Surgical considerations for dacryocystorhinostomy with special emphasis on hemostatic techniques

Thirty patients were treated. All surgical procedures were carried out without technical difficulty. Estimated blood loss varied between 5 ml and 25 ml. In no case did bleeding obscure the operative field. Two patients did experience transient hypertension after injection of lidocaine with epinephrine. This was easily controlled by the anesthesiologist. After follow-up periods ranging from one year to five years, all patients have achieved a satisfactory result. No recurrent epiphora or infection has been noted. The technique described in this communication involves drugs, instruments, and equipment which have made our dacryocystorhinostomy rapid (35 to 45 minutes), controlled, and predictable. Surgical morbidity is negligible. Hemorrhage is no longer a fearsome problem. Exposure is always adequate. And, above all, uniform success has been very gratifying to surgical patients and surgeons.

Controlled sedation, sphenopalatine and nasociliary blocks, and bloodless flap suturing in dacryocystorhinostomy

Recently general anesthesia has become more popular than local for dacryocystorhinostomy, but the increasing bleeding tendency has hindered precise suturing of the nasal and lacrimal flaps. This paper describes a method of achieving controlled sedation with meperidine and chlorpromazine, postural sphenopalatine block with a mixture of cocaine and epinephrine, and nasociliary block with lidocaine. The dry field permits precise suturing of the mucosal flaps and has enabled the authors to gain experience with the miniature aneurysm needle of Reverdin, which facilitates suturing, and with Guibor's canaliculus intubation set, which is especially useful when flap suturing is not possible. Of 20 patients in whom this method was used, 16 obtained relief from dacryocystitis or tearing. Retrobulbar hemorrhage occurred in one patient during induction of the nasociliary block, necessitating cancellation of the operation, and pneumonitis occurred postoperatively in another patient. Respiratory gas exchange was normal when tested. The controlled sedation induced a fall in blood pressure and a rise in heart rate. No adverse effects of any of the drugs were noted. Thus, this method of controlled sedation and regional anesthesia is safe and effective, and because it reduces the bleeding tendency it makes the operation easier and shorter.

Bilateral Candida albicans dacryocystitis with facial cellulitis

Candida albicans rarely infects the lacrimal drainage system. This paper describes a case of bilateral C. albicans dacryocystitis following midfacial trauma. The patient presented with recurrent facial cellulitis and a fistula opening onto the cheek. The condition was controlled only after bilateral dacryocystorhinostomy along with amphotericin B therapy. This appears to be the first reported case in which the lacrimal sacs acted as a reservoir for microorganisms causing recurrent facial cellulitis.

Twenty years experience with intranasal transseptal dacryocystorhinostomy

The intranasal transeptal approach for treating chronic dacryocystitis has been utilized by the authors since 1959. A total of 305 operations have been performed with a high success rate and very low complication rate. The intranasal approach is preferred since it allows good visualization of the lacrimal sac, avoids a facial scar, and is most successful. Two hundred and eighty-four primary operations were performed with an 89% success. Of 29 failures, 25 were re-operated on with only 2 failures. Counting patients who required a revision operation, the overall success rate was 99%. Most revisions had to be performed because of scar formation in the nose or bony regrowth over the nasal opening. Complications were few with two patients having postoperative bleeding requiring nose to be repacked, two small septal perforations, one periorbital abscess and one case in which there was severe scar formation in the nose.

Acute suppurative dacryoadenitis caused by a cysticercus cellulosa

A case of acute suppurative dacryoadenitis caused by a cysticercus cellulosa in a male of 20 years is reported. The diagnosis was established by histopathologic examination of the cyst that escaped along with pus during drainage of the abscess. The abscess in the palpebral lobe of the lacrimal gland resulted from acute inflammation produced by the presence of an intact larva. There was no other focus of cysticercosis in the same eye, in the other eye, or anywhere else in the body. Postoperative recovery was uneventful and there were no sequelae. To our knowledge, this is the first case report of acute dacryoadenitis caused by a cysticercus cellulosa. As cysticercosis is still prevalent in the underdeveloped countries, it is to be kept in mind in the differential diagnosis of ocular and adnexal lesions in patients coming from these areas of the world.

Fibroma of the orbital wall after dacryocystectomy: case report

A rare case of fibroma of the inner and lower orbital wall in a 75-year-old man is described. The tumor was adherent to the periosteum of the orbital bones and occurred 1 1/2 years after an uncomplicated dacryocystectomy.

[The treatment of congenital obstructions of the lacrimal passages (author's transl)]

The Authors describe their method of treatment of congenital dacryocystitis. Up to 3-4 months of age the treatment consists in the use of antibiotic eye drops and message of the lacrimal sack. After this age and up to 8 months of age irrigation of the lacrimal passages is carried out. If this is unsuccessful or if the children are older a probing is performed. The Authors report the results of the probing in a series of 118 children (146 eyes). The best results are obtained when the probing is effectuated before 8 months of age. After this age the success decreases with the increase in age of the young children. There is no apprecciable difference between the unilateral and bilateral cases.

Silica granuloma of eyelid and ocular adnexa

Seven cases of subcutaneous epithelioid granulomas caused by silica and involving the eyelids and periorbital region are described. Histologically, all cases disclosed epithelioid tubercles and varying numbers of foreign-body-type giant cells, areas of scarring, and birefringent crystals. Light microscopy with polarized readily facilitated visualization of the crystals. Scanning electron microscopy and energy dispersive x-ray analysis clearly established that the crystals were composed of silica in both its pure and combined forms. This study emphasizes the need for examination of all epithelioid granulomas with polarized light. If crystalline foreign bodies are identified, further special techniques should be used for chemical characterization of the crystals.

Combined Jones tube-canalicular intubation and conjunctiva dacryocystorhinostomy

Six patients underwent combined Jones tube-canalicular intubation and conjunctival dacryocystorhinostomy. These patients had epiphora secondary to partial obstruction of the upper and lower canaliculi, complete obstruction of the common canaliculus or a single canaliculus, or paresis of the orbicularis oculi muscle. In these patients we would have performed a dacryocystorhinostomy with silicone elastic intubation, risking recurrent obstruction, or a conjunctival dacryocystorhinostomy with placement of a Jones tube, risking failure of the procedure and complete obstruction of patent canaliculi by placement of the tube. The combined Jones tube-canalicular silicone elastic intubation and conjunctival dacryocystorhinostomy ensured successful treatment of epiphora for this group of patients. Intubating the canaliculi with Bowman probes during placement of the Jones tube avoids injury and subsequent postoperative canalicular obstruction. After several months, the silicone elastic tubing is removed and the Jones tube is plugged. If the patient is asymptomatic and the canaliculi are patent and can be irrigated freely to the nasal cavity, the Jones tube can be removed. However, if epiphora occurs, the plug can be removed and the tube left in place to drain the tears without additional surgery.

Lacrimal system dacryoliths

Seventy consecutive patients undergoing dacryocystorhinostomy for chronic dacryocystitis or dacryostenosis were analyzed. Lacrimal sac stones were found in 11 patients for an incidence of 16%. All stones were studied histopathologically and six of these stones demonstrated morphological characteristics compatible with fungus. Two stones were cultured and one of these grew aerobes with the other growing fungi only. A series of nine patients with canalicular dacryoliths was analyzed. All patients were studied clinically and bacteriologically. No fungus was found on any of these cases. Aerobic cultures were positive in two patients. All patients with canalicular stones grew anaerobes with arachnia propionica and fusobacterium species predominating. The treatment for both problems is recognition and removal of the stones.

A simplified dacryocystorhinostomy technique

The evoluation of various types of dacryocystorhinostomies has been reviewed. The indications for operation are discussed. A simplified technique of surgery is illustrated and described in detail. The advantages of the method are: (1) The elimination of elaborate methods to remove the lacrimal bone while preserving the nasal mucosa. (2) The avoidance of the necessity of suturing the nasal mucosa membrane to the sac flaps. (3) The use of a comfortable, inconspicuous, easily inserted and easily removed silicone sponge stent to help avoid closure of the osteotomy.

Pityrosporum species associated with dacryoliths in obstructive dacryocystitis

Two dacryoliths removed from the obstructed and enlarged lacrimal sac of a 54-year-old woman during dacryocystorhinostomy were found to contain filamentous forms consistent with Pityrosporum orbiculare. To my knowledge, this fungus has not been observed before in a dacryolith or in dacryocystitis.