Unilateral Nasolacrimal Duct Obstruction Research Articles

Higher Order Aberrations in Patients with Unilateral Nasolacrimal Duct Obstruction.

To compare corneal higher order aberrations (HOAs) in patients with epiphora caused by unilateral primary acquired nasolacrimal duct obstruction (PANDO) and their fellow eyes. One hundred twenty two eyes of 61 patients with unilateral PANDO were included. Affected eyes named as Group 1 and contralateral eyes named as Group 2. Munk scale and fluorescein dye disappearance test (FDDT) were assessed. Corneal topographic and HOAs measurements were taken by Sirius topography. There were 47 female and 14 male patients. The mean Km were 43.84± 1.4 in Group 1 and 43.96± 1.4 in Group 2 (p=0.73). The mean corneal topographic astigmatism were 0.81± 0.7 in Group 1 and 0.78± 0.5 in Group 2 (p=0.57). The mean coma-like aberration was 0.19± 0.2 in Group 1 and 0.1± 0.1 in Group 2 (p=0.03). The mean spherical-like aberration was 0.16± 0.1 in Group 1 and 0.11± 0.1 in Group 2 (p=0.04). The mean total corneal HOA was 0.3±0.5 in Group 1 and 0.23±0.2 in Group 2 (p=0.04). The mean munk score was 3.47± 1 in Group 1. There was a positive correlation between munk score and coma-like aberration and total corneal HOAs levels (r=0.53; p=0.003 and r=0.44; p=0.01 respectively). The mean FDDT was grade 2.6± 0.1 in Group 1. There was a positive correlation between FDDT grade and coma-like aberration and total corneal HOAs levels (r=0.48; p=0.001 and r=0.33; p=0.001 respectively). Epiphora in patients with PANDO can affect corneal HOAs. As patients symptoms and tear pooling were increased corneal HOA levels increased.

Dry eye and decreased tear film stability in primary acquired nasolacrimal duct obstruction patients.

Exploring the prevalence of dry eye (DE) and the changes of tear film stability in patients with primary acquired obstruction of the nasolacrimal duct (PANDO). In this cross-sectional, observational study, 370 eyes in 223 patients with PANDO were assessed. The ocular surface disease index (OSDI) was used to evaluate ocular surface symptoms, and the Keratograph 5M non-invasive ocular surface analyser was used to assess ocular surface parameters. According to the TFOS DEWS II criteria, patients with OSDI ≥ 13 and NIKBUT < 10s were diagnosed with DE. Of the 223 PANDO patients, 65 (29.1%) met the diagnostic criteria for DE. Compared with patients without DE, PANDO patients with DE were significantly older (p < 0.001), had a longer duration of epiphora (p = 0.023), and more likely to have a positive regurgitation on pressure over the lacrimal sac (ROPLAS) sign (p = 0.003). Multifactorial analysis showed that older age, positive ROPLAS and hypertension were significant independent predictors of DE (p < 0.05). Among the 147 unilateral PANDO patients without DE, the TMH, NIKBUT-first, NIKBUT-average and bulbar erythema scores were significantly higher in the PANDO sides. This study illustrated the prevalence of DE in PANDO patients was 29.1% and DE is more likely to occur in those who are older, have hypertension and are positive for ROPLAS. In addition, in patients with unilateral nasolacrimal duct obstruction, a decrease in tear film stability was observed in the healthy eye.

Difference between skin incision size at the start and at the end of external dacryocystorhinostomy

Purpose To study the difference between the intended skin incision size at the start of the surgery in Ex-DCR and the actual final intraoperative incision size after its closure at the end of the surgery, and to look for a correlation between this difference and the patient’s age, gender and side of surgery. Methods A prospective Observational case series study was performed on 50 patients with unilateral nasolacrimal duct obstruction. The incision will be measured in millimeters using a caliper. The incision size was measured again after wound closure at the end of the surgery in millimeters. The difference between both sizes was correlated to the age, gender and side of surgery. Results The mean age of the patients was 45.6±16.6 years. Twenty-nine were females (58%). There was a statistically significant increase in the mean incision size at the end of the surgery (10.5±0.6 vs. 12.9±1.3 mm). This change was related to female gender, age above 50 years of age and procedures done on the left side. Conclusions Size of skin incision increases inevitably at the end of the surgery. The amount of increase is related to age, sex and side of the procedure.

Incidental detection of acquired unilateral nasolacrimal duct obstruction on I-131 whole body scan following I-131 therapy for thyroid cancer: a case report

BackgroundRadioactive iodine 131 (I-131) is used in the treatment of differentiated thyroid cancer after thyroidectomy; however, its accumulation in non-thyroidal regions may give false positive results on iodine whole body scan (WBS). Only a few cases of radioiodine uptake in the orbital region in patients with thyroid cancer have been reported, which could be due to metastasis or false positive causes resulting from contamination or inflammatory etiology.Case presentationWe describe a case of 49-year-old male with history of papillary thyroid carcinoma. The follow-up I-131 whole body scan showed a focus of increased radiotracer uptake in the region of left orbit. Correlative single photon emission computed tomography (SPECT-CT) showed that uptake was due to stenosis of the left nasolacrimal duct causing obstructive symptoms on left side. Dacryoscintigraphy also demonstrated significant obstruction of left nasolacrimal system.ConclusionsThe nasolacrimal duct obstruction is a rare adverse event after I-131 therapy that can result in an accumulation of radioiodine on whole body scan, mimicking metastasis. The use of additional spot views and SPECT-CT images along with thyroglobulin levels can help physicians in clarifying the situation in these uncertain cases.

Reference role of middle turbinate axilla in lacrimal sac localization assisted by computed tomographic dacryocystography-reference value of middle turbinate in locating lacrimal sac

BackgroundThe middle turbinate axilla (MTA) has always been used as a stable anatomic landmark for endoscopic surgeons to locate the lacrimal sac on the lateral nasal wall. Yet, little is known about whether the lacrimal sac size will affect the positioning effect of MTA on lacrimal sac. The aim of this study was to investigate the regularity of lacrimal sac size and lacrimal sac localization through the reference position of the MTA on computed tomographic dacryocystography (CT-DCG) images.MethodsA series of 192 endoscopic dacryocystorhinostomy (DCR) surgeries were performed. All the patients had been diagnosed as unilateral nasolacrimal duct obstruction and received CT-DCG examinations. According to the maximum transverse diameter of the lacrimal sac on CT-DCG, the patients were classified into three groups. Measurements were taken on CT-DCG parasagittal images.ResultsThe average distance from the sac superior fundus (SSF) to the MTA was 7.52 mm ± 3.23 mm, and it increased with the increase of the maximum transverse diameter of the sac among groups (p < 0.01). The average distance from the common canaliculus (CC) to the MTA was 3.95 mm ± 2.49 mm. No significant difference was observed among the groups (p = 0.11). The average distance from the CC to the SSF was 3.41 mm ± 1.31 mm, and it increased with the increase of the sac transverse diameter among groups (p < 0.01).ConclusionsThe lacrimal sac can be accurately located on the lateral nasal wall by the reference position of the MTA on CT-DCG images. The distance of the SSF to the MTA and the SSF to the CC is related to the lacrimal sac size. The relative position of the CC to the MTA is relatively stable on CT-DCG images, which make it possible to locate the lacrimal sac of different sizes and the corresponding nasal mucosa incision design in endoscopic DCR.

Matrix Metalloproteinase-9 Point-of-Care Immunoassay after Dacryocystorhinostomy in Patients with Nasolacrimal Duct Obstruction

ABSTRACT PURPOSE To compare matrix metalloproteinase-9 (MMP-9) point-of-care immunoassay (InflammaDry) results before and after dacryocystorhinostomy (DCR) in patients with nasolacrimal duct (NLD) obstruction. METHODS Thirty-eight eyes of 38 patients who were diagnosed with unilateral NLD obstruction were treated with endoscopic DCR. Treatment response was monitored using InflammaDry test, tear meniscus height was measured by slit-lamp microscopy, and tear meniscus parameters (tear meniscus height, depth, and area) were measured by anterior segment optical coherence tomography at baseline and at 1 month after surgery. RESULTS In 38 patients, the positive percentage of MMP-9 in diseased eyes was 100% (38 eyes), much higher than that in healthy fellow eyes (13.2%, 5 of 38 eyes) at baseline (p<0.001, χ 2 test test). MMP-9 levels before and after surgery were significantly different (p<0.001), and MMP-9-positive eyes showed a significant improvement in MMP-9 grade after surgery (p< 0.0001; generalized McNemar test). Furthermore, other clinical parameters (tear meniscus area, tear meniscus height, and tear meniscus depth) showed a general improvement. CONCLUSION The concentration of MMP-9 increased in the tears of patients’ eyes with NLD obstruction compared to the contralateral healthy eyes. These abnormal findings showed a significant improvement after DCR. The improvement of postoperative MMP-9 expression might be because of the improvement of tear retention.

Prevalence of Amblyogenic Risk Factors in Congenital Nasolacrimal Duct Obstruction in a Developing Country

PURPOSE: Conventionally, congenital nasolacrimal duct obstruction (NLDO) has been treated as an entity with no bearing on development of visual acuity and routine refraction is not done considering the volume of patients in a in a developing Asian country like India. This research was designed to study the prevalence of amblyogenic refractive error in patients with congenital NLDO, as compared to an age-matched control group, in a developing country. METHODS: In this study, 89 patients with congenital NLDO and 78 patients as age matched controls, less than 4 years of age were included at a tertiary care centre in India. All underwent a complete ocular examination and risk factors for amblyogenic refractive error were noted based on the AAPOS guidelines. RESULTS: There was no gender predisposition and no significant difference between the two groups in terms of mode of delivery, orthoptic check-up, keratometry, axial length, fundus or anterior segment examination. Amblyogenic refractive error, as defined by the AAPOS guidelines, was found in 18 (20.5%) patients in the case group compared to 3 (3.8%) in the control group, and this was as follows: astigmatism in 10, anisometropia in 5, hyperopia in 3 subjects, and myopia in 1. These risk factors were not greater in children with unilateral NLDO compared to bilateral NLDO, but both were greater than their control group. There was also no significant difference found between the two groups in terms of distribution of anisometropia. CONCLUSIONS: The prevalence of amblyogenic refractive error in congenital NLDO was significantly higher than in the control group. Hence, a thorough evaluation is warranted in cases of congenital NLDO for early detection amblyogenic refractive error.

Office- or Facility-Based Probing for Congenital Nasolacrimal Duct Obstruction: A Report by the American Academy of Ophthalmology

To review the published literature assessing the efficacy and safety of in-office probing compared with facility-based probing to treat congenital nasolacrimal duct obstruction (NLDO). Literature searches were conducted in March 2020 in the PubMed database with no date restrictions and limited to studies published in English and in the Cochrane Library database with no restrictions. The combined searches yielded 281 citations. Of these, 21 articles were deemed appropriate for inclusion in this assessment and assigned a level of evidence rating by the panel methodologist. Four articles were rated level I, 2 articles were rated level II, and 15 articles were rated level III. Treatments consisted of observation, in-office nasolacrimal probing, or facility-based nasolacrimal probing. Success rates and complications or recurrences were recorded from 1 week to 6 months after surgery. Complete resolution of symptoms after surgery ranged from 66% to 95.6% for office-based procedures versus 50% to 97.7% for facility-based procedures. Level I evidence indicated that 66% of cases spontaneously resolved after 6 months of observation in infants between 6 and 10 months of age. Success rates for in-office probing were lower for bilateral than for unilateral NLDO (67% vs. 82%), whereas success rates were high in both unilateral (83%) and bilateral (82%) patients who underwent facility-based probing after 6 months of observation. Cost data did not indicate a definitive cost savings of either treatment method ($562 for in-office vs. $701 for facility-based, depending on cost models predicting spontaneous resolution rates at different ages). No serious adverse events with treatment or anesthesia were reported for either treatment method. Evidence supports the efficacy and safety of both in-office and facility-based surgery for congenital NLDO. However, treating bilateral NLDO in a facility setting may be better. Because a significant percentage of children achieved resolution spontaneously before 12 months of age, deferring treatment until 12 to 18 months of age is a reasonable option. Additional research may address symptom burden on families and the impact of anesthesia and emotional trauma of nonsedated office probings on patients and may explore further the cost of treatment for each treatment method.

Changes of Visual Symptoms and Functions in Patients with and without Dry Eye after Lacrimal Passage Obstruction Treatment

ABSTRACT Purpose: To determine the quality of life (QOL) and quality of vision (QOV) of patients who developed and did not develop dry eye disease (DED) after nasolacrimal duct obstruction (NLDO) treatment. Methods: This was a retrospective nonrandomized observational study of 91 patients diagnosed with unilateral NLDO. The subjects underwent lacrimal stent insertion, and the stent was removed after 10–12 weeks. The QOL and QOV of the patients were examined preoperatively and at 6 months after the stent was removed. The postoperative outcomes were assessed subjectively with the Glasgow Benefit Inventory (GBI) questionnaire and an ocular specific questionnaire of 6 symptoms. The best-corrected visual acuity, functional visual acuity, and dry eye scores were also determined. Results: Of the 91 eyes, 19 eyes (20.9%) were diagnosed with DED (D group) and 72 were not (N group). Five of the 6 symptoms improved in the N group, while only 3 symptoms improved in the D group without blurred vision. For the GBI questionnaire, the social support and physical health scores were significantly higher in the N group than in the D group. The functional visual acuity improved significantly in the N group but not significantly in the D group. Conclusions: Patients who develop DED after treatments for NLDO may not have an improvement of their QOL or QOV. Therefore, careful dry eye assessments are important before treatments for NLDO.

Doğumsal Tek Taraflı Gözyaşı Kanal Tıkanıklığı Olan Olgularda Refraktif Durum

Objective: To investigate the refractive status and frequency of amblyopia risk factors in children who underwent probing for unilateral nasolacrimal duct obstruction (NLDO). Material and Methods: This descriptive cross-sectional study included 65 consecutive children with unilateral congenital NLDO who were still symptomatic at one year examination and necessiated nasolacrimal duct probing. A complete ophthalmic evaluation including cycloplegic refraction was performed. The spherical, cylindrical and spherical equivalent retinoscopy measurements of both eyes were noted. The risk factors for amblyopia and differences between refractive values of both eyes were evaluated. Results: The mean age at presentation was 20.4±9.2 months (range, 12 to 48 months). The left eye was involved in 30 (46.2 %) patients. Thirty-five subjects (54 %) were female. Nine children had amblyopia risk factors (13.8%). There was no statistically significant difference regarding cylindrical refractive error, spherical refractive error and spherical equivalent (p=0.9, p=0.9 and p=0.5 respectively) between two eyes. Conclusion: In the current study, no statistically significant difference was found between refractive values of both eyes. One tenth of children in our study group were found to be under risk of amblyopia mostly due to high astigmatism. Further studies about the effect of blurred vision on visual development of both eyes and binocular vision may provide more information about the refractive status in this group of patients.

Clinical utility of SPECT/CT and CT-dacryocystography-enhanced dacryoscintigraphy in the imaging of lacrimal drainage system obstruction

PurposeEpiphora is commonly caused by a relative or complete occlusion in the lacrimal drainage system (LDS), principally a nasolacrimal duct obstruction (NLDO). Dacryoscintigraphy (DSG), an extensively assessed imaging technique in diagnosing its abnormalities, can provide only planar images, according to which it needs to be improved. Our aim was to evaluate clinical utility of simultaneous DSG and single-photon emission computed tomography/computed tomography (SPECT/CT) combined with computed tomographic dacryocystography (CT-DCG) in the evaluation of LDS.MethodsDynamic imaging with DSG was performed, and tracer radioactivity was detected by a gamma camera. Successively, SPECT/CT images of the involved region were gained, followed by CT-DCG, during which a contrast medium was syringed into the affected LDS, and finally contrast CT scans were obtained again from the same region.ResultsFifty-seven patients, mean age 54.25 (± 18.26) years all with unilateral NLDO and 32 control subjects, all with patent LDS, mean age 49.88 (± 18.61) years were evaluated in the study. Delayed outflow of tearing eyes was exposed to DSG compared to the fellow and control eyes. The highest value for sensitivity was observed for SPECT/CT, followed by CT-DCG and DSG techniques, while combining DSG with SPECT/CT, DSG with CT-DCG, and SPECT/CT with CT-DCG, the sensitivity increased to 96.49%, 92.98%, and 94.73%, respectively.ConclusionsAlthough DSG is a sensitive nuclear medicine method, it only provides useful clinical data when simultaneously supplemented with SPECT/CT and CT-DCG trials as they jointly can offer valuable information about the localization of an abnormality and verify stenosis or obstruction.

Probing for congenital nasolacrimal duct obstruction.

Probing for congenital nasolacrimal duct obstruction.

Increased Concomitant Nasal Procedure Frequency in Bilateral Endoscopic Dacryocystorhinostomy.

The etiology of primary nasolacrimal duct obstruction (NLDO) is unknown, and the disease may exist bilaterally in a small number of patients. Dacryocystorhinostomy (DCR) surgery is the recommended treatment for these patients, but concomitant nasal pathologies are believed to be related to decreased surgical success. The authors aim to assess the concomitant required nasal surgical procedure frequency for endoscopic surgical access retrospectively in bilateral and unilateral NLDO patients. Twenty-eight patients who underwent bilateral endoscopic DCR simultaneously and 30 patients who underwent unilateral endoscopic DCR were enrolled in this retrospective study. Required concomitant nasal procedure frequency was recorded. In the bilaterally applied DCR group, septoplasty, partial midline turbinectomy, and inferior nasal concha submucosal resection rates were 16 (57.1%), 5 (17.8%), and 3 (10.7%) patients, respectively. Septoplasty and concha bullosa resection were performed simultaneously in 2 patients. Also, uncinectomy was performed with septoplasty in 1 patient. The concomitant nasal surgery rate was 22 of 28 patients (78.6%). On the other hand, in the unilaterally applied DCR group, septoplasty, partial midline turbinectomy, and inferior nasal concha submucosal resection rates were 5 (16.7%), 1 (3.3%), and 2 (6.7%) patients, respectively. Both septoplasty and concha bullosa resection were done in 1 patient. Uncinectomy was performed on 1 (3.3%) patient. A concomitant surgery rate was observed in 8 of 30 patients (26.7%). Nasal pathology, which requires surgical intervention, is seen much more frequently in bilateral than in unilateral NLDO patients.

Conjunctival bacterial flora in fellow eyes of patients with unilateral nasolacrimal duct obstruction and its changes after successful dacryocystorhinostomy surgery

PurposeTo evaluate the results of conjunctival culture in fellow eyes of patients with unilateral nasolacrimal duct obstruction (NLDO) and its changes after successful dacryocystorhinostomy (DCR) surgery. MethodsIn this prospective study, 71 adult patients with unilateral NLDO and 41 age and sex-matched controls without NLDO were evaluated. The patients were divided into 2 groups based on clinical examination; group A with purulent regurgitation and group B without purulent regurgitation. They all underwent DCR. Before DCR surgery, microbiologic specimens were taken bilaterally from the conjunctiva of both eyes. Postoperative conjunctival sampling was continued weekly until the culture became negative or the colony count reached to the range of the control group. ResultsThere were 38 and 33 patients in groups A and B, respectively. Silicone tube was inserted for 17 patients (23.9%). The culture was positive for bacterial growth in 56 fellow eyes (79%). The conjunctival culture in the control group was positive in 17 eyes (41.4%). The mean count of colonies in a sample unit was 624.73 ± 2412.31, 195.75 ± 407.56, and 9.5 ± 1.5 for group A, group B, and controls, respectively. The mean time of normalization of specimens was 1.43 ± 0.69 weeks (range 1–4). Higher colony count at baseline and presence of silicone tube in infected eye were significantly associated with longer normalization time for fellow eye (P < 0.001 and P = 0.003 respectively). ConclusionsThis study suggests that after successful DCR surgery, a waiting period of 4 weeks is needed for conjunctival bacterial cultures to become negative or reach the level of the normal eyes, in the fellow eyes of patients with unilateral NLDO.

Nine-Month Follow-up Results of Treatment for Nasolacrimal Duct Obstruction by Probing with Adjunctive Mitomycin C in Adults: A Prospective Randomized Placebo-Controlled Trial.

The current study aimed to determine the efficacy of probing with adjunctive mitomycin C (MMC) as a treatment for nasolacrimal duct obstruction (NLDO) in adults and to study the association of probing success with demographic and obstruction characteristics. This was a prospective, randomized, double-blind, placebo-controlled trial including 140 patients (each with a unilateral NLDO) scheduled for nasolacrimal probing who were randomly assigned to receive MMC (0.2 mg/ml, 70 patients; group A) or placebo (normal saline, 70 patients; group B). Irrigation was carried out with 0.5 cc of MMC (0.2 mg/mL) in the duct with a nasal pack for 10 minutes in group A. Patients' postprobing epiphora was evaluated at 2 weeks and 1, 3, 6, and 9 months postoperatively. Probing was judged to be a success if there was no or mild watering for at least 9 months after the procedure. There were no significant differences between the two study groups in demographic characteristics or duration of the operation (p=0.062). The overall success rate of probing with MMC was 47/70 (67.1%), which was significantly higher than the success rate of the procedure with placebo (p=0.0027). When the sex of the patients was controlled for by logistic regression, a significant association between the failure rate of probing and increasing age was found in cases and controls (p=0.004 vs. p=0.006, respectively). No significant side effects of probing with MMC were noted after 9 months of follow-up. Administering MMC in a dosage of 0.2 mg/mL during nasolacrimal probing significantly increased the success rate of probing. The failure rate of probing increased with age. A low dose of MMC is cheap, safe, and easily accessible; thus, it is recommended during nasolacrimal probing, especially in patients who refuse dacryocystorhinostomy surgery.

Office probing for treatment of nasolacrimal duct obstruction in infants

To determine whether demographic or clinical factors are associated with the outcome of office-based nasolacrimal duct probing for the treatment of congenital nasolacrimal duct obstruction (NLDO). In two multicenter prospective studies, 384 eyes of 304 children aged 6 to <15 months with NLDO underwent a nasolacrimal duct probing performed in the office using topical anesthesia. Treatment success, defined as no clinical signs of NLDO (epiphora, increased tear lake, or mucous discharge) and no reoperation, was assessed 1 month after probing in one study and 6 months after probing in the other study. Data from both studies were pooled to evaluate associations between baseline characteristics and treatment success. Office probing was successful in 75% of eyes overall (95% CI, 70%-80%). The procedure was less successful in eyes of children with bilateral NLDO compared with unilateral NLDO (63% vs 80%; relative risk = 0.78 [95% CI, 0.66-0.92]) and in eyes that had 2 or 3 clinical signs of NLDO compared with one (71% vs 83%; relative risk = 0.88 [95% CI, 0.81-0.96]). Treatment success did not appear to be related to age, specific clinical signs of NLDO, prior treatment, or research study. Performing nasolacrimal duct probing in the office successfully treats NLDO in the majority of cases in children aged 6 to <15 months. The success rate is lower with bilateral disease or when more than one clinical sign of NLDO is present.

Anisometropia and amblyopia in nasolacrimal duct obstruction

To investigate an association of childhood nasolacrimal duct obstruction (NLDO) with anisometropia and amblyopia. The medical records of patients from newborn to 6 years of age with a diagnosis of NLDO seen from 2000 to 2010 were retrospectively reviewed. Data collected included age at onset of NLDO, laterality of NLDO, cycloplegic refractive error, determination of clinically significant anisometropia (defined as ≥1 D), and diagnosis of amblyopia with amblyopia subtype (anisometropic vs other). A total of 1,218 patients with NLDO were included. Of these, 887 cases (72.8%) were unilateral; 331 (27.2%), bilateral. Anisometropia was found in 67 (7.6%) unilateral cases and 12 (3.6 %) bilateral cases on initial examination (χ2=5.48, P < 0.01). Same-sided unilateral NLDO was significantly associated with greater hyperopia in the anisometropia patients (χ(2) = 33.01, P < 0.001). Follow-up data were available for 482 NLDO patients and revealed an additional 26 patients with anisometropia for a total of 105 of 1218 (8.6%). Of the 482 patients, 28 (5.8%) developed amblyopia, 16 cases of which were purely attributable to anisometropia. Of 41 patients with anisometropia who were in the follow-up, 9 (22%) developed amblyopia. Anisometropia occurred at a greater rate in unilateral NLDO patients compared with bilateral NLDO patients and occurred at a greater rate in this NLDO cohort than expected in the general pediatric population. Several patients with anisometropia developed clinical amblyopia. Measurement of cycloplegic refraction in all NLDO patients at initial examination should be considered. Periodic follow-up is appropriate for patients with NLDO and anisometropia.

Nasolacrimal Duct Obstruction After Maxillary Orthognathic Surgery

To report cases of nasolacrimal duct obstruction (NLDO) after maxillary orthognathic surgery. The authors reviewed the clinical manifestations, dacryocystographic images, and orbital computed tomographic scans of 10 patients who were diagnosed with NLDO after undergoing maxillary orthognathic surgery. Six of the 10 patients (60%) complained of epiphora immediately after the surgery. Bilateral (n= 2, 20%) or unilateral (n= 8, 80%) NLDO occurred in all patients involved in the study. Twelve eyes of 10 patients were examined, and dacryocystography showed that the obstruction was present in the distal ostium in 7 eyes (58.3%), the junction between the sac and duct in 3 eyes (25%), and the common canaliculus in 2 eyes (16.7%). Computed tomographic scans of all subjects showed that mucosal swelling and congestion around the distal NLD opening narrowed the space between the lateral nasal wall and the inferior turbinate of the affected side. Dacryocystorhinostomy was performed in 9 eyes (8 patients), with a success rate of 100%. The distal to proximal portion of the NLD can become obstructed after maxillary orthognathic surgery. This obstruction seems to be caused by secondary inflammatory changes associated with an indirect injury of the NLD. Therefore, clinicians should be aware of the possibility of NLDO after orthognathic surgery, which can be treated successfully with dacryocystorhinostomy.

Anisometropia and amblyopia in nasolacrimal duct obstruction

IntroductionChildhood nasolacrimal duct obstruction (NLDO) has long been considered to be a benign condition which does not affect vision development. Recent studies have suggested an association between NLDO and amblyopia.MethodsA retrospective review was conducted of 1,218 patients between ages of birth to six years with diagnosis of nasolacrimal duct obstruction (NLDO) from 2000-2010. Data collected included onset of NLDO, laterality of NLDO, cycloplegic refractive error, determination of clinically significant anisometropia (defined as ≥ 1 D), and diagnosis of amblyopia with amblyopia sub-type (anisometropic vs other).Results887/1218 (72.8%) had unilateral NLDO. Anisometropia was found in 79/1218 (6.5%) patients on initial examination; an additional 26 patients developed anisometropia on follow-up examination for a total of 105/1218 (8.6%). A significant association between same sided unilateral NLDO and higher hyperopia in the anisometropia patients (2= 33.01, P < 0.001) was found on initial examination. Follow-up data of 482 patients showed 28 (5.8%) developed amblyopia, 16 of which were due purely to anisometropia.DiscussionUnilateral NLDO appears to be associated with anisometropia. The incidence of anisometropia (8.6%), amblyopia (5.8%) and anisometropic amblyopia (3.3%) in this large NLDO cohort exceeds that found in the general pediatric population. No cause–effect relationship could be established in this retrospective study.ConclusionsMeasurement of cycloplegic refraction and periodic follow-up of children diagnosed with NLDO is warranted. Future prospective studies could elucidate any benefit to early spontaneous resolution or surgical intervention. IntroductionChildhood nasolacrimal duct obstruction (NLDO) has long been considered to be a benign condition which does not affect vision development. Recent studies have suggested an association between NLDO and amblyopia. Childhood nasolacrimal duct obstruction (NLDO) has long been considered to be a benign condition which does not affect vision development. Recent studies have suggested an association between NLDO and amblyopia. MethodsA retrospective review was conducted of 1,218 patients between ages of birth to six years with diagnosis of nasolacrimal duct obstruction (NLDO) from 2000-2010. Data collected included onset of NLDO, laterality of NLDO, cycloplegic refractive error, determination of clinically significant anisometropia (defined as ≥ 1 D), and diagnosis of amblyopia with amblyopia sub-type (anisometropic vs other). A retrospective review was conducted of 1,218 patients between ages of birth to six years with diagnosis of nasolacrimal duct obstruction (NLDO) from 2000-2010. Data collected included onset of NLDO, laterality of NLDO, cycloplegic refractive error, determination of clinically significant anisometropia (defined as ≥ 1 D), and diagnosis of amblyopia with amblyopia sub-type (anisometropic vs other). Results887/1218 (72.8%) had unilateral NLDO. Anisometropia was found in 79/1218 (6.5%) patients on initial examination; an additional 26 patients developed anisometropia on follow-up examination for a total of 105/1218 (8.6%). A significant association between same sided unilateral NLDO and higher hyperopia in the anisometropia patients (2= 33.01, P < 0.001) was found on initial examination. Follow-up data of 482 patients showed 28 (5.8%) developed amblyopia, 16 of which were due purely to anisometropia. 887/1218 (72.8%) had unilateral NLDO. Anisometropia was found in 79/1218 (6.5%) patients on initial examination; an additional 26 patients developed anisometropia on follow-up examination for a total of 105/1218 (8.6%). A significant association between same sided unilateral NLDO and higher hyperopia in the anisometropia patients (2= 33.01, P < 0.001) was found on initial examination. Follow-up data of 482 patients showed 28 (5.8%) developed amblyopia, 16 of which were due purely to anisometropia. DiscussionUnilateral NLDO appears to be associated with anisometropia. The incidence of anisometropia (8.6%), amblyopia (5.8%) and anisometropic amblyopia (3.3%) in this large NLDO cohort exceeds that found in the general pediatric population. No cause–effect relationship could be established in this retrospective study. Unilateral NLDO appears to be associated with anisometropia. The incidence of anisometropia (8.6%), amblyopia (5.8%) and anisometropic amblyopia (3.3%) in this large NLDO cohort exceeds that found in the general pediatric population. No cause–effect relationship could be established in this retrospective study. ConclusionsMeasurement of cycloplegic refraction and periodic follow-up of children diagnosed with NLDO is warranted. Future prospective studies could elucidate any benefit to early spontaneous resolution or surgical intervention. Measurement of cycloplegic refraction and periodic follow-up of children diagnosed with NLDO is warranted. Future prospective studies could elucidate any benefit to early spontaneous resolution or surgical intervention.

A Randomized Trial Comparing the Cost-effectiveness of 2 Approaches for Treating Unilateral Nasolacrimal Duct Obstruction

To compare the cost-effectiveness of 2 approaches for treating unilateral nasolacrimal duct obstruction (NLDO).One hundred sixty-three infants aged 6 to less than 10 months with unilateral NLDO were randomly assigned to receive immediate office-based nasolacrimal duct probing (n = 82) or 6 months of observation/nonsurgical management (n = 81) followed by probing in a facility for persistent symptoms.Treatment success was defined as the absence of clinical signs of NLDO (epiphora, increased tear lake, mucous discharge) on masked examination at age 18 months. Cost of treatment between randomization and age 18 months included costs for all surgical procedures and medications.In the observation/deferred facility-probing group, NLDO resolved within 6 months without surgery in 44 of the 67 patients (66%; 95% CI, 54% to 76%) who completed the 6-month visit. Twenty-two (27%) of the 81 patients in the observation/deferred facility-probing group underwent surgery, 4 of whom were operated on within the initial 6 months. At age 18 months, 69 of 75 patients (92%) in the immediate office-probing group were treatment successes, compared with 58 of 71 observation/deferred facility-probing group patients (82%) (10% difference in success; 95% CI, -1% to 21%). The mean cost of treatment was $562 in the immediate office-probing group compared with $701 in the observation/deferred facility-probing group (difference, -$139; 95% CI, -$377 to $94). The immediate office-probing group experienced 3.0 fewer months of symptoms (95% CI, -1.8 to -4.0).The immediate office-probing approach is likely more cost-effective than observation followed by deferred facility probing if needed. Adoption of the immediate office-probing approach would result in probing in approximately two-thirds of infants whose obstruction would have resolved within 6 months of nonsurgical management, but would largely avoid the need for probing under general anesthesia.Although unilateral NLDO often resolves without surgery, immediate office probing is an effective and potentially cost-saving treatment option.clinicaltrials.gov Identifier: NCT00780741.