Bilateral Kuttner tumours of the lacrimal glands

Kuttner Tumour is a chronic inflammatory disease diagnosed histologically. It is under-diagnosed due to lack of awareness of the disease. We present a case of a 40-year old female with recurrent upper lid swelling. Biopsy revealed the diagnosis of Kuttner Tumours of the lacrimal glands. Although surgical excision is a treatment option, it can be treated with a course of steroids. Our patient opted for conservative management. We describe the presentation and course of the case, with an emphasis on the histological features of the tumour.

Predictors of anatomical patency following primary endonasal dacryocystorhinostomy: a pilot study

PURPOSE

To identify factors influencing early anatomical patency following primary endonasal dacryocystorhinostomy (DCR) for nasolacrimal obstruction.

METHODS

A prospective study of 50 patients who underwent primary endonasal DCR for nasolacrimal obstruction was undertaken. Age, gender, dacryocystitis, endonasal access, clearance (bony clearance superiorly from the common canaliculus after bone removal), mobility (mobility of the flaps created from the lacrimal sac once opened), marsupialization (degree of reflection of the lacrimal sac following surgical opening) and a combined score (incorporating clearance, mobility and marsupialization) were examined. Outcomes were measured 10 weeks postoperatively by assessing anatomical patency via probe and syringe and modified functional endoscopic dye test.

RESULTS

Using the Kendall's tau-beta test, there was a significant relationship between greater mobility and better outcome (p<.03) and greater marsupialization and better outcome (p=.03). A higher combined score (incorporating mobility, marsupialization and bony clearance) was also related to better outcome (p<.02). There was no significant relationship between outcome and age, gender, dacryocystitis, endonasal access or bony clearance. Overall, 47 patients (94%) had complete or partial patency at 10 weeks and 3 patients (6%) had complete nasolacrimal obstruction at 10 weeks.

CONCLUSIONS

Greater flap mobility and greater lacrimal sac marsupialization in endonasal DCR are associated with better rates of early anatomical patency. A novel scoring system incorporating mobility, marsupialization and bony clearance also showed a significant relationship to early outcome, with higher scores being associated with better outcomes. These results may enable greater understanding of the perioperative features associated with better outcomes in endonasal DCR.

Endoscopic dacryocystorhinostomy in acute dacryocystitis: a multicenter case series

OBJECTIVE

To present our experience of early endonasal DCR (endoDCR) in the treatment of acute dacryocystitis (AD). Methods. International multicenter non-comparative retrospective study.

RESULTS

Eighteen patients were identified. All were treated with antibiotics prior to surgery with a median of time from referral to endoDCR surgeon to surgery of 3 days (range 1-7). Surgery was performed using mechanical powered endoDCR (MENDCR) in 15/18 (83.3%) cases; mitomycin C was used in 5/18 (27.8%) and all cases underwent bicanalicular intubation. An increase in perioperative bleeding was noted in 5/18 (27.8%), causing interference in surgical technique in one (5.6%). Resolution of AD was seen in all cases, with no recurrences. 17/18 (94.4%) cases were free of epiphora at median follow-up of 12 months (range 2-36), with nasal endoscopy revealing free flow of fluorescein through the ostium in 17/18 (94.4%) of cases. The median total length of stay was 1 night (range 0-3).

CONCLUSIONS

EndoDCR surgery performed early in AD led to rapid resolution of the condition in all cases and was associated with subsequent anatomical and functional success in 94.4% of cases. Early endoDCR surgery in the context of AD and the potential associated health economic benefits are worth further consideration and study.

[The ocular optic fiber used in the endoscopic sinus surgery of dacryocystorhinostomy in the treatment of chronic dacryocystitis and recurrent dacryocystitis]

OBJECTIVE

To explore a method for locating the area of lacrimal sac in dacryocystorhinostomy under endoscopy.

METHOD

Sixty-eight patients were performed dacryocystorhinostomy under endoscopy. Take light spot of ocular optic fiber as the lacrimal sac projection to the lateral wall of the nasal cavity position.

RESULT

With the guiding of ocular optic fiber, lacrimal sac can be located accurately. The operating time of dacryocystorhinostomy under endoscopy was shortened significantly, and the operation procedure was simplified. All patients were followed up for 2 years, only 2 recurrent cases were found. The success rate reach to 97.06% (66/68).

CONCLUSION

Ocular optical fiber used in locating the lacrimal sac in dacryocystorhinostomy under endoscopy is simple and feasible, and can be widely used.

Endonasal laser-assisted microscopic dacryocystorhinostomy: surgical technique and follow-up results

PURPOSE

Endonasal dacryocystorhinostomy is known as an increasingly attractive and effective approach for the surgical treatment of nasal duct obstruction with minimal complications and best cosmetic consequences. In a relatively large-scale case-series study over a 5-year period, we describe the surgical technique and 12-month follow-up results of microscopic laser dacryocystorhinostomy with particular regard to the effect of various pre-/postoperational factors (ie, patients' sex, age, symptoms chronicity, previous interventions, duration of silicone intubation) on the surgical outcome.

MATERIALS AND METHODS

A total of 162 cases in 151 patients with chronic epiphora, mucocele, or recurrent episodes of dacryocystitis were included in the study. Endonasal laser dacryocystorhinostomy was performed using a surgical microscope with transcanalicular lacrimal sac illumination. The laser types used were potassium-titanyl-phosphate and neodymium:yttrium-aluminum-garnet for ablation of nasal mucosa and application to bone, respectively. Patients were evaluated 6 months and 1 year later. Data were analyzed by chi(2) tests.

RESULTS

There were no major complications during or after the operations. Complete cure occurred in 89.5% (after 6 months) and 74.2% (after 1 year) of the cases. Anatomical patency was shown by lacrimal system irrigation with fluorescein in 81.5% of the cases after the 12-month follow-up. It was found that patients younger than 55 years, with symptoms lasting less than 1 year, and without history of nasal problems, had significantly higher surgical success rates (P < .05). Moreover, rates of failure were significantly lower in cases whose canaliculi were intubated for 5 to 6 months (P < .05).

CONCLUSIONS

Endonasal microscopic laser dacryocystorhinostomy is a safe and minimally invasive procedure with reasonable results. It has many advantages over external or other conventional approaches. Successful results could be further enhanced by more wisely selecting the patients and by silicone extubation after 6 months.

Experience with endoscopic dacryocystorhinostomy using four methods

OBJECTIVE

Evaluation of four methods of endoscopic dacryocystorhinostomy (EDCR) for treating chronic dacryocystitis.

STUDY DESIGN

Case series with chart review.

MATERIALS AND METHODS

A total of 1450 patients underwent EDCR for epiphora, chronic dacryocystitis, and blocked nasolacrimal ducts. Relief from epiphora, dacryocystitis, and patency of the fistula for all four techniques was compared. A total of 292 patients underwent incision and drainage, 343 patients had grommets inserted, 258 had silastic lacrimal stents inserted, and 557 had the medial wall of the lacrimal sac (LS) removed. Parameters of success were 1) resolution of epiphora, 2) no further attacks of dacryocystitis, and 3) patency of the new fistula.

RESULTS

Sixty-five percent failed the incision method, and 68 percent of the patients who underwent the grommet method failed. All 258 patients with lacrimal stents experienced success while the stent remained in situ. Ten patients required removal because the stents created corneal opacities. One required removal because of a foreign body granuloma at the punctum. Only eight (1.4%) patients with removal of the LS failed. On multivariate analysis, female sex (OR = 5.6) was found to be associated with a higher rate of failure. Incision and drainage (OR = 100.1) and grommet insertion (OR = 60.6) were associated with increased risk of failure. Removal of the medial wall of the LS (OR = 0.069) and findings of a clear sac (OR = 0.001) or mucus (OR = 0.204) were associated with success.

CONCLUSION

The best EDCR results are achieved by stenting or removal of the medial wall of the LS. In our experience, excision of the medial wall of the LS was as successful as insertion of silastic lacrimal intubation stents, without the disadvantage of causing corneal opacities.

[Application of the Ritleng intubation lacrimal system for the surgical treatment of combined lesions of lacrimal passages]

A total of 46 patients suffering persistent lacrimation were available for examination. Chronic catarrhal dacryocystitis was diagnosed in 19 (41.3%) of them and chronic purulent dacryocystitis in the remaining 27 (58.7%). All the patients presented with lacrimal duct obstruction. Surgical treatment included mucroscopic endonasal canaliculocystorhinostomy with intubation of lacrimal passages using the Ritleng system. After the completion of the one-year dynamic follow-up period and removal of the stent from the lacrimal passages, results of the treatment were described as positive in 42 (91.3%) patients and as negative in 4 (8.7%) cases.

Outcome of external dacryocystorhinostomy in Ethiopian patients

BACKGROUND

An imbalance between tear production and drainage results in epiphora, which is an annoying symptom embarrassing the patient socially and functionally. The two widely accepted modalities of treatment for nasolacrimal duct obstruction (NLDO) are external dacryocystorhinostomy (EDCR) and endoscopic dacryocystorhinostomy. EDCR is the mainstay of treatment of NLDO and it remains to be the gold standard with which all other methods must be compared.

OBJECTIVE

To determine the outcome of EDCR in Menelik II hospital, Addis Ababa, Ethiopia. The study was also intended to give a baseline data at a tertiary eye care center.

METHODS

A prospective study was done in Menelik II Hospital. All patients scheduled for EDCR between June 2005 and May 2006 were included in the study. EDCR was done for all our cases. Success was defined by patient satisfaction (no complaint of tearing) supported by examination for regurgitation of fluid on pressing the lacrimal sac; and slit lamp assessment for increased tear meniscus.

RESULTS

One hundred and twenty eight eyes of 106 patients were included in the study, 36 (34%) were males and 70 (66%) were females. The male to female ratio was approximately 1:2. The commonest indication for dacryocystorhinostomy was chronic dacryocystitis 93 (72.7%). Patients were followed postoperatively for a mean follow up period of 9.3 months (6-12 months). Success was recorded in 119 (93%) of operated eyes. Patients graded incision scar as excellent in 107 (83.6%) eyes, good in 9 (14.8%) and bad in 2 (1.6%) eyes. All patients respond that they would recommend operation for others.

CONCLUSION

The success rate of EDCR in our set up is comparable to studies done in other parts of the world and EDCR is a very effective surgical procedure for our patients with NLDO.

Dacryocystitis secondary to an iatrogenic foreign body in the lacrimal apparatus

Dacryocystitis is an infection of the lacrimal sac that is usually caused by obstruction of the nasolacrimal duct. We describe a case of iatrogenic dacryocystitis that occurred secondary to the presence of an impacted piece of a metallic dilator in the lacrimal apparatus. The foreign body was detected on dacryocystography and removed during dacryocystorhinostomy. The patient recovered uneventfully.

Anastomosis of nasal mucosal and lacrimal sac flaps in endoscopic dacryocystorhinostomy

Endoscopic dacryocystorhinostomy (DCR) is a well-established alternative to external approaches in the treatment of nasolacrimal canal obstruction. From July 2004 to December 2008, 92 endoscopic DCRs were performed on 88 patients at the Department of Otorhinolaryngology, San Raffaele Hospital, Milan. All patients were affected by chronic dacryocystitis with epiphora. Preoperative work-up included Jones tests, lacrimal pathways irrigation, nasal endoscopy, and imaging evaluation by computed tomography. The technique involved anastomosis of nasal mucosal, lacrimal sac flaps and a large bony ostium. A silicone tube was inserted in all patients that remained for a period of 3 months. The first endoscopic intervention was successful in 91.30% of patients. After a second revision endoscopic DCR, the overall success rate raised to 95.65%. Anastomosis of nasal mucosal between lacrimal sac flaps plays a key role in endoscopic DCR with a high success rate both in primary nasolacrimal obstructions and in revision cases.

Non-endoscopic endonasal dacryocystorhinostomy--technique, indications, and results

PURPOSE

To describe the technique of non-endoscopic endonasal dacryocystorhinostomy (NEN-DCR), and its indications and results.

MATERIALS AND METHODS

In a prospective, non-randomized interventional case series, all consecutive cases presenting with epiphora between 2004 and 2006 were enrolled. Adult patients were divided into three subgroups: chronic nasolacrimal duct obstruction (NLDO), NLDO with dacryocystitis (NLDO-DC), and recurrent NLDO with previous failed external DCR (REV-DCR). All procedures were performed by one surgeon (first author). An endonasal DCR was performed through a nasal speculum without the use of an endoscope. Success was measured by both improvement of the epiphora and patency of the lacrimal system during irrigation.

RESULTS

Ninety-five patients (24 men, 71 women) underwent 99 NENDCR procedures; 54% of cases had NLDO, 32% had NLDO-DC, and 14% were REV-DCR. Mean duration of surgery was 30 minutes, and the average amount of intraoperative bleeding was 12 ml. After a minimum follow-up of 6 months, success was achieved in 96% of all patients, 94% in the NLDO group, 97% in the NLDO-DC group, and 92% in the REV-DCR group. The failure rate was 4% overall. Two patients failed from the NLDO group, one patient from the NLDO-DC group, and one patient from the REV-DCR group. No significant late complications were detected.

CONCLUSION

The success rate of NEN-DCR compares favorably with external DCR. The technique is also useful in cases of NLDO-DC and DCR-REV.

Dacryocystitis: an unusual form of Mucorales infection

Mucormycosis is an acute fungal infection in humans that is often fulminant and potentially fatal. It occurs most frequently in immunocompromised individuals. We report a diabetic patient who presented in ketoacidosis with lacrimal sac infection from this organism. To the best of our knowledge, this is only the second patient with dacryocystitis caused by this fungus described in the medical literature. Our patient is unique in that she had no evidence of concurrent sinus involvement. Surgical debridement and antifungal therapy were combined to ensure a successful outcome.

Clinicobacteriological study of chronic dacryocystitis in adults

Chronic dacryocystitis is the inflammation of lacrimal sac, frequently caused by bacteria. Obstruction of nasolacrimal duct converts the lacrimal sac a reservoir of infection. It is a constant threat to cornea and orbital soft tissue. Moreover, it causes social embarrassment due to chronic watering from the eye. This study was conducted to find out the current clinicobacteriological profile of chronic dacryocystitis in adults. A total of 56 adult patients were selected from ophthalmology OPD. Detail history and clinical examinations were carried out. All patients underwent either dacryocystorhinostomy or dacryocystectomy. A part of the sac was collected for culture and sensitivity. This study revealed that chronic dacryocystitis is more common in females and left eye is more frequently involved than right eye. It is common among lower socioeconomic strata with habit of pond-bathing. Some form of nasal pathology like hypertrophied inferior turbinate, deviated nasal septum, nasal polyp and allergic rhinitis werefound in 19.6% of the patients. Complications of chronic dacryocystitis like conjunctivitis, corneal ulcer, acute on chronic dacryocystitis, lacrimal abscess and fistula were seen in 25.0% of these patients; 53.6% of the culture samples were positive for bacterial growth. Gram-positive organisms were most common isolate. Unlike other studies, Staphylococcus aureus (40.0%) was found to be most common Gram-positive organism, followed by Staphylococcus epidermidis (10.0%) and Steptococcus pneumoniae (10.0%). Among the Gram-negative organisms, Pseudomonas aeruginosa (16.6%) was the most common, followed by Klebsiella pneumoniae (6.6%) and Haemophilus influenzae (6.6%). Antibiotic sensitivity tests were done. Most of the organisms were resistant to penicillin. Chloramphenicol was effective against most of the Gram-positive organisms. Aminoglycosides, tobramycin in particular, was effective against Staphylococcus epidermidis. Fluoroquinolones, namely ciprofloxacin and ofloxacin were effective against Pseudomonas aeruginosa and Klebsiella pneumoniae.

Primary endoscopic dacryocystorhinostomy as treatment for acute dacryocystitis with abscess formation

AIMS

The aim of this study is to analyze the success rate of endoscopic dacryocystorhinostomy as treatment modality for acute dacryocystitis complicated by abscess formation.

METHODS

A total of 11 patients presenting with acute dacryocystitis with abscess formation during the period from April 2003 to December 2005 were treated with primary endoscopic dacryocystorhinostomy under antibiotic cover. These were followed up for 1 year.

RESULTS

A total of 11 patients were studied (mean age, 43.4 years), 2 males and 9 females with complaint of pain and swelling around the medial side of eye and adjoining facial tissue. A history of chronic epiphora and recurrent nasolacrimal infections was present in all the patients. Resolution of signs and symptoms of acute dacryocystitis occurred in all the patients. During the follow-up period of 1 year, no patient reported signs and symptoms of acute dacryocystitis. Subjective success rate (assessed by absence of epiphora) was 72.7%. Objective success rate was 81.8% (assessed by lacrimal irrigation).

CONCLUSIONS

Primary endoscopic dacryocystorhinostomy is an effective treatment in cases of acute dacryocystitis complicated by abscess formation. Preexisting symptoms of epiphora and recurrent nasolacrimal infections are also relieved in most patients.

Endo-DCR: is it an end of the road for external DCR?

Endo-DCR is a safe, quick, less traumatic, with minimal blood loss and post-operative discomfort and last but not the least, avoids external scar. It has high success rate in both primary and secondary cases. Fifty two cases of chronic dacryocystitis were treated by the endoscopic technique including 33 females and 19 males in mean age group 35.8 year, 29 left eye and 23 right eye with 8 patients cannulated with nasolacrimal tube with very good results and few complications.

Meningitis and Pneumocephalus. A rare complication of external dacryocystorhinostomy

Meningitis due to fracture of the fovea ethmoidalis during external dacryocystorhinostomy is a rare complication. We report a case of pneumocephalus and meningitis in a 51-year-old female who underwent an external dacryocystorhinostomy (DCR). Although extracranial complications during or after external DCR have been well-described, only one case of meningitis has been reported in the literature. Physical examination, computerised tomography, lumbar puncture, and bacteriologic cultures were used to make the diagnosis. The patient responded well to antibiotic therapy. Her symptoms resolved immediately and she was discharged on the 21st post-operative day. This complication emphasises the importance of careful surgical technique and a thorough knowledge of regional anatomy, during DCR and similar procedures.

[Long-term follow-up for outcomes of intranasal endoscopic dacryocystorhinostomy]

OBJECTIVE

To sum up and analyze the long-term follow-up outcomes of intranasal endoscopic dacryocystorhinostomy (IEDCR) in patients with chronic dacryocystitis. The related factors to clinical effects were discussed.

METHODS

The operative and postoperative data were collected in 275 patients (310 eyes, mean age 28.3 years; range 3 to 76 years) who were undergone IEDCR with chronic dacryocystitis. All patients conceived the preoperative dacryocystography. Surgical intervention was performed under general or local anesthesia and all were done by the same surgeon. The silicon intubation was used according to the size of lacrimal sac. The postoperative follow-up management included endoscopic cleaning, lacrimal duct irrigation and nasal corticosteroid spray.

RESULTS

The patients with follow-up period less than 1 year were excluded from this group. 211 cases (230 eyes) were followed up over 1 year and the results showed that 75.3% were cured, 11.7% improved and 13.0% had no effects. The natural lacrimal apparatus was found reopened in 9 cases while their lacrimal rhinostomies were closed with scar. There was no operative complications.

CONCLUSIONS

The long-term outcomes of IEDCR are good. The wide bony rhinostomy, less mucosal damage and closed follow-up debrided should benefit for getting a high operative success rate. After surgical drainage, the inflammation mucosa of lacrimal sac might return to normal and the function of nasolacrimal apparatus might recover.

[The management of the stoma in endoscopic dacryocystorhinostomy]

OBJECTIVE

To explore the better management of the stoma in endoscopic dacryocystorhinostomy.

METHOD

To review the 102 chronic dacryocystitis patients (109 eyes), who underwent the endoscopic dacryocystorhinostomy surgery with silver clips used to maintain the stoma. They were given combined therapy after the surgery, and were followed up for a period range from 3-73 months.

RESULT

99/109 eyes (91%) were cured, 5/109 eyes (4.5%) were improved, and the total effective rate reached to 104/109 (95.5%).

CONCLUSION

The application of silver clip in endoscopy dacryocystorhinostomy surgery and combined therapy after the surgery can effectively prevent the stoma stenosis or atresia.

[A novel retrograde intubation procedure for treatment of nasolacrimal duct obstruction]

OBJECTIVE

To investigate the effect of a novel intubation procedure for the treatment of nasolacrimal duct obstruction.

METHODS

Nasolacrimal duct obstruction patients with chronic dacryocystitis were selected for undergoing the procedure of intubation in outpatient clinic. This procedure was performed under local anesthesia. Retrograde intubation was inserted into the nasolacrimal duct and guided with probing. The location of drainage tube, cleanliness, epiphora, secretion from lacrimal sac and other signs were observed 2-4 weeks after intubation. Patients were grouped according to postoperative follow-up time. Group A consisted 521 cases (613 eyes) who underwent operations from May 1997 to December 2001 in Shenzhen Ophthalmic Hospital and observed for 3-5 years to evaluate long-term results. Group B consisted 381 cases (411 eyes) who underwent operations from October 2003 to October 2005 in Shenzhen Ophthalmic Hospital and 5 cases (6 eyes) who underwent operations at the same time period in Beijing Shunyi District Hospital (a total of 386 cases, 417 eyes) and observed for 0.5-1.5 years as the recent treatment group. The cure rates of these two groups were compared using the chi-square test.

RESULTS

The lacrimal system was able to be irrigated one week after the operation. Epiphora symptoms were eliminated 2-3 weeks postoperatively. Lacrimal sac secretions disappeared within 1-3 weeks in most cases, few patients still had mucous secretions after 3 weeks and needed the second intubation operation. The cure rate of second intubation was 92.3% (23/26). The cure rates of Group A and Group B were 84.5% and 88.2%, respectively. There was no significant difference in cure rate between these two groups. Surgery and anesthesia could lead to a short period of diplopia and discomfort without any other complications.

CONCLUSIONS

The novel lacrimal retrograde tube and the operation procedure are safe, simple and without obvious trauma. The prognosis of the intubation operation is good and this method could be used as a treatment for nasolacrimal duct obstruction and chronic dacryocystitis.

Surgical treatment of recurrent dacryocystitis secondary to cystic dilatation of the nasolacrimal duct in a dog

A 3-year-old, castrated male golden retriever was presented for evaluation of recurrent ocular discharge of 4 months' duration from the left eye. Dacryocystorhinography was performed and demarcated a cystic dilatation of the left nasolacrimal duct with obstruction of the duct distal to the cystic cavity. Surgical exploration of the left maxillary sinus was performed to confirm the diagnosis and reestablish drainage into the nasal cavity. Recovery was uneventful, and the dog has been asymptomatic for >36 months postoperatively. This report documents the third published case of surgical treatment for cystic dilatation of the nasolacrimal duct.

[Diagnosis and treatment of chronic epiphora and recurrent dacryocystitis]

The goal of this article is to highlight relevant diagnostic tools to assess chronic epiphora and recurrent dacryocystitis in order to avoid unnecessary diagnostic explorations. Probing of the canaliculi is important for the differential diagnosis of chronic epiphora. Surgical steps are detailed, such as the inferiorly based mucosal flap on the AGGER NASI, which is repositioned at the end of the surgery improving wound healing on the lateral wall. Potential complications are presented, as well as measures to avoid and to treat them. Long-term follow-up of 750 endoscopic DCR confirms the good results in more than 90% after endoscopic dacryocystorhinostomies in adults and in children.

External and endoscopic dacryocystorhinostomy in chronic dacryocystitis: comparison of results

To compare external and endoscopic dacryocystorhinostomy outcomes in patients with chronic dacryocystitis, a total of 103 patients with the complaint of epiphora and diagnosed as chronic dacryocystitis were included in the study. We performed external dacryocystorhinostomy on 55 patients under local anesthesia and endoscopic dacryocystorhinostomy on 48 patients under general anesthesia by means of drill and placed silicon stents to all the patients. The patients were examined endoscopically, at postoperative intervals of 1 week, first month, third month, sixth month and the first year. The patency of the tubes and nasolacrimal ducts were evaluated by irrigation and complaints of the patients were noted. Silicon stents were harvested at the sixth week postoperatively. Outcomes were classified as successful when epiphora diminished, no recurrent infection was noted and minimal or no reflux from the canaliculis during or after lacrimal irrigation was seen. A prospective endoscopic surgery group was compared to a prospective control group (external dacryocystorhinostomy). Full success was achieved in 69.9% of the patients with external dacryocystorhinostomy group whereas the full success rate of endoscopic dacryocystorhinostomy was 89.7%. Recently popularized endoscopic dacryocystorhinostomy is a safe and reliable procedure with high success rates.