scholarly journals Dacryocystorhinostomy for the treatment of nasolacrimal duct obstruction: a pilot trial to assess impact on coexisting sinus symptoms

2020 ◽  
Vol 17 (1) ◽  
pp. 10-18
Author(s):  
Ankur Mehta ◽  
Wan Yi ◽  
Arjuna Ananda ◽  
Raf Ghabriel
Keyword(s):  
Pilot Study ◽  
Nasolacrimal Duct ◽  
Nasolacrimal Duct Obstruction ◽  
Patient Questionnaire ◽  
Nasal Discharge ◽  
Duct Obstruction ◽  
Post Surgery ◽  
Endonasal Dcr ◽  
The Impact

Purpose: To report on coexistent sinus symptoms in a population of patients who underwent endonasal dacryocystorhinostomy (DCR) surgery for nasolacrimal duct obstruction (NLDO) in a pilot study designed to test and refine methods and to estimate patient sample size for a larger multicentre randomised trial. Methods: Ninety-four consecutive patients with NLDO who underwent endonasal DCR by three surgeons in both public and private practice over a two-year period were included in this study. Questionnaires were given preceding DCR surgery and at 10 weeks post-surgery. Sinus symptoms including sinusitis, nasal congestion, hyposmia, nasal discharge, and facial pressure were assessed in the questionnaire. All subjects underwent primary endonasal DCR and all patients underwent the same post-operative regimen. Results: Questionnaire responses revealed that 48/94 (51%) patients had one or more sinus symptoms prior to DCR surgery. Ten-week post-DCR follow-up questionnaires were obtained from 77/94 (82%) patients. About 20/31 (65%) patients with one or more sinus symptoms prior to DCR surgery reported resolution of coexisting sinus symptoms by 10 weeks post-DCR surgery. Conclusion: The data from this pilot study suggest that approximately half of patients attending for NLDO have coexisting sinus symptoms. There was some loss to follow-up. This pilot study highlighted the need for a validated patient questionnaire, longer length of follow-up, control groups for surgical intervention, and use of perioperative medications. Any clinical trial designed to assess the impact of endonasal surgery on sinus symptoms would need to enrol several hundred patients in order to reach a statistically valid conclusion.

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.

Non-Surgical Crigler massage for treatment of congenital nasolacrimal duct obstruction in infants below one year age.

2021 ◽  
Vol 28 (06) ◽  
pp. 804-807
Author(s):  
Mohammad Alam
Keyword(s):  
Nasolacrimal Duct ◽  
Nasolacrimal Duct Obstruction ◽  
Medical Sciences ◽  
Congenital Nasolacrimal Duct Obstruction ◽  
Duct Obstruction ◽  
Topical Antibiotics ◽  
One Year ◽  
Medical University ◽  
Age Range

Objective: To analyse the efficacy of non-surgical Crigler massage for treatment of congenital nasolacrimal duct obstruction in infants below one year age. Study Design:  Setting: Khyber Medical University Institute of Medical Sciences (KMU-IMS) KDA Teaching Hospital Kohat. Period: April 2014 to June 2019.  Materials & Methods:  on Non-Surgical Crigler massage for conservative   treatment of congenital nasolacrimal duct obstruction in infants below one year age. Proper proforma was designed for documentation of patients and their follow up. Consents were taken from their parents. 93 patients with age range of 2-6 months with congenital nasolacrimal duct obstruction were included in the study out of which 51(54.83%) were male and 42(45.16%) were female. 79(84.94%) patients had unilateral while 14(15.05%) patients had bilateral congenital nasolacrimal duct obstruction. So total 107 eyes with congenital nasolacrimal duct obstruction were included. Parents were trained and educated for conservative non-surgical Crigler massage of the lacrimal sacs along with topical antibiotics. Parents were instructed to do 8-10 massage four times a day. Patients were followed up to one year of age. 11 patients were lost from complete follow up in which 9 had unilateral while 2 patients had bilateral congenital nasolacrimal duct obstruction. Cumulatively 13 eyes were missed from follow up. Final results of remaining 82 patients with 94 eyes were analysed. Results: Out of 94 eyes epiphora was abolished with negative regurgitation test in 68(72.34%) patients at the end of one year while in 26(27.65%) the procedure was failed. Conclusion: Non-surgical conservative Crigler massage is very successful in management of congenital nasolacrimal duct obstruction.

Endoscopic dacryocystorhinostomy for acquired nasolacrimal duct obstruction

2009 ◽  
Vol 123 (11) ◽  
pp. 1226-1228 ◽  
Author(s):  
S Agarwal
Keyword(s):  
Nasolacrimal Duct ◽  
Nasolacrimal Duct Obstruction ◽  
Published Data ◽  
Duct Obstruction ◽  
Endoscopic Dacryocystorhinostomy ◽  
External Dacryocystorhinostomy ◽  
One Year ◽  
Conventional Manner ◽  
Gain Access

AbstractObjective:To evaluate the results of endoscopic dacryocystorhinostomy performed to treat acquired nasolacrimal duct obstruction.Design:Retrospective analysis of the outcome of endoscopic dacryocystorhinostomy performed in the conventional manner (i.e. without power instruments or laser) to treat acquired nasolacrimal duct obstruction.Subjects:Outcomes for 300 patients with acquired nasolacrimal duct obstruction were evaluated. Cases with congenital or traumatic blockages were excluded. All the cases were evaluated for nasolacrimal duct blockage by the syringing and regurgitation test. Surgery was performed under local anaesthesia with sedation. Follow up was conducted by syringing and nasal endoscopy, up to one year. Results were compared with published data for endoscopic and external dacryocystorhinostomy.Results:Outcomes were evaluated subjectively using patient symptoms, syringing results and endoscopic appearance. All cases were symptom-free following endoscopic dacryocystorhinostomy. Revision surgery was performed in 18 cases. Stents were placed in 10 patients, of which two developed granulations. Septoplasty was performed in 25 cases to gain access to the lacrimal sac area.Conclusion:The results were comparable with published data for endoscopic and external dacryocystorhinostomy.

Laser Transcanalicular Endonasal DCR

2010 ◽  
Vol 3 (1) ◽  
pp. 23-25 ◽  
Author(s):  
Pravesh Yadav ◽  
Ravi Meher ◽  
Kavita Goyal ◽  
Virad Kumar ◽  
Aditi Chopra
Keyword(s):  
Success Rate ◽  
Failure Rate ◽  
Nasolacrimal Duct ◽  
Success Rates ◽  
Duct Obstruction ◽  
Endonasal Dcr ◽  
Endoscopic Dcr ◽  
External Dacryocystorhinostomy ◽  
Preliminary Study

Abstract Nasolacrimal duct obstruction is a common disorder which clinically manifests as epiphora. Many procedures have been described to bypass this obstruction, for example external dacryocystorhinostomy (DCR), endoscopic DCR with and without stents, Laser endoscopic DCR. Each of these procedures has its own success rates and complications. We did an analysis of all laser assisted endonasal DCR performed in our department from Feb 2006 to July 2009. In all we had operated 237 total cases out of which 203 were with normal endonasal DCR and 34 cases were Laser transcanalicular endonasal DCR (Laser DCR). Over all success rate was 92%(218 cases). In case of Laser assisted endonasal DCR the success rate was 70.3% (19 cases) with failure rate of 29.7% (8 cases) at three months follow-up. This preliminary study reveals that LASER DCR is associated with higher failure rates as compared to the normal endonasal DCR.

Efficacy of endonasal dacryocystorhinostomy, using ‘cold steel’ instruments without stenting, in treatment of distal nasolacrimal duct obstruction

2011 ◽  
Vol 125 (6) ◽  
pp. 590-594 ◽  
Author(s):  
L Ananth ◽  
P Hosamani ◽  
G Chary
Keyword(s):  
Complete Resolution ◽  
Cost Effective ◽  
Nasolacrimal Duct ◽  
Nasolacrimal Duct Obstruction ◽  
Success Rates ◽  
Duct Obstruction ◽  
Lacrimal System ◽  
Reliable Procedure ◽  
One Year

AbstractObjective:To assess the efficacy of an endonasal dacryocystorhinostomy technique using conventional instruments, without the use of any adjunctive techniques.Study design:Prospective, non-randomised, cohort study.Methods:Patients diagnosed with nasolacrimal duct obstruction between January 2006 and December 2008 were included in the study. Seventy-eight endonasal dacryocystorhinostomies (primary or revision) were performed with conventional ‘cold steel’ instruments. The technique involved complete exposure and marsupialisation of the lacrimal sac. No adjunctive procedures were used. Success was defined as complete resolution of epiphora and a patent lacrimal system, evaluated by lacrimal irrigation and endoscopy, one year post-operatively.Results:Seventy-four of the 78 cases were symptom-free after a minimum follow up of 12 months, giving an overall success rate of 94.9 per cent. The success rates for primary and revision cases were 95.5 and 90.9 per cent, respectively.Conclusion:Meticulous surgical technique can ensure high success rates with the use of conventional cold steel instruments, without the use of adjunctive procedures, making endonasal dacryocystorhinostomy a cost-effective, reliable procedure.

scholarly journals Nine-Month Follow-up Results of Treatment for Nasolacrimal Duct Obstruction by Probing with Adjunctive Mitomycin C in Adults: A Prospective Randomized Placebo-Controlled Trial

2015 ◽  
Vol 51 (1) ◽  
pp. 19
Author(s):  
Nader Dehghani ◽  
Mohamad Reza Fouladivanda ◽  
Mohamed Amin Ghobadifar ◽  
Gelayol Safshekan-Esfahani ◽  
Armin Akbarzadeh
Keyword(s):  
Mitomycin C ◽  
Controlled Trial ◽  
Nasolacrimal Duct ◽  
Nasolacrimal Duct Obstruction ◽  
Duct Obstruction ◽  
Results Of Treatment

Long-Term Results of Closed Nasolacrimal Intubation in Adults

2007 ◽  
Vol 17 (4) ◽  
pp. 490-493 ◽  
Author(s):  
A. Shah ◽  
A.K. Tekriwal ◽  
P.M. Drummond ◽  
G. Woodruff
Keyword(s):  
Surgical Treatment ◽  
Invasive Procedure ◽  
Nasolacrimal Duct ◽  
Nasolacrimal Duct Obstruction ◽  
Long Term Results ◽  
Minimally Invasive Procedure ◽  
Duct Obstruction ◽  
Primary Procedure

Purpose Dacryocystorhinostomy (DCR) is the standard surgical treatment for adult nasolacrimal duct obstruction. There have been relatively few studies of closed nasolacrimal duct intubation in adults. The aim of this study was to determine rates of anatomic patency following this procedure. Methods The authors carried out a survey of all patients undergoing closed nasolacrimal duct intubation as a primary procedure over a period of 3 years and 4 months. There were 32 eligible patients of whom 20 attended for review. Results A total of 75% of these cases had patent drainage after follow-up of between 6 months and 3 years. The proportion of patients with persistent patency after intubation was the same regardless of length of follow-up. Conclusions The minimally invasive procedure of lacrimal intubation may have a role in some adults with nasolacrimal duct obstruction.

scholarly journals Symptom score questionnaire for nasolacrimal duct obstruction in adults--a novel tool to assess the outcome after endoscopic dacryocystorhinostomy

2010 ◽  
Vol 48 (4) ◽  
pp. 446-451
Author(s):  
G. Smirnov ◽  
H. Tuomilehto ◽  
H. Kokki ◽  
T. Kemppainen ◽  
V. Kiviniemi ◽  
...  
Keyword(s):  
Symptom Score ◽  
Nasolacrimal Duct ◽  
Nasolacrimal Duct Obstruction ◽  
Subjective Outcome ◽  
Duct Obstruction ◽  
Endoscopic Dacryocystorhinostomy ◽  
Glasgow Benefit Inventory ◽  
One Year

BACKGROUND: The incidence of nasolacrimal pathway obstruction increases with age, and dacryocystorhinostomy (DCR) is a commonly applied surgical technique to treat severe cases. However, no disease-specific tools to assess the symptoms and the subjective outcome after DCR have been established. We have developed a specific Nasolacrimal Duct Obstruction Symptom Score (NLDO-SS) questionnaire to evaluate the outcome, and tested it in a prospective clinical trial. STUDY DESIGN: Prospective clinical follow-up study. METHODS: Sixty-eight consecutive primary endoscopic dacryocystorhinostomy (EN-DCR) procedures were performed in 64 patients during 2004-2008. Preoperatively and during the three follow-up visits (at 1 week, 2 and 6 months), the patients filled in the NLDO-SS, and at the second and third follow-up visits they also filled in the Glasgow Benefit Inventory (GBI) questionnaire. At one year after the operation, a GBI questionnaire was sent to the patients. RESULTS: The surgical success rate of EN-DCR was 93 %. EN-DCR resulted in a significant reduction in all of the eight symptoms scores of the NLDO-SS (p= 0.001). The GBI scores indicated a significant benefit at 2 months (+37 (SD; 28) and an even higher benefit at 6 months after surgery (+52 (SD; 29), p= 0.001), but no further improvement was found between 6 and 12 months (+52 vs +52, p= 1.0). The correlation between the total GBI and NLDO-SS was significant (p=0.001). CONCLUSIONS: EN-DCR significantly improves the quality of life as measured by the GBI. The NLDO-SS correlated with the GBI and gave more information about the benefits after EN-DCR than GBI alone. The NLDO-SS proved to be an effective tool to evaluate lacrimal obstructions and EN-DCR benefits. Further studies to validate NLDO-SS are needed.

Endoscopic dacryocystorhinostomy with circumostial mitomycin C injection, simultaneous limited septoplasty and the use of tissue glue

2020 ◽  
Vol 13 (9) ◽  
pp. e235565
Author(s):  
Rafal Nowak ◽  
Iwona Nowak
Keyword(s):  
Mitomycin C ◽  
Nasolacrimal Duct ◽  
Observation Time ◽  
Septal Deviation ◽  
Nasolacrimal Duct Obstruction ◽  
Duct Obstruction ◽  
Endoscopic Dacryocystorhinostomy ◽  
Tissue Glue

Epiphora due to nasolacrimal duct obstruction is a common condition worsening one’s quality of life. It requires surgical treatment. We present a combined technique of transnasal endoscopic dacryocystorhinostomy with simultaneous limited septoplasty, circumostial mitomycin C injection and the use of tissue glue in a case of a 72-year-old patient with nasolacrimal duct obstruction complicated by septal deviation. The multiprocedure surgery was performed successfully. Follow-up time was 2 years. The patient remained asymptomatic within the observation time. Functional and anatomical success was achieved. We believe that the transnasal endoscopic dacryocystorhinostomy extended by limited endoscopic septoplasty, circumostial mitomycin C injection and the use of fibrin glue may be a solution for selected cases of nasolacrimal obstruction accompanied by significant local septal deviation.

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