PubMed · 13400727
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R E FISCHER. 1957. Epiphora.. https://pubmed.ncbi.nlm.nih.gov/13400727/
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We report an unusual presentation of a dacryocystocele in a 3-day-old child, with clinical and novel MRI findings. The literature contains extensive CT documentation, but descriptions of the MRI appearances of dacryocystoceles are lacking. Although CT is the standard initial imaging modality, MRI can be helpful if there are questions as to the content of the lesion or a need for further anatomical characterization.
OBJECTIVE: To describe our experience with potassium-titanyl-phosphate (KTP) laser-assisted dacryocystorhinostomy, controlled via endolacrimal and endonasal endoscopy. The development of miniendoscopes enables endoscopy of the lacrimal drainage system via the lacrimal puncta to visualize the exact site of a stenosis. DESIGN: A case series of 78 patients, with 1-year postoperative follow-up. SETTINGS: A university medical center. PATIENTS: Consecutive sample of 78 adult patients who required surgery for dacryostenosis. INTERVENTION: Endolacrimal use of a KTP laser to perform a bony osteotomy of the lacrimal sac into the nasal cavity. The position for the perforation was controlled by endonasal endoscopy. The procedure was performed under either general or local anesthesia. RESULTS: One year after surgery, 65 (83%) of the 78 patients were free of symptoms. Seven patients experienced intermittent tearing, and 6 had revision surgery because of restenosis. CONCLUSIONS: The success rate of 83% achieved with KTP laser-assisted dacryocystorhinostomy, using miniendoscopes for lacrimal endoscopy to visualize the exact site of obstruction, is better compared with that of prior studies without the use of miniendoscopes (with success rates of 47%-85%). The advantages of this technique are that it is a minimally invasive procedure, requires a short operating time, and avoids use of an external incision.
PURPOSE: To determine the incidence of intranasal cysts associated with lacrimal sac mucoceles and the cure rate with nasal endoscopic cyst marsupialization. DESIGN: Interventional case series. METHODS SETTING: University-affiliated teaching hospital. PATIENT POPULATION: Twenty-five infants with non infected or infected lacrimal sac mucoceles or dacrocystitis without obvious mucocele were consecutively enrolled. INTERVENTION PROCEDURES: Management included local lacrimal massage, parenteral antibiotics, and when still symptomatic, nasolacrimal duct probing with concomitant nasal endoscopy. Intranasal cysts identified were marsupialized until the distal end of the nasolacrimal duct probe was visualized. MAIN OUTCOME MEASURES: Presence of intranasal cyst identification and cure rate. RESULTS: Infants were 4 days to 10 weeks old (mean 19 days). Forty-eight percent had a bluish cutaneous mass inferior and lateral to the lacrimal sac. Twenty percent were bilateral. At presentation, 76 percent had dacrocystitis. Fourteen percent had respiratory distress. Only one child responded to medical management. At endoscopy, 23 of 24 infants had ipsilateral intranasal cysts. The one child without nasal cyst had recurrent dacrocystitis and no mucocele. All children with mucocele were cured except one child with residual nasolacrimal duct obstruction. CONCLUSIONS: Lacrimal sac mucoceles were almost always associated with intranasal cysts. Nasal endoscopy is a valuable addition to the treatment plan for lacrimal sac mucoceles not responding to a brief trial of massage or infantile dacrocystitis. To avoid potential complications, we recommend against waiting until infection occurs before proceeding with surgery.