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.

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.

scholarly journals Endoscopic dacryocystorhinostomy for nasolacrimal duct obstruction: an assessment of post-operative outcomes at a tertiary health care centre

2021 ◽  
Author(s):  
R. K. L. N. Raju Dantuluri
Keyword(s):  
Health Care ◽  
Success Rate ◽  
Drainage System ◽  
Nasolacrimal Duct ◽  
Nasolacrimal Duct Obstruction ◽  
Deviated Nasal Septum ◽  
Health Care Centre ◽  
Duct Obstruction ◽  
Endoscopic Dacryocystorhinostomy ◽  
Operative Outcomes

Background: Endoscopic dacryocystorhinostomy (Endo DCR) is a well-established surgical treatment for nasolacrimal duct obstruction (NLDO) cases. Advances in surgical technique and a better understanding of the anatomy have resulted in improvement of the success rate. The objective of this study is to assess the factors responsible for the recurrence of nasolacrimal system obstruction by evaluating the post-operative outcomes of Endo DCR at a tertiary health care centre.Methods: A retrospective study was conducted in the department of ENT, GVP IHC and MT, Visakhapatnam – Andhra Pradesh on 52 patients who underwent Endo DCR procedure from September 2018 to September 2021. The data regarding lacrimal drainage system, operative details, surgical outcomes and complications were analysed.Results: Fifty-two patients (18 male and 34 female) underwent 63 Endo DCR surgeries for NLDO. Success was achieved in 50 cases (79.4%), and failure in 13 (20.6%). Of the 13 failed cases, anatomical obstruction at the fistula site was found in 6 (46.2% of failed cases), whereas functional failure with no evidence of obstruction was found in 7 (53.8%).Conclusions: The success rate appears to be influenced by preoperative parameters like clinical as well as radiological examination of eye and nose; ruling out intraoperative conditions like sinusitis, deviated nasal septum, polyps. These are essential for better coordinating therapeutic expectations and better patient selection. Endo DCR proved to be a safe invasive procedure as it has direct approach to the sac and produced excellent results without any external scar.

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.

Topical Application of Mitomycin-C in Endoscopic Dacryocystorhinostomy

2000 ◽  
Vol 14 (3) ◽  
pp. 205-208 ◽  
Author(s):  
Yookyung K. Selig ◽  
Brian S. Biesman ◽  
Elie E. Rebeiz
Keyword(s):  
Success Rate ◽  
Mitomycin C ◽  
Topical Application ◽  
Drainage System ◽  
Endoscopic Dacryocystorhinostomy ◽  
Small Series ◽  
Endoscopic Dcr ◽  
Intraoperative Adjuncts ◽  
Lacrimal Drainage

Endoscopic dacryocystorhinostomy (DCR) is a well-established alternative to external DCR for treatment of obstruction of the lacrimal pathway and has a success rate of up to 95% in primary cases. Despite the benefits of using an endoscopic approach, including enhanced intranasal access to the lacrimal drainage system, there still exists a significant failure rate, particularly in revision procedures. As these failures are mainly due to obstructive postoperative adhesions, intraoperative adjuncts that prevent or minimize scarring should enhance the success rate. Endoscopic DCR was performed with intraoperative topical application of mitomycin-C, an antimetabolite often used in ophthalmologic procedures to reduce scarring and formation of adhesions following surgery. The procedure was successful in 7 of 8 instances, with a follow-up of 3 to 27 months. In one procedure, obstruction recurred 10 weeks after surgery. We feel that the results of this small series are encouraging and that further studies are warranted to determine the effectiveness of mitomycin-C as an adjunct to endoscopic DCR.

scholarly journals Nasolacrimal Duct Obstruction Caused by Lymphoproliferative Infiltration in the Course of Chronic Lymphocytic Leukemia

2015 ◽  
Vol 6 (3) ◽  
pp. ar.2015.6.0130 ◽  
Author(s):  
Ralph Litschel ◽  
Marco Siano ◽  
Abel-Jan Tasman ◽  
Sergio Cogliatti
Keyword(s):  
Standard Treatment ◽  
Malignant Tumors ◽  
Drainage System ◽  
Nasolacrimal Duct ◽  
Lymphocytic Leukemia ◽  
Nasolacrimal Duct Obstruction ◽  
Duct Obstruction ◽  
Proactive Approach ◽  
Lymphatic Leukemia ◽  
Lacrimal Drainage

Background Endoscopic dacryocystorhinostomy (DCR) is the standard treatment of nasolacrimal duct obstruction. Only in rare cases, blockage may be caused by malignant tumors and even more exceptionally by lymphatic neoplasms so that biopsies are not routinely taken for diagnostic purposes. Methods A computerized retrieval system was used for this retrospective study to identify all patients with histologically documented lymphoproliferative infiltration in the lacrimal drainage system from 2001 to 2009. Results In four of 191 patients (2.1%), infiltration of the nasolacrimal sac mucosa with a small lymphocytic lymphoma (SLL)/chronic lymphatic leukemia (CLL) was found. Patients who develop symptoms like epiphora within the course of known CLL are highly suspicious for lymphoproliferative infiltration of the lacrimal drainage associated lymphoid tissue. Conclusion A proactive approach with ophthalmologic consultation and DCR should be followed in these patients to avoid dacryocystitis.

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 Conventional Dacryocystorhinostomy Versus Pawar’s Implant Dacryocystorhinostomy- A Prospective Study

2019 ◽  
Vol 4 (01) ◽  
Author(s):  
Shivcharan Lal Chandravanshi ◽  
Sunil Kumar Shrivastava ◽  
Devendra Kkumar Shakya ◽  
Uma Saran Tiwari
Keyword(s):  
Success Rate ◽  
Nasal Mucosa ◽  
Clinical Success ◽  
Operating Time ◽  
Nasolacrimal Duct ◽  
Operative Complication ◽  
Chronic Dacryocystitis ◽  
Group B ◽  
Surgical Duration

Purpose: To compare conventional dacryocystorhinostomy (DCR) with Pawar’s intracystic implant dacryocystorhinostomy in terms of surgical technique, complications and success rate for primary acquired nasolacrimal duct obstruction (NLDO). Materials and Methods: This is a prospective comparative, nonrandomized, clinical study. It is carried out on 50 cases of primary acquired NLDO. The 50 cases were divide into two groups; Group A consisting of 30 cases that underwent Pawar’s intracystic implant DCR whereas Group B consisting of 20 cases those operated by conventional DCR technique. Data regarding demographic profile of patients, mode of presentation, diagnosis, intraoperative variables such as surgical duration, intra- and post-operative complications, hospital stay and causes of failure and final surgical outcome, were analyzed. Clinical success was defined as patent lacrimal system on irrigation (objective) and absence of symptoms (subjective). Results: Out of 50 cases 40 (80%) were female and 10 cases (20%) were males. In this study, 39 (78%) cases had chronic dacryocystitis, followed by pyocele/mucocele 5 (10%), chronic dacryocystitis with lacrimal fistula 3 (6%), and previous failed DCR surgery 3 (6%). Hemorrhage from nasal mucosa was observed in 9 cases (45%) during conventional DCR surgery and one case (3.33%) in implant DCR. Hemorrhage from angular vein occurred in 1 case (5%) during conventional DCR. Nasal mucosa was disrupted/damage in 8 cases (40%) during conventional DCR. The average operating time in convention DCR is 110.50 minutes while for Pwar’s implant DCR is 27.33 minutes. The commonest post-operative complication of Pawar’s intracystic implant DCR was obstruction of passage found in 4 cases (13.33%). Hypertrophic scar was the most common postoperative complication in 8 cases (40%) in conventional DCR. Success rate of implant DCR at 2 months follow up was 83.33% and at the end of 3 months after management of failed cases of implant DCR was 96.66%. Success rate of conventional DCR at 2 months follow up was 80% and at the end of 3 months after management of failed cases of conventional DCR was 85%. Conclusion: The success rate of Pawar’s intracystic implant DCR is comparable with conventional DCR with additional advantages such as easy, quick, minimal intra- and post operative complication and possibility of conventional DCR in future in failed Pawar’s implant DCR.

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