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Kerber L, Kerman T, Hazan I, Ziv O, Kordelul S, Tsumi E. Are inflammation-related diseases risk factors for primary acquired nasolacrimal duct obstruction? A large scale, national case-control study. Graefes Arch Clin Exp Ophthalmol 2024; 262:1911-1917. [PMID: 38194111 DOI: 10.1007/s00417-023-06352-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/22/2023] [Accepted: 12/20/2023] [Indexed: 01/10/2024] Open
Abstract
PURPOSE To evaluate the incidence and risk factors for inflammatory conditions among patients with primary acquired nasolacrimal duct obstruction (PANDO). METHODS A retrospective case-control study was conducted among patients of Clalit Health Services (CHS) in Israel from 2001 to 2022. For each case, three controls were matched among all CHS patients according to year of birth, sex, and ethnicity. Differences in demographic characteristics, ocular surface, eyelid, upper airway, and systemic diseases were assessed between the groups, and odds ratios (OR) were calculated. RESULTS A total of 60,726 patients diagnosed with PANDO were included. The average age of PANDO patients was 63 ± 18 years, 63% were female. Significant associations were found between PANDO and various ocular surface and eyelid conditions, including chronic conjunctivitis (OR 2.96, 95% CI [2.73-3.20]), vernal keratoconjunctivitis (OR 2.89, 95% CI [2.45-3.29]), and blepharitis (OR 2.75, 95% CI [2.68-2.83]). There was a significant association with various upper airway conditions, including rhinitis (OR 1.62, 95% CI [1.58-1.66]), chronic sinusitis (OR 1.71, 95% CI [1.62-1.80]), and deviated nasal septum (OR 1.76, 95% CI [1.69-1.84]). Association was also observed with systemic conditions, including asthma (OR 1.34, 95% CI [1.27-1.41]) and atopic dermatitis (OR 1.36, 95% CI [1.32-1.41]). CONCLUSION Ocular surface, eyelid, upper airway, and systemic inflammatory-related diseases were found to be associated with PANDO, supporting the theory that inflammation has a prominent role in the pathophysiology of PANDO.
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Affiliation(s)
- Lior Kerber
- Department of Ophthalmology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Tomer Kerman
- Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Itai Hazan
- Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Oren Ziv
- Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Sofia Kordelul
- Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Erez Tsumi
- Department of Ophthalmology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Xiao W, Wang B, Wang X, Zhang G, Zhao Y, Zhang Z, Li L, Qu C. Two-electron oxidized polyphenol chemistry-inspired superhydrophilic drug-carrying coatings for the construction of multifunctional nasolacrimal duct stents. J Mater Chem B 2024; 12:2877-2893. [PMID: 38426303 DOI: 10.1039/d3tb02668j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Nasolacrimal duct obstruction due to infection, inflammation, or excessive fibroblast proliferation may result in persistent tearing, intraocular inflammation, or even blindness. In this study, surface engineering techniques are applied to nasolacrimal duct stents for the first time. Based on the functioning of marine mussels, "one-pot" and "stepwise" methods were employed to construct a novel multifunctional superhydrophilic PDA/RAP coating using dopamine and rapamycin. Micron-sized rapamycin crystals combined with nano-sized polydopamine particles form a micro-nano topographical structure. Therefore, acting synergistically with in situ-generated hydrophilic groups (amino, carboxyl, and phenolic hydroxyl), they impart excellent and long-lasting superhydrophilicity to the nasolacrimal duct stent. The PDA/RAP coating effectively maintained the stability of the initial microenvironment during stent implantation by inhibiting the onset of acute inflammation and infection during the early stages of implantation. Meanwhile, the rapamycin crystals, supported by the superhydrophilic platform, exhibited a sustained-release capability that helped them to better exert their anti-inflammatory, antibacterial, and anti-fibroblast proliferative properties, ensuring conducive conditions for the rapid repair of nasolacrimal duct epithelial cells, verified by a series of experiments. In conclusion, the PDA/RAP hydrophilic coating has anti-inflammatory, antifibrotic, antibacterial, and antithrombotic properties, offering a new strategy to address restenosis following clinical nasolacrimal duct stent implantation.
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Affiliation(s)
- Wenzhe Xiao
- Eye School of Chengdu University of TCM, Chengdu 610075, China
- Department of Ophthalmology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China.
- Sichuan Key Laboratory for Disease Gene Study, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Binjian Wang
- Eye School of Chengdu University of TCM, Chengdu 610075, China
- Department of Ophthalmology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China.
- Sichuan Key Laboratory for Disease Gene Study, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Xuemei Wang
- Department of Ophthalmology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China.
- Sichuan Key Laboratory for Disease Gene Study, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Guanghong Zhang
- Department of Ophthalmology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China.
- Sichuan Key Laboratory for Disease Gene Study, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Yihao Zhao
- Department of Ophthalmology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China.
- Sichuan Key Laboratory for Disease Gene Study, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Zezhen Zhang
- Department of Ophthalmology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China.
- Sichuan Key Laboratory for Disease Gene Study, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Linhua Li
- Kidney Research Laboratory, Department of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, China.
| | - Chao Qu
- Department of Ophthalmology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China.
- Sichuan Key Laboratory for Disease Gene Study, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
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Zhang W, Huang H, Liu X, Zhang L, Li L, Ding Y, Xiao Y, Ali MJ, Sun H, Xiao C. scRNA-Seq: First Atlas and Cellular Landscape of Lacrimal Sac: Implications in Primary Acquired Nasolacrimal Duct Obstruction Pathogenesis. Invest Ophthalmol Vis Sci 2024; 65:38. [PMID: 38551583 PMCID: PMC10981439 DOI: 10.1167/iovs.65.3.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 03/10/2024] [Indexed: 04/01/2024] Open
Abstract
Purpose The aim of this study was to describe the transcriptional changes of individual cellular components in the lacrimal sac in patients with primary acquired nasolacrimal duct obstruction (PANDO) and attempt to construct the first lacrimal sac cellular atlas to elucidate the potential mechanisms that may drive the disease pathogenesis. Methods Lacrimal sac samples were obtained intra-operatively during the endoscopic dacryocystorhinostomy (EnDCR) procedure from five patients. Single-cell RNA sequencing was performed to analyze each individual cell population including epithelial and immune cells during the early inflammatory and late inflammatory phases of the disease. Results Eleven cell types were identified among 25,791 cells. T cells and B cells were the cell populations with the greatest variation in cell numbers between the two phases and were involved in immune response and epithelium migration-related pathways. The present study showed that epithelial cells highly expressed the genes of senescence-associated secretory phenotype (SASP) and were involved in influencing the inflammation, neutrophil chemotaxis, and migration during the late inflammatory stage. Enhanced activity of CXCLs-CXCRs between the epithelial cells and neutrophils was noted by the cell-cell communication analysis and is suspected to play a role in inflammation by recruiting more neutrophils. Conclusions The study presents a comprehensive single-cell landscape of the lacrimal sac cells in different phases of PANDO. The contribution of T cells, B cells, and epithelial cells to the inflammatory response, and construction of the intercellular signaling networks between the cells within the lacrimal sac has further enhanced the present understanding of the PANDO pathogenesis.
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Affiliation(s)
- Wenyue Zhang
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Huan Huang
- CAS Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Xueru Liu
- Ophthalmic Center, Xinjiang 474 Hospital, Urumqi, Xinjiang, China
| | - Leilei Zhang
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Lunhao Li
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yi Ding
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yichuan Xiao
- CAS Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India
| | - Hao Sun
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Caiwen Xiao
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
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Ali MJ. Etiopathogenesis of primary acquired nasolacrimal duct obstruction (PANDO). Prog Retin Eye Res 2023; 96:101193. [PMID: 37394093 DOI: 10.1016/j.preteyeres.2023.101193] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/04/2023]
Abstract
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.
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Affiliation(s)
- Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India.
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Zimmermann JA, Esser EL, Merté RL, Danzer MF, Rosenberger F, Brücher VC, Eter N, Alnawaiseh M, Blumberg AF, Lahme L, Mihailovic N. Nasolacrimal intubation in transcanalicular endoscopic dacryoplasty: a long-term follow-up study. Sci Rep 2023; 13:7521. [PMID: 37160950 PMCID: PMC10170144 DOI: 10.1038/s41598-023-34351-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 04/27/2023] [Indexed: 05/11/2023] Open
Abstract
Nowadays, transcanalicular endoscopic dacryoplasty represents the majority of lacrimal duct surgery procedures performed in adults in specialised centers. However, there are still hardly any data available regarding the intra- and postoperative care, particularly regarding the duration of silicone tube intubation (STI). Our aim was to evaluate the relation between tube duration and recurrence of symptoms in patients who underwent transcanalicular microdrill dacryoplasty (MDP) in a long-term setting. Medical records of 576 adult patients after MDP were retrospectively reviewed. A total of 256 eyes of 191 patients could be included. The median follow-up time was 7.83 [7.08; 9.25] years. In 57.0% of the cases there was still full resolution of symptoms at the time of the survey. The median duration of the STI was 6 [3.00; 6:00] months. When distinguishing between a tube duration < 3 months and ≥ 3 months there was a significant difference in the long-term success rate (< 3 months: 38%; ≥ 3 months: 61%; p = 0.011). In conclusion, an early removal of the STI (< 3 months) after transcanalicular MDP seems to be associated with a higher incidence of recurrence of symptoms. This should be considered in the intra- and postoperative care of patients following this minimally invasive first-step procedure.
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Affiliation(s)
- Julian Alexander Zimmermann
- Department of Ophthalmology, University of Muenster Medical Center, Domagkstraße 15, 48149, Muenster, Germany
| | - Eliane Luisa Esser
- Department of Ophthalmology, University of Muenster Medical Center, Domagkstraße 15, 48149, Muenster, Germany
| | - Ralph-Laurent Merté
- Department of Ophthalmology, University of Muenster Medical Center, Domagkstraße 15, 48149, Muenster, Germany
| | - Moritz Fabian Danzer
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Friederike Rosenberger
- Department of Ophthalmology, University of Muenster Medical Center, Domagkstraße 15, 48149, Muenster, Germany
| | - Viktoria C Brücher
- Department of Ophthalmology, University of Muenster Medical Center, Domagkstraße 15, 48149, Muenster, Germany
| | - Nicole Eter
- Department of Ophthalmology, University of Muenster Medical Center, Domagkstraße 15, 48149, Muenster, Germany
| | - Maged Alnawaiseh
- Department of Ophthalmology, Klinikum Bielefeld Gem. GmbH, Bielefeld, Germany
| | - Alina Friederike Blumberg
- Department of Ophthalmology, Klinikum Fulda gAG, University of Marburg, Campus Fulda, Fulda, Germany
| | - Larissa Lahme
- Department of Ophthalmology, University of Muenster Medical Center, Domagkstraße 15, 48149, Muenster, Germany
| | - Natasa Mihailovic
- Department of Ophthalmology, University of Muenster Medical Center, Domagkstraße 15, 48149, Muenster, Germany.
- Department of Ophthalmology, Klinikum Bielefeld Gem. GmbH, Bielefeld, Germany.
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Borchert GA, Blah TR, Fu MY, Cheng ACM, Kaushik N, Francis IC. Spontaneous Extrusion of a Conjunctivolith Containing Herpes Virus Confirmed by Electron Microscopy and Energy Dispersive Spectroscopy. Ophthalmic Plast Reconstr Surg 2023; 39:e60-e64. [PMID: 36867772 DOI: 10.1097/iop.0000000000002326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
: This report describes the spontaneous extrusion from between the eyelids of a presumed conjunctivolith in a patient with resolving severe herpes zoster ophthalmicus. A 57-year-old man presented for ophthalmologic assessment and management due to severe left herpes zoster ophthalmicus. At one subsequent ophthalmologic assessment, a conjunctivolith spontaneously egressed the lateral commissure of the OS when the lateral fornix was inspected. The conjunctivolith was retrieved from the floor of the consulting room. Electron microscopic analysis and energy dispersive spectroscopy was undertaken to determine its composition. Scanning electron microscopy showed that the conjunctivolith was composed of carbon, calcium, and oxygen. Transmission electron microscopy diagnosed Herpes virus within the conjunctivolith. Conjunctivoliths, or possible lacrimal gland stones, are a very rare phenomenon, and their etiology is currently unclear. In this case, there was likely to have been an association between herpes zoster ophthalmicus and the conjunctivolith.
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Affiliation(s)
| | - Tyler R Blah
- Royal North Shore Hospital, Sydney, NSW, Australia
- University of Notre Dame, Sydney, NSW, Australia
| | - Michele Y Fu
- University of New South Wales, Sydney, NSW, Australia
| | - Adrian C M Cheng
- Royal North Shore Hospital, Sydney, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
| | - Natasha Kaushik
- Microscopy Department, Electron Microscopy Unit, University of New South Wales, Sydney, NSW, Australia
| | - Ian C Francis
- University of New South Wales, Sydney, NSW, Australia
- Department of Ophthalmology, Prince of Wales Hospital, Sydney, NSW, Australia
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Nakamura J, Kamao T, Mitani A, Mizuki N, Shiraishi A. Accuracy of the Lacrimal Syringing Test in Relation to Dacryocystography and Dacryoendoscopy. Clin Ophthalmol 2023; 17:1277-1285. [PMID: 37162802 PMCID: PMC10164386 DOI: 10.2147/opth.s409662] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 04/28/2023] [Indexed: 05/11/2023] Open
Abstract
Purpose This study aimed to evaluate the accuracy of the lacrimal syringing test (syringing) in relation to dacryocystography (DCG) and dacryoendoscopy (DE) in lacrimal pathway (LP) obstruction. Methods We retrospectively reviewed 101 patients (188 LPs) who underwent syringing, cone-beam computed tomography (CBCT)-DCG, and DE to diagnose the degree and site of LP obstruction. The degree of obstruction was classified into patent, partial obstruction, and complete obstruction. The degree of LP obstruction was determined by combining the findings of DE and CBCT-DCG and was designated as DCG+DE. When differentiating complete or partial obstruction on DE was uncertain, complete or partial obstruction was assigned if the DCG showed evidence of contrast media obstruction or passage, respectively. The consistency between syringing and DCG+DE was evaluated by calculating the weighted kappa coefficient. Results The sensitivity and specificity of syringing were 94% and 89%, respectively. The weighted Cohen's kappa value of agreement between syringing and DCG+DE was κ = 0.73 (SE = 0.04, 95% confidence interval [CI]: 0.66-0.80, p < 0.01). When divided into presaccal and postsaccal obstruction categories, the kappa values were κ = 0.40 (SE = 0.11, 95% CI: 0.19-0.62, p < 0.01) and 0.55 (SE = 0.09, 95% CI: 0.37-0.73, p < 0.01), respectively. Furthermore, when limited to common canaliculus obstruction (stenoses), which accounted for 78% (46 LPs) of the total presaccal obstructions, the kappa value was κ = 0.29 (SE = 0.12, 95% CI: 0.05-0.54, p = 0.021), which demonstrated the lowest consistency between syringing and DCG+DE. Conclusion Syringing was "substantially" in agreement with DCG+DE in detecting the degree of LP obstruction. Moreover, syringing was a sufficiently sensitive and specific test when performed by an experienced clinician. However, distinguishing between complete and partial obstructions by syringing was sometimes difficult, particularly in the common canaliculus obstruction (stenosis).
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Affiliation(s)
- Jutaro Nakamura
- Department of Ophthalmology, Ehime University Graduate School of Medicine, Toon, Ehime, 791-0295, Japan
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, 236-0004, Japan
- Correspondence: Jutaro Nakamura, Department of Ophthalmology, Ehime University Graduate School of Medicine, Toon, Ehime, 791-0295, Japan, Tel +8189-960-5361, Fax +8189-960-5364, Email
| | - Tomoyuki Kamao
- Department of Ophthalmology, Ehime University Graduate School of Medicine, Toon, Ehime, 791-0295, Japan
| | - Arisa Mitani
- Department of Ophthalmology, Ehime University Graduate School of Medicine, Toon, Ehime, 791-0295, Japan
| | - Nobuhisa Mizuki
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, 236-0004, Japan
| | - Atsushi Shiraishi
- Department of Ophthalmology, Ehime University Graduate School of Medicine, Toon, Ehime, 791-0295, Japan
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Atkova EL, Astrakhanstev AF, Subbot AM, Yartsev VD. [Dynamic pathomorphological characteristics of the nasolacrimal duct in its stenosis]. Arkh Patol 2023; 85:22-28. [PMID: 37814846 DOI: 10.17116/patol20238505122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
OBJECTIVE Pathological description of the process of stenosis of the nasolacrimal duct at its various stages. MATERIAL AND METHODS The material for the study was obtained from the wall of the nasolacrimal duct during surgery in 50 patients whose condition was attributed to the 1st, 2nd or 3rd clinical stage of dacryostenosis. The material was fixed in formalin and sent for pathohistological and immunohistochemical (IHC) studies. RESULTS In the 1st stage, the integrity of the epithelium of the nasolacrimal duct was preserved, the density of goblet cells was reduced. Seromucinous glands were single in the lamina propria in the area of stenosis. Diffuse lymphoid-plasmacytic infiltration was observed along the periphery of the terminal sections of the glands and in the subepithelial zone. The infiltrate includes CD68+ tissue macrophages and CD20+ and CD3+ lymphocytes, with a predominance of B-lymphocytes over T-lymphocytes. In the 2nd stage, changes in the epithelial layer in the stenosis zone were detected. In the IHC study, only individual leukocytes were observed in these zones, and T cells were found mainly in the subepithelial zone, B cells - deeper, monocytes - evenly in all layers. In the adjacent zones, the picture of the infiltrate corresponded to the 1st stage. In the 3rd stage, fragments of the nasolacrimal duct wall were represented by dense fibrous connective tissue with pronounced atrophic changes, areas of squamous metaplasia or proliferation of the basal layer, goblet cells were not detected. There was no infiltrate in the area of stenosis during IHC study. In the cellular elements of the infiltrate in areas adjacent to the stenosis zone, CD20+ and CD3+ lymphocytes were present in equal proportions, the arrangement in layers corresponded to that of the 2nd stage. CONCLUSION The results of the study showed that dacryostenosis is a progressive pathological process associated with the progredient development of chronic productive inflammation in the lacrimal ducts.
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Affiliation(s)
- E L Atkova
- M.M. Krasnov Scientific Research Institute of Eye Diseases, Moscow, Russia
| | - A F Astrakhanstev
- D.I. Mastbaum Bureau of Forensic Medical Examination, Ryazan, Russia
| | - A M Subbot
- M.M. Krasnov Scientific Research Institute of Eye Diseases, Moscow, Russia
| | - V D Yartsev
- M.M. Krasnov Scientific Research Institute of Eye Diseases, Moscow, Russia
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Optimizing clinical outcomes for endoscopic lacrimal duct recanalization in patients with complete PANDO. Int Ophthalmol 2023; 43:175-184. [PMID: 35809164 DOI: 10.1007/s10792-022-02414-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/15/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE The study aims to describe modifications and refinements in the technique and technology of Transcanalicular Endoscopic Lacrimal Duct Recanalization (TELDR) based on anatomical foundations to optimize its clinical outcomes in patients with complete Primary Acquired Nasolacrimal Duct Obstruction (PANDO). METHODS The medical records of 115 patients who underwent TELDR procedures from January 2018 to July 2020 were reviewed retrospectively. Of the 115 patients, only those 35 patients with complete PANDO characterized by longstanding epiphora of 3-5 years duration, dense, diffuse fibrous tissue obstruction involving the sac, sac duct junction and the entire length of the nasolacrimal duct were included in the study. Parameters for success were analyzed based on patency on irrigation, functional endoscopic dye test, and improvement of epiphora. RESULTS Forty-five cases from 35 patients with complete PANDO were included in the study. The mean length of time from the date of operation to silicone stent removal was 8.1 weeks, while the mean length of follow-up starting from the removal of silicone stent to last follow-up was 61.0 weeks. There were 95.6% anatomic patency on canalicular irrigation with saline and 95.6% functional patency based on functional endoscopic dye test. There was significant improvement of epiphora (p value of < 0.0001) post-operatively. CONCLUSION The results of modified TELDR improved clinical outcomes and could be a definitive treatment in patients with complete PANDO with longstanding, dense, diffuse, fibrous tissue obstruction. Patients who experience reobstruction, may undergo a repeat of the recanalization approach.
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Changes in Tears Monocyte Chemoattractant Protein-1 Level After External Dacryocystorhinostomy in Primary Acquired Nasolacrimal Duct Obstruction. J Craniofac Surg 2022; 33:e776-e779. [PMID: 35882040 DOI: 10.1097/scs.0000000000008723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/22/2022] [Indexed: 10/16/2022] Open
Abstract
BACKGROUND The authors aimed to define tears monocyte chemoattractant protein-1 (MCP-1) changes after external dacryocystorhinostomy surgery. MATERIALS AND METHODS Tears samples were collected with a Schirmer strip and stored in Eppendorf tubes at -80°C. At the end of the study, the papers were cut into small pieces and incubated with phosphate-buffered saline solution. Monocyte chemoattractant protein-1 levels were determined by using an enzyme-linked immunosorbent assays kit. RESULTS The MCP-1 levels were 498.66±101.35, 576.40±149.78, 422.53±85.94, and 436.96±81.38 ng/L before surgery, in the first week, the first, and third months after surgery, respectively. Its level significantly increased in the first week compared with the preoperative level ( P <0.001). There was a prominent decrease in the postoperative first month ( P <0.001). In the third postoperative month, the mean MCP-1 level was not significantly increased compared with the postoperative first month ( P =0.196). CONCLUSION The tears MCP-1 level was significantly decreased after external dacryocystorhinostomy surgery.
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11
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Comparison of the efficacies of 1.0 and 1.5 mm silicone tubes for the treatment of nasolacrimal duct obstruction. Sci Rep 2022; 12:11785. [PMID: 35821075 PMCID: PMC9276691 DOI: 10.1038/s41598-022-16018-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 07/04/2022] [Indexed: 11/08/2022] Open
Abstract
This retrospective observational study analyzed the postoperative outcomes of bicanalicular intubation using different diameters of tube stents for treating postsaccal nasolacrimal duct obstruction. A total of 130 patients diagnosed with postsaccal obstruction who underwent endoscopic-assisted silicone tube intubation were included in the study. Patients intubated with a 1.5-mm large-diameter tube were designated as the LD group, and those with a 1.0-mm normal-diameter tube were designated as the ND group. The patency rates of the two groups at 1 year after tube removal were compared using the Kaplan–Meier curve and restricted mean survival time (RMST) method with τ = 365 days. Results demonstrated that the recurrence rate after tube removal was significantly lower in the LD group as compared with the ND group (p = 0.001). The patency rates at 1 year after removal in the LD and ND group were 85.7% (95% confidence interval [CI]: 75.4, 91.9) and 73.9% (95% CI: 61.7, 82.8), respectively. When comparing the patency rates by the RMST method at τ = 365 days, the RMST difference, RMST ratio, and RMTL ratio were higher in the LD group at p = 0.045, 0.052, and 0.046, respectively.
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Nakamura J, Kamao T, Mitani A, Mizuki N, Shiraishi A. Analysis of Lacrimal Duct Morphology from Cone-Beam Computed Tomography Dacryocystography in a Japanese Population. Clin Ophthalmol 2022; 16:2057-2067. [PMID: 35770249 PMCID: PMC9235895 DOI: 10.2147/opth.s370800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/14/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose The dacryoendoscope is a practical instrument for the examination and the treatment of lacrimal duct obstruction. Nevertheless, as it is a rigid fiberscope, manipulation of the endoscope is somewhat affected by the patient’s lacrimal duct alignment and the skeletal structure of the face. The morphology and inclination of the lacrimal duct vary among individuals and ethnic groups. We aimed to evaluate the alignment of the lacrimal duct from the perspective of endoscopic maneuverability in a Japanese population. Methods This retrospective study analyzed the cone-beam computed tomography dacryocystography (CBCT-DCG) images of 102 patients diagnosed with unilateral primary acquired nasolacrimal duct obstruction (PANDO) at Ehime University Hospital from December 2015 to May 2021. The following parameters of the lacrimal duct on the contralateral side of unilateral PANDO were investigated: (1) angle formed by the superior orbital rim–internal common punctum–nasolacrimal duct opening, (2) angle formed by the lacrimal sac and the nasolacrimal duct, (3) length of the lacrimal sac, and (4) length of the nasolacrimal duct. Results Measurements of the above parameters were (1) 10.2° ± 7.8° (range, −11° to +27°), (2) −6.3° ± 14.1° (range, −43° to +40°), (3) 8.9 ± 2.3 mm (range, 4.3–17.1), and (4) 13.2 ± 2.7 mm (range, 5.7–20.7), respectively. The Shapiro–Wilk test demonstrated that the values of all parameters, except (3), followed a normal distribution (p = 0.55, 0.30, 0.0002, and 0.39, respectively). No significant difference was found between the female and male groups (p > 0.05). Conclusion This study reported anthropometric analysis data of the morphology of the lacrimal ducts using CBCT-DCG in a Japanese population. In our cohort, the line from the superior orbital rim through the internal common punctum to the nasolacrimal duct opening inclined anteriorly in 92% of the patients.
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Affiliation(s)
- Jutaro Nakamura
- Department of Ophthalmology, Ehime University Graduate School of Medicine, Toon, Ehime, 791-0295, Japan
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, 236-0004, Japan
- Correspondence: Jutaro Nakamura, Department of Ophthalmology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan, Tel +81-89-960-5361, Fax +81-89-960-5364, Email
| | - Tomoyuki Kamao
- Department of Ophthalmology, Ehime University Graduate School of Medicine, Toon, Ehime, 791-0295, Japan
| | - Arisa Mitani
- Department of Ophthalmology, Ehime University Graduate School of Medicine, Toon, Ehime, 791-0295, Japan
| | - Nobuhisa Mizuki
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, 236-0004, Japan
| | - Atsushi Shiraishi
- Department of Ophthalmology, Ehime University Graduate School of Medicine, Toon, Ehime, 791-0295, Japan
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Yartsev VD, Atkova EL, Rozmanov EO, Yartseva ND. Rhinological Status of Patients with Nasolacrimal Duct Obstruction. Int Arch Otorhinolaryngol 2021; 26:e434-e439. [PMID: 35846831 PMCID: PMC9282945 DOI: 10.1055/s-0041-1730018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 02/14/2021] [Indexed: 10/31/2022] Open
Abstract
Abstract
Introduction Studying the state of the nasal cavity and its sinuses and the morphometric parameters of the inferior nasal conchae, as well as a comparative analysis of obtained values in patients with primary (PANDO) and secondary acquired nasolacrimal duct obstruction (SALDO), is relevant.
Objective To study the rhinological status of patients with PANDO) and SALDO).
Methods The present study was based on the results of computed tomography (CT) dacryocystography in patients with PANDO (n = 45) and SALDO due to exposure to radioactive iodine (n = 14). The control group included CT images of paranasal sinuses in patients with no pathology (n = 49). Rhinological status according to the Newman and Lund-Mackay scales and volume of the inferior nasal conchae were assessed. Statistical processing included nonparametric statistics methods; χ2 Pearson test; and the Spearman rank correlation method.
Results The difference in values of the Newman and Lund-Mackay scales for the tested groups was significant. A significant difference in scores by the Newman scale was revealed when comparing the results of patients with SALDO and PANDO. Comparing the scores by the Lund-Mackay scale, a significant difference was found between the results of patients with SALDO and PANDO and between the results of patients with PANDO and the control group.
Conclusion It was demonstrated that the rhinological status of patients with PANDO was worse than that of patients with SALDO and of subjects in the control group. No connection was found between the volume of the inferior nasal conchae and the development of lacrimal duct obstruction.
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Affiliation(s)
| | | | | | - Nina D. Yartseva
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia
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14
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Poignet B, Sultanik P, Beaujeux P, Koch E, Benkhatar H. Primary balloon dacryoplasty for nasolacrimal duct obstruction in adults: a systematic review. Orbit 2021; 40:455-460. [PMID: 32912011 DOI: 10.1080/01676830.2020.1818264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 08/28/2020] [Indexed: 06/11/2023]
Abstract
Introduction: Acquired nasolacrimal duct obstruction (NLDO) is a major cause of epiphora. Balloon dacryoplasty (BD) is a minimally invasive procedure effectively used for congenital NLDO which has also been used in adults, instead of dacryocystorhinostomy (DCR), the current gold standard technique. The main objectives were to assess the results of BD with and without silicone tube insertion (STI) in NLDO in adults.Materiel and Method: A systematic review of literature was conducted on PubMed, SCOPUS and Cochrane databases. The articles were scanned to identify all studies that evaluated the outcomes of primary BD for NLDO in adults. The mean success rates were calculated and compared using the multiple comparisons Sidak's T-testResults: Sixty-seven articles were identified but only 13 publications matched the inclusion criteria. For partial NLDO, BD had a mean, success rate of 73.29% (64.86% with STI) with a mean follow-up of 16 months. For complete NLDO, BD had a success rate of 36.67% (52.50% with STI) with a mean follow-up of 15.5 months. Altogether the success rate of BD was significantly higher for partial NLDO compared to complete stenosis (p = 0,002).Conclusion: BD is significantly more successful for partial NLDO, without significant additional benefit from subsequent STI. The main complication would be the high recurrence rate. BD is not effective for complete NLDO with very low success rates. However, BD could be proposed for partial NLDO, as it is a safe procedure, with minimal invasiveness in comparison to DCR. Further prospective and controlled studies are required to confirm these encouraging results.
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Affiliation(s)
- Barthélémy Poignet
- Centre Hospitalier de Versailles, Service d'Ophtalmologie, Le Chesnay, France
| | - Philippe Sultanik
- Faculté de Médicine Paris Descartes, Université Paris V, Paris, France
- Service d'hépato gastro entérologie, Assistance Publique-Hôpitaux De Paris, Paris, France
| | - Pauline Beaujeux
- Centre Hospitalier de Versailles, Service d'Ophtalmologie, Le Chesnay, France
| | - Edouard Koch
- Centre Hospitalier de Versailles, Service d'Ophtalmologie, Le Chesnay, France
| | - Hakim Benkhatar
- Centre Hospitalier de Versailles, Service d'ORL et Chirurgie Cervico-faciale, Le Chesnay, France
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Lin Z, Kamath N, Malik A. High-resolution computed tomography assessment of bony nasolacrimal parameters: variations due to age, sex, and facial features. Orbit 2021; 40:364-369. [PMID: 32669001 DOI: 10.1080/01676830.2020.1793374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/02/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE To compare nasolacrimal duct anatomy between gender, age, and facial features, and explore correlations between bony parameters. METHODS A retrospective case series of patients of four races who had high-resolution computed tomography (CT) between 2004 and 2019 covering the full length of their nasolacrimal ducts in two hospitals in Essex, England. Only normal ducts were included; patients with tearing or radiological abnormalities were excluded. Measurements were taken of the nasolacrimal duct and surrounding anatomy based on measurements found in the existing literature. RESULTS More females (n = 114) than males (n = 40) were included. Mean age was slightly older for females (45.7 years) compared to males (42.5). Males have taller noses and wider faces. Nasolacrimal duct calibre correlated positively with age, male gender, and facial width, and negatively with nasal height. There was a tendency for nasolacrimal ducts to be longer in males. CONCLUSION The bony nasolacrimal duct is smaller in younger female patients. Having a taller nose and narrower upper face is also correlated with a smaller calibre duct. Acquired nasolacrimal duct obstruction in patients without these demographics or facial features may be more likely due to secondary causes.
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Affiliation(s)
- Zhiheng Lin
- Ophthalmology Department, East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
- Radiology Department, Southend University Hospital NHS Foundation Trust, Southend-on-Sea, UK
| | - Namita Kamath
- Ophthalmology Department, Southend University Hospital NHS Foundation Trust, Southend-on-Sea, UK
| | - Adeela Malik
- Radiology Department, Southend University Hospital NHS Foundation Trust, Southend-on-Sea, UK
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Mimura M, Sato Y, Fujita Y, Oku H, Sato B, Ikeda T. Impact of habitual swimming on the success of lacrimal surgery. Jpn J Ophthalmol 2021; 65:849-854. [PMID: 34357441 DOI: 10.1007/s10384-021-00865-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/18/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To elucidate how factors associated with swimming affect the lacrimal ducts of swimmers. STUDY DESIGN Prospective, interventional cohort study, METHODS: Five hundred seventy four consecutive epiphora patients were surveyed via a questionnaire regarding details of their swimming-pool usage; i.e., frequency, swim-goggles' wear, and type of pool activity (i.e., swimming vs. waist-depth walking). In this cohort, all the swimmers over 20 years old with anatomical lacrimal duct obstruction underwent surgical reconstruction. The surgical success rates at 12-months postoperative were compared using multivariable logistic regression analyses between swimmer/non-swimmer patients, those with a history of high/low frequency of pool usage, and those with high/low amount of conjunctival contact with the swimming-pool water. RESULTS Of the patients with anatomical lacrimal duct obstruction, 6.4% were habitual swimmers; nasolacrimal duct obstruction was more common in the swimmers than in the non-swimmers' controls (89.1%/66.7%, P = 0.025). The success rate of lacrimal surgery for the swimmers with anatomical nasolacrimal duct obstruction was lower (60.6%) than of the non-swimmers (83.3%, P = 0.048). A receiver operating characteristic curve analysis of the frequency for the prediction of surgical failure showed that the threshold was 4 days/week. The success rate was statistically lower (26.7%) in the high-frequency swimmers compared to the low-frequency swimmers (88.9%, P = 0.037). However, no statistical difference in the high/low ocular surface contact to the swimming-pool water was observed (71.4%/57.7%, P = 0.56). CONCLUSION Habitual swimmers have a high risk of nasolacrimal-duct damage retrogradely from the nasal cavity that lowers lacrimal surgery's success rate.
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Affiliation(s)
- Masashi Mimura
- Department of Ophthalmology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan. .,Department of Ophthalmology, Osaka Kaisei Hospital, Osaka, Japan.
| | - Yohei Sato
- Department of Ophthalmology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Yasushi Fujita
- Department of Ophthalmology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Hidehiro Oku
- Department of Ophthalmology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Bunpei Sato
- Department of Ophthalmology, Osaka Kaisei Hospital, Osaka, Japan
| | - Tsunehiko Ikeda
- Department of Ophthalmology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
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Dunlop N, Ting M, Rose G, Baduna J, Ezra D. Pilot study of a nurse-led adult lacrimal clinic at a tertiary ophthalmic centre. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2020; 29:1341-1347. [PMID: 33325281 DOI: 10.12968/bjon.2020.29.22.1341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This article provides the reader with an outline of the anatomy and physiology of the lacrimal system and illustrates how a variety of pathologies within this system can result in the development of a watery eye. It describes the role of the nurse consultant in the diagnosis and management of patients with watery eye in the lacrimal clinic, and how the training programme for the development of such skills was implemented. Following training, within the realms of an established pilot study, the nurse consultant began to implement her skills in a newly established nurse-led lacrimal clinic. Patients seen in the lacrimal clinic would previously have been assessed and managed by a doctor. To confirm the accuracy of this approach, an audit was undertaken comparing the nurse-led diagnosis and management plans with that of an oculoplastic doctor. In addition, patient waiting times in the clinic and patient satisfaction were assessed, as important indicators of quality of care.
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Affiliation(s)
| | | | - Geoffrey Rose
- Consultant Ophthalmologist Surgeon, Moorfields Eye Hospital, London
| | - Joanna Baduna
- Adnexal Nurse Specialist, Moorfields Eye Hospital, London
| | - Daniel Ezra
- Adnexal Service Director and Consultant Ophthalmologist, Moorfields Eye Hospital, London
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18
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Heichel J, Struck HG. Tränenwegsstenosen im Erwachsenenalter. AUGENHEILKUNDE UP2DATE 2020. [DOI: 10.1055/a-1075-9276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
ZusammenfassungZur Aufrechterhaltung der okulären Oberflächenhomöostase und damit den Erhalt der
optischen Eigenschaften sind Tränenproduktion, -verteilung und -abtransport
essenzielle physiologische Funktionen. Störungen dieser funktionellen Einheit
gehen mit starken Beschwerden und einem hohen Leidensdruck bei den Patienten
einher. Da etwa 3% unserer Patienten eine Tränenabflussstörung aufweisen, ist
die Thematik von hohem klinischem Interesse.
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Abstract
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.
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20
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Lin Z, Kamath N, Malik A. Morphometric differences in normal bony nasolacrimal anatomy: comparison between four ethnic groups. Surg Radiol Anat 2020; 43:179-185. [PMID: 33184673 DOI: 10.1007/s00276-020-02614-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/27/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare bony nasolacrimal duct anatomy between ethnic groups. METHODS A retrospective observational study of patients of four ethnic groups who had high-resolution CTs between 2004 and 2019 covering the full length of their nasolacrimal ducts in two hospitals in Essex, England. Only normal ducts were included; patients with tearing or radiological abnormalities were excluded. Measurements were taken of the nasolacrimal duct and surrounding anatomy based on measurements found in the existing literature. RESULTS More females (n = 114) than males (n = 40) were included. South Asian (Indian subcontinent), Afro-Caribbean and European groups were equivocal demographically (n = 25-29, mean age 40-45); however, the Oriental group was fewer in number (n = 13) and slightly older (mean age 51). South Asian and European ducts had no significant differences. Afro-Caribbean ducts were wider and shorter than European. Afro-Caribbean faces are wider and their noses flatter and wider than European. Oriental ducts were wider and longer than European, but Europeans have taller noses. CONCLUSION The results from our Oriental group fits with the published data in Orientals. The bony nasolacrimal duct is greater in calibre (inner diameter) if the patient is of Afro-Caribbean or Oriental origin compared to European or South Asian. Acquired nasolacrimal duct obstruction in Afro-Caribbean or Oriental patients may be more likely due to secondary causes.
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Affiliation(s)
- Zhiheng Lin
- East Suffolk and North Essex NHS Foundation Trust, Colchester, UK.
- Southend University Hospital NHS Foundation Trust, Southend-on-Sea, UK.
| | - Namita Kamath
- Southend University Hospital NHS Foundation Trust, Southend-on-Sea, UK
| | - Adeela Malik
- Southend University Hospital NHS Foundation Trust, Southend-on-Sea, UK
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21
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Yartsev VD, At Kova EL. [Formation of concrements in the lacrimal excretory system]. Vestn Oftalmol 2020; 136:78-83. [PMID: 33084283 DOI: 10.17116/oftalma202013606178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Studying the pathogenesis of concrements formation in lacrimal ducts is of fundamental and practical importance. This article attempts to analyze available information related to the pathogenesis of this phenomenon, provides information on the etiopathogenesis, physical and chemical properties of concrements obtained from horizontal and vertical parts of the lacrimal duct, and considers in detail bacteriological and mycotic composition of concrements, as well as various theories of their formation. The analysis helped justify the need to separate the concrements formed in the horizontal and vertical parts of the lacrimal ducts on the basis of differences in their pathogenesis. Actinomycotic infection is the cause of concrements formation in the horizontal part of the lacrimal duct in the overwhelming majority of cases. The process of concrements formation in the vertical part of the lacrimal duct in some cases occurs as a result of previous clinical events, but in many other cases the trigger mechanisms remain unknown. To date, the role of the initial narrowing of the lacrimal ducts in the pathogenesis of concrements is not clearly defined. The accumulated knowledge regarding the pathogenesis of concrements is currently not enough to formulate a complete theory of the development of this phenomenon. Further studies of the pathogenesis of concrements will help develop new diagnostic and therapeutic measures aimed at restoring the patency of the lacrimal ducts.
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Affiliation(s)
- V D Yartsev
- Research Institute of Eye Diseases, Moscow, Russia
| | - E L At Kova
- Research Institute of Eye Diseases, Moscow, Russia
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22
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Epiphora and unrecognized paranasal sinuses pathology. Am J Ophthalmol Case Rep 2020; 19:100798. [PMID: 32671284 PMCID: PMC7350086 DOI: 10.1016/j.ajoc.2020.100798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose to report five patients all presenting with persistent unilateral epiphora as a sign of unexpected and rare lesions causing Secondary Acquired Nasolacrimal Duct Obstruction (SANDO) and the risks associated to an incomplete diagnostic work-up. Observations the cases presented are: (1) Fungus ball, (2) Pyogenic granuloma, (3) Sinonasal inverted papilloma (4) Sinonasal inverted papilloma with synchronous squamous cell carcinoma, (5) Squamous cell carcinoma of the lacrimal sac. Conclusions and importance masses are uncommon but not a rare cause of nasolacrimal duct obstruction. Surgical teams performing large numbers of dacryocystorhinostomies should be aware of such pathology and perform a systematic multidisciplinary approach.
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23
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Samarei R, Samarei V, Aidenloo NS, Fateh N. Sinonasal Anatomical Variations and Primary Acquired Nasolacrimal Duct Obstruction: A Single Centre, Case-Control Investigation. Eurasian J Med 2020; 52:21-24. [PMID: 32158308 DOI: 10.5152/eurasianjmed.2019.19034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective Primary acquired nasolacrimal duct obstruction (PANDO) is an idiopathic narrowing of the nasolacrimal duct caused by chronic inflammation and consecutive stenosis of the nasal tissue. In the current investigation, we aimed to study the etiopathogenic role of sinonasal anatomical abnormalities and paranasal inflammatory pathologies in PANDO. Materials and Methods Computed tomography (CT) findings of 459 patients who were diagnosed with unilateral PANDO between April 2009 and March 2017 were compared with that of a control group, which comprised 200 subjects without nasolacrimal duct obstruction who had been referred to the ear nose throat (ENT) clinic with the complaint of vertigo and headache. A radiologist (R. S.) masked to the clinical situation of participants retrospectively examined their CT findings. Results The prevalence of deviated nasal septum was found to be strongly associated with PANDO incidence (55.3% on PANDO side of patients vs. 28.3% among controls; p<0.001). Significant increases, albeit of smaller magnitude, were also observed in the relative frequency of Agger nasi cells and maxillary sinusitis on the PANDO side of the subjects (14.6% and 27.0%, respectively) compared to controls (9.5% and 20.6%, respectively) (p=0.023 and p=0.038, respectively). Unilateral PANDO was also found to be robustly associated with an ipsilateral deviated nasal septum (p<0.001). The odds of septal deviation occurrence were 3.037 times (95% Confidence Interval (CI): 2.303-3.990; p<0.001) more on the PANDO than the non-PANDO side of the studied cases. Conclusion Ipsilaterally deviated nasal septum appears to have a role in the development of unilateral primary acquired obstructive disease of the lacrimal drainage system. The incidence of PANDO might also be affected by Agger nasi cells and maxillary sinusitis. Multicenter studies are essential to further elucidate the interaction between type, severity, extent, and dimensions of different pathologies with nasolacrimal duct obstruction.
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Affiliation(s)
- Reza Samarei
- Department of Otolaryngology, Urmia University of Medical Sciences, Urmia, Iran
| | - Vafa Samarei
- Department of Ophthalmology, Urmia University of Medical Sciences, Urmia, Iran
| | | | - Nasrin Fateh
- Department of Otolaryngology, Urmia University of Medical Sciences, Urmia, Iran
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Qin Q, Li B, Ming J, Liu B, Mou Y, Jin X. Clinical efficacy comparison of low-temperature plasma radiofrequency ablation and Nd:YAG laser in treating recurrent acquired nasolacrimal duct obstruction. Lasers Med Sci 2020; 35:1937-1944. [PMID: 32065299 DOI: 10.1007/s10103-020-02982-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 02/07/2020] [Indexed: 12/21/2022]
Abstract
To evaluate the effectiveness and safety of low-temperature plasma radiofrequency ablation (coblation) and Nd:YAG laser in treating recurrent nasolacrimal duct obstruction. A prospective study was performed on patients who agreed to be treated with coblation or Nd:YAG laser for recurrent nasolacrimal duct obstruction after failed lacrimal Nd:YAG laser combined with silicone intubation. The visual analogue scale (VAS) pain grade was assessed at baseline, immediately, and 3 and 7 days after surgery. The degree of watering, lacrimal passage irrigation, and complications were also evaluated 1 week and 1, 3, and 6 months after surgery. Ninety-five patients who met the criteria for recurrent nasolacrimal duct obstruction from February 2018 to February 2019 were included in this study, with 46 patients receiving coblation and 49 patients Nd:YAG laser. The intraoperative and postoperative (3 days after surgery) VAS pain grades of the patients who received coblation were significantly lower than those who received Nd:YAG laser (P < 0.001). The number of patients in the coblation group who achieved complete clinical relief (no epiphora symptoms with fluent lacrimal passage irrigation) was significantly larger than that in the lacrimal Nd:YAG laser group at 1, 3, and 6 months after surgery (P = 0.033, P = 0.006, P = 0.003, respectively). During the follow-up period, there were no unexpected complications in either group. Compared with Nd:YAG laser, coblation performed well in alleviating pain and maintaining sustained disease relief and may therefore be an alternative to conventional laser or dacryocystorhinostomy surgery in the management of recurrent nasolacrimal duct obstruction.
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Affiliation(s)
- Qiyu Qin
- Eye Center, Affiliated Second Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China
| | - Bihua Li
- Eye Center, Affiliated Second Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China
| | - JinJin Ming
- Eye Center, Affiliated Second Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China
| | - Bo Liu
- Eye Center, Affiliated Second Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China
| | - Yujie Mou
- Eye Center, Affiliated Second Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China
| | - Xiuming Jin
- Eye Center, Affiliated Second Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.
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Etiopathogenesis of Primary Acquired Nasolacrimal Duct Obstruction: What We Know and What We Need to Know. Ophthalmic Plast Reconstr Surg 2020; 35:426-433. [PMID: 30730434 DOI: 10.1097/iop.0000000000001310] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To provide a systematic review of the literature on the etiopathogenesis of primary acquired nasolacrimal duct obstruction (PANDO). METHODS The authors performed a PubMed search of all articles published in English with specific reference to etiopathogenesis of PANDO or associations of PANDO. Data captured include demographics, study techniques, hypothesis, presumed or confirmed interpretations with regards to pathogenesis, mechanisms, or pathways. Specific emphasis was laid on addressing the lacunae and potential directions for future research. RESULTS Numerous factors are believed to contribute to the etiopathogenesis of PANDO. The basic pathogenesis involves inflammation, vascular congestion, mucosal edema, fibrosis, obstruction, and stasis. Bony nasolacrimal duct diameter does not appear to play a significant role. There is no convincing data to substantiate nose as the site of disease origin and nasal factors appear to be comorbidities. Hormonal mechanisms are more evidence-based but can only partly explain the pathogenesis. Vascular theories are based on the behavior of perilacrimal cavernous bodies, their autonomic control, and additional structural changes in the helical patterns of connective tissue fiber arrangements. Repeated vascular malfunction leading to structural epithelial and subepithelial changes currently appears to be the most evidence-based and accepted theory. Tear proteomics holds a promise in decoding the etiopathogenesis of PANDO, at least in part. CONCLUSIONS The etiopathogenesis of PANDO appears to be multifactorial. Hormonal microenvironments, vascular factors, and tear proteomics are promising candidates for further work. There is a need for focused work by Clinician-Scientists and the answers can have far reaching clinical implications.
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Park JY, Lee JB, Shin WB, Kang ML, Shin YC, Son DH, Yi SW, Yoon JK, Kim JY, Ko J, Kim CS, Yoon JS, Sung HJ. Nasolacrimal stent with shape memory as an advanced alternative to silicone products. Acta Biomater 2020; 101:273-284. [PMID: 31707084 DOI: 10.1016/j.actbio.2019.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/29/2019] [Accepted: 11/01/2019] [Indexed: 01/27/2023]
Abstract
Epiphora is the overflow of tears typically caused by obstruction or occlusion of the nasolacrimal duct. More attention is required to address this global health issue owing to the increase in air pollution. Implantation of a silicone stent is the preferred treatment for epiphora; however, introducing a silicone stent into a narrow duct with complex geometry is challenging as it requires guidance by a sharp metal needle. Additionally, silicone can cause adverse reactions such as biofilm formation and tear flow resistance due to its extreme hydrophobicity. To overcome these problems, in this study we developed a new type of biocompatible shape memory polymer (SMP) stent with elasticity capacity for self-expansion. First, SMPs in the form of x%poly(ε-caprolactone)-co-y%poly(glycidyl methacrylate) (x%PCL-y%PGMA) were synthesized via ring opening polymerization by varying the molar ratio of PCL (x%) and PGMA (y%). Second, the shape memory and mechanical properties were tuned by controlling the crosslinking degree and concentration of x%PCL-y%PGMA solution to produce a test type of SMP stent. Lastly, this 94%PCL-06%PGMA stent exhibited more standout critical functions in a series of in vitro and in vivo experiments such as a cell growth-supporting level of biocompatibility with nasal epithelial cells without significant inflammatory responses, better resistance to biofilm formation, and more efficient capacity to drain tear than the silicone control. Overall, 94%PCL-06%PGMA can be suggested as a superior alternative to the currently used materials for nasolacrimal stents. STATEMENT OF SIGNIFICANCE: Silicone intubation (stenting) has been widely used to treat nasolacrimal duct obstruction, however, it can cause adverse clinical effects such as bacterial infection; presents procedural challenges because of the curved nasolacrimal duct structure; and shows poor drainage efficiency stemming from the highly hydrophobic nature of silicone. In this work, we describe an innovative shape memory polymer (SMP) as a superior alternative to conventional silicone-based materials for nasolacrimal duct intubation. We demonstrate the clear advantages of the SMP over conventional silicone, including a much higher drainage capacity and superior resistance to bacterial infection.
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Affiliation(s)
- Ju Young Park
- Department of Medical Engineering, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Jung Bok Lee
- Department of Medical Engineering, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Woo Beom Shin
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722 Republic of Korea
| | - Mi-Lan Kang
- Department of Medical Engineering, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea; TMD Lab Co., Ltd., 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722 Republic of Korea
| | - Yong Cheol Shin
- Department of Medical Engineering, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Deok Hyeon Son
- Department of Medical Engineering, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Se Won Yi
- TMD Lab Co., Ltd., 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722 Republic of Korea
| | - Jeong-Kee Yoon
- Department of Medical Engineering, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Ji Young Kim
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722 Republic of Korea
| | - JaeSang Ko
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722 Republic of Korea
| | - Chang-Soo Kim
- Department of Medical Engineering, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea; Numais Co., Ltd., 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722 Republic of Korea
| | - Jin Sook Yoon
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722 Republic of Korea.
| | - Hak-Joon Sung
- Department of Medical Engineering, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
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Yanık Ö, Hoşal B, Tekeli A, Nalcı H. Viral nucleic acid analysis with PCR in lacrimal tissue and nasal swab samples of primary acquired nasolacrimal duct obstruction cases. Eur J Ophthalmol 2019; 31:138-143. [PMID: 31630558 PMCID: PMC7140976 DOI: 10.1177/1120672119882331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the role of viral infections in the pathogenesis of primary acquired nasolacrimal duct obstruction. METHODS The study included 48 patients diagnosed with primary acquired nasolacrimal duct obstruction undergoing dacryocystorhinostomy surgery. Prior to dacryocystorhinostomy surgery, nasal swab sample was taken from the inferior meatus at the same side. During dacryocystorhinostomy, tissue biopsy sample (2 × 2 mm) was taken from the junction area of the lacrimal sac and nasolacrimal duct. Following nucleic acid extraction, polymerase chain reaction was performed. RESULTS The patients consisted of 9 (18.8%) men and 39 (81.2%) women with a mean age of 51.0 ± 14.3 years. Qualitative polymerase chain reaction showed viral genome in the nasal swabs of 10 (20.8%) patients, including coronavirus 229E (three cases), coronavirus HKU1 (two cases), respiratory syncytial virus (two cases), coronavirus OC43 (one case), coronavirus NL63 (one case), and adenovirus (one case). In the dacryocystorhinostomy samples, viral genomes were detected in four (8.3%) cases, including respiratory syncytial virus (two cases), coronavirus HKU1 (one case), and adenovirus (one case). There was a statistically significant agreement between nasal mucosal swab and dacryocystorhinostomy biopsy samples in terms of respiratory syncytial virus positivity (kappa = 1.000, p = 0.001). CONCLUSION Although the viral genome was detected in the samples, a direct relationship between viruses and pathogenesis of primary acquired nasolacrimal duct obstruction could not be revealed because of the low number of positive results. However, considering the profibrotic characteristics of specific viruses such as respiratory syncytial virus and adenovirus, viral infections may be one of the many predisposing factors of primary acquired nasolacrimal duct obstruction.
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Affiliation(s)
- Özge Yanık
- Department of Ophthalmology, Ankara University School of Medicine, Ankara, Turkey
| | - Banu Hoşal
- Department of Ophthalmology, Ankara University School of Medicine, Ankara, Turkey
| | - Alper Tekeli
- Department of Medical Microbiology, Ankara University School of Medicine, Ankara, Turkey
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Ali MJ, Patnaik S, Kelkar N, Ali MH, Kaur I. Alteration of Tear Cytokine Expressions in Primary Acquired Nasolacrimal Duct Obstruction – Potential Insights into the Etiopathogenesis. Curr Eye Res 2019; 45:435-439. [DOI: 10.1080/02713683.2019.1665186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India
| | - Satish Patnaik
- Prof. Brien Holden Eye Research Center, L.V. Prasad Eye Institute, Hyderabad, India
| | - Natasha Kelkar
- Prof. Brien Holden Eye Research Center, L.V. Prasad Eye Institute, Hyderabad, India
| | - Mohammad Hasnat Ali
- Prof. Brien Holden Eye Research Center, L.V. Prasad Eye Institute, Hyderabad, India
| | - Inderjeet Kaur
- Prof. Brien Holden Eye Research Center, L.V. Prasad Eye Institute, Hyderabad, India
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Abstract
PURPOSE Histological investigation in the use of indigo carmine for detection of mucosal pathology in lacrimal microendoscopy. To investigate the histopathological correlation of staining found on lacrimal microendoscopy. METHODS A prospective case series was conducted in patients with a history of nasolacrimal duct obstruction and dacryocystitis requiring treatment with dacryocystorhinostomy or dacryocystectomy. Prior to lacrimal surgery, all patients underwent endolacrimal evaluation using transpunctal lacrimal microendoscopy. Indigo carmine dye (0.2 mg/0.5 ml) was injected into the lacrimal system via the irrigation channel of the endoscope, and after copious irrigation, the differential mucosal staining was recorded. Histopathologic analysis of tissue samples of positively and negatively stained lacrimal sac mucosa collected after surgery was performed to investigate the correlation with the results of each endoscopic evaluation. RESULTS Four patients underwent dacryocystorhinostomy and 2 patients underwent dacryocystectomy. Histopathology of positive-stained lacrimal sac mucosa corresponded to areas of the advanced fibrous stage of mucosal changes resulting from dacryocystitis, which showed atrophy of epithelium associated with the loss of goblet cells and subepithelium fibrous scarring. In contrast, areas of lacrimal mucosa that did not stain with indigo carmine were still in an active inflammatory stage of dacryocystitis preserving columnar epithelium with goblet cells. CONCLUSIONS This study suggests that indigo carmine staining is a useful adjunct in lacrimal microendoscopy for accurately detecting areas of highly damaged fibrous lacrimal mucosa, as it allows for direct visualization of lacrimal mucosal pathology and can provide prognostic insight and guidance in regard to treatment options for patients with lacrimal drainage obstruction.Use of indigo carmine dye as an in vivo adjunct in lacrimal microendoscopy is useful for accurately detecting areas of highly damaged lacrimal mucosa.
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Relationship Between Lacrimal Bone Thickness and Lacrimal Sac in Chronic Dacryocystitis. J Craniofac Surg 2019; 31:207-209. [PMID: 31469733 DOI: 10.1097/scs.0000000000005856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Chronic inflammation in the lacrimal sac may lead to thickening of the surrounding bony tissues. This study aimed to assess the thickness of lacrimal bone surrounding the lacrimal sac, and the thickness of maxilla, based on the presence of purulent secretion in the lacrimal sac in patients who underwent EDCR. MATERIAL AND METHODS Lacrimal bone thickness and the maximum and midpoint maxillary bone thickness of 70 patients (mean age of 49.07 years) who underwent EDCR, were assessed along 3 planes (upper, middle, and lower) using CT of the paranasal sinus. The patients were divided into 2 groups: the 1 who had purulent secretion in the lacrimal sac during the intraoperative period (Group 1) and another who did not have purulent secretion (Group 2). RESULTS No significant difference was detected between the 2 groups in terms of maximum and midpoint maxillary bone thickness. The increase in the thickness of lacrimal bone in Group 1 was statistically significant in all the 3 planes as compared to that in Group 2. Cutoff values for the thickness of the upper, middle, and lower plane of lacrimal bone were detected to be 0.710 mm, 0.685 mm, and 0.675 mm, respectively. CONCLUSION The presence of purulent secretion in the lacrimal sac, along with the detected increase in the thickness of the lacrimal bone, as assessed by CT, offers an insight on the lacrimal sac before the surgery.
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Soriano LM, Damasceno NA, Herzog Neto G, Damasceno EF. Comparative study of the clinical profile of chronic dacryocystitis and chronic rhinosinusitis after external dacryocystorhinostomy. Clin Ophthalmol 2019; 13:1267-1271. [PMID: 31409965 PMCID: PMC6643063 DOI: 10.2147/opth.s200923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 06/20/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare the clinical profile of patients with chronic dacryocystitis (CDC) with and without associated chronic rhinosinusopathies who had been submitted to external dacryocystorhinostomy (EDCR). Methods This was a retrospective, observational, and longitudinal study that included all patients diagnosed with CDC who were submitted to EDCR at the Antonio Pedro University Hospital. Patients were divided into two groups, with and without rhinosinusopathies (Group I and Group II, respectively). The following variables were assessed to compare the Group I and Group II: age, ethnicity, epiphora, discharge by expression of the lacrimal sac, duration of the CDC, and previous history of CDC exacerbation. Results The study included a total of 78 patients, 22 patients (28.2%) in Group I and 56 patients (71.8%) in Group II. The mean age was 64.3 (±19.7) years. In Group I and II predominated elderly, female, and White (p=0.93, p=0.38, p=0.77). In relation to the clinical characteristics, most of the patients presented epiphora and discharge by compression of the lacrimal sac in both Groups (p=0.61, p=0.44). In relation to a previous history of exacerbations of the CDC, six patients in Group I and four patients in Group II presented it as purulent discharge (p=0.04). Conclusion Chronic rhinosinusopathies may favor episodes of exacerbations of chronic dacryocystitis in particular with the presence of purulent discharge.
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Affiliation(s)
- Luciana Mc Soriano
- Department of Ophthalmology, Universidade Federal Fluminense, Niterói, Brazil
| | - Nadyr A Damasceno
- Department of Ophthalmology, Universidade Federal Fluminense, Niterói, Brazil.,Department of Ophthalmology, Hospital Naval Marcílio Dias, Rio de Janeiro, Brazil
| | | | - Eduardo F Damasceno
- Department of Ophthalmology, Universidade Federal Fluminense, Niterói, Brazil
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Atkova EL, Astrakhantsev AF, Fedorov AA, Rein DA, Krakhovetsky NN, Yartsev VD. [The nasal mucosa and outcomes of dacryocystorhinostomy]. Arkh Patol 2019; 81:24-28. [PMID: 31006776 DOI: 10.17116/patol20198102124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the impact of the nasal mucosa on the outcomes of dacryocystorhinostomy on the basis of morphologic findings. MATERIAL AND METHODS The investigation enrolled 73 patients who had undergone endonasal endoscopic dacryocystorhinostomy. Nasal mucosal biopsies were intraoperatively taken from all the patients. The obtained samples were subjected to standard histological examination, as well as to immunohistochemical study using an anti-alpha-smooth muscle actin antibody. To determine the intensity of inflammation in the tissue sample, a chronic inflammation score was calculated. The cell elements positively stained with α-smooth muscle actin were estimated using a semi-automatic method. The patients were divided into groups in accordance with the outcome of surgical treatment after 6 months. RESULTS An unfavorable outcome of dacryocystorhinostomy was observed in 10 (13.7%) patients. The samples obtained from the patients showed a higher chronic inflammation score (8.33%) and a larger number of the cell elements positively stained with α-smooth muscle actin (6026.38±1944.29). The correlation between the outcome of surgical intervention and the quantitative characteristics of myofibroblasts was statistically significant (p<0.05). CONCLUSION These studies suggest that there is a direct correlation of the efficiency of endonasal endoscopic dacryocystorhinostomy with the presence and degree of chronic nasal mucosal inflammation at baseline.
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Affiliation(s)
- E L Atkova
- Research Institute of Eye Diseases, Moscow, Russia
| | - A F Astrakhantsev
- N.A. Semashko Central Clinical Hospital Two, OAO 'RZhD', Moscow, Russia
| | - A A Fedorov
- Research Institute of Eye Diseases, Moscow, Russia
| | - D A Rein
- Research Institute of Eye Diseases, Moscow, Russia
| | | | - V D Yartsev
- Research Institute of Eye Diseases, Moscow, Russia
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Gonzalez-Barlatay J, Ortiz-Basso T, Pagano Boza C, Segretin Gutierrez E, Hernández Gauna G, Prémoli EJ. Chronic conjunctivitis as a prognosis factor of dacryocystorhinostomy: a retrospective case-controlled study. Can J Ophthalmol 2019; 54:417-420. [PMID: 31358137 DOI: 10.1016/j.jcjo.2018.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 07/09/2018] [Accepted: 07/23/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine whether the history of chronic conjunctivitis increases the likelihood of epiphora after an external dacryocystorhinostomy (Ex-DCR) and to elucidate other factors that may affect the prognosis of this surgery. METHODS This is a retrospective case-controlled study. Patients who had epiphora after an Ex-DCR were compared with patients who did not present epiphora. Medical history of conjunctivitis, use of antiglaucomatous drops, rhinitis, and nasal pathology were evaluated. RESULTS A total of 129 adult patients undergoing external DCR were evaluated, of which 73% had decreased tearing. Forty-five percent of the patients who continued with epiphora had a history of conjunctivitis, compared to the 20% of those who did not (p = 0.003). At the same time, the 20% of those who continued with epiphora had a history of rhinitis compared to the 8% of those who did not (p = 0.043). CONCLUSION Patients with a history of chronic conjunctivitis are less likely to improve the epiphora after performing an Ex-DCR. We consider that it is important to evaluate this antecedent before surgery.
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Affiliation(s)
| | - Tomás Ortiz-Basso
- Oculoplastic Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Carla Pagano Boza
- Oculoplastic Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Abstract
Tularemia is a zoonotic disease caused by Francisella tularensis, a highly virulent gram-negative coccobacillus. Oropharyngeal tularemia, one of the clinical subtypes, is the most common clinical form of the disease in Eastern Europe, including Turkey. This clinical form affects mostly the head and neck region and the most common complaints of patients are mass in the neck, sore throat, and fever. This form of tularemia may be confused with tonsillitis, pharyngitis, or cervical lymphadenitis caused by other microbial agents due to the nonspecific clinical and laboratory features. In this study, we present a patient with nasolacrimal duct obstruction and dacryocystitis caused by oropharyngeal tularemia.
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Affiliation(s)
- Helin Ceren Köse
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Melek Banu Hoşal
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
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Ali MJ, Paulsen F. Prolactin and Prolactin-inducible protein (PIP) in the pathogenesis of primary acquired nasolacrimal duct obstruction (PANDO). Med Hypotheses 2019; 125:137-138. [DOI: 10.1016/j.mehy.2019.02.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/15/2019] [Accepted: 02/28/2019] [Indexed: 10/27/2022]
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Abstract
GOALS This study aimed to evaluate the association between gastroesophageal reflux disease (GERD) and development of lacrimal drainage obstruction (LDO). BACKGROUND It has been hypothesized that GERD may contribute toward the development of LDO. STUDY This was a retrospective study of Koreans aged 40 to 79 years registered in the Korean National Health Screening Cohort from 2002 to 2013. Incident cases of LDO were identified according to the Korean Classification of Disease. We compared hazard ratios (HRs) for LDO between 22,570 patients with GERD and 112,850 patients without GERD by 1:5 propensity score-matched analysis. RESULTS A total of 135,420 patients, representing 1,237,909 person-years, were evaluated. LDO developed in 1998 (8.9%) patients with GERD and 8565 (7.6%) patients without GERD (P<0.001). The incidence of LDO per 1000 person-years in patients with GERD was 9.7 and 8.3 in those without GERD; the age-adjusted and sex-adjusted HR was 1.17 (95% confidence interval, 1.11-1.23). This association between GERD and LDO was more pronounced among younger individuals (HR, 1.20 for patients 40 to 59-y old; HR, 1.12 for patients 60 to 79-y old) and among men (HR, 1.20 for men; HR, 1.14 for women). Patients with GERD had a higher risk of LDO than those without GERD, irrespective of history of proton-pump inhibitor use. In the sensitivity analysis, GERD patients with esophagitis had a higher risk of LDO than those without esophagitis. CONCLUSIONS Our findings suggest that GERD is associated with an increased risk of subsequent LDO and that this effect is more pronounced among adults aged 40 to 59-years old and men.
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Ali MJ, Paulsen F. Ultrastructure of the lacrimal drainage system in health and disease: A major review. Ann Anat 2019; 224:1-7. [PMID: 30862471 DOI: 10.1016/j.aanat.2019.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/13/2019] [Accepted: 02/13/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE To provide a systematic review of the literature on the ultrastructural findings of the lacrimal drainage system in healthy state and in few of the disorders studied so far. METHODS The authors performed a PubMed search of all articles published with reference to electron microscopic features of the lacrimal drainage pathways. Data captured include demographics, study techniques, scanning or transmission electron microscopic features, presumed or confirmed interpretations and their implications. Specific emphasis was laid on addressing the lacunae and potential directions for future research. RESULTS Ultrastructural studies have led to better understanding of the lacrimal drainage anatomy-physiology correlations. Cellular interactions between fibroblasts and lymphocytes could form a basis for pathogenesis of punctal stenosis. Ultrastructural characterization of peri-lacrimal cavernous bodies and changes in primary acquired nasolacrimal duct obstruction (PANDO) led to them being partly implicated in its etiopathogenesis. Electron microscopic characterization of the dacryolith core promises insights into their evolution. Ultrastructural tissue effects of mitomycin-C during a DCR surgery has provided potential evidence of its role in cases with high-risk of failure. Lacrimal stent biofilms are common but their clinical implications are currently uncertain. CONCLUSION Ultrastructural exploration of lacrimal drainage system so far has been limited and sparsely explored. The list of unexplored areas is exhaustive. There is a need for the lacrimal Clinician-Scientist to make themselves familiar with techniques and interpretation of electron microscopy to advance the ultrastructural frontier of this science.
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Affiliation(s)
- Mohammad Javed Ali
- Institute of Functional and Clinical Anatomy, Friedrich Alexander University Erlangen-Nürnberg, Germany; Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India.
| | - Friedrich Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich Alexander University Erlangen-Nürnberg, Germany
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Relationship between lacrimal sac size and duration of tearing in nasolacrimal duct obstruction. Can J Ophthalmol 2019; 54:111-115. [PMID: 30851763 DOI: 10.1016/j.jcjo.2018.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 03/12/2018] [Accepted: 03/13/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To analyze the relationship among the presence of lacrimal sac mucus retention, the vertical size of the lacrimal sac, and the duration of tearing symptom in patients with nasolacrimal duct obstruction (NLDO). DESIGN Retrospective case series. PARTICIPANTS We reviewed the medical records of 473 patients (664 eyes) who underwent external dacryocystorhinostomy for primary NLDO. METHODS The information about the presence of lacrimal sac mucus retention and vertical size of the lacrimal sac lumen was collected intraoperatively. The vertical size of the lacrimal sac was classified into 3 groups: small (<5 mm), medium (5-10 mm), and large (>10 mm). The relationship between the lacrimal sac size, presence of mucus retention, and duration of tearing was analyzed. RESULTS Of the 664 eyes, 138 had a small lacrimal sac, 199 had a medium lacrimal sac, and 327 had a large lacrimal sac. The distribution of the lacrimal sac size groups differed significantly between the eyes with (n = 245) and without (n = 419) mucus retention (p < 0.001). Among all the subjects of each lacrimal sac size group, there was no significant difference in the duration of symptoms (p = 0.176). However, in patients without mucus retention, the symptom duration in the small lacrimal sac group was significantly longer than that in the large lacrimal sac group (p = 0.017). CONCLUSIONS In cases with mucus retention, a small lacrimal sac is rare. In cases without mucus retention, the duration of tearing symptom was significantly longer in small lacrimal sac group.
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Ali MJ, Paulsen F. Human Lacrimal Drainage System Reconstruction, Recanalization, and Regeneration. Curr Eye Res 2019; 45:241-252. [DOI: 10.1080/02713683.2019.1580376] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Mohammad Javed Ali
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India
| | - Friedrich Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
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Park JH, Huh JA, Piao JF, Lee H, Baek SH. Measuring nasolacrimal duct volume using computed tomography images in nasolacrimal duct obstruction patients in Korean. Int J Ophthalmol 2019; 12:100-105. [PMID: 30662848 DOI: 10.18240/ijo.2019.01.16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 07/12/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate nasolacrimal duct (NLD) volume in Korean patients and to examine the correlation between NLD volume and obstruction. METHODS Of patients who underwent orbital computed tomography from March 2013 to January 2016, patients diagnosed with NLD obstruction were classified into the patient group and patients without obstruction were classified into the control group. The NLD volume was measured using the Image J program, which showed the NLD in axial, coronal, and sagittal images on computed tomography. RESULTS The average value of men's NLD volume, 265.33±90.57 mm3, was significantly larger than women's, 211.87±68.61 mm3 (P=0.009). In the patient group, the NLD volume of the obstructed eyes, 242.49±82.93 mm3, and the non-obstructed eyes, 225.20±73.20 mm3, were significantly higher than the control group, 217.61±82.04 mm3 (P<0.001, P<0.001). CONCLUSION The NLD volume is larger in men than in women in Korean adults. If there is NLD obstruction in women, the NLD volume is larger and it is judged that inflammatory reaction caused a chronic change in the bone around the NLD and affect the measurement of NLD volume.
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Affiliation(s)
- Jin-Hwan Park
- Department of Ophthalmology, Korea University College of Medicine, Seoul 02841, Korea
| | - Jung-Ah Huh
- Department of Ophthalmology, Korea University College of Medicine, Seoul 02841, Korea
| | - Jun-Feng Piao
- Department of Ophthalmology, Korea University College of Medicine, Seoul 02841, Korea
| | - Hwa Lee
- Department of Ophthalmology, Korea University College of Medicine, Seoul 02841, Korea
| | - Se-Hyun Baek
- Department of Ophthalmology, Korea University College of Medicine, Seoul 02841, Korea
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Pathological changes of the nasolacrimal duct in rabbit models of chronic dacryocystitis: correlation with lacrimal endoscopic findings. Graefes Arch Clin Exp Ophthalmol 2018; 256:2103-2112. [PMID: 30187128 DOI: 10.1007/s00417-018-4129-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 07/19/2018] [Accepted: 08/29/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE The aim of this study was to explore the pathological changes of the nasolacrimal duct in rabbits with experimentally induced obstructive dacryocystitis in correlation with lacrimal endoscopic findings. METHODS The rabbit model of obstructive dacryocystitis was created by injecting 0.15 ml of self-curing resin into the lacrimal duct. The control group received 0.15 ml of normal saline. Within 16 weeks after the obstructive, lacrimal endoscopy and pathological examination of the nasolacrimal duct were conducted at different time points of 1, 2, 4, 8, and 16 weeks. RESULTS In the control group, lacrimal endoscopy revealed pink and smooth mucosa; and the pathological analysis revealed an epithelial layer that was composed of superficial columnar cells and a deep basal epithelial layer. The experimental rabbits showed clinical manifestations of obstructive dacryocystitis a week after the injection of self-curing resin. At weeks 1 and 2, the lacrimal endoscopy showed mucosal hyperemia and hemorrhagic spots on the nasolacrimal duct; and the pathological features included epithelial cell swelling and inflammatory cell infiltration. At weeks 4 and 8, the experimental group showed alternatively red and white mucosa under the lacrimal endoscopy, and the pathological features included proliferative epithelium accompanied by papillary hyperplasia. At week 16, the experimental group showed pale and coarse mucosa and white membrane-like layer covering the mucosal surface, and the pathological features included epithelial necrosis, squamous metaplasia, and sub-epithelial fibrosis. CONCLUSION The mucosa of the nasolacrimal duct showed different pathological features at different time points after lacrimal duct obstruction, which was well correlated with the endoscopic findings. It is possible to predict the pathological stages by the endoscopic observation in NLOD patients.
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Ueda K, Watanabe A, Yokoi N, Sugimoto M, Fukuoka H, Shinomiya K, Kinoshita S, Rajak S, Selva D. Biopsy of recurrent nasolacrimal duct obstruction using sheath-guided dacryoendoscopy. Orbit 2018; 38:37-42. [PMID: 30142018 DOI: 10.1080/01676830.2018.1513536] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE The purpose of this article is to present a novel technique, as well the histopathological findings, of dacryoendoscopic guided nasolacrimal duct (NLD) biopsy for recurrent nasolacrimal duct obstruction (NLDO). METHODS This study involved subjects with recurrent NLDO. Direct endoscopic probing or sheath-guided endoscopic probing was used for the initial intubation in all treated eyes, and the stent had been removed at between 2 and 11 months (mean 3.5 months) post-intubation with dacryoendoscopic confirmation of patency and mucosal regeneration. Biopsy specimens were obtained by scraping the recurrent lesion by sheath advancement. Histopathological examination and immunohistochemical (IHC) staining were performed. RESULTS In five patients (two males and three females, mean age: 71.2 ± 5.6 years [range: 61-78 years]) with recurrent NLDO, biopsy specimens were obtained from six ducts of six eyes, and stratified epithelium and a mixed inflammatory cell infiltrates were identified. IHC staining was positive for cytokeratin (CK)4 and CK13, and negative for paired box protein Pax-6. CONCLUSIONS This novel technique enabled a minimally invasive biopsy of the NLD to be obtained, and IHC staining indicated the presence of mucus epithelium, thus suggesting squamous metaplasia of the usual respiratory epithelium which likely occurs secondary to chronic inflammation.
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Affiliation(s)
- Kosuke Ueda
- a Department of Ophthalmology , Kyoto Prefectural University of Medicine , Kyoto , Japan
| | - Akihide Watanabe
- a Department of Ophthalmology , Kyoto Prefectural University of Medicine , Kyoto , Japan
| | - Norihiko Yokoi
- a Department of Ophthalmology , Kyoto Prefectural University of Medicine , Kyoto , Japan
| | | | - Hideki Fukuoka
- a Department of Ophthalmology , Kyoto Prefectural University of Medicine , Kyoto , Japan
| | - Katsuhiko Shinomiya
- a Department of Ophthalmology , Kyoto Prefectural University of Medicine , Kyoto , Japan
| | - Shigeru Kinoshita
- a Department of Ophthalmology , Kyoto Prefectural University of Medicine , Kyoto , Japan
| | - Saul Rajak
- c Sussex Eye Hospital , Brighton and Sussex University Hospital , Brighton , United Kingdom
| | - Dinesh Selva
- d Discipline of Ophthalmology and Visual Sciences , South Australian Institute of Ophthalmology and Royal Adelaide Hospital , Adelaide , Australia
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Owji N, Radaei M, Khademi B. The Relationship between Primary Acquired Nasolacrimal Duct Obstruction and Gastroesophageal Reflux. Curr Eye Res 2018; 43:1239-1243. [DOI: 10.1080/02713683.2018.1485948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Naser Owji
- Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Mohammad Radaei
- Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Behzad Khademi
- Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
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Qualitative Hormonal Profiling of the Lacrimal Drainage System: Potential Insights into the Etiopathogenesis of Primary Acquired Nasolacrimal Duct Obstruction. Ophthalmic Plast Reconstr Surg 2017; 33:381-388. [DOI: 10.1097/iop.0000000000000962] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lee MJ, Khwarg SI, Kim IH, Choi JH, Choi YJ, Kim N, Choung HK. Intraoperatively Observed Lacrimal Obstructive Features and Surgical Outcomes in External Dacryocystorhinostomy. KOREAN JOURNAL OF OPHTHALMOLOGY 2017; 31:383-387. [PMID: 28913995 PMCID: PMC5636713 DOI: 10.3341/kjo.2016.0096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 12/26/2016] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To analyze the features of lacrimal drainage system obstruction confirmed during external dacryocystorhinostomy surgeries and report the surgical outcomes. METHODS We reviewed the medical records of a total of 769 cases who underwent external dacryocystorhinostomy for primary lacrimal drainage obstruction between 2005 and 2014. Data about detailed location and extent of obstruction were collected intraoperatively. The sites of obstruction were classified into nasolacrimal duct obstruction (NLDO), common canalicular obstruction (CCO), and canalicular obstruction. Lacrimal sac mucosa and lumen were grossly inspected, and the frequency of lacrimal sac changes, such as significant inflammation or fibrosis, was analyzed in cases of CCO or canalicular obstruction. The surgical success rate was also evaluated including effect of lacrimal sac status in the CCO and canalicular obstruction groups. RESULTS Of 769 cases, primary NLDO with patent canaliculi was diagnosed intraoperatively in 432 cases (56.2%), CCO in 253 (32.9%), and canalicular obstruction in 84 (10.9%). Of 253 cases with CCO, 122 (48.2%) showed clear lacrimal sac lumen, and the other 131 (51.8%) showed significant inflammation or fibrosis of the lacrimal sac. In cases with canalicular obstruction, 35 of 84 (41.7%) showed a clear lacrimal sac, and the other 49 cases (58.3%) cases revealed mucosal changes of the lacrimal sac. The functional success rate was 87.5% for primary NLDO, 75.5% for CCO, and 72.6% for canalicular obstruction. In the CCO group, the functional success rate was lower in cases with significant lacrimal sac change (p = 0.044). CONCLUSIONS Even in patients with CCO or canalicular obstruction, a large number of cases have lacrimal sac changes, and those changes were associated with lower functional success rate.
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Affiliation(s)
- Min Joung Lee
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Sang In Khwarg
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea.
| | | | - Jeong Hoon Choi
- Department of Ophthalmology, Korean Armed Forces Capital Hospital, Seongnam, Korea
| | - Youn Joo Choi
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
| | - Namju Kim
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ho Kyung Choung
- Department of Ophthalmology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
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Heichel J, Struck HG, Viestenz A, Hammer T, Viestenz A, Fiorentzis M. Anatomic landmarks in lacrimal surgery from an ophthalmologist's point of view: Clinical findings of external dacryocystorhinostomy and dacryoendoscopy. Clin Anat 2017; 30:1034-1042. [PMID: 28509331 DOI: 10.1002/ca.22902] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 05/05/2017] [Indexed: 11/05/2022]
Abstract
Epiphora is a common clinical symptom of nasolacrimal duct obstruction. However, it is present in several pathologies and can lead to decreased quality of life for patients. A careful clinical examination including a detailed patient's history and diagnostic tests such as the fluorescein dye disappearance test and diagnostic syringing of the lacrimal duct are essential. Depending on the time of presentation (congenital, primary, or secondary acquired), grade (subtotal or total) and location of the stenosis, different surgical approaches can be considered. These are subdivided into minimally invasive (transcanalicular) and anastomosing (dacryocystorhinostomy) procedures. Furthermore, the anatomical landmarks and the site of surgical intervention differentiate the surgical techniques into endoscopic or transcutaneous. Modern intubation techniques offer a large spectrum of therapeutic possibilities enabling patient care to be customized and individualized. Knowledge of the topographical anatomy is crucial for achieving greater success and a lower complication rate. Clin. Anat. 30:1034-1042, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Jens Heichel
- Department of Ophthalmology, University Hospital Halle (Saale), Martin-Luther, University Halle-Wittenberg, Halle, Saale, Germany
| | - Hans-Gert Struck
- Department of Ophthalmology, University Hospital Halle (Saale), Martin-Luther, University Halle-Wittenberg, Halle, Saale, Germany
| | - Anja Viestenz
- Department of Ophthalmology, University Hospital Halle (Saale), Martin-Luther, University Halle-Wittenberg, Halle, Saale, Germany
| | - Thomas Hammer
- Department of Ophthalmology, University Hospital Halle (Saale), Martin-Luther, University Halle-Wittenberg, Halle, Saale, Germany
| | - Arne Viestenz
- Department of Ophthalmology, University Hospital Halle (Saale), Martin-Luther, University Halle-Wittenberg, Halle, Saale, Germany
| | - Miltiadis Fiorentzis
- Department of Ophthalmology, University Hospital Halle (Saale), Martin-Luther, University Halle-Wittenberg, Halle, Saale, Germany
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Modeling Chronic Dacryocystitis in Rabbits by Nasolacrimal Duct Obstruction with Self-Curing Resin. J Ophthalmol 2017; 2017:3438041. [PMID: 28717520 PMCID: PMC5498895 DOI: 10.1155/2017/3438041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/28/2017] [Accepted: 06/07/2017] [Indexed: 11/17/2022] Open
Abstract
We established a chronic dacryocystitis model by injecting of 0.05, 0.1, and 0.15 ml self-curing resin via the lacrimal punctum in rabbits. Animals were randomized into four groups (n = 11 animals/group). The control group received 0.15 ml normal saline. Within three months postinjection, epiphora and eye discharge were observed. At the 90th day postlacrimal passage irrigation, CT dacryocystography was performed to find changes in the lacrimal image, and hematoxylin and eosin staining was made to identify pathological changes of the lacrimal sac. Three months postinjection, the rabbits in control group and those who received 0.05 and 0.1 ml self-curing resin failed to develop chronic dacryocystitis. However, 8/11 (72.7%) rabbits those received 0.15 ml self-curing resin were symptomatic and showed complete reflux in lacrimal passage irrigation, indicating the obstruction of the nasolacrimal duct. CT dacryocystography showed that the obstruction was present only in the animals with chronic dacryocystitis. Pathological examinations of chronic dacryocystitis also revealed significantly inflammatory changes, such as mucus epithelium thickening, irregular papillary proliferation, and submucosal fibrous deposition. Local injection of 0.15 ml self-curing resin can induce permanent obstruction of the nasolacrimal duct in rabbits and establish a model of chronic dacryocystitis.
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Singh S, Alam MS, Ali MJ, Naik MN. Endoscopic intranasal findings in unilateral primary acquired nasolacrimal duct obstruction. Saudi J Ophthalmol 2017; 31:128-130. [PMID: 28860907 PMCID: PMC5569328 DOI: 10.1016/j.sjopt.2017.05.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/17/2017] [Accepted: 05/23/2017] [Indexed: 11/29/2022] Open
Abstract
Purpose To evaluate intranasal endoscopic findings in patients with unilateral primary acquired nasolacrimal duct obstruction and compare them with the normal cohort. Methods A prospective case-control study with 50 unilateral primary acquired nasolacrimal duct obstruction (PANDO) and 50 healthy controls. All patients were evaluated by endoscopic nasal examination for the presence of deviated nasal septum (DNS), type of deviation (bony or cartilaginous), side of deviation, septal spurs, caudal dislocation, any turbinate hypertrophy and endoscopic features suggestive of sinusitis. Results A significant increase in the incidence of nasal septal deviation was found in PANDO cases (60%, 30/50) compared to controls (36%; 18/50; P = 0.03). The laterality of septal deviation corresponded to the side of NLD obstruction in 90% (27/30) cases. Higher location of DNS (73% vs 22%; P = 0.0009) and bony deviation (77% vs 44%; P = 0.02) were observed among study group as compared to controls. The odds of having NLD obstruction are 2.7 times more among individuals having septal deviation versus no deviation (95% CI, 1.19–5.99). Conclusion Unilateral PANDO has a higher incidence of ipsilaterally deviated nasal septum. This association is significant. Routine nasal endoscopic examination should be performed in cases undergoing dacryocystorhinostomy to better plan a concomitant septoplasty if needed.
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Affiliation(s)
| | | | - Mohammad Javed Ali
- Corresponding author at: Govindram Seksaria Institute of Dacryology, L V Prasad Eye Institute, Road No. 2, Banjara Hills, Hyderabad 34, India.Govindram Seksaria Institute of DacryologyL V Prasad Eye InstituteRoad No. 2Banjara HillsHyderabad34India
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Factors influencing endoscopic dacryocystorhinostomy outcome. Eur Arch Otorhinolaryngol 2017; 274:2773-2777. [DOI: 10.1007/s00405-017-4541-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 03/15/2017] [Indexed: 11/25/2022]
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Paulsen F, Garreis F, Schicht M, Bräuer L, Ali MJ, Sel S. [Anatomy and physiology of the nasolacrimal ducts]. HNO 2017; 64:354-66. [PMID: 27240791 DOI: 10.1007/s00106-016-0164-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Ophthalmologists and interventional radiologists are not the only professionals for whom diseases of the efferent tear duct system occupy centre stage; this applies also to ENT specialists involving endonasal conservative or surgical treatment. On the basis of current knowledge and taking account of results yielded by own research in recent years and of clinical aspects, we here give an overview of basic knowledge on the anatomy and physiology of the nasolacrimal system. In doing so functional aspects regarding tear transport as well as embryological and pathophysiological issues are integrated.
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Affiliation(s)
- F Paulsen
- Institut für Anatomie, Lehrstuhl II, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstr. 19, 91054, Erlangen, Deutschland.
| | - F Garreis
- Institut für Anatomie, Lehrstuhl II, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstr. 19, 91054, Erlangen, Deutschland
| | - M Schicht
- Institut für Anatomie, Lehrstuhl II, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstr. 19, 91054, Erlangen, Deutschland
| | - L Bräuer
- Institut für Anatomie, Lehrstuhl II, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstr. 19, 91054, Erlangen, Deutschland
| | - M J Ali
- The Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India
| | - S Sel
- Universitätsaugenklinik, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Deutschland
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