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Ahmad TR, Lindquist KJ, Oatts JT, de Alba Campomanes AG, Kersten RC, Chan DK, Indaram M. Probing versus primary nasal endoscopy for the treatment of congenital dacryocystoceles. J AAPOS 2024; 28:103865. [PMID: 38458602 DOI: 10.1016/j.jaapos.2024.103865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 03/10/2024]
Abstract
PURPOSE To compare outcomes and complications of three surgical techniques for the treatment of congenital dacryocystoceles: nasolacrimal probing and irrigation (P+I), P+I plus nasal endoscopy (NE) with intranasal cyst marsupialization, and primary NE with intranasal cyst marsupialization. METHODS The medical records of children ≤2 years of age at a single academic center with a diagnosis of dacryocystocele from 2012 to 2022 were retrospectively identified and reviewed. The primary outcome was resolution of the dacryocystocele (ie, elimination of the medial canthal mass and resolution of tearing or discharge) after a single procedure ("primary success"). Surgical techniques were compared using exact logistic regression. RESULTS Of 54 patients, 21 (39%) underwent P+I, 23 (43%) underwent P+I plus nasal endoscopy, and 10 (18%) underwent primary NE. Primary success was 76% for P+I and 100% for the other two cohorts. Most patients (89%) who underwent P+I received general anesthesia compared with none who underwent primary nasal endoscopy. Most complications were related to the use of general anesthesia, with a complication rate of 10% for P+I, 48% for P+I plus NE, and 0% for primary NE. Most P+I procedures required hospital admission compared to half of primary NE procedures. CONCLUSIONS In our study cohort, primary NE provided good outcomes and was associated with a lower complication rate than P+I with or without NE.
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Affiliation(s)
- Tessnim R Ahmad
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | - Karla J Lindquist
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Julius T Oatts
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | | | - Robert C Kersten
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | - Dylan K Chan
- Department of Otolaryngology Head and Neck Surgery, University of California San Francisco, San Francisco, California
| | - Maanasa Indaram
- Department of Ophthalmology, University of California San Francisco, San Francisco, California.
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Arici C, Mergen B, Ozan T, Batu Oto B. Comparison of Endoscopically Assisted Primary Probing and Bicanalicular Silicone Intubation for Congenital Nasolacrimal Duct Obstruction in Children Aged 4 to 7 Years. J Pediatr Ophthalmol Strabismus 2022; 60:101-107. [PMID: 35446188 DOI: 10.3928/01913913-20220321-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the clinical outcomes of primary nasolacrimal duct probing and primary bicanalicular intubations with endoscopic assistance for congenital nasolacrimal duct obstruction (CNLDO) in children aged 4 to 7 years. METHODS Forty-three eyes of 43 children (25 boys and 18 girls) with congenital epiphora who underwent primary unilateral probing and bicanalicular intubation were evaluated retrospectively. The tubes were removed 3 to 4 months after their placement, and the children were followed up for another 6 months after their removal. Treatment success was defined as the normal result of the fluorescein dye disappearance test and complete resolution of the lacrimal symptoms and signs of patients. The success rates were compared between the two groups (bicanalicular intubation vs probing). Type of CNLDO (membranous, incomplete complex, and complete complex) was determined with an endonasal endoscope. RESULTS The mean age was 63.3 ± 11.1 months (range: 48 to 84 months) for the probing group and 64.4 ± 12.1 months (range: 48 to 84 months) for the bicanalicular intubation group (P = .915). The bicanalicular intubation group showed significantly greater treatment success (21 of 24, 87.5%) compared to the probing group (11 of 19, 57.9%; P = .038). Bicanalicular intubation provided higher treatment success among patients with complex CNLDO compared to probing (80.0% vs 11.1%, P = .002). There was no difference in mean age between the patients with successful and failed treatment in both groups (P = .631 and .137, respectively). CONCLUSIONS Bicanalicular intubation was associated with a higher success rate than probing under nasal endoscopic visualization for the treatment of CNLDO in children aged 4 to 7 years. The type of CNLDO might be the primary factor for the treatment success. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XX-XX.].
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Fayet B, Racy E, Ruban JM, Katowitz JA, Katowitz WR, Brémond-Gignac D. Preloaded Monoka (Lacrijet) and congenital nasolacrimal duct obstruction: Initial results. J Fr Ophtalmol 2021; 44:670-679. [PMID: 33836913 DOI: 10.1016/j.jfo.2020.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/05/2020] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE To study the performance of a pre-loaded Monoka stent in the management of congenital nasolacrimal duct obstruction (CNLDO). STUDY DESIGN Non-randomized study of consecutive cases. MATERIALS AND METHODS A preloaded classic Monoka silicone stent contained entirely inside its introducer (Lacrijet) was used to treat a consecutive series of subjects with CNLDO over an 11-month period (May 2019-March 2020). Only subjects with chronic symptomatic CNLDO were included. Subjects with intermittent tearing, canalicular pathology, trisomy 21, facial cleft, or history of lacrimal surgery were excluded. Intraoperative findings were recorded, including the degree and location of the nasolacrimal obstruction, successful metal to metal contact with the probe, any difficulties encountered by the Lacrijet device itself, procedure duration, tolerability of the fixation punctal plug, and finally, inspection of the stent after withdrawal of the inserter. Functional success was defined as disappearance of all symptoms of epiphora. RESULTS A total of 45 preloaded Monoka Lacrijet stents (Lcj) were placed consecutively in 38 children. The mean age was 27.9 months (12-78 months). The mean procedural duration was 2.8minutes (range: 1-10min). The overall success with disappearance of all symptoms of epiphora was 88.8% (40/45). Surgery in cases of simple mucosal stenosis was successful in 92.2% (35/38) of cases, with a mean follow-up time of 7.9 months (range: 1 to 12 months). The duration of stent intubation was for this group was 32 days (range: 1-103). The surgical outcomes for the other 7 cases with more complex intraoperative findings are summarized in the publication. All withdrawn probes were intact. CONCLUSIONS The Lacrijet stent system is a simple and reliable pushed intubation device for CNLDO in appropriately selected cases where bony stenosis of the canal is minimal.
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Affiliation(s)
- B Fayet
- Department of Ophthalmology, Hospital Cochin, University of Paris VI - Medical School, 22, rue du Faubourg-Saint-Jacques, Paris, France.
| | - E Racy
- ENT, Fondation Saint-Jean-de-Dieu, 02, rue Rousselet, 75007 Paris, France
| | - J-M Ruban
- Department of Ophthalmology, Hospital Edouard Herriot, Place d'Arsonval, Lyon, France
| | - J A Katowitz
- Division of Ophthalmology, The Children's Hospital of Philadelphia and The Edwin and Fannie Gray Hall Center for Human Appearance, University of Pennsylvania, Philadelphia PA, USA
| | - W R Katowitz
- Division of Ophthalmology, The Children's Hospital of Philadelphia and The Edwin and Fannie Gray Hall Center for Human Appearance, University of Pennsylvania, Philadelphia PA, USA
| | - D Brémond-Gignac
- Department of Ophthalmology, Hôpital Necker-Enfants malades, 149, rue de Sèvres, 75015 Paris, France
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Incision of Hasner's valve under endoscopic intranasal surgery for the treatment of nasolacrimal duct obstruction in children. The Journal of Laryngology & Otology 2020; 134:56-62. [PMID: 31918765 DOI: 10.1017/s0022215119002597] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the effectiveness and safety of a Hasner's valve incision performed under endoscopic intranasal surgery for the management of congenital nasolacrimal duct obstruction. METHODS This retrospective study comprised 484 patients with congenital nasolacrimal duct obstruction who underwent incision of Hasner's valve under endoscopic intranasal surgery between April 2000 and October 2016. The primary endpoint was the procedure's functional success rate. The secondary endpoints were Hasner's valve and inferior turbinate anatomical findings, demographic data, complication rate and surgical duration. RESULTS In patients with no medical history of nasolacrimal duct probing, 91 per cent had a successful result, 5 per cent had a partially successful result, 3.9 per cent showed no change and 0.1 per cent had a worse result following the procedure. Concerning the secondary endpoints, outcomes were more frequently successful in children younger than three years. Only one patient had a post-operative infection. All patients underwent general anaesthesia; no complications related to general anaesthesia were observed. Mean surgical duration was 13.1 ± 5.7 minutes. CONCLUSION Incising Hasner's valve after medially displacing the inferior turbinate under nasal endoscopy seems to be an adequate primary surgical treatment for congenital nasolacrimal duct obstruction.
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Ahn SH, Lee TE, You IC, Cho NC, Ahn M. Clinical Outcomes of Nasolacrimal Probing and Silicone Intubation in Patients with Congenital Nasolacrimal Duct Obstruction. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.7.613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sung Hyun Ahn
- Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea
| | - Tae Eun Lee
- Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine, Chonbuk National University, Jeonju, Korea
- Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea
| | - In Cheon You
- Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine, Chonbuk National University, Jeonju, Korea
- Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea
| | - Nam Chun Cho
- Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine, Chonbuk National University, Jeonju, Korea
- Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea
| | - Min Ahn
- Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine, Chonbuk National University, Jeonju, Korea
- Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea
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Dobberpuhl MR, Timoney PJ, Comer BT. Endoscopically Assisted Crawford Tube Placement Results in Shorter General Anesthesia Times in Pediatric Patients. Am J Rhinol Allergy 2018; 32:31-33. [DOI: 10.2500/ajra.2018.32.4500] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Crawford tube placement is commonly used to achieve patency of nasolacrimal ducts for epiphora secondary to nasolacrimal duct obstruction. The nasal passages of pediatric patients are narrower than adults, and the result is a relatively higher risk of intranasal complications (e.g., synechiae, bleeding) with Crawford tube placement. There is evidence that general anesthesia may negatively affect the neurocognitive function and behavioral development of children, which prompts efforts to decrease operation times for potential health benefits and also potentially to reduce health care costs. Analysis ofresearch reports supports the use of nasal endoscopy to reduce intranasal complications with Crawford tube placement; however, no publications currently address the effect of nasal endoscopy concurrent with Crawford tube placement on operative times on pediatric patients or the resulting effects on health care costs. Objective To determine the difference in procedure time and cost between Crawford tubes placed traditionally and those placed with endoscopic assistance in pediatric patients. Methods A chart review was performed from January 1, 2011 to December 31, 2016 for cases using CPT codes 68815 or 31231. Within this group of patients, the patient in whom nasal endoscopy was performed were placed in the “endoscopic” group and the patients without endoscopy were placed in the “traditional” group. Procedure times were noted, and the t-test was performed to examine for any statistically significant difference in operative times. Estimates of anesthesia cost savings were made. We identified 24 patients in the traditional group and 7 patients in the endoscopic group. Results The average operative time for the traditional group was 27.3 minutes compared with 14.0 minutes for the endoscopic group (p = 0.02). The cost comparison data revealed no significant difference with the traditional group averaging $9369 per procedure and the endoscopic group averaging $8891 (p = 0.51). Conclusion An endoscopically assisted Crawford tube placement resulted in patients who had less time under general anesthesia compared with the traditional technique at no difference in cost.
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Affiliation(s)
| | - Peter J. Timoney
- Department of Ophthalmology, University of Kentucky, Lexington, Kentucky
| | - Brett T. Comer
- Department of Otolaryngology, University of Kentucky, Lexington, Kentucky
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Kim JH, You IC, Ahn M. The Clinical Outcome of Endoscopic Endonasal Silicone Tube Intubation According to Nasolacrimal Duct Resistance. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Joon Hyung Kim
- Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea
| | - In Cheon You
- Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine, Chonbuk National University, Jeonju, Korea
- Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea
| | - Min Ahn
- Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine, Chonbuk National University, Jeonju, Korea
- Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea
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Long-term results of probing guided with soft cannula in children with congenital nasolacrimal duct obstruction. Jpn J Ophthalmol 2013; 58:94-9. [PMID: 24242082 DOI: 10.1007/s10384-013-0289-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 09/17/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To report the results of soft probing in children with congenital nasolacrimal duct obstruction (CNLDO). MATERIALS AND METHODS A prospective, non-randomised interventional study included 158 eyes of 122 children aged 2 months-5 years, with CNLDO. A plastic intravenous catheter sheath supported intraluminally with a guiding metal probe was introduced through the superior canaliculus. During intubation, the plastic cannula was gently introduced through the nasolacrimal system, while the metal probe inside was withdrawn concurrently. After the complete withdrawal of the metal probe, the duct was irrigated with a high pressure saline solution through the plastic cannula. Once the obstruction was totally dissolved and a patent passage was observed, the plastic cannula was withdrawn and the procedure was completed with a nasolacrimal lavage with a gentamycin and dexamethasone combination. RESULTS Clinically successful results were achieved in 142 eyes (89.8 %). No significant complications occured intraoperatively or postoperatively. CONCLUSIONS In children under age 5, our technique has a high success rate with no significant complications. This method allows probing in a more controlled way. This method may be particularly suitable for surgeons during training, when the most false lumen formation is observed.
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Al-Faky YH. Nasal endoscopy in the management of congenital nasolacrimal duct obstruction. Saudi J Ophthalmol 2013; 28:6-11. [PMID: 24526852 PMCID: PMC3923206 DOI: 10.1016/j.sjopt.2013.11.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 10/29/2013] [Accepted: 11/04/2013] [Indexed: 11/19/2022] Open
Abstract
Probing is a reliable surgical intervention for the management of congenital nasolacrimal duct obstruction (CNLDO). However, it is a blind procedure that carries the risk of false passage formation. Moreover, its success rate is variable, with unexplained causes of failure. Recent literature suggests the use of nasal endoscopic-assisted probing to minimize nasal mucosal trauma, decreases the chance of creating a false passage and provides the optimum management option of different congenital variants of nasolacrimal duct obstruction. Nasal endoscopic-assisted probing has more or less consistent success rates varied between 85% and 98% compared with probing success rates, which vary between 55% and 95% despite having almost the same age range.
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Affiliation(s)
- Yasser H. Al-Faky
- Address: Department of Ophthalmology, College of Medicine, King Saud University, PO Box 245, Riyadh 11411, Saudi Arabia. Tel.: +966 01 477 57 23; fax: +966 01 477 57 24.
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Success rates of endoscopic-assisted probing for congenital nasolacrimal duct obstruction in children. The Journal of Laryngology & Otology 2013; 127:794-8. [PMID: 23803229 DOI: 10.1017/s0022215113001370] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To determine the success rate of initial probing in children with congenital nasolacrimal duct obstruction at different ages, using nasal endoscopy. METHODS Fifty eyes of 38 consecutive children with congenital nasolacrimal duct obstruction underwent endoscopic nasolacrimal duct probing under general anaesthesia. Patients were followed up for at least three months. Probing success was defined as complete remission of symptoms and a normal fluorescein dye disappearance test result. RESULTS The age range of patients was 17-109 months. The success rates of probing were: 100 per cent (29 out of 29) for cases of stenosis at the lower nasolacrimal duct, 100 per cent (7 out of 7) for functional epiphora cases and 92.86 per cent (13 out of 14) for nasolacrimal atresia cases. Overall, there was only one child for whom the probing treatment for nasolacrimal duct obstruction was not successful; this child had Down's syndrome and a more complex developmental abnormality of the nasolacrimal duct. Age and site of obstruction were not found to significantly affect the outcome of probing. CONCLUSION Probing of the nasolacrimal system using an endoscopic approach allows direct visualisation of the nasolacrimal duct. This can facilitate diagnosis of the anomaly and significantly increase the procedure success rate.
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Lee JJ, Ahn JH, Kim JL, Yang JW. The Clinical Outcome of Endoscopic Silicone Tube Intubation for Congenital Nasolacrimal Duct Obstruction. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2012. [DOI: 10.3341/jkos.2012.53.7.929] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jung Jae Lee
- Department of Ophthalmology, DongKang Medical Center, Ulsan, Korea
| | - Jae Hwan Ahn
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jung Lim Kim
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jae Wook Yang
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Cakmak SS, Yildirim M, Sakalar YB, Keklikci U, Alakus F. Is it necessary to accompany probing with endoscopy in cases of congenital nasolacrimal canal obstruction? Int J Pediatr Otorhinolaryngol 2010; 74:1013-5. [PMID: 20708130 DOI: 10.1016/j.ijporl.2010.05.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 05/18/2010] [Accepted: 05/23/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the results of probing with and without endoscopy in cases of congenital nasolacrimal duct obstruction who had previously not undergone probing. METHODS Fifty-one children with congenital nasolacrimal duct obstruction who underwent surgical intervention between June 2007 and April 2009 in our hospital were included in the study. Patients who had had previous probings were excluded from the study. Conventional probing was performed in 37 eyes of 25 patients, and probing with intranasal endoscopic visualization in 36 eyes of 26 patients. Diagnosis was based on history of epiphora since birth or shortly after, and fluorescein dye disappearance test. RESULTS Thirty-two of 37 eyes (86.48%) were cured by probing. Of the 5 cases with complaints, 1 had lacrimal sac fistula. Thirty-four of 36 eyes (94.44%) were cured by probing guided by endoscope observation. Thirty-two cases had stenosis at the lower end of the nasolacrimal duct which required probing. In two cases the probe passed submucosally to the floor of the nose. In two cases a false passage was made at the upper end of the inferior meatus. In these cases, the operation was continued by repeating the process until the distal end of the nasolacrimal canal was seen to have been passed. CONCLUSION Probing with endoscopy may be excessive in primary cases but in cases which have undergone unsuccessful probing, it is useful for visualization of anomalies in the lower nasolacrimal canal and to obtain the correct anatomic position for the probe.
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Affiliation(s)
- Sevin Soker Cakmak
- Department of Ophthalmology, Dicle University Faculty of Medicine, TR-21280 Diyarbakir, Turkey.
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Puvanachandra N, Trikha S, MacEwen CJ, Morris RJ, Hodgkins PR. A national survey of the management of congenital nasolacrimal duct obstruction in the United kingdom. J Pediatr Ophthalmol Strabismus 2010; 47:76-80. [PMID: 20349898 DOI: 10.3928/01913913-20100308-04] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2008] [Accepted: 11/12/2008] [Indexed: 11/20/2022]
Abstract
PURPOSE To survey national variation in the management of congenital nasolacrimal duct obstruction, particularly the timing of intervention and the use of nasolacrimal intubation, nasal endoscopy, and assistance from an ear, nose, and throat surgeon at different stages of management. METHODS A telephone survey was conducted of 100 ophthalmologists in the United Kingdom who were involved in the management of congenital nasolacrimal duct obstruction. A sequential management protocol was established for each, including the nature of procedures, their timing, and the use of nasal endoscopy and ear, nose, and throat surgeons. RESULTS Of those surveyed, 49% use the dye disappearance test for diagnosis. Eighty-four percent suggest lacrimal sac massage to parents. No surveyed ophthalmologists perform "office" probing or balloon dilation. Seventy-four percent perform initial probing after 1 year, with 25% using nasal endoscopy. If symptoms persist, 64.5% (60 of 93) repeat the probing, whereas 35.5% (33 of 93) intubate the lacrimal system. The use of nasal endoscopy increases to 50.5% (47 of 93). By the third intervention, 77.6% (45 of 58) perform lacrimal intubation, with 72.4% (42 of 58) using nasal endoscopy. All opt for dacryocystorhinostomy as the fourth intervention and 28.3% (13 of 46) perform this procedure themselves, whereas 71.7% (33 of 46) refer the patient to another practitioner. In total, 65% (65 of 100) use tubes at some stage of management, 58% (58 of 100) make some use of nasal endoscopy, and 33% (33 of 100) involve ear, nose, and throat surgeons. CONCLUSION Based on the results of this survey, huge variation exists in the management of congenital nasolacrimal duct obstruction in the United Kingdom. Most ophthalmologists intervene soon after patients reach 1 year of age. The rate of nasal endoscopy increases with successive interventions, especially to aid with nasal intubation, either alone or with the assistance of ear, nose, and throat surgeons.
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Affiliation(s)
- Narman Puvanachandra
- Southampton Eye Unit, Southampton University Hospital Trust, Southampton, Hampshire, UK
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Pushed monocanalicular intubation: a preliminary report. J Fr Ophtalmol 2010; 33:145-51. [PMID: 20185206 DOI: 10.1016/j.jfo.2010.01.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Accepted: 12/22/2009] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To study the behavior of a "pushed" monocanalicular stent by means of nasal endoscopy. PATIENTS AND METHODS Four children (six affected sides) with congenital nasolacrimal duct obstruction were treated with monocanalicular intubation with an anchoring plug. The children's mean age at the time of the operation was 33 months (range, 30-37 months). The procedure began with probing in order to verify (a) dacryostenosis (simple or extensive nasolacrimal duct impatency) and (b) the metal-to-metal contact in the lower nasal meatus. The stent was similar to a Monoka(TM), but the guide (a malleable stainless steel probe) is located inside the silicone stent rather than projecting from it. The silicone's total length is 40 mm and the external diameter 0.96 mm. Simultaneously, the guide acts to catheterize the nasolacrimal duct by pushing the silicone through the upper and lower parts of the outflow system. The guide is removed via a punctal approach. This mode of intubation dispenses with the nasal recovery step. Nasal endoscopy was used to monitor (a) the position of the stent in the lower nasal meatus (free or submucosal), (b) mucosal damage and bleeding, and (c) the behavior of the silicone tube during removal of the guide. RESULTS Because of the complexity of nasolacrimal ducts, two of the six sides were treated with the classical Monoka intubation method of pulling the silicone tubing out from the nasal exit of the duct (the pull technique). The pushed intubation method was used for the four simple nasolacrimal stenoses, with no problems whatsoever. In all four cases, endoscopic examination showed (a) no submucosal tunneling (false passage), (b) no noteworthy mucosal damage, and (c) no retraction (bunch-up) of the silicone tube during the metal guide removal. No particular complications were reported during the procedure or the intubation period, which lasted an average of 3 weeks. The stents were removed in the consulting room. Tearing ceased during the 1(st) week in two cases, during the intubation period. Tearing persisted throughout the intubation period in the other two cases, but ceased during the week following stent removal. The follow-up lasted 2 months. CONCLUSIONS The pushed procedure simplifies monocanalicular nasal intubation. Its indications remain to be determined.
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Kouri AS, Tsakanikos M, Linardos E, Nikolaidou G, Psarommatis I. Results of endoscopic assisted probing for congenital nasolacrimal duct obstruction in older children. Int J Pediatr Otorhinolaryngol 2008; 72:891-6. [PMID: 18440076 DOI: 10.1016/j.ijporl.2008.02.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Revised: 02/27/2008] [Accepted: 02/28/2008] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the results of lacrimal probing with the use of nasal endoscopy and identify the anatomical anomalies responsible for the symptoms in older children. METHODS Fifty-two eyes of 40 children with congenital nasolacrimal duct obstruction underwent primary probing of the lacrimal duct under general anaesthetic in conjunction with nasal endoscopy. Patients followed up for at least 6 months. Cure was defined as complete resolution of symptoms or minimal symptoms brought on by cold or wind. RESULTS The age range was 12-126 months. In 30/52 (57.7%) eyes the symptoms were attributed to a single mechanical obstruction. Seven eyes had canalicular stenosis. Three eyes had upper nasolacrimal duct obstruction. Nine eyes had narrow duct and nine eyes had atresia of the distal end of the duct. Two eyes had only intranasal abnormalities. In 16/52 (30.76%) eyes a combination of anomalies was responsible for the symptoms. Nine eyes had canalicular stenosis in association with: either a membrane at the valve of Hasner in four, or a narrow duct in three, or intranasal anomalies in two. Two eyes had punctual stenosis and narrow duct. Two eyes had narrow duct and tight inferior turbinate. Three eyes had abnormal openings in association with stenotic ducts. Six (11.54%) eyes had functional blockage. With the use of endonasal endoscopy, intranasal anomalies identified in 12 eyes and treated in nine. One eye had large inferior conchae. One eye had inferior concha adherent to lateral nasal wall. One eye had redundant nasal mucosa. Three eyes had tight inferior turbinate. Three had abnormal openings. In three eyes the probe went submucosally. The overall success rate was 84.6% (44/52 eyes). Eight eyes remained unchanged. Endoscopically treated cases contributed to the overall success by 17.31%. CONCLUSION Multiple anatomical anomalies within the lacrimal system and abnormalities of the nose are quite common in older children. Lacrimal probing remains the primary treatment and nasal endoscopy is a useful adjunct to probing increasing the success rate of the procedure.
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Affiliation(s)
- A S Kouri
- Ophthalmology Department, "P.& A. Kyriakou" Children's Hospital, Athens, Greece.
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Abstract
PURPOSE To evaluate the results of lacrimal probing in children at or older than 1 year of age with congenital nasolacrimal duct obstruction. MATERIALS AND METHODS Fifty eyes of 38 children (24 males, 14 females) with congenital epiphora who underwent nasolacrimal duct probing were evaluated in a prospective study. The age of the patients was between 12 and 101 months (mean: 33 months). Success of probing was defined as complete resolution of preoperative symptoms and signs. The mean follow-up was 8 months (3-28 months). RESULTS The success rate of probing was 88% (44/50 eyes). Residual epiphora was observed in 6 eyes of 4 patients (12%). Age of the patient, gender, the frequency of epiphora before probing and the unilaterality or bilaterality of epiphora did not correlate with the success of probing (p > 0.05). CONCLUSION Nasolacrimal duct probing is advocated as a primary treatment in children younger than 9 years of age before proceeding to more complex treatment options. Unsuccessful probing may result from the selection of nonmembranous obstructions rather than the increased age of the patients.
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Wallace EJ, Cox A, White P, Macewen CJ. Endoscopic-assisted probing for congenital nasolacrimal duct obstruction. Eye (Lond) 2005; 20:998-1003. [PMID: 16138115 DOI: 10.1038/sj.eye.6702049] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To determine the success rate of initial probing in children with congenital nasolacrimal duct obstruction (CNLDO) at different ages using nasal endoscopy, and to identify the anatomical sites of blockage within the drainage system. METHODS A total of 87 eyes from 67 consecutive children with CNLDO underwent endoscopic nasolacrimal duct (NLD) probing under general anaesthetic. Patients who had had previous probings were excluded from the study. Diagnosis was based on history of epiphora since birth or shortly after, and fluorescein dye disappearance test (FDDT). Cure was judged as complete or near-complete remission of symptoms and signs and a normal FDDT. RESULTS The age range was 12-91 months (mean 32.3 months). The success rates of probing were: 100% (58/58) for atresia and stenosis at the lower NLD, 100% (13/13) for punctal stenosis, 55.6% (5/9) for functional epiphora, and 0% (0/7) for canalicular and upper NLD obstruction. Age was not found to significantly affect the outcome of probing, whereas site did. Obstruction at canalicular or upper NLD level became more common with increasing age. CONCLUSION Probing of the nasolacrimal system using the endoscopic approach allows direct visualisation of the distal nasolacrimal duct, which facilitates diagnosis of the anomaly at this site. More complex proximal anomalies became increasingly prevalent in older children, which accounted for the poorer results with increasing age. Site of obstruction has a greater bearing on outcome than patient age.
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Affiliation(s)
- E J Wallace
- 1Department of Ophthalmology, Tayside University Hospitals NHS Trust, Dundee, UK
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Yalaz M, Ozcan AA, Akcali C, Soylu L. Lacrimal intubation with the Ritleng system in recurrent congenital nasolacrimal duct obstruction in children. ORL J Otorhinolaryngol Relat Spec 2004; 66:35-7. [PMID: 15103199 DOI: 10.1159/000077231] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2003] [Accepted: 01/29/2004] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the efficacy of the Ritleng lacrimal intubation system in the treatment of congenital nasolacrimal duct obstruction. METHODS Twenty-six patients (29 eyes) with congenital nasolacrimal duct obstruction, who ranged in age from 2 to 12 years (mean, 4.85 +/- 2.9 years), underwent silicone intubation with the Ritleng lacrimal intubation system. The Ritleng lacrimal intubation system is composed of a Ritleng probe, a monofilament guide thread and a silicone tube. The prolene tip was removed from the inferior meatus with nasal endoscopy in 26 eyes, whereas this was done by using a Ritleng hook in 3. Clinical success was defined by the relief from symptoms and signs of obstruction. The tubes were left in place for an average of 6 months. The patients were followed up between 6 and 25 months (mean, 8.3 months). RESULTS All cases were successfully intubated with the Ritleng system. Two cases underwent reintubation because of tube dislocation during the first week. Granuloma developed at the edge of the inferior punctum in 1 case. We observed relief from symptoms in all cases. CONCLUSION The Ritleng lacrimal intubation system is an easy, effective and nontraumatizing procedure for the treatment of congenital nasolacrimal duct obstruction.
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Affiliation(s)
- Muslime Yalaz
- Department of Ophthalmology, Faculty of Medicine, Cukurova University, Balcali, TR-01330 Adana, Turkey
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Berlucchi M, Staurenghi G, Rossi Brunori P, Tomenzoli D, Nicolai P. Transnasal endoscopic dacryocystorhinostomy for the treatment of lacrimal pathway stenoses in pediatric patients. Int J Pediatr Otorhinolaryngol 2003; 67:1069-74. [PMID: 14550960 DOI: 10.1016/s0165-5876(03)00188-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Lacrimal pathway stenoses in pediatric patients are uncommon after the age of 1 year. Various conservative treatments (massages, hot compresses, topical antibiotics, probing and intubation of the lacrimal pathways) are generally used to resolve these disorders. When non-invasive procedures fail, dacryocystorhinostomy (DCR) is indicated. While this surgical procedure has traditionally been performed by an external approach, a less-invasive endonasal technique has recently been advocated. We herein review a series of six children affected by lacrimal pathway stenosis who were treated at the Department of Pediatric Otorhinolaryngology, Spedali Civili, Brescia (Italy) between November 2000 and January 2002. All patients underwent successful transnasal endoscopic DCR and, to date, no re-stenoses have occurred. A review of the literature focusing on diagnostic work-up and different therapeutic options is also presented.
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Affiliation(s)
- Marco Berlucchi
- Department of Pediatric Otorhinolaryngology, Spedali Civili, Brescia, Italy
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Abstract
This review covers evolving concepts in lacrimal outflow obstruction. Recent studies have increased our understanding of the surgical anatomy and pathophysiology of the lacrimal drainage system through radiologic, clinical, and microbiologic techniques. While external dacryocystorhinostomy remains an important treatment for nasolacrimal duct obstruction, there have been a number of therapeutic developments worthy of review, including advances in endoscopic and transcanalicular dacryocystorhinostomy, conjunctivodacryocystorhinostomy, and the use of mitomycin C in these procedures. In addition, we summarize recent advances in minimally invasive techniques for lacrimal outflow obstruction, including balloon dacryocystoplasty, lacrimal stents, and conjunctivoplasty. Finally, the roles of probing versus irrigation, nasal endoscopy, and endoscopic dacryocystorhinostomy in children are discussed.
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Affiliation(s)
- John T H Mandeville
- Ophthalmic Consultants of Boston and the Center for Eye Research, Boston, Massachusetts, USA
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