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Macri CZ, Shapira Y, Tong J, Hood K, Drivas P, Patel S, Selva D. A Pilot Study of Dynamic Magnetic Resonance Dacryocystography Imaging to Assess Functional Epiphora. Semin Ophthalmol 2024; 39:158-164. [PMID: 37697818 DOI: 10.1080/08820538.2023.2256842] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/01/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVE To evaluate dynamic magnetic resonance dacryocystography (MRDCG) in eyes with functional epiphora. METHODS We included prospective eyes with epiphora if no alternative cause was found on clinical examination, were patent on syringing, had no obstruction or stenosis on DCG, and had an abnormal DSG. MRDCG was performed to qualitatively assess for block or patency and quantitatively measure tear transit time. We compared measurements to asymptomatic fellow eyes and to historical reference values from asymptomatic eyes. RESULTS We included 26 symptomatic eyes of 19 patients (median age 63 years). There was a block on MRDCG in 18 (69%) eyes and patency in 8 (31%) eyes. The block occurred at the sac-nasolacrimal duct (NLD) junction in 9 (50%), proximal NLD in 5 (28%), mid-NLD in 1 (5.6%), and distal NLD in 1 (5.6%) eye(s). No contrast was observed in the lacrimal system in two eyes. For eyes patent on MRDCG, median times to the sac, NLD, inferior meatus, first 25%, and first 50% of the fundus-to-nose distance (FND) were 22, 54, 118, 34, and 84 s, respectively. Times to the sac, NLD, and to fill the first 25% and 50% of the FND were significantly longer than historical values from asymptomatic lacrimal systems (p = 0.017, 0.050, 0.035, 0.017, respectively). CONCLUSION MRDCG shows a high rate of block in functional epiphora. However, DSG and MRDCG results may not always correlate. The improved temporal resolution of this emerging modality may be advantageous in the critical first 2 min of tear transit.
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Affiliation(s)
- Carmelo Zak Macri
- The Discipline of Ophthalmology and Visual Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Ophthalmology, The Royal Adelaide Hospital Adelaide, Adelaide, South Australia, Australia
| | - Yinon Shapira
- Department of Ophthalmology, The Royal Adelaide Hospital Adelaide, Adelaide, South Australia, Australia
| | - Jessica Tong
- The Discipline of Ophthalmology and Visual Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Ophthalmology, The Royal Adelaide Hospital Adelaide, Adelaide, South Australia, Australia
| | - Kylie Hood
- Department of Radiology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Peter Drivas
- Department of Radiology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Sandy Patel
- Department of Radiology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Dinesh Selva
- The Discipline of Ophthalmology and Visual Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Ophthalmology, The Royal Adelaide Hospital Adelaide, Adelaide, South Australia, Australia
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Oklar M, Yazıcıoglu T, Talan M. Modified Horner-Duverney's muscle plication in the treatment of functional epiphora. Graefes Arch Clin Exp Ophthalmol 2023; 261:2971-2978. [PMID: 37195338 DOI: 10.1007/s00417-023-06090-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/17/2023] [Accepted: 04/29/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND The orbicularis oculi muscle, especially its part (Horner-Duverney's muscle), which is surrounded by the pericanalicular and located deep in the lacrimal sac, is of primary importance in all stages of tear fluid flow. PURPOSE This study aimed to demonstrate that tightening the pretarsal-preseptal orbicularis oculi and Horner-Duverney muscles may improve the function of the lacrimal pump and may be a surgical alternative for treating functional epiphora. MATERIAL AND METHODS This was a prospective interventional case series of 28 patients with functional epiphora. During surgery, sutures were used to perform the intervention, and these were first passed through the upper and lower eyelid pretarsal-preseptal orbicular muscles, through the Horner-Duverney's muscle, and finally, through the dacriocystorhinostomy incision and tightened. Each patient completed the Lac-Q questionnaire and Munk scale prior to surgery, as well as six weeks and six months later. Before surgery, a fluorescein dye disappearance test was performed, which was repeated at follow-up appointments. Pre- and post-operative data were analyzed and compared at the most recent visit. RESULTS Twenty-eight patients (10 males and 18 females) with a mean age of 59 ± 35 years were included in this study. The severity of epiphora and its tearing effect on daily life significantly improved following the operation. The fluorescein dye disappearance test result was significantly improved after 6 weeks of followup in %89.3 of eyes and at 6 months followup in 92.9% of eyes. The Lac-Q questionnaire's mean social impact scores improved significantly postoperatively, from 3.76 to 0.77 (p < 0.001). The changes in total scores (7.29 before surgery to 1.71 after 6 months) were statistically significant (p < 0.001). The Munk score success rate was 64.3% and 85.7%, respectively. No significant complications or adverse effects were observed. CONCLUSION Our findings suggest that a beneficial and seemingly simple, safe, and easy procedure to reduce functional epiphora is to tighten the preseptal-pretarsal orbicularis and Horner-Duverney's muscles.
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Affiliation(s)
- Murat Oklar
- Department of Ophthalmology, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Turkey.
| | - Titap Yazıcıoglu
- Department of Ophthalmology, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Turkey
| | - Mustafa Talan
- Department of Ophthalmology, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Turkey
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Maroto Rodríguez B, Stoica BTL, Toledano Fernández N, Genol Saavedra I. Treatment for functional epiphora with botulinum toxin-A versus lateral tarsal strip in a randomized trial. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:549-557. [PMID: 35879178 DOI: 10.1016/j.oftale.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/13/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION To compare the efficacy of botulinum toxin A (BoNTA) injection into the lacrimal gland versus lateral tarsal strip (LTS) for functional epiphora. METHODS Randomized clinical trial. Sequential, parallel, non-blinded study design. Patients aged 18 years or older with functional epiphora and a minimum score of 3 in Munk Scale (MS) were randomized to BoNTA or LTS group. Changes in Munk scale, Schirmer test (ST) and quality of life (QoL) were assessed at week 6 and during follow-up until week 30. The mean time without epiphora and the adverse events (AE) were recorded. RESULTS The final analysis included 25 patients, 12 (21 eyes) assigned to BoNTA (5U/0.05 mL) and 13 (20 eyes) to LTS. At 6 weeks there was an improvement in the MS in BoNTA versus LTS group (-2.48 vs -1.55, P = .0152) and at 12 weeks (-2.68 vs -1.69, P = .0267). A significant decrease was noted in the ST at week 2, 12 and 30 with BoNTA. The QoL improved after both interventions without statistical significance. The mean duration of effectiveness in BoNTA group was 26.2 weeks (range 7.7-36.6) and in LTS group was 24.8 weeks (range 6.7-37.6), P = .937. The main AE were temporary eyelid ptosis in 25% (3/12) of the BoNTA group and surgical scar discomfort in 23% (3/13) of the LTS groups, P = .722. No AE were classified as severe. CONCLUSION BoNTA injection into the lacrimal gland is a safe and effective treatment for functional epiphora, with a greater decrease in MS at 6 and 12 weeks compared with LTS.
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Affiliation(s)
- B Maroto Rodríguez
- Servicio de Oftalmología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain.
| | - B T L Stoica
- Servicio de Oftalmología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - N Toledano Fernández
- Servicio de Oftalmología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - I Genol Saavedra
- Servicio de Oftalmología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
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Mirshahvalad SA, Chavoshi M, Bahmani Kashkouli M, Fallahi B, Emami-Ardakani A, Manafi-Farid R. Diagnostic value of lacrimal scintigraphy in the evaluation of lacrimal drainage system obstruction: a systematic review and meta-analysis. Nucl Med Commun 2022; 43:860-868. [PMID: 35506272 DOI: 10.1097/mnm.0000000000001578] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE A systematic review and meta-analysis to evaluate the diagnostic performance of lacrimal scintigraphy (LS) versus anatomical methods in the evaluation of the nasolacrimal duct obstruction (NLDO). MATERIALS AND METHODS A systematic search was performed using electronic bibliographic databases until the end of May 2021. Inclusion criteria: (a) used LS as a diagnostic method to evaluate NLDO; (b) used anatomical studies [including syringing, irrigation, probing, and dacryocystography (DCG)] as reference tests; and (c) provided adequate crude data. A hierarchical method was used to pool the sensitivity and specificity. The hierarchical summary receiver-operating characteristic model was performed. Additionally, the studies' heterogeneity and publication bias were analyzed. All analyses were conducted by the 'Midas' module of STATA 16. RESULTS Twelve articles (with 14 separate populations) were considered eligible to enter the meta-analysis. They were divided into two groups based on the reference standard method, called irrigation and DCG groups. In the irrigation group, the pooled sensitivity and specificity were 89% [95% confidence interval (CI), 72-96%] and 25% (95% CI, 8-56%), respectively. In DCG group, the pooled sensitivity and specificity were 97% (95% CI, 85-100%) and 27% (95% CI, 0.12-0.49), in turn. CONCLUSION LS is a sensitive modality to evaluate the anatomical obstruction of NLD. In contrast, it shows low pooled specificity compared with anatomical methods. Thus, LS can be used as the first noninvasive modality for the evaluation of epiphora. However, in case of any abnormality, confirmatory procedures are required.
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Affiliation(s)
- Seyed Ali Mirshahvalad
- Research Center for Nuclear Medicine, Dr. Shariati Hospital, Tehran University of Medical Sciences
| | - Mohammadreza Chavoshi
- Department of Radiology, Dr. Shariati Hospital, Tehran University of Medical Sciences
| | - Mohsen Bahmani Kashkouli
- Skull Base and Eye Research Center, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Babak Fallahi
- Research Center for Nuclear Medicine, Dr. Shariati Hospital, Tehran University of Medical Sciences
| | - Alireza Emami-Ardakani
- Research Center for Nuclear Medicine, Dr. Shariati Hospital, Tehran University of Medical Sciences
| | - Reyhaneh Manafi-Farid
- Research Center for Nuclear Medicine, Dr. Shariati Hospital, Tehran University of Medical Sciences
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Yazicioglu T, Inan R, Agaçkesen A, Oklar M, Şimşek S. The electromyographic analysis of orbicularis oculi muscle in epiphora. Indian J Ophthalmol 2022; 70:2094-2100. [PMID: 35647989 PMCID: PMC9359296 DOI: 10.4103/ijo.ijo_2744_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: Functional epiphora is a clinical condition that presents with the complaint of watery eyes, but without anatomical stenosis in the lacrimal drainage system. Although the mechanism is not clear, there are various possibilities involving the movement of the orbicularis oculi muscle, especially its deeper segment (Horner’s muscle). We aimed to evaluate the function of the orbicularis oculi muscle in patients with patent, but dysfunctional lacrimal drainage system using a quantitative motor unit potential (MUP) analysis. Methods: Twenty-eight patients with functional epiphora (mean age = 59 years) and a control group of 28 volunteers were included in the study. Inclusion criteria were persistent and symptomatic epiphora or wiping >10 times per day and diagnosis confirmation by lacrimal irrigation test. Electromyography (EMG) was performed on the deeper segment of the orbicularis oculi muscle (medial and lateral parts). MUP parameters (duration time, amplitude, number of phases, number of turns, area, rise time, and thickness) were evaluated in both groups. Any increase in amplitude, prolongation time (>14 ms), number of turns, and satellite potential was taken as characteristic of the neurogenic type of epiphora, whereas shortened motor unit duration time, increased phase number, and low amplitude are the features of myopathic type. Results: Upon MUP analysis of the medial and lateral orbicularis oculi muscle, the increase in duration and thickness values in the medial part and the increase in duration, amplitude, area, and thickness values of the lateral part were found to be statistically significant in the patient group compared to the control group (P < 0.001). In the evaluation of the patients’ medial and lateral orbicularis oculi muscle, the increase in phase values and decrease in amplitude, area, and rise time values were found to be statistically significant (P = 0.024, P < 0.001, P < 0.001, and P = 0.010, respectively). Conclusion: These data show that functional epiphora is due to neurogenic damage of the orbicularis oculi muscle and should be investigated in more detail.
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Affiliation(s)
- Titap Yazicioglu
- Department of Ophthalmology, Kartal, Dr. Lutfi Kirdar City Hospital, Istanbul/, Turkey
| | - Rahsan Inan
- Department of Neurology Clinics, Kartal, Dr. Lutfi Kirdar City Hospital, Istanbul/, Turkey
| | - Anıl Agaçkesen
- Department of Ophthalmology, Kartal, Dr. Lutfi Kirdar City Hospital, Istanbul/, Turkey
| | - Murat Oklar
- Department of Ophthalmology, Kartal, Dr. Lutfi Kirdar City Hospital, Istanbul/, Turkey
| | - Saban Şimşek
- Department of Ophthalmology, Kartal, Dr. Lutfi Kirdar City Hospital, Istanbul/, Turkey
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Singh S, Dhull A, Selva D, Ali MJ. Tear transit time evaluation using real-time technique for dynamic MR dacryocystography. Orbit 2020; 40:34-38. [PMID: 32126865 DOI: 10.1080/01676830.2020.1735453] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To explore the utility of a novel real-time dynamic magnetic resonance dacryocystography (MRDCG) technique to assess the transit times through the lacrimal drainage system (LDS). Methods: Twenty-six patent LDS of 13 normal and asymptomatic individuals underwent MRDCG using a dynamic recalled three-dimensional spoiled gradient sequence (3DSPGR) on 1.5-Tesla magnetic resonance (1.5T MR) scanner while pre-determined diluted gadolinium drops were instilled into the eyes simultaneously. MR images of 0.8 mm thickness were captured every 9.4 s for 10 min. Evaluated parameters include the time taken for contrast to first appear in lacrimal sac, nasolacrimal duct (NLD), and inferior meatus (IM). Results: Dynamic MRDCG demonstrated contrast outflow in all cases with good structural delineation. The mean transit time for contrast to appear in lacrimal sac was 15.2 s (9.4-66 s; SD, 11.9), 50.4 s for nasolacrimal duct (18.9-151; SD, 32), and 150.5 s for inferior meatus (37.8-490; SD, 135). Contrast appeared in the IM in less than 2 min in 62% (16/26) systems, and only 19% (5/26) required more than 5 min. The maximum time taken for the contrast to reach IM was 6.2 min and all the LDS eventually showed the contrast into the nasal cavity. No statistically significant differences were noted in the transit times between the right and left sides. Conclusion: Dynamic MR-DCG using real-time 3DSPGR sequence reliably demonstrates the structural and physiological assessment of LDS and could be further explored to study the physiology and pathologies of the LDS.
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Affiliation(s)
- Swati Singh
- Ophthalmic Plastic Surgery Services, LJ Eye Institute , Ambala, India
| | - Anuj Dhull
- Goodhopes Diagnostic Centre , Karnal, India
| | - Dinesh Selva
- Department of Ophthalmology, Royal Adelaide Hospital , Adelaide, Australia
| | - Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, LV Prasad Eye Institute , Hyderabad, India
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