Co-existing lacrimal drainage anomalies in eyes with congenital Glaucoma

2022 ◽  
pp. 112067212110734
Author(s):  
Sirisha Senthil ◽  
Mohammad Javed Ali ◽  
Raghava Chary ◽  
Anil K Mandal
Keyword(s):  
Time Delay ◽  
Glaucoma Surgery ◽  
Nasolacrimal Duct ◽  
Congenital Glaucoma ◽  
Treatment Interventions ◽  
Congenital Nasolacrimal Duct Obstruction ◽  
Duct Obstruction ◽  
Canalicular Obstruction ◽  
Lacrimal Fistula ◽  
Lacrimal Drainage

Aim To evaluate the occurrence of co-existing congenital nasolacrimal duct obstruction (CNLDO) and other lacrimal anomalies in eyes with congenital glaucoma (CG). Methods Retrospective analysis of children aged ≤1-year with co-existing CG and CNLDO seen between 1998 and 2019, treatment interventions and outcomes. Results During the study period, 1993 children had CG and 6203 children had CNLDO, among the children aged 1-year or less. Of these, 51 children (73 eyes) had co-existing CG and CNLDO. The prevalence of CNLDO in CG was 2.5% (51/1993) and the prevalence of CG among CNLDO was 0.8% (51/6203). Median age (Interquartile range, IQR) was 53 days (IQR: 8, 155), when they were diagnosed with CG. Among the children with CNLDO, 68 eyes (93.1%) had simple CNLDO, and 5 eyes (6.9%) had complex CNLDO. Associated lacrimal anomalies were present in 7/73 eyes, including congenital lacrimal fistula in two eyes, upper punctal agenesis and upper mid-canalicular obstruction in two eyes each, and upper single canalicular-wall hypoplasia in one eye. Lacrimal syringing and probing were successful in 69/72 eyes (95.8%), and failed in 3 eyes (4.2%). These 3 eyes had complex CNLDO and underwent Dacryocystorhinostomy (DCR) with Mitomycin-C and intubation. Sixty-two eyes underwent combined trabeculotomy and trabeculectomy, and two eyes underwent trabeculectomy. Median age at glaucoma surgery was 87 days (IQR: 54, 193). Median time delay for glaucoma surgery after probing was 18 days (IQR: 12, 35). Conclusion Among children aged ≤1-year presenting with congenital glaucoma coexisting lacrimal drainage anomalies was noted in 2.5% and simple CNLDO was the commonest. Early intervention is of paramount importance to prevent sight-threatening intraocular infection with CNLDO, and to minimize the delay of glaucoma surgery. The outcomes of lacrimal probing were excellent, however complex CNLDO required DCR.

scholarly journals Congenital Lacrimal Fistula in a Seven-Year-Old Female: A Rare Cause of Epiphora

2020 ◽  
Author(s):  
Praveena Kher ◽  
Jigna Motwani
Keyword(s):  
Surgical Management ◽  
Drainage System ◽  
Nasolacrimal Duct ◽  
Medial Canthus ◽  
Direct Communication ◽  
Developmental Abnormalities ◽  
Duct Obstruction ◽  
Lacrimal Fistula ◽  
Rare Diagnosis ◽  
Lacrimal Drainage

Congenital lacrimal fistulas are rare epithelium-lined tracts that tend to have a direct communication between skin and the lacrimal drainage system. These are benign developmental abnormalities, that may require no treatment. This is a rare diagnosis since patients are usually asymptomatic and presents only when epiphora is associated. When symptomatic, congenital lacrimal fistula presents as epiphora, or mucoid discharge, rarely patients could develop nasolacrimal duct obstruction, which may present as recurrent dacryocystitis. Thorough clinical examination is the best way to diagnose the condition, where a fistula ostium may be found inferonasal to medial canthus of the eye. Further, lacrimal probing and irrigation is helpful. Surgical management of the fistula is advised only if the disease is symptomatic which ranges from simple excision to dacryocystorhinostomy. This is a report of one such patient with congenital lacrimal fistula which was treated surgically by fistulectomy.

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.

Spontaneous resolution rates in congenital nasolacrimal duct obstruction managed with massage or topical antibiotics compared with observation alone

2021 ◽  
pp. bjophthalmol-2021-318853
Author(s):  
Brian G Mohney ◽  
Saraniya Sathiamoorthi ◽  
Ryan D Frank
Keyword(s):  
Medical Records ◽  
Population Based ◽  
Nasolacrimal Duct ◽  
Spontaneous Resolution ◽  
Nasolacrimal Duct Obstruction ◽  
Olmsted County ◽  
Congenital Nasolacrimal Duct Obstruction ◽  
Duct Obstruction ◽  
Topical Antibiotics

Background/aimsTo determine if nasolacrimal massage or topical antibiotics are associated with higher rates of resolution compared with observation alone in a population-based cohort of infants with congenital nasolacrimal duct obstruction (CNLDO).MethodsThe medical records of all children <5 years diagnosed with CNLDO while residing in Olmsted County, Minnesota from 1 January 1995 through 31 December 2004 were retrospectively reviewed for type of management and non-surgical resolution of tearing.ResultsAmong 1958 infants diagnosed and followed for CNLDO, 516 (26.4%) were merely observed, 506 (25.8%) were prescribed massage alone, 485 (24.8%) were prescribed at least one course of topical antibiotics, 397 (20.3%) were prescribed both topical antibiotics and massage, and 54 (2.8%) had no documented therapy. Non-surgical resolution, occurring in 1669 (85.2%) during a median follow-up of 3.1 months (range: 1 week–248 months), was 74.6% for the merely observed, 89.7% for those prescribed digital massage, 87.0% for those prescribed antibiotics and 90.7% for those treated with both. This comparison was significant in unadjusted (p<0.001) and multivariable comparisons (p<0.001).ConclusionPrescribing topical antibiotics or digital massage for infants with CNLDO in this cohort, individually or in combination, was associated with a higher rate of spontaneous resolution than observation alone.

scholarly journals Resolution of congenital nasolacrimal duct obstruction with conservative management

2017 ◽  
Vol 6 (1) ◽  
pp. 12-15
Author(s):  
J B Shrestha
Keyword(s):  
Congenital Anomaly ◽  
Conservative Management ◽  
Pediatric Population ◽  
Clinical Signs ◽  
Nasolacrimal Duct ◽  
Nasolacrimal Duct Obstruction ◽  
Congenital Nasolacrimal Duct Obstruction ◽  
Duct Obstruction ◽  
Topical Antibiotics ◽  
Appropriate Treatment

Congenital nasolacrimal duct obstruction is the commonly encountered congenital anomaly in pediatric population occurring in as many as 30% of new borns. Conservative management of such condition with topical antibiotics and properly performed massage of the nasolacrimal sac is appropriate treatment during the first few months of age. The purpose of this study was to determine the rate of resolution of nasolacrimal duct obstruction with conservative management in infants up to 10 months of age. A total of 181 infants of age up to 10 months old with the diagnosis of Congenital nasolacrimal duct obstruction were advised nasolacrimal duct massage with or without the prescription of topical antibiotics. Resolution of nasolacrimal duct obstruction was assessed at 3 month and 6 month and was defined as the absence of all clinical signs of nasolacrimal duct obstruction. At the 6-month examination, 163 eyes (83%) of 181 children showed resolution with conservative management. The overall success rate of Congenital nasolacrimal duct obstruction with conservative management was high and this form of management can be considered as one of the best options in infants.

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