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Indian Journal of Otolaryngology and... Oct 2022Epiphora is a bothersome condition seen in chronic dacryocystitis. The mainstay of treatment is surgical, that is creating an opening to establish a drainage pathway....
Epiphora is a bothersome condition seen in chronic dacryocystitis. The mainstay of treatment is surgical, that is creating an opening to establish a drainage pathway. With the advent of endoscope, endonasal DCR has gained popularity. Use of silicone stent in endonasal DCR has added advantage in improving the surgical outcome. And the use of DOS system in improving the success rates of endonasal DCR: (Mohammad et al. in Clin Ophthalmol 8:2491-2499, 2014) a total of 35 patients with chronic dacryocystitis were subjected for endonasal DCR with silicone bicanalicular stent. Patients were followed up at an interval of 1 week, 3 weeks, 6 weeks and 6 months post surgery. DCR ostium parameters were evaluated using DOS system. Silicone stent removal was done at sixth week and evaluated for success. The success rate in our study was 89%. The DOS score of the patient with successful surgery had a score of more than 30 and in the failed cases the score was between 22 and 28. The success rate of the procedure primarily depends on the ostium parameters and the position of the silicone stent. The DOS scoring system can be suitable tool in evaluating the same.
PubMed: 36452807
DOI: 10.1007/s12070-020-01908-8 -
Journal of Ophthalmology 2022To evaluate the efficacy and safety of a modified seamless endoscopic dacryocystorhinostomy (EN-DCR) with chronic dacryocystitis.
OBJECTIVE
To evaluate the efficacy and safety of a modified seamless endoscopic dacryocystorhinostomy (EN-DCR) with chronic dacryocystitis.
METHODS
This study included 54 patients (54 eyes) with chronic dacryocystitis treated in our hospital from 2019 to 2021, including 32 patients (32 eyes) who underwent modified and 22 patients (22 eyes) who underwent routine EN-DCR. In the modified EN-DCR, the nasal cavity was filled 30 min before the operation by injection of 1 mg/ml adrenaline hydrochloride and application of ephedrine hydrochloride and nitrofurazone nasal drops. Before the operation, the lacrimal passages were rinsed with a 1 : 2 mixture of dilute methylene blue and normal saline. The "I"-shaped incision was replaced by a C-shaped incision near the lateral bone window. In place of suturing, a gelatin sponge was applied at the confluence of the lacrimal sac and nasal mucosa. After the end of the operation, the lacrimal sac was filled with tapered expansion sponge for 1 week. In routine EN-DCR, the nasal cavity was filled with 1 mg/ml epinephrine hydrochloride, and nitrofurazone nasal drops were provided for 5 minutes after the beginning of the operation; and a "I"-shaped incision was made in the nasal mucosa, with one stitch for each anterior and posterior flap. Operation time, intraoperative bleeding, and postoperative lacrimal duct irrigation were compared, with the curative effect evaluated after a follow-up of 6 months.
RESULTS
Operation time was significantly shorter (41.3 ± 12.1 min vs. 65.4 ± 11.6 min; = 7.312, < 0.05) and intraoperative bleeding was significantly lower (12.5 ± 5.2 ml vs. 60.3 ± 8.9 ml; = 24.883, < 0.05) in the modified group than in the routine EN-DCR group. After follow-up for 6 months, the effective cure rate was significantly higher in the modified group than in the routine group (96.9% vs. 68.2%; = 6.383, < 0.05).
CONCLUSION
Compared with routine EN-DCR, modified seamless EN-DCR can achieve better surgical outcomes, shorten operation time, and reduce intraoperative bleeding.
PubMed: 36419412
DOI: 10.1155/2022/3061859 -
Clinical & Experimental Optometry May 2022Conjunctivitis, chalazion and blepharitis are routinely managed by optometrists. However, it is especially important to consider the diagnosis of canaliculitis in...
CLINICAL RELEVANCE
Conjunctivitis, chalazion and blepharitis are routinely managed by optometrists. However, it is especially important to consider the diagnosis of canaliculitis in patients with chronic or recurrent conditions.
BACKGROUND
This study aimed to report the clinical features, radiological findings and treatment outcomes in patients with plug-related canaliculitis.
METHODS
This retrospective study included patients with canaliculitis secondary to plug insertion between 2007 and 2020. All data regarding epidemiological characteristics, clinical presentation, isolated microorganisms, computed tomography imaging findings, treatment, and outcomes were analysed.
RESULTS
A total of 20 plug-related canaliculitis from 19 patients (18.3%) among all 109 cases of canaliculitis were identified. All patients with plug-related canaliculitis were females with a past history of lacrimal plug insertion for dry eye (mean age: 58.2 years). Most patients were initially treated as conjunctivitis with the mean time lapse to a diagnosis of 5.2 months. The average time from plug insertion to onset of symptoms was 5.1 years. Eighteen patients underwent canaliculotomy, and one patient received lacrimal irrigation. Plugs were identified in 18 cases, with SmartPlug in 13 cases (72%), followed by EaglePlugTM (two cases), Herrick Lacrimal Plug (two cases), and migrated FCI Painless Plug (1 case). Cultures of discharge, concretions, and/or infected plugs mostly revealed Pseudomonas aeruginosa (42%). Orbital computed tomography in four cases with SmartPlug revealed central radiolucency with surrounding soft-tissue enhancement. No recurrent canaliculitis was observed throughout a mean follow-up period of 13.7 months. No patient needed re-plugging after canaliculotomy and plug removal, with only one required additional lubricants for recurrent dry eye.
CONCLUSION
Plug-related canaliculitis is often underdiagnosed due to late onset and similar symptoms to common ocular diseases. Awareness of plug insertion history as well as meticulous removal of the plug, concretion and/or granulation tissue is important for early diagnosis and to ensure a good outcome.
Topics: Canaliculitis; Conjunctivitis; Dry Eye Syndromes; Female; Humans; Lacrimal Apparatus; Male; Middle Aged; Retrospective Studies
PubMed: 34139956
DOI: 10.1080/08164622.2021.1927675 -
Eye (London, England) Aug 2020To review the outcome for primary or revisional external dacryocystorhinostomy in patients with granulomatous polyangiitis.
AIM
To review the outcome for primary or revisional external dacryocystorhinostomy in patients with granulomatous polyangiitis.
PATIENTS AND METHODS
Retrospective case-note review to include age at presentation, duration of prior GPA, immunosuppression at time of surgery, nature of first lacrimal surgery, and symptomatic control.
RESULTS
Forty-eight patients (25 female; 52%) presented at an average age of 50.5 years and 7 (15%) had prior lacrimal surgery on one (5/7; 71%) or both sides. The duration of systemic GPA varied, with 40% having disease for up to 3 years prior to lacrimal referral, and 41/48 (85%) being on systemic immunosuppression. Forty-eight patients had 71 affected drainage pathways-having symptoms for an average of 22 months (range <1 month to 7 years). Surgery was undertaken on 70/71 systems-62/70 primary DCRs (20 unilateral; 8 simultaneous bilateral; 13 sequential bilateral). Of nine systems with persistent symptoms after prior surgery, eight underwent revisional surgery (six unilateral; one sequential bilateral). With a follow-up of 2.5 years (range 3 months to 14 years), volume symptoms were cured in all 70 cases. Flow symptoms were controlled in 58/62 (94%) systems after primary DCR, and all eight after revisional surgery. Of four sides with persistent epiphora, one was cured with revisional DCR and three with placement of Jones' canalicular bypass tubes.
CONCLUSION
Mucoid discharge, dacryocystitis and recurrent conjunctivitis were cured in all patients with GPA after either primary and revisional surgery. Continued epiphora was controlled in most patients with additional closed procedures.
Topics: Dacryocystitis; Dacryocystorhinostomy; Female; Humans; Lacrimal Apparatus; Lacrimal Apparatus Diseases; Lacrimal Duct Obstruction; Middle Aged; Nasolacrimal Duct; Retrospective Studies; Treatment Outcome
PubMed: 31685972
DOI: 10.1038/s41433-019-0662-1 -
JPMA. the Journal of the Pakistan... May 2021To evaluate the success rate of endoscopic endonasal dacryocystorhinostomy.
OBJECTIVE
To evaluate the success rate of endoscopic endonasal dacryocystorhinostomy.
METHODS
The prospective cohort study was conducted at the Ophthalmology and Otorhinolaryngology departments, Shifa Foundation Community Health Centre, Islamabad, Pakistan, from October 2017 to September 2019, and comprised chronic dacryocystitis patients who underwent endoscopic endonasal dacryocystorhinostomy. Endoscopic dacryocystorhinostomy with or without lacrimal intubation was performed under general anaesthesia. The patients were followed up post-operative at 1 week, 1 month, 6 months and 12 months. Data was analysed using SPSS 20.
RESULTS
Of the 47 patients, 41(87.2%) were females. The overall mean age was 40.70±10.84 years (range: 25-66 years). Lacrimal intubation was performed in 31(66%) patients. Surgical success was achieved in 46(97.9%) patients. Of them, 37(78.7%) patients were completely symptom-free, while 9(19.1%) were partially symptomatic and were managed conservatively. Treatment failure requiring repeat surgical procedure was the case with 1(2.1%) patient. Procedure failure was more likely in patients with previous attacks of acute dacryocystitis (p=0.003).
CONCLUSIONS
Endoscopic dacryocystorhinostomy was found to be a safe procedure with good anatomical and functional outcomes in chronic dacryocystitis patients.
Topics: Adult; Dacryocystorhinostomy; Endoscopy; Female; Humans; Male; Middle Aged; Pakistan; Prospective Studies; Treatment Outcome
PubMed: 34091626
DOI: 10.47391/JPMA.187 -
Italian Journal of Pediatrics Jan 2024Dacryocystitis is a common disease in pediatric ophthalmology. Analysis of basic information, flora distribution, and characteristics of information on drug-resistant...
BACKGROUND
Dacryocystitis is a common disease in pediatric ophthalmology. Analysis of basic information, flora distribution, and characteristics of information on drug-resistant bacteria in children with dacryocystitis for 6 years, providing evidence for ophthalmologic infection prevention and clinical management strategies.
METHODS
A retrospective cohort study was conducted to evaluate the demographics of dacryocystitis in children and microbiological characteristics of secretion cultures, and to analyze the basic information, distribution of pathogenic bacteria, drug resistance, and to plot trendsand distribution pie charts according to the years.
RESULTS
This study recruited 5791 specimens. Decreased incidence of dacryocystitis from 2020 to 2022 (including the COVID-19 pandemic). The age of highest incidence of dacryocystitis is infancy, followed by the neonatal period, and the incidence decreased with age. Streptococcus pneumoniae had the highest percentage in 2017, and the overall trend was decreasing, the difference was statistically significant (p < 0.001); Streptococcus mitis showed an overall increasing trend, with the highest incidence in 2022 and the lowest in 2017, with a statistically significant difference (p < 0.001); Haemophilus influenzae was the most common gram-negative bacteria with an overall decreasing trend (p < 0.001); The incidence of Catamoeba and Stenotrophomonas varied from year to year, with statistically significant differences (p = 0.010, p = 0.033, respectively). Methicillin-resistant Staphylococcus aureus (MRSA) had the lowest incidence in 2017 and 2022 the highest incidence in 2022, with a statistically significant difference in incidence between years (p = 0.003); β-lactamase-positive was the most common type of resistance, and MRSA was the second, with statistically significant differences between years (p = 0.003, p < 0.001, respectively). Streptococcus pneumoniae is a common etiologic agent of dacryocystitis in all age groups.
CONCLUSIONS
Dacryocystitis in children is significantly associated with age characteristics and infection-related pathogens, and infection prevention and control can help reduce the infection of related pathogens and the increase of new drug-resistant strains. Close monitoring of changes in pathogen distribution in ocular secretion cultures can help in early intervention and treatment of infectious dacryocystitis.
Topics: Infant, Newborn; Humans; Child; Methicillin-Resistant Staphylococcus aureus; Pandemics; Retrospective Studies; Dacryocystitis; Streptococcus pneumoniae; China
PubMed: 38247004
DOI: 10.1186/s13052-024-01582-4 -
Arquivos Brasileiros de Oftalmologia Jun 2017To compared the ultrasound findings of the lacrimal sac between subjects with normal lacrimal systems those with chronic dacryocystitis.
PURPOSE
To compared the ultrasound findings of the lacrimal sac between subjects with normal lacrimal systems those with chronic dacryocystitis.
METHODS
A retrospective study of 10 subjects with a normal lacrimal system (Group 1) and 10 with chronic dacryocystitis (Group 2) diagnosed according to B-mode ultrasound with a 10-MHz transducer and the direct-contact technique (AVISO, Quantel Medical) for lacrimal sac assessment. We analyzed the dimensions, features, and content of the sacs. Characteristics of the population: female: 6, Group 1; 8, Group 2; mean age 48.4 years (SD=19.9; range, 22-80 years), Group 1; 50.5 years (SD=15.5; range, 25-75 years), Group 2.
RESULTS
The dimensions of the lacrimal sac were as follows: anteroposterior 1.86 and 10.99 mm in Groups 1 and 2, respectively, p<0.0001; vertical 9.79 and 14.13 mm in Groups 1 and 2, respectively, p=0.049. Qualitative evaluation of the lacrimal sac contents showed hypoechogenic content in Group 1 (10, 100%) and hyperechogenic punctiform content in Group 2 (10, 100%) with partial filling in seven cases (70%).
CONCLUSIONS
Ultrasonography can differentiate normal lacrimal sacs from sacs compromised by chronic dacryocystitis, thus being useful as an adjunct to clinical examination and surgical planning.
Topics: Adult; Aged; Aged, 80 and over; Case-Control Studies; Chronic Disease; Dacryocystitis; Female; Humans; Lacrimal Duct Obstruction; Male; Middle Aged; Nasolacrimal Duct; Organ Size; Reproducibility of Results; Retrospective Studies; Ultrasonography
PubMed: 28832742
DOI: 10.5935/0004-2749.20170042 -
Acta Ophthalmologica Dec 2013IgG4-related orbital disease (IgG4-ROD) is a recently described condition that may account for a significant proportion of idiopathic lymphoplasmacytic or sclerotic... (Meta-Analysis)
Meta-Analysis Review
IgG4-related orbital disease (IgG4-ROD) is a recently described condition that may account for a significant proportion of idiopathic lymphoplasmacytic or sclerotic orbital lesions. This study is the first meta-analysis of published cases and reveals several differences between IgG4-related disease affecting the orbit and that affecting the pancreas. IgG4-ROD affects a slightly younger group of patients, affects men and women approximately equally, is commonly associated with salivary gland lesions, is associated with a relatively higher serum IgG4 and may confer an increased risk of non-Hodgkin Lymphoma. Its pathogenesis may involve an immune response to antigen exposure in the upper aerodigestive tract.
Topics: Dacryocystitis; Humans; Hypergammaglobulinemia; Immunoglobulin G; Orbital Myositis; Orbital Pseudotumor; Paraproteinemias
PubMed: 22963447
DOI: 10.1111/j.1755-3768.2012.02526.x -
Indian Journal of Ophthalmology Feb 2024To evaluate the association between meibomian gland dysfunction (MGD) and primary chronic dacryocystitis (PCD) and the effect of dacryocystorhinostomy (DCR) on tear film... (Clinical Trial)
Clinical Trial
PURPOSE
To evaluate the association between meibomian gland dysfunction (MGD) and primary chronic dacryocystitis (PCD) and the effect of dacryocystorhinostomy (DCR) on tear film stability and MGD.
METHODS
This prospective, interventional, non-randomized study involved 50 unilateral acquired PCD cases and 50 age-matched healthy controls. Patients with lid abnormalities, ocular trauma, previous ocular surgery, contact lens wearers, and chronic topical or systemic drug users were excluded from the study. After a detailed history, the ocular surface disease index (OSDI) was calculated. The ocular assessment included visual acuity, tear meniscus height (TMH), tear break-up time (TBUT), tear well diameter (TWD), Schirmer 1 test, meibomian gland (MG) expressibility, and meibography. PCD eyes underwent external DCR, and the tests were repeated after 8 weeks.
RESULTS
The mean age of PCD cases was 42.58 ± 12.74 years, the male: female ratio was 7:19, and the mean duration of epiphora was 2.2 ± 1 years. The MG expressibility grade of ≥2 was seen in 98% (49/50) PCD eyes, which was strongly associated with PCD as compared to controls (OR = 563, P = 0.00, 95% CI = 60.71-5229.70). MG loss ≥50% was seen in 62% (31/50) of PCD eyes and none of the control eyes. Following DCR, MG loss remained unchanged, and a significant decrease occurred in OSDI scores, TWD and Schirmer 1 values, and MG expressibility grade (Z = -6.85). The mean TMH decreased from 767.60 ± 331.60 µm to 384 ± 204.29 µm ( P = 0.004) post DCR.
CONCLUSIONS
PCD is strongly associated with MGD. DCR reverses the functional MG changes with improvement in the tear film stability but no effect on MG loss.
Topics: Humans; Male; Female; Adult; Middle Aged; Meibomian Gland Dysfunction; Eyelid Diseases; Prospective Studies; Meibomian Glands; Dacryocystitis; Tears; Dry Eye Syndromes
PubMed: 38099354
DOI: 10.4103/IJO.IJO_1449_23 -
Auris, Nasus, Larynx Feb 2017IgG4-related disease (IgG4-RD) is a chronic inflammatory disorder, characterized by elevated serum IgG4 levels as well as abundant infiltration of IgG4-positive... (Review)
Review
IgG4-related disease (IgG4-RD) is a chronic inflammatory disorder, characterized by elevated serum IgG4 levels as well as abundant infiltration of IgG4-positive plasmacytes and fibrosis in various organs, including the head and neck region. In particular, the salivary glands, orbit, and thyroid are common sites of disease involvement. IgG4-RD is diagnosed based on various clinical, serological, and histopathological findings, none of which are pathognomonic. Hence, various differential diagnoses, which exhibit elevated serum IgG4 levels and infiltration of IgG4-postive cells into tissues, need to be excluded, especially malignant diseases and mimicking disorders. Systemic corticosteroids are generally effective in inducing IgG4-RD remission; however, recurrent or refractory cases are common. In addition, although the pathogenic mechanisms of IgG4-RD remain unclear, an antigen-driven inflammatory condition is believed to be involved. Recent studies have indicated the important pathogenic role of B cell/T cell collaboration and innate immunity in this disease. Nevertheless, additional research and discussions are needed to resolve many remaining questions. In this review, we provide an overview of the recent insights on the history, clinical features, diagnosis, and treatment of IgG4-RD in the head and neck region. Furthermore, we have also addressed the pathogenesis of this disease.
Topics: Adrenal Cortex Hormones; Autoimmune Diseases; Autoimmune Hypophysitis; Dacryocystitis; Humans; Immunoglobulin G; Lymphadenitis; Mastoiditis; Neuritis; Otitis; Rhinitis; Sialadenitis; Sinusitis; Thyroiditis, Autoimmune
PubMed: 27956101
DOI: 10.1016/j.anl.2016.10.011