scholarly journals Canaliculitis masquerading as Dacryocystitis: Rhinologist's Dilemma

2017 ◽  
Vol 10 (2) ◽  
pp. 91-92
Author(s):  
Sima Das ◽  
Nishi Gupta ◽  
Neeraj Chawla
Keyword(s):  
Correct Diagnosis ◽  
Nasolacrimal Duct ◽  
Purulent Discharge ◽  
Delay In Diagnosis ◽  
Lacrimal System ◽  
Chronic Dacryocystitis ◽  
History Of ◽  
Endoscopic Dcr ◽  
Nose And Throat ◽  
Punctal Plug

ABSTRACT Aim To highlight canaliculitis masquerading as chronic dacryocystitis that may mislead a rhinologist. Background Canaliculitis is an inflammation of the lacrimal canaliculi caused by infection or as a complication of punctal plug insertion. It is often misdiagnosed, leading to a delay in diagnosis. Case report We report a case of a 20-year-old female patient who presented with complaints of watering from left eye since 1 year and was referred to the Department of Ear, Nose, and Throat for endoscopic dacryocystorhinostomy (DCR). She had a history of silicone punctal plug insertion in the same eye for “dry eye” following an attack of herpes zoster 12 years earlier. She was asymptomatic for 10 years following punctal plug insertion, but started complaining of epiphora since the last 2 years. Punctal plug was removed 1 year back by an ophthalmologist but the epiphora persisted. Regurgitation of purulent discharge on pressure over lacrimal sac area made it look like dacryocystitis. Syringing through lower punctum was blocked while through the upper punctum it was patent. Thus, possibility of nasolacrimal duct block was ruled out. An occuloplasty opinion was sought and a diagnosis of lower canaliculitis with possibility of retained plug was made. Conclusion Canaliculitis should be considered as a differential diagnosis in cases presenting with epiphora as canaliculitis is a close masquerade of dacryocystitis. Clinical significance As more and more rhinologists are getting direct referrals of cases needing endoscopic DCRs, it is important for them to be well aware of other associated pathologies of proximal lacrimal system. This will help them to reach a correct diagnosis before going ahead with endoscopic DCR. How to cite this article Gupta N, Das S, Chawla N. Canaliculitis masquerading as Dacryocystitis: Rhinologist's Dilemma. Clin Rhinol An Int J 2017;10(2):91-92.

scholarly journals Specific features of endoscopic dacryocystorhinostomy – case report

2015 ◽  
Vol 5 (17) ◽  
pp. 45-51
Author(s):  
Lucian Lapusneanu ◽  
Alina Neacsu ◽  
Andreea Naca
Keyword(s):  
Nasolacrimal Duct ◽  
Stent Insertion ◽  
Lacrimal Sac ◽  
Endoscopic Dacryocystorhinostomy ◽  
Evaluation Protocol ◽  
Chronic Dacryocystitis ◽  
History Of ◽  
Ophthalmologic Examination ◽  
Endoscopic Dcr ◽  
Age Range

AbstractOBJECTIVE. The aim of the study was to evaluate the endoscopic dacryocystorhinostomy (DCR) with some particularities and its advantages over external DCR. MATERIAL AND METHODS. We evaluated 3 female patients (age range 35-84 years) diagnosed with chronic dacryocystitis - lacrimal sac abscess (2 cases) and lacrimal sac fistula (1 case). All patients presented a history of repeated episodes of acute dacryocystitis initially treated with broad spectrum antibiotics by the ophthalmologist. The evaluation protocol consisted in cranio-facial CT scan or MRI for the evaluation of the lacrimal sac and nasal structures, an ophthalmologic examination with the catheterization of the superior and inferior lacrimal punctum with a light probe to verify the permeability of the lacrimal pathway, and the Jones test with fluorescein to receive information about the common lacrimal path. Lacrimal syringing with regurgitation of fluid from the opposite punctum was the only criteria to decide the surgery. In all three cases we performed an endoscopic DCR, with stent insertion in two cases and a laco-dacryo-rhinostomy in one case. In only one case a reintervention was needed 12 months later. CONCLUSION. The endoscopic DCR, with its different particularities, is a safe surgical procedure with a low rate of complications, being the treatment of choice for the treatment of nasolacrimal duct obstruction.

Results of endoscopic endonasal dacryocystorhinostomy: a prospective cohort study

2021 ◽  
pp. 1-12
Author(s):  
Ayesha Jawad ◽  
Ayisha Kausar ◽  
Saira Iftikhar ◽  
Nadia Akhtar ◽  
Zafar Rabbani
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Health Centre ◽  
Purulent Discharge ◽  
Deviated Nasal Septum ◽  
Endoscopic Endonasal ◽  
Chronic Dacryocystitis ◽  
History Of ◽  
Endoscopic Dcr

Abstract Objective: To evaluate the success rate of endoscopic endonasal Dacryocystorhinostomy Methods: This prospective cohort study was conducted at Ophthalmology and Otorhinolaryngology Department of Shifa Foundation Community Health Centre, Islamabad, Pakistan, from Oct 2017 to Sep 2019. The patients with chronic dacryocystitis who underwent endoscopic endonasal Dacryocystorhinostomy (DCR) were enrolled. Data for demographic information and clinical features (mucocele, deviated nasal septum, epiphora, purulent discharge and regurgitation test, history of acute dacryocystitis and probing and syringing etc.) was noted. Endoscopic DCR with or without lacrimal intubation was performed under general anesthesia. Patients were reviewed at post-operative week1, 1 month, 6 months and 12 months with documentation of epiphora, purulent discharge, need for syringing, nasal adhesions etc. Telephonic interviews were done in cases of missing data. Statistical analysis was done with SPSS 20.0. Results: The study enrolled 47 patients, majority of them were females (87.2%).  The mean age of patients was 40.70 ± SD 10.84 yrs, Range 25-66 yrs.. Minimum postoperative follow up period was 12 months; mean duration (14.53 ± 3.0 months). Lacrimal intubation was performed in 31 (66%) patients. Nasal endoscopy was performed and lacrimal tubes were removed after 6 months post operatively. Surgical success was achieved in 46 (97.9%) patients: 37 (78.7 %) patients were completely symptom free, 9 (19.1%) were partially symptomatic and were managed conservatively. Treatment failure requiring repeat surgical procedure was observed in only one patient (2.1%). Continuous...

scholarly journals ENDOSCOPIC ENDONASAL DACRYOCYSTORHINOSTOMY: EXPERIENCE OF HUNDRED CASES

2021 ◽  
Vol 71 (6) ◽  
pp. 2104-08
Author(s):  
Muhammad Shahid ◽  
Muhammad Awais ◽  
Amjad Akram ◽  
Syed Abid Hassan Naqvi ◽  
Omar Zafar ◽  
...  
Keyword(s):  
Armed Forces ◽  
Nasolacrimal Duct ◽  
Nasolacrimal Duct Obstruction ◽  
Sample Population ◽  
Endoscopic Endonasal ◽  
Duct Obstruction ◽  
Lacrimal System ◽  
Chronic Dacryocystitis ◽  
Quasi Experimental ◽  
External Dacryocystorhinostomy

Objective: To determine the success rate of Endonasal Endoscopic Dacryocystorhinostomy (Endo-DCR) in cases of chronic dacryocystitis secondary to primary acquired nasolacrimal duct obstruction (NLDO). Study Design: Quasi-experimental study. Place and Duration of Study: Department of Oculoplastic Surgery, Armed Forces Institute of Ophthalmology Rawalpindi, from Sep 2018 to Nov 2019. Methodology: Endo-DCR under General Anaesthesia was performed on 100 patients of primary acquired nasolacrimal duct obstruction causing chronic dacryocystitis. Post-operatively these patients were checked on first post-op day, then on one week and finally four months after surgery. We removed silicone tubes of all the patients four months after surgery. To ensure patency of lacrimal passage, we did syringing and irrigation of lacrimal system of all cases, at conclusion of the study. We chose absence of epiphora and patent lacrimal system on syringing as indicators of successful procedure. Results: Hundred patients (males 37; females 63) were recruited for this study. Mean age of our sample population was 51.1 ± 29 years. Right nasolacrimal duct obstruction cases were 56 whereas left nasolacrimal duct obstruction cases were 44. Subjective improvement i.e., absence of epiphora was found in 90% patients. We got successful irrigation of lacrimal passages (objective improvement) in 94% of patients. Conclusion: Endo-DCR yields comparable results to external Dacryocystorhinostomy (Ex DCR). It offers additional benefits of esthetically better outcome, lesser complication rate and short surgery and patient recovery time.

scholarly journals Idiopathic Hypoparathyroidism: Still a Diagnostic Conundrum – A Tertiary Centre Experience

2020 ◽  
Vol 52 (10) ◽  
pp. 708-711
Author(s):  
Rujul Jain ◽  
S. K. Singh ◽  
N. K. Agrawal
Keyword(s):  
Antiepileptic Drugs ◽  
Correct Diagnosis ◽  
Signs And Symptoms ◽  
Common Indication ◽  
Delay In Diagnosis ◽  
Tertiary Centre ◽  
History Of ◽  
Lag Period ◽  
Carpopedal Spasm

AbstractIdiopathic hypoparathyroidism leads to hypocalcemia and hyperphosphatasemia and usually has a genetic aetiology. The variable but often subtle signs and symptoms usually lead to a misdiagnosis of hypoparathyroidism. Case records of 32 patients of idiopathic hypoparathyroidism admitted over a period of five years were analysed. There was a lag period of 5.94 years from the onset of symptoms to the diagnosis. Carpopedal spasm was the most common indication for admission to the hospital. Trivial symptoms such as fatigue (84%) and paresthesia (62.5%) were the most common reported symptoms. A sum of 46.5% of the patients were on antiepileptic drugs before the correct diagnosis of hypoparathyroidism was made. This observation emphasized that Calcium profile should be obtained in patients with history of paresthesia and seizure to avoid the long delay in diagnosis of hypoparathyroidism.

Incidence of neoplasia in patients with unilateral epiphora

2015 ◽  
Vol 129 (S3) ◽  
pp. S53-S57 ◽  
Author(s):  
T Bewes ◽  
R Sacks ◽  
P L Sacks ◽  
D Chin ◽  
N Mrad ◽  
...  
Keyword(s):  
Nasolacrimal Duct ◽  
Nasolacrimal Duct Obstruction ◽  
Stricture Formation ◽  
Benign Stricture ◽  
Common Cause ◽  
Duct Obstruction ◽  
Lacrimal System ◽  
History Of ◽  
Surgical Teams ◽  
Operative Findings

AbstractBackground:Nasolacrimal duct obstruction is common and is usually a result of benign stricture formation. Although neoplasia near or around the lacrimal system may produce epiphora, the incidence of neoplasia from within the lacrimal system as a cause of nasolacrimal duct obstruction is not well documented.Methods:A retrospective study was performed on all patients undergoing dacryocystorhinostomy with a history of epiphora. The incidence of patients with operative findings of intra-lacrimal neoplasm was sought. Histopathologically confirmed cases were included.Results:The study comprised 537 patients, who underwent a total of 631 endoscopic dacryocystorhinostomy procedures between January 1998 and July 2013. Non-stenotic causes of nasolacrimal duct obstruction were encountered in 3.01 per cent of dacryocystorhinostomy procedures, and included neoplastic, inflammatory and infectious pathologies. Inverted papilloma was the most common cause, encountered in 0.79 per cent of dacryocystorhinostomy operations.Conclusion:These findings suggest that neoplasia is an uncommon but not a rare cause of nasolacrimal duct obstruction. Surgical teams performing high numbers of dacryocystorhinostomy procedures should be aware of such pathology and patients counselled appropriately.

scholarly journals Osteoma of the Medial Wall of the Maxillary Sinus: A Primary Cause of Nasolacrimal Duct Obstruction and Review of the Literature

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Athanasios Saratziotis ◽  
Enzo Emanuelli
Keyword(s):  
Maxillary Sinus ◽  
Nasolacrimal Duct ◽  
Medial Wall ◽  
Review Of The Literature ◽  
Computed Tomography Scan ◽  
Duct Obstruction ◽  
Chronic Dacryocystitis ◽  
History Of ◽  
Left Maxillary Sinus ◽  
Tomography Scan

A 74-year-old male patient presented to the outpatient department with left-sided epiphora and chronic dacryocystitis, without any history of head trauma or previous nasal or paranasal sinuses surgery. No abnormalities were noted at the time with the use of nasal endoscopy. The computed tomography scan however revealed an osteoma of the medial wall of the left maxillary sinus. An endonasal endoscopic dacryocystorhinostomy (DCR) with osteoma removal by using a drill with temporary silicone stenting of the nasolacrimal duct system was performed. Due to a granuloma formation at the DCR-window site 2 months postoperatively a revision-DCR was performed and the new window remained patent at control 6 months after surgery.

scholarly journals Study of patient outcome in endoscopic dacrocystorhinosomy using a microdebrider in chronic dacryocystitis patients

2020 ◽  
Vol 7 (2) ◽  
pp. 440
Author(s):  
Ankit Vishwani ◽  
H. C. Taneja ◽  
G. K. Das ◽  
Neelima Gupta ◽  
Vipin Arora
Keyword(s):  
Patient Outcome ◽  
Nasolacrimal Duct ◽  
Minimal Amount ◽  
Endoscopic Endonasal ◽  
Chronic Dacryocystitis ◽  
Silicone Stent ◽  
Recent Advancement ◽  
Suitable Treatment ◽  
Endoscopic Dcr

Background: Endoscopic dacryocystorhinostomy (DCR) has become accepted as a suitable treatment for patients with chronic dacryocystitis. In this study authors did endoscopic dacrocystorhinosomy using a microdebrider, which is a recent advancement tool being used successfully in other endoscopic sinus surgeries also. Limited studies are available as of now on this topic.Methods: A total number of 33 patients (with 40 affected eyes) presenting with complains of epiphora having nasolacrimal duct obstruction were selected. They underwent an endoscopic DCR in which dissection of some nasal mucosa and widening of bony ostium was done using a microdebrider. Silicone stent was passed into the nasolacrimal duct through both punctum. Patient outcome was assessed by using both objective (endoscopy and dye test) and subjective (improved symptoms) criteria. Standard follow up time for clinical course was kept 3 months with weekly visits.Results: Patients which got relief from epiphora in 37 eyes (92.5% cases) had no obstruction on endoscopy and positive dye test. Rest (7.5 % cases) had presence of granulation tissue at rhinostoma site and negative dye test, which was cited as the cause of failure.Conclusions: The use of microdebrider is potentially beneficial in endoscopic endonasal dacryocystorhinostomy. By using such an instrument, the minimal amount of tissue damage occurs, a large fistula is formed, and the recurrence due to the formation of adhesions/synechiae/granulations is prevented/reduced thus reducing the time of surgery, complications and failure rate.

scholarly journals Agger nasi mucocele cause nasolacrimal duct obstruction and chronic dacryocystitis: clinical profile, management and outcome

2021 ◽  
Vol 14 (5) ◽  
pp. e242140
Author(s):  
Athanasios Saratziotis ◽  
Claudia Zanotti ◽  
Jiannis Hajiioannou ◽  
Enzo Emanuelli
Keyword(s):  
Paranasal Sinuses ◽  
Nasolacrimal Duct ◽  
Nasolacrimal Duct Obstruction ◽  
Lateral Nasal Wall ◽  
Imaging Studies ◽  
Duct Obstruction ◽  
Chronic Dacryocystitis ◽  
Endoscopic Dcr ◽  
Profile Management ◽  
Ct And Mri

Epiphora is the first symptom of acquired nasolacrimal duct obstruction (NLDO), which may be due to various causes, including paranasal sinuses and tumours of the nasal cavity. A 28-year-old male patient presented chronic dacryocystitis with left-sided epiphora. Endoscopically, a bulging of the lateral nasal wall at the left-sided agger nasi area was noted. Imaging studies (CT and MRI) revealed a left-sided giant agger nasi mucocele. An endonasal endoscopic dacryocystorhinostomy (DCR) as well as opening of the agger nasi cell with mucocele removal and anterior ethmoidectomy was performed. Based on the literature, intranasal causes have very often occurred in patients with chronic dacryocystitis, but not reported as the cause of inflammation in the mucocele of agger nasi. Identification and recognition of this endonasal rare cause of NLDO-like agger nasi mucocele entity may facilitate timely intervention and can be treated successfully with a simultaneous endoscopic DCR procedure.

scholarly journals Endoscopic DCR with and without prolene stent in rural area: a prospective randomized study

2018 ◽  
Vol 4 (4) ◽  
pp. 1081
Author(s):  
Abhay Kumar ◽  
Prateek Kumar Porwal ◽  
Kailash Prasad Dubey ◽  
Harshita Singh
Keyword(s):  
Randomized Study ◽  
Nasolacrimal Duct ◽  
Nasolacrimal Duct Obstruction ◽  
Successful Outcome ◽  
Endoscopic Endonasal ◽  
Female Ratio ◽  
Duct Obstruction ◽  
Chronic Dacryocystitis ◽  
Endonasal Dcr ◽  
Endoscopic Dcr

<p class="abstract"><strong>Background:</strong> The objective of the study was<strong> </strong>to compare the results of endoscopic DCR with and without prolene stenting and to assess subjective and anatomical success in patients undergoing prolene stenting.</p><p class="abstract"><strong>Methods:</strong> The surgical outcomes of endoscopic endonasal DCR was compared in 100 patients of chronic dacryocystitis with nasolacrimal duct obstruction from June 2013 to May 2018. The successful outcome of surgery was defined by subjective improvement of symptoms and anatomical patency of the neo-ostium on syringing by nasal endoscopy.  </p><p class="abstract"><strong>Results:</strong> In our study females were predominant in both groups with around 60% being females in group with stenting and 64% in group without stenting. Male to female ratio was 1:1.5 and 1:1.77 in group with stenting and without stenting. The symptomatic success rate of the surgery at the end of 3 months was 92% in group without stenting and 88% in group with stenting. There was no statistical difference in the results of two groups.</p><p><strong>Conclusions:</strong> We recommend that stenting is not routinely required for endoscopic DCR surgeries. A selective stenting approach may be advocated using prolene 3-0, using stenting for specific indications. With proper surgical technique and good follow up, endoscopic DCR without stenting is treatment of choice for chronic nasolacrimal duct obstruction.</p>

scholarly journals Endoscopic Dacryocystorhinostomy: Advantage over External Approach

2019 ◽  
Vol 27 (2) ◽  
pp. 161-166
Author(s):  
Bijan Basak ◽  
Kaustuv Das Biswas ◽  
Subhradev Biswas ◽  
Ankit Choudhary
Keyword(s):  
Standard Treatment ◽  
Nasolacrimal Duct ◽  
External Approach ◽  
Interventional Study ◽  
Safe Alternative ◽  
Endoscopic Dacryocystorhinostomy ◽  
Chronic Dacryocystitis ◽  
Endoscopic Dcr ◽  
Prospective Longitudinal ◽  
External Dcr

Introduction Although external DCR was considered to be the Gold Standard treatment for NLD obstruction, endoscopic DCR appears to give comparable results,  with the advantage of the absence of external facial scar and no disruption of the medial palpebral ligament or the angular facial vessels. This study aims to evaluate the outcome of endoscopic dacryocystorhinostomy (DCR) and compare with the outcome of external DCR, based on data available on literature search. Materials and Methods In this prospective, longitudinal, interventional study, 67 cases of chronic dacryocystitis were operated endoscopically from January 2017 to December 2018. All patients were documented about detailed medical and operative history, thorough medical check up including ocular and ENT examination. Level of obstruction of nasolacrimal duct (NLD) was diagnosed by lacrimal syringing and probing. Surgery was performed under local anaesthesia except in uncooperative patients where general anaesthesia was used. 0˚ & 30˚ endoscopes were used in surgery. The surgical outcomes and complications were recorded, analyzed and compared to those of external DCR from available literature.   Results The overall success rate of endoscopic DCR was 94.7%, which is closely comparable to external DCR. Conclusion Endoscopic DCR is an effective and safe alternative to external DCR, with comparable results and better patient satisfaction.

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