[The Interdisciplinary Conference on Lacrimal System Disorders of ophthalmic and ENT surgeons at the University Hospital Halle : An analysis of present patient material]

[Importance of interdisciplinary collaboration for optimal treatment of orbital tumors]

Optimal treatment of tumors with orbital invasion may exceed the competences of an individual medical specialty and require interdisciplinary cooperation. The aim of this article is to present an interdisciplinary treatment concept based on the examples of intraorbital hemangioma and squamous cell carcinoma of the paranasal sinuses infiltrating the orbit. In addition to a detailed medical history and a complete ophthalmological examination, a detailed imaging technique with standardized echography and tomography methods such as orbital thin-slice CT and/or in many cases MRI is essential for the primary classification of an intraorbital pathology. Depending on the type of pathology, a purely surgical procedure involving various disciplines such as ophthalmology, otorhinolaryngology, maxillofacial surgery, neurosurgery, and pathology, or an interdisciplinary treatment regimen including (neo)adjuvant radiotherapy or chemotherapy is necessary. Orbital tumors have a wide range of potential pathologies, requiring complex surgical procedures and multimodal therapies. In case of infiltration of the paranasal sinuses or intracranial structures, an interdisciplinary team including neuroradiologists, oral-maxillofacial surgeons, otorhinolaryngologists, neurosurgeons, radiation therapists, ophthalmologists, pathologists, oncologists, and psycho-oncologists is essential for successful treatment.

[Recognition and prevention of problems in lacrimal duct surgery]

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.

[Possible surgical approaches to the orbit]

For removal of tumors and foreign bodies from the orbit, for treatment of severe inflammatory diseases, and for repositioning of bone fragments following fractures or during reconstruction of the bony orbit, several different surgical approaches are available. During the past decade, improved understanding of the pathology and pathophysiology of particular orbital diseases, advancements in clinical endoscopy and microscopy, the introduction of modern imaging techniques for preoperative visualization of pathologic findings, modern approaches to orbital reconstruction, as well as developments in adjuvant therapy have led to a reduction in invasiveness and development of the modern minimally invasive surgical approaches to the orbit usually used today. This review article aims to describe several surgical approaches to the orbit that are nowadays commonly applied-frequently in the context of interdisciplinary therapy-as well as their indications and potential complications. Particular attention is paid to minimally invasive approaches. These different surgical approaches allow a 360-degree exposure of the internal orbital structures with the optic nerve at the center ("round the clock access to the orbit"). The review is complemented by hints and tricks for particular approaches, as well as by a review of the latest literature in the field.

[Low-dose helical CT-dacryocystography in nasolacrimal duct obstruction-a prospective study]

BACKGROUND

In addition to basic ophthalmologic diagnostic workup, different radiologic procedures can be performed for assessment of nasolacrimal duct obstruction. However, no gold standard imaging technique has yet been established. Using the results of the present study, the advantages of helical CT-dacryocystography (CT-DCG) are demonstrated, particularly when performed before endonasal endoscopic dacryocystorhinostomy.

MATERIALS AND METHODS

In 21 patients with uni- or bilateral epiphora, 24 low-dose helical CT-DCGs were performed with non-ionic iodine-containing contrast medium and including three-dimensional reconstruction. For 8 patients, digital subtraction angiography (DSA)-DCG results were available for comparison with CT-DCG.

RESULTS

Using low-dose helical CT-DCG, either the location of nasolacrimal duct pathology could be exactly identified (n = 19; stenosis presaccal n = 3, intrasaccal n = 11, postsaccal n = 5) or nasolacrimal system block could be definitively excluded as the cause of epiphora (n = 5). For imaging of the perilacrimal and periorbital bony structures, CT-DCG is significantly better than DSA-DCG.

CONCLUSION

Low-dose helical CT-DCG with reconstruction of the coronal and sagittal planes represents an ideal imaging technique with low exposure for detection of nasolacrimal duct obstruction. By demonstrating all relevant anatomic landmarks for endoscopic dacryocystorhinostomy, helical CT-DCG enables head and neck surgeons to plan surgery optimally.

[Diagnostics and treatment of lacrimal duct diseases : A structured patient-centred care concept]

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.