Symptoms Of Nasolacrimal Duct Obstruction Research Articles

Lacrimal Plasty with Dacryocystorhinostomy-Anastomosis Using Microsurgery.

In DCR, the lateral aspect of the dacryocyst and the nasal mucosa are incised, and the mucosal valves are sutured together. In DCR-A, the occluded section of the dacryocyst or nasolacrimal duct was trimmed and anastomosed by circumferential suturing through a hole in the nasal mucosa. The success rate and the requirement for postoperative therapy were compared between 21 sides of DCR patients and 11 sides of nasal DCR-A patients. DCR-A was significantly better than conventional DCR. No additional postoperative therapy was required for DCR-A. DCR-A improves symptoms of nasolacrimal duct obstruction to a greater extent than conventional DCR and does not require additional postoperative treatment.

Lacrimal Sac Anterior Border-Maxillary Line Distance: Effect on Endoscopic Dacryocystorhinostomy (EDCR) Surgery Results and NLDO-SS Questionnaire.

This study aimed to investigate the effect of the maxillary line (ML)-lacrimal sac anterior border (LSA) distance on the results of endoscopic dacryocystorhinostomy (EDCR) operation. The study was designed retrospectively. The distance between LSA and ML was measured from preoperative paranasal sinus computed tomography (PNSCT) images. Nasolacrimal duct obstruction symptom score (NLDO-SS) was calculated before and after surgery. The endoscopically proven of the transition of the 2% fluorescein drop instilled into the eye to the nasal passage accepted as a surgical success. 47 patients included in the study and eight of them underwent bilateral EDCR. The average age of the patients was 50.3 ± 14.8. The LSA-ML distance was 4.2 ± 1.0mm in all patients. The duration of surgery was found as 38.1 ± 6.1min for each side. The preoperative NLDO-SS mean was 54.9 ± 11.7 and 22.2 ± 12.1 postoperatively (p = 0.000, CI = 28.9-36.2). Six patients (11%) required revision surgery. A statistically significant high positive correlation was found between duration of surgery and LSA-ML distance (p = 0.000, r = 0.840). There was a significant negative correlation between the duration of surgery and postoperative NLDO-SS (p = 0.041, r = -0.276). The LSA-ML distance calculated in this study was found to be significantly associated with the decrease in the duration of surgery and the NLDO-SS score obtained after surgery. However, more valid results can be obtained if similar studies are carried out in larger samples containing a sufficient number of revision cases.

Lithuanian version of nasolacrimal duct obstruction symptom scoring questionnaire. Cross-cultural adaptation and validation. Short- and long-term results.

The objective of this study was to perform translation, cross-cultural adaptation and validation of the Lithuanian version of specific nasolacrimal duct obstruction symptom scoring (NLDO-SS) questionnaire and to evaluate short- and long-term results of endoscopic endonasal dacryocystorhinostomy (EN-DCRS) procedure. Permission for questionnaire translation, cross-cultural adaptation and validation was obtained from the authors of the original questionnaire. Translation, validation and cross-cultural adaptation were carried out according to generally accepted methodology. Validation study of the Lithuanian version of NLDO-SS (L-NLDO-SS) was performed, and short- and long-term results of EN-DCRS procedure were evaluated according to symptoms. In total, 44 patients were evaluated 2weeks before the surgical intervention, a day before the surgery and 41 patients 2months after the surgery, and again 10months later. We analysed the internal consistency and test-retest reliability of the L-NLDO-SS questionnaire. Cronbach's alpha was used to represent and evaluate internal consistency for ordinal responses. Validity was assessed by comparing scores between a control group of volunteers without NLDO and the NLDO group using Mann-Whitney test. To test the limiting score on which the sensitivity and specificity curves cross in identifying patients with NLDO, receiver operating characteristic (ROC) curve analysis was used. The pre- and post-operative scores were compared using the paired t-test. The results showed an acceptable internal consistency of L-NLDO-SS questionnaire, with Cronbach's alpha-.73 in the initial test group and .71 in the retest group. Pearson's correlation coefficient was .94 (P<.001), revealing good correlation between the initial scores and the retest scores. Our sample of healthy individuals had a mean L-NLDO-SS score of 11.42 (±12.69) points, and patients being scheduled for EN-DCRS had a mean L-NLDO-SS score of 27.45 (±9.81) points. Post-operatively mean L-NLDO-SS scores improved from 27.45 (±9.81) points to 4.45 (±6.29) points in the short term and to 5.83 (±4.17) in the long term, demonstrating the statistically significant responsiveness of the instrument over both timescales. Lithuanian version of NLDO-SS questionnaire is a valid instrument for assessing patients with NLDO in the Lithuanian population. It demonstrated good internal consistency, reproducibility, validity and responsiveness.

Non-Surgical Persian Medicine-Based Treatment of Chronic Refractory Congenital Nasolacrimal Duct Obstruction in a Surgical Candidate (Thirteen-month-old) Infant

Congenital or acquired obstruction is the most common anomaly of nasolacrimal duct (NLD). NLD obstruction (NLDO) is one of the most common problems in pediatric ophthalmology. Some symptoms of NLDO are seen in 6-20% of infants. NLDO creates two problems; first is disruption in the flow of tears that is due to epiphora. Another is the infection leading to stasis of fluid in the lacrimal system. Surgery is the choice treatment of chronic congenital NLDO in the refractory infants to massage and antibiotics. Dam-e is a watery discharge of eyes that has different reasons in Persian Medicine (PM). Based on the symptoms which was seen in patients with NLDO, it could be one of the subgroups of Dam-e. Conforming to Persian Medicine, residue of materials that moves from brain to the eyes and sediments in the NLD, can be the main reason of NLDO. Our case is the thirteen-month-old infant with congenital NLDO unresponsive to antibiotics and massage and has been a candidate for surgery. In PM view, to open the lacrimal duct obstruction, we use the properties of Persian Medicine’drugs (including Honey, camphor, vinegar and sesame oil) such as fragmentation of excreta (are Moghatte in PM), anti- obstruction (Mofatteh in PM), cleansing (Monaghi in PM) and descaling (Jali in PM) effects, and the patient’s symptoms were nonsurgically relieved. In the discussion of this paper, the properties of these drugs also check point of view of contemporary medicine’s viewpoints compared to Persian Medicine.

Bilateral Simultaneous Endoscopic Dacryocystorhinostomy: Outcome and Impact on the Quality of Life of the Patients.

Introduction Bilateral simultaneous endoscopic dacryocystorhinostomy (endo-DCR) has received little attention in the literature, thus many surgeons continue to address bilateral nasolacrimal duct obstruction at two stages, rather than in the same setting. Objective To evaluate the feasibility and the outcome of simultaneous bilateral Endo-DCR and its impact on the quality of life of the patients. Methods We have conducted a retrospective analysis of patients who underwent bilateral simultaneous endo-DCR between March 2013 and February 2017 at our tertiary care institution. The reviewed data included clinical presentation; operative details; success rate; pre and postoperative evaluation of the symptoms of the patients, using the Nasolacrimal Duct Obstruction Symptom Score Questionnaire; satisfaction of the patients, and improvement in the quality of life, assessed by the Glasgow Benefit Inventory (GBI) questionnaire. Results Out of 128 cases in which endo-DCRs were performed, 13 were bilateral (26 sides). Postoperative success was documented in 24 of the 26 sides (92.3%), with a mean follow-up duration of 16.2 months. The two failed sides were reported in the same case. The preoperative symptom score ranged between 12 and 80 (mean ± standard deviation [SD]: 38.23 ± 15.7). The postoperative symptom score was significantly lower (mean ± SD: 5.4 ± 12.9). The success rates in unilateral and bilateral cases were comparable, with no statistically significant difference. A notable improvement in the quality of life of the patients was also reported, with a mean GBI score of 81.38 ± 12.37. Conclusion Our results support that a simultaneous bilateral endo-DCR is a safe procedure that offers a high success rate, spares the patient from the stress of a second surgery, provides the patient with a bilateral resolution of the symptoms, and confers an immediate improvement in the quality of life of the patients.

A Systematic Review of Patient-Reported Outcomes for Surgically Amenable Epiphora.

In evaluating epiphora and its management, the bottom line for all stakeholders is whether an intervention confers any real benefit on quality of life. A review was conducted to identify and appraise patient-reported outcome measures (PROMs) in surgically amenable epiphora. A systematic search was conducted of studies relating to surgical intervention for epiphora. Patient-reported outcome measures were identified and assessed against standard criteria. Of 30,544 identified articles, 227 were eligible for data extraction. Of these, 69% reported a PROM as the primary outcome. PROMs identified included single-item symptom scores (48% of primary outcome PROMs), single-item reports of improvement (30%), the Glasgow Benefit Inventory (3%), Lacrimal Symptom Questionnaire (0.5%), Nasolacrimal Duct Obstruction Symptom Score (0.5%), Ocular Surface Disease Index (0.5%), Visual Function Questionnaire-25, the Short Form-36 Health Survey, and 3 other symptom scores. None were developed through consultation with the target population, and there was inadequate testing of content validity. The strengths and limitations of each PROM are presented, with regard to interpretation, responsiveness, reliability, and validity. The importance of robust and psychometrically sound PROMs is essential if the under-reporting of quality of life improvement in patients treated for epiphora is to change. Recommendations for the use of each identified PROM are discussed. Several PROMs have been used in the recent literature to evaluate patients undergoing surgery to treat epiphora. Assessed against standard criteria, no PROM has proven to be both psychometrically robust and clinically meaningful for use in this population. Future PROM development should be guided by this standard framework.

Validation of a symptom-score questionnaire and long- term results of endoscopic dacryocystorhinostomy

Endoscopic dacryocystorhinostomy (EN-DCR) is a commonly used procedure in the treatment of nasolacrimal duct obstruction (NLDO). However, there is no generally accepted disease-specific questionnaire for assessing outcomes. We conducted a prospective study to initially validate a Nasolacrimal Duct Obstruction Symptom Score questionnaire(NLDO-SS) and to evaluate the long-term success of EN-DCR procedures. Seventy-six patients (86 eyes) were evaluated in follow-up visits at 1-8 years after EN-DCR. The patients completed the NLDO-SS questionnaire twice, first, at home and, second,after receiving information from the otorhinolaryngologist, during the visit. The surgical outcome was considered successful if the irrigation succeeded and if the patient symptoms were relieved as assessed with the NLDO-SS. The diagnostic accuracy of the NLDO-SS was 84%, sensitivity 82%, specificity 85%, positive predictive value 58%, negative predictive value 95%, odds ratio 26, risk ratio 11 and usefulness index 0.55. Cronbach's alpha was 0.85, and the test-retest reliability coefficient was 0.87. The long-term success rate after EN-DCR was 79%. The NLDO-SS iss a feasible clinical tool in assessing the success of EN-DCR. The success rate was found to decrease EN-DCR at long-term follow-up.

Corrective techniques of lacrimal obstruction in the vertical system

PurposeTo describe current surgical techniques of dacryocystorhinostomy (DCR) and compare their effectiveness by analyzing the advantages and disadvantages between external, endonasal and transcanalicular surgery. Patients and methodsA total of 91 DCRs were analyzed using a retrospective, cross-sectional and multicentre study in 75 patients who had symptoms of nasolacrimal duct obstruction. Of these, 28 were operated using external DCR, 31 endonasal technic, and 32 transcanalicular DCR with diode laser. Outcomes were evaluated subjectively using patient symptoms for the grade of epiphora and the results from the syringing before and after surgery. ResultsExternal DCR was performed in 28 cases, with 19 cases asymptomatic (67.85%), and 20 patients had a patent tract (71.42%). Endonasal DCR was performed in 31 cases, of which 19 cases were asymptomatic (61.29%), and 21 showed patency of the nasolacrimal duct (67.74%). A transcanalicular technique was performed in 32 cases, with absence of epiphora in 24 patients (75%), and the syringing was successful in 24 of them (75%). ConclusionsAny of these 3 surgery techniques would be an adequate treatment for lacrimal obstruction, due to the significant development of endonasal and transcanalicular techniques in recent decades. With improvement, we could use either endonasal or trans-canalicular techniques with diode laser with the same level of effectiveness as the classic external approach, with the advantages of minimally invasive surgery.

Técnicas correctoras de la obstrucción del sistema lagrimal en el sistema vertical

PurposeTo describe current surgical techniques of dacryocystorhinostomy (DCR) and to compare their effectiveness by analysing the advantages and disadvantages between external, endonasal and transcanalicular surgery. Patients and methodsA total of 91 DCRs were analysed using a retrospective, cross-sectional and multicentre study in 75 patients who had symptoms of nasolacrimal duct obstruction. Of these, 28 were operated using external DCR, 31 endonasal technic, and 32 transcanalicular DCR with diode laser. Outcomes were evaluated subjectively using patient symptoms for the grade of epiphora and the results from the syringing before and after surgery. ResultsExternal DCR was performed in 28 cases, with 19 cases asymptomatic (67.85%), and 20 patients had a patent tract (71.42%). Endonasal DCR was performed in 31 cases, of which 19 cases were asymptomatic (61.29%), and 21 showed patency of the nasolacrimal duct (67.74%). A transcanalicular technique was performed in 32 cases, with absence of epiphora in 24 patients (75%), and the syringing was successful in 24 of them (75%). ConclusionsAny of these 3 surgery techniques would be an adequate treatment for lacrimal obstruction, due to the significant development of endonasal and transcanalicular techniques in recent decades. With improvement, we could use either endonasal or transcanalicular techniques with diode laser with the same lever of effectiveness as the classic external approach, with the advantages of minimally invasive surgery.

Mitomycin C in Revision Endoscopic Dacryocystorhinostomy: A Prospective Randomized Study

Endoscopic dacryocystorhinostomy (EN-DCR) is an effective and safe procedure when treating saccal and postsaccal nasolacrimal duct obstruction. However, sometimes scarring of the rhinostomy site caused by fibrosis may occur, particularly in revision operations. The application of intraoperative mitomycin C (MMC), an antiproliferative agent, has been introduced as one possible technique to improve the outcome. We conducted a prospective, randomized study to evaluate if the use of MMC improves the success in endonasal revision DCR procedure. Thirty revision EN-DCR procedures were performed during 2004-2010. The patients were randomized into two study groups, according to whether the intraoperative MMC was used or not. The technique of EN-DCR procedure in both groups was the same, but in the MMC group, at the end of the procedure a piece of tampon soaked in MMC (0.4 mg/mL) was placed into the rhinostoma for 5 minutes. No silicone stents were inserted. The surgical outcome at the 6-month follow-up visit was considered successful if the lacrimal sac irrigation succeeded and if the patients' symptoms were relieved. The success rate after revision EN-DCR with MMC was 93% and without MMC was 60%. The overall success rate was 77%. The difference between the two groups was not statistically significant (p = 0.08). The relief of the symptoms between groups in both the Nasolacrimal Duct Obstruction Symptom Score and ocular symptoms was statistically significant (p = 0.007 and p = 0.02, respectively). The results of our study indicate that the application of intraoperative mitomycin C may improve the outcome in revision EN-DCR.

Symptom score questionnaire for nasolacrimal duct obstruction in adults--a novel tool to assess the outcome after endoscopic dacryocystorhinostomy

The incidence of nasolacrimal pathway obstruction increases with age, and dacryocystorhinostomy (DCR) is a commonly applied surgical technique to treat severe cases. However, no disease-specific tools to assess the symptoms and the subjective outcome after DCR have been established. We have developed a specific Nasolacrimal Duct Obstruction Symptom Score (NLDO-SS) questionnaire to evaluate the outcome, and tested it in a prospective clinical trial. Prospective clinical follow-up study. Sixty-eight consecutive primary endoscopic dacryocystorhinostomy (EN-DCR) procedures were performed in 64 patients during 2004-2008. Preoperatively and during the three follow-up visits (at 1 week, 2 and 6 months), the patients filled in the NLDO-SS, and at the second and third follow-up visits they also filled in the Glasgow Benefit Inventory (GBI) questionnaire. At one year after the operation, a GBI questionnaire was sent to the patients. The surgical success rate of EN-DCR was 93 %. EN-DCR resulted in a significant reduction in all of the eight symptoms scores of the NLDO-SS (p= 0.001). The GBI scores indicated a significant benefit at 2 months (+37 (SD; 28) and an even higher benefit at 6 months after surgery (+52 (SD; 29), p= 0.001), but no further improvement was found between 6 and 12 months (+52 vs +52, p= 1.0). The correlation between the total GBI and NLDO-SS was significant (p=0.001). EN-DCR significantly improves the quality of life as measured by the GBI. The NLDO-SS correlated with the GBI and gave more information about the benefits after EN-DCR than GBI alone. The NLDO-SS proved to be an effective tool to evaluate lacrimal obstructions and EN-DCR benefits. Further studies to validate NLDO-SS are needed.

Repeat probing for treatment of persistent nasolacrimal duct obstruction

Repeat probing of the nasolacrimal duct is one treatment option for children with persistent symptoms of nasolacrimal duct obstruction (NLDO) following an initial probing. The authors conducted a prospective, multicenter study in which 20 subjects age 6 to <48 months underwent a repeat probing for symptomatic NLDO and had follow-up visits 1 month and 6 months after surgery. Treatment success was defined as the absence of all three clinical signs of nasolacrimal duct obstruction-epiphora, increased tear lake, and mucous discharge. Repeat probing was successful in 56%(95% CI, 33%-76%) of cases.

Balloon catheter dilation for treatment of persistent nasolacrimal duct obstruction

PURPOSE: To report the outcome of balloon catheter dilation of the lacrimal duct for treatment of children with persistent nasolacrimal duct obstruction after previous surgery. DESIGN: Interventional case series. METHODS: Thirty-two consecutive children with a history of persistent nasolacrimal duct obstruction following previous surgery were treated with nasolacrimal duct probing with balloon catheter dilation of the distal nasolacrimal duct. Patients were excluded from this study if they had a history of facial trauma, systemic disorders that involved the lacrimal system, or nasolacrimal duct cysts. Outcomes were considered excellent if the patient had complete symptomatic resolution of epiphora and dacryocystitis and normal tear drainage on examination, good if the patient had only minimal residual symptoms or a minimally delayed dye disappearance test, fair if the patient had moderate residual symptoms or delayed tear drainage, and poor if there was no improvement. RESULTS: Thirty-two children (20 with bilateral nasolacrimal duct obstruction and 12 with unilateral nasolacrimal duct obstruction) underwent balloon catheter dilation. Overall results were excellent in 9 (28%) patients, good in 15 (47%) patients, fair in 7 (22%) patients, and poor in 1 (3%) patient. Seven patients had undergone more than one previous procedure. Of these patients, 3 had excellent outcomes, 2 had good outcomes, 1 had a fair outcome, and 1 had a poor outcome following balloon catheter dilation. CONCLUSIONS: Balloon catheter dilation is a safe and generally effective treatment for children with persistent symptoms of nasolacrimal duct obstruction following previous surgery.

Factors affecting the success of nasolacrimal duct probing for congenital nasolacrimal duct obstruction

PURPOSE: To ascertain the effect of certain parameters on nasolacrimal duct probing. METHODS: In a retrospective study of 142 infants and children who underwent nasolacrimal duct probing for congenital nasolacrimal duct obstruction, age at time of probing, gender, symptom severity, presence of mucous discharge, and history of probing were correlated with success of nasolacrimal probing. Success of probing was defined as complete resolution of signs and symptoms of nasolacrimal duct obstruction. Chi-square test was used to analyze covariance. RESULTS: Success of nasolacrimal duct probing was negatively correlated with increasing age: 92%, 89%, 80%, 71%, and 42% at age 12, 24, 36, 48, and 60 months, respectively ( P = .001 at each interval). Increasing severity of epiphora was correlated with increased failure of nasolacrimal duct probing ( P = .05). CONCLUSIONS: Although the success of nasolacrimal duct probing declines with age, probing in older children can remain the first line of treatment. Because increasing frequency of epiphora correlates with failure of nasolacrimal duct probing, children with daily epiphora should undergo early nasolacrimal duct probing.

Balloon dilatation for treatment of resistant nasolacrimal duct obstruction

Purpose: Our purpose was to report our experience with balloon catheter dilatation for resistant nasolacrimal duct obstruction. Methods: Patients enrolled had symptoms of nasolacrimal duct obstruction and (1) had failed previous probing or (2) were more than 2 years old. Balloon dilatation was performed with a LacriCATH lacrimal catheter (Atrion Medical Products, Birmingham, Ala.). A subset of patients had Silastic silicone rubber (Dow Corning, Midland, Mich.) intubation after balloon dilatation. Success was determined by clinical examination a minimum of 6 weeks later. Results: Twenty-one lacrimal systems of 12 patients were treated (age range 4 months to 7 years). Of the patient subset treated with a LacriCATH lacrimal catheter alone, 9 of 18 systems demonstrated complete resolution of symptoms. Three of the 12 patients underwent balloon dilatation intraoperatively after attempts at Silastic silicone rubber intubation were unsuccessful. In two of these patients, who were younger, Silastic silicone rubber tubes passed easily after balloon treatment; however, in an older patient, age 5 years, intubation still could not be accomplished. Conclusion: Common clinical strategy for treatment of resistant nasolacrimal obstruction includes repeat probing, intubation of the nasolacrimal system with Silastic silicone rubber tubes, or dacryocystorhinostomy. Balloon catheter dilatation is an alternative or adjunct to consider. Factors that may affect the success of treatment include the age of the patient, the complexity of the nasolacrimal anatomy, and use of adjunctive systemic antibiotics and steroids.

The Effect of Silicone Nasolacrimal Intubation on Epiphora After Helium Ion Irradiation of Uveal Melanomas

We evaluated prophylactic silicone tube intubation of the nasolacrimal drainage system prior to helium ion irradiation of uveal melanomas located on the nasal side of the globe. Twelve patients received silicone tubes and were compared to a control group of 12 patients with irradiated nasal tumors without silicone tubes. Symptoms of nasolacrimal duct obstruction and epiphora were evaluated by means of a questionnaire. All patients had nasolacrimal duct irrigation. Patients intubated before irradiation maintained patency (11 of 12), whereas those in the control group did not (zero of 12) (P less than .0014); ten of 12 control patients had closure of both superior and inferior puncta. No significant difference in symptoms of epiphora was observed between the two groups.

Standardized echography in the diagnosis of lacrimal drainage dysfunction.

Fifteen patients with symptoms of nasolacrimal duct obstruction were evaluated with B-scan and standardized A-scan ultrasonography. Results were correlated with findings on routine clinical tests of lacrimal drainage function, and echographic findings were confirmed at surgery in all cases. Ten normal lacrimal systems were also examined. In all patients the lacrimal sac and duct were easily visualized as an echolucent defect bounded by the bony lacrimal crests. Abnormal dilatation, diverticuli, and inflammatory exudates were readily detected. Surgically created dacryocystorhinostomy ostia were imaged on both A- and B-scans, as were obstructing membranes seen before surgical revision. Physiologic lacrimal pump failure could not be evaluated, and the exact site of obstruction could not be determined.