Search Results (16)

The pathogenesis of primary acquired nasolacrimal duct obstruction (PANDO) remains unclear, with several factors implicated, including anatomical structures, hormones, and tear components. This study explored tear proteins to better understand PANDO etiology by comparing protein expression in tears from patients with PANDO and healthy controls. Tear samples were collected from 22 patients with PANDO (mucous and membranous types) and 8 controls using Weck-Cel sponges. Protein analysis was conducted using LC-MS/MS to identify and quantify tear proteins. Female patients with PANDO had higher numbers of differentially expressed proteins (DEPs) compared with males. Certain DEPs associated with inflammatory pathways or the lacrimal duct epithelium, including SERPINB1, SERPINA3, CTSG, SLPI, and EZR, were identified in male patients. Although this is a preliminary study, our results offer insights into the pathogenesis of PANDO, with potential to distinguish between mucous and membranous subtypes. The potential biomarkers identified in this study could enhance early diagnosis and treatment, shedding light on inflammatory and immune processes in PANDO. Full article

Congenital nasolacrimal duct obstruction (CNLDO) is a prevalent condition in newborns, characterized by lacrimation excess due to anatomic occlusion of the nasolacrimal ducts (NLD). This narrative review provides a comprehensive overview of CNLDO, encompassing its etiology, epidemiology, clinical manifestations, diagnosis and current treatment options. Diagnosis comprises the fluorescein dye disappearance test (FDDT) and imaging studies. In most cases, CNLDO resolves spontaneously within the first year of life. However, if spontaneous resolution does not occur, or if complications arise during observation period, treatment with conservative methods such as massage is introduced earlier, depending on the severity and complexity of the case. If these methods prove unsuccessful, more invasive procedures, including probing, intubation or dacryocystorhinostomy, are employed. While early diagnosis is crucial, its direct impact on treatment outcomes is more related to the prompt identification of cases that may require escalation of care. Full article

Background/Objectives: The aim of the study was to evaluate the long-term outcomes of revisional powered endoscopic dacryocystorhinostomy (EnDCR) with the intraoperative application of Mitomycin C in patients after failed transcanalicular laser-assisted dacryocystorhinostomy (LDCR) or external dacryocystorhinostomy (ExDCR). Methods: This prospective, non-randomized, comparative, single-center clinical study was conducted between 2020 and 2023. The study included all patients presenting with epiphora graded ≥3 on the Munk scale (0–4) and confirmed ostium occlusion or significant narrowing on endoscopic examination following primary LDCR or ExDCR. All the participants underwent pre- and postoperative assessment using the Munk scale and fluorescein dye disappearance test (FDDT). The primary endpoints were ostium patency on irrigation and change in epiphora grade at 24-month follow-up. Secondary endpoints included changes in the FDDT results, endoscopic assessment of ostium patency, and ostium size. Outcomes were compared between the LDCR and ExDCR groups. Results: A total of 24 patients (mean age: 62 ± 19 years; range: 27–93 years) were included, with 12 cases after failed LDCR and 12 cases after failed ExDCR. The follow-up period ranged from 24 to 58 months. Significant improvement in epiphora was observed at the 24-month follow-up, both in the Munk scale (p < 0.001) and FDDT (p < 0.001). The overall anatomical and functional success rate was 95.8% (23/24). The mean time to recurrence was 63 weeks after ExDCR and 38 weeks after LDCR. Although there was a trend toward a longer symptom-free interval following ExDCR, the difference was not statistically significant (p = 0.231). Conclusions: Powered endoscopic DCR with intraoperative Mitomycin C application is an effective reoperative approach for managing recurrent lacrimal drainage obstruction following failed laser or external dacryocystorhinostomy. Full article

Background/Objectives: Disruptions in lacrimal function can lead to various conditions, including chronic nasolacrimal duct obstruction and dacryocystitis, which may cause symptoms like excessive tearing, pain, and recurrent infections. In cases where pharmacological treatments are insufficient, surgical intervention becomes essential, which is widely used to restore effective tear drainage. Methods: This study evaluated postoperative outcomes of laser-assisted dacryocystorhinostomy (LDCR) in 48 patients, totaling 56 treated eyes, over a follow-up period of 6 months to 3.5 years. During the follow-up examination, patients completed the Glasgow Benefit Inventory questionnaire. Results: The outcomes demonstrated significant improvements, particularly in the GBI total score (+35.07) and general subscale (+44.36), with minimal effects on social support and physical health subscales. Conclusions: LDCR proves to be an effective, minimally invasive alternative to traditional dacryocystorhinostomy, offering significant patient satisfaction, faster recovery, and reduced complications in treating nasolacrimal duct obstruction. Full article

Background/Objectives: Epiphora, or excessive tearing, is a common symptom often attributed to benign conditions such as dry eye or nasolacrimal duct obstruction. However, it can also be an early indicator of lacrimal sac tumors, which are frequently misdiagnosed or diagnosed late due to their subtle presentation. This study aims to identify the clinical features that contribute to delays and misdiagnoses of lacrimal sac tumors in patients presenting with epiphora, with the goal of improving early detection and treatment outcomes. Methods: This retrospective study reviewed medical records from Taipei Veterans General Hospital between 2007 and 2023, focusing on patients who presented with epiphora and were later diagnosed with pathologically confirmed lacrimal sac tumors. Inclusion criteria were limited to cases that were initially misdiagnosed or had a delayed diagnosis, with imaging and clinical evaluations confirming tumor-related tear drainage obstruction. Patients with non-tumor causes of epiphora were excluded. Results: Eleven cases of lacrimal sac tumors were identified, including two benign and nine malignant tumors. The average duration from symptom onset to diagnosis was 22.4 months. Common symptoms included epiphora (100%), discharge (54.5%), and hemolacria (18.2%). Subtle clinical signs, such as asymmetry in the medial canthal region and non-tender swelling, were frequently noted. Despite receiving appropriate surgical and adjuvant treatments, the impact of delayed diagnosis was significant. Two patients succumbed to tumor-related disease; one developed lung metastasis 12 years after diagnosis, and another experienced recurrence during a six-year follow-up after undergoing extensive exenteration, adjuvant chemotherapy, and radiotherapy. Conclusions: Lacrimal sac tumors can present insidiously with symptoms often mistaken for benign conditions, leading to significant diagnostic delays. Thorough history taking, meticulous physical examination, and timely imaging are crucial for early detection. Increased clinician awareness and a high index of suspicion for lacrimal sac tumors in patients with atypical epiphora are essential to improve prognosis and reduce the risk of severe outcomes. Full article

Laser dacryocystorhinostomy (LDCR) is a surgical procedure designed to treat obstructions in the lacrimal duct system, which can cause excessive tearing, infections, and discomfort. This technique involves creating a new passage for tear drainage, thereby restoring normal tear flow and alleviating symptoms associated with duct obstruction. A retrospective study was conducted on 48 patients who underwent the LDCR procedure, amounting to 56 eyes. The primary outcome measured was the anatomical success rate, defined as the restoration of duct patency. Patients were examined postoperatively from 6 months to 3.5 years. The LDCR method demonstrated a 95% success rate, encompassing both anatomical and functional outcomes. The procedure’s effectiveness was determined by achieving a patent osteotomy and resolving symptoms. Anatomical success was measured by the creation of a viable drainage pathway, while functional success pertained to the resolution of symptoms such as epiphora. The efficacy of the procedure was found to be independent of both age and gender. Among patients with successful anatomical outcomes, there was a statistically significant improvement in their Munk scores. The LDCR method is highly effective in treating lacrimal duct obstruction. These findings highlight the importance of the Munk score as a predictive indicator of procedural success in LDCR. Full article

With increased awareness of dry eye disease (DED), a multitude of therapeutic options have become available. Nevertheless, the treatment of severe DED remains difficult. In a patient whose DED is related to the loss of lacrimal function without severe destruction of the salivary glands, autologous transplantation of the latter as functioning exocrine tissue to rebuild a stable tear film is an attractive idea. All three major and minor salivary glands have been used for such transplantation. Due to the complications associated with and unfavorable prognosis of parotid duct and sublingual gland transplantation, surgeons now prefer to use the submandibular gland (SMG) for such procedures. The transplantation of the SMG not only has a high survival rate, but also improves dry eye symptoms and signs for more than 20 years post-surgery. The regulation of the secretion of the transplanted SMG is critical because the denervated SMG changes its mechanism of secretion. Innovative procedures have been developed to stimulate secretion in order to prevent the obstruction of the Wharton’s duct and to decrease secretion when postoperative “epiphora” occurs. Among the minor salivary glands, the transplantation of the labial salivary glands is the most successful in the long-term. The measurement of the flow rates of minor salivary glands and donor-site selection are critical steps before surgery. Full article

In this retrospective study, we compared and analyzed two groups of patients who underwent silicone tube intubation (STI) to treat congenital nasolacrimal duct obstruction (CNDO). We employed dacryoendoscopy to visualize the lacrimal pathways of one group. In total, 85 eyes of 69 patients were included (52 of 41 patients in the non-dacryoendoscopy and 33 eyes of 28 patients in the dacryoendoscopy group). Clinical characteristics, dacryoendoscopic findings, and surgical outcomes were evaluated. The overall STI success rate was 91.8%, and the success rate was significantly higher in the dacryoendoscopy versus non-dacryoendoscopy group (97.0% and 88.5%, respectively). For patients < 36 months of age, the success rate was 100% (23 eyes). All patients with Hasner valve membranous obstructions were younger than 36 months and had structural obstructions of the lacrimal drainage system (LDS) (p = 0.04). However, in patients lacking Hasner valve obstructions, LDS secretory (50.0%) and structural (50%) obstructions occurred at similar rates, which did not vary by age. Dacryoendoscopy-assisted STI enhanced the therapeutic efficacy of CNDO and identified diverse CNDO etiologies beyond Hasner valve obstructions. These findings emphasize the potential advantages of dacryoendoscopy in surgical treatment for CNDO patients. Full article

(1) Background: We aim to find a novel blink parameter in nasolacrimal duct obstruction (NDO) patients and analyze parameters that could reflect subjective symptoms and objective indicators at the same time through a blink dynamic analysis. (2) Methods A retrospective study was conducted with 34 patients (48 eyes) who underwent lacrimal passage intubation (LPI) and 24 control groups (48 eyes). All patients’ blink patterns were measured using an ocular surface interferometer before and after LPI, including total blink (TB) and partial blink (PB) and the blink indices blink time (BT), lid closing time (LCT), closure time (CT), lid opening time (LOT), interblink time (IBT), closing speed (CS) and opening speed (OS). The tear meniscus height (TMH) was measured, and the questionnaire “Epiphora Patient’s Quality of Life (E-QOL),” which includes daily activity restriction as well as static and dynamic activities, was completed. (3) Results: Compared to CT and the ratio of CT during BT (CT/BT) in control (89.4 ± 20.0 msec, 13.16%), those in NDOs were longer (140.3 ± 92.0 msec, 20.20%) and were also related to TMH. After LPI, CT and CT/BT were recovered to 85.4 ± 22.07 msec, 13.29% (p < 0.001). CT and CT/BT showed a positive correlation with the E-QOL questionnaire score, particularly with dynamic activities. (4) Conclusions: CT and CT/BT, which are objective indicators associated with subjective symptoms of patients, are considered new blink indices for the evaluation of NDO patients with Munk’s score. Full article

As a rare and often misdiagnosed disease of the lacrimal apparatus, only limited data exist on long-term outcomes of surgical methods for the treatment of primary canaliculitis. The aim of this study was to evaluate canaliculotomy with silicone tube intubation (STI) as a surgical procedure for canaliculitis in a long-term follow-up setting. A total of 25 eyes of 25 patients with canaliculitis treated with canaliculotomy and STI at the University of Muenster Medical Center, Germany, from 2015 to 2021 were included in this study. Data analysis involved clinical symptoms, complications, duration of STI and rate of recurrence. Mean patient age was 63.7 ± 17.2 years. After a follow-up time of 3.7 ± 1.5 years, 88% of cases showed no recurrence of inflammation. The mean duration of STI was 5.8 ± 3.4 months. Complications such as post-operative hemorrhage, spread of infection, obstruction of the canaliculus or migration of the STI were not observed in any of the patients. However, tube dislocation occurred in four cases, a pyogenic granuloma in two cases and a fistula formation in one case. The management of canaliculitis by canaliculotomy with STI showed very good postoperative outcomes and low complication rates in the long-term and can therefore be considered a safe and successful surgical approach. Full article

Background: The Caldwell-Luc (CL) procedure, an outdated operative procedure that is used to treat inflammatory sinus diseases, is rarely performed presently. However, physicians may encounter patients with a history of CL surgery who develop considerable postoperative changes that may lead to diagnostic confusion in imaging evaluation; increase the difficulty of future surgery, such as sinonasal surgery; and increase the incidence of future intraoperative complications. Case summary: A 67-year-old man with a surgical history of chronic sinusitis reported epiphora of the left eye for five years. Balloon dacryocystoplasty was attempted but failed. Endo-DCR (Endoscopic dacryocystorhinostomy) was indicated; however, preoperative CT (computed tomography) imaging and nasal endoscopic examination showed sinonasal anomalies and the loss of internal landmarks for localizing the lacrimal sac. Preoperative CT results indicated previous CL surgery. Endo-DCR was performed with the aid of nasal forceps and a 20-gauge vitreoretinal fiberoptic endoilluminator. A six-month follow-up revealed the complete resolution of symptoms and no signs of recurrence. Conclusions: Epiphora might be a delayed complication of the CL procedure. Before performing endo-DCR, ophthalmologists should be familiar with the sinonasal anatomy and carefully assess preoperative imaging to identify anatomical variations. Nasal forceps and transcanalicular illumination can assist in determining the precise location of the lacrimal sac during endo-DCR. Full article

This prospective case series aimed to investigate the contrast sensitivity function before and after lacrimal passage intubation (LPI) in eyes with epiphora due to lacrimal passage obstruction. We included 58 eyes of 51 patients who underwent LPI for lacrimal passage obstruction. The best-corrected visual acuity (BCVA), contrast sensitivity function, and lower tear meniscus were compared before LPI and one month after lacrimal duct stent removal. The area under the log contrast sensitivity function (AULCSF) was calculated for the analyses. Lower tear meniscus was assessed using anterior segment optical coherence tomography. The BCVA was comparable (p = 0.61) before and after LPI, while AULCSF increased significantly after treatment (before LPI: 1.29 ± 0.17, after LPI: 1.37 ± 0.14, p < 0.0001). Treatment resulted in a significant increase in contrast sensitivity at all spatial frequencies, 3–18 cycles/degree (p < 0.01 for 3, p < 0.01 for 6, p < 0.0005 for 12, p < 0.05 for 18 cycles/degree). The lower tear meniscus parameters improved significantly after treatment (p < 0.005); however, no correlation between the changes in the tear meniscus and those of the AULCSF was found. The contrast sensitivity significantly improved after LPI in eyes with epiphora due to lacrimal passage obstruction. Full article

Purpose: This article reviews cases of nasolacrimal obstruction (NLO) secondary to maxillofacial hardware placement. Methods: A retrospective review was performed at a single institution from 2012 to 2017 of patients with NLO following maxillofacial reconstruction. The study was approved by the Institutional Review Board of the University of California, San Francisco, adhered to the tenets of the Declaration of Helsinki, and was Health Insurance Portability and Accountability Act compliant. Patients were included if external dacryocystorhinostomy (DCR) confirmed previously placed maxillofacial hardware as the primary contributor to lacrimal outflow obstruction and had at least 3 months of follow-up. Results: Of 420 patients who underwent external DCR, 6 cases of implant-related NLO were identified. The mean age was 47.3 ± 9.6 years and 66.7% of patients were male. All patients presented with epiphora and 50% also had chronic dacryocystitis. Patients had prior maxillofacial hardware placement for paranasal sinus tumors (66.7%) or facial fractures (33.3%). In addition to external DCR, all patients had revision or removal of implants that were impeding lacrimal outflow by 2 mechanisms: (1) an orbital implant impinging the lacrimal sac or nasolacrimal duct (NLD) and/or (2) maxillofacial screws placed into the bony NLD or nasolacrimal fossa. Five of the 6 patients (83.3%) had complete resolution of symptoms and patency of the nasolacrimal system at their last follow-up visit (range 3-30 months). Conclusion: NLO secondary to hardware placement, though infrequent, is underreported. Two mechanisms of hardware-induced NLO were encountered in this case series. Specific attention to nasolacrimal anatomy at the time of maxillofacial reconstruction may help minimize implant-induced NLO. Full article

Nasolacrimal duct obstruction (NLDO) is the most common cause of childhood epiphora. It is managed conservatively in the first year of life, after which surgical treatment is classically based on a stepwise paradigm of probing, intubation, and dacryocystorhinostomy. This systematic review aims to present the current role of intubation in the management of children with NLDO requiring surgical intervention. A search for English-language articles from the electronic databases PubMed, SCOPUS, and the COCHRANE library was conducted over a period of five months in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane Handbook. The following keywords were used to aid retrieval: stents, children, lacrimal intubation, endoscopic dacryocystorhinostomy, external dacryocystorhinostomy, NLDO, dacryocystitis, congenital, acquired. The primary outcome was defined as the success of the intervention, determined by resolution of symptoms and patency of the lacrimal anatomy confirmed by the fluorescein dye disappearance test or syringing. Secondary outcomes included the presence of complications. A total of 144 articles were identified; of these, 35 fulfilled the study criteria. The majority of the included studies involved lacrimal intubation alone, followed by intubation as an adjunctive procedure to balloon dacryoplasty and dacryocystorhinostomy. The overall success rate of these procedures ranged from 41.1% to 100%. Post-operative complications were reported in 65.7% of the included studies. Lacrimal intubation was most commonly performed as a primary procedure in children with NLDO, with high success rates. The main complication was stent dislodgement. There is lack of evidence regarding the benefit of intubation over probing as primary treatment of congenital NLDO. In the absence of high-quality evidence, the decision of whether to perform lacrimal intubation in children with NLDO requiring surgical intervention depends on clinical judgement and other low-level evidence, such as observational non-randomised trials. Full article

Congenital nasolacrimal duct obstruction (CNLDO) is a common condition causing excessive tearing or mucoid discharge from the eyes, due to blockage of the nasolacrimal duct system. Nasolacrimal duct obstruction affects as many as 20% children aged <1 year worldwide and is often resolved without surgery. Available treatment options are conservative therapy, including observation, lacrimal sac massage and antibiotics, and invasive therapy. Observation, combined with conservative options, seems to be the best option in infants aged <1 year. Meanwhile, in children aged >1 year, nasolacrimal probing successfully addresses most obstructions. However, the most favorable timing for probing remains controversial. To alleviate persistent epiphora and mucous drainage that is refractory to probing, repeat probing, silicone tube intubation, balloon catheter dilation or dacryocystorhinostomy can be considered as available treatment options. Our review aims to provide an update to CNDO management protocols. Full article