Tear Outflow Research Articles

Bimatoprost-loaded lipidic nanoformulation development using quality by design: liposomes versus solid lipid nanoparticles in intraocular pressure reduction.

Background: Bimatoprost is a drug used to lower intraocular pressure in the treatment of glaucoma. Conventional eye dropshave the limitations ofrepeated dosing, drug loss due to tear outflow and hence poor availability for action. Materials & methods: Using a systematic quality by design approach, liposomes and solid lipid nanoparticles were formulated and further encapsulated in thermo-sensitive in situ hydrogel. Results & conclusion: Optimized liposomes had 87.04% encapsulation efficiency and 306.78 nm mean particle size, while solid lipid nanoparticles had 90.51% and 304.21 nm. Bimatoprost liposomes had controlled zero-order drug kinetics and no initial burst release, making them better than solid lipid nanoparticles. Bimatoprost-loaded liposomes in thermo-sensitive hydrogel decreased intraocular pressure for 18 h.

Post-Operative Endonasal Debridement May Improve Outcomes of Endoscopic Dacryocystorhinostomy.

Background: Endoscopic dacryocystorhinostomy (endoDCR) has proven to be an effective minimally invasive surgical procedure for treatment of nasolacrimal duct obstruction. Post-surgical endonasal debridement has not yet been independently assessed for its impact on functional success. Methods: A retrospective review was performed of all patients who underwent endoDCR by an experienced oculofacial plastic surgeon over 7 years (2012-2019). Post-operative intranasal debridement was not routinely performed from March 2012 to February 2016. From March 2016 to June 2019, all patients underwent routine ipsilateral intranasal debridement at post-operative week 2. Surgical success was determined based upon subjective assessment of epiphora resolution at the patient's final post-operative visit. Results: A total of 69 patients (88 surgeries) were included. Thirty-five patients had standard post-operative follow-up without debridement, whereas 34 underwent endonasal debridement at post-operative week 2. Demographics and follow-up were similar between the 2 groups. Functional success was achieved in 84.1% of patients without debridement, and in 97.7% with debridement (P = .058). Conclusion: This review demonstrates a trend toward improvement in the rate of surgical success of endoDCR when routine endonasal debridement was instituted 2 weeks following surgery. We believe that removal of nasal crusts, clots, and residual absorbable gelatin sponge at the osteotomy site improves tear outflow and reduces cicatricial healing enhancing patency of the surgically derived lacrimal-nasal fistula. We advocate for postoperative debridement in the perioperative management of endoDCR patients to optimize successful outcomes.

Lacrimal gland activity in lacrimal drainage obstruction: exploring the potential cross-talk between the tear secretion and outflow

PurposeTo investigate the effects of lacrimal drainage obstructions on the lacrimal gland activity and if there exists a potential link between the two.MethodsDirect assessment of the lacrimal gland activity from...

Efficacy of pyridostigmine (Mestinon) in the relief of patients with epiphora.

Although the mechanism is not clear, the inability of the orbicularis oculi muscle, especially the deeper segment (Horner muscle), is thought to be responsible in epiphora. This study evaluates the effect of the anticholinergic drug pyridostigmine (Mestinon) in patients with patent but dysfunctional lacrimal drainage system. Twenty patients with bilateral epiphora (mean age:60.78±6.49 yrs) were included in this study. Patients with a patent lacrimal irrigation test based on persistent and symptomatic epiphora, wiping >10 times daily or continuous tearing and grade 4-5 epiphora according to Munk scale, showing neuropathic involvement in the orbicularis oculi muscle by the quantitative motor unit potential (MUP) analysis method were evaluated prospectively. Fluorescein dye disappearance test (a semi-quantitative assessment of delayed tear outflow) together with a Schirmer test reading were performed in order to detect dry eye. The patients were evaluated for tear meniscus measurements by anterior segment optical coherence topography (OCT) and non-invasive tear break-up time (NI-BUT) was measured by Oculus Keratograph 5 M. Those with a NI-BUT value above 10s, without eyelid laxity, previous ocular surgery or ocular surface disease, or nasolacrimal duct obstruction, and who agreed to use the drug were included in the study. Each subject underwent OCT measurements of the lower tear meniscus of both eyes before and 15mins after taking Mestinon (1×60mg tablet). Upon measurement of the positive effect of the drug on tear meniscus height (TMH), the patients were asked to continue this regime daily for 1 month and then evaluated for relief in their epiphora complaints and any systemic drug side effects. A total of 20 patients (40 eyes) with bilateral epiphora were included in the study. All eyes had grade 4 Munk-score epiphora, Schirmer's test was within the normal range in all eyes (mean, 14±4mm), and patent lacrimal irrigation test. The lower mean TMH reductions 15min after Mestinon in the right and left eyes were 135.41±85.47 and 55.44±61.56mm, respectively, a statistically significant decrease in both eyes (p=0.001, p<0.01). The mean tear meniscus area (TMA) in the right and left eyes was 131.83±68.27mm2 and 62.72±50.57mm2, respectively; 15 mins after administration of Mestinon, the mean TMA in the right and left eyes was 77.27±48.34 and 59.18±44.74mm2, respectively (p=0.001, p<0.01). The mean decreases of 54.56±39.34mm2 in the right eye area and 3.53±42.32mm2 in the left eye area were statistically significant (p=0.041, p<0.05). Symptomatic relief for epiphora cannot be achieved with known treatment options due to lacrimal pump dysfunction. We found that pyridostigmine (Mestinon) provided relief in patients' complaints of epiphora consistent with a significant reduction in TMH levels.

Возрастные особенности течения сочетанной острой воспалительной патологии риноорбитальной зоны и среднего уха у детей

Acute inflammatory diseases of the nasal cavity and paranasal sinuses can contribute to the development of pathological processes in the auditory tube and middle ear, lacrimal ducts and orbit. Purpose of the study: to identify age-related features of the course of combined acute inflammatory pathology of the rhino-orbital zone and middle ear in children that require consideration in the treatment of these diseases. 248 patients in the study were divided into five groups: children aged 3-4 weeks to 11 months, from 1 year to 2 years, from 3 to 6 years, from 7 to 11 years old, from 12 to 17 years old. In children of the first years of life, a combination of acute otitis media and rhinitis was often noted, with concomitant conjunctivitis, stenosis of the nasolacrimal canal, or dacryocystitis. Acute sinusitis, their orbital complications, occurring in combination with the pathology of the lacrimal system and the middle ear, mainly occurred in children from 3 years of age and older. All patients underwent conservative treatment: topical and systemic decongestant, anti-inflammatory, unloading, irrigation-elimination, mucolytic therapy. Oxymetazoline was used as a decongestant, taking into account the age of the child. Systemic beta-lactam antibiotics were prescribed according to indications. Surgical interventions were carried out: puncture of the maxillary sinuses for sinusitis in children from 7 years of age, endoscopic sinus surgery for reactive edema of the tissue and subperiosteal abscess upholstered. Ophthalmological care was provided aimed at stopping conjunctivitis and disrupting the outflow of tears (using eye drops, probing and recanalization of the lacrimal ducts). In all groups, patients showed a positive dynamics of the course of diseases and recovery.

А case of combination of dacryocystocele with a nasolacrymal cyst in infant child

INTRODUCTION: Dacryocystocele (hydrops of the lacrimal sac) is a rare variant of a congenital pathology caused by the obstruction of proximal and distal lacrimal ducts, followed by progressive distension of the lacrimal sac [1]. Given the accumulation of abundant contents in the lacrimal sac and nasolacrimal duct, the membrane that closes their outlet under the inferior turbinate can be stretched, and the prominence of such a membrane into the inferior nasal passage is in the form of the so-called nasolacrimal cyst [3].&#x0D; Description of the clinical case. A 1.5-month-old girl was hospitalized in the ophthalmology department of the University. Below are the history data. At the 30th week of pregnancy, the fetus had a bilateral space-occupying lesion in the area of the inner canthus of the eye. At birth, the child had a dense swelling in the region of the left lacrimal sac but without discharge. From birth, he had difficulty in nasal breathing.&#x0D; RESULTS: According to the results of multislice computed tomography of the lacrimal ducts with contrast (Ultravist), cavity formations were found under the inferior turbinate on both sides with a contrast level. At the age of two months, the child, accompanied by an otolaryngologist, underwent surgery for the removal of nasolacrimal cysts on both sides and reconstruction of the lacrimal ducts and their intubation with a silicone thread on the left. After surgical treatment, the outflow of tears and nasal breathing were restored, and no signs of dacryocystocele were detected. The silicone thread was removed after 1 month, and no tear production was observed.&#x0D; DISCUSSION: Treatment of children with dacryocystocele involves the simultaneous reconstruction of lacrimal ducts by an ophthalmologist and excision of the nasolacrimal cyst by an otolaryngologist.&#x0D; CONCLUSION: When examining a child with dacryocystocele, the possible presence of a nasolacrimal cyst should be considered. The interaction of an ophthalmologist and an otolaryngologist at all stages of the treatment and diagnostic process enables the prevention of disease complications and unnecessary surgical procedures.

Conjuntivochalasis: A Review Article

Conjunctivochalasis is a chronic conjunctival condition often underdiagnosed. The hallmark is loose, redundant conjunctival folds classically located in the inferior conjunctiva. It is often bilateral and the prevalence rates increase dramatically in the elderly. The exact pathogenesis remains unknown. Conjunctivochalasis has been strongly correlated with aging and concomitant dry eye disease. The currently recognised pathophysiology is associated with mechanical friction, tear film instability, delayed tear clearance, and ocular surface inflammation. Not all cases of conjunctivochalasis are symptomatic or clinically significant. Depending on the severity, it can lead to a spectrum of symptoms, ranging from exacerbation of a dry eye disease in mild forms, to the interference with physiological tear outflow in moderate forms, or even to exposure complications in rare severe cases. The diagnosis of conjunctivochalasis is clinical and mainly supported on a thorough history of symptoms and biomicroscopic findings. No specific treatment is required for the asymptomatic cases. When the disease is symptomatic, the therapeutic approach starts with the medical treatment. For refractory cases, an arsenal of surgical interventions is currently available as a second-line approach.

Ocular manifestations of diabetes mellitus: a general overview

Introduction: Diabetes is on the rise – according to the World Health Organization (WHO) over 400 million people worldwide are affected. Elevated blood sugar levels pose a risk for the lives of these patients as well as a serious deterioration in their quality of life. Apart from diabetic retinopathy, which poses an immediate risk to vision, virtually any part of the visual-sensory system can be irreversibly damaged. The objective of the study is to evaluate the prevalence of different eye complications in patients with type two diabetes and to propose guidelines for early diagnosis, clinical evaluation and treatment. Contingent and Methods: A total of 1654 adult patients hospitalized at the Clinic of Ophthalmology in the Alexandrovska Hospital were clinically evaluated including OCT scanning and visual field testing. Results: Approximately 13% of the patients (212) had type two diabetes as a concomitant disease. The most common eye manifestation of diabetes was cataract found in 73% of the patients. Other ocular manifestations of diabetes included primary open-angle glaucoma (POAG), secondary glaucoma, retinopathy and vitreal bleeding, retinal detachment, ischemic optic neuropathy, oculomotor dysfunction and eye-lid inflammation. Conclusion: Diabetes mellitus bears a significant risk for ocular complications and visual disability. The disease can affect any part of the visual system ‒ the sensory, the oculomotor and the adjacent tissues (eyelids and tear production and outflow). Patients with diabetes require regular follow up and timely intervention to prevent irreversible damage to the visual system.

Canaliculorhinostomy as a treatment for nasolacrimal duct obstruction in dogs and cats.

To create a replacement nasolacrimal system, using the puncta and canaliculi, with prolonged implant retention and minimal use of Elizabethan collars or other restraint devices. The method was used in 11 dogs and two cats. Silicone tubing was placed through both canaliculi and, via a drill hole, into the nasal cavity. Distally, the tubing ends were tied in a subcutaneous pocket lateral to the premaxilla. Tubing retention time was 4 to 7 months. Elizabethan collars were used only until skin suture removal at 2 weeks. In all animals, a functional nasolacrimal system was re-created and remained patent over prolonged follow-up periods. Adverse effects and complications were mild. The described method is relatively straightforward, thereby making relief of tear outflow problems widely accessible.

The proportion of ocular surface diseases in untreated patients with epiphora.

PurposeVarious ocular surface disorders, such as dry eye, infectious and non-infectious inflammation, anatomical anomalies in lid structure, and/or obstruction of the tear outflow tract, can cause epiphora. However, few reports have described the proportions of causative diseases in patients with epiphora. Therefore, we investigated the frequent causes of epiphora in older adult patients.Materials and methodsWe enrolled 220 patients (70 men, 150 women) who visited a primary eye care clinic from January 2016 to August 2017 with lacrimation as a chief complaint. The mean age of the patients was 61.3±10.9 years. The causes of epiphora were assessed by slit-lamp examinations, dry eye tests, fluorescein disappearance tests, and lacrimal pathway washing.ResultsThe causes of epiphora were dry eye in 96, conjunctivochalasis in 56, lacrimal obstruction in 30, conjunctivitis in 20, trichiasis in 16, and facial palsy in 2 patients. Ocular surface diseases were identified in 187 of the 220 (85%) patients who complained of epiphora. Conjunctivochalasis was observed in 36 of the 96 (38%) patients with dry eye. Among the patients with dry eye, 99% had short break-up time type dry eye, with the random break type being the most frequent type (61/96; 64%) in patients with epiphora.ConclusionAmong older adult patients whose main complaint was epiphora, 85% had ocular surface diseases. In contrast, only 15% of patients had lacrimal diseases. Short break-up time dry eye, especially the random break type, was the most frequently observed form of dry eye in our cohort.

Laserowa dakriocystorinostomia – zastosowanie laserów w leczeniu niedrożności dróg łzowych

Obstruction of the nasolacrimal duct, impeding the proper outflow of tears from the conjunctival sac to the nasal cavity, is a common disorder that is clinically manifested as tearing. Dacryocystorhinostomy is the creation of a direct fistula between the tear sack and the nasal cavity. The surgical approach may be external or endoscopic with or without a laser. Laser dacryocystorhinostomy is now a recognized procedure for the treatment of lacrimation resulting from nasal-lacrimal duct obstruction. The method has many advantages over conventional treatment. These advantages include: the absence of external scars, the possibility of simultaneous treatment of nasal cavity pathology, sparing of the medial lining of the eyelids, intact tear pump mechanism. The laser treatment time is also shorter with a comparable success rate to classic surgery. The introduction of a laser for tear-ditch surgery made it possible to treat tear-lacrimal obstruction in a simpler and less invasive way.

The initial experience of using the drain implant to eliminate epiphora in patients with rhinogenous pathology

The pathology of upper lacrimal pathways associated with cicatrical strictures and obliteration, anatomical features of this zone is an essential problem of epiphora occurrence. The diseases of nasal cavity and paranasal sinuses play a significant role in the etiopathogenesis of this kind of epiphora. The search of new methods of preventing or eliminating epiphora, also caused by rinological pathology, is reasonable.&#x0D; Aim: To estimate the efficacy of drainage implant HEALAFLOW (Aptissen, Switzerland) in patients with complains on epiphora and concomitant nasal cavity pathology.&#x0D; Material and methods. 29 patients (50 eyes) with complains on permanent (more than 6 months) epiphora were under the supervision. Ge nerally accepted ophthalmological, dacryological, rhinological examinations, including cone-ray computer tomography of the paranasal sinuses with preliminary contrast of the lacrimal pathways were carried out. Patients were divided into two groups. 15 people (28 eyes) composed the main group (I). 14 people (22 eyes) formed a control group (II). In I group the drainage implant HEALAFLOW (Aptissen, Switzerland) was inserted in 1 day after operation aimed on elimination of nasal cavity pathology. Patients of the II group instillation of Tobradex according to the scheme and moistening drops were prescribed.&#x0D; Results. According to dacryological examination 29 patients (50 eyes) with complains on epiphora had normal passive lacrimal pathway passablness, but delayed or negative results of probes characterizing active passablness. All 29 patients had a rhinological pathology, which was eliminated by the otorhinolaryngologist with the operation at the first stage. In I group 9 patients noticed an increased epiphora immediately after the administration of HEALAFLOW in lacrimal pathway, which lasted during the first 24 hours after the procedure. Based on the results of the follow-up examination, after 3 months, all patients showed an improvement, expressed in the absence or decrease of epiphora. It should be noted that in the I group (after the insertion of the implant) the positive effect was more expressed. In the I group 12 of 15 patients didnt have epiphora and in 3 patients it decreased. In the II group 7 patients didnt have epiphora and in 6 patients it decreased.&#x0D; Conclusion. Insertion of drainage implant HEALAFLOW in the lacrimal pathway after elimination of rhinological pathology in patients with complains on epiphora is safe, well tolerated and produces a positive drainage effect. This allows to recommend the implant to patients with tear-off device abnormality in the complex treatment of tear outflow disorders.

Magnetic resonance imaging features of tear outflow and structural changes of the lacrimal sac and nasolacrimal duct in normal subjects with eyes closed

Objective: To investigate the static and dynamic features of the normal lacrimal sac (LS)-nasolacrimal duct (NLD), and find out if tear flows while the subject is in supine position with eyes closed. Methods: Cross-sectional study. Healthy volunteers and patients whose head were examined by MRI in Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine with normal LS-NLD were recruited. The normal lacrimal ducts of the candidates were scanned, while candidates remained in supine position, by static or dynamic imaging procedures with a 1.5T MRI system, which adopted the thinnest slice thickness, consecutive sections (no spacing) and two scanning planes (axial and coronal planes of LS-NLD). The static and dynamic imaging procedures were done in June and July 2014 and October 2015, respectively. The static imaging was performed with conventional T(2)WI, contrast-enhanced 3D FIESTA-C, contrast-enhanced T(1)WI and heavy T(2)WI pulse sequences under normal physiological condition, and 104 eyes with normal LS-NLD from 39 patients and 13 healthy volunteers (21 male and 31 female) aged 10 to 75 years were scanned with the static procedure. The dynamic imaging was done with heavy T(2)WI pulse sequence. The coronal dynamic imaging was done only after 0.9% NaCl was instilled in the conjunctival sacs, and 20 eyes with normal LS-NLD of 10 volunteers (6 male and 4 female) aged 23 to 53 years were scanned with the coronal dynamic procedure. The axial dynamic imaging was done under normal physiological condition and after 0.9% NaCl was instilled in the conjunctival sacs respectively, and 20 eyes with normal LS-NLD of 10 volunteers (8 male and 2 female) aged 20 to 40 years were scanned with the axial dynamic procedure. The incidences on the axial dynamic imaging under the two conditions were compared with χ(2) test. Results: A total of 104 eyes with normal LS-NLD (52 candidates) were scanned with the static imaging sequences. In all LS-NLDs, an indentation located at the posterior-lateral side wall of the junction of LS-NLD was discovered, and its depth was variable. In 28.8% (30/104) of LS, 64.4% (67/104) of the junctions and 22.1% (23/104) of NLD, lumens were closed. As for the coronal dynamic imaging (20 eyes with normal LS-NLD in 10 subjects), segmental tear transit was observed in 15/20 of NLD. As for the axial dynamic imaging (20 eyes with normal LS-NLD in 10 subjects), after 0.9% NaCl was instilled, dynamic changing of their lumen size was revealed in 17/20 of LS-NL and the occurrence rate of the lumen size changing (29.3%, 94/321, the number of the axial slices with lumen changes/total number of the axial slices imaged) was higher than that (16.4%,52/317) under normal physiological condition. The difference between the two rates was statistically significant (χ(2)=14.993, P<0.001). LS contained more tear than NLD. Conclusion: While the candidates are in supine position with eyes closed (absolutely no blinking), an indentation is at the posterior-lateral side wall of the junction of LS-NLD, and there are autonomous, segmental lumen open-close actions in normal LS-NLD and tear transit in their lumens. (Chin J Ophthalmol, 2018, 54: 205-211).

Lacrimal system pathology in patients with malignant thyroid tumors after radioactive iodine therapy, and its correction methods

Introduction. Radioactive iodine therapy after thyroidectomy is the standard of differentiated thyroid cancer treatment in the modern world. Main dose-dependent side effects described in the literature include: sialadenitis, xerostomia, taste and/or odor loss, swelling of surrounding tissues. Ophthalmic complications are rarely reported.&#x0D; Aim. To assess the lacrimal system condition in patients after radioactive iodine therapy for thyroid cancer.&#x0D; Material and methods. The study included 17 patients (34 eyes). There were female patients aged 19 to 43 years (mean age was 31 years) who underwent a course of radioactive iodine therapy for thyroid cancer. All of them complained of periodic or constant tearing in the period from 2 months to 1 year after therapy course. In four patients, there was a permanent or periodic mucopurulent discharge when pressing on the lacrimal sac area. All patients underwent a standard ophthalmological examination, including visual acuity testing, anterior segment biomicroscopy, ophthalmoscopy, and tear production tests. Dye disappearance test, Jones I and II tests, lacrimal pathways irrigation, and, if necessary, cone-ray computer tomography with preliminary lacrimal pathways contrasting were performed to evaluate the tear outflow abnormalities.&#x0D; Results. Tear production disorders were detected in 20 eyes (58.8%) (among them, moderate dry eye syndrome was diagnosed in 3 cases); tear outflow pathology was revealed in 14 eyes (41.2%) (namely naso-lacrimal duct obstruction and stenosis, and chronic purulent dacryocystitis). For patients with tear production pathology artificial tears were prescribed, and endoscopic endonasal dacryocystorhinostomy was performed in cases of tear outflow disturbances.&#x0D; Conclusion. The use of radioactive iodine in doses exceeding 80 mCi leads to the development of lacrimal system pathology: dry eye syndrome of various severity, and tear outflow disorders. Lacrimal system pathology significantly worsens the patient's quality of life, and the prophylaxis of these diseases before the radioactive iodine therapy course remains the imminent key problem.

Penetration of mucoadhesive chitosan-dextran sulfate nanoparticles into the porcine cornea

Topical application of drugs to the eyes suffers from poor bioavailability at the ocular surface and in the anterior chamber. This is due to rapid clearance of the drug because of tear secretion and outflow. This study has investigated mucoadhesive and penetration characteristics of chitosan-dextran sulfate nanoparticles (CDNs), prepared by polyelectrolyte complexation technique, following topical administration to the ocular surface. Topical FITC-labeled CDNs (FCDNs; mean size of 400nm and a surface charge of +48mV) were retained on the porcine ocular surface for more than 4h. Topical FCDNs were partially endocytosed into porcine corneal epithelial cells via a clathrin-dependent pathway. After 6h of topical FCDNs, particles accumulated in the corneal epithelium but not found in the corneal stroma. When epithelium was removed, FCDNs penetrated the stroma. Thus, CDNs are potentially useful for drug/gene delivery to the ocular surface and to stroma when epithelium is damaged.

About endonasal laser dacryocystorhinostomy unfavorable outcomes

Dacryocystorhinostomy (DCRS) performed with a variety of surgical approaches is the most common surgical procedure aimed at restoring the tear outflow. However, regardless of the chosen method, surgery sometimes provides only temporary effect and requires re-intervention (revision). This article presents the analysis of clinical observation of a case series including 76 patients with lacrimal outflow impairment who, in 2014-2015, underwent endonasal endoscopic laser DCRS at the Otorhinolaryngology Department of the First Pavlov State Medical University of St. Petersburg. Among these, re-operation to restore the lacrimal passage was required necessary in 19.7% of cases. The authors concluded that the most frequent reasons of DCRS insufficiency are intractable individual anatomical features of nasal structures and/or lacrimal apparatus of the patients (including atypical anatomy of the lacrimal sac and nasolacrimal duct) and high regeneration ability of the nasal cavity mucous membrane. The probability of re-stenosis increases with previously performed DCRS with unstable result in the patient’s history, concomitant somatic general diseases (diabetes, arterial hypertension, etc.). These reasons may be successfully overcome when choosing an endoscopic approach with laser technology.

The early prophylaxis of postoperative stenosis by means of modifiedendonasal functional dacryocystorhinostomy

The objective of the present study was to increase the effectiveness of the prevention of the postoperative complications by means of the newly proposed modified variant of endonasal functional dacryocystorhinostomy. The method was used to treat 230 patients presenting with chronic dacryocystitis. It was shown that the new method permits to prevent the recurrence of the pathological process by virtue of the attachment of the middle nasal turbinates to the nasal septum and the prevention of its adhesion to the dacryostoma. The prevention of fibrin precipitation near the operative field is possible thanks to the ointment discharge through the perforations towards the cavity of the newly for meddacryostoma . Simultaneously, the formation of the organized blood clots is prevented. At a later stage, the silicone plate introduced to adjoin the middle nasal turbinate becomes an obstacle to the formation of adhesions. It is concluded that the proposed functional arrangement of the nasal structures and the outflow of tears makes it possible to reduce the recurrence of the disease to 2.1% of the cases.

Diagnostic imaging of the nasolacrimal drainage system. Part I. Radiological anatomy of lacrimal pathways. Physiology of tear secretion and tear outflow.

Excessive watering of the eye is a common condition in ophthalmological practice. It may be the result of excessive production of tear fluid or obstruction and insufficiency of efferent tear pathways. The differentiation between obstruction and insufficiency of the lacrimal pathways is still clinically questionable. In the diagnostic process it is necessary to perform clinical tests and additional diagnostic imaging is often needed. Dacryocystography, with or without the extension of the dynamic phase or subtraction option, still remains the criterion standard for diagnostic imaging of the lacrimal obstruction. It may help to clarify the cause and exact place of the obstruction and provide information for further management, especially surgical treatment. Increasingly, new techniques are used in diagnostic imaging of the lacrimal tract, such as computed tomography, magnetic resonance, and isotopic methods.Adequate knowledge of the anatomy and physiology of the lacrimal system and the secretion and outflow of tears is the basis for proper diagnostic imaging. The purpose of this paper is to present the exact anatomy of the lacrimal system, with particular emphasis on the radiological anatomy and the current state of knowledge about the physiology of tear secretion and drainage.

Epiphora After Radioactive Iodine Ablation for Thyroid Cancer

Epiphora is a condition in which an overflow of tears occurs because of excessive lacrimal secretion or insufficient drainage of tears due to obstruction of the nasolacrimal system. This ophthalmic complication can be an intermediate to late sequela of radioactive iodine ((131)I) therapy in thyroid cancer patients. We present a case of a 23-year-old woman with complaints of bilateral excessive tearing 6 months after (131)I therapy for well-differentiated thyroid cancer. She was diagnosed with epiphora secondary to nasolacrimal duct obstruction (NDO) and had bilateral endoscopic dacryocystorhinostomy, which resulted in complete resolution of her symptoms. The sodium iodide symporter, present in cells of the lacrimal drainage system, is the potential mechanism by which (131)I therapy can cause inflammation, fibrosis, and ultimate obstruction of tear outflow. Risk factors such as (131)I dose, female sex, older age, and anatomical variations may also play a role in the obstruction. However, the precise pathophysiologic mechanisms remain incompletely understood. NDO is an under-recognized complication of (131)I therapy in thyroid cancer patients. Questions regarding eye symptoms should be an integral part of clinical follow-up in management of such patients so that effective intervention may be performed.

Pigment dispersion syndrome and pigmentary glaucoma treatment results

Aim. To assess the pigment dispersion syndrome and pigmentary glaucoma treatment results. Methods. 22 patients (44 eyes) aged 16 to 38 years (male - 12, female - 10) were observed. Pigmentary glaucoma was diagnosed in 12 eyes, pigment dispersion syndrome - in 32 eyes. Visual acuity testing, visual field testing, biomicroscopy, ocular tonometry and tonography, ophthalmoscopy, gonioscopy, scanning laser ophtalmoscopy, computed perimetry were performed. The follow-up period ranged from 6 months to 10 years. All patients underwent laser iridotomy. All patients were treated with anti-glaucoma medications and antioxidants unless intraocular pressure was compensated. Results. Intraocular pressure was lowered to normal in 26 out of 44 eyes. Intraocular pressure was compensated on the rest of 18 eyes using treatment with local pressure-lowering medications and antioxidants. Laser iridotomy allowed to remove the anatomical predisposition (the main pathogenetic link) leading to additional pigment deposition and intraocular pressure increase. Prolonged use of antioxidants has resulted in tear outflow drainage and normalization level of intraocular pressure. Conclusion. Early diagnosis of the pigment dispersion syndrome and proper treatment tactics allows to prevent the pigmentary glaucoma development and to preserve the vision.