Morphological Characteristics of the Lacrimal Apparatus in its Obstruction of Various Genesis

Purpose: morphological assessment of the lacrimal ducts at various anatomical levels in patients with primary (PANDO) and secondary (SALDO) obstruction after radioactive iodine therapy.Methods. The material was obtained during endoscopic dacryocystorinostomy with revision of Hasner's valve in patients with PANDO (n=7) in the distal segments of the nasolacrimal duct and in patients with SALDO (n=7) after radioactive iodine therapy. During the surgery, a biopsy of Hasner's valve, as well as a biopsy of the lacrimal sac wall were performed. The resulting material was stained with hemotoxylin and eosin, alcyan blue and by Masson method. Morphological and morphometric analyses were performed in semi-automatic mode. The results of histochemical staining of sections were translated into points taking into account the area and optical density (chromogenicity) in relative units: 1 – weak (0 – 0.3); 2 – moderate (0.3 – 0.6); 3 – significant (>0.6). The nonparametric Mann-Whitney criterion was used for statistical analysis. The differences were considered significant at p<0.05.Results. The comparative morphological study both confirmed the available information concerning the radiation nature of the obstruction and allowed to quantify the fibrosis level of the stromal component and other lacrimal ducts structures.Conclusion. It was shown that the nasolacrimal duct sclerosis is significantly lower (p=0.029) in patients with SALDO than in patients with PANDO while fibrosis in the lacrimal sac is the same in patients of the compared groups.

Ultrasound, Dacryocystorhinography and Morphological Examination of Normal Eye and Lacrimal Apparatus of the Donkey (Equus asinus)

The study investigated normal macromorphological and ultrasonographic features of the eye and lacrimal gland, as well as normal dacryocystorhinography of the donkey (Equus asinus) in Egypt. A total of 36 donkeys of different ages, weights, and sexes were included in the study: 21 live animals for ultrasonography and dacryocystorhinography, and 15 cadaver skulls for morphological anatomy of the lacrimal apparatus. The ultrasound biometric values of the eye were 33.7 ± 1.7 mm for axial globe length (AGL), 39.8 ± 2.1 mm for globe diameter (GD), 10.8 ± 0.7 mm for lens thickness (LT), 3.2 ± 0.7 mm for anterior chamber depth (ACD), and 19.3 ± 1.6 mm for vitreous chamber depth (VCD). The lacrimal gland was recognized as a hypoechogenic structure with an anechoic core, located at the dorsolateral aspect of the orbit, and ovoid in shape. The mean NLD length was 193.0 ± 9.8 mm by radiography and 206.0 ± 20.4 mm by gross assessment. One NL orifice (NLO) was noticed on each side, with a diameter of 3.0 ± 0.1 mm and located 12.1 ± 2.1 mm from the dorsal commissure of the nostril. These results may act as the baseline for proper management of conditions of the eye and lacrimal apparatus in the donkey in the future.

Management of Traumatic Soft Tissue Injuries of the Face

Facial soft tissue injuries encompass a broad spectrum of presentations and often present significant challenges to the craniofacial surgeon. A thorough and systematic approach to these patients is critical to ensure that the patient is stabilized, other injuries identified, and the full extent of the injuries are assessed. Initial management focuses on wound cleaning with irrigation, hemostasis, and debridement of nonviable tissue. Definitive management is dependent on the region of the face involved with special considerations for critical structures such as the globe, lacrimal apparatus, facial nerve, and parotid duct. Following sound surgical principles, these injuries can be managed to maximize both functional and aesthetic outcomes while minimizing complications.

OCT-meniscometry as a method for quantifying the balance of the lacrimal system

All diseases of the lacrimal apparatus of the eye disrupt the balance of the lacrimal system either due to changes in the production of tears, or due to the insufficiency of its removal, so the study of the quantity and quality of tears on the eye surface allows us to reliably assess the effectiveness of methods of treating the pathology of the lacrimal organs. OCT-meniscometry is the only non-contact, non-invasive, accurate method of examining the lacrimal apparatus, which is reflected in the publications of many authors. The aim of our study was to improve the accuracy and automate the process of calculating the area of the lacrimal meniscus, as well as to evaluate the correlation between the indicators of OCT-meniscometry and functional tests. Materials and methods. The study included 50 patients with dacryostenosis (group 1), who were examined before and 1 month after surgical treatment (recanalization of SOP), as well as 30 patients without pathology of the lacrimal organs, who did not complain of lacrimation and dry eyes (group 2). All patients underwent a Schirmer and Norn test according to the generally accepted method, and OCT-meniscometry was performed using an optical coherence tomograph. The resulting OCT-meniscogram was transferred to a special mathematical program. Green's formula was used to calculate the area. Results. Meniscometry data had a strong correlation with functional tests (p<0.05) and high diagnostic sensitivity and specificity. Conclusion. The method of OCT-meniscometry has a higher sensitivity and specificity compared to routine tests, is less invasive, highly informative, which, of course, increases the reliability of the analysis of treatment results. Key words: meniscometry, TMA, lacrimal meniscus area, lacrimal system balance, dacryology.

Mascara-induced nasolacrimal duct obstruction

A 35-year-old woman underwent left external dacryocystorhinostomy (DCR) following a recent bout of left acute dacryocystitis. She had a right DCR 14 years earlier. Her relatively young age of presentation prompted suspicion of secondary nasolacrimal duct obstruction and, although the left lacrimal sac appeared macroscopically normal peroperatively, a lacrimal sac biopsy was taken. Histopathology revealed florid chronic inflammation, with abundant granular brown pigment and polarisable crystals suggestive of an exogenous material in the lacrimal sac mucosa compatible with mascara. After initial improvement, her epiphora has recurred 1-year postoperatively, but her ocular discharge has resolved. Mascara-induced conjunctival pigmentation is well established. However, there are very few published reports of nasolacrimal duct obstruction due to mascara. Since cosmetic application of mascara and kohl eyeliner is widespread, patients and practitioners should be aware of their potential to migrate into the lacrimal apparatus and cause chronic inflammation with secondary nasolacrimal duct obstruction.

Radiological evaluation of lacrimal apparatus injury after functional endoscopic sinus surgery

ObjectiveTo determine the incidence of nasolacrimal duct injury after functional endoscopic sinus surgery radiologically, using computed tomography.MethodsFifty patients of either sex who underwent functional endoscopic sinus surgery were evaluated for nasolacrimal duct injury by computed tomography. Computed tomography was conducted pre-operatively, and post-operatively at the end of four weeks, and nasolacrimal duct injury was analysed.ResultsThe prevalence of nasolacrimal duct injury dehiscence was 1.16 per cent, with a similar incidence of 1.16 per cent for nasolacrimal duct injury post-operatively. However, no cases of symptomatic nasolacrimal duct injury were recorded.ConclusionComputed tomography scan is an effective, non-invasive method to evaluate nasolacrimal duct injury following functional endoscopic sinus surgery, in accordance with evidence-based medicine.

Anatomy of the lacrimal apparatus from a rhinologist’s perspective: a review

<p class="abstract">The postero-superioly situated lacrimal glands secreate tears to lubricate the exposed sclera, limbus and the cornea. The tears are ultimately are channeled into the antero-inferior sited lacrimal sac and thereby into the nasal inferior meatus. Epiphora may be secondary to irritative or obstructive pathology in the naso-lacrimal system. Individual with epiphora necessitates intervention, medical or surgical. The naso-lacrimal system with its unique anatomy has been elaborated upon to assist in detecting the precise site of pathology and plan management likewise.</p><p class="abstract"> </p>

Congenita ptosis; Frequency of congenital ptosis.

Objectives: To compare the frequency of congenital ptosis of Pakistani children with the children of the world. Study Design: Comparative study. Setting: Al Shifa Tertiary Eye Hospital Rawalpindi. Period: August 2013 to September 2016. Material & Methods: The record of admitted patients of all malformations of eyes was collected from pediatric eye department from age zero to 15 years. The data of each eye malformation was documented separately as per age and gender. The total numbers of eye malformations were arranged according to prevalence, age and gender. The data was analyzed separately for frequency, age and gender. All data was analyzed and arranged according to percentage of frequency, gender and age. The age data was analyzed making different age groups. Seven groups of age were made with 2 years difference between each group starting from age 0 to 15 years. The number of male and females were calculated in each age group. Total numbers of each malformation was calculated separately and percentage of each malformation calculated as per simple mathematical way to total malformations. Results: The data of five hundreds and fourteen congenital malformations of eyes was collected. The numbers of male patients were 289 and female patients were 225. As per percentage the males were 56.2% and females patients were 43.8 %. The patient age range was from age zero to fifteen years. The majority of the patients were between ages zero to two years. The total numbers of patients in this age group were 222. Out of 222 patients the males were 120 and females were 102. The total percentage of this age group was 43.2 % among all age groups. The most common frequency of eye malformation was cataract i.e. 116 (22.6 %) patients followed by lacrimal apparatus anomalies i.e. 103(20 %) and ptosis was 45 (8.8 %). Conclusion: The frequency of congenital ptosis is the third most common eye malformation among total eye malformations in this study.

Erkrankungen des Tränenapparats, Teil 2: Grundlagen der Therapie

The tearing eye (epiphora) is deemed to be the leading symptome of efferent tear duct stenosis. Nevertheless, epiphora might be caused by ocular surface pathologies or even intraocular diseases. A distinguished anamnesis and sufficient clinical examination is most meaningful for the differential diagnostic distinction. Therapy is based on pathologic changes. In case of ocular surface disease, a suitable tear substitution and antiinflammatory approach is mandatory. Multifarious triggers have to be considered as well. Addressing tear film distribution, suitable oculoplastic surgery is required. Efferent tear duct stenosis necessitates surgical treatment as the level of suffering is often very high and acute exacerbations may develop. Besides recanalization, anastomosing techniques represent the available therapeutic principles. Possible surgical approaches offer a great variety and many influencing factors navigate therapy decisions. This part of the review comments on the most important therapeutic approaches for lacrimal apparatus diseases.