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The New England Journal of Medicine Aug 2018
Topics: Acute Disease; Dacryocystitis; Humans; Infant, Newborn; Male; Nasolacrimal Duct; Staphylococcus aureus
PubMed: 30067930
DOI: 10.1056/NEJMicm1713250 -
BMC Ophthalmology Jan 2022Acquired nasolacrimal duct obstruction is a blockage of the lacrimal outflow system usually caused by local nonspecific inflammation of the lacrimal sac and the...
BACKGROUND
Acquired nasolacrimal duct obstruction is a blockage of the lacrimal outflow system usually caused by local nonspecific inflammation of the lacrimal sac and the nasolacrimal duct. However, cases exist where the primary nasolacrimal system obstruction is caused by malignancies. Our aim was to investigate lacrimal sac pathologies in patients with acquired nasolacrimal duct obstruction and compare their clinical manifestations.
METHODS
This retrospective clinical study included 275 patients with acquired nasolacrimal duct obstruction who underwent external dacryocystorhinostomy and lacrimal sac biopsy. Cases were classified into tumor or nonspecific pathology groups and subdivided according to the level of inflammation. Histological and clinical data were analyzed.
RESULTS
Three tumors (1.1%) (an adenoid cystic carcinoma, an eccrine spiradenoma and small B cell lymphoma) were diagnosed. Chronic nongranulomatous inflammation was the most common histological finding, corresponding to 194 cases (70.5%). The other 81 (29.5%) were subacute, acute forms of nongranulomatous inflammation, tumors and fibrosis cases. Epiphora with continuous purulent discharge was the most common clinical sign reported by 144 (52.4%) patients, and two (0.7%) patients had a palpable mass near the medial canthal tendon, which was identified as an eccrine spiradenoma and small B cell lymphoma. There was no significant difference in the clinical symptoms, duration or case history between the nonspecific pathology and tumor groups (p = 0.292).
CONCLUSIONS
Chronic nongranulomatous inflammation of the lacrimal sac was the most common finding among acquired nasolacrimal duct obstruction cases. There were no associations between the histological findings and clinical presentation. The authors recommend a lacrimal sac biopsy only in cases when a tumor is clinically suspected.
Topics: Dacryocystorhinostomy; Humans; Lacrimal Apparatus; Lacrimal Duct Obstruction; Nasolacrimal Duct; Retrospective Studies
PubMed: 34986808
DOI: 10.1186/s12886-021-02185-x -
BMJ Case Reports May 2021A 35-year-old woman underwent left external dacryocystorhinostomy (DCR) following a recent bout of left acute dacryocystitis. She had a right DCR 14 years earlier. Her...
A 35-year-old woman underwent left external dacryocystorhinostomy (DCR) following a recent bout of left acute dacryocystitis. She had a right DCR 14 years earlier. Her relatively young age of presentation prompted suspicion of secondary nasolacrimal duct obstruction and, although the left lacrimal sac appeared macroscopically normal peroperatively, a lacrimal sac biopsy was taken. Histopathology revealed florid chronic inflammation, with abundant granular brown pigment and polarisable crystals suggestive of an exogenous material in the lacrimal sac mucosa compatible with mascara. After initial improvement, her epiphora has recurred 1-year postoperatively, but her ocular discharge has resolved. Mascara-induced conjunctival pigmentation is well established. However, there are very few published reports of nasolacrimal duct obstruction due to mascara. Since cosmetic application of mascara and kohl eyeliner is widespread, patients and practitioners should be aware of their potential to migrate into the lacrimal apparatus and cause chronic inflammation with secondary nasolacrimal duct obstruction.
Topics: Adult; Dacryocystitis; Dacryocystorhinostomy; Female; Humans; Lacrimal Duct Obstruction; Nasolacrimal Duct; Neoplasm Recurrence, Local
PubMed: 33962923
DOI: 10.1136/bcr-2020-240942 -
Progress in Retinal and Eye Research Sep 2023Primary acquired nasolacrimal duct obstruction, or PANDO, is a common adult lacrimal drainage disorder. The current treatment modality of dacryocystorhinostomy to bypass... (Review)
Review
Primary acquired nasolacrimal duct obstruction, or PANDO, is a common adult lacrimal drainage disorder. The current treatment modality of dacryocystorhinostomy to bypass the obstructed nasolacrimal duct has excellent outcomes. However, the understanding of the disease etiopathogenesis needs to be revisited. There are not many studies that specifically assessed any hypothesis or ones that convincingly put forth the presumed or confirmed interpretations regarding the PANDO pathogenesis or the mechanisms or pathways involved therein. Histopathological evidence points to recurrent inflammation of the nasolacrimal duct, subsequent fibrosis, and the resultant obstruction. The disease etiopathogenesis is considered multifactorial. Several implicated suspects include anatomical narrowing of the bony nasolacrimal duct, vascular factors, local hormonal imbalance, microbial influence, nasal abnormalities, autonomic dysregulation, surfactants, lysosomal dysfunction, gastroesophageal reflux, tear proteins, and deranged local host defenses. The present work reviewed the literature on the etiopathogenesis of primary acquired nasolacrimal duct obstruction (PANDO) to gain insights into the present state of the understanding and the high-value translational implications of precisely decoding the disease etiology.
Topics: Adult; Humans; Nasolacrimal Duct; Lacrimal Duct Obstruction; Dacryocystorhinostomy; Risk Factors; Inflammation
PubMed: 37394093
DOI: 10.1016/j.preteyeres.2023.101193 -
Taiwan Journal of Ophthalmology 2020The purpose of this study is to describe the results of endonasal endoscopic nasolacrimal duct dissection (EE-NLDD); a surgical technique used for the treatment of...
PURPOSE
The purpose of this study is to describe the results of endonasal endoscopic nasolacrimal duct dissection (EE-NLDD); a surgical technique used for the treatment of primary nasolacrimal duct obstruction (NLDO).
MATERIALS AND METHODS
Before the operation, the patency of the nasolacrimal duct (NLD) was evaluated through irrigation and probing. The EE-NLDD surgical procedure involved the removal of the bony structure covering the NLD. The NLD mucosa was dissected and marsupialized with nasal mucosa, creating a mucosa-covered ostium. The bone surrounding the lacrimal fossa and lacrimal sac mucosa was preserved throughout procedure. The postoperative anatomical and functional outcomes were evaluated through irrigation, endonasal endoscopic fluorescein dye test, and subjective descriptions of the patients.
STUDY DESIGN
This is a retrospective chart review study which included all patients with primary NLDO treated with EE-NLDD surgical technique from February 2012 to July 2016 in Taipei Medical University Shuang Ho Hospital by a single surgeon (YD, Shen).
RESULTS
The mean follow-up time for the 39 patients (43 eyes) was 14.7 months (range: 0.5-46 months). Anatomical patency was achieved in all patients. Under endonasal endoscopy, fluorescein dye was observed at the internal orifice after the dye was instilled into the conjunctival sac in all patients. The complete resolution of the epiphora was reported in 36 patients (39 eyes) and two patients (2 eyes) exhibited an improvement of the epiphora after surgery. However, one patient (2 eyes) reported persistent bilateral epiphora without improvement even under solid evidence of anatomical patency. No major complications were noted intraoperatively or postoperatively.
CONCLUSIONS
The results suggested that the EE-NLDD is a safe and effective procedure and has a success rate comparable with that of conventional endonasal dacryocystorhinostomy.
PubMed: 32874840
DOI: 10.4103/tjo.tjo_111_18 -
Children (Basel, Switzerland) Feb 2023Down Syndrome is one of the most common chromosomal conditions in the world, affecting an estimated 1:400-1:500 births. It is a multisystem genetic disorder but has a... (Review)
Review
Down Syndrome is one of the most common chromosomal conditions in the world, affecting an estimated 1:400-1:500 births. It is a multisystem genetic disorder but has a wide range of ophthalmic findings. These include strabismus, amblyopia, accommodation defects, refractive error, eyelid abnormalities, nasolacrimal duct obstruction, nystagmus, keratoconus, cataracts, retinal abnormalities, optic nerve abnormalities, and glaucoma. These ophthalmic conditions are more prevalent in children with Down Syndrome than the general pediatric population, and without exception, early identification with thoughtful screening in this patient population can drastically improve prognosis and/or quality of life.
PubMed: 36832470
DOI: 10.3390/children10020341 -
The Canadian Veterinary Journal = La... Oct 2020A 1.5-year-old neutered male black Labrador retriever dog was presented to a referral teaching hospital for evaluation of chronic, continuous, mucoid discharge and...
A 1.5-year-old neutered male black Labrador retriever dog was presented to a referral teaching hospital for evaluation of chronic, continuous, mucoid discharge and associated conjunctivitis of the left eye. Nasolacrimal flush revealed a patent duct on the right side but not on the left side. Computed tomography (CT) with a dacryocystogram identified severe stenosis or atresia of the left nasolacrimal duct. The patient was referred to a veterinary ophthalmologist for a reconstruction of the left nasolacrimal system. Ultimately, a conjunctivobuccostomy was performed and resolved all ocular clinical signs. Key clinical message: Dacryostography, a procedure in which the lacrimal punctum is cannulated, and iodinated contrast is instilled into the nasolacrimal system was combined with CT to enable excellent visualization and evaluation of the nasolacrimal canal.
Topics: Animals; Dog Diseases; Dogs; Lacrimal Duct Obstruction; Male; Nasolacrimal Duct; Radiography; Tomography, X-Ray Computed
PubMed: 33012829
DOI: No ID Found -
Eye (London, England) Jan 2016PurposeThe purpose of this study was to investigate the outcomes of nasolacrimal duct intubation in the primary treatment of congenital nasolacrimal duct obstruction...
PurposeThe purpose of this study was to investigate the outcomes of nasolacrimal duct intubation in the primary treatment of congenital nasolacrimal duct obstruction (CNLDO) in children aged 7 years and older.MethodsThirty children aged ≥7 years who underwent primary unilateral nasolacrimal duct intubation because of CNLDO were enrolled in this study. CNLDO diagnosis was based on signs and symptoms including typical epiphora, increased tear meniscus, recurrent or persistent mucopurulent discharge, and an abnormal dye disappearance test (DDT). Surgical success was defined as complete resolution of previous signs and symptoms and DDT grade 0-1.ResultsThe mean age was 10.7±2.5 years (ranging from 7 to 15 years). Of the 30 patients, 18 were male and 12 were female. The mean follow-up period was 8.8±3.4 months (ranging from 6 to 16 months). The mean silicone tube removal time was 4.6±1.1 months (ranging from 3 to 6 months). The complete resolution of signs and symptoms with DDT grade 0-1 was observed in 22 of 30 cases (73.3%) during the follow-up period. The mean age of the patients with unsuccessful outcomes was 12.7±1.4 years, whereas that of the patients with successful outcomes was 10.0±2.4 years, and the difference was statistically significant (P=0.006). No serious intra- and/or post-operative complication was observed.ConclusionsThe current study demonstrates that nasolacrimal duct silicone intubation with intranasal endoscopic visualization has favorable outcomes as a primary treatment of persistent CNLDO in children aged 7 years and older. It can be used to reduce the need for dacryocystorhinostomy which is a more invasive procedure.
Topics: Adolescent; Child; Female; Follow-Up Studies; Humans; Intubation; Lacrimal Duct Obstruction; Male; Nasolacrimal Duct; Silicone Elastomers; Treatment Outcome
PubMed: 26449195
DOI: 10.1038/eye.2015.189 -
Acta Ophthalmologica Nov 2021The aims of the review are to summarize the aethiopathogenesis, management and outcomes of different treatments of proximal lacrimal obstructions. (Review)
Review
PURPOSE
The aims of the review are to summarize the aethiopathogenesis, management and outcomes of different treatments of proximal lacrimal obstructions.
METHODS
An electronic database (PubMed, MEDLINE and Google Scholar) search of all articles written in English and non-English language with abstract translated to English on proximal lacrimal obstructions was performed. The articles were reviewed along with their relevant cross references. Data reviewed included demographics, presentations, investigations, management, complications and outcomes.
RESULTS
Punctoplasty is as effective as punctal dilatation with monocanalicular or bicanalicular stent in case of punctal stenosis. Dacryocystorhinostomy with retrograde intubation is more effective in case of proximal canalicular obstructions than in case of mid-canalicular obstructions. Trephination and intubation is effective in both mid and distal canalicular obstructions in patients with no associated nasolacrimal duct obstruction. Canaliculodacryocystorhinostomy has a specific indication in case of proximal common canalicular obstruction. Bypass surgery is the preferred treatment if there is no residual patency, however surgical success may not match patient satisfaction.
CONCLUSION
Optimal choice of surgical method depends on identification of the site of obstruction. Mini-invasive techniques should be avoided in cases that would only benefit from standard surgical treatment.
Topics: Dacryocystorhinostomy; Disease Progression; Humans; Lacrimal Duct Obstruction; Nasolacrimal Duct; Stents
PubMed: 33455087
DOI: 10.1111/aos.14762 -
Indian Journal of Ophthalmology Oct 2017
Review
Topics: Child; Dacryocystorhinostomy; Endoscopy; Humans; Lacrimal Duct Obstruction; Nasolacrimal Duct
PubMed: 29044070
DOI: 10.4103/ijo.IJO_696_17