Study of intranasal ostium external dacryocystorhinostomy

A rigid endoscope was used to directly examine, measure, and photograph the intranasal ostium created by an external dacryocystorhinostomy (DCR). This technique was used to examine 19 patients who underwent 22 standard external DCRs. All patients had clinically successful results, documented by a positive Jone I dye test following surgery. The dimension of the bony opening created at surgery was measured and averaged 11.84 mm in diameter. The average diameter of the healed intranasal ostium was only 1.80 mm. No statistically valid correlation between the size of the bony opening and the final size of the healed intranasal ostium could be established. Thus, a large surgical anastomosis did not necessarily result in a large healed intranasal ostium. Excellent functional results were obtained even when the intranasal ostium was quite small. Other indications for the use of this technique are discussed.

The natural course of congenital obstruction of the nasolacrimal duct

In order to establish the rate of spontaneous resolution of congenital obstruction of the nasolacrimal duct, 50 infants, referred from a local pediatric group practice over a period of five years, were followed from the time of first symptoms until 8 to 13 months of age. Among the 50 infants, 65 nasolacrimal ducts were blocked and 58 ducts in 44 patients opened spontaneously. Only seven ducts in six patients required probing for relief of the obstruction. During the same period another seven patients from various referral sources were seen because of noninflammatory swelling of the lacrimal sac at birth. These patients were also found to have nasolacrimal duct obstruction, but early surgical intervention was required in six of the seven patients to relieve the distention of the sac.

Comparative external versus endoscopic dacryocystorhinostomy: results in 115 patients (130 eyes)

BACKGROUND

Epiphora is an annoying symptom, embarrassing the patient both socially and functionally. The two widely accepted treatment modalities of epiphora resulting from obstruction of the nasolacrimal ductus are external and endoscopic dacryocystorhinostomy (DCR).

OBJECTIVE

The aim was to compare the results, operative time, and complications of external and videoendoscopic endonasal DCR performed between December 1994 and December 1998.

METHODS

In group 1, conventional primary external DCR with or without silicone tube intubation was performed in 79 patients (66 women and 13 men) with unilateral dacryocystitis. In group 2, endoscopic primary endonasal DCR with hammer-chisel removal of bone located over the lacrimal sac was performed in 51 eyes of 36 patients, 33 women and 3 men (15 bilateral procedures).

RESULTS

The follow-up period was 6 to 48 months (mean 25 months) after surgery. The age range was from 4 to 76 years (mean 38.5 years). The success rates of external and endoscopic hammer-chisel DCR were found to be 89.8% and 88.2%, respectively. A lower complication rate was observed in the endoscopic group, with minimal morbidity and shorter operative time compared with the external approach.

CONCLUSIONS

Hammer-chisel endoscopic DCR is practical, less traumatic, less time-consuming, and cosmetically more convenient than the external approach. The success rate of the endoscopic DCR procedure is comparable with that of traditional external DCR, and it also allows simultaneous correction of any intranasal pathology.

Results of endonasal laser-assisted dacryocystorhinostomy

BACKGROUND

Endonasal laser-assisted dacryocystorhinostomy has been a subject of much interest since its introduction in 1990, offering the potential advantages of decreased postoperative morbidity and the lack of a cutaneous scar. In this study, the authors report the results of 46 endonasal laser-assisted dacryocystorhinostomy procedures performed on 42 patients between February 1991 and July 1992.

METHODS

The medical records of all patients undergoing endonasal laser-assisted dacryocystorhinostomy procedures were reviewed retrospectively in detail. Patients undergoing laser-assisted external dacryocystorhinostomies or conjunctivo-dacryocystorhinostomies and those with follow-up periods less than 4 months were not included in the study.

RESULTS

A total of 46 endonasal laser-assisted dacryocystorhinostomy procedures were performed. Of these, 32 were successful and 14 failed after a single attempt, yielding a success rate of 70% (32/46). Of the 14 patients with failed procedures, 6 underwent a second endonasal laser-assisted dacryocystorhinostomy. Of these, five were successful. The success rate calculated on the basis of one or two attempts was 80% (37/46).

CONCLUSIONS

The science and technology of endonasal laser-assisted dacryocystorhinostomy is undergoing a continuous process of evolution as a number of modifications are introduced, including better patient selection, more complete tissue removal at the osteotomy site, and the adjunctive use of mitomycin C. As this process continues, it is likely that the success rates in this modality will improve, making it an increasingly attractive alternative to external dacryocystorhinostomy.

Success rates of nasolacrimal duct probing at time intervals after 1 year of age

OBJECTIVE

The purpose of the study was to determine the success rate of probing for congenital nasolacrimal duct obstruction after 1 year of age.

DESIGN

A record review.

PARTICIPANTS AND INTERVENTION

Two hundred fifty-two patients with 303 obstructed nasolacrimal ducts underwent probing and irrigation by the author between 1971 and 1997 while under brief general anesthesia.

MAIN OUTCOME MEASURES

Successful outcome of probing was defined as absence of tearing and discharge in the affected eye.

RESULTS

The overall cure rate in all patients was 92%, varying from 88.9% to 96.8% at different age intervals up to and beyond 3 years of age. Chi-square analysis showed no significant change in cure rate with increasing age.

CONCLUSION

Probing for congenital nasolacrimal duct obstruction beyond 1 year of age is highly successful, and the cure rate does not vary significantly at intervals of increasing age.

Dacryocystorhinostomy with intraoperative mitomycin C

PURPOSE

To observe the effect of intraoperative mitomycin C on the size of the osteotomy site after dacryocystorhinostomy.:

METHODS

A total of 15 eyes of 14 patients diagnosed with primary acquired nasolacrimal duct obstruction were assigned randomly to either a mitomycin C group or a control group. The surgical procedures in both groups were exactly the same, except that in the patients in the mitomycin C group, a piece of neurosurgical cottonoid soaked with 0.2 mg/ml mitomycin C was applied to the osteotomy site and then after 30 minutes was removed transnasally. Nasoendoscopic findings were recorded at the completion of the surgery and at 1 month, 3 months, and 6 months after surgery for the two groups. A computer-aided digitizer was used to calculate the surface area of the osteotomy site, and a Student's t test was used to compare the difference between the two groups.

RESULTS

All patients in the mitomycin C group remained symptom free after removal of their silicone tube (100% success), and there was one patient in the control group who had recurrent epiphora (87.5% success). Septo-osteotomy adhesion was found in two patients in the control group (25%), but there was no such adhesion found in the patients in the mitomycin C group. In the mitomycin C group, the average final surface area of the osteotomy at the end of the sixth postoperative month was 27.10 +/- 5.78 mm2, whereas that of the control group was only 10.83 +/- 3.37 mm2. Although the immediate postoperative surface area of the osteotomy showed no significant difference between the two groups, a statistically significant difference was noted at 6 months.

CONCLUSION

Intraoperative mitomycin C is effective in maintaining a larger osteotomy size. This modification may possibly improve success rates over the traditional dacryocystorhinostomy procedure.

Long-term results and reasons for failure of intranasal endoscopic dacryocystorhinostomy

The aim of this study was to evaluate the long-term results and the factors influencing the success in patients with nasolacrimal duct obstruction treated with intranasal endoscopic dacryocystorhinostomy (DCR) and silicone tube intubation (STI). We prospectively investigated 158 patients with lacrimal obstruction in two groups, one of which comprised 108 patients treated primarily with intranasal endoscopic DCR by experienced surgeons and the other comprised 50 patients who were operated on by inexperienced surgeons. In a mean follow-up time of 49 months the surgical success was 94.4% in experienced hands and 58.0% in inexperienced hands. The endoscopic examination of six patients with failure in the first group revealed granulation tissue around the tube in four, atonic sac in one and persistence of bone that was supposed to have been excised in the nasal cavity in one. There were 21 failures out of 50 patients in the second group: granulation tissue in 2 cases, fenestration to the nasolacrimal duct instead of the sac in 6 cases, synechia between the lateral nasal wall and the middle turbinate in 2 cases, bony spicles causing obstruction in 5 cases and fenestration anterior to the sac in 2 cases. In 4 cases no reasons were found for failure, but perhaps the small fenestration and failure to remove the medial half of the membranous sac wall was the reason. DCR and STI can be performed for primary treatment in lacrimal obstruction. There is a learning curve for the operation. False localization of the lacrimal sac, granulation tissue formation around the tubes, retained bony spicles, inadequate removal of the medial wall of the sac and the synechia between the lateral wall and the middle turbinate are the most common causes of failure.

Congenital nasolacrimal system obstruction

A series of 132 children with congenital nasolacrimal system obstruction was prospectively randomized into three groups to determine the effectiveness of different modes of nonsurgical treatment. Massaging the nasolacrimal sac in a manner that increased hydrostatic pressure and ruptured the membranous obstruction was more effective (with a high degree of statistical significance) than simple massage or no massage at all. Of those children requiring nasolacrimal probing, a high success rate was found with simple obstructions in the nasolacrimal duct. Failure of probing was more common in canalicular obstructions or generally narrow nasolacrimal ducts. Silicone intubation of the nasolacrimal system is an effective way of treating cases not cured by probing.

Clinicopathologic findings from lacrimal sac biopsy specimens obtained during dacryocystorhinostomy

PURPOSE

To retrospectively review the pathologic diagnoses and clinical characteristics of patients undergoing dacryocystorhinostomy (DCR).

METHODS

Specimens accessioned between 1991 and 2001 in a single ophthalmic pathology laboratory were reviewed. All of the specimens included a lacrimal sac biopsy specimen. The pathologic diagnoses were recorded. The clinical features of the patients with significant pathologic abnormalities were reviewed to determine if the pathology was suspected before or at the time of the DCR.

RESULTS

There were 377 DCR specimens from 316 patients representing 1.8% of 21,018 ophthalmic pathology specimens accessioned between 1991 and 2001. Diagnoses, in decreasing order of frequency, were nongranulomatous inflammation (321, 85.1%), granulomatous inflammation consistent with sarcoidosis (8, 2.1%), lymphoma (7, 1.9%), papilloma (4, 1.11%), lymphoplasmacytic infiltrate (4, 1.1%), transitional cell carcinoma (2, 0.5%), and single cases of adenocarcinoma, undifferentiated carcinoma, granular cell tumor, plasmacytoma, and leukemic infiltrate. A total of 31 (8.2%) specimens from 25 (7.9%) of patients demonstrated significant pathology. Among 17 specimens (4.5%) from 14 patients with neoplasms whose clinical histories were available, 8 (2.1%) were not suspected before surgery.

CONCLUSIONS

Nongranulomatous inflammation consistent with chronic dacryocystitis is the most common diagnosis in lacrimal sac specimens obtained at DCR. Neoplasms resulting in chronic nasolacrimal duct obstruction occurred in 4.6% of cases and were unsuspected before surgery in 2.1% of patients. We recommend pathologic examination of DCR specimens.

Congenital nasolacrimal duct obstruction: natural history and the timing of optimal intervention

Nasolacrimal duct obstruction (NLDO) is a relatively common clinical problem. Debate continues about optimal management. Intervening early and intervening late each have advantages and disadvantages. We reviewed the world literature on NLDO. We assembled information on occurrence, natural history, and results of treatment. Spontaneous remission data were used to derive the probability of continued obstruction versus age. The prevalence a hypothesized treatment-resistant form of NLDO was estimated. Symptomatic NLDO probably occurs in 5 to 6% of infants. Given a symptomatic case under the age of 14 months, the probability of spontaneous remission within the following month appears to be approximately one of three. Probe failure risk increases with age, doubling every 6 months. Increasing probe failure risk may be due to self-selection. Preliminary analysis of management strategies suggests that lacrimal duct probing at age 4 months in the office is the most cost-effective strategy. Further descriptive studies of NLDO remission and treatment are indicated.

Late and very late initial probing for congenital nasolacrimal duct obstruction: what is the cause of failure?

AIMS

To find the cure rate of late (second year of age) and very late (3-5 years of age) initial probing for congenital nasolacrimal duct obstruction (CNLDO) and to identify the factors contributing to the failure rate of the probing in older children.

METHODS

In a prospective interventional case series study, 169 eyes of 125 consecutive patients (1-5 years old) with CNLDO underwent probing under general anaesthesia. Cure was defined as absence of tearing and discharge in the affected eye.

RESULTS

138 eyes of 101 patients aged 13-60 months (mean 23.4 (SD 10.2)) were included. Of 15 eyes (10.8%) with complex CNLDO, 80% presented after 24 months of age (p<0.0001). The cure rate was 89% in patients 13-24 months of age and 72% after the age of 24 months (p = 0.01). It was 90.2% in the membranous and 33.3% in the complex CNLDO in both late and very late probing (p<0.0001). There was a high correlation (r = 0.97) and no significant difference between the cure rate at 1 week and final follow up.

CONCLUSION

Accumulation of the complex CNLDO is the main risk factor for failure of probing in the older children. The outcome of the nasolacrimal duct probing at 1 week follow up is highly indicative of the final outcome.

Problems associated with conjunctivodacryocystorhinostomy

Fifty-eight patients (69 eyes) underwent conjunctivodacryocystorhinostomy for lacrimal canalicular obstruction. The cause of lacrimal obstruction and the results and complications of the operation were analyzed. Trauma and idiopathic disease were the most common causes of lacrimal canalicular obstruction in 24 of 69 (34.8%) eyes each. Relief of epiphora was achieved in 68 of the 69 eyes (98.5%). The complications included tube displacement in 40 of the 69 eyes (57.9%), tube obstruction in 19 of the 69 eyes (27.5%), and infection of the lacrimal sac in four of the 69 eyes (5.8%). Despite frequent complications, most Jones tubes can be made to function satisfactorily. Conjunctivodacryocystorhinostomy remains the best surgical treatment at this time for permanent loss of canalicular function.

Factors affecting the success of nasolacrimal duct probing for congenital nasolacrimal duct obstruction

PURPOSE

To ascertain the effect of certain parameters on nasolacrimal duct probing.

METHODS

In a retrospective study of 142 infants and children who underwent nasolacrimal duct probing for congenital nasolacrimal duct obstruction, age at time of probing, gender, symptom severity, presence of mucous discharge, and history of probing were correlated with success of nasolacrimal probing. Success of probing was defined as complete resolution of signs and symptoms of nasolacrimal duct obstruction. Chi-square test was used to analyze covariance.

RESULTS

Success of nasolacrimal duct probing was negatively correlated with increasing age: 92%, 89%, 80%, 71%, and 42% at age 12, 24, 36, 48, and 60 months, respectively (P = .001 at each interval). Increasing severity of epiphora was correlated with increased failure of nasolacrimal duct probing (P = .05).

CONCLUSIONS

Although the success of nasolacrimal duct probing declines with age, probing in older children can remain the first line of treatment. Because increasing frequency of epiphora correlates with failure of nasolacrimal duct probing, children with daily epiphora should undergo early nasolacrimal duct probing.

Congenital dacryocele. A collaborative review

Fifty-four cases of congenital dacryocele from several medical centers were reviewed retrospectively. There was strong female preponderance (73%) and unilateral involvement (88%). Lacrimal sac contents could be expressed by local massage through the puncta in 21% of cases. Probing and irrigation were done under general (27.8%) or local (55.6%) anesthesia, while in other cases (16.7%), the cyst resolved before intervention. Recurrence of the dacryocele occurred in 10 patients (22%) after probing. Nasal cysts were visualized in six cases. Marsupialization of nasal cysts was necessary in four cases. In one center, after conservative therapy, 80% of cysts resolved spontaneously and 20% developed dacryocystitis. Surgical intervention is indicated in cases of dacryocystitis, cellulitis, breathing difficulty from large nasal cysts, recurrent dacryocele, and lack of its resolution after a short trial of digital massage.

New insights into the pathophysiology of primary acquired dacryostenosis

OBJECTIVE

To obtain new insights into the pathophysiology of primary acquired dacryostenosis.

DESIGN

Comparative autopsy tissue study with histopathologic correlations.

MATERIALS

Tissue specimens from the human nasolacrimal ducts of 36 patients undergoing endonasal dacryocystorhinostomy within a framework of primary acquired dacryostenosis were analyzed by histologic studies and electron microscopic examination. Six lacrimal systems of body donors served as controls.

TESTING

One group of tissue specimens from each lacrimal system was prepared and processed with paraffin, sectioned, stained by different methods, and finally examined by light microscopy. The other group was processed with araldite after preparation, sectioned semithin and ultrathin, and examined by transmission electron microscopy.

MAIN OUTCOME MEASURES

The degree of dacryostenosis was scored in each tissue specimen by grading the histologic sections as mild (active chronic inflammation), moderate (proliferative sclerotic forms of chronic fibrosis), or severe (total subepithelial fibrosis).

RESULTS

Of 36 patients with epiphora, 13 had functional obstruction with a patent lacrimal system on syringing; in 23 cases, the lacrimal passage was completely obstructed. Different pathologic stages correlating to duration of symptoms were found ranging from active chronic inflammation to proliferative sclerotic forms and total subepithelial fibrosis.

CONCLUSIONS

Descending inflammation from the eye or ascending inflammation from the nose initiates swelling of the mucous membrane, remodeling of the helical arrangement of connective tissue fibers, malfunctions in the subepithelial cavernous body with reactive hyperemia, and temporary occlusion of the lacrimal passage. In the follow-up, repeated isolated occurrence of dacryocystitis leads to structural epithelial and subepithelial changes, which may lead either to a total fibrous closure of the lumen of the efferent tear duct or to a nonfunctional segment in the lacrimal passage that is manifest on syringing.

Analysis of the results of surgical endoscopic dacryocystorhinostomy: effect of the level of obstruction

AIM

One of the main factors in determining success rate of lacrimal surgery is the level of obstruction in the lacrimal drainage system. There are only few reports which quantify this, and none on endoscopic dacryocystorhinostomy (DCR).

METHODS

A case series of patients who had endoscopic DCR for anatomical obstruction of the lacrimal drainage system was performed. All patients who had lacrimal blockage referred to a district general hospital, irrespective of the level of blockage, had endoscopic DCR as the initial treatment by the authors. A total of 191 endoscopic DCRs were performed between 1994 and 1999. No other forms of lacrimal surgery were performed during this period. The level of the obstruction was assessed by the ophthalmologist before the operation and confirmed at surgery. All cases were followed up for a minimum of 6 months, and 96 cases were also reviewed 12 months after surgery. The outcome of the endoscopic DCR operation for each eye was categorised into complete cure, partial cure, or no improvement according to the degree of symptomatic relief following the operation.

RESULTS

Complete relief from epiphora was achieved in 89% of cases overall at 6 months. The success rate in cases with lacrimal sac/duct obstruction (93%) or common canalicular blockage (88%) was comparable. In canalicular obstruction, however, the complete cure rate was lower at 54%. The benefit of the operation was maintained at 12 months.

CONCLUSION

This study demonstrates that the success rate of surgical (non-laser) endoscopic DCR is comparable to that reported for external DCR. Moreover, the technique is appropriate for initial treatment of patients with common canalicular or even canalicular obstruction.

Management of canalicular laceration

Although canalicular injuries are relatively common, controversy persists regarding indications for repair and the surgical methods that should be employed. In this review, these various treatment philosophies and techniques are analyzed in an historical and a contemporary context. The surgical anatomy, epidemiology and clinical presentation of canalicular injuries are discussed. Inconsistencies in current nomenclature regarding the surgical anatomy of canalicular lacerations are analyzed. Recent studies of lacrimal drainage in systems with monocanalicular obstruction are cited. Various surgical techniques in the repair of canalicular injuries are reviewed, including methods of identifying the medial lacerated lacrimal passages and the various lacrimal stents that have been used. The current popularity of silicone tubing as a lacrimal stent is reviewed. The various methods of stent placement and fixation are systematically categorized. Case series of canalicular repair reported in the literature are reviewed, and the results and complications are compared.

Intranasal endoscopic analysis of dacrocystorhinostomy failure

Intranasal abnormalities are the most common cause of dacryocystorhinostomy failure. The nasal endoscope facilitates recognition of these abnormalities and provides photo documentation to guide the surgeon to the appropriate postoperative management.

"One-stitch" canalicular repair. A simplified approach for repair of canalicular laceration

BACKGROUND

It has been widely believed that direct microsurgical re-anastomosis of the canalicular epithelium is necessary for satisfactory repair of canalicular lacerations. However, because repair is carried out in conjunction with placement of an indwelling silicone stent, this stent should keep the canalicular edges adequately approximate without the need for suturing. The authors report their results in repairing canalicular lacerations using a single, fine, horizontal, mattress suture to re-approximate the overlying pericanalicular orbicularis muscle and eliminate direct microsurgical re-anastomosis of the canalicular epithelium.

METHODS

The authors retrospectively reviewed the charts of 67 patients who underwent repair of lacerated canaliculi with one-stitch re-approximation of the overlying orbicularis muscle in conjunction with bicanalicular silicone tube intubation. Stents were left in place for 3 months postoperatively and then removed. Probing across the lacerated portion of the canaliculus was carried out at the time of stent removal to ensure patency. Dye disappearance testing with 2% fluorescein and irrigation through the canaliculus then was performed 6 weeks to 3 months after stent removal.

RESULTS

Of the 67 patients, 59 were followed to stent removal. Probing with a 00 probe showed canalicular patency in all 59 patients. Irrigation resulted in reflux in two patients, indicating unrelated nasolacrimal duct obstruction. Of these 59 patients, 45 complied with scheduled follow-up 6 weeks to 3 months after stent removal. Dye disappearance testing using 2% fluorescein demonstrated delay in lacrimal outflow in 6 of the 45 patients. Only two patients had symptomatic epiphora, and in both patients there was an underlying nasolacrimal duct obstruction confirmed by irrigation.

CONCLUSIONS

Simple re-approximation of the lacerated overlying soft tissue combined with bicanalicular silicone intubation proved highly successful in managing canalicular lacerations. Probing through the lacerated canaliculus demonstrated patency in 100% of the 59 patients followed to stent removal. Only 4% of patients had symptomatic epiphora postoperatively, and 13% demonstrated some delay in outflow with dye disappearance testing. This compares very favorably with previous reported series in which lacerated canaliculi were microsurgically re-anastomosed.

Jones' lacrimal canalicular bypass tubes: twenty-five years' experience

The results after implantation of Lester Jones canalicular bypass tubes in 326 eyes (310 patients) are reviewed. The bypass tubes were implanted after canalicular obstruction from a variety of causes, of which post-herpetic or post-traumatic obstruction accounted for one-half of all cases. With up to 23 years' follow-up, replacement of the bypass tube was needed in 142 (44%) patients, the majority after spontaneous loss. The median interval to first replacement may be estimated as about ten years for spontaneous loss and five years for all causes. Despite complications and the need for further surgery in many patients, most patients (91%) were pleased with the functional result of surgery. The principles, techniques and complications of lacrimal canalicular bypass surgery are presented and the long-term care of bypass prostheses is discussed.

The management of nasolacrimal duct obstruction in children between 18 months and 4 years old

PURPOSE

Success with nasolacrimal duct probing has been shown to be inversely correlated with age. Consequently, several authors have suggested that the older child with a previously untreated nasolacrimal duct obstruction should undergo silicone intubation or a balloon catheterization as the primary surgical procedure because older children are more likely to have complicated obstructions that will not respond to simple probing. The purpose of this study was to investigate the hypothesis that older children with uncomplicated nasolacrimal duct obstruction can be successfully managed with simple probing.

METHODS

A 14-year prospective study was conducted of consecutive patients older than age 18 months with nasolacrimal duct obstruction. All were treated (subject to certain exclusion criteria) with a simple nasolacrimal duct probing. Careful attention was paid to the type of obstruction encountered at surgery. Outcome evaluation included a standard ophthalmologic examination plus a dye disappearance test at 6 weeks after surgery. A follow-up examination or telephone interview was conducted 1 year after surgery.

RESULTS

Of 378 children undergoing nasolacrimal duct probing, 23 met the inclusion criteria of being older than age 18 months (18 to 48 months). Seventy percent of the 23 children had a good outcome from the probing procedure. When analyzed by the type of obstruction, 12 of the 12 children (100%) with a simple membrane at the valve of Hasner had a good outcome. This contrasted with a success rate of 4 of 11 children (36%) who had complicated obstructions (p < 0.01). Complicated nasolacrimal duct obstructions were more prevalent in older children.

CONCLUSION

A simple probing of the nasolacrimal duct has an excellent success rate in children up to 4 years old if an uncomplicated obstruction is found at the valve of Hasner.

Lacrimal surgery in children

Of 142 children who underwent major lacrimal surgery (160 dacryocystorhinostomies, one congenital fistula excision, one dacryocystectomy, and one canaliculostomy), 49 had congenital nasolacrimal duct obstruction (34%). Lacrimal obstruction was also associated with canaliculitis, punctal agenesis, trauma, congenital fistula, dacryocystitis, craniofacial defects, and functional eyelid abnormalities. Although the timing and technique of the surgery varied according to the abnormalities, an overall functional success rate of 90% (144 of 160 procedures) was achieved.

The prognostic value of preoperative dacryocystography in endoscopic intranasal dacryocystorhinostomy

Endoscopic intranasal dacryocystorhinostomy has been used as a primary treatment of lacrimal obstruction and for revision of conventional dacryocystorhinostomy. This study correlates dacryocystographic anatomy with the success of the endoscopic surgical technique. Eighteen patients with epiphora and nasolacrimal obstruction underwent operations. Preoperative dacryocystography identified 11 patients with either normal or enlarged lacrimal sacs, and seven patients with cicatrized lacrimal sacs. Patients with lacrimal sac stones and tumors were excluded. Endoscopic intranasal dacryocystorhinostomy was successful in nine of 11 (82%) patients with normal or enlarged lacrimal sacs, and in two of seven (29%) patients with cicatrized lacrimal sacs. The endoscopic technique was much more successful with normal or enlarged lacrimal sacs than with cicatrized lacrimal sacs (P = .049). Lacrimal sac anatomy as determined by preoperative dacryocystography is an important prognostic factor in technically achieving surgical success.

Blockage of the lacrimal drainage apparatus as a side effect of docetaxel therapy

BACKGROUND

The current study was conducted to report the severity and management of canalicular and nasolacrimal duct stenosis as a side effect of docetaxel therapy and to report the outcomes of surgical intervention for this condition.

METHODS

The records of 148 patients with epiphora associated with docetaxel therapy who were evaluated at the Ophthalmology Service at The University of Texas M. D. Anderson Cancer Center were reviewed. The frequency of docetaxel administration, the dose intensity, the cumulative dose of docetaxel, and any concomitant chemotherapeutic agents were recorded. Each patient underwent an ophthalmologic examination and in-office probing and irrigation. The patients either were treated with topical steroids or offered a surgical procedure for canalicular stenosis- (silicone intubation, dacryocystorhinostomy [DCR] with the placement of silicone tubes, or DCR with the placement of Pyrex glass tubes), depending on the severity of the canalicular stenosis.

RESULTS

Docetaxel was given weekly in 71 patients, every 2 weeks in 5 patients, and every 3 weeks in 72 patients. Thirty patients (59 eyes) who received weekly docetaxel underwent surgery to correct epiphora. Twenty-three patients (39 eyes) were treated with temporary silicone tube placement, 9 patients (13 eyes) were treated with DCR with temporary silicone tube placement, and 4 patients (7 eyes) were treated with DCR with permanent Pyrex glass tube placement. Twenty-nine of the 30 patients who underwent surgery reported improvement or total resolution of epiphora after the procedure. Ten additional patients (20 eyes) who received weekly docetaxel had complete closure of their canaliculi but elected not to undergo surgery. Of special note were two patients who received weekly docetaxel in the neoadjuvant setting and developed complete closure of the canaliculi. Of the patients who received docetaxel every 2 or 3 weeks, only 3 required a surgical intervention to correct epiphora; none required Pyrex glass tube placement.

CONCLUSIONS

Canalicular and nasolacrimal duct obstruction is a common side effect of weekly docetaxel therapy and can occur even when this drug is used in the neoadjuvant setting. The results of the current study indicate that early temporary silicone intubation in symptomatic patients receiving weekly docetaxel can prevent further closure of the lacrimal drainage apparatus and obviate more involved surgical interventions and permanent Pyrex glass tube placement. Cancer 2003;98:504-7.