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Nteli Chatzioglou G, Önal V, Gayretli Ö. Morphometric and morphological evaluation of the nasolacrimal groove in 150 dry bones in the Anatolian population. Surg Radiol Anat 2024; 46:559-566. [PMID: 38393369 DOI: 10.1007/s00276-024-03311-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/19/2024] [Indexed: 02/25/2024]
Abstract
PUPOSE In this study, we aimed to evaluate the anatomical features of the nasolacrimal groove in detail by providing a morphological classification based on morphometric evaluations of the nasolacrimal groove. METHODS A total of 150 sagittal dry bones in the Department of Anatomy, Faculty of Medicine, Istanbul University were evaluated. The length and the width at different points of the nasolacrimal canal were calculated. According to the widths of the nasolacrimal canal ten different morphological types were revealed. RESULTS The length of the canal was found as mean 13.62 ± 2.42 mm on the right and 12.44 ± 2.68 mm on the left side. The entrance, the base, the upper and the lower thirds of nasolacrimal canal were 6.22 ± 1.19 mm, 7.95 ± 1.85 mm, 5.85 ± 1.06 mm, 6.60 ± 1.54 mm, on the right and 6.08 ± 1.16 mm, 7.24 ± 1.64 mm, 5.45 ± 1.29 mm, 6.23 ± 1.48 mm, on the left side, respectively. The width of the entrance of the nasolacrimal canal was the narrowest width compared to the base, upper and lower thirds in 7/10 types of 71/150 cranial bones. CONCLUSION This comprehensive morphological classification of the nasolacrimal groove sheds new light on its complex variations. We support that the finding of this study has the potential to improve the precision of diagnostic assessments and guide specific therapeutic interventions for patients with lacrimal drainage disorders.
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Affiliation(s)
- Gkionoul Nteli Chatzioglou
- Department of Anatomy, Faculty of Medicine, Istanbul Health and Technology University, İmrahor St., Beyoglu, 34015, Istanbul, Turkey.
| | - Vildan Önal
- Department of Anatomy, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Özcan Gayretli
- Department of Anatomy, Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Liu Y, Jiang A, Nie S, Cao S, Wumaier A, Ding R, Kuerban M, Zhou R, Lin F, Yang H, Liang X, Huang D, Chen R. CT-Measured Angulation Between the Frontal Bone and Bony Nasolacrimal Duct: Variations in Obstructed and Healthy Lacrimal Ducts. Semin Ophthalmol 2024:1-8. [PMID: 38493299 DOI: 10.1080/08820538.2024.2330501] [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] [Received: 01/19/2024] [Accepted: 03/09/2024] [Indexed: 03/18/2024]
Abstract
PURPOSE The aim of this study was to analyze the characteristics of CT-measured intersection angle (FB-BNLD) between the frontal bone and bony nasolacrimal duct and to provide suggestions for treating primary acquired nasolacrimal duct obstruction (PANDO) patients in West China. METHODS Three hundred and nine participants' CT were, respectively, evaluated with RadiAnt DICOM Viewer. We defined the FB-BNLD angle >0° as the anterior type and the FB-BNLD angle ≤0° as the posterior type. RESULTS The mean FB-BNLD was -2.52° (95% CI, -3.16° to -1.88°) across all participants, of whom 37.2% were of the anterior type and 62.8% of the posterior type. Approximately 65.0% of the female patients had a posterior FB-BNLD type, and 54.2% of the male patients had an anterior FB-BNLD type (p = .002). Posterior FB-BNLD was the dominant type in the PANDO and control groups (p = .011), and the angle of FB-BNLD was statistically different in both groups (PANDO group, -2.54° to -0.71°; control group, -4.42° to -2.67°; p < .001). Among the male participants, the type of FB-BNLD differed between the two groups (p = .036), with differences in the angle of FB-BNLD (PANDO group, 0.59° to 5.13°; control group, -4.08° to 1.89°; p = .034). There was no difference in the type of FB-BNLD in female participants between the two groups (p = .051). CONCLUSION The present study revealed individual differences in the type of FB-BNLD, with anterior-type majority in males and posterior-type dominance in females. Evaluating the FB-BNLD type on CT can provide a fast method for knowing the nasolacrimal duct condition during planning for lacrimal manipulation.
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Affiliation(s)
- Yong Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Ophthalmologic Center, The Affiliated Kashi Hospital of Sun Yat-Sen University, Kashi, China
| | - Aixin Jiang
- Ophthalmologic Center, The Affiliated Kashi Hospital of Sun Yat-Sen University, Kashi, China
| | - Shihuai Nie
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Shujuan Cao
- Ophthalmologic Center, The Affiliated Kashi Hospital of Sun Yat-Sen University, Kashi, China
| | - Aizezi Wumaier
- Ophthalmologic Center, The Affiliated Kashi Hospital of Sun Yat-Sen University, Kashi, China
| | - Ruxin Ding
- Ophthalmologic Center, The Affiliated Kashi Hospital of Sun Yat-Sen University, Kashi, China
| | - Mayila Kuerban
- Ophthalmologic Center, The Affiliated Kashi Hospital of Sun Yat-Sen University, Kashi, China
| | - Renbing Zhou
- Ophthalmologic Center, The Affiliated Kashi Hospital of Sun Yat-Sen University, Kashi, China
| | - Fangzeng Lin
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Huasheng Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xuanwei Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Danping Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Rongxin Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Ophthalmologic Center, The Affiliated Kashi Hospital of Sun Yat-Sen University, Kashi, China
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Zhang W, Li L, Zhang L, Ding Y, Liu X, Ali MJ, Xiao C. Evaluation of primary acquired nasolacrimal duct obstruction: Comparison of CT-DCG and dacryoendoscopy in accurately localizing the lacrimal drainage obstructions. Eur J Ophthalmol 2024:11206721241230581. [PMID: 38327083 DOI: 10.1177/11206721241230581] [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: 02/09/2024]
Abstract
OBJECTIVE To correlate and evaluate the power and limitations of CT-DCG in determining the level and type of lacrimal duct obstruction in comparison to dacryoendoscopy in patients clinically suspected to be having partial or complete primary acquired nasolacrimal duct obstruction (PANDO). METHODS A retrospective chart review was performed on 1232 lacrimal drainage systems of 957 patients who suffered from primary acquired nasolacrimal duct obstruction (PANDO) at Shanghai Ninth People's Hospital. Patients were examined with CT-DCG and correlated with dacryoendoscopy and the findings of clinical examination. RESULTS Of the studied patients, 173 were men and 784 were women with an age range of 18-93 years. Of the 1232 lacrimal pathways, good CT-DCG images could be obtained in 980 cases and dacryoendoscopy in 957 cases. Of these complete obstructions were noted in 81% (794/980), and partial obstructions were identified in 19% (186/980) with CT-DCG. CT-DCG and dacryoendoscopy showed 68.4% agreement for the type of the obstruction and 63% for the level of the obstruction. The majority of the obstructions occurred at the sac-duct junction (62.5%) followed by the upper half of the nasolacrimal duct (27.5%). There was a significant difference in the correlation of the obstruction type with age group and with the duration of symptoms. As the duration of symptoms increased, the proportion of complete lacrimal duct obstructions as shown on CT-DCG images increased and the proportion of incomplete obstruction decreased (p = 0.015). CONCLUSIONS The junction of lacrimal sac and nasolacrimal duct was the most common obstruction site. Age and the duration of symptoms influenced the type of obstruction noted. The degree and level of agreement between the investigations was moderate. A combination of CT-DCG and Dacryoendoscopy could together identify the location more accurately.
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Affiliation(s)
- Wenyue Zhang
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Lunhao Li
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Leilei Zhang
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yi Ding
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Xueru Liu
- Ophthalmic Center, Xinjiang 474 Hospital, Urumqi, Xinjiang 830011, China
| | - Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India
| | - Caiwen Xiao
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
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Gaca PJ, Heindl LM, Paulsen F, Ali MJ. Valvular System of the Lacrimal Drainage Pathway and the Valve of Rosenmüller. Ann Anat 2023; 249:152105. [PMID: 37207850 DOI: 10.1016/j.aanat.2023.152105] [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: 02/21/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/21/2023]
Abstract
The valves of the lacrimal drainage system are an enigma with a rich eponymous history. The unidirectional flow of tears along with the ultrastructural demonstration of distinctive mucosal folds on the luminal surface has rekindled an interest in them. The first in vivo direct demonstration of the valve of Rosenmüller and its functions has laid to rest some of the controversies of its existence and that of the valve of Huschke. The dynamic assessment of the valve of Rosenmüller has shown a well-defined functional role in the facilitation of unidirectional tear flow. The present mini review describes the embryological aspects, brief overview of the eponymous valves, techniques for their identification along with recent structural and functional aspects of the valve of Rosenmüller.
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Affiliation(s)
- Piotr J Gaca
- Department of General Ophthalmology, Medical University of Lublin, ul. Chmielna 1, 20-079 Lublin, Poland
| | | | - Friedrich Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich Alexander University, Erlangen, Germany
| | - Mohammad Javed Ali
- 'Govindram Seksaria Institute of Dacryology', L.V. Prasad Eye Institute, Hyderabad, India.
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Macri C, Shapira Y, Selva D. Lacrimal imaging findings in fellow asymptomatic eyes of unilateral epiphora. Eur J Ophthalmol 2022; 32:3328-3332. [PMID: 35261267 DOI: 10.1177/11206721221085426] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS To investigate the prevalence of subclinical anatomical and functional abnormalities of lacrimal drainage in fellow asymptomatic eyes of unilateral epiphora using dacryocystography and dacryoscintigraphy. METHODS Retrospective case note review of lacrimal imaging of adult patients presenting to a hospital Oculoplastic clinic with unilateral epiphora over 10 years. RESULTS A total of 172 patients with unilateral epiphora were included. The median age was 67 (range 18-96 years). A dacryoscintigraphy (DSG) abnormality was present in 54 (42%) asymptomatic eyes, and dacryocystography (DCG) abnormality in 10 (10%). The most common finding on DSG was no delay in 76 eyes (58%), and most common DSG abnormality was post sac delay in 51 (39%) eyes. The most common finding on DCG was no obstruction in 88 (90%) eyes, and the most common DCG abnormality was post sac stenosis (7.1%). Of the 92 asymptomatic eyes with both DCG and DSG, 53 (57%) showed neither an obstruction on DCG or delay on DSG, and 28 (30%) showed a post sac delay on DSG and no abnormality on DCG. CONCLUSION Greater than a third of asymptomatic eyes displayed post sac delay on DSG, frequently without accompanying anatomical obstruction on DCG. Subclinical DSG delay in asymptomatic eyes may represent physiological variation in tear transit time, subclinical lacrimal drainage dysfunction or anatomical stenosis undetected by DCG. Furthermore, the DSG results of fellow asymptomatic eyes in unilateral epiphora may not represent a normal standard that can be utilised for comparison. Further investigation with dacroyendoscopy, the use of control eyes, and long term follow up is required.
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Affiliation(s)
- Carmelo Macri
- Discipline of Ophthalmology and Visual Sciences, 1066The University of Adelaide, Adelaide, South Australia, Australia
- 1062The Royal Adelaide Hospital, Adelaide, South Australia, Australia
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Yinon Shapira
- 1062The Royal Adelaide Hospital, Adelaide, South Australia, Australia
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Dinesh Selva
- Discipline of Ophthalmology and Visual Sciences, 1066The University of Adelaide, Adelaide, South Australia, Australia
- 1062The Royal Adelaide Hospital, Adelaide, South Australia, Australia
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
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Lacrimal Duct Obstruction Caused by Nasomaxillary Fracture: A Retrospective Analysis of Consecutive 12 Patients by Computed Tomographic Dacryocystography. J Craniofac Surg 2021; 32:1396-1399. [PMID: 33427771 DOI: 10.1097/scs.0000000000007433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Nasomaxillary fracture is a characteristic mid-facial fracture, and there are no reports showing the fracture damaging the nasolacrimal system (NLS). This report described nasomaxillary fracture cases with NLS damages, which were assessed by computed tomographic dacryocystography (CT-DCG). A retrospective cohort study of nasomaxillary fractures diagnosed by CT was conducted from 2007 to 2015. Twelve patients (mean age: 27.5 years) were found, and their clinical symptoms were as follows: nasal deformity in 10 patients, infra-orbital hypoesthesia in 7, epiphora in 5, and diplopia in one. CT-DCG was performed for 2 patients who complained epiphora, and obstruction was found in 1 patient. All patients underwent open reduction and internal fixation (ORIF), and epiphora in 5 patients was improved. One patient, however, complained epiphora postoperatively, which was supposed to be due to the unsuitable screw insertion. Since nasomaxillary fracture could give NLS obstruction, CT-DCG is useful for diagnosis. Although ORIF is an optimal treatment, attention is needed to avoid the lacrimal canal in screwing on the nasomaxillary buttress.
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Sun H, Ding JW, Li DM, Wang NL. Comparison of Hasner valvulotomy outcomes in pediatric and adult patients: does age matter? Chin Med J (Engl) 2020; 133:2422-2428. [PMID: 32960846 PMCID: PMC7575182 DOI: 10.1097/cm9.0000000000001128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Hasner valve incision has been recently introduced as a new treatment for ophthalmic patients with epiphora symptoms. The aim of this study was to examine whether surgical outcomes of Hasner valve incision for inferior nasolacrimal duct obstruction were different between pediatric and adult patients. METHODS A total of 53 eyes of 52 patients who underwent Hasner valve incision in the Beijing Tongren Hospital from October 2016 to November 2019 were retrospectively observed. Patients were divided into two groups, including pediatric group (23 eyes of 22 patients, <18 years old) and adult group (30 eyes of 30 patients, ≥18 years old). Success rate of surgery was determined by both subjective measure (complete resolution of epiphora) and objective measure (lacrimal passage irrigation and tear meniscus height). Fisher exact test was conducted. RESULTS By conducting Fisher exact test and comparing complete resolution of epiphora (P = 0.627), lacrimal passage irrigation (P = 0.663), measurement of Tear Meniscus Height (P = 0.561), and appearance of complication (P = 0.339), there was no statistically significant difference of surgical outcomes between pediatric and adult patients (P > 0.05). CONCLUSION Hasner valve incision was effective for both adult and children with inferior nasolacrimal duct obstruction, with no difference in surgical outcomes between the two groups.
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Affiliation(s)
- Hua Sun
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
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Comparison of digital subtraction dacryocystography and dacryoendoscopy in patients with epiphora. Eye (Lond) 2020; 35:877-882. [PMID: 32467631 DOI: 10.1038/s41433-020-0990-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/02/2020] [Accepted: 05/18/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To assess the diagnostic information provided by digital subtraction dacryocystography (DCG) and dacryoendoscopy in patients with epiphora. METHODS Sixty-eight lacrimal systems of 34 patients with epiphora were prospectively studied. Patients were initially examined with syringing, followed by digital subtraction DCG and dacryoendoscopy to confirm the diagnosis. Obstructions in lacrimal pathways were evaluated by degree, location, and cause. The weighted kappa coefficient was used to compare the agreement between the tests. RESULTS Of the 68 lacrimal pathways, partial or complete obstructions were identified in 56 cases (82.3%) with syringing, in 38 cases (55.9%) with DCG, and in 60 cases (88.2%) with dacryoendoscopy. DCG and dacryoendoscopy showed the same result in 42 of the 68 (61.8%) lacrimal pathways. The weighted kappa value for DCG and dacryoendoscopy was 0.60 (95% CI: 0.40-0.81). The most common sites of obstruction were the common canaliculus (36.7%) and the nasolacrimal duct (28.3%) in dacryoendoscopy. Thirty-three lacrimal pathways (48.5%) were identified to have obstructions on the same level between DCG and dacryoendoscopy. Among the 30 lacrimal pathways (44.1%) that were normal by DCG, obstruction was revealed in 22 cases by dacryoendoscopy, with 11 cases in the common canaliculus. Additional useful information on the cause of obstruction and identification of multiple obstructed sites was provided by dacryoendoscopy. CONCLUSIONS DCG and dacryoendoscopy showed moderate agreement in detecting lacrimal pathway obstruction. Dacryoendoscopy allowed for comprehensive investigations of the lacrimal pathway and can help explain unidentified factors associated with lacrimal pathway obstruction in patients with epiphora.
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Lacrimal drainage anatomy in the Japanese population. Ann Anat 2019; 223:90-99. [DOI: 10.1016/j.aanat.2019.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 01/29/2019] [Accepted: 01/29/2019] [Indexed: 11/17/2022]
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Dacryocystography: From theory to current practice. Ann Anat 2019; 224:33-40. [PMID: 30954539 DOI: 10.1016/j.aanat.2019.03.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE To provide a review and an update on dacryocystography (DCG) and its relevance in the current era. METHODS The authors performed a PubMed search of all articles published in English on DCG, digital subtraction-DCG (DS-DCG), computed tomographic DCG (CT-DCG) and magnetic resonance-DCG (MR-DCG). Data analyzed include the indications, techniques, interpretations, complication and limitations. RESULTS Dacryocystography has been used for illustrating the morphological and functional aspects of the lacrimal drainage system (LDS). Subtraction DCG provides the precise location of the alterations and acceptably delineates stenosis or an obstruction. Transit time for contrast into the nose varies widely across the studies. Low osmolality iodinated contrast media are tolerated well for DS-DCG and CT-DCG. However, normal saline either mixed with lidocaine or alone provided similar image quality as obtained with gadolinium for MR-DCG. CT-DCG provides useful information in complex orbitofacial trauma and lacrimal tumors. MR-DCG allows better 3D visualization of the LDS and dynamic functional evaluation. Sensitivity of CT-DCG and MR-DCG are mostly similar in identifying an LDS obstruction. CONCLUSION Various forms of DCGs can provide additional information to evaluate patients with maxillo-facial trauma, functional epiphora, suspected lacrimal sac diverticula, partial nasolacrimal duct obstruction, and lacrimal drainage tumors. Canaliculi and the membranous part of the nasolacrimal duct are not yet visualized in detail and further focused studies with advanced techniques are required.
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Kashkouli MB, Abolfathzadeh N, Abdolalizadeh P, Karimi N, Hedayati R, Jafari S, Alemzadeh A. How reliable is the lacrimal scintigraphy report? An inter-observer agreement and reliability study. Int J Ophthalmol 2019; 12:401-406. [PMID: 30918807 DOI: 10.18240/ijo.2019.03.08] [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: 04/16/2018] [Accepted: 07/13/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To assess the inter-observer agreement and reliability as well as intra-observer repeatability for lacrimal scintigraphy (LS) reports with and without considering the irrigation test results. METHODS A prospective, observational, cross sectional study. Two masked clinicians (lacrimal surgeon and nuclear medicine specialist) independently reported 100 LS images (50 patients of >6 years of age with unilateral anophthalmic socket) in a university hospital. The lacrimal surgeon performed a diagnostic irrigation test and repeated the report of the same LS images 2y after the first report (intra-observer agreement). A weighted Kappa analysis was performed to determine inter-observer agreement and reliability as well as intra-observer repeatability for the type (normal, partial and complete obstruction) and location (presac, preduct, and intraduct) of the obstruction. Subgroup analysis was also performed with consideration of irrigation test results. RESULTS A significantly moderate agreement was found between lacrimal surgeon and nuclear medicine specialist for both the type (Kappa=0.55) and location (Kappa=0.48) of obstruction. Agreement values were higher for the type (Kappa=0.61 vs 0.41) and location (Kappa=0.56 vs 0.31) of obstruction in cases with normal than abnormal irrigation test. Strong and significant intra-observer (lacrimal surgeon) repeatability was found for both the type (Kappa=0.66) and location (Kappa=0.69) of obstruction. LS showed no to slight reliability based on irrigation test. CONCLUSION A moderate agreement is found between lacrimal surgeon and nuclear medicine specialist regarding the interpretation of LS suggesting the importance of consensus groups among nuclear medicine specialists and lacrimal surgeons to create a common language for interpretation of LS. Intra-observer repeatability is strong for the lacrimal surgeon.
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Affiliation(s)
- Mohsen Bahmani Kashkouli
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran 14455-364, Iran
| | - Navid Abolfathzadeh
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran 14455-364, Iran
| | - Parya Abdolalizadeh
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran 14455-364, Iran
| | - Nasser Karimi
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran 14455-364, Iran
| | - Raheleh Hedayati
- Department of Nuclear Medicine, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran 14455-364, Iran
| | - Samira Jafari
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran 14455-364, Iran
| | - Amirpooya Alemzadeh
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran 14455-364, Iran
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Yedavalli V, Das D, Massoud TF. Eponymous "valves" of the nasolacrimal drainage apparatus. I. A historical review. Clin Anat 2018; 32:41-45. [PMID: 30260544 DOI: 10.1002/ca.23284] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 11/09/2022]
Abstract
The nasolacrimal drainage apparatus (NDA) is of interest to anatomists, radiologists, and ophthalmologists alike, owing to its intricate luminal contour, complex surrounding structural morphology, and its clinical relevance. Here, we review the history of anatomical descriptions of so-called luminal "valves" of the NDA, including the numerous historical figures whose eponyms adorn the NDA. By 1908, multiple false "valves" that are likely no more than mounds of mucosa along the NDA had been recorded. In the modern era, these have all been largely considered speculative in nature and function aside from the consistently described true valve of Hasner (plica lacrimalis). Back then, eight so-called "valves" were believed to be identifiable. These were the "valves" of Foltz, Bochdalek, Rosenmüller, Huschke, Aubaret, Béraud or Krause, Taillefer, and Hasner or Cruveilhier or Bianchi. With the advent of detailed characterization through modern high-resolution imaging techniques, such as digital subtraction dacryocystography (DS-DCG), many of these valvular folds have come into question owing to their inconsistent identification. This historical review should be useful for greater understanding and accurate contextual interpretation of "valves" encountered on DS-DCG studies, and in clinical management and therapeutic planning of patients prior to undergoing luminal procedures on the NDA. Clin. Anat., 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Vivek Yedavalli
- Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University School of Medicine, Stanford, California
| | - Devsmita Das
- Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University School of Medicine, Stanford, California
| | - Tarik F Massoud
- Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University School of Medicine, Stanford, California.,Department of Radiology, Section of Neuroradiology, Addenbrooke's Hospital, University of Cambridge School of Clinical Medicine, Cambridge, CB2 0QQ, United Kingdom
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Yedavalli V, Das D, Massoud TF. Eponymous “valves” of the nasolacrimal drainage apparatus. II. Frequency of visualization on dacryocystography. Clin Anat 2018; 32:35-40. [DOI: 10.1002/ca.23283] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/20/2018] [Accepted: 09/20/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Vivek Yedavalli
- Department of Radiology, Division of Neuroimaging and Neurointervention; Stanford University School of Medicine; Stanford California
| | - Devsmita Das
- Department of Radiology, Division of Neuroimaging and Neurointervention; Stanford University School of Medicine; Stanford California
| | - Tarik F. Massoud
- Department of Radiology, Division of Neuroimaging and Neurointervention; Stanford University School of Medicine; Stanford California
- Department of Radiology, Section of Neuroradiology; Addenbrooke's Hospital, University of Cambridge School of Clinical Medicine; Cambridge CB2 0QQ UK
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14
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Effect of Facial Parameters in Primary Acquired Nasolacrimal Duct Obstruction. J Craniofac Surg 2018; 28:e752-e756. [PMID: 28953146 DOI: 10.1097/scs.0000000000003911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE In this study, the authors aimed to identify facial and nasal parameters, which may create an anatomic disposition toward obstruction in patients with primary acquired nasolacrimal duct obstruction. MATERIALS AND METHODS Forty-eight patients (14 males and 34 females) who presented to the ophthalmology outpatient clinic and were diagnosed with primary acquired nasolacrimal duct obstruction between January 2014 and January 2015 were included in the study. The control group comprised 59 patients (38 females and 21 males) without nasolacrimal duct obstruction. Measurements of nasal height, length, and depth, presence of a nasal hump, alar width and alar angle, distance between the maxillary bone nasal notches, and right and left distances between outer canthi and corners of the mouth were made using photographs of the patients. The presence of facial asymmetry was also assessed. RESULTS Facial asymmetry (P = 0.014) and nasal hump (P = 0.048) were more common in the patient group. The patient group had smaller nasal radix depth (P < 0.001), nasal length (P = 0.001), and alar width (P < 0.001), larger distance between maxillary bone nasal notches (P < 0.001), and smaller alar angle (P < 0.001). CONCLUSION In the current study, the authors found that primary acquired nasolacrimal duct obstruction occurred more frequently on the side of the face with shorter facial measurements. Smaller nasal radix depth, nasal length, and alar base width, presence of a nasal hump and longer distance between maxillary bone nasal notches may form an anatomic basis for nasolacrimal duct obstruction. Based on our results, the authors believe that primary acquired nasolacrimal duct obstruction is associated with facial structure.
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Ghasemi H, Asghari Asl S, Yarmohammadi ME, Jafari F, Izadi P. External Dacryocystorhinostomy; Success Rate and Causes of Failure in Endoscopic and Pathologic Evaluations. IRANIAN JOURNAL OF PATHOLOGY 2017; 12:189-194. [PMID: 29531542 PMCID: PMC5835365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 02/05/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES External dacryocystorhinostomy (DCR) is the method of choice to treat nasolacrimal duct (NLD) obstruction and the other approaches are compared with it, with a failure rate of 4% to 13%. The current study aimed to assess the causes of failure in external DCR by postoperative endoscopic and pathological evaluation. METHODS The current retrospective cross sectional study followed-up113 patients with external DCR and silicone intubation for three months. Silicone tubes were removed after the third months. Failure was confirmed based on the clinical findings and irrigation test. Paranasal sinus computed tomography (CT) scanning, and endoscopic and pathological evaluations were performed in the failed cases. RESULTS Totally, 113 patients underwent external DCR. The patients included 71 females and 42 males. The mean age of the patients was 55.91 years; ranged from 18 to 86. Epiphora was the most common complaint before surgery (90.3%). Clinically, epiphora continued in 17 cases (15%), of which 94.11% had at least one sinus CT abnormality and 82.35% had at least one endoscopic abnormality. The most common endoscopic findings were deviated septum (70.6%), scar tissue (52.94%), concha bullosa (46.9%), septal adhesion (47.05%), enlarged middle turbinate (41.2%), and sump syndrome (11.7%). The failure was significantly associated with the chronicity of the initial symptoms (P-value=0.00). Pathologically, there were significant relationship amongst the failure rate, scar formation, and allergic rhinitis (P-values =0.00 and <0.05, respectively). CONCLUSION Preoperative endonasal evaluation and consultation with an otolaryngologist can improve surgical outcomes and help to have a better conscious to intranasal abnormalities before external DCR surgery.
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Affiliation(s)
- Hassan Ghasemi
- Dept. of Ophthalmology, Medical School, Shahed University, Tehran, Iran
| | | | | | - Farhad Jafari
- Dept. of Ophthalmology, Medical School, Shahed University, Tehran, Iran
| | - Pupak Izadi
- Dept. of Ophthalmology, Medical School, Shahed University, Tehran, Iran
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Shen GL, Ng JD, Ma XP. Etiology, diagnosis, management and outcomes of epiphora referrals to an oculoplastic practice. Int J Ophthalmol 2016; 9:1751-1755. [PMID: 28003974 DOI: 10.18240/ijo.2016.12.08] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 05/10/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the etiology, diagnosis, management and outcome of epiphora referrals to an oculoplastic practice. METHODS Retrospective chart review of patients referred for epiphora to an oculoplastic clinic between 2005 and 2009. Patient demographics, past history, ophthalmic examination, treatment and outcome were analyzed. RESULTS There were 237 subjects with a primary complaint of epiphora. They included 130 (55%) females and 107 (45%) males with an average age of 55.9±25.9y. The most common cause of epiphora was lacrimal obstruction (46%); followed by multifactorial epiphora (22%), reflex tearing (22%) and eyelid malposition (11%). Differences in prevalence of etiology were noted in terms of age and gender distribution. Of the 182 (77%) patients who returned for follow up, 41 (23%) reported a complete resolution and 102 (56%) reported a significant improvement in their symptoms. CONCLUSION Epiphora is a common condition with many causes. A thorough history and examination are required to provide the appropriate treatment tailored to the underlying cause.
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Affiliation(s)
- Guang-Lin Shen
- Department of Ophthalmology, Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - John D Ng
- Casey Eye Institute, Oregon Health and Science University, Portland, Oregon 97239, USA
| | - Xiao-Ping Ma
- Department of Ophthalmology, Zhongshan Hospital of Fudan University, Shanghai 200032, China
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Jañez-Garcia L, Saenz-Frances F, Ramirez-Sebastian JM, Toledano-Fernandez N, Urbasos-Pascual M, Jañez-Escalada L. Three-Dimensional Reconstruction of the Bony Nasolacrimal Canal by Automated Segmentation of Computed Tomography Images. PLoS One 2016; 11:e0155436. [PMID: 27187800 PMCID: PMC4871497 DOI: 10.1371/journal.pone.0155436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 04/28/2016] [Indexed: 11/18/2022] Open
Abstract
Objective To apply a fully automated method to quantify the 3D structure of the bony nasolacrimal canal (NLC) from CT scans whereby the size and main morphometric characteristics of the canal can be determined. Design Cross-sectional study. Subjects 36 eyes of 18 healthy individuals. Methods Using software designed to detect the boundaries of the NLC on CT images, 36 NLC reconstructions were prepared. These reconstructions were then used to calculate NLC volume. The NLC axis in each case was determined according to a polygonal model and to 2nd, 3rd and 4th degree polynomials. From these models, NLC sectional areas and length were determined. For each variable, descriptive statistics and normality tests (Kolmogorov-Smirnov and Shapiro-Wilk) were established. Main Outcome Measures Time for segmentation, NLC volume, axis, sectional areas and length. Results Mean processing time was around 30 seconds for segmenting each canal. All the variables generated were normally distributed. Measurements obtained using the four models polygonal, 2nd, 3rd and 4th degree polynomial, respectively, were: mean canal length 14.74, 14.3, 14.80, and 15.03 mm; mean sectional area 15.15, 11.77, 11.43, and 11.56 mm2; minimum sectional area 8.69, 7.62, 7.40, and 7.19 mm2; and mean depth of minimum sectional area (craniocaudal) 7.85, 7.71, 8.19, and 8.08 mm. Conclusion The method proposed automatically reconstructs the NLC on CT scans. Using these reconstructions, morphometric measurements can be calculated from NLC axis estimates based on polygonal and 2nd, 3rd and 4th polynomial models.
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Affiliation(s)
- Lucia Jañez-Garcia
- Ramon Castroviejo Institute of Ophthalmological Investigations, Complutense University, Madrid, Spain
| | - Federico Saenz-Frances
- Ophthalmology Department, Clinico Universitario San Carlos Hospital, Complutense University, Madrid, Spain
- * E-mail:
| | - Jose M. Ramirez-Sebastian
- Ramon Castroviejo Institute of Ophthalmological Investigations, Complutense University, Madrid, Spain
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Kakizaki H, Takahashi Y, Kang H, Nakano T, Asamoto K, Ikeda H. Two Types of the Sinus of Maier: An Anatomic Study. Orbit 2015; 34:253-256. [PMID: 26186131 DOI: 10.3109/01676830.2015.1056309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To show the morphological characteristics of two different types of the sinus of Maier, one with a lacrimal sac diverticulum supplied by separate canalicular openings, and the other with a terminal dilatation of the common lacrimal canaliculus. METHODS Twelve coronal specimens (6 right and 6 left) from 6 Japanese cadavers (age range, 70-90 years at death) and 15 axial specimens of 11 Japanese cadavers (8 right, 7 left; age range, 45-89 years at death), fixed in 10% buffered formalin, were used. All specimens were stained with Masson's trichrome. RESULTS The sinus of Maier, with a lacrimal sac diverticulum supplied by separate canalicular openings, was shown in one coronally sectioned group, with a diameter of 1.29 mm. The mucosa between both openings (0.282 mm length) comprised stratified squamous epithelia, which was characteristic of the lacrimal canaliculi. The diverticular mucosa was lined by a stratified columnar epithelium, which corresponded to the lacrimal sac. The sinus of Maier, with a terminal dilatation of the common lacrimal canaliculus and with a diameter of 0.51 mm, was demonstrated in one axially sectioned group. CONCLUSIONS The morphological characteristics of two types of the sinus of Maier were described in this study. One type was the lacrimal sac diverticulum supplied by separate canalicular openings, and the other was the terminal dilatation of the common lacrimal canaliculus.
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Affiliation(s)
- Hirohiko Kakizaki
- a Department of Ophthalmology , Aichi Medical University , Nagakute , Japan
| | - Yasuhiro Takahashi
- a Department of Ophthalmology , Aichi Medical University , Nagakute , Japan
| | - Hyera Kang
- a Department of Ophthalmology , Aichi Medical University , Nagakute , Japan
- b Department of Ophthalmology , University of Seonam College of Medicine, Presbyterian Medical Center , Jeonju , Korea
| | - Takashi Nakano
- c Department of Anatomy , Aichi Medical University , Nagakute , Japan , and
| | - Ken Asamoto
- c Department of Anatomy , Aichi Medical University , Nagakute , Japan , and
| | - Hiroshi Ikeda
- d Department of Pathology , Aichi Medical University , Nagakute , Japan
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Comparison of bony nasolacrimal canal narrowing with or without primary acquired nasolacrimal duct obstruction in a Japanese population. Ophthalmic Plast Reconstr Surg 2015; 30:434-8. [PMID: 25098445 DOI: 10.1097/iop.0000000000000238] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the minimum diameter of the nasolacrimal canal and its location between patients with or without primary acquired nasolacrimal duct obstruction (NLDO) in a Japanese population. METHODS One hundred one patients with unilateral primary acquired NLDO (Group A, 101 affected sides; Group B, 101 unaffected sides) and 50 non-NLDO patients (Group C, 100 sides) were included. Anteroposterior and transverse diameters were measured at the canal entrance and the shortest point using contiguous 1-mm axial computed tomographic images. Canal shapes were classified into 2 types: the "funnel" type (a canal with both minimum diameters at the canal entrance) and the "hourglass" type (a canal with at least one minimum diameter in the canal). The distance from the entrance to the part with the shortest diameter was measured on sides with the hourglass type. RESULTS The funnel type was found more frequently in Groups A and B than in Group C (p<0.050), although a difference was not found between Groups A and B (p=0.778). The distance of the transverse diameter was significantly shorter in Groups A and B than Group C (p<0.050), although no significant difference was found in this distance between Groups A and B (p=1.000). There were no significant differences between the groups for each value except for the above mentioned (p>0.050). CONCLUSIONS Primary acquired NLDO patients exhibited the funnel type more frequently or there was a shorter distance from the entrance to the part with the shortest diameter than non-NLDO patients, which may enhance the risk of primary acquired NLDO.
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Abstract
OBJECTIVES Epiphora (excess tearing) is a common complaint among patients visiting ophthalmology clinics. The etiology of epiphora in patients presenting to a primary ophthalmologist might be very different compared to those referred to an oculoplastic unit. PURPOSE To describe the etiology of epiphora in patients referred to an oculoplastics clinic. METHODS A retrospective, observational study of all consecutive referrals to oculoplastic service for epiphora in 2011-2012. Slit-lamp examination, eyelid position, dry eye tests, ocular surface pathology, the patency of the nasolacrimal system, and punctal aperture were evaluated. RESULTS A total of 445 eyes of 280 patients (205 men; 46.1%) participated. The mean age was 69.4 ± 15 (range 15-96) years. Bilateral epiphora occurred in 165 (58.9%) patients and unilateral in 115 (41.1%). The etiologies referred for epiphora were lower lid malposition (33.3%), nasolacrimal/canalicular obstruction (29%), multifactorial (22%), punctal stenosis (11%), and reflex tearing (4.7%). Women were younger than men (p < 0.0001). More women had punctal stenosis compared to men (34.6% versus 22.4%, p = 0.01), and more men had eyelid malposition than women (39.5% versus 27.9%, p = 0.005). CONCLUSIONS Women with epiphora tend to present with nasolacrimal duct obstruction and punctal stenosis at younger ages, and unilaterally more often than men. Men with epiphora were older, with more cases attributed to laxity of the lower eyelid. Multiple etiologies frequently need to be addressed to achieve optimal results in treating epiphora.
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Affiliation(s)
- Arie Y Nemet
- a Department of Ophthalmology , Meir Medical Center , Kfar Sava , Israel
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Kakizaki H, Takahashi Y, Nakano T, Asamoto K, Ikeda H. Elastic nature of the lacrimal canalicular wall. Ophthalmic Plast Reconstr Surg 2014; 30:521-3. [PMID: 25105525 DOI: 10.1097/iop.0000000000000239] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To examine the elastic nature of the lacrimal canalicular wall. METHODS Fifteen postmortem specimens of 11 Japanese individuals (8 right, 7 left; age range, 45-89 years at death) fixed in 10% buffered formalin were axially sliced parallel to the lower eyelid margin to include all 3 portions of the lacrimal canaliculi (intrasac, extrasac-extramuscular, and intramuscular portions). All specimens were stained with Elastica van Gieson. Microscopic photographs were taken and converted to white (elastic fibers) and black (the other tissues) images to measure the elastic fibers in an area in each portion. RESULTS Six specimens in 4 individuals (2 right, 4 left; age range, 62-87 years) included all 3 portions. The area of elastic fibers in the intrasac portion (mean area, 125.8±93.6 white dot) was not significantly different from that in the extrasac-extramuscular portion (p=0.637: mean area, 268.5±150.2 white dots) but was significantly smaller than the areas in the intramuscular portion (p<0.001: mean area, 796.3±278.1 white dots) and Horner's muscle fascia (p<0.001: mean area, 1052.8±250.1 white dots). The area of elastic fibers in the extrasac-extramuscular portion was also significantly smaller than areas in the intramuscular portion (p=0.001) and Horner's muscle fascia (p<0.001). There was no significant difference in the area between the intramuscular portion and Horner's muscle fascia (p=0.172). CONCLUSIONS The elastic nature of the lacrimal canalicular wall was different in areas with or without Horner's muscle envelope.
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Affiliation(s)
- Hirohiko Kakizaki
- Departments of *Ophthalmology, †Anatomy, and ‡Pathology, Aichi Medical University, Nagakute, Aichi, Japan
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Takahashi Y, Nakamura Y, Nakano T, Asamoto K, Iwaki M, Selva D, Leibovitch I, Kakizaki H. The Narrowest Part of the Bony Nasolacrimal Canal. Ophthalmic Plast Reconstr Surg 2013; 29:318-22. [DOI: 10.1097/iop.0b013e31828de0b0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lorena SHT, Silva JAF, Scarpi MJ. Congenital nasolacrimal duct obstruction in premature children. J Pediatr Ophthalmol Strabismus 2013; 50:239-44. [PMID: 23614467 DOI: 10.3928/01913913-20130423-01] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 03/04/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the incidence of congenital nasolacrimal duct obstruction (CNLDO) in premature and full-term children. METHODS Medical records of 200 premature and 200 full-term children from July 2004 to November 2009 at the Peri-Peri Health Center were retrospectively reviewed. Fifty-three nasolacrimal ducts in 32 premature children (21 patients were bilateral) and 9 nasolacrimal ducts in 7 full-term children (2 patients were bilateral) diagnosed as having CNLDO were retrospectively examined. RESULTS Of the 200 premature children, 32 (16%) had CNLDO compared with 7 (3.5%) of the 200 full-term infants (P < .0001). Thirty premature infants and five full-term children underwent conservative treatment. Bilateral obstruction was found in all 3 extremely premature children (gestational age < 28 weeks), in 9 (69.23%) moderately premature children (gestational age of 28 to 31 weeks), in 9 (56.25%) mildly premature children (gestational age of 32 to 36 weeks), and in 2 (28.57%) full-term children (gestational age > 37 weeks). CONCLUSIONS This study reported a higher incidence of CNLDO in preterm infants when compared to full-term infants. This might be expected in light of the normal development of the nasolacrimal duct system, the patency of which normally occurs after the preterm infant is born.
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Abstract
Epiphora is a common problem seen by the ophthalmologist. There are numerous etiologies of a watering eye, and the underlying diagnosis is not always clear. A variety of in-office examination techniques and procedures exist to aid with diagnosis and determination of appropriate therapy, but sometimes the diagnosis remains elusive, or an instituted therapy fails. Lacrimal imaging, particularly in these cases, can be helpful in assessing the function and anatomy of the lacrimal drainage system. This review serves to examine the literature of the last 10 years concerning imaging of the lacrimal drainage system.
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Affiliation(s)
- Daniel R Lefebvre
- Division of Ophthalmic Plastic Surgery, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA.
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Kim TH, Lee JH, Ahn JH, Kim JH, Kim YD, Woo KI. Dacryocystographic Findings in Unilateral Epiphora with Patent Lacrimal Drainage System. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.6.839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Tae Hyup Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Hye Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Hyun Ahn
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Hoon Kim
- Department of Ophthalmology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Yoon Duck Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung In Woo
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Endoscopic endonasal retrieval of a nasolacrimal duct stone via the valve of Hasner in the inferior meatus. Ophthalmic Plast Reconstr Surg 2012; 28:e48-50. [PMID: 21743370 DOI: 10.1097/iop.0b013e318220861f] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 37 year old man presented with a 6 month history of a right epiphora with associated mucus discharge. Lacrimal irrigation demonstrated right unilateral partial nasolacrimal duct obstruction, confirmed with lacrimal scintigraphy. Nasal endoscopy showed a pale elevation in the right inferior meatus. Endoscopic endonasal examination revealed a yellow-white nasolacrimal duct stone emerging from the valve of Hasner in the inferior meatus. The distal nasolacrimal duct in the lateral wall of the inferior meatus was marsupialised and the stone removed. At 12 months follow-up the patient maintained complete resolution of symptoms.
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Lee H, Ha S, Lee Y, Park M, Baek S. Anatomical and morphometric study of the bony nasolacrimal canal using computed tomography. ACTA ACUST UNITED AC 2011; 227:153-9. [PMID: 22025179 DOI: 10.1159/000331986] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 08/12/2011] [Indexed: 11/19/2022]
Abstract
AIMS To determine the diameters, angles and sectional area of the bony nasolacrimal canal using computed tomography for obtaining detailed anatomical knowledge of the drainage system and utilizing these measurements in planning interventions for nasolacrimal duct obstruction in adults and children. METHODS Using standard computed tomographic images, we measured the diameters, angles and sectional area of the bony nasolacrimal duct in 228 patients without nasolacrimal duct disease. RESULTS There was no statistically significant difference in other parameters between males and females. In particular, age had a significant effect on the angle between the bony nasolacrimal canal and the nasal floor in the pediatric patients (<10 years; p = 0.00), and pediatric patients had more acute angles than adult patients (>10 years old). CONCLUSIONS In nasolacrimal probing of congenital nasolacrimal duct obstruction, the probe should be passed more to the posterior part of the nasal cavity. In other words, the distal part of the probe should form a more obtuse angle with the forehead in pediatric patients than in adults. This study may contribute to the establishment of a detailed anatomical and morphometric baseline of the bony nasolacrimal canal and provide useful information for the planning of interventions for nasolacrimal duct obstruction in adults and children.
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Affiliation(s)
- Hwa Lee
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Republic of Korea
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Bony nasolacrimal duct entrance diameter: gender difference in cadaveric study. Ophthalmic Plast Reconstr Surg 2011; 27:204-5. [PMID: 21386745 DOI: 10.1097/iop.0b013e3182078e47] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To examine gender differences in bony nasolacrimal canal entrance diameters in cadavers. METHODS Fifty-seven orbits from 29 Japanese cadavers (37 orbits from 19 men and 20 orbits from 10 women), aged 61 to 96 years at death (mean: 79.5 years; men: 77.8 years; women: 82.7 years), were fixed in 10% buffered formalin. The anteroposterior and transverse diameters of the bony nasolacrimal canal entrance were measured. The diameters were compared between genders using Student's t test. RESULTS The mean anteroposterior diameters in all subjects, men, and women, were 6.9, 6.8, and 7.2 mm, and the equivalent transverse diameters were 5.7, 6.1, and 5.0 mm, respectively. There was no significant gender difference in the anteroposterior diameter (p = 0.287), but the transverse diameter was significantly shorter in women than in men (p = 0.004). CONCLUSIONS The transverse diameter of the bony nasolacrimal canal entrance was significantly shorter in women than in men, which may be a possible factor contributing to the higher incidence of primary acquired nasolacrimal duct obstruction in women.
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Konuk O, Abdulgani A, Gonul II, Unal M. Orbital cyst of lacrimal derivation presenting as a recurrent orbital abscess in a pediatric patient. J Pediatr Ophthalmol Strabismus 2009; 46:365-7. [PMID: 19928743 DOI: 10.3928/01913913-20091104-09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2007] [Accepted: 02/27/2008] [Indexed: 11/20/2022]
Abstract
A 2-year-old girl presented with inflammatory eyelid swelling in the left eye over a 2-week period. Ophthalmologic examination showed hyperemia and swelling, with a palpable mass at the inferior orbital rim. Orbital magnetic resonance imaging showed periorbital edema and a cystic lesion located in the inferomedial orbit. Histopathologic evaluation showed an orbital cyst of lacrimal derivation.
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Affiliation(s)
- Onur Konuk
- Department of Ophthalmology, Gazi University Medical School, Ankara, Turkey
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Rogers GA, Murchison AP, Wojno TH, DelGaudio JM. Inferior meatus endoscopy and directed treatment for epiphora: early experience with a novel approach. Otolaryngol Head Neck Surg 2009; 140:579-84. [PMID: 19328350 DOI: 10.1016/j.otohns.2008.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Revised: 11/06/2008] [Accepted: 12/02/2008] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Epiphora results from obstruction along the nasolacrimal (NL) system. The inferior meatus (IM) is not routinely evaluated. IM pathology is common in patients with epiphora, allowing surgery to be directed at the IM. METHODS Retrospective review of patients referred for epiphora. Patients underwent office endoscopy of the IM. Patients with identifiable pathology underwent intervention directed at the IM. RESULTS Seventeen patients were evaluated, four with bilateral epiphora. Two had no IM disease, and one with pathology refused surgery. The remaining 14 (18 sides) had IM pathology. Two patients were successfully treated in the office. Twelve patients underwent surgery (16 sides). Three NLD orifices were obstructed by a cyst, and the remaining 13 by hypertrophied soft tissue at the level of the NLD orifice. Thirteen of 14 sides with distal NLD pathology had resolution or dramatic improvement and patent NL ducts with IM treatment alone. Obstruction extending proximal to Hasner's valve was found in four NL systems, and three developed recurrent epiphora. Median follow-up was 9 months. CONCLUSIONS IM endoscopy identified pathology in most constant epiphora patients in this study. Pathology at the distal NL system portends a better outcome, whereas extension to the proximal NL duct had poorer outcome.
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Affiliation(s)
- G Aaron Rogers
- Department of Otolaryngology, Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA
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Abstract
BACKGROUND Dacryocystographic evaluation of the location of stenoses of the lacrimal pathways was carried out in patients with epiphora to define the frequency and morphology of canalicular stenosis. PATIENTS AND METHODS Digital subtraction angiography (DSA) dacryocystograms of 55 consecutive patients with severe epiphora and stenoses of the lacrimal draining system were reviewed in a consensus between three evaluators to determine radiomorphologic criteria for the diagnosis of canalicular stenosis. In 9 cases 3D rotational dacryocystography was additionally used. RESULTS A total of 80 stenotic lesions were detected including 19 (24%) canalicular, 26 (32%) saccal and 35 (44%) ductal stenoses. In 9 of the patients 3D rotational dacryocystography was used to differentiate between canalicular (n=4) and saccal (n=5) stenosis. Increased resistance during continuous injection of contrast material and lack of distension of the distal ductal system were the main criteria for diagnosis of canalicular stenosis. CONCLUSION Presaccal stenoses accounted for nearly 25% of the stenoses found in this study. This type of stenosis occurs frequently and should not be overlooked on dacryocystography. 3D rotational dacryocystography may be helpful in unclear cases.
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Affiliation(s)
- M Lüchtenberg
- Klinik für Augenheilkunde, Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main.
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