Surgical results of endoscopic dacryocystorhinostomy and lacrimal trephination in distal or common canalicular obstruction

Objectives

To evaluate the surgical outcomes of endoscopic dacryocystorhinostomy followed by canalicular trephination and silicone stenting in patients with distal or common canalicular obstructions.

Methods

The medical records of 29 patients (31 eyes) from January 2001 to December 2009 who underwent endoscopic dacryocystorhinostomy followed by canalicular trephination and silicone tube insertion for the treatment of distal or common canalicular obstructions were retrospectively reviewed. The level of obstruction was confirmed by intraoperative probing. The outcome of the surgery was categorized as a complete success, partial success, or failure according to the functional and anatomic patency.

Results

The average age of the patients was 52 years. The duration of silicone intubation ranged from 4 to 11 months with an average of 5.7±1.6 months. The follow-up period after stent removal ranged from 4 to 15 months with an average of 8.2±3.3 months. Complete success was achieved in 25 out of 31 eyes (80.6%), partial success in 4 out of 31 eyes (12.9%), and failure in 2 out of 31 eyes (6.5%).

Conclusion

Endoscopic dacryocystorhinostomy followed by canalicular trephination and silicone stent intubation may be safe and considered as an initial treatment of patients with distal or common canalicular obstructions.

Middle turbinate osteoma

Osteoma is the most common benign tumor of the paranasal sinuses. Turbinate osteomas are very rare and only four middle turbinate, one superior turbinate and one inferior turbinate osteoma cases have been reported. We present a rare case of osteoma of the left middle turbinate in a patient presented with unilateral nasal obstruction and epiphora that was removed endoscopically, and conduct a literature review on turbinate osteomas arising from different turbinates, their symptoms and management.

Prevalence of punctal stenosis among ophthalmology patients

Purpose:

To estimate the prevalence of punctal stenosis among patients visiting the general ophthalmology clinic for routine checkup.

Design:

Prospective, observational case series.

Materials and Methods:

A total of 682 patients were evaluated for evidence of punctal stenosis from May to November 2008. Any associated findings from clinical examination were recorded.

Results:

As many as 54.3% (370/682) of the candidates had punctal stenosis. The prevalence is associated significantly with increasing age (p=.001), and no gender predilection was found. It was due to chronic blepharitis in 97% (359/370), entropion in 1.4% (5/370) and unknown causes in 1.6% (6/370) of the patients. As many as 58.1% (215/370) did not have subjective or objective evidence of epiphora, and all of them had a tear film breakup time of less than 10 seconds and positive corneal fluorescein staining.

Conclusion:

Punctal stenosis is a common finding among patients presenting for routine eye checkup. It increases with advancing age, and the most common predisposing factor is chronic blepharitis. A significant number of patients can be asymptomatic as they have concurrent dry eye disease. Surgical intervention is not recommended unless the patient is symptomatic after treating any associated blepharitis and dry eye disease.

The surgical outcome of endoscopic dacryocystorhinostomy according to the obstruction levels of lacrimal drainage system

OBJECTIVES

Many factors influence the outcome of endoscopic dacryocystorhinostomy (DCR). One of the most important prognostic factors is the level of obstruction in the lacrimal drainage system. The main objective of this report is to evaluate both the frequency of obstruction by anatomical region of the lacrimal drainage system on dacryocystography (DCG) and the surgical outcome of endoscopic DCR according to the obstruction level.

METHODS

A retrospective series of 48 patients (60 eyes) who had undergone endoscopic DCR from January 2005 to November 2007 were enrolled. Preoperative evaluation consisted of a standard examination which included lacrimal irrigation, probing, DCG and osteomeatal unit (OMU) computed tomography. Patients were classified into four groups according to the obstruction level on DCG. Surgical outcome was evaluated postoperatively by subjective improvement of epiphora and patent rhinostomy opening on nasal endoscopic exam.

RESULTS

Of 60 eyes, the levels of obstruction were the common canaliculus in 14 eyes (23.3%), the lacrimal sac in 13 eyes (21.7%), the duct-sac junction in 13 eyes (21.7%) and the nasolacrimal duct (NLD) in 20 eyes (33.3%). The ductsac junction obstruction was treated most successfully (100%), followed by NLD obstruction (90%), common canaliculus obstruction (78.6%) and saccal obstruction (69.2%).

CONCLUSION

In patients with lacrimal drainage system obstruction, preoperative evaluation of obstruction level using DCG may be helpful for predicting the surgical outcome of endoscopic DCR. The saccal obstruction may have a worse prognosis than the other obstruction levels.

Endonasal endoscopic dacryocystorhinostomy: our experience

OBJECTIVES

To study the outcome of endonasal endoscopic dacryocystorhinostomy (DCR) with or without mucosal flap preservation, without mitomycin local application, silicon tube stenting or laser assistance. To determine the duration of the surgical procedure of DCR, influence of simultaneously performed endonasal endoscopic procedures for concomitant sinonasal diseases.

METHODS

Combined retrospective and prospective study in our tertiary referral center. 24 patients with chronic dacryocystitis underwent 25 standard endonasal endoscopic DCR procedures, 10 with and 15 without mucosal flap preservation. 6 of these had concomitant sinonasal diseases for which they underwent septoplasty or functional endoscopic sinus surgery (FESS) or both, simultaneously or as staged procedures. Relief from epiphora and patency of the nasolacrimal fistula was assessed by nasal endoscopy and syringing of the lacrimal apparatus at 1 week, 3 weeks and 3 months postoperatively.

RESULTS

Out of 18 patients who underwent only DCR, 17 patients (94.44%) had complete relief from epiphora. Out of 6 patients who underwent 7 DCRs with concomitant sinonasal surgery, 5 patients (85.71%) had complete relief from epiphora. Overall 23 out of 25 DCRs (92%) had complete relief. In 15 of the 25 procedures, mucosal flap was excised completely. In remaining 10 procedures, flap was trimmed, repositioned to cover exposed bone around the newly created nasolacrimal fistula. In either situation, only one patient each had partial block of the nasolacrimal fistula. Average duration of the surgical procedure of DCR was 18 min.

CONCLUSION

Endonasal endoscopic DCR is a viable alternative to external DCR, co-existing sinonasal diseases can be managed simultaneously, as may be required in 25% of cases. It can be performed under 20 min without mucosal flap preservation, mitomycin local application, silicon tube stenting or laser assistance and can still provide a good success rate (92%) with less complications.

Comparative Analysis of Laser Assisted Endoscopie and Conventional Endoscopie Dacryocystorhinostomy

BACKGROUND

Dacryocystorhinostomy (DCR) is the standard surgical treatment for epiphora caused by obstructions distal to the common canaliculus. Endoscopic DCR (EDCR) and laser assisted DCR (LAEDCR) are becoming increasingly popular alternatives.

METHOD

69 cases of EDCR were compared with 18 cases of LAEDCR. The success rates were noted at 01 week, 01, 03 and 06 months. The operating time required, incidence of adjuvant procedures, complications and post operative morbidity were recorded.

RESULTS

At the end of 06 months, 100% and 95% success was achieved with LAEDCR and EDCR respectively. Operating time, complication rates and the incidence of adjuvant procedures required were lesser in the LAEDCR group.

CONCLUSION

In our study both the procedures have comparable success rates, though LAEDCR has an edge over EDCR in terms of decreased duration of surgery, decreased post operative morbidity and lesser complications.

Intranasal endoscopic DCR (END-DCR) in cases of dacryocystitis

A prospective study on 27 cases of chronic dacryocystitis was done to see the outcome of management by End-DCR in Indian population and to look for advantages or disadvantages over Ext-DCR from available datas in literature All cases were diagnosed clinically by regurgitation test and lacrimal syringing In selected cases Jones dye test, dacryocystogram and CT scan of nose and paranasal sinuses (PNS) was done to confirm the site of obstruction and find out the cause Cases having hyperlacrumation due to other causes and epiphora due to presaccal stenosis were excluded Cause of NLD obstruction was atrophic rhinitis (4 cases), chronic sinusitis (4 cases), enlarged agger nasi cells (4 cases), faciomaxillary injury (1 case) and unknown in rest of cases All cases were treated by End-DCR under local anaesthesia Concommitent nose and PNS surgeries were done in selected cases where it was supposed to be the cause Average follow-up was from 3 months to 1 year Primary success rate was 92 6% and after revision in two cases final success was 96% Success rate was 100% in cases of atrophie rhinitis Major complication was not found in any case Our result of End-DCR was as good as Ext-DCR Our results of End-DCR are better than those who had used lacnmal stent, lasers, microdebriders, dacryoendoscope and electrocautery It was finally concluded that end-DCR by using simple instruments is a safe and effective procedure.

A case of epiphora and recurrent basal cell carcinoma of the nasal tip and review of acquired nasolacrimal system obstruction

A case of a 67-year-old man with recurrent basal cell carcinoma of the nasal tip and an incidental symptom of epiphora (volunteered by the patient) is presented. Epiphora is an abnormal overflow of tears that fail to drain into the inferior nasal meatus via the nasolacrimal system. Within the differential diagnosis of epiphora and nasolacrimal obstruction is neoplasm - primary, secondary or metastatic. On further investigation, including computed tomography imaging, he was subsequently found to have invasive disease extending along the left embryological cleavage plane superiorly to the medial canthal tendon. An excision attempt using Mohs technique by the dermatological surgeon was unsuccessful in adequately clearing the margins, and revealed a diagnosis of morphea-like basal cell cancer. This failure, taken together with the extent of disease identified by computed tomography scan, resulted in significant alteration of the operative approach. The patient underwent extensive tumour extirpation and nasal reconstruction using a forehead flap. The present case alerts surgeons involved in the management of skin cancers to the importance of the anatomical relationship of the nasolacrimal apparatus to embryological soft tissue cleavage planes when dealing with recurrent and aggressive lesions. In addition, it serves as a reminder to inquire about the signs and symptoms associated with nasolacrimal obstruction. Moreover, when preparing for surgical excision of recurrent aggressive basal cell carcinoma, high-quality imaging is essential to tailor the operative plan.