Treatment Of Nasolacrimal Duct Obstruction Research Articles

Blind Bi-canalicular Intubation Versus Endoscopic Guided Intubation in Treatment of Nasolacrimal Duct Obstruction in Children

Blind Bi-canalicular Intubation Versus Endoscopic Guided Intubation in Treatment of Nasolacrimal Duct Obstruction in Children

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.

Surgical results of endonasal dacrocystorhinostomy

Background: The lacrimal system includes the tear film of the eye and the tear drainage system. Endoscopic dacryocystorhinostomy (DCR) is a safe and effective method of surgical treatment of nasolacrimal duct obstruction. The anatomy of the nasal cavity is better visualized endoscopically and sac is approached under vision and hence the results are decided at the time of surgery. Methods: Present clinical study was conducted in tertiary medical centre from July 2015 to July 2016. Total 50 patients with epiphora as evidenced by nasolacrimal duct blockage on sac syringing were included in the study. Children less than 10 years and revision cases were excluded. These patients underwent DCR without stenting. Results: Out of the 50 patients, 60% were males and 40% were females. Surgical success was defined as anatomical patency and symptomatic relief at the end of the follow up period which was observed in 45 of 50 (90%) patients. Incidence of complications was as low as only 5 patients. These patients were followed up for 6 months with no complaints of epiphora. Conclusions: Endoscopic DCR is a safe and effective method of surgical treatment of nasolacrimal duct obstruction. It gives equivalent symptomatic relief from epiphora when compared to external method. Thus, we can minimize complications, discomfort, cost of stenting and follow up visits after endonasal surgery. Due to higher success rate, minimal invasiveness and high patient satisfaction as compared to other procedures, it has gained more popularity.

Cost-effectiveness analysis of endoscopic dacryocystorhinostomy using Markov modelling

ObjectifDéterminer le rapport coût-efficacité de la dacryocystorhinostomie (DCR) endoscopique. MéthodesNous avons mis au point un modèle de Markov selon lequel des patients qui présentaient une obstruction du canal nasolacrymal ont été répartis en 2 groupes : DCR endoscopique ou absence de traitement chirurgical. Le rapport coût-efficacité différentiel, l'analyse de sensibilité à un critère et l'analyse de sensibilité probabiliste ont permis d’évaluer la sensibilité du modèle en présence de multiples intrants. RésultatsOn a pu conclure que la DCR endoscopique était rentable, son coût-efficacité différentiel s’établissant à 2162 $US par année de vie ajustée en fonction de la qualité. Le modèle s'est révélé particulièrement sensible à la déduction de l'utilité au chapitre de la santé en lien avec l’épiphora. L'analyse de sensibilité probabiliste a permis de conclure que 93,7 % du temps, la DCR endoscopique offre un bon rapport coût-efficacité comparativement à l'absence de traitement chirurgical. ConclusionsLa DCR endoscopique est un traitement rentable en présence d’épiphora. Le modèle est très sensible à l'effet négatif de l’épiphora sur la qualité de vie. Compte tenu des progrès technologiques et chirurgicaux en matière de soins de santé, les taux de réussite de la DCR endoscopique continuent de s'améliorer, ce qui en fait un traitement encore plus efficace et économique de l'obstruction du canal nasolacrymal.

Comparison of the efficacies of 1.0 and 1.5 mm silicone tubes for the treatment of nasolacrimal duct obstruction

This retrospective observational study analyzed the postoperative outcomes of bicanalicular intubation using different diameters of tube stents for treating postsaccal nasolacrimal duct obstruction. A total of 130 patients diagnosed with postsaccal obstruction who underwent endoscopic-assisted silicone tube intubation were included in the study. Patients intubated with a 1.5-mm large-diameter tube were designated as the LD group, and those with a 1.0-mm normal-diameter tube were designated as the ND group. The patency rates of the two groups at 1 year after tube removal were compared using the Kaplan–Meier curve and restricted mean survival time (RMST) method with τ = 365 days. Results demonstrated that the recurrence rate after tube removal was significantly lower in the LD group as compared with the ND group (p = 0.001). The patency rates at 1 year after removal in the LD and ND group were 85.7% (95% confidence interval [CI]: 75.4, 91.9) and 73.9% (95% CI: 61.7, 82.8), respectively. When comparing the patency rates by the RMST method at τ = 365 days, the RMST difference, RMST ratio, and RMTL ratio were higher in the LD group at p = 0.045, 0.052, and 0.046, respectively.

Efficacy of powered endoscopic dacryocystorhinostomy in treatment of nasolacrimal duct obstruction

Background and Objectives: To evaluate the success rate of the therapeutic effectiveness and safety of endoscopic dacryocystorhinostomy to treat obstruction of the lacrimal pathway. Methods: The study involved prospective randomized case series. Operative and postoperative data were prospectively collected on 114 patients (120 eyes) who presented to Rizgary Teaching Hospital (Erbil city – Iraq) with epiphora and obstruction of the nasolacrimal system, from February 2013 until October 2017. All patients consecutively underwent endoscopic dacryocystorhinostomy. The follow-up evaluation included system evaluation and endoscopic assessment of the newly created ostium; the follow-up was done at 1 week, 1 month, and 3 months postoperatively, and results were compared between the different groups. Results: A total of 120 cases of endoscopic dacryocystorhinostomy were performed on 114 patients. Procedure success rate was around 95.8%using powered drill and endoscopic system with minimum complication. Age group of 25-44 years (45.8%) is the higher percentage and the female gender accounts for 83.3%. No complications were recorded in78.3% of the patients, while 10% had developed granulation tissue at fistula site. Only 5%of the cases suffered from synechia and 5.7%were miscellaneous complications. No statistical significant differences were found between the surgery and age, gender, or side of operation. Conclusion: Powered endoscopic dacryocystorhinostomy is the most suitable treatment for patients at the level of the sac or in the nasolacrimal duct obstruction.

Study the quality of life post endoscopic dacryocystorhinostomy

Background & Method: Aim of this study is to Study the quality of life post Endoscopic Dacryocystorhinostomy. The records of patients who underwent Endoscopic DCR in the last five years were retrieved from the archival records of Department of Otorhinolaryngology and Head-Neck Surgery, K.G.M.U and were reviewed for demographic data, laterality, pre-operative complaints, co-morbidities, clinical and surgical profiles, adjunctive procedures, complications, and success rates at the last follow up. Result: On comparing pre to post op swelling around eye status, it was found that at pre op the mean swelling score was 2.90±2.33 which was reduced to 0.50±1.03 at post op. So a mean reduction of 2.40±0.14 was observed which was significant statistically (p<0.001). On comparing pre to post op general condition status, it was found that at pre op the mean condition score was 0.08±0.48 which was unchanged at post op. Conclusion: Endoscopic DCR has improved the treatment of Nasolacrimal duct obstruction, with outcome as comparable to external DCR. Thus the present study state Endoscopic DCR as an effective and safe alternative to external DCR with improved patient satisfaction.

A Case of Angioleiomyoma in Nasolacrimal Duct

Epiphora is a symptom in which tears overflow onto the face, with its most common cause being the obstruction of the nasolacrimal system. As a cause of nasolacrimal system obstruction, nasolacrimal duct tumors are very rare. Angioleiomyoma, which is a benign tumor, arises from vascular smooth muscle, occurs in the nasolacrimal duct, and is extremely rare. With the development of endoscopic intranasal approach for the treatment of nasolacrimal duct obstruction, there is increased importance for the consideration of otorhinolaryngological evaluation and treatment as well as dacryocystorhinostomy by conventional external approach. In this article, we introduce a case in which angioleiomyoma in the nasolacrimal duct was detected by nasal endoscopy and was successfully treated with endoscopic surgery.

Endonasal Endoscopic Dacryocystorhinostomy with and Without Stents-A Comparative Study.

The study aims to compare the outcomes of endonasal endoscopic dacryocystorhinostomy (DCR) with and without nasolacrimal stents. A prospective randomized comparative study involving fifty patients, divided into two groups of 25 patients each. Group A consists of patients who underwent endoscopic DCR with silicon stent and group B consists of patients who underwent endoscopic DCR without stent. Patients were regularly followed up at 1st week, 6th week, 10th week and at the end of 5th month postoperatively. The silicone stents were removed at 6th postoperative week. Using statistical analysis results between the two groups were compared. Post-operative improvement in nasolacrimal duct obstruction and epiphora was seen in both the groups. Age of the patients ranged from 18 to 69years with most of the patients in the age group of 40 to 49years (46% N = 23, 12 in group A and 11 in group B). 88% of the patients were females. (N = 44, 21 in group A and 23 in group B) and 12% were males (N = 6, 4 in group A and 2 in group B). The disease was more commonly observed on the left side with 72% of the cases (N = 36, 19 in group A and 17 in group B) and 28% (N = 14, 6 in group A and 8 in group B) on the right side. In group A, (En DCR with silicone stent) 96% of the cases were successful while 4% resulted in failure whereas in group B (En DCR without stent) 92% of the cases were successful while 8% resulted in failure. Endoscopic DCR is simple and safe method. It is minimally invasive procedure as it is a direct approach to the sac. Cosmetically it is acceptable as there is no external scar. Endoscopic dacryocystorhinostomy with canalicular silicone intubation for shorter duration (6weeks) is a safe and successful procedure for the treatment of nasolacrimal duct obstruction. Close follow up immediately after surgery is needed to reduce the failure rate. Regular post-operative follow up is necessary and any defect like synechia and granulation tissue formation can be released at follow up period thus increasing the success rate. En DCR has a good success rate with and without stenting of 96% and 92% respectively.

Outcomes of External Dacryocystorhinostomy under General and Local Anesthetics in a Tertiary Clinic.

Objectives:In our clinic, although we prefer to perform dacryocystorhinostomy (DCR) under general anesthetics, we also perform it under local anesthetics for patients with a high risk of general anesthesia. Herein this study, we aimed to present our experiences in external DCR under both general and local anesthetics in a tertiary clinic.Methods:Medical records of the patients who had epiphora, were followed up in the oculoplastic section between January 2014 and December 2020 were collected. Patients who underwent external DCR were included in the study. Patients were divided into two groups: local and general anesthesia. All demographic characteristics of patients, previous DCR, history of dacryocystitis, surgery time, perioperative complications, and the American Society of Anaesthesiology (ASA) physical status score were recorded.Results:A total of 106 eyes from 82 patients were included in the study. The mean age of the patients was 57±24 years (range 18–89) and the median age was 56. Of 82 patients, 49 were female and 33 were male. 24 patients underwent bilateral external DCR. The mean surgery time for the general group and the local group was 66±12 min and 52±7 min, respectively. A significant difference was observed between the general and local groups in terms of the duration of the surgery (p=0.03). Of these, 11 patients underwent revision DCR during the follow-ups, and 7 patients were in the general group and 3 patients were in the local group. The overall success rate was 90%.Conclusion:External DCR surgery with both general and local anesthesia is a very effective technique for the treatment of nasolacrimal duct obstruction. In addition, local anesthesia may be brought to mind as an option considering less bleeding, shorter discharge time, and cost-effectivity and also to avoid perioperative and postoperative systemic complications for patients with high risks of general anesthesia.

3D morphological classification of the nasolacrimal duct: Anatomical study for planning treatment of tear drainage obstruction.

The purpose of this study is to analyze and classify morphological features of the nasolacrimal duct (NLD) through 3D reconstruction to help understand the causes and treatment of NLD obstruction. In this study, we included 63 males and 55 females who underwent autopsy without NLD obstruction with ages ranging from 20 to 78 years. The NLD was defined from the lacrimal fossa to the opening of the BNLD to the inferior meatus, and all continuous CT images showing the NLD were selected. Segmentation was performed semi-automatically, and the reconstruction and measurement of NLD was performed using the Mimics program. Overall NLD length, bony nasolacrimal duct (BNLD) length, anteroposterior and transverse diameters at the entrance to the BNLD, anteroposterior and transverse smallest diameters of the BNLD, BNLD volume, and lacrimal sac BNLD angle were significantly higher in males than females (p < .05). BNLD direction in the coronal plane was slightly more likely to be inward. The most common type in both sexes was cylinder type (42.0%), males were more likely to have lower-thicker types (34.1%), and females more likely to have upper-thicker types (22.7%). There were sex differences in NLD measurements, and females had significantly smaller NLDs. These results may partially explain the increased prevalence of primary acquired NLD obstruction in females. The BNLD tends toward the midline, and inclines posteriorly.

Powered versus non-powered endoscopic dacryocystorhinostomy in the treatment of nasolacrimal duct obstruction

Powered versus non-powered endoscopic dacryocystorhinostomy in the treatment of nasolacrimal duct obstruction

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.

Role of silicone stenting in endoscopic dacryocystorhinostomy

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Dacryocystorhinostomy (DCR) is a surgical procedure performed to relief nasolacrimal duct obstruction, which involves the creation of ostium at the lacrimal bone to form a shunt in the nasolacrimal pathway. Closure of the rhinostomy opening was considered a major factor for surgical failure. Use of silicone stent in endoscopic DCR to improve the success rate of the operation have been tried by many surgeons. In this study we assess the success rates of endoscopic DCR with and without silicone stents.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Prospective study includes 30 patients were operated in the Department of ENT, Misrata Medical Center, from April 2017 to March 2018. They underwent endonasal endoscopic DCR for primary acquired nasolacrimal duct obstruction.&lt;strong&gt; &lt;/strong&gt;These patients were randomly divided in two groups: A and B with 15 patients in each group. The group A patients underwent endoscopic DCR with silicone stent and group B patients underwent endoscopic DCR without stent. The results were statistically analyzed by chi-square test. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 30 patients were included in this study, their age ranged from 17 to 60 years, complaining of epiphora, 24 (80%) were females and 6 (20%) were males. The success rate was higher in patients with silicone stent (93.33%) as compared to patients without silicone stent (86.67%) but this difference in the results is not statistically significant (As p value is 0.542 which is &amp;gt;0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Endoscopic DCR is safe, successful procedure for treatment of nasolacrimal duct obstruction and there was no significant difference in the success rates of performing endonasal DCR with silicone or without silicone stents.&lt;/p&gt;

Dacryocystorhinostomy for the treatment of nasolacrimal duct obstruction: a pilot trial to assess impact on coexisting sinus symptoms

Purpose: To report on coexistent sinus symptoms in a population of patients who underwent endonasal dacryocystorhinostomy (DCR) surgery for nasolacrimal duct obstruction (NLDO) in a pilot study designed to test and refine methods and to estimate patient sample size for a larger multicentre randomised trial.&#x0D; Methods: Ninety-four consecutive patients with NLDO who underwent endonasal DCR by three surgeons in both public and private practice over a two-year period were included in this study. Questionnaires were given preceding DCR surgery and at 10 weeks post-surgery. Sinus symptoms including sinusitis, nasal congestion, hyposmia, nasal discharge, and facial pressure were assessed in the questionnaire. All subjects underwent primary endonasal DCR and all patients underwent the same post-operative regimen.&#x0D; Results: Questionnaire responses revealed that 48/94 (51%) patients had one or more sinus symptoms prior to DCR surgery. Ten-week post-DCR follow-up questionnaires were obtained from 77/94 (82%) patients. About 20/31 (65%) patients with one or more sinus symptoms prior to DCR surgery reported resolution of coexisting sinus symptoms by 10 weeks post-DCR surgery.&#x0D; Conclusion: The data from this pilot study suggest that approximately half of patients attending for NLDO have coexisting sinus symptoms. There was some loss to follow-up. This pilot study highlighted the need for a validated patient questionnaire, longer length of follow-up, control groups for surgical intervention, and use of perioperative medications. Any clinical trial designed to assess the impact of endonasal surgery on sinus symptoms would need to enrol several hundred patients in order to reach a statistically valid conclusion.

Incision of Hasner's valve under endoscopic intranasal surgery for the treatment of nasolacrimal duct obstruction in children.

To evaluate the effectiveness and safety of a Hasner's valve incision performed under endoscopic intranasal surgery for the management of congenital nasolacrimal duct obstruction. This retrospective study comprised 484 patients with congenital nasolacrimal duct obstruction who underwent incision of Hasner's valve under endoscopic intranasal surgery between April 2000 and October 2016. The primary endpoint was the procedure's functional success rate. The secondary endpoints were Hasner's valve and inferior turbinate anatomical findings, demographic data, complication rate and surgical duration. In patients with no medical history of nasolacrimal duct probing, 91 per cent had a successful result, 5 per cent had a partially successful result, 3.9 per cent showed no change and 0.1 per cent had a worse result following the procedure. Concerning the secondary endpoints, outcomes were more frequently successful in children younger than three years. Only one patient had a post-operative infection. All patients underwent general anaesthesia; no complications related to general anaesthesia were observed. Mean surgical duration was 13.1 ± 5.7 minutes. Incising Hasner's valve after medially displacing the inferior turbinate under nasal endoscopy seems to be an adequate primary surgical treatment for congenital nasolacrimal duct obstruction.

Predictors of long-term success and failure in primary and revision endoscopic dacryocystorhinostomy.

Although endoscopic dacryocystorhinostomy (endo-DCR) is a common treatment of nasolacrimal duct obstruction, little is known about the determinants of surgical success and failure. The purpose of this study was to identify patient- and technique-specific factors that may influence surgical outcomes of primary and revision endo-DCR. A retrospective review was conducted of 596 patients who underwent endo-DCR over a 30-year period (1989-2018). Patients' demographics and surgical techniques were assessed. Among the cohort of patients (n = 478) who underwent primary endo-DCR, 10% (n = 48) required revision surgery. Patients who failed primary DCR tended to be younger (p = 0.015) and were less likely to have chronic sinonasal inflammation on histopathology (p = 0.047) than the successful surgery group. After adjusting for patient demographics and comorbidities, the occurrence of a postoperative complication was significantly associated with primary DCR failure (odds ratio [OR], 2.2; p = 0.032). Among the cohort of patients (n = 118) who underwent revision endo-DCR, 8.5% (n = 10) required additional revision surgery. Patients who failed revision DCR tended to be younger (p = 0.022), more likely to have had intraoperative laser usage (p = 0.031), and more likely to have had an intraoperative complication (p = 0.013) than the successful revision surgery group. Endo-DCR failure was not associated with smoking status, middle turbinate resection, or intraoperative visualization of the internal common punctum (p > 0.05). An understanding of factors associated with primary and revision endo-DCR failure can help to inform preoperative counseling, intraoperative surgical technique, and postoperative care in the treatment of patients with nasolacrimal duct obstruction.

Endoscopic dacryocystorhinostomy: reasons for failure.

Endoscopic dacryocystorhinostomy (DCR) is a widely performed and safe procedure for the treatment of nasolacrimal duct obstruction manifested as epiphora or dacryocystitis. Current success rates are above 90%. Data on causes for failure of the procedure are sparse. We investigated the influence of several preoperative parameters on surgery outcome and to establish that parameters are linked with failure. A retrospective analysis of the medical records of all consecutive patients who underwent endoscopic DCR in the Tel-Aviv Medical Center, a tertiary referral center, between January 2010 and August 2016 were retrospectively examined and data on the occurrence of surgical failure and reasons for failure were retrieved. A total of 165 patients (183 eyes) were included. The overall success rate for the surgery was 94.7%. The parameters that correlated significantly with failure were coexisting diabetes mellitus (P = 0.037), allergy to medications (P = 0.034), and prior ocular surgery (P = 0.043). There was no correlation between the surgical failure rates and facial trauma, previous nasal or lacrimal surgery, or the usage of a stent. Endoscopic DCR is a safe and effective surgical procedure. Diabetes mellitus, allergies, and previous ocular surgery may lead to surgical failure. Patients with these risk factors should be aware of increased failure rates.

Comparison of early versus standard timing for silicone stent removal following External Dacrocystorhinostomy under local anaesthesia

Introduction: The first line treatment for nasolacrimal duct obstruction (NLDO) is external dacrocystorhinostomy (DCR). Following DCR, patients are required to return to Tilganga Institute of Ophthalmology (TIO) six weeks postoperatively for the removal of a silicone stent. As the majority of patients travel large distances at significant cost to reach TIO, most often patients remain within Kathmandu during this six weeks interval. This places a large financial burden on patients.&#x0D; Methods: A randomized controlled trial was designed to compare patient outcomes after early (two weeks postoperatively) versus standard (six weeks postoperatively) removal of silicone stents. 50 selected patients were randomized into two equal groups.&#x0D; Results: At the time of publication, 31 patients (14 in group A and 17 in group B) had completed three months follow up. A success rate of 92.9% was noted in Group A and a success rate of 94.1% observed in group B. No significant difference was found between the two groups for success rate and rate of complications.&#x0D; Conclusion: Early tube removal post DCR appears to cause no significant difference in outcome or complication rates compared to standard tube removal.

Comparison of early versus standard timing for silicone stent removal following External Dacrocystorhinostomy under local anaesthesia.

The first line treatment for nasolacrimal duct obstruction (NLDO) is external dacrocystorhinostomy (DCR). Following DCR, patients are required to return to Tilganga Institute of Ophthalmology (TIO) six weeks postoperatively for the removal of a silicone stent. As the majority of patients travel large distances at significant cost to reach TIO, most often patients remain within Kathmandu during this six weeks interval. This places a large financial burden on patients. A randomized controlled trial was designed to compare patient outcomes after early (two weeks postoperatively) versus standard (six weeks postoperatively) removal of silicone stents. 50 selected patients were randomized into two equal groups. At the time of publication, 31 patients (14 in group A and 17 in group B) had completed three months follow up. A success rate of 92.9% was noted in Group A and a success rate of 94.1% observed in group B. No significant difference was found between the two groups for success rate and rate of complications. Early tube removal post DCR appears to cause no significant difference in outcome or complication rates compared to standard tube removal.