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Klinische Monatsblatter Fur... Feb 2021The tearing eye (epiphora) is the guiding symptome of nasolacrimal duct obstruction. Depending on the localization of stenosis, mucopurulent lacrimal discharge occurs...
The tearing eye (epiphora) is the guiding symptome of nasolacrimal duct obstruction. Depending on the localization of stenosis, mucopurulent lacrimal discharge occurs additionally. These symptoms induce alterations of the optical system and can cause severe complications such as acute phlegmonous dacryocystitis. The grade of suffering in these patients is very high. For the diagnosis, patient's history, ocular surface conditions and inspection (macro-/microscopically) as well as palpation of the lacrimal region are essential examinations. Moreover, functional and anatomical tests enable a classification of nasolacrimal duct obstruction regarding grade of stenosis (incomplete vs. complete), type (functional vs. mechanical), and localization (pre-, intra-, postsaccal). ENT consultation prior to lacrimal surgery is obligate. Through this, a purposeful therapeutic intervention is warranted. Surgical methods consist of minimally invasive transcanalicular procedures or anastomosing surgeries. Dependent on the clinical findings, these treatment options can be applied in a patient centered therapeutic concept.
Topics: Adult; Dacryocystitis; Dacryocystorhinostomy; Humans; Lacrimal Apparatus; Lacrimal Duct Obstruction; Nasolacrimal Duct
PubMed: 33207380
DOI: 10.1055/a-1283-9271 -
Seminars in Ophthalmology 2005The most widespread treatment for dry eyes in clinical practice is an instillation containing artificial tear fluid. When an instillation does not ameliorate dry eye, we... (Review)
Review
The most widespread treatment for dry eyes in clinical practice is an instillation containing artificial tear fluid. When an instillation does not ameliorate dry eye, we use punctal plugs. The insertion of punctal plugs is an eminent curative that positively improves the corneal and conjunctival epithelial disorders and the amount of lacrimal fluid accumulated in the conjunctival sac. We shall introduce the lacrimal duct occlusion utilizing atelocollagen solutions, which solves many of the issues induced by conventional methods.
Topics: Collagen; Dry Eye Syndromes; Humans; Lacrimal Apparatus; Prostheses and Implants; Prosthesis Implantation; Silicone Elastomers; Tears
PubMed: 16020347
DOI: 10.1080/08820530590931133 -
HNO Oct 2018The cardinal symptom of lacrimal stenosis is epiphora and a subjective high level of discomfort due to continuous dacryorrhea. (Review)
Review
BACKGROUND
The cardinal symptom of lacrimal stenosis is epiphora and a subjective high level of discomfort due to continuous dacryorrhea.
OBJECTIVE
The aim of the current paper is to present a structured review of common diagnostic and therapeutic strategies for lacrimal stenosis.
MATERIALS AND METHODS
The most important diagnostic and therapeutic approaches are analysed using the existing literature and by reporting the authors' own experiences.
RESULTS
A detailed patient history is crucial for diagnosis of lacrimal disorders. Precise inspection and palpation of the lacrimal and lid region may confirm lacrimal stenosis. Examinations of tear production, tear quality and the properties of the ocular surface are helpful. The most important diagnostic tool is lacrimal duct probing and syringing. Therapy is guided by underlying pathologies. Treatment of congenital lacrimal stenosis follows a staged concept. Epiphora in adults without signs of dacryocystitis should be treated with dacryoendoscopy. Dacryoendoscopy is also a therapeutic option for chronic dacryocystitis, but dacryocystorhinostomy may also be required. Lacrimal trauma should be reconstructed rapidly after the incident by lacrimal intubation. Neoplasia of the lacrimal excretory system requires histological classification to enable multidisciplinary management.
CONCLUSION
Basic ophthalmologic diagnostics are complemented by special symptom-based examinations. Due to ongoing improvement of available diagnostic and therapeutic options, patients' care is becoming increasingly individualised.
Topics: Adult; Dacryocystitis; Dacryocystorhinostomy; Humans; Intubation; Lacrimal Apparatus; Lacrimal Apparatus Diseases; Lacrimal Duct Obstruction; Nasolacrimal Duct
PubMed: 30019233
DOI: 10.1007/s00106-018-0535-0 -
Survey of Ophthalmology 2016Numerous long-standing controversies influence the management of lacrimal sac abscesses, canalicular lacerations, and obstruction of the nasolacrimal duct. We examined... (Review)
Review
Numerous long-standing controversies influence the management of lacrimal sac abscesses, canalicular lacerations, and obstruction of the nasolacrimal duct. We examined the debatable beliefs that underline these controversies and concluded the following: drainage of a pointing lacrimal sac abscess can be well tolerated under local anesthesia, is associated with few adverse events, and should be performed regardless of whether systemic antibiotics have been administered. Reconstruction of monocanalicular lacerations should be considered in all cases, without distinction to whether the injury involves the upper or lower canaliculus. Finally, no firm evidence currently exists supporting intubation with routine dacryocystorhinostomy.
Topics: Abscess; Dacryocystorhinostomy; Drainage; Eye Injuries; Humans; Intubation; Lacerations; Lacrimal Apparatus; Lacrimal Apparatus Diseases; Lacrimal Duct Obstruction; Stents
PubMed: 26700821
DOI: 10.1016/j.survophthal.2015.12.003 -
Pediatric Clinics of North America Jun 2014The lacrimal system comprises of a series of anatomical structures with specific physiologic properties. Tearing from a nasolacrimal duct obstruction (NLDO) is the most... (Review)
Review
The lacrimal system comprises of a series of anatomical structures with specific physiologic properties. Tearing from a nasolacrimal duct obstruction (NLDO) is the most common lacrimal system abnormality encountered by pediatric ophthalmologists. Most NLDOs spontaneously improve with conservative management by 12 months of age, but persistent or atypical cases may be treated with a procedure consisting of probing and irrigation of the lacrimal system. Other less common but significant lacrimal system abnormalities are also discussed.
Topics: Adolescent; Child; Humans; Lacrimal Apparatus; Lacrimal Duct Obstruction; Treatment Outcome
PubMed: 24852150
DOI: 10.1016/j.pcl.2014.03.002 -
Indian Journal of Ophthalmology Nov 2022
Topics: Humans; Lacrimal Duct Obstruction; Nasolacrimal Duct; Dacryocystorhinostomy; Lacrimal Apparatus
PubMed: 36308106
DOI: 10.4103/ijo.IJO_2228_22 -
Klinische Monatsblatter Fur... Jan 2023Concrements of the lacrimal apparatus, known as dacryoliths, can occur at different localizations and can cause a variety of symptoms. A common clinical sign is chronic... (Review)
Review
Concrements of the lacrimal apparatus, known as dacryoliths, can occur at different localizations and can cause a variety of symptoms. A common clinical sign is chronic inflammation, possibly exhibiting acute exacerbation. Based on a literature review and descriptive clinical cases with histopathological correlations, this contribution summarises the most important information concerning epidemiology, aetiopathogenesis, composition, histology, and therapy of lacrimal concrements. Furthermore, factors known to affect lacrimal lithogenesis are addressed. Concrements of the lacrimal gland cause a swelling at the lateral canthus. With only mild pain, this manifests as circumscribed conjunctival hyperaemia. Histologically, the gland tissue is characterised by acute-erosive to chronic inflammation. The concrements consist of amorphic material. Inflammatory infiltration is dominated by neutrophil granulocytes. Canalicular concrements are highly correlated with chronic canaliculitis. Besides epiphora, patients present with purulent discharge at the affected canaliculus. Actinomyces are frequently found inside these deposits and form drusen-like formations. The surrounding tissue reacts with plasma-cellular and granulocytic inflammation. Dacryoliths (concrements of the lacrimal sac) are associated with dacryocystitis, whereby acute and chronic types are common. Stones can be found in up to 18% of patients undergoing dacryocystorhinostomy or dacryoendoscopy. Preoperative diagnostic testing is challenging, as many lacrimal sac stones cannot be reliably visualised by diagnostic procedures. Recurring episodes of epiphora, mucopurulent discharge, and dacryocystitis are common indicators of dacryoliths. Lacrimal syringing is often possible and shows that total blockage is not present. Histology of the lacrimal mucosa reveals lymphocytic infiltration and submucosal fibrosis. The immediate vicinity of the dacryoliths shows acute inflammation. Therapy consists of stone extraction and improving lacrimal drainage, as the latter is recognised as the main risk factor for dacryolith formation.
Topics: Humans; Lacrimal Apparatus; Lacrimal Apparatus Diseases; Dacryocystorhinostomy; Nasolacrimal Duct; Dacryocystitis; Inflammation; Lacrimal Duct Obstruction
PubMed: 36706767
DOI: 10.1055/a-1975-0190 -
The Journal of Craniofacial Surgery Jun 2021Nasomaxillary fracture is a characteristic mid-facial fracture, and there are no reports showing the fracture damaging the nasolacrimal system (NLS). This report...
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.
Topics: Adult; Dacryocystorhinostomy; Humans; Lacrimal Apparatus; Lacrimal Apparatus Diseases; Lacrimal Duct Obstruction; Nasolacrimal Duct; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 33427771
DOI: 10.1097/SCS.0000000000007433 -
HNO Jun 2018Surgical management of lacrimal duct obstruction beyond the canaliculi proves to be a promising endeavor in most cases. To realize the full potential of endonasal... (Review)
Review
Surgical management of lacrimal duct obstruction beyond the canaliculi proves to be a promising endeavor in most cases. To realize the full potential of endonasal dacryocystorhinostomy, some aspects of diagnosis and differential indication setting should be considered in order to avoid errors and problems during patient selection, execution of the technical procedure, and communication with ophthalmologists. These issues are described according to the clinical management of patients; current literature is cited.
Topics: Dacryocystorhinostomy; Endoscopy; Eyelids; Humans; Lacrimal Apparatus; Lacrimal Duct Obstruction; Nasolacrimal Duct
PubMed: 29761204
DOI: 10.1007/s00106-018-0507-4 -
Scientific Reports Feb 2020Nasolacrimal duct obstruction (NLDO) is thought to be due to inflammation and fibrosis of lacrimal duct epithelial cells (LDECs). Here we investigated the effect of...
Nasolacrimal duct obstruction (NLDO) is thought to be due to inflammation and fibrosis of lacrimal duct epithelial cells (LDECs). Here we investigated the effect of rebamipide, a drug that is used for the protection of the mucosa and the treatment of gastritis and gastroduodenal ulcers, on LDECs, both in vitro and in vivo. In this study, LDECs were cultured from rabbit lacrimal duct tissues, and the barrier function of LEDCs was examined in vitro via transepithelial electrical resistance (TER) measurement, with or without interleukin (IL)-6 and/or rebamipide. For the in vivo examination, benzalkonium chloride (BAC) was injected into the rabbit lacrimal ducts, followed by the application of rebamipide or a placebo vehicle alone. The results of the in vitro examination revealed a significant decrease in TER in the group treated with IL-6 alone compared with the placebo-vehicle group (p < 0.05) and the group treated with IL-6 and rebamipide (p < 0.01). The results of the in vivo examination revealed that the infiltration of neutrophils under the basement membrane and the disruption of tight junction proteins with BAC injection and rebamipide attenuates the disturbance of tissue construction. These results suggest that rebamipide protects LDECs via an anti-inflammatory effect and preserves the barrier function of those cells.
Topics: Alanine; Animals; Anti-Ulcer Agents; Cell Survival; Cells, Cultured; Disease Models, Animal; Electric Impedance; Epithelial Cells; Interleukin-6; Lacrimal Apparatus; Lacrimal Duct Obstruction; Male; Microscopy, Electron, Scanning; Protective Agents; Quinolones; Rabbits
PubMed: 32015381
DOI: 10.1038/s41598-020-58314-x