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Ahmad TR, Lindquist KJ, Oatts JT, de Alba Campomanes AG, Kersten RC, Chan DK, Indaram M. Probing versus primary nasal endoscopy for the treatment of congenital dacryocystoceles. J AAPOS 2024; 28:103865. [PMID: 38458602 DOI: 10.1016/j.jaapos.2024.103865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 03/10/2024]
Abstract
PURPOSE To compare outcomes and complications of three surgical techniques for the treatment of congenital dacryocystoceles: nasolacrimal probing and irrigation (P+I), P+I plus nasal endoscopy (NE) with intranasal cyst marsupialization, and primary NE with intranasal cyst marsupialization. METHODS The medical records of children ≤2 years of age at a single academic center with a diagnosis of dacryocystocele from 2012 to 2022 were retrospectively identified and reviewed. The primary outcome was resolution of the dacryocystocele (ie, elimination of the medial canthal mass and resolution of tearing or discharge) after a single procedure ("primary success"). Surgical techniques were compared using exact logistic regression. RESULTS Of 54 patients, 21 (39%) underwent P+I, 23 (43%) underwent P+I plus nasal endoscopy, and 10 (18%) underwent primary NE. Primary success was 76% for P+I and 100% for the other two cohorts. Most patients (89%) who underwent P+I received general anesthesia compared with none who underwent primary nasal endoscopy. Most complications were related to the use of general anesthesia, with a complication rate of 10% for P+I, 48% for P+I plus NE, and 0% for primary NE. Most P+I procedures required hospital admission compared to half of primary NE procedures. CONCLUSIONS In our study cohort, primary NE provided good outcomes and was associated with a lower complication rate than P+I with or without NE.
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Affiliation(s)
- Tessnim R Ahmad
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | - Karla J Lindquist
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Julius T Oatts
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | | | - Robert C Kersten
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | - Dylan K Chan
- Department of Otolaryngology Head and Neck Surgery, University of California San Francisco, San Francisco, California
| | - Maanasa Indaram
- Department of Ophthalmology, University of California San Francisco, San Francisco, California.
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2
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Sunshein CK, Nestander CM, Eighmy MS. Respiratory Distress in a Newborn: Who Nose? Pediatr Rev 2023; 44:S85-S87. [PMID: 37777230 DOI: 10.1542/pir.2021-005313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Affiliation(s)
- Cpt Kyle Sunshein
- Department of Pediatrics, Brooke Army Medical Center, Fort Sam Houston, TX
| | - Cpt Matthew Nestander
- Department of Pediatrics, Neonatal Division, Brooke Army Medical Center, Fort Sam Houston, TX
| | - Maj Stephanie Eighmy
- Department of Pediatrics, Neonatal Division, Brooke Army Medical Center, Fort Sam Houston, TX
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Pur DR, Husein M, Makar I. Management of Congenital Dacryocystocele: A Case Series and Literature Review. J Pediatr Ophthalmol Strabismus 2023; 60:e31-e34. [PMID: 37227990 DOI: 10.3928/01913913-20230320-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Congenital dacryocystocele presents with a distinct bluish swelling in the medial canthal region in neonates. The authors present four illustrative cases with differing courses and a literature review on dacryocystocele management to raise awareness of the importance of prompt diagnosis, initiation of conservative management, and appropriate referral for surgical assessment. [J Pediatr Ophthalmol Strabismus. 2023;60(3):e31-e34.].
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Diab MM, Ali MJ, Mohammed KK. Clinico-radiologic characteristics of lacrimal sac area swellings misdiagnosed as dacryocystocele or mucocele. Eur J Ophthalmol 2023; 33:152-160. [PMID: 35950228 DOI: 10.1177/11206721221120152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE Several non-lacrimal lesions can present with lacrimal sac area swelling mimicking a dacryocystocele or mucocele with a possibility of misdiagnosis. This study investigates the clinic-radiologic characteristics of the mimicking conditions compared to true lacrimal sac distension. DESIGN Retrospective, comparative, interventional case series. PARTICIPANTS Patients referred by primary care ophthalmologists between January 2015 and October 2021 with a misdiagnosis of dacryocystocele or lacrimal sac mucocele (n = 39) and an age-matched group of proven true lacrimal sac swelling (TLS group, n = 44). METHODS Data collected included demographics, presenting features, investigations, management, histopathology, and outcomes. Both groups were statistically compared for several clinical and radiological variables. RESULTS Final diagnoses in the mimicking group were skin/subcutaneous swellings (14/39, 35.9%), vascular malformations (10/39, 25.6%), inferomedial anterior orbital cysts (7/39, 17.9%), sino-orbital masses (5/39, 12.8%). Female gender (<0.001), epiphora (p = 0.001), and discharge (p < 0.001) were significantly more frequent in the TLS group. The mimicking group was more likely to be associated with a longer swelling duration (p < 0.001), a swelling extending beyond the lacrimal sac area (p <0.001), orbital signs (p <0.001), and periorbital abnormality. Non-patent lacrimal irrigation (p < 0.001) was significantly more frequent in the TLS group. On imaging, all swellings in the mimicking group were separate from the lacrimal pathway and 94.9% (37/39) extended beyond the lacrimal sac fossa. CONCLUSION Various cutaneous, subcutaneous, vascular, inferomedial orbital cystic, and sinonasal pathologies can present with lacrimal sac area swelling and mimic a TLS. A high index of suspicion, a thorough clinical evaluation and proper imaging are essential to avoid a misdiagnosis.
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Affiliation(s)
- Mostafa Mohammed Diab
- Department of Ophthalmology, Faculty of Medicine, Fayoum University, Al Fayoum, Egypt
| | - Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, L V Prasad Eye Institute, Hyderabad, India
| | - Khaled Kotb Mohammed
- Department of Ophthalmology, Faculty of Medicine, Fayoum University, Al Fayoum, Egypt
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Yoshida H, Kihara C, Kitaoka K, Satoh C, Kumai Y. Congenital bilateral nasolacrimal duct cysts with respiratory distress in a newborn. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2022. [DOI: 10.1080/23772484.2022.2150628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Haruo Yoshida
- Department of Otolaryngology-Head and Neck Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Chiharu Kihara
- Department of Otolaryngology-Head and Neck Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kyoko Kitaoka
- Department of Otolaryngology-Head and Neck Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Chisei Satoh
- Department of Otolaryngology-Head and Neck Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yoshihiko Kumai
- Department of Otolaryngology-Head and Neck Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Microdebridement of Intranasal Cysts Associated With Congenital Dacryocystoceles. Ophthalmic Plast Reconstr Surg 2022; 38:401-403. [DOI: 10.1097/iop.0000000000002140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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7
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di Furia D, Pignataro L, Gaffuri M, Osnaghi SG, Battilocchi L, Cantarella G. Surgical treatment of a congenital dacryocystocele by means of microdebrider marsupialization in a newborn. Clin Case Rep 2021; 9:e04886. [PMID: 34987806 PMCID: PMC8696236 DOI: 10.1002/ccr3.4886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 11/10/2022] Open
Abstract
Congenital dacryocystocele is a rare clinical condition, more commonly unilateral, secondary to the defective canalization of the nasolacrimal duct. In case of failure of conservative treatment, surgical marsupialization is recommended. We describe the case of a 40-day-old male newborn treated by means of microdebrider marsupialization.
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Affiliation(s)
- Domenico di Furia
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoDepartment of Otolaryngology and Head and Neck SurgeryMilanItaly
- Università degli Studi di MilanoDepartment of Clinical Sciences and Community HealthMilanItaly
| | - Lorenzo Pignataro
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoDepartment of Otolaryngology and Head and Neck SurgeryMilanItaly
- Università degli Studi di MilanoDepartment of Clinical Sciences and Community HealthMilanItaly
| | - Michele Gaffuri
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoDepartment of Otolaryngology and Head and Neck SurgeryMilanItaly
- Università degli Studi di MilanoDepartment of Clinical Sciences and Community HealthMilanItaly
| | | | - Ludovica Battilocchi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoDepartment of Otolaryngology and Head and Neck SurgeryMilanItaly
- Università degli Studi di MilanoDepartment of Clinical Sciences and Community HealthMilanItaly
| | - Giovanna Cantarella
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoDepartment of Otolaryngology and Head and Neck SurgeryMilanItaly
- Università degli Studi di MilanoDepartment of Clinical Sciences and Community HealthMilanItaly
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Congenital Nasolacrimal Duct Obstruction Update Study (CUP Study): Paper 4-Infantile Acute Dacryocystitis (InAD)-Presentation, Management, and Outcomes. Ophthalmic Plast Reconstr Surg 2021; 38:270-273. [PMID: 34652315 DOI: 10.1097/iop.0000000000002077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To study the presentation, management, and outcomes of infantile acute dacryocystitis. METHODS Retrospective study of infants diagnosed with acute dacryocystitis over a period from June 2016 to December 2019. Data collected include demographics, clinical history, presenting features, management, complications, and outcomes. Treatment provided was intensive medical care followed by early probing under endoscopic guidance. Further interventions, where needed, were performed based on intraoperative findings during probing. Successful outcomes were defined as resolution of infection, subjective relief from epiphora, and anatomical patency determined by a normal fluorescein dye disappearance test. RESULTS Twenty-seven eyes of 27 infants were analyzed during the study period. The mean age of infants was 3.26 months, and males were more affected than females (male:female 15:12). The mean duration of symptoms was 4.66 weeks, with 96% (26/27) presenting with symptoms of redness, watering, discharge, and swelling. Preseptal cellulitis was seen in 74% (20/27) infants, lacrimal abscess in 67% (18/27) infants, and lacrimal fistula in 37% (10/27). Most infants had complex congenital nasolacrimal duct obstruction (62%, 13/27), of which 7 also had intranasal cysts. One infant successfully underwent endoscopic dacryocystorhinostomy. At a mean follow-up period of 7.95 months, successful outcomes were observed in 90.4% (19/21) infants. The 2 failed cases were complex congenital nasolacrimal duct obstruction with associated sac diverticula and are scheduled for an endoscopic dacryocystorhinostomy. CONCLUSION Infantile acute dacryocystitis is a distinct clinical entity. The outcomes of systemic antibiotics and early probing are excellent.
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Bothra N, Bansal O, Sharma A, Ali MJ. Congenital Nasolacrimal Duct Obstruction Update Study (CUP Study): Report III. Analysis of Earlier Failed Probing without Endoscopy Guidance. Semin Ophthalmol 2021; 37:249-252. [PMID: 34606409 DOI: 10.1080/08820538.2021.1980057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM The purpose of this study was to report the profile and outcomes of children with an earlier failed probing that was performed without endoscopy guidance. METHODS Retrospective interventional case study was performed on all the patients who were referred with a diagnosis of a single or multiple failed probing from Jan 2016 to June 2019 to a tertiary care Dacryology center. All the patients had a blind probing without an endoscopy assistance before referral. The parameters evaluated were patient demographics, number of earlier probings, prior operative notes, clinical presentation, findings of endoscopy guidance during the repeat procedure, simple vs complex CNLDO, types of complex CNLDO, management, complications and outcomes. RESULTS One hundred eyes of 82 children had a failed probing experience without endoscopic guidance elsewhere. The mean age of the children was 55.7 months (range: 9-168 months). Of these, 63 eyes underwent repeat probing under endoscopic guidance, 35 eyes being simple CNLDO (35/63, 55.5%), and 28 eyes (28/63, 44.5%) being complex CNLDO. Among the complex subset, balloon dacryoplasty was performed for five cases and monoka-Crawford stents for eight cases under direct endoscopy visualization. Buried probes were managed successfully by standard protocols of probe exteriorization. The two cases of misdirected probes were re-directed under endoscopy guidance for appropriate recanalization and the single case of granuloma at the NLD opening was excised followed by intubation without any recurrence. CONCLUSION Endoscopy guidance plays a crucial role in the management of CNLDO with an earlier failed probing.
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Affiliation(s)
- Nandini Bothra
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India
| | - Oshin Bansal
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India
| | - Abhimanyu Sharma
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India
| | - Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India
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Annac G, Yassa M. Is congenital dacryocystocele a benign, self-limited disorder? A review of the literature with four new cases. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:813-821. [PMID: 34235752 DOI: 10.1002/jcu.23037] [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: 04/07/2021] [Revised: 05/12/2021] [Accepted: 06/27/2021] [Indexed: 06/13/2023]
Abstract
Congenital dacryocystocele (CD) is a rare disorder about which little is known. A nonsystematic review was performed with an addition of four new cases. Thirty-seven studies were reviewed. The mean gestational age at evaluation was 32 ± 1.09 weeks suggesting that CD is a disorder of late second and third trimester. The mean diameter of dacryocystocele was 7.5 ± 1 mm. The overall associated fetal anomaly rate was 10.7%. In-utero resolution, neonatal resolution, and surgical management was concluded in 62% (n = 108), 29% (n = 52), and 8% (n = 14), respectively. In conclusion, the need for surgical correction and rate of accompanying fetal anomaly was found high.
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Affiliation(s)
- Gokce Annac
- Radiology Department, Bartin State Hospital, Bartin, Turkey
| | - Murat Yassa
- Department of Obstetrics and Gynecology, Prof Dr Ilhan Varank Sancaktepe Training and Research Hospital, Istanbul, Turkey
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Affiliation(s)
- Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India
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12
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Prat D, Magoon K, Revere KE, Katowitz JA, Katowitz WR. Management of Pediatric Acute Dacryocystitis. Ophthalmic Plast Reconstr Surg 2021; 37:482-487. [PMID: 33782322 DOI: 10.1097/iop.0000000000001932] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To analyze the clinical presentation, course, and management in a large cohort of pediatric acute dacryocystitis subjects and to examine whether hospitalization and urgent surgical intervention are indeed mandatory. METHODS A retrospective analysis of all pediatric subjects diagnosed with dacryocystitis at the Children's Hospital of Philadelphia over a 12-year period (2009-2020). RESULTS One-hundred sixty-nine pediatric acute dacryocystitis patients were included in this study. Management included admission in 117 cases (69%). Sixty-eight patients (40%) were treated medically with no surgical intervention, 75 cases (44%) required urgent surgical intervention, and 26 additional cases (15%) required surgery due to persistent tearing symptoms after medical management. The urgent procedures included most commonly: 1) endonasal examination and microdebridement of intranasal cysts in 26 cases (35%); 2) probing and irrigation without examination and microdebridement, with or without stent intubation, in 30 cases (40%); and 3) dacryocystorhinostomy (13 endonasal and 4 external) in 17 cases (23%). CONCLUSIONS Management of pediatric acute dacryocystitis should be tailored individually for each case. Hospital admission and early surgical intervention are not mandatory, as 31% of cases resolved without admission, and 56% without early surgical intervention. Although a specific age cutoff is not plausible, hospital admission for younger patients is more commonly advocated. When surgical intervention is indicated, endonasal examination and microdebridement of any associated intranasal cyst and probing with possible stenting are the initial procedures of choice. Dacryocystorhinostomy is reserved for more complex obstructions. Although pediatric acute dacryocystitis is an infection with serious potential problems, when managed appropriately, complications are rare.
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Affiliation(s)
- Daphna Prat
- Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
- Department of Ophthalmology, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Katie Magoon
- Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
| | - Karen E Revere
- Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
| | - James A Katowitz
- Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
| | - William R Katowitz
- Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
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13
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Mehner LC, Singh JK. Ocular Disorders in the Newborn. Neoreviews 2021; 22:e461-e469. [PMID: 34210810 DOI: 10.1542/neo.22-7-e461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Visual development begins at birth and continues throughout childhood. Ocular pathology can lead to permanent visual impairment and subsequent problems in overall development and school performance as well as signify serious systemic disease or even life-threatening malignancies. Prompt identification of congenital or early acquired ocular pathology via regular bedside ocular examinations and assessments of visual behaviors by neonatal clinicians is a critical component of newborn care. The goal of this article is to review the components of the newborn eye examination, describe key ocular findings and diagnoses that are common or critical to identify in the newborn period, and offer guidance on necessity and timing of ophthalmology referral.
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Affiliation(s)
- Lauren C Mehner
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO
| | - Jasleen K Singh
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO
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Ali M, Bothra N. Orbital involvement in lacrimal drainage disorders. Saudi J Ophthalmol 2021. [DOI: 10.4103/sjopt.sjop_121_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Akpolat C, Sendul SY, Unal ET, Karatas E, Ucgul Atilgan C, Demir M. Outcomes of lacrimal probing surgery as the first option in the treatment of congenital dacryocystocele. Ther Adv Ophthalmol 2021; 13:25158414211030427. [PMID: 34291188 PMCID: PMC8274130 DOI: 10.1177/25158414211030427] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/16/2021] [Indexed: 12/03/2022] Open
Abstract
PURPOSE To determine the demographic and clinical characteristics of newborn patients who underwent lacrimal probing surgical intervention with or without the marsupialization of intranasal cysts as the primary management for dacryocystocele treatment. METHODS Data from the medical charts of 350 infants who underwent lacrimal probing surgery due to nasolacrimal duct obstruction were reviewed retrospectively. Ten newborn patients with a naive diagnosis of congenital dacryocystocele were included in the study. Congenital dacryocystocele diagnosis was based on a triad of swelling in the inner canthal region, a bluish appearance, and epiphora. Lacrimal probing surgery accompanied by nasal endoscopy was planned for all patients as the first treatment option. RESULTS The mean age of the patients was 24.90 ± 7.15 days, with a range of 6-85 days. A total of 10 patients were included, comprising seven females and three males. The mean postoperative follow-up period was 38.7 ± 24.41 months. Five patients had left, four patients had right, and one patient had bilateral dacryocystocele. Seven eyes of the six patients had uncomplicated dacryocystocele, while the remaining patients had dacryocystocele with complications of dacryocystitis and/or preseptal cellulitis. All patients had intranasal cysts. All patients underwent one session of lacrimal probing surgery under general anesthesia; all with successful outcomes. Four patients with additional dacryocystocele-associated complications underwent combined intranasal marsupialization of the cyst wall. DISCUSSION Lacrimal probing surgery ± intranasal marsupialization of the cyst wall as a first treatment option can be effective for both congenital dacryocystocele and/or congenital dacryocystocele plus associated complications and provide complete resolution of dacryocystocele-related symptoms.
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Affiliation(s)
- Cetin Akpolat
- Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, Etfal Street Sisli, Istanbul 34280, Turkey
| | - Selam Yekta Sendul
- Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Ebru Turkoglu Unal
- Department of Neonatology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Egemen Karatas
- Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Cemile Ucgul Atilgan
- Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital, Altındag, Ankara, Turkey
| | - Mehmet Demir
- Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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Congenital nasolacrimal duct obstruction update study (CUP study): Paper II - Profile and outcomes of complex CNLDO and masquerades. Int J Pediatr Otorhinolaryngol 2020; 139:110407. [PMID: 33068946 DOI: 10.1016/j.ijporl.2020.110407] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 09/24/2020] [Accepted: 09/24/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the profiles and outcomes of complex congenital nasolacrimal duct obstruction (C-CNLDO). METHODS Retrospective interventional case-series was performed on patients diagnosed with C-CNLDO and managed at a tertiary care Dacryology Institute from Jan 2016 to June 2019. Complex CNLDO was diagnosed based on intraoperative findings during probing and are defined as entities where CNLDO is secondary to, or associated with complex embryonic entities like buried probe, mal-development or non-development of bony NLD, additional proximal lacrimal dysgenesis, atonic sac, or associated craniofacial syndromes and craniofacial dysostosis. The parameters studied include patient demographics, clinical presentation, types of C-CNLDO, management modalities, and outcomes. Success was defined as the subjective resolution of epiphora and discharge with objective measures of normal tear meniscus height and dye clearance on fluorescein dye disappearance test. For patients who underwent a dacryocystorhinostomy (DCR), a minimum follow-up of 1-year post-DCR was considered for outcome analysis. RESULTS Of the 2714 cases of CNLDO managed during this period, 482 (17.75%) were diagnosed as complex CNLDO. C-CNLDO showed predilection to the male gender (60.3%, 291/482). A significant number of patients (40.2%, 194/482) presented beyond 36 months of age. The common subtypes of C-CNLDO were atonic sacs (33.8%, 163/482), buried probes (19.7%, 95/482), and associated proximal lacrimal drainage anomalies (11.2%, 54/482). Since C-CNLDO is usually confirmed during the initial endoscopy-guided probing, the managements varied based on the type of C-CNLDO. Silicone intubation and/or balloon dacryoplasty (BDCP), and/or additional minimally invasive procedures were added to the initial endoscopy-guided irrigation and probing based on the nature of C-CNLDO. The overall resolution rate with these non-bypass modalities was 72.6% (350/482). Although the success rates start dropping in C-CNLDO patients beyond 3-years of age, significant success rates with multi-modal (non-bypass) management were noted in age-groups 3-5 years (71.8%, 79/110) and encouraging results (38.5%, 27/70) in 5-10 years age group. The anatomical and functional outcomes in those who underwent endoscopic or external dacryocystorhinostomy with a follow-up beyond 1-year was 96.4% (55/57). CONCLUSION The age at presentation is delayed in patients with C-CNLDO. Multi-modal endoscopy-guided management facilitates the identification of several sub-types of C-CNLDO, and achieves significantly high favourable outcomes in older children. C-CNLDO refractory to probing, intubation and BDCP demonstrates high success with external or endoscopic dacryocystorhinostomy.
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Bonafede L, Go M, Cheng J, Belcastro AA, Bellet JS, Gabr H, Freedman SF, Velez FG. Periocular infantile hemangioma masquerading as dacryocele. J AAPOS 2020; 24:326-328. [PMID: 32693170 DOI: 10.1016/j.jaapos.2020.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/07/2020] [Accepted: 07/13/2020] [Indexed: 11/18/2022]
Abstract
A 2-month-old boy developed a protuberant, blue nodule inferomedial to the left medial canthus. It was unresponsive to oral and intramuscular antibiotics. After developing difficulty breathing, he was admitted, with the diagnosis of a dacryocele, and, after an inconclusive ultrasound, underwent probing and irrigation with nasal endoscopy. Intraoperatively, the lesion appeared discontinuous with the nasolacrimal system and could not be decompressed. Postoperative magnetic resonance imaging suggested a hemangioma or possible collapsed dacryocele. Doppler ultrasound confirmed a perinasolacrimal duct hemangioma. Systemic propranolol treatment was initiated.
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Affiliation(s)
- Lucas Bonafede
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Michelle Go
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Jeffrey Cheng
- Department of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina
| | - Alexandra A Belcastro
- Department of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina
| | - Jane S Bellet
- Departments of Dermatology and Pediatrics, Duke University, Durham, North Carolina
| | - Hesham Gabr
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Sharon F Freedman
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Federico G Velez
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina.
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Ali MJ, Ponnaganti S, Barla K, Varma DR, Bothra N. Color Doppler Imaging Features of the Lacrimal Sac in Health and Diseased States. Curr Eye Res 2020; 46:758-761. [PMID: 32886568 DOI: 10.1080/02713683.2020.1820527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE The objective of this study is to present Color Doppler imaging (CDI) features of the lacrimal sac in normal and diseased states. METHODS Prospective study was performed on 20 lacrimal sacs of 20 eyes of 10 patients who underwent Color Doppler imaging at a tertiary care Dacryology service over a period of 6 months. All the patients were subjected to Duplex doppler scanning of the lacrimal sacs. Of the 20 lacrimal drainage systems studied, 8 were normal, 8 had primary acquired nasolacrimal duct obstruction (PANDO) and 4 were that of acute dacryocystitis (AcDac). Patient demographics, clinical presentation, duration of the disease and Color Doppler vascular characteristics like peri-sac vascular flow, peak systolic velocity (PSV), end-diastolic velocity (EDV), resistivity index (RI), arterial spectral waveforms and sac dimensions and wall thickness were analyzed. RESULTS The vascular flow around the lacrimal sac was increased with higher flow velocities in PANDO as compared to normal and grossly enhanced in AcDac. Flow disturbances were also quite discernible in AcDac. The mean PSV and EDV were 9 & 3.87 cm/sec, 13.07 & 4.63 cm/sec and 18 & 8.5 cm/sec in normal, PANDO and AcDac, respectively. The mean vascular resistivity index increased in patients with PANDO (0.67) and decreased in AcDac (0.53) as compared to the normal (0.57). The arterial spectral waveforms in PANDO and AcDac showed low pulsatility, but the systolic peaks were sharper with more continuous forward flow through diastole in AcDac. This reflects vascular dilatation and reduced resistance to flow in AcDac. CONCLUSION Characteristic Color Doppler flow parameters can be demonstrated in patients with PANDO and acute dacryocystitis. Color Doppler techniques have the potential to enhance the understanding of lacrimal drainage pathophysiology.
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Affiliation(s)
- Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India
| | | | - Kiran Barla
- Department of Neuroradiology, Citi Neuro Centre, Hyderabad, India
| | - D Ravi Varma
- Department of Neuroradiology, Citi Neuro Centre, Hyderabad, India
| | - Nandini Bothra
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India
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Bothra N, Wagh RD, Ali MJ. Masquerades of Acquired Dacryocystocele. Clin Ophthalmol 2020; 14:1855-1858. [PMID: 32753833 PMCID: PMC7342387 DOI: 10.2147/opth.s261098] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 06/23/2020] [Indexed: 12/01/2022] Open
Abstract
Introduction Dacryocystocele can be congenital or acquired and acute or chronic, based on underlying pathology. An inferomedial anterior orbital mass lesion can masquerade an acquired dacryocystocele with similar symptomatology; however, the treatment varies. Hence, a careful examination of the swelling to differentiate these masquerades is needed to ensure rightful treatment. Patients and Methods A retrospective, interventional study was performed on consecutive patients from January 2017 to October 2019 who presented with swelling in the lacrimal sac area of varying durations. They underwent computed tomography scans followed by surgical intervention. Their relation to the lacrimal drainage apparatus was explored. Results During the study period, 5 such patients were found in the records. The radiology was consistent with anterior orbital mass lesions, not involving the lacrimal sac. Histopathology after surgical excision was consistent with three of the lesions being dermoid cysts, one was cavernous hemangioma and one was a solitary fibrous tumor. Conclusion Inferomedial anterior orbital mass lesions can present as masquerades of acquired dacrycystoceles. Careful examination and high degree of suspicion is needed to distinguish these lesions and ensure correct treatment.
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Affiliation(s)
- Nandini Bothra
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad 500034, Telangana, India
| | - Richa Dharap Wagh
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad 500034, Telangana, India
| | - Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad 500034, Telangana, India
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Ladeiras R, Nunes JS, Torres S, Duarte C, Pereira E, Rosmaninho A. An Ultrasound Diagnosis of a Congenital Periorbital Rare Condition. J Med Ultrasound 2020; 29:142-143. [PMID: 34377653 PMCID: PMC8330682 DOI: 10.4103/jmu.jmu_42_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/18/2020] [Accepted: 04/28/2020] [Indexed: 11/21/2022] Open
Affiliation(s)
- Rita Ladeiras
- Department of Gynecology and Obstetrics, Hospital Senhora da Oliveira, Guimarães, Braga, Portugal
| | - Joana Sousa Nunes
- Department of Gynecology and Obstetrics, Hospital Senhora da Oliveira, Guimarães, Braga, Portugal
| | - Sílvia Torres
- Department of Gynecology and Obstetrics, Hospital Senhora da Oliveira, Guimarães, Braga, Portugal
| | - Carla Duarte
- Department of Gynecology and Obstetrics, Hospital Senhora da Oliveira, Guimarães, Braga, Portugal
| | - Elsa Pereira
- Department of Gynecology and Obstetrics, Hospital Senhora da Oliveira, Guimarães, Braga, Portugal
| | - Adosinda Rosmaninho
- Department of Gynecology and Obstetrics, Hospital Senhora da Oliveira, Guimarães, Braga, Portugal
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Ali MJ, Rehorek SJ, Paulsen F. A major review on disorders of the animal lacrimal drainage systems: Evolutionary perspectives and comparisons with humans. Ann Anat 2019; 224:102-112. [DOI: 10.1016/j.aanat.2019.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/08/2019] [Accepted: 04/09/2019] [Indexed: 01/12/2023]
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