Nasolacrimal probing and intubation for children with nasolacrimal duct obstruction and history of dacryocystitis

Lacrimal drainage system disorders leading to epiphora are a common ophthalmologic complaint. When such a patient is identified, the ophthalmologist frequently collaborates with the otolaryngologist to perform a dacryocystorhinostomy (DCR). In rare cases, sinonasal sarcoidosis may lead to nasolacrimal duct obstruction (NLD) and dacryocystitis. A 48-year-old Caucasian female was referred to the Otolaryngology clinic for evaluation of a 6-month history of persistent right-sided nasal obstruction and epiphora. After physical examination and computerized tomography (CT) scan, she was diagnosed with right NLD with dacryocystitis. The patient underwent right endoscopic DCR. Pathology from the lacrimal bone and nasal tissue demonstrated noncaseating granulomas suggestive of sarcoidosis. Postoperative evaluation including lung CT scan confirmed systemic sarcoidosis. Nasolacrimal duct obstruction very rarely is the presenting symptom in patients with sarcoidosis. Imaging is necessary to rule out other causes of NLD, and histopathology is essential for diagnosis. Noncaseating granulomas are found along the nasal tissue and lacrimal sac, specifically in the subepithelial layer. Treatment consists of DCR, either endoscopic or external. Both approaches achieve long-lasting resolution of symptoms but may require revision from inflammation and scarring. There is no consensus on the use of intraoperative or postoperative steroids.

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Incidence of neoplasia in patients with unilateral epiphora

The Journal of Laryngology & Otology ◽

10.1017/s0022215115001504 ◽

2015 ◽

Vol 129 (S3) ◽

pp. S53-S57 ◽

Cited By ~ 6

Author(s):

T Bewes ◽

R Sacks ◽

P L Sacks ◽

D Chin ◽

N Mrad ◽

...

Keyword(s):

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

Stricture Formation ◽

Benign Stricture ◽

Common Cause ◽

Duct Obstruction ◽

Lacrimal System ◽

History Of ◽

Surgical Teams ◽

Operative Findings

AbstractBackground:Nasolacrimal duct obstruction is common and is usually a result of benign stricture formation. Although neoplasia near or around the lacrimal system may produce epiphora, the incidence of neoplasia from within the lacrimal system as a cause of nasolacrimal duct obstruction is not well documented.Methods:A retrospective study was performed on all patients undergoing dacryocystorhinostomy with a history of epiphora. The incidence of patients with operative findings of intra-lacrimal neoplasm was sought. Histopathologically confirmed cases were included.Results:The study comprised 537 patients, who underwent a total of 631 endoscopic dacryocystorhinostomy procedures between January 1998 and July 2013. Non-stenotic causes of nasolacrimal duct obstruction were encountered in 3.01 per cent of dacryocystorhinostomy procedures, and included neoplastic, inflammatory and infectious pathologies. Inverted papilloma was the most common cause, encountered in 0.79 per cent of dacryocystorhinostomy operations.Conclusion:These findings suggest that neoplasia is an uncommon but not a rare cause of nasolacrimal duct obstruction. Surgical teams performing high numbers of dacryocystorhinostomy procedures should be aware of such pathology and patients counselled appropriately.

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Conservative Treatment for Congenital Nasolacrimal Duct Obstruction – Factors Affecting the Success

Acta Medica Bulgarica ◽

10.2478/amb-2021-0019 ◽

2021 ◽

Vol 48 (2) ◽

pp. 25-28

Author(s):

K. P. Valcheva ◽

S. V. Murgova

Keyword(s):

Conservative Treatment ◽

Clinical Signs ◽

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

Congenital Nasolacrimal Duct Obstruction ◽

Factors Affecting ◽

Duct Obstruction ◽

Nonsurgical Management ◽

History Of ◽

A Prospective Study

Abstract Aim To examine the success rate and factors affecting the effect of conservative treatment for congenital nasolacrimal duct obstruction (CNLDO) in children. Methodology A prospective study was made on 167 eyes of 131 patients with clinical signs of CNLDO. All of them were initially treated nonsurgically with Crigler massage. The curative effect of this management was evaluated on the basis of no history of watery eyes, negative regurgitation test, and dye disappearance test 0 or 1 grade. Exploratory analyses assessed whether baseline characteristics including age, gender and laterality were associated with the probability of CNLDO resolving without surgery. If the nonsurgical treatment failed, probing was done in the Eye Clinic in Pleven. Results The conservative treatment for CNLDO with Crigler massage was successful in the majority of treated cases – in 115 out of 167 eyes with CNLDO (68,9%). The remaining 52 (31,1%) eyes were probed. Age (p = 0,001) and laterality (p = 0,001) were found to be associated with resolution of the clinical signs. Conclusions Nonsurgical management for CNLDO was successful initial treatment in patients with this pathology. The Crigler massage was more effective in children up to 12 months of age with unilateral obstruction.

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Is there an association between congenital nasolacrimal duct obstruction and cesarean delivery?

European Journal of Ophthalmology ◽

10.1177/1120672119889522 ◽

2019 ◽

Vol 30 (6) ◽

pp. 1228-1231

Author(s):

Mehmet Fuat Alakus ◽

Umut Dag ◽

Selahattin Balsak ◽

Seyfettin Erdem ◽

Hasan Oncul ◽

...

Keyword(s):

Family History ◽

Cesarean Section ◽

Positive Family History ◽

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

First Birth ◽

Congenital Nasolacrimal Duct Obstruction ◽

Duct Obstruction ◽

Obstruction Group ◽

History Of

Purpose: The aim of this study was to research the relationship between types of birth and congenital nasolacrimal duct obstruction. Method: The study enrolled 665 infantile patients with prediagnosis of congenital nasolacrimal duct obstruction due to associated ophthalmic symptoms. Age, gender, family history, delivery type, and patient medical records were investigated. Patients were grouped and compared according to their birth type and whether it was the first birth. Results: The number of the infants with and without congenital nasolacrimal duct obstruction was 227 (34.1%) and 438 (65.9%), respectively. Comparison of the congenital nasolacrimal duct obstruction and non-congenital nasolacrimal duct obstruction groups according to the first births showed that ratio of cesarean section was significantly higher in the congenital nasolacrimal duct obstruction group than the non- congenital nasolacrimal duct obstruction group (58.7% and 20.7%, respectively). Number with positive family history also was significantly higher in the congenital nasolacrimal duct obstruction group. Conclusion: Cesarean section in first birth and positive family history of congenital nasolacrimal duct obstruction appear to be important risk factors in the etiopathogenesis of congenital nasolacrimal duct obstruction.

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Success Rate of Probing for Congenital Nasolacrimal Duct Obstruction in Children

Folia Medica ◽

10.2478/folmed-2018-0054 ◽

2019 ◽

Vol 61 (1) ◽

pp. 97-103 ◽

Cited By ~ 3

Author(s):

Krasina P. Valcheva ◽

Snezhana V. Murgova ◽

Emilia K. Krivoshiiska

Keyword(s):

Success Rate ◽

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

Cure Rate ◽

Congenital Nasolacrimal Duct Obstruction ◽

Duct Obstruction ◽

History Of ◽

Group A ◽

Group B

Abstract Aim: To determine the success rate of initial and repeated probing for congenital nasolacrimal duct obstruction (CNLDO) in children between 2-41 months. Patients and methods: One hundred and twelve children aged 1.8 to 13 years responded to the control examination. They were diagnosed with CNLDO in the past and now included in a retrospective study. The mean follow-up period was 5.2 years (from 0.6 to 11.6 years). Patients were divided into two groups according to their age at the time of surgery: group A (2-12 months) and group B (13-41 months). Probing and irrigation of NLD was performed in the Eye Clinic in Pleven under general anesthesia in all subjects. A controlled examination was done to evaluate the effect of probing on the basis of a history of watery eyes, regurgitation test, and dye disappearance test (DTT). Results: Of the 131 eyes in 112 children, 110 eyes (84%) had one probing and 21 eyes (16%) had repeat probing. Success rate of the initial probing was 90% (99 of 110) for all patients’ eyes: 89% (70 of 79) in group A and 94% (29 of 31) in group B. The cure rate of the repeat probing was 76% (16 of 21) for all patients: 88% (7 of 8) in group A and 69% (9 of 13) in group B. The overall success rate of probing was 88% (115 of 131). Conclusion: Nasolacrimal duct probing followed by irrigation is a commonly performed, highly successful treatment for congenital nasolacrimal duct obstruction in children. The success rate for initial and repeated nasolacrimal duct probing is not affected by age.

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