Symptoms Of Epiphora Research Articles

Sinonasal Schwannoma in a Six-Year-Old: An Unusual Presentation

Schwannomas commonly occur in the head and neck region and extremities, but nasal schwannoma is extremely rare. It accounts for less than 4% of benign solitary schwannomas of the head and neck region. Few cases and very few case series have been reported till date. We report the case of a six-year-old female who presented with mouth breathing of two years with persistent and progressive right nasal obstruction of three months. There was recurrent watery ipsilateral nasal discharge, but no epistaxis, no otologic or throat symptoms, no headaches, facial pain, proptosis or visual loss, no facial hypoesthesia, fever or weight loss. She also had right sided epiphora. She had used topical steroid and decongestant without improvement. Ten months prior to presentation, she had right dacrocystorhinostomy. Examination revealed mucosa mass completely filling the right nasal cavity with an ipsilateral deviation of nasal septum—it was painless with no contact bleeds. Nasal patency was clinically absent bilaterally. Computed tomogram revealed expansile isodense soft tissue mass in the right nasal cavity with heterogeneous enhancement on contrast administration which measured 2.5 cm by 3.7 cm by 5.2 cm. She had an intranasal excision of the tumour and histology revealed Antoni A and B patterns, which is diagnostic of schwannoma. She was fully relieved of symptoms after surgery. Conclusion: Solitary nasal schwannoma is rare especially in childhood. There are various causes of epiphora; definitive investigation of the cause in the index case was not established before dacrocystorhinostomy. Thorough nasal evaluation of epiphora or related ocular symptoms should be sought before definitive procedures.

Predictors of Silicone Tube Intubation Success in Patients with Lacrimal Drainage System Stenosis.

PurposeTo evaluate prognostic factors affecting silicone tube intubation outcomes in Asian patients with lacrimal drainage system stenosis.MethodsA retrospective review was conducted on the medical records of 822 patients (1,118 eyes) who had undergone silicone tube intubation to treat lacrimal drainage system stenosis between January 2011 and December 2012. Patients were divided into two groups: a success group and a failure group. Success was defined as the disappearance of epiphora symptoms, normalization of tear meniscus height, and the easy passage of fluid without resistance on the postoperative syringing test. Patient and ocular parameters were compared between the success and failure groups.ResultsA total of 994 eyes of 727 patients were included in analyses. Patients had a mean follow-up period of 34.11 ± 18.70 weeks. Silicone tube intubation was successful in 67.2% of participants. Significant differences between the success and failure groups were found for age (p < 0.001), history of ipsilateral facial palsy (p = 0.028), follow-up period (p < 0.001), and degree of passage on the preoperative syringing test (p = 0.001). Only age (p < 0.001) and degree of passage on the preoperative syringing test (p = 0.002) remained significantly associated with silicone tube intubation success in multivariate analysis.ConclusionsAge was negatively associated with silicone tube intubation success in patients with lacrimal drainage system stenosis. The success rate was higher in patients who showed easy passage of fluid without resistance on the preoperative syringing test. These factors should be considered by surgeons planning silicone tube intubation in patients with lacrimal drainage system stenosis.

Clinical Characteristics and Effectiveness of the Lateral Tarsal Strip and Medial Spindle Procedure

This study was undertaken to evaluate the clinical characteristics and efficacy of the lateral tarsal strip (TS) and medial spindle procedure (MS). We conducted a retrospective chart review of the patients who underwent TS and MS between September 2008 and July 2011 by a single surgeon (S.H.B.). Data were collected on patient age, sex, laterality, diagnosis, procedures performed simultaneously, follow-up duration, postoperative complications, and surgical outcomes. One hundred eleven eyelids of 74 patients who underwent TS and 41 eyelids of 29 patients who underwent MS were included in this study. Patients' mean age was 61.5 years (range, 24-82) in the TS group and 68.2 years (range, 45-89) in the MS group. The most common diagnoses were lower lid laxity (54.1%) and involutional entropion (26.1%) in the TS group, and punctal ectropion in the MS group (95.1%). The percentage of patients who underwent an additional simultaneous procedure was 86.5% of the TS group and 92.7% of the MS group. Endoscopic dacryocystorhinostomy was the most commonly performed simultaneous procedure in both TS and MS groups (28.1% and 65.8%, respectively). Success rates were 96.4% in the TS group and 97.6% in the MS group. In the TS group, 3 eyelids (2.7%) required reoperation. The most common complication was chemosis in both TS and MS groups (51.4% and 50%, respectively). TS and MS are commonly performed simultaneously with other surgical procedures. These procedures aim to resolve lower lid laxity and punctal ectropion as well as relieve the symptoms of epiphora by stabilizing medial and lateral lid laxity. This review of the clinical features and effectiveness of MS and TS procedures provides useful information for clinicians.

Recent Advances in Management of Acquired External Punctal Stenosis

Acquired external punctal stenosis (AEPS) denotes anatomical narrowing of lacrimal punctum, which clinically manifests as epiphora. AEPS may be asymptomatic in a patient with dry eye. Under conditions of normal or excessive tear production; AEPS can produce symptomatic epiphora, which is an indication for intervention. Chronic blepharitis and idiopathic stenosis are the most common etiological factors. Preventable punctal stenosis in patients on long term taxanes or 5- fluorouracil occurs due to systemic absorption of these drugs and secretion in tears. In such cases, AEPS may be prevented by prophylactic lacrimal intubation. AEPS may have associated canalicular stenosis in 45% of cases. This review deals with the etiology, clinical diagnosis and management of AEPS, which has evolved over the years from the earliest description of simple punctal dilatation to present day use of monocanalicular and bicanalicular silicone stents.

Clinical Effectiveness of Monocanalicular Silicone Intubation for Congenital Nasolacrimal Duct Obstruction Under Nasal Endoscopic Visualization of the Terminal End of the Obstructed Nasolacrimal Duct.

To evaluate the cause of nasolacrimal duct obstruction through confirmation by nasal endoscopic findings of Hasner's valve and to report the success rate of monocanalicular silicone intubation (MCI) for the management of congenital nasolacrimal duct obstruction (CNLDO). Seventy-seven eyes of 56 patients with CNLDO underwent MCI under nasal endoscopic visualization of the terminal end of the obstructed nasolacrimal duct at the Korea University Ansan Hospital and Guro Hospital from October 2008 to March 2013. The following demographic information was analyzed: age, sex, endoscopic findings of Hasner's valve during operation, complications, and outcomes. The main outcome measures were disappearance of epiphora symptoms beginning the first 2 months after removal of the silicone tube. The silicone tube was removed under topical anesthesia in the office between 2 and 3 months, postoperatively. The mean (± SD) age of the study population was 29.8 (± 26.9) months (range: 6 months to 12 years). Under nasal endoscopic view, 45 ducts (58.4%) had a thin membranous obstruction or had a simple stenotic opening of Hasner's valve. Seven ducts (9.1%) had thick obstructing membranes with probe passage under the lateral nasal mucosa. Twenty-three ducts (29.9%) showed the probe tip protruding through balloon-like nasal mucosa. Two ducts (2.6%) appeared to have probe protrusion through a stretchable valve. The overall success rate was 89.6% (69/77). The incidence of tube prolapse and tube loss was 18.2% (14 eyes) and 13.0% (10 eyes), respectively. No other complications were observed. Monocanalicular silicone intubation under nasal endoscopic visualization of the terminal end of the obstructed nasolacrimal duct can be an effective procedure for the management of CNLDO.

Three-Snip Punctoplasty Outcome Rates and Follow-Up Treatments

ABSTRACTPurpose: To demonstrate the success rate of three-snip punctoplasty (TSP) for the treatment of punctual stenosis and to evaluate the need for additional treatment after TSP.Methods: A retrospective chart review was conducted of all patients undergoing TSP by a single surgeon at Bascom Palmer Eye Institute from January 1, 2006 to January 1, 2010. Outcome measures include the persistence of symptomatic epiphora, the need for additional surgical interventions, and postoperative time required until complete resolution of symptoms achieved.Results: Primary TSP resulted in an 86% success rate with resolution of symptomatic epiphora without further surgical intervention. Seven eyes (14%) required secondary TSP with or without stent placement. All 6 eyes with TSP with stent placement achieved functional success within an average of 6.8 months (stdev 6.83) from the first TSP. The one eye that was not stented during secondary TSP required a tertiary TSP with stenting and achieved functional success within the 1 month of the final procedure.Conclusion: Primary TSP showed an 86% success rate with the resolution of tearing by an average of 1.2 months post-operatively. Membrane formation or scarring over the surgical site required an additional TSP with stenting in 14% of patients. All 50 eyes eventually achieved functional success. TSP alone as a primary procedure is a safe, relatively simple, and effective treatment of epiphora caused by punctual stenosis. Stenting should be explored as an adjunct to this procedure if primary TSP alone does not produce resolution of symptoms.

Association of rhinostomy shape and surgical outcome after endoscopic endonasal dacryocystorhinostomy.

The purpose of this study was to investigate surgical outcomes and complications after endoscopic endonasal dacryocystorhinostomy (EDCR) in relation to rhinostomy shape. A retrospective electronic medical record review of patients who underwent EDCR for primary acquired nasolacrimal duct obstruction (PANDO) was performed. Surgical success rates and postoperative complications were compared among three groups of patients in relation to rhinostomy shape (alcove, cavern, or concealed cavern). A total of 280 patients (358 eyes) were included in the study. Of the 358 eyes, 194 rhinostomies were alcove-shaped, 157 were cavern-shaped, and 7 were concealed cavern-shaped. There were no patients with flat-shaped rhinostomies. The nasal cavity was wider in patients in the alcove group than those in the cavern and concealed cavern groups (p = 0.012). The mean time to tube removal was longest in the concealed cavern group (p = 0.029). There were no significant differences in anatomical success rates among the three groups (p = 0.338). With regard to functional success for patients with anatomically patent DCR, the cavern and concealed cavern groups had significantly poorer results than the alcove group (p = 0.001). Functional success rates were 91.6 %, 84.8 %, and 57.1 % for the alcove, cavern, and concealed cavern groups, respectively. Development of postoperative granuloma was more frequent in the concealed cavern group (85.7 %) than in the alcove (29.3 %) or cavern groups (26.1 %) (p= 0.003). Multiple logistic regression models for surgical outcome showed that rates of functional failure after EDCR were influenced by patient age and rhinostomy shape (odds ratio 1.824, p = 0.045 for age; odds ratio = 9.605, p = 0.000 for rhinostomy shape) (Table 5). The incidence rate of symptomatic epiphora after EDCR was approximately 12 %, and this result may have been associated with cavernous and concealed rhinostomy shapes. For patients with persistent epiphora and anatomically patent DCR, it is important to identify rhinostomy shape by endoscopy in order to differentiate causes of functional failure.

English

AIM: To compare the success rate and complications of external dacrycystorhinostomy with that of endonasal dacryocystorhinostomy. STUDY DESIGN: Prospective randomized comparative study. MATERIAL AND METHODS: Sample Size: The study comprises of 60 eyes of 54 consecutive patients with chronic dacryocystitis of which 28 patients underwent external dacryocystorhinostomy and 26 patients underwent endonasal endoscopic dacryocystorhinostomy. All the patients were selected by simple random method. INCLUSION CRITERIA: All symptomatic epiphora cases diagnosed for primary acquired nasolacrimal duct obstruction by the means of lacrimal sac syringing were taken for the study. Nasal endoscopy was done in all the patients to rule out any associated nasal pathology. EXCLUSION CRITERIA: Patients with nasal and canalicular pathology, bleeding disorders, uncontrolled hypertension and diabetes mellitus were excluded. STATISTICAL ANALYSIS: The data was analysed by the SPSS software version 16.0. Chi Square and Fisher's exact test were used to compare the assumption between the two groups. P value less than 0.05 was considered as significant. RESULTS: The overall primary success rate of external dacryocystorhinostomy was 93.33% and that of endonasal dacryocystorhinostomy was 90% at 3 months after surgery, but this difference was not statistically significant (P=1.0). CONCLUSION: External DCR remains as the gold standard in the treatment of nasolacrimal duct obstruction for a successful outcome with minimal complications.

Endoscopic endonasal dacryocystorhinostomy combined with canaliculus repair for the management of dacryocystitis with canalicular obstruction.

Purpose. The aim of this study is to propose a simple and efficient combination surgery for the management of dacryocystitis with canalicular obstruction. Methods. A retrospective noncomparative case series of dacryocystitis with canalicular obstruction has been studied. Twelve patients with dacryocystitis and canalicular obstruction underwent a conventional endoscopic endonasal dacryocystorhinostomy (EE-DCR) combined with a modified canalicular repair. Postoperative observations included slit lamp, fluorescein dye disappearance test, lacrimal syringing, lacrimal endoscopy, and nasal endoscopy. Results. After 6–18 months of postoperative follow-up, the symptoms of epiphora and mucopurulent discharge disappeared completely in 10 patients, and occasional or intermittent epiphora remained in 2 patients. All of the twelve patients showed an opened intranasal ostium and normal fluorescein dye disappearance test. Patent bicanalicular irrigation was achieved in 9 patients. One patient had a partial and the other two had a complete reobstruction by lacrimal irrigation to their repaired lower canaliculus; however, all of them had a patent lacrimal irrigation to upper canaliculus. The functional success rate for the combination surgery is 83% (10/12), and anatomical success rate is 75% (9/12). Conclusion. EE-DCR combined with modified canalicular repair is a simple and efficient method for the management of dacryocystitis with canalicular obstruction.

Effects of medication methods after simple and effective probing of lacrimal passage.

To evaluate the effect of reducing the use of antibiotics in the treatment of infant bacterial dacryocystitis after probing of the lacrimal duct. A total of 542 cases of children under one year old and accepting nasolacrimal duct probing treatment were divided into two groups, which were treated with topical and oral antibiotics, respectively. Conjunctival sac secretions were used as a control index of bacterial infection, whereas the disappearance of epiphora symptoms and lacrimal passage patency were used as cure indexes. The χ (2) test was used to compare enumeration and measurement data, and a statistical significance was set at P<0.05. The therapeutic effect on the two groups of postoperative patients was investigated. In the two study groups, no significant differences in gender, age and postoperative control of lacrimal sac infection were observed. The cure rates after three probing operations also showed no significant difference. After probing of the lacrimal passage, results of this study confirmed that postoperative medication without oral antibiotics but an ophthalmic dosage of antibiotics was a simple and effective treatment method.

Optical Coherence Tomography Imaging of the Proximal Lacrimal System

Introduction: There are currently no routinely used imaging modalities for the proximal lacrimal system. Optical Coherence Tomography (OCT) is a safe and non-invasive method of high resolution cross-sectional imaging of tissue microstructures using infra-red radiation. In this study we investigate whether OCT may be used to image the punctum and proximal canaliculus.Methods: A cohort of healthy subjects with normal ocular anatomy and no symptoms of epiphora were prospectively invited to enrol. Spectral OCT images of the lower punctae were captured with a Topcon 3D Optical Coherence Tomography 2000 machine. Measurements were made of the maximal punctal diameter, canalicular diameter and canalicular depth. Our data for depth of the vertical canaliculus was compared to the widely quoted figure of 2 mm using a two-tailed t-test to check for a statistically significant difference at p < 0.05.Results: Thirty-six punctae of 18 subjects were scanned. The punctum was recognisable on the OCT image in all cases. The mean depth, width and cross- sectional area of the visualised canaliculi were 0.753 mm (SD 0.216), 0.110 mm (SD 0.067) and 9.49 × 10−3 mm2, respectively. The mean width of the punctum was 0.247 mm (SD 0.078).Discussion: We have demonstrated the first in-vivo high resolution images of normal punctal and vertical canalicular anatomy using spectral OCT. There is currently no other practical way to accurately image punctal and proximal canalicular morphology in vivo. OCT is a convenient and readily available tool in most eye clinics with resolution ideally suited for imaging of the punctum and proximal canaliculus.

A new method using xenogeneicacellular dermal matrix in the reconstruction of lacrimal drainage

AimsTo prospectively evaluate the reliability and efficacy of a new treatment for the reconstruction of the lacrimal duct using a new histo-engineered material, xenogeneic (bovine) acellular dermal matrix.MethodFive patients (five...

Etiology of acute conjunctivitis due to coxsackievirus A24 variant, human adenovirus, herpes simplex virus, and Chlamydia in Beijing, China.

Acute conjunctivitis is a common disease associated with high morbidity and economic burden. To clarify the etiological characteristics of acute conjunctivitis in Beijing, surveillance of acute conjunctivitis was conducted from July to October during 2007-2012 by collecting eye swabs from patients treated at surveillance hospitals affiliated with a surveillance program of 18 districts Center for Disease Prevention and Control in Beijing. Coxsackievirus A24 variant (CA24v), enterovirus 70 (EV70), human adenovirus (HAdV), herpes simplex virus (HSV), and chlamydia were identified by PCR. Phylogenetic analysis of the VP1 region of CA24v was conducted. Comparisons of proportions and statistical significance were performed using the chi-square test. HAdV was found to be the most prevalent pathogen, followed by CA24v, chlamydia, and HSV. Significant differences in the symptoms of ocular pain, photophobia, and epiphora were identified among the 4 agents. The prevalence of HAdV- and CA24v-mediated conjunctivitis peaked in July or August and September or October, respectively. Nucleotide sequences of the VP1 regions among the isolated CA24v strains shared 92.8%-100% homology. In conclusion, HAdV followed by CA24v, chlamydia, and HSV were the most common causative agents of acute conjunctivitis in Beijing. Comprehensive, continuous surveillance and advanced laboratory techniques are needed for further studies.

A Dentigereus Cyst Containing Displaced Tooth In The Maxillary Sinus

Ectopic eruption of tooth has been reported in the nasal septum, chin, palate, coronoid process and maxillary sinus in the literature. A tooth may erupt maxillary sinus and present with chronic sinusitis, mucosele and cyst formation. Obstruction the osteomeatal complex, formation of cyst in the maxillary sinus, obstruction of nasolacrimal canal leading to epiphora may occur because of the anatomic variation. There may be sinonasal symptoms of sinusitis, epiphora and pain. The diagnosis of this condition can be made radiologically. If it is symptomathic treatment of ectopic maxillary tooth with dentigerous cyst is surgical removal via a Caldwell-Luc procedure. Herein we present an original image of a dentigerous cyst containing premolar tooth in the maxillary sinus.

Efficacy of endoscopic guided anterograde 3 mm balloon dacryoplasty with silicone intubation in treatment of acquired partial nasolacrimal duct obstruction in adults

AimTo report the outcomes of endoscopic guided anterograde 3mm balloon dacryoplasty with silicone intubation in patients with acquired partial nasolacrimal duct obstructions in adults. MethodsRetrospective case series, included 21 eyes with partially obstructed nasolacrimal ducts of 12 patients. All the 21 ducts were initially probed and the probe confirmed with an endoscope in the inferior meatus. After confirming the presence of probe in the inferior meatus, a 3mm balloon was used for dilating the distal and proximal portions of nasolacrimal duct, followed by stenting of ducts with Crawford tubes. Main outcome measures were anatomical patency of the passage and resolution of epiphora. ResultsOf the 12 patients, 9 had bilateral and 3 had unilateral acquired partial nasolacrimal duct obstructions. All the patients underwent bicanalicular stenting under endoscopic guidance which were retained for a period of 12weeks. A minimum follow up of 6months following stent removal was considered for final analysis. 15 of the 21 ducts (71%) were freely patent on irrigation but 13 of the 21 reported improvement of epiphora. Two nasolacrimal ducts showed similar partial regurgitation and partial patency on syringing as before with no improvement of symptoms. Four nasolacrimal ducts were completely obstructed with complete regurgitation of fluid on syringing with worsening of the epiphora. Two eyes persisted with symptoms of epiphora despite patent nasolacrimal duct with grade 2 dye retention on dye disappearance test. Conclusions3mm balloon dacryoplasty is an alternative and safe way to manage partial nasolacrimal duct obstructions with an anatomical success in 71% and functional success in 62% of the patients. Further studies with a large sample size and longer follow-up are required to ascertain the long term benefits.

Microscope-Assisted Reconstruction of Canalicular Laceration Using Mini-Monoka

A canalicular laceration is the most common injury of the lacrimal drainage system and can result from direct or indirect injury to the canalicular system. If the wounds are not managed properly, they can lead to scarring, stenosis, and inflammation, which may lead to symptomatic epiphora. We successfully reconstructed canalicular lacerations using Mini-Monoka tubes (FCI Ophthalmics, Marshfield Hills, MA) under microscopic magnification.We treated 14 patients for canalicular lacerations at the Soonchunhyang University Bucheon Hospital between August 2009 and October 2012. All patients underwent placement of a Mini-Monoka tube and a mucosal canalicular anastomosis microscopically to reconstruct monocanalicular lacerations. The tubes were removed at 6 to 8 months postoperatively, and follow-up was 8 to 12 months. No complications related to the Mini-Monoka tube, such as punctual plug migration, eye irritation, inflammation, granuloma formation, or erosion, occurred during the follow-up period.The goal of reconstructing a lacerated canaliculus is accurate approximation of the injured end of the canaliculus to facilitate mucosal healing and to prevent a canalicular obstruction. We believe that microscopic canalicular reconstruction with a Mini-Monoka tube is a safe, reliable, and straightforward method with fewer complications and is more effective for preventing iatrogenic injury in the unaffected canaliculus and minimizing patient discomfort.

Derangements of Lacrimal Drainage-associated Lymphoid Tissue (LDALT) in Human Chronic Dacryocystitis

Aims: To study the changes in the lacrimal drainage-associated lymphoid tissue of the lacrimal sac in human chronic dacryocystitis and its possible implications in understanding the immune defense mechanisms and etiopathogenesis of primary acquired nasolacrimal duct obstruction.Methods: Retrospective interventional study involving 200 lacrimal sacs of 164 consecutive patients seen between July 2009 and July 2012. Data collected include demographics, clinical presentation, laterality, age at presentation, duration of symptoms, diagnostic irrigation, indications for a dacyrocystectomy, pattern and severity of lymphoid infiltrate, types of lymphoid follicles and their locations, plasma cells, and other cellular infiltrates. The associated epithelial, stromal, and luminal changes with an emphasis on acini, mucosal glands, blood vessels, lymphatics, and goblet cells were also noted. Immunohistochemistry using CD3, CD20, CD138, and immunoglobulin A were used to substantiate the lymphoid tissues of the lacrimal sac.Results: A total of 200 lacrimal sacs were obtained from dacryocystectomy of 164 patients. The patients included 60.5% (99/164) females and 39.6% (65/164) males, with a mean age of 58.4 years at presentation. Laterality showed a predominance of left lacrimal sacs (55%, 110/200) as compared to the right lacrimal sacs (45%, 90/200). Symptoms of epiphora and discharge of more than 6 months duration were considered to be chronic. Lymphoid infiltrate pattern was diffuse in majority of the sacs (81%, 162/200), with subepithelial and intraepithelial together being the commonest location (46.5%, 93/200). Distinct lymphoid follicles were seen in 28% (56/200). Most of the sacs showed mild plasma cell infiltration (66.5%, 133/200). IgA-rich secretions were noted in the lumen and the lining epithelium in 34.5% (69/200). Other common changes noted include increase in the goblet cells (82%, 164/200), dilated lymphatics (94%, 188/200), proliferating blood vessels (99%, 198/200), thickened epithelium (54.5%, 109/200), and stromal fibrosis (88%, 176/200).Conclusion: This study presents the largest series to date (n = 200 lacrimal sacs) exclusively on changes in lacrimal drainage-associated lymphoid tissue in human chronic dacryocystitis. This study could be the starting point for further exploration into the molecular biology, immunological implications, and possible implications of LDALT derangements on etiopathogenesis of primary acquired nasolacrimal duct obstruction.

Endoscopic dacryocystorhinostomy without mucosal flap : Our experience

Background: The purpose of our study was to evaluate outcome of Endoscopic dacryocystorhinostomy without preservation of mucosal flap for the management of acquired nasolacrimal duct obstruction Methods: A retrospective review of 26 patients were performed on patients who underwent Endoscopic dacryocystorhinostomy without preservation of mucosal flap from March 2007 to November 2010 at our hospital. Twenty six patients were operated and followed up postoperatively for five to six weeks with lacrimal syringing by ophthalmologists and diagnostic endoscopy done at third month and followed up until the formation of well formed ostium and patients became asymptomatic. Main outcome were subjective improvement in epiphora and persistence of anatomic patency of ostium. Result: There were 26 patients operated, one is male and all others were female. The age of patients were ranging within 20 to 78 years (mean 36.65years).Every patients were followed up in the range of four months to two years (mean 6.2 months). Septoplasty was required in only one patient prior to DCR. Anatomic patency were confirmed by nasal endoscopy in twenty four patients (92%), remaining two had synechiae without ostium. One patient among 24 patients had ostium and lacrimal flow with intermittent epiphora. Our overall success rate with anatomical patency and without symptoms of epiphora is 88%. Conclusion: Our results with endoscopic dacryocystorhinostomy are comparable with previously published outcomes. Our data suggest that endoscopic dacryocystorhinostomy without preservation of mucosal flap may be performed DOI: http://dx.doi.org/10.3329/bjo.v19i1.11728 Bangladesh J Otorhinolaryngol 2013; 19(1): 41-45

Treatment of Epiphora in Connection with Endolacrimal Surgery using Trephines: New and Overview Data

To provide new and to summarize published data on endolacrimal surgery with Piffaretti's trephines, in particular in patients having patent lacrimal drainage system (syringing) and epiphora resistant to medical treatments. From two tertiary referral centers (Basel/Switzerland; Belo Horizonte/Brazil), 126 patients undergoing endolacrimal surgery with Piffaretti's trephines, combined, when clinically indicated, with other procedures known to improve epiphora (canthoplasty/pexie and/or conjunctivochalasisplasty). I) A study (Basel) in 17 patients showed one-year after surgery marked epiphora symptoms' improvement in 88% (15/17) of patients, 65% (11/17) being symptom-free. II) Unpublished data (Belo Horizonte) in 42 patients found 81% (34/42) symptom-free six-months after surgery. Dacryoscintigraphy illustrated postoperative tears' clearance improvement. III) Unpublished data (Belo Horizonte) in 45 patients solely undergoing endolacrimal surgery for complete ductal obstruction found symptom-free, six-months after surgery, 27% (8/30) of patients with preoperatively enlarged lacrimal sac and 80% (12/15) with none-enlarged sac (p < 0.01, Fisher's test). IV) A study (Basel) in 22 epiphora patients reported no correlation (p = 0.62, rho -0.11, Spearman) between preoperative basal Schirmer's test II (oxybuprocain-HCL 0.4%) values and one-year surgical outcome. Patients with preoperative Schirmer's test's values ≤ or > 6 mm had similar mean postoperative symptoms' improvement (82 ± 30%, n = 11 vs. 76 ± 34%, n = 11, p = 0.97, Mann-Whitney). Endolacrimal surgery with Piffaretti's trephines, sometimes combined, when clinically indicated, with other procedures also known to ameliorate epiphora, can in particular improve (different conditions, surgeons, centers) epiphora's symptoms resistant to medical treatments in patients with patent lacrimal drainage system, and this apparently, even when pre-operative basal Schirmer-test values are low. By enlarged lacrimal sac, outcome is poor.

A Novel Effective Y-Shaped Silicon Stent for Treating Canalicular Laceration

Purpose: To introduce the novel effective Y-shaped silicon stent for treating canalicular laceration. Methods: Fifty-four canalicular laceration cases (54 eyes) underwent the lacrimal surgery using the novel Y-shaped silicon stents were collected, and the stents were removed 3 months after surgery. All cases were followed up for 12 months. The operability of stenting and removing the stent were assessed. The data we collected during each follow-up are: stent position and integrity, aesthetic results, the discomfort, the symptom of epiphora, the patency of lacrimal passage, complications, and patient’s satisfaction. Results: The stenting time was 14.3±5.8 min and the time of removing it was 1.8±0.5 min. Both of the operability of stenting and removing were accessed to be easy in more than 94.4% cases. All stents were in position and integrated. 51 cases (94.4%) had no problems on aesthetic results. Three patients (5.4%) complained about the discomfort. Two cases (3.7%) had the symptom of epiphora, which were obstructed after removing the stents. Fifty-two cases (96.3%) were with patent canaliculus and satisfied with the surgery and symptom improvement. Only 5 cases (9.3%) had complications. Conclusion: The novel Y-shaped silicon stent is an effective stent for treating canalicular laceration.