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PubMed2001

The pathogenesis and treatment of lacrimal obstruction: The value of lacrimal sac and bone analysis.

INTRODUCTION. The cause of primary acquired nasolacrimal duct obstruction (NLDO) has not been fully elucidated. In an attempt to determine the role of an inflammatory etiology, the pathology of nasolacrimal sac and bone specimens was assessed and correlated with clinical lacrimal variables. MATERIALS AND METHODS. Lacrimal sac and bone tissues from patients with known NLDO were sampled at the time of external dacryocystorhinostomy (DCR). Histopathological analysis was carried out to determine the presence and degree of inflammatory changes present in the tissues, and to correlate them with the clinical presentation. RESULTS. Of 104 cases analyzed, bony inflammatory changes were seen in 14% and lacrimal sac inflammatory changes in 94%. All cases of bony inflammation had accompanying lacrimal sac inflammation. The inflammatory changes were independent of the following variables: gender, duration of symptoms, a history of dacryocystitis, the presence of a lacrimal sac mucocele, the location of obstruction, and the presence of lacrimal sac calculi. CONCLUSIONS. Inflammatory changes are almost invariably present in all patients with NLDO. Its occurrence in bone is probably secondary to lacrimal sac inflammation. Although attempts are made to perform DCR surgery only in the absence of lacrimal sac inflammation, almost all cases exhibit subclinical inflammation. This may suggest that bypassing this 'critical area' of the sac-duct junction, as in a dacryocystorhinostomy, would be more reasonable than to re-canalize through an inflammatory obstruction.

Journal Article↗
PubMed2005

A case of primary adenocarcinoma of the lacrimal sac.

PURPOSE: To present a rare case of adenocarcinoma arising from the lacrimal sac. DESIGN: Interventional case report. METHODS: Report of a new case of primary lacrimal sac adenocarcinoma. RESULTS: The clinical presentation, workup, surgical treatment and pathology of a case of adenocarcinoma of the lacrimal sac are described. CONCLUSION: Although very rare, these tumors should be in the differential diagnosis of any lacrimal sac mass, especially those presenting above the medial canthal tendon. Other common features include expressible blood from the punctum, lack of pain, and a history of chronic epiphora or intermittent dacryocystitis. Local destruction and metastatic spread can be prevented by a high index of suspicion and early intervention.

Adenocarcinoma↗
PubMed2005

Long-term follow-up of external dacryocystorhinostomy and the factors affecting its success.

AIM: To evaluate the long-term follow-up results of external dacryocystorhinostomy (Ex-DCR) and to assess the role of some factors in its success. PATIENTS AND METHODS: Between January 1990 and November 2002, 437 nasolacrimal systems of 387 patients were operated on and included in the study. The success rates were determined on the basis of the last examinations of the patients, and the correlations between success rates and factors such as age, gender, the duration of obstruction, history of acute dacryocystitis, the side of obstruction, and the postoperative follow-up period were calculated. RESULTS: The mean follow-up period was 5.9 +/- 2.5 years. Fifty cases (12.9%) were operated bilaterally. The initial success rate was 91.5% and the last success rate was 98.4% after reoperations. We found meaningful correlations between success and duration of obstruction, age of the patient, and the duration of postoperative follow-up (r = 0.18, 0.17 and -0.14, p = 0.036, 0.001 and 0.002, respectively). DISCUSSION: In comparison to newly developed surgical techniques for the treatment of nasolacrimal duct obstruction, Ex-DCR still appears to offer higher success rates, even after long-term follow-up. In addition to being a cost-effective procedure, it requires no sophisticated instruments. In our opinion, the high success rates may be explained by the nature of the operation, which creates a fistula between the sac and the nasal mucosa.

Adolescent↗
PubMed2005

Balloon catheter dilatation of common canaliculus stenoses.

OBJECTIVE: To determine the efficacy of balloon catheter dacryocystoplasty in treating stenoses of the common canaliculus. MATERIALS AND METHODS: Between 1997 and 2004, elective balloon catheter dilatation was performed under local anesthesia in 36 patients with epiphora and dacryocystography (DCG)-proven high-grade stenosis of the common canaliculus. Eight of the 36 patients had additional stenosis of the nasolacrimal duct. A 2.5-mm diameter balloon was used for common canaliculus obstructions, a 3-mm balloon for nasolacrimal duct obstructions. RESULTS: Dilatation was technically successful in 34/36 patients. In 2/36 patients the guide wire could not be advanced beyond the obstruction. There were no complications. During a mean follow-up of 9 months restenosis occurred in 4/36 patients, in one of whom it led to occlusion of the common canaliculus; a chronic dacryocystitis had already resulted in occlusion of the common canaliculus in this patient's other eye. Two of four restenoses were successfully dilated in a second procedure. In one patient, a bilateral presaccal occlusion was suspected clinically. DCG revealed a high-grade common canaliculus stenosis in both eyes. After balloon catheter dilatation the patient was complaint free in one eye, and in the other eye symptoms improved. CONCLUSIONS: The therapy of choice for common canaliculus stenoses in addition to canaliculodacryocystorhinostomy is silicone tube implantation. The results of both procedures, however, are often disappointing. Balloon catheter dilatation is a minimally invasive technique carried out under local anesthesia which represents an alternative therapy option for the treatment of stenoses of the common canaliculus.

Catheterization↗
PubMed2004

Prevalence of non-vision-impairing conditions in a village in Chakwal district, Punjab, Pakistan.

PURPOSE: To determine the prevalence of non-vision-impairing ocular conditions (NVIC) and estimate the number of primary eye care treatments per 1000 population per month. METHODS: A cross-sectional study in a random sample of 1670 people was done to determine the load of NVIC in a village in Chakwal district. RESULTS: The prevalence of NVIC was 30.6% (306 per 1000 population). NVIC with the exclusion of presbyopia accounted for 14.6%. The main NVIC were allergic conjunctivitis (3.7%), bacterial conjunctivitis (3.5%), pterygium/pinguicula (2.6%) and acute/chronic dacryocystitis (1%). The average Complaint Frequency (CF) per month/1000 population was 55, excluding complaints of near vision and watery eyes. CONCLUSIONS: The foundation of a comprehensive district eye care strategy in the light of VISION 2020 - the Right to Sight - remains an effective primary eye care service whose elements are treatment of NVIC, detection and referral of cataracts and refractive errors, and promotion of eye health.

Adolescent↗
PubMed1997

Skin and soft-tissue manifestations of Shewanella putrefaciens infection.

Shewanella putrefaciens, a saprophytic gram-negative rod, is infrequently recovered from clinical specimens. Although a number of clinical syndromes have been attributed to S. putrefaciens, the pathogenic role of this agent remains largely undefined. We report 16 cases of S. putrefaciens infection that occurred at the Veterans General Hospital-Kaohsiung in Taiwan between 1990 and 1995. S. putrefaciens infection was associated with a wide clinical spectrum including bacteremia/septicemia, skin and soft-tissue infection, biliary tract infection, peritonitis, and empyema. Five of our patients had skin and soft-tissue manifestations, including fulminant periorbitofacial cellulitis, dacryocystitis, perineal abscess, finger abscess, and postcholecystectomy wound infection. These clinical features deviated from the chronic ulcers or infected burns of the lower extremities that have been described in previous reports. Seven (44%) of our 16 patients had bacteremia/septicemia, and all seven had underlying hepatobiliary diseases. S. putrefaciens was isolated in mixed cultures of specimens from 14 patients; Escherichia coli was the most common coisolate. Hepatobiliary diseases and malignancy were the major predisposing factors for S. putrefaciens infection of the biliary tract and S. putrefaciens bacteremia/septicemia.

Aged↗
PubMedDate not supplied

Phialophora richardsiae infection in humans.

Phialophora richardsiae infection in humans is rare. The first human isolate was recovered from a patient with a phaeomycotic cyst in 1968. Since 1975 seven other cases have appeared in the world literature, and an additional case is reported here. The mean age of these nine patients was 61.4 years. Two patients had diabetes mellitus, one had diabetes mellitus and disseminated adrenocortical carcinoma, and one had a myeloproliferative disorder. The mode of acquisition was presumed to be inoculation with contaminated plant material, but a history consistent with an inoculation injury was obtained in only four patients and a retained splinter was found in the lesion of only one patient. Infection with P. richardsiae was not associated with systemic symptoms or signs. Six patients presented with a single subcutaneous cystic granulomatous lesion. One patient had chronic dacryocystitis. More extensive or invasive disease occurred in two patients, both with an ultimately fatal underlying neoplastic process. A specific etiologic diagnosis was made by culture of purulent material obtained by excisional biopsy in six patients, incision and drainage in one patient, aspiration in one, and spontaneous drainage in one. Subcutaneous nodules were cured with surgical excision. There is insufficient information concerning antifungal therapy to recommend its use.

Female↗
PubMed1985

Exogenous ball valve in the lacrimal sac.

A young man presented with symptoms and findings of a chronic partial obstruction of the lacrimal sac outlet. A dacryocystogram revealed a BB in the lower portion of the lacrimal sac where this foreign body was functioning as a ball valve, impeding lacrimal drainage. Surgical removal of the BB and dacryocystorhinostomy were curative. Previously reported foreign bodies in the lacrimal sac have all been endogenous in origin. This is the first reported case of an exogenous foreign body in the lacrimal sac outlet. Exogenous sources of lacrimal sac foreign bodies should be considered in chronic dacryocystitis.

Adolescent↗
PubMed1989

The management of pediatric lacrimal problems.

The most common cause of tearing in the pediatric age group is blockage of the distal end of the nasolacrimal duct at the valve of Hasner. Evaluation with fluorescein using the dye disappearance test and the primary dye test, although not always as accurate as in adults, is possible. Conservative treatment is attempted initially followed by probing and, if necessary, silicone intubation. Less common causes of tearing are punctal atresia and congenital lacrimal sac fistula, which are usually diagnosed later, requiring opening of the atretic membrane and excision of the fistula tract, respectively. Amniotoceles are usually seen within a week of birth and are treated aggressively with medication and/or probing to prevent acute dacryocystitis.

Humans↗
PubMed1990

Stevens-Johnson syndrome with associated nasolacrimal duct obstruction treated with dacryocystorhinostomy and Crawford silicone tube insertion.

Although Stevens-Johnson syndrome (SJS) has long been recognized as a cause of punctal and canalicular obstruction, nasolacrimal duct obstruction secondary to SJS is rare and has not been reported in the ophthalmologic literature. Keratoconjunctivitis sicca, entropion, and trichiasis are well-known complications of SJS that may require measures to supplement or preserve tears. Lacrimal drainage system obstruction may occasionally occur in the face of relatively normal tearing, resulting in clinically significant epiphora. We report two cases of SJS, one associated with epidemic keratoconjunctivitis, that led to nasolacrimal duct obstruction and canalicular obstruction or stenosis. Epiphora and, in one case, dacryocystitis, necessitated dacryocystorhinostomy and Crawford tube insertion.

Adult↗
PubMed1990

Dacryocystorhinostomy in Wegener's granulomatosis.

Dacryocystorhinostomy was performed on two patients with Wegener's granulomatosis that had been quiescent for many years. Excellent results were attained, with elimination of dacryocystitis, complete relief from epiphora, and maintenance of a patent outflow tract. No wound necrosis occurred postoperatively, in contrast to a previous report in the literature. Our experience suggests that nasolacrimal duct obstruction in the setting of quiescent Wegener's granulomatosis can be treated safely and effectively with dacryocystorhinostomy.

Adult↗
PubMed1994

Lacrimal sac tumors.

This is a clinicopathologic study of 115 lacrimal sac neoplasms in adults (mean 52 years). The most common presenting signs and symptoms were epiphora (53%), recurrent dacryocystitis (38%), and/or lacrimal sac mass (36%). The tumors were divided into epithelial (82 cases) and nonepithelial (33 cases) neoplasms. Benign epithelial tumors included squamous and transitional cell papillomas (32), oncocytomas (4), and benign mixed tumors (2). The malignant epithelial neoplasms included squamous cell carcinoma (22), transitional cell carcinoma (5), adenocarcinoma (4), mucoepidermoid (3), adenoid cystic (3), and poorly differentiated carcinoma (1). The nonepithelial tumors consisted of fibrous histiocytoma (13), lymphoid lesions (10), malignant melanoma (6), hemangiopericytoma (1), lipoma (1), granulocytic sarcoma (1), and neurofibroma (1). Review of the literature, including our own series, discloses a 55% malignancy rate for tumors originating in the lacrimal sac. Malignant epithelial neoplasms, especially invasive transitional cell carcinoma, often recur locally and can metastasize and be fatal. Epithelial malignancies tend to grow along the epithelium of the lacrimal drainage system, and thus cure is dependent on a wide surgical excision of the tumor and of the entire lacrimal drainage system (canaliculi, sac, and nasolacrimal duct) combined with a lateral rhinostomy and radiation therapy.

Adolescent↗
PubMed1997

Endoscopic evaluation and management of the lacrimal sump syndrome.

Failed dacryocystorhinostomy caused by the presence of residual lacrimal sac has been termed the "lacrimal sump syndrome." Epiphora occurs when tears collect in this residual pouch and lacrimal drainage is delayed. Irrigation into the nose may seem normal. This condition can be easily diagnosed with nasal endoscopy and has a characteristic radiologic appearance. Six patients with failed dacryocystorhinostomy caused by lacrimal sump syndrome were successfully treated with an endoscopic contact Nd:YAG laser technique. Endoscopic dacryocystorhinostomy using the contact Nd:YAG laser is an effective method for treating patients who have persistent epiphora or dacryocystitis after failed dacryocystorhinostomy.

Adult↗
PubMed1999

A multidisciplinary approach to atypical lacrimal obstruction in childhood.

PURPOSE: This study explores the diagnosis and management of unusual anomalies involving the canaliculi, nasolacrimal duct, nasal cavity, and sinuses in childhood. METHODS: A case series of eight children with lacrimal outflow anomalies ranging from distal nasolacrimal duct cyst formation to persistent dacryocystitis following failed probing or silicone intubation were reviewed retrospectively. Diagnostic studies including intranasal endoscopy and preoperative or intraoperative dacryocystography (DCG) were of value. RESULTS: Treatment modalities included endoscopically guided resection of lacrimal cyst mucosa, endoscopic dacryocystorhinostomy (DCR), and monocanalicular or bicanalicular intubation of the lacrimal outflow system. In our series, endoscopic surgery was well tolerated by all patients with improvement in symptoms. CONCLUSIONS: This initial experience suggests that endoscopic techniques may be useful in the management of atypical lacrimal outflow obstruction in childhood.

Child↗
PubMed1998

Prospective randomized comparison of endonasal endoscopic dacryocystorhinostomy and external dacryocystorhinostomy.

OBJECTIVES AND STUDY DESIGN: The advent of the rigid endonasal endoscope and the development of functional endoscopic sinus surgery (FESS) technique have awakened interest in an endonasal endoscopic dacryocystorhinostomy (EESC-DCR) in treating nasolacrimal obstruction. This prospective, randomized study compares EESC-DCR with traditional external dacryocystorhinostomy (EXT-DCR) for their success rates, surgical duration, and postoperative symptoms. PATIENTS AND METHODS: Sixty-four cases in 60 patients with primary acquired nasolacrimal sac or duct obstruction were divided into two subgroups by symptoms (simple epiphora/chronic dacryocystitis). These patients were randomized within both subgroups into two operation groups. Altogether 32 EESC-DCRs and 32 EXT-DCRs were performed. The final follow-up visit was at 1 year. The patency of the lacrimal passage was investigated by irrigation and patients were questioned about their symptoms. RESULTS: The success rate at 1 year after surgery was 75% for EESC-DCR and 91% for EXT-DCR after primary surgery. The difference was not statistically significant (P = .18). The success rate after secondary surgery with a follow-up time of 1 year was 97% in both study groups. The average duration for EESC-DCR was 38 minutes, and 78 minutes for EXT-DCR, (P < .001). CONCLUSIONS: EXT-DCR, when compared with EESC-DCR, appears to give a higher, although not statistically significant, primary success rate, but the secondary success rates are equal, indicating that these two different DCR techniques are acceptable alternatives.

Adult↗
PubMed2003

Congenital dacryocystocele associated with intranasal cysts: diagnosis and management.

OBJECTIVE: To improve the diagnostic and therapeutic database for congenital dacryocystoceles. STUDY DESIGN/METHODS: Retrospective case study of 10 patients with dacryocystoceles treated in an academic integrated tertiary care practice. Management and outcomes are compared to previous reports in the literature. RESULTS: Between the years 1990 and 2001, 10 patients were diagnosed with dacryocystoceles. Seven were females, and 3 were males. Age ranged from 1 to 75 days. Nine of 10 had a unilateral dacryocystocele, and 1 had bilateral dacryocystoceles. Epiphora was reported in 8 patients. Preoperatively, dacryocystitis, facial cellulitis, or both were present/developed in 2 patients. Symptoms of airway obstruction were present in 3 neonates. Surgery was performed in 9 of 10 patients and was a combined ophthalmology/otolaryngology surgery in 7 cases. Two patients were treated with probing only. Intranasal cysts were identified in all 7 patients who underwent a combined approach. Three of 7 patients had bilateral intranasal cysts. Follow-up ranged from 9 months to 10 years (mean, 5 years). Complete resolution was observed in 9 patients. One patient had postoperative nasolacrimal duct obstruction 2 months postoperatively, presenting with mucopurulent drainage and cellulitis. The existing literature often suggests conservative management as a treatment option. CONCLUSION: True dacryocystoceles are a relative rarity. The literature describes a variable natural course of these lesions with resultant controversy in their management. The current results demonstrate successful treatment in 6 of 7 patients with an early combined surgical approach and 2 of 2 patients treated by probing alone. The high failure rate with conservative management, reported in the literature, supports early surgical intervention.

Cysts↗
PubMedDate not supplied

Clinical features and management of tumors affecting the lacrimal drainage apparatus.

PURPOSE: To report the clinical features of a series of patients with lacrimal drainage apparatus tumors and present guidelines for management based on histopathology. METHODS: A non-comparative retrospective chart review of the clinical, imaging, and pathologic findings of 37 patients presenting to four regional orbital surgery departments with tumors affecting the lacrimal drainage apparatus between 1990 and 2004. RESULTS: There were 37 patients, of whom 62% were male. The mean age at referral was 54 years. Epiphora, a palpable mass, and dacryocystitis were the most common presentations. Two thirds of the tumors were epithelial, with carcinomas being the most frequent (38%), followed by papillomas (27%). Lymphomas were the most common nonepithelial malignancy (30%). Epithelial tumors were more common in men (87%), whereas lymphomas were more common in women (57%). Treatment modalities included surgery, in addition to radiotherapy and/or chemotherapy and immunotherapy. Mean follow-up was 38 months. Thirty-three patients (89%) remain alive without evidence of disease and 4 patients died of recurrence and/or metastases. CONCLUSIONS: Lacrimal drainage apparatus tumors require careful initial management to ensure adequate local and systemic disease control. Atypical mucosa encountered during dacryocystorhinostomy should be biopsied and small papillomas or pedunculated tumors excised and analyzed with frozen sections. If a diffuse or infiltrative mass is encountered, it should be biopsied and managed on the basis of histopathology and extent of disease. Lymphomas should be treated according to protocols, whereas noninvasive carcinoma and extensive papillomas require complete excision of the system. Invasive disease requires en bloc excision. Long-term follow-up is essential for early detection of recurrence.

Adult↗
PubMed2005

The role of lacrimal intubation in the management of facial trauma and tumor resection.

BACKGROUND: Lacrimal drainage dysfunction is a common and problematic consequence of any pathologic process that interferes with the physiology or continuity of the lacrimal drainage apparatus. The literature widely documents several reliable, safe, and consistently well-tolerated techniques of nasolacrimal intubation for the repair of lacrimal system dysfunction; however, the role and the timing of such intubation in primary surgery involving the regional anatomy of the lacrimal system remain controversial. The authors evaluated the role of lacrimal intubation as a therapeutic and prophylactic procedure in complex primary surgery for trauma, tumor, and chronic infection of the lacrimal drainage system. METHODS: Sixty-one cases of either unilateral or bilateral silicone intubation of the lacrimal drainage system in 54 patients were analyzed retrospectively with respect to diagnosis, indication for intubation (therapeutic or prophylactic), and clinical outcome. Final long-term patency of the system after tube removal was assessed by the absence of epiphora and positive Jones primary dye test. RESULTS: Lacrimal intubation as part of the primary repair of facial trauma, tumor resection, and relief of lacrimal system obstruction resulted in a patent, functional lacrimal drainage system in all 61 cases, with no associated morbidity. The risks of diagnostic manipulation at the time of surgery were avoided. CONCLUSIONS: This series demonstrates that prophylactic intubation of the lacrimal system in any trauma or tumor resection near or around the region in addition to those that directly involve these systems should be considered, as the risks of silicone intubation in such cases are relatively negligible compared with the morbidity and nuisance associated with postoperative epiphora and/or recurrent dacryocystitis. Concomitant nasolacrimal intubation in conjunction with the repair of complex midfacial fractures or tumor extirpation is a safe and effective means of ensuring the establishment of a patent, functional drainage system in the absence of direct lacrimal system involvement.

Adolescent↗