Management of Bi-Punctal Stenosis by One-Snip Punctoplasty Combined with Silicone Intubation

The purpose of this study was to report the external dacryocystorhinostomy (ext-DCR) using silicone intubation in a child with dyskeratosis congenita (DC) who had presented by bilaterally acquired nasolacrimal duct obstruction (NLDO), punctal stenosis, and mucocutaneous changes. We report the 13-month results of an 11-year-old boy with DC who underwent bilateral ext-DCR with silicone stenting under general anesthesia. Ophthalmic examination revealed bilateral punctal stenosis and NLDO with normal fundus examination. He was referred to pediatrics and was diagnosed as DC, based on classic reticular skin pigmentation, nail dystrophy, and oral leukoplakia, without any other systemic involvement. Treatment consisted of bilateral ext-DCR using silicone stenting by 6 months. Management of surgery and post-operative 13-month follow up results was observed. DC is a rare heterogeneous multisystem disorder of telomere maintenance, which may present with ophthalmologic features. Although the lacrimal system abnormalities have been reported most frequently ocular findings in DC, this is the first case to present the management and long-term results of DCR using silicone intubation. This case aims to raise awareness of the various systemic and ocular manifestations and possible complications of DC and to present long-term results of ext-DC in a patient with DC.

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Bicanalicular Silicone Intubation for the Management of Punctal Stenosis and Obstruction in Patients With Allergic Conjunctivitis

Ophthalmic Plastic and Reconstructive Surgery ◽

10.1097/iop.0000000000001315 ◽

2019 ◽

Vol 35 (5) ◽

pp. 451-455 ◽

Cited By ~ 2

Author(s):

Naif Alsulaiman ◽

Adel H. Alsuhaibani

Keyword(s):

Allergic Conjunctivitis ◽

Silicone Intubation ◽

Punctal Stenosis

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Rectangular 3-snip punctoplasty versus punch punctoplasty with silicone intubation for acquired external punctal stenosis: a prospective randomized comparative study

International Journal of Ophthalmology ◽

10.18240/ijo.2021.06.09 ◽

2021 ◽

Vol 14 (6) ◽

pp. 849-854

Author(s):

Xin Cao ◽

◽

Ying Wu ◽

Yu Song ◽

Qing-Huai Liu ◽

...

Keyword(s):

Comparative Study ◽

Group A ◽

Silicone Intubation ◽

Time Test ◽

Fluorescein Dye ◽

Tear Meniscus ◽

Tear Meniscus Height ◽

Group B ◽

Anatomical Success ◽

Punctal Stenosis

AIM: To evaluate the effectiveness of rectangular 3-snip punctoplasty versus punch punctoplasty via Kelly punch with silicone intubation for the management of acquired external punctal stenosis (AEPS). METHODS: A prospective, randomized, comparative study was performed on 123 eyes of 94 patients with AEPS. Patients were recruited into either group of rectangular 3-snip punctoplasty (group A) or group of punch punctoplasty with silicone intubation (group B). Outcomes measured were Munk score, grade of punctal stenosis, fluorescein dye disappearance time test (FDDT) and tear meniscus height (TMH) 6 and 12mo after surgery. RESULTS: Twelve months after surgery, Munk score, FDDT and TMH significantly decreased in both groups compared with the baseline (all P<0.05), and grade of punctal stenosis increased significantly (P<0.05). The grade of punctal stenosis, Munk score, FDDT and TMH were better in group B compared with group A at 6 or 12mo (all P<0.05). There was a positive correlation between TMH and Munk score (R=0.655, P<0.001). At the last followed-up, anatomical success was noted in 96.7% eyes in group A and 98.4% eyes in group B (P=0.613). CONCLUSION: Punch punctoplasty via Kelly punch with silicone intubation achieves better outcomes than rectangular 3-snip punctoplasty. The new technique is a simple, minimally invasive, with high anatomical and functional success in patients with AEPS.

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A new bicanalicular intubation method: Direct silicone intubation (DSI)

Orbit ◽

10.3109/01676839409084263 ◽

1994 ◽

Vol 13 (1) ◽

pp. 11-15 ◽

Cited By ~ 1

Author(s):

Katsuaki Kurihashi

Keyword(s):

Silicone Intubation

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Delayed unilateral pneumocephalus after bilateral endoscopic dacryocystorhinostomy in an elderly patient

BMJ Case Reports ◽

10.1136/bcr-2020-241540 ◽

2021 ◽

Vol 14 (5) ◽

pp. e241540

Author(s):

Jaekyoung Lee ◽

Dong Cheol Lee

Keyword(s):

Elderly Patient ◽

Cerebrospinal Fluid ◽

Gold Standard ◽

Standard Treatment ◽

Nasolacrimal Duct ◽

Intravenous Antibiotic ◽

Duct Obstruction ◽

Orbital Wall ◽

Silicone Intubation ◽

Endoscopic Dcr

Dacryocystorhinostomy (DCR) is the ‘gold standard’ treatment for nasolacrimal duct obstruction (NLDO). However, despite its recent technical advancements, complications are possible. Herein, to the best of our knowledge, we present the first reported case of delayed unilateral pneumocephalus after bilateral endoscopic DCR. An 85-year-old man with bilateral NLDO underwent endoscopic DCR with silicone intubation. After 1 month, he became lethargic and was admitted to emergency room. Brain CT demonstrated left pneumocephalus and a suspected microfistula in left orbital wall. Intravenous antibiotic therapy was started, and cerebrospinal fluid studies showed no evidence of meningitis. After 13 days of antibiotic treatment, his mental state recovered with no signs of pneumocephalus. Although DCR has high success rate and is relatively safe, surgeons should be aware of the risk, although low, of pneumocephalus, especially in elderly patients who are vulnerable to fractures and who exhibit headache or mental status changes after endoscopic DCR.

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