OUTCOME OF INITIAL 100 CASES OF ENDOSCOPIC DACRYOCYSTORHINOSTOMY IN KIRKUK
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This study aimed at determining the effect and safety of endoscopic dacryocystorhinostomy (ENDO-DCR) in initial 100 cases of nasolacrimal duct obstruction. This study was done in Kirkuk general hospital from 2010 to 2017 with a total of 100 cases. A standardized method was applied to all cases through employing an endonasal technique to the lachrymal sac. Then, an operative resection was applied to the mucosa of nose, lacrimal bone and a part of the anterior maxilla. Next, a complete removal of the medial wall of the lacrimal sac was done. A tube of canalicular silicone intubation was placed for 6 months after operation. The key results of such measures were epiphora resolution, lack of discharge and clearness of the ostium. The success of ENDO-DCR method with adjunctive tube of canalicular silicon intubation was demonstrated in 80 cases (80%) and 10 cases represented acceptable improvements. However, there were minor complications faced during or after operation period. Finaly Endoscopic dacryocystorhinostomy is a safe and effective method for treating nasolacrimal duct obstruction in adults and children with nasolacrimal duct obstruction and epiphora.Keywords:
Nasolacrimal Duct Obstruction
Ostium
Nasolacrimal duct
Lacrimal sac
Lacrimal apparatus
Lacrimal duct
Lacrimal sac
Nasolacrimal duct
Nasolacrimal Duct Obstruction
Lacrimal apparatus
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The article gives a detailed description of the clinical case of a rather rare eye disease - tumors of the lacrimal SAC and nasolacrimal duct, that usualy is difficult in diagnosis and treatment. We used computer tomography, dacryocystography, endoscopy for examination. The operation of removing tumor of the lacrimal SAC is well described and illustrated. Distinctive appearance of squamous papilloma, which is different from the prevailing views of papilloma attracts attention. Also we noted the number of postopertive features. The paper includes review of the literature concerning tumors of the lacrimal SAC and nasolacrimal duct, analisys of criteria for differential diagnostics of tumors of the lacrimal SAC, classification of malignant tumors of the lacrimal SAC in stages. The information obtained can contribute to the proper diagnosis and treatment of patients with pathology of the lacrimal drainage than will be useful for clinical ophthalmologists.
Lacrimal sac
Nasolacrimal duct
Lacrimal apparatus
Lacrimal duct
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A 68-year-old man with known history of IgG4-related disease presented with a 1-year history of mucoid discharge OD and progressive proptosis OS. MRI showed diffuse enlargement of the left lacrimal gland along with prolonged infiltrative changes involving the left extraocular muscles, supraorbital nerve, and infraorbital nerve. No identifiable masses were noted in either nasolacrimal drainage system on MRI. Due to clinical evidence of nasolacrimal duct obstruction, a right external dacryocystorhinostomy was performed along with biopsies of the right lacrimal sac and left lacrimal gland. Immunohistochemical stains identified IgG4-positive plasma cells in the biopsy of the right lacrimal sac indicative of secondary acquired nasolacrimal duct obstruction despite the absence of mass forming lesions on exam and nasolacrimal imaging. This report is the first to describe nasolacrimal drainage system IgG4-related ophthalmic disease involvement in an otherwise clinically and radiographically normal appearing tear drainage system.
Nasolacrimal Duct Obstruction
Lacrimal sac
Nasolacrimal duct
Lacrimal apparatus
Occult
Infraorbital nerve
Orbit (dynamics)
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Several minimally invasive modifications of endoscopic medial maxillectomy have been proposed recently, with the least traumatic techniques utilizing the lacrimal recess as a route to enter the sinus. The aim of the study was to analyze the anatomy of medial maxillary wall in the region of nasolacrimal canal and, thus, to determine the capability of performing minimally invasive approach to the maxillary sinus leading through the lacrimal recess. The course of nasolacrimal canal and the distance between the anterior maxillary wall and the nasolacrimal canal (the width of lacrimal recess) were evaluated in 125 randomly selected computed tomography (CT) head examinations. The proportion of cases with unfavorable anatomical conditions (lacrimal recess too narrow to accept a 4 mm optic) to perform minimally invasive middle maxillectomy was assessed. The width of lacrimal recess, measured at the level of the inferior turbinate attachment, varied between 0 and 15.2 mm and was related to slanted course of nasolacrimal canal. The more perpendicular the axis of the canal to the nasal flor, the narrower the lacrimal recess. In about 16% of cases, lacrimal recess width was less than 4 mm and in 14.4% it was missing. The endoscopic approach to maxillary sinus leading through lacrimal recess is possible in about 70% of patients. In the remaining group of patients when the lacrimal recess is too narrow, this type of approach may be difficult to perform without damaging the piriform aperture rim or bony framework of nasolacrimal duct, or it may be impracticable when lacrimal recess is missing.
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Lacrimal sac
Lacrimal duct
Lacrimal apparatus
Medial wall
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Nasolacrimal duct obstruction (NLDO ) leads to excessive tearing and mucoid discharge that may require nasolacrimal duct probing with irrigation and/or balloon dacryoplasty to remove debris or dilate the lacrimal duct. Skin irritation, crust of the lashes and rim of the eye, and infection may occur with NLDO as tears are unable to drain from the eye through the lacrimal duct into the sinus. Congenital NLDO is the most common disorder leading to epiphora, which is the abnormal overflow of tears due to excessive secretion of tears or obstruction of the lacrimal drainage passages. Nasolacrimal duct obstruction in early childhood occurs in 5% to 20% of children and often does not require surgery, typically resolving with conservative treatment such as lacrimal duct massage and antibiotics. This chapter describes the indications, contraindications, special considerations and anesthesia management for nasolacrimal duct probing, irrigation, and dacryoplasty.
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Nasolacrimal Duct Obstruction
Lacrimal duct
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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.
Nasolacrimal Duct Obstruction
Lacrimal sac
Nasolacrimal duct
Dacryocystitis
Lacrimal apparatus
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Backgrounds We report successful outcomes of monocanalicularnasal intubation with Monoka tubes and endoscopic findings for Hasner valve area. This method is presented as a primary treatment modality in congenital nasolacrimal duct obstruction (CNLDO) with an enlarged lacrimal sac and chronic dacryocystitis. Methods In a prospective noncomparative consecutive case series, 23 eyes of 18 patients with CNLDO with an enlarged lacrimal sac and chronic dacryocystitis underwent endoscopic probing and monocanalicularnasal intubation under general anesthesia. Demographic information, including age, sex, duration of preoperative symptoms, operative endoscopic findings, timing of silicone tube removal, follow-up periods, complications, and outcomes, was analyzed. Results The study included 23 eyes of 18 patients. Mean (SD) age was 19.7 (12.2) months (range, 9–48 mo). Under nasal endoscopic view, the probe tip protruded through a balloon-like nasal mucosa around the Hasner valve. In all cases, tubes were removed in an office setting under topical anesthesia. Mean follow-up period was 24.6 (5.4) weeks. Complications, such as punctal slitting and corneal abrasion, were not observed. All patients showed successful results until the final follow-up. Conclusions In cases of CNLDO with an enlarged lacrimal sac and chronic dacryocystitis, monocanalicular intubation is recommended rather than simple probing. Monoka tube intubation has the advantages of technical ease of insertion and tube removal. Moreover, the tubing does not threaten the unprobed part of the lacrimal drainage system. Endoscopic findings revealed that the probe tip protruded through a balloon-like nasal mucosa with pus around the Hasner valve.
Lacrimal sac
Nasolacrimal Duct Obstruction
Nasolacrimal duct
Canthus
Lacrimal duct
Chronic dacryocystitis
Dacryocystitis
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A computed tomograph (CT) scanner was used in the diagnostics of diseases of the lacrimal drainage system. During the past three years, 22 patients with lacrimal disease were examined: 20 patients with dacryocystitis, two of them after maxillo-facial injury, and two with lacrimal sac tumor. Computed tomographic dacryocystography (CTD) was used to diagnose dacryocystitis or other types of obstruction in the lacrimal sac or nasolacrimal duct. In dacryocystitis cases CTD clearly visualized the lacrimal sac, the nasolacrimal duct and its connections with the surrounding bone tissue, and showed the correct anatomical obstruction site, even in complicated cases. In tumor cases, CT with intravenous contrast material was used to detect the extent of the tumor and also the bone defect. Because of the expense, the authors suggest ultrascan diagnostics as the first choice of imaging diagnostic method in simple dacryocystitis cases, and the use of CT and other imaging diagnostic methods in complicated cases.
Lacrimal sac
Dacryocystitis
Nasolacrimal duct
Lacrimal duct
Nasolacrimal Duct Obstruction
Lacrimal apparatus
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Inverted papillomas of the lacrimal sac and nasolacrimal duct are exceedingly rare. Though histologically benign, these tumors are locally aggressive, have propensity for recurrence and are associated with a chance of malignant transformation. These tumors can present in an innocuous manner, masquerading as more common conditions such as primary acquired nasolacrimal duct obstruction. We present our experience with one such case and a review of the literature to emphasize the importance of pre-operative assessment and intra-operative vigilance, so as to aid in accurate diagnosis and early treatment.
Nasolacrimal duct
Nasolacrimal Duct Obstruction
Lacrimal sac
Lacrimal duct
Inverted Papilloma
Malignant Transformation
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Objective To explore the effects of crush-massage to ameliorate lacrimal sac treating congenital obstruction of nasolacrimal duct.Methods A retrospective review was made on the treatment of 34 cases (36 eyes) involving congenital obstructions of nasolacrimal duct from June 1991 to June 2005,and massage was done in the areas of lacrimal sac and Yingxiang point,then antibiotic eye drops and pastes were put.Results Of the 36 eyes in 34 cases,35 eyes in 33 cases were cured,the remaining one case was cured by using the therapy of bony sounding of the lacrimal passage.Conclusion Crush-massage to ameliorate lacrimal sac is easy to perform to cure congenital obstruction of nasolacrimal duct,which has no side effect and may be considered as first-choice.
Lacrimal sac
Nasolacrimal duct
Nasolacrimal Duct Obstruction
Lacrimal apparatus
Lacrimal duct
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