nasolacrimal duct

Congenital nasolacrimal duct mucocele (CNDM) is a very rare condition in newborns. Prolapse or expansion of the mucocele into the nose may lead to respiratory distress and difficulty in feeding. The triad of cystic medial canthal mass, dilatation of the nasolacrimal duct and a contiguous sub-mucosal nasal mass on computed tomography (CT) is indicative in the diagnosis of CNDM. The case of a five-week-old girl with infected CNDM is described. The authors aim to emphasize the very rare incidence of CNDM in Polish newborns, delayed diagnosis in the case described and the paramount importance of CT of the head for the correct diagnosis and treatment.

We performed 63 intubations with silicone tubing for nasolacrimal duct obstruction in children in whom nasolacrimal duct probings had failed. Fifty-nine (93.7%) obstructions were congenital and four (6.3%) were acquired. The average length of intubation was 4.3 months. The final results for both congenital and acquired obstructions combined were good in 52 cases (82.5%), fair in three (4.8%), and poor in eight (12.7%). Complications, with the exception of some with infection, were easily treated or minimal and did not affect the outcome significantly. We recommend silicone intubation as the procedure of choice for congenital or acquired nasolacrimal duct obstructions in children after failure of medical therapy and nasolacrimal duct probings.

PurposeTo report the outcome of nasolacrimal duct intubation as the primary treatment of congenital nasolacrimal duct obstruction (NLDO) in children less than 4 years of age.Methods182 eyes of 139 children receiving intubation with planned tube retention for 2 to 5 months were enrolled in a prospective, non-randomized observational multicenter study (19 sites). Children were aged 6 to <45 months at the time of surgery, with no prior nasolacrimal surgical procedure, and had at least one of the following clinical signs of NLDO: epiphora, mucous discharge and/or increased tear lake.ResultsTreatment success was defined as absence of epiphora, mucous discharge and increased tear lake at the outcome visit one month after tube removal. The surgical outcome was assessed in 150 eyes (82% of cohort). The proportion of eyes treated successfully was 91% (95% confidence interval = 86% to 95%). The outcome dye disappearance test was normal in 125 (86%) eyes, indeterminate in 13 (9%), and abnormal in 7 (5%) of the 145 eyes tested. Monocanalicular tubes were used in 74% of cases. The tube was removed prior to the planned minimum retention time of months in 61 eyes (41%). For 23 eyes the early removal was due to inadvertent displacement by the patient.ConclusionIn children 6 to <45 months of age, nasolacrimal duct intubation in a non-randomized and non-comparative trial was a successful primary treatment of NLDO in about 90% of cases not lost to follow up.

Four alpacas, 2 wk to 1 y of age, were diagnosed with congenital atresia of the nasal puncta of the nasolacrimal duct. Dacryocystorhinography confirmed and localized the atresia. All animals were treated successfully by surgical creation of nasal puncta and patency was ensured by placement of a surgical stent for several weeks.

Purpose: Topical steroids are considered to be the first line of treatment for some forms of idiopathic punctal stenosis causing epiphora. We present a case of epiphora, which was unresponsive to traditional management, but responded to one week of systemic steroids. Observations: A 48-year-old male with no significant medical history, was referred to us for excessive tearing. He was seen earlier by an ophthalmologist for redness in one of his eyes. He was prescribed Pataday (Olopatadine) eye drops and Zylet (Tobramycin, Lotepriol) eye drops for both eyes. The patient was seen again after a week of treatment without much improvement. His treatment was changed to Alrex (Loteprednol) and Azasite (Azithromycin) eye drops. The redness of the eye disappeared in a week but patient noticed excessive tearing of his eyes. He was referred to reconstructive ophthalmologist for treatment of possible punctal stenosis. On examination the height of tear meniscus was increased and diagnostic lacrimal probing and syringing of the lacrimal drainage system demonstrated both lacrimal drainage system patent. Punctal stenosis was diagnosed. Over the next couple of weeks, patient underwent multiple syringing of the lacrimal duct system with temporary relief of symptoms. He was also prescribed Tobradex (Tobramycin+Dexamethasone) eye drops to be used for a month. Eye drops helped for the duration of treatment but symptoms returned after a couple of days of discontinuing eye drops. Patient also received ductal probing and punctal dilation in the office without much relief. Mini perforated plugs were placed in both puncta resulting in temporary relief. At the same time the intra ocular pressure started to rise and Tobradex eye drops were discontinued immediately. After almost three months of treatment and continuation of debilitating symptoms of epiphora, patient decided to consider surgical intervention and consulted an ENT surgeon for second opinion. Since he was responding to topical steroids, which was causing an increase in his intra ocular pressure, the ENT surgeon suggested Medrol Pack (Prednisolone for a week). Patient was symptom free after 4 days of treatment and by 7th day, his eyes were back to normal with complete disappearance of epiphora symptoms. Conclusions and importance: Systemic steroids can be beneficial in patients suffering from Idiopathic/Iatrogenic punctal stenosis unresponsive to topical steroids and conventional treatments.

To determine the histopathologic characteristics of lacrimal sac specimens in adult patients undergoing external dacryocystorhinostomy (DCR) for acquired nasolacrimal duct obstruction. A total of 471 lacrimal sac biopsies were obtained from 449 patients undergoing external DCR for symptoms or signs of acquired nasolacrimal duct obstruction and examined histopathologically. A total of 449 subjects including 283 (63%) female and 166 (37%) male subjects with mean age of 50.02 years underwent DCR and histopathologic examination of specimens. Presenting symptoms were epiphora in 411 patients (91%), history of acute dacryocystitis in 17 patients (4%) and obstruction revealed during ophthalmic examinations in 21 patients (5%). Histopathologic findings included: chronic inflammation in 450 patients (95.5%), fibrosis in 18 patients (3.8%), lymphoma in two patients (0.4%) and reactive lymphoid hyperplasia in one patient (0.2%). Lacrimal sac appearance during surgery was grossly abnormal in two cases: one case of lymphoma and one instance of reactive lymphoid hyperplasia. Chronic inflammation and fibrosis are the most common histopathologic findings in lacrimal sac specimens obtained during DCR. Only two cases of lymphoma (0.4%) were encountered in the series, one of which had a suspicious lacrimal sac appearance during surgery while the other case (0.2% of all specimens) was unsuspected. The rate of malignant etiology for NLD obstruction is low enough to justify lacrimal sac biopsy only in suspicious cases.

To survey the management of congenital nasolacrimal duct obstruction (CNLDO) by pediatric primary health care providers in Spain. This was a descriptive study using a web-based questionnaire to evaluate the perceptions of the members of the Pediatric Primary Care Society in Castilla-León, Spain (APAPCYL), regarding management of CNLDO. The questionnaire contained 14 direct questions and was sent by e-mail to all the pediatricians. All the responses were analyzed by the frequency of occurrence and percentages. Ninety physicians responded to the questionnaire. Massage 2 or 3 times a day was the initial treatment advised by 60.47% of pediatricians. Nearly half of the pediatricians recommended continuing massage until symptoms resolved. Fewer than 50% of children required referral to an ophthalmologist. Reasons for an ophthalmic consult included persistence of symptoms among 87.21% of pediatricians and parental/guardian request among 10.5% of pediatricians. According to 45.6% of pediatr...

Epiphora is a frequent reason for ophthalmologic consultation. Among the multiple causes, obstructions of the lacrimal excretory system are common. Sacal and postsacal obstructions are much more frequent than presacal obstructions. Obstruction at the level of the Hasner&#39;s valve is rare and likely underestimated. The authors report the clinical history and the imaging of 3 patients with a cystic dilation of the distal end of the nasolacrimal duct (NLD). These patients were easily managed by an ENT surgeon. In one case, the surgery consisted of an endonasal DCR where in the 2 other cases, a marsupialisation of the cystic expansion of the nasolacrimal duct was successfully performed with the micro- debrider. The authors review the world literature on this specific topic. They conclude that a coronal sinus CT scan and an inferior meatus endoscopy should be included in the ophthalmologic work-up performed in all cases of low obstruction of the lacrimal system. When there is a dilatio...

Dacryocystorhinostomy (DCR) is a procedure used to create a lachrymal drainage pathway into the nasal cavity in order to reestablish the permanent drainage of a previously obstructed excretory system. to report our results obtained with endoscopic DCR technique, describing its advantages and disadvantages Historic cohort. we retrospectively analyzed thirty-two dacryocystorhinostomies performed at the Otorhinolaryngology Discipline from March 2002 to January 2004 on patients with post-lachrymal sac obstruction confirmed by dacryocystorhinography (DCG). In all cases, the patients were submitted to probing with Crawford probe. surgery was bilateral in ten of the twenty-two analyzed patients, totaling thirty-two procedures, twenty-nine of which were primary surgeries and three revision procedures after unsuccessful external DCR. Our success rate was 79.12%. endoscopic DCR proved to be a safe and low morbidity technique, which also avoids facial scars and maintains the mechanism of the l...

A prospective series of 44 consecutive endonasal DCRs performed from January 1999 to December 2000 was entered into the study. The new technique involved creation of a large bony ostium and mucosal flaps to create an anastamosis between the lacrimal sac mucosa and nasal ...

Insulin administration in eye drops containing 1% saponin caused a rapid and reproducible reduction in blood levels of D-glucose in anesthetized rats; insulin eye drops lacking saponin were ineffective. Systemic insulin absorption also was observed when Brij 78 or BL-9 was substituted for saponin in eye drops containing insulin. Nonanesthetized rats displayed lower initial D-glucose levels than anesthetized rats, and little hypoglycemic response to insulin eye drops could be observed, suggesting that counter-regulatory hormones could effectively counterbalance the influence of exogenous insulin on glycemic control. Streptozotocin-diabetic rats displayed elevated blood D-glucose values (greater than 400 mg/dl), and these values were decreased to 100-200 mg/dl after the administration of insulin in eye drop solutions containing saponin. The site of insulin absorption appears to be the nasolacrimal drainage system of the rat because administration of a solution containing insulin plus ...

A 3-year-old, castrated male golden retriever was presented for evaluation of recurrent ocular discharge of 4 months&#39; duration from the left eye. Dacryocystorhinography was performed and demarcated a cystic dilatation of the left nasolacrimal duct with obstruction of the duct distal to the cystic cavity. Surgical exploration of the left maxillary sinus was performed to confirm the diagnosis and reestablish drainage into the nasal cavity. Recovery was uneventful, and the dog has been asymptomatic for &gt;36 months postoperatively. This report documents the third published case of surgical treatment for cystic dilatation of the nasolacrimal duct.

To present the success rate in treating congenital nasolacrimal duct obstruction with hydrostatic pressure (Crigler method). Clinical data from 186 children aged up to 32 months treated from 1990 until 2005 were reviewed retrospectively. The procedure was repeated up to 3 times at a one week interval. Using EPI INFO version 6.04 software for analysis, data were tabulated and statistical significance was evaluated by applying chi-square and Kruskal-Wallis tests. Leading age group was 1 to 5 months old (56.4%) for males and females. Affection was bilateral in 36.3%, 34.1% on right side and 29.6% on the left side. All cases had epiphora and 56.5% presented mucopurulent discharge. Cure was achieved with one massage for 43.6%, 23.3% with two, 17.4% with three and, with 4 and 5+ sessions in respectively 5.8% and 9.0%. Those 14 cases who did not respond to massage were treated with probing. The Crigler method was effective in managing congenital nasolacrimal duct obstruction cases.

To evaluate the causes of failed dacryocystorhinostomy (DCR) surgery, recommend specific endoscopic endonasal techniques in revision DCR, and report postoperative success rates. Retrospective case series in a tertiary referral center of 19 consecutive, endonasal revision DCR surgeries in 17 adult patients with previous failed DCR. All cases were revised endonasally by 1 surgeon. Analysis of etiology of failure and techniques of surgery were supplemented by review of surgical video and medical records. Surgical outcomes were measured functionally by resolution of epiphora and anatomically by patency of nasolacrimal duct system on syringing and positive functional endoscopic dye test. The most common cause for failed DCR was a blocked ostium due to membranous scarring (74%). Multiple causes for failure were found in 9 of 19 cases. Adjunctive procedures during revision surgery included partial middle turbinectomy (53%) and anterior ethmoidectomy (21%). The serrated oscillating blade was required in 89% cases, the high-speed diamond bur in 26%. Mean follow up was 15 months (range 7-26 months). All 19 cases had an anatomically successfully outcome. Fifteen of 19 cases (79%) had a functionally successful outcome. In this study, the most frequent cause of failed DCR was a scarred ostium, which is optimally visualized endonasally and precisely managed with the oscillating blade. Using the abovementioned specific endonasal techniques, the authors have demonstrated a high success rate in endonasal revision DCR surgery.

This study was designed to compare outcomes of endocanalicular laser-assisted endonasal dacryocystorhinostomy (DCR) with and without partial anterior middle turbinectomy. A prospective randomized comparative study was conducted on 91 subjects with primary acquired nasolacrimal duct obstruction, undergoing endocanalicular (ECL) procedures. Group 1 was composed of 44 (7 bilateral) patients undergoing ECL diode laser-assisted endonasal DCR without partial anterior middle turbinectomy and group 2 was composed of 47 (7 bilateral) patients undergoing partial anterior middle turbinectomy and ECL diode laser-assisted endonasal DCR. Follow-up period was 11.0 (6.0-14.5 months) months for group 1 and 9.2 (5.0-14.2 months) months for group 2. Functional success was defined as absence of epiphora and anatomic success was defined as ability to irrigate the lacrimal system. Anatomic and functional success at the 1st week, 3rd month, and final postoperative examinations of two groups were compared using chi-square tests. Final anatomic successes were 39/51 (76%) cases for group 1 and 51/54 (94%) cases for group 2. Final functional successes were 36/51 (%71) patients in group 1 and 48/54 (88%) patients in group 2. Group 2 had higher success at the final examination and the difference was statistically significant. We recommend partial anterior middle turbinectomy in all laser ECL laser-assisted endonasal DCR, but further studies with larger sample sizes are needed to strengthen our hypothesis.

The common cold affects millions of people. Unfortunately, it remains unknown whether cold viruses enter the respiratory tract only through the nose and mouth or whether they can also enter through the tear ducts. Transocular exposure to an airborne infectious dose of human rhinovirus did not lead to infection.