86 years (average, 62.8 years). These were the contralateral sides of the sides with nasolacrimal duct obstruction that were treated with dacryocystorhinostomy. After enlarging a superior lacrimal punctum, a dacryoendoscope (FT-203F; FiberTech) was inserted. When the tip of the dacryoendoscope passed through the common internal ostium, the handgrip was rotated 90° superiorly to face the tip inferiorly. Water was poured into the cavity throughout this process via the water channel of the dacryoendoscope. Then, with the water poured or suctioned from the same channel, namely causing positive or negative pressure changes in the intrasac cavity, movement of the lacrimal sac wall was examined with dacryoendoscopy. The lateral wall of the lacrimal sac moved with pressure changes fairly flexibly. Under positive pressure, the wall moved outward, but it moved inward under negative pressure. The present study demonstrated movement of the lacrimal sac wall with intrasac pressure changes, which was suggestive of its contribution to lacrimal drainage of the sac.

The comparison of three different methods to localize nasal broken end of lacerated inferior lacrimal canaliculus

Objective To compare the clinical efficacy of three different methods to localize nasal broken end of lacerated inferior lacrimal canaliculus.Methods 24 cases of lacerated inferior lacrimal canaliculus due to trauma were treated by three different methods (pushing water into the superior punctum,finding directly under operating microscope,probing needle)to localize nasal breakage.The clinical effects were analyzed.Results The searching method of pushing water into the superior punctum was performed in 24 cases and only 7 nasal breakages were localized successfully accounting for 29.17％.The searching method of finding directly under microscope was performed in 24 cases and the nasal breakages were found in all cases and the success rate was 100％.The searching method of probing needle was performed in 24 cases.The nasal broken ends were localized in 12 cases,but 4 cases were not successful because of iatrogenic false passage.The success rate was 50％.Conclusion For the patients with lacerated inferior lacrimal canaliculus due to trauma,searching nasal broken ends directly under microscope is the preferred method.If the searching time is more than 30 minutes,pushing water into the superior punctum can be tried.Using probing needle is the last choice,but not be performed when the trauma tissue is edema. Key words: Laceration,canalicular, lacrimal; Ends, broken, nasal

Silicone punctal plugs as an adjunctive therapy for open‐angle glaucoma and ocular hypertension

Background: Primary open‐angle glaucoma is a progressive optic neuropathy that can cause an irreversible loss of vision. A reduction in intraocular pressure (IOP) is beneficial in slowing or halting its progression. Once‐per‐day monotherapy glaucoma medications, such as prostaglandin analogues, are effective in lowering IOP while maintaining patients' adherence. Achieving the desired target IOP often requires multiple medications. The present study evaluates punctal occlusion of both the inferior and superior puncta as an adjunctive therapy to travoprost ophthalmic solution 0.004% for patients with primary open‐angle glaucoma or ocular hypertension in order to reduce IOP.Methods: Thirteen patients who were using travoprost 0.004% ophthalmic solution for the treatment of open‐angle glaucoma or ocular hypertension received silicone punctal plugs in the superior and inferior puncta of one eye. After one month, the IOP was remeasured. The percentage change of the IOP from the baseline was analysed by using a paired sample t‐test.Results: The mean baseline IOP was 19.82 ± 1.19-mmHg in the test eyes and 18.32 ± 1.11-mmHg in the control eyes. The mean IOP at the one‐month visit was 18.23 ± 1.17-mmHg in the test eyes and 18.45 ± 1.04-mmHg in the control eyes. The test eyes demonstrated a decrease in IOP of 1.59 (± 0.95) mmHg from the baseline, or a 6.82 per cent decrease in the IOP from the baseline. The control eyes had an increase in IOP of 0.14 ± 0.77-mmHg from the baseline, or a 1.91 per cent increase in the IOP. The relative difference in the IOP between the test eyes and the control eyes at the one‐month visit was 1.73-mmHg, or 8.74 per cent.Conclusion: Based on the results of this study, punctal occlusion offers a statistically and clinically significant decrease in IOP when it is used as an adjunctive therapy to travoprost 0.004% for patients who are suffering from open‐angle glaucoma or ocular hypertension.

Effectiveness of canalicular laceration repair using monocanalicular intubation with Monoka tubes

This study aimed to evaluate the clinical efficacy of canalicular laceration repair using monocanalicular intubation with Monoka tubes. A total of 36 single lacerated canaliculi were repaired using monocanalicular intubation with Monoka tubes, without mucosal anastomosis of the canaliculi, and were retrospectively reviewed. Demographic information, injury locations, associated ocular injuries, complications and outcomes were analysed. Mean patient age was 34 years (range 1-64 years). Tubes were removed at a mean of 4.2 months (range 3-6 months). There were 26 lower canalicular lacerations (72%) and 10 upper canalicular lacerations (28%). Overall, 34 of 36 cases (92%) showed improvement in symptoms and exhibited positivity on the dye disappearance test at 4-12 months after the procedure (mean 7.8 months). In total, 21 patients (58%) achieved complete success, 13 patients (36%) achieved partial success and two patients (6%) suffered surgical failure. Complications were seen in five cases and included two early tube protrusions, two punctal slits and one punctal granuloma. Monocanalicular intubation with Monoka tubes leads to successful outcomes without significant complications and offers an alternative to bicanalicular intubation in the treatment of monocanalicular lacerations.

Dilatação por cateter-balão (dacrioplastia) para tratamento das obstruções congênitas do ducto lacrimonasal

To verify the results of balloon-catheter dilatation for the treatment of congenital lacrimal duct obstruction. To the best of author's knowledge this procedure has not been previously used in Brazil and deserves scientific studies. Children between 2 and 5 years old, with congenital lacrimal duct obstruction, were treated with balloon-catheter dilatation (Lacricath). Catheter was introduced by the superior lacrimal punctum, under general anesthesia. Twenty-seven eyes were treated and 23 presented total improvement of epiphora signs and symptoms (85.2% success rate). During a one year follow-up, all the procedures had good outcomes, without complications and all the children had 1 year of follow-up. Balloon-catheter dilatation is an efficient and safe procedure and might be used for congenital lacrimal duct obstruction treatment in children older than 2 years.

Clinical analysis on 345 cases of neonatorum dacryocystitis treated by probing in early period

目的 探讨早期探通术治疗新生儿泪囊炎的效果.方法 345眼新生儿泪囊炎,均在门诊治疗室进行治疗.方法 是自上泪点进针,加压冲洗并直接行泪道探通.随访2年以上.结果 343眼痊愈,治愈率达99.42%.结论 对于新生儿泪囊炎,早期自上泪点进行探通治疗,是治愈该病的有效方法。

Bilateral corneal ulcerations after superior punctal monocanalicular intubations in a child with trisomy-21

Ocular complications have previously been reported after nasolacrimal system intubation for patients with symptomatic lacrimal drainage system abnormalities. Corneal complications, including keratitis and ulceration, have been described after monocanalicular intubation, and placement in the superior punctum has been recommended to lessen the chance of corneal contact. This report describes a child with trisomy-21 who developed bilateral corneal ulceration shortly after bilateral monocanalicular intubations in the superior puncta.

Results of endoscopic endonasal non-laser dacryocystorhinostomy.

Endoscopic dacryocystorhinostomy (EN-DCR) is a procedure that presents itself as an alternative choice to the conventional external approach. This study describes the results of endoscopic endonasal non-laser lacrimal surgery. We reported the data of 64 procedures of 63 patients with epiphora or chronic dacryocystitis who underwent primary EN-DCR by means of a microdrill or revision EN-DCR. One of these cases had bilateral surgery. There were 42 women and 21 men. Thirty-four cases had primary EN-DCR and 30 cases had revision EN-DCR secondary to previously failed external DCR. Mean follow up time was 11.34 months. The procedure was successful in 79.4% of primary EN-DCR cases and in 80% of revision EN-DCR cases. The overall success rate was 79.6%. Postoperative complications included periorbital edema, eyelid ecchymosis, punctal granuloma, cyst of the punctum, adhesion between the superior and inferior punctum. Tube dislocation occurred in 3 patients. Premature loss of silicone tube was determined in 5 patients and granulation tissue occurred at the internal osteum in 11 cases. EN-DCR, when compared with external dacryocystorhinostomy (EX-DCR), has lower success rate, but provides the potential advantages of better intraoperative hemostasis, and lack of cutaneous scar.

Congenital Lacrimal System Obstruction: Treatment with Balloon Dilation

To evaluate the safety and effectiveness of balloon dilation for the treatment of congenital lacrimal system obstruction. Fluoroscopically guided balloon dilation was attempted in 20 eyes of 16 patients with an age range of 12-78 months (mean, 33 mo) for congenital lacrimal system obstruction. Fifteen eyes had complete obstruction at the valve of Hasner, three eyes had completely obstruction at the junction between the lacrimal sac and the nasolacrimal duct, and two eyes had partial obstruction at the nasolacrimal duct. Under general anesthesia, a ball-tipped guide wire was introduced through the superior punctum into the inferior meatus of the nasal cavity and pulled out through the naris with use of a hook. A deflated 3-mm-diameter balloon catheter was then advanced in a retrograde direction and the balloon was dilated. Every patient underwent an ophthalmic evaluation before the procedure and was scheduled to be followed with office examination at 1, 3, and 6 months after the procedure. There were no major complications. "Technical success" was defined as free passage of contrast medium through the entire lacrimal system to the nasal cavity. The procedure failed in one eye. After balloon dilation, all 19 eyes in which technical success was achieved showed improvement of epiphora. During the follow-up period of 2-33 months (mean, 16 mo), all eyes maintained improvement of epiphora and needed no further treatment. Balloon dilation is a safe and effective therapeutic technique for the treatment of congenital lacrimal system obstruction.

Clinical efficacy of the polyurethane stent without fluoroscopic guidance in the treatment of nasolacrimal duct obstruction

Purpose To evaluate the clinical efficacy of the polyurethane (Song) stent in the treatment of nasolacrimal duct obstruction without fluoroscopic guidance, especially at the junction between the lacrimal sac and nasolacrimal duct or at the nasolacrimal duct. Design Retrospective noncomparative case series. Participants This study evaluated 59 cases of nasolacrimal duct obstruction in 53 patients, with mean epiphora of 36 months (range, 2 months–17 years). Methods Without the assistance of a radiologist, a polyurethane nasolacrimal stent was placed by introducing a guidewire through the superior or inferior punctum into the canaliculus and advancing it across the obstruction into the opening of the inferior meatus of the nasal cavity. The mean follow-up period was 22 months (range, 12 months–48 months). Main outcome measures Patency of the lacrimal passage to irrigation and the duration of this procedure. Results Complete resolution of epiphora was accomplished in 55 (93.2%) of the 59 eyes. There was recurrence of epiphora in four cases because of obstruction of the stent in three cases and obstruction of the common canaliculus by recurrent dacryocystitis in one case. Conclusions Polyurethane stenting without fluoroscopic guidance seems to be a valuable technique for primary management of nasolacrimal duct obstruction before dacryocystorhinostomy.

Pyogenic Granuloma: A Rare Complication of Silicone Punctal Plugs

To describe pyogenic granuloma formation associated with silicone punctal plugs. A 65-year-old woman with severe dry eye was treated with silicone punctal plugs in both upper and lower puncta. After 14 months of success with the plugs, the patient presented with a fleshy ampullary lesion overlying the plugged superior punctum of her right eye. It was clinically diagnosed as a pyogenic granuloma, and the silicone plug was removed. Since the lesion persisted for 1 month, it was surgically removed. Histopathologic examination confirmed the diagnosis of pyogenic granuloma. A new plug was inserted and tolerated well. The routine use of silicone plugs are recommended as long as patients are informed of possible rare complications.