scholarly journals Pulled versus Pushed Monocanalicular Silicone Intubation in Adults with Lacrimal Drainage System Stenosis: A Comparative Case Series

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Abolfazl Kasaee ◽  
Bahram Eshraghi ◽  
Kambiz Ameli ◽  
Hossein Ghahvehchian ◽  
Mansooreh Jamshidian-Tehrani ◽  
...  
Keyword(s):  
Success Rate ◽  
Drainage System ◽  
Case Series ◽  
Nasolacrimal Duct ◽  
Lacrimal Drainage System ◽  
Tube Removal ◽  
Silicone Intubation ◽  
Canalicular Stenosis ◽  
Grade 3 ◽  
Lacrimal Drainage

Purpose. To compare the success rate and complications of pulled versus pushed monocanalicular intubation in adults with incomplete lacrimal drainage system obstruction (lacrimal drainage system stenosis). Methods. Patients with lacrimal drainage system stenosis (Munk grade ≥3), including both nasolacrimal duct (NLD) stenosis and common canalicular stenosis, were recruited in this prospective comparative case series. Patients underwent probing and either Monoka (51 eyes) or Masterka (48 eyes) intubation under general or local anesthesia. Tubes were removed 4–14 weeks after the procedure. Six months after tube removal, Munk grades 0 and 1 were defined as a complete success, Munk grade 2 was defined as a partial success, and Munk grade ≥3 was defined as failure. All complications were recorded. Results. Ninety-nine eyes from 89 patients with lacrimal drainage system stenosis who underwent either Monoka (51 eyes) or Masterka (48 eyes) intubation were included. The mean (SD) age of the patients was 55.4 (12) years in the Monoka group and 53.5 (12.9) in the Masterka group. Groups were matched on demographics. Masterka intubation could not be performed in one eye. Complete and partial successes were observed in 52.9% (27/51) and 17.6% (9/51) of eyes in the Monoka group and 42.6% (20/47) and 12.8% (6/47) of eyes in the Masterka group, respectively ( p = 0.29 ). There was a trend toward a higher total success rate in patients with NLD stenosis treated with Monoka 66.7% (26/39) than Masterka 45.5% (15/33) intubation ( p = 0.07 ). This trend also existed in patients with common canalicular stenosis (83.3% (10/12) vs. 76.6% (11/14), p = 0.75 ). Age, sex, bilateral involvement, and duration of intubation did not have a significant impact on the success rate. Early tube loss, slit puncta, and temporary superficial punctate keratopathy were observed complications. Conclusion. Intubation with the pulled monocanalicular silicone tube was associated with a slightly but not significantly higher success rate in adults with lacrimal drainage system stenosis. Patients with NLD stenosis may achieve better results with pulled silicone tubes.

Silicone Intubation as an Alternative to Dacryocystorhinostomy for Nasolacrimal Drainage Obstruction in Adults

1993 ◽  
Vol 3 (2) ◽  
pp. 71-76 ◽  
Author(s):  
K. Psilas ◽  
V. Eftaxias ◽  
J. Kastanioudakis ◽  
C. Kalogeropoulos
Keyword(s):  
Success Rate ◽  
Drainage System ◽  
Nasolacrimal Duct ◽  
Silicone Tube ◽  
Duct Obstruction ◽  
Silicone Tubing ◽  
Chronic Dacryocystitis ◽  
Silicone Intubation ◽  
Lacrimal Drainage

Silicone tubing was used to repair the patency of the nasolacrimal drainage system in 115 patients (four bilaterally) with chronic nasolacrimal duct obstruction. The patients were over 20 years old and 16 were men and 99 women; 46% presented an uncomplicated obstruction with epiphora and 54% presented additional signs of chronic dacryocystitis. We used the technique of Quickert and Dryden with modifications. The silicone tube remained for a mean of 5.5 months (± 2.5 SD). After removal of the tube the follow-up ranged from 6 to 42 months (mean ± SD: 16 ± 9). Patency was maintained in 89% of cases with uncomplicated obstruction and in 69% of those with chronic dacryocystitis (total success rate 78%). We can therefore recommend silicone intubation of the lacrimal drainage system as an alternative to dacryocystorhinostomy (DCR), in adults with obstruction of the nasolacrimal duct. In addition, unlike DCR this technique is bloodless and the operation takes less time.

Features of surgical treatment of nasolacrimal duct stenoses in children

2014 ◽  
Vol 5 (2) ◽  
pp. 30-34
Author(s):  
Vladimir Vsevolodovich Brzheskiy ◽  
Margarita Nikolayevna Chistyakova ◽  
Irina Vyacheslavovna Kalinina
Keyword(s):  
Surgical Treatment ◽  
Inflammatory Response ◽  
Nasolacrimal Duct ◽  
Control Group ◽  
Functional Effect ◽  
Lacrimal System ◽  
Group A ◽  
Silicone Intubation ◽  
Canalicular Stenosis ◽  
Lacrimal Drainage

42 children at age from 1 to 15 years (36 - with relapse of congenital nasolacrimal duct (NLD ) stenosis and 6 - with canalicular stenosis) bougienage NLD was done with Ritleng stent intubation. The control group included 25 children 1-5 years old with relapsed congenital stenosis of the NLD, the treatment of which was limited to probing the NLD. In the first group full functional effect was observed in 21 children (58.3 %), in 9 (25.0 %) - was light epiphoria, in 1 (2.8 %) - moderate, and in 5 (13.9 % ) treatment was not effective. In the second group a full functional effect was obtained for each child. In the control group lacrimal drainage was restored fully in 16 (64.0 %) children, in 2 (8.0 %) - moderate and in 7 (28.0 %) - severe epiphora was remained. Using of silicone intubation with the Ritleng lacrimal system allows to continuously retain their foramen in stenotic site without causing an inflammatory response and bedsores lacrimal punctum and canaliculus.

Evaluation of the Lacrimal System

2011 ◽  
Author(s):  
John V. Linberg
Keyword(s):  
Drainage System ◽  
Nasolacrimal Duct ◽  
Careful Examination ◽  
History Taking ◽  
Lacrimal Drainage System ◽  
Anatomy And Physiology ◽  
Tear Production ◽  
System P ◽  
Concomitant Reduction ◽  
Lacrimal Drainage

The common complaint of a watering eye may be caused by a variety of problems, including lacrimal hyposecretion, lacrimal hypersecretion, or blockage of the lacrimal drainage system. This system is a complex membranous channel whose function depends on the interaction of anatomy and physiology. Effective tear drainage depends on a variety of factors, including the volume of tear secretion, eyelid position, and anatomy of the lacrimal drainage passages. Epiphora is defined as an abnormal overflow of tears down the cheek. The patient with symptomatic tearing may have a normal lacrimal drainage system overwhelmed by primary or secondary (reflex) hypersecretion or a drainage system that is anatomically compromised and unable to handle normal tear production. On the other hand, a patient with partial drainage obstruction may have a concomitant reduction in tear production and therefore be completely asymptomatic or may even suffer from symptomatic dry eye syndrome. Epiphora is determined by the balance between tear production and tear drainage, not by the absolute function or dysfunction of either one. The causes of lacrimal drainage problems can be divided into two categories: anatomic and functional. Anatomic obstruction refers to a mechanical or structural abnormality of the drainage system. The obstruction may be complete, such as punctal occlusion, canalicular blockage, or nasolacrimal duct fibrosis, or partial, caused by punctal stenosis, canalicular stenosis, or mechanical obstruction within the lacrimal sac (i.e., dacryolith or tumor). In patients with functional obstruction, epiphora results not from anatomic blockage but from a failure of lacrimal drainage physiology. This failure may be caused by anatomic deformity such as punctal eversion or other eyelid malpositions, but can also result from lacrimal pump inadequacy caused by weak orbicularis muscle action. It is helpful to determine whether the patient’s complaint is true epiphora or a “watery eye.” Detailed history-taking and careful examination will help direct the evaluation of a tearing eye. A host of clinical tests have been described, and the selection of appropriate tests will depend on the initial history and ophthalmic examination. 13-1-1 History-Taking. Any clinical evaluation should begin with a thorough history. A complaint of watery eye does not necessarily imply a lacrimal drainage problem.

Usefulness of high definition sialoendoscope for evaluation of lacrimal drainage system in congenital nasolacrimal duct obstruction

2021 ◽  
pp. 112067212110080
Author(s):  
Nishi Gupta ◽  
Poonam Singla ◽  
Suma Ganesh
Keyword(s):  
Light Transmission ◽  
Drainage System ◽  
Nasolacrimal Duct ◽  
Nasolacrimal Duct Obstruction ◽  
High Definition ◽  
Congenital Nasolacrimal Duct Obstruction ◽  
Duct Obstruction ◽  
Lacrimal Drainage System ◽  
Membranous Obstruction ◽  
Lacrimal Drainage

Purpose: Sialoendoscope was used as a dacryoendoscope, high- definition images of the lacrimal drainage system (LDS) were captured and its performance in congenital nasolacrimal duct obstruction (CNLDO) is reported. Methods: Nasal endoscopy was done as the first in all the cases using a 0°, 2.7 mm nasal endoscope (Karl Stroz Tutlingan Germany). This was followed by Dacryoendoscopy (DEN) of the lacrimal drainage system from puncta till the valve of Hasner. DEN was performed under general anaesthesia in 26 children (including 17 primary and 9 failed probing cases). All cases were examined using 0.8 mm sialoendoscope (Karl Storz, Tuttlingen, Germany) with fibreoptic light transmission with a side port for irrigation. Results: We were able to obtain high-definition images of canaliculi, lacrimal sac, sac duct junction, proximal, mid and distal segments of nasolacrimal duct in all the children with CNLDO. In 17 primary cases 16 had distal membranous obstruction and I case had proximal canalicular obstruction. In nine children with history of failed probing, five had membranous obstruction, two had dacryoliths, two had NLD malformation at different levels. An overall success rate of 88.4% was achieved. Conclusion: Sialoendoscope can be used as high-definition dacryoendoscope for diagnostic and therapeutic use in CNLDO. Useful information can be obtained on dacryoendoscopy in complex CNLDO cases.

scholarly journals Incidence of acquired lacrimal drainage system obstruction in epiphoric patients in Thailand

2010 ◽  
Vol 4 (1) ◽  
pp. 159-162
Author(s):  
Suppapong Tirakunwichcha ◽  
Ehwika Rengwanidchakul ◽  
Somkiat Asawaphureekorn ◽  
Supaporn Tengtrisorn ◽  
Khanchai Juangphanich ◽  
...  
Keyword(s):  
Incidence Rate ◽  
Dry Eye ◽  
Drainage System ◽  
Nasolacrimal Duct ◽  
Common Cause ◽  
Duct Obstruction ◽  
Lacrimal Drainage System ◽  
Medical Centers ◽  
Outpatient Departments ◽  
Lacrimal Drainage

Abstract Background: There were few reports regarding the incidence of the acquired nasolacrimal duct obstruction, and the incidence in different geography or countries might be alike. Since the nasolacrimal drainage system obstruction is a common problem in Thailand, knowledge of the incidence may disclose the burden of the disease that has never been reported. Objectives: Evaluate the incidence of acquired lacrimal drainage system obstruction (ALDO) in Thailand. Methods: This study was conducted in multi-centers. It was based on prospective and descriptive design. All patients with epiphoric symptoms visiting the outpatient departments of five tertiary eyecare centers were recruited between 2004 and 2007. Features of epiphoric symptoms and medical history were recorded, and complete ophthalmic examinations were performed. Results: Epiphoric patients were enrolled from all medical centers with 245 eligible patients, female:male ratio was 4.2:1. Ninety-nine patients (40%) had duration of epiphoric symptoms between one-five years. ALDO was found in 111 patients (45%) with female preponderance (6.9:1). Seventy-one patients (64%) had pre-sac obstruction and 40 patients (36%) had post-sac obstruction. Among other causes of epiphora, dry eye was the most common. Conclusion: The most common cause of epiphora was ALDO. The four-year incidence rate of ALDO among epiphoric patients was 45%.

scholarly journals Anatomical and Functional Outcome of Rectangular Three Snip Punctoplasty in Primary Acquired Punctal Stenosis in a Tertiary Care Hospital of Karachi

2021 ◽  
Vol 37 (2) ◽  
Author(s):  
Nazia Qidwai ◽  
Muhammad Ashraf ◽  
Mujahid Inam ◽  
Adil Salim Jafri ◽  
Saima Majid
Keyword(s):  
Tertiary Care ◽  
Drainage System ◽  
Posterior Wall ◽  
Care Hospital ◽  
Lacrimal Drainage System ◽  
Quasi Experimental ◽  
History Of ◽  
Canalicular Stenosis ◽  
Lacrimal Drainage ◽  
Punctal Stenosis

Purpose:  To find out the anatomical and functional outcomes of rectangular three-snip punctoplasty in primary acquired punctal stenosis. Study Design:  Quasi Experimental study. Place and Duration of Study:  Isra Postgraduate Institute of Ophthalmology, Karachi, from July to December 2020. Methods:  Patients of age 50 years and above, from either gender with primary acquired punctal stenosis of any grade (0-5) presenting with epiphora were recruited from Oculoplasty Outpatient department. Punctal stenosis with secondary causes like lesion on or around punctum or lacrimal drainage system and history of surgery or radiotherapy, lower canalicular or common canalicular stenosis were excluded from the study. Punctal stenosis was graded by Kashkouli scale and epiphora by the Munk score. After local anesthesia, two vertical cuts were given in the posterior wall of the punctum and a third cut was given horizontally to connect the vertical cuts. This resulted in a posterior ampullectomy. Syringing and probing was done to assess patency of the lower lacrimal drainage system. The patients were followed up for 6 months to assess for anatomical and functional success. Results:  At the end of six month anatomical success was achieved in 85% cases and functional success in 70% patients. Fifteen percent patients suffered re-stenosis of punctum. Conclusion:  Rectangular punctoplasty is a functionally successful procedure for treating primary acquired punctal stenosis. The anatomy is least distorted and long-term recurrence rate is also low. Key Words:  Epiphora, Primary acquired punctual stenosis, Punctoplasty, Munk score.

Lacrimal drainage anomalies in Tessier cleft 3 with unilateral anophthalmos

2019 ◽  
pp. 112067211989147
Author(s):  
Swati Singh ◽  
Abhimanyu Sharma ◽  
Vikas Mittal ◽  
Mohammad Javed Ali
Keyword(s):  
Drainage System ◽  
Nasolacrimal Duct ◽  
Anatomical Location ◽  
Lacrimal Sac ◽  
Duct Obstruction ◽  
Lacrimal Drainage System ◽  
Computed Tomographic ◽  
The Right ◽  
Current Report ◽  
Lacrimal Drainage

Bilateral Tessier cleft types 3 and 4 are rare and commonly involve the lacrimal drainage system owing to their anatomical location. Such clefts commonly present with associated ocular anomalies and include colobomatous eyelids, hypertelorism, microphthalmia, punctal or canalicular agenesis, and nasolacrimal duct obstruction or exstrophy. The current report presents an 18-month-old baby with bilateral Tessier cleft 3 with a unilateral anophthalmos, symmetrical eyelid colobomas, and lacrimal drainage anomalies. The lacrimal anomalies noted include small lacrimal sac with inferior canaliculus on the right side and upper and lower punctal and canalicular agenesis on the left side. Computed tomographic dacryocystography demonstrated unilateral lacrimal sac and bilateral maldevelopment of the bony nasolacrimal duct.

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