Usefulness of high definition sialoendoscope for evaluation of lacrimal drainage system in congenital nasolacrimal duct obstruction

Dacryoendoscopy in patients with lacrimal outflow obstruction: a systematic review

PURPOSE

Dacryoendoscopy (DE) is an emerging, minimally invasive, surgical technique for lacrimal outflow obstruction (LOO). This is a systematic review on the diagnostic and therapeutic use, as well as the safety of DE in the lacrimal literature.

METHODS

Up to 22nd November, 2024, 259 studies were retrieved from PubMed, Cochrane Library, and Ovid MEDLINE. After removing duplicates and applying the selection criteria, 18 eligible studies were included. A risk of bias assessment was conducted. The primary outcomes included diagnostic accuracies, therapeutic outcomes, and treatment-related complications. The specifications of DE, lacrimal stents, key procedural steps, and the use of operative adjuvants were also evaluated.

RESULTS

The DE provides additional endoluminal information for LOO by identifying the type (structural or secretory), the location (pre-sac or post-sac), and the pattern (focal or diffuse) of obstruction, while these parameters varied across studies. Notably, pressure-controlled, air-insufflated, high-definition DE (HDDE) provides significantly better image quality than saline-infused system. DE demonstrated variable therapeutic success, both objectively (anatomical and functional patency), and subjectively (symptomatic improvement). The use of adjuvants, such as ballon dacryoplasty, intubation, postoperative topical steroids, antibiotics, and irrigation, appeared to enhance the therapeutic outcomes. Complications were generally mild to minimum, with false passages being the commonest. DE manufactured in Japan and the "Nunchaku-type" of silicone tubes were most commonly used in the literature.

CONCLUSIONS

With instrumental advances and endoscopic experience, DE showed potential and early promises to be a minimal invasive alternative for diagnosing and treating LOO of different etiologies.

Nasal endoscopy-guided primary nasolacrimal duct intubation for congenital nasolacrimal duct obstruction in children older than 4 years

PURPOSE

To evaluate the clinical outcomes of endoscopic guided primary bicanalicular intubation (BCI) for congenital nasolacrimal duct obstruction (CNLDO) in children older than 4 years.

METHODS

A total of 40 eyes from 33 children (18 males, 15 females) with CNLDO who underwent bicanalicular intubation were evaluated. The type of CNLDO was determined by endonasal endoscopic visualisation. The mean silicone tube removal time was 4.3 ± 0.9 months (ranging from 3 to 6 months). The children were followed up for 6 months after the removal of tubes. Therapeutic success was defined as the normal result of the fluorescein dye disappearance test and complete resolution of previous lacrimal symptoms and signs.

RESULTS

The median age was 80 [48] (range 48-156) months. Treatment success was achieved in 32 of 40 eyes (80.0%). A statistically significant correlation was observed between the age and success rate (p = 0.006). The success rate was lower in older children. Membranous type of CNLDO was observed in 47.5% (19/40) of the cases. The median age of patients with a membranous and complex type of CNLDO were 60 [30] months and 96 [53] months, respectively. Surgical success was 100% in the membranous type of CNLDO and 61.9% in the complex CNLDO group.

CONCLUSIONS

Primary BCI using nasal endoscopic visualisation has a favourably high success rate for treating CNLDO in children aged 4 to 13 years. Treatment success was found to be related to both the type of CNLDO and age.