Deterioration of contrast sensitivity in eyes with epiphora due to lacrimal passage obstruction

Outcomes of external and endonasal dacryocystorhinostomy according to a modified Lacrimal Symptom Questionnaire (Lac-Q)

Background

Nasolacrimal duct obstruction is usually treated using endoscopic or external dacryocystorhinostomy (DCR). The anatomic outcomes of both the endoscopic and external approaches are considered excellent. However, anatomic success does not translate into patient satisfaction. The current study assessed pre- and postoperative lacrimal problems using the symptom-based Lacrimal Symptom Questionnaire (Lac-Q) and investigated patient satisfaction depending on the choice of surgical technique.

Methods

A total of 112 eligible patients with lacrimal problems treated using external or endonasal DCR at the ophthalmology and ear, nose, and throat clinics at Skane University Hospital, Scania, Sweden, over a four-year period, were enrolled in this retrospective study. Patients were considered eligible if they experienced preoperative epiphora and had lacrimal duct stenosis. They were offered treatment using either external or endonasal DCR and were allowed to freely choose the technique. Exclusion criteria consisted of previous ipsilateral DCR, congenital NLDO, age < 18 years, presence of cancer, previous orbital trauma, or noncompliance with postoperative follow-up. After surgery, the patients were sent the Lac-Q to evaluate their lacrimal symptoms pre- and postoperatively. Complementary questions were added pertaining to the operative scar and the patients' overall satisfaction with the operation.

Results

In total, 67 (60%) patients with ages ranging from 18 to 88 years completed the questionnaire, 33 (49%) of whom underwent external DCR and 34 (51%) endonasal DCR. Of the 67 respondents, 51 (76%) were women and 16 (24%) were men. Patients scored preoperative lacrimal problems highly on the Lac-Q, reporting both symptomatic and social problems due to epiphora. Following surgery, the group that underwent external DCR remained home from work for 2 - 14 days (median, 3.5 days). However, 17 (52%) were retired. After the endonasal DCR, the patients remained home for 0 - 7 days (median, 2 days). Most patients were satisfied after DCR surgery, with both techniques significantly improving total, lacrimal symptom, and social impact scores (all P < 0.001). No differences in postoperative satisfaction were observed between the external DCR and endonasal DCR groups (P > 0.05). A small number of patients expressed scar-related concerns after external DCR.

Conclusions

The patients perceived lacrimal problems as a significant symptomatic and social burden. Postoperative satisfaction and symptom relief were good regardless of the surgical approach. Further prospective studies assessing patient satisfaction and its correlation with anatomical and functional success rates after external and endonasal DCR could provide robust, practical, real-world implications.

Association between tear meniscus dimensions and higher-order aberrations in patients with surgically treated lacrimal passage obstruction

PURPOSE

To analyze the relationship between tear meniscus dimensions and higher-order aberrations (HOAs) in patients with lacrimal passage obstruction using anterior segment optical coherence tomography (AS-OCT).

METHODS

This study was a retrospective observational study of 71 eyes of 49 patients with lacrimal passage obstruction. These patients received sheath-guided dacryoendoscopic probing and bicanalicular intubation (SG-BCI) at Toyama University Hospital between August 2020 and October 2021. Using AS-OCT, tear meniscus height (TMH), tear meniscus area (TMA), and total corneal HOAs values were measured before and after surgery.

RESULTS

Surgical success was achieved in 69 eyes (97.1%). At the final observation, 62 eyes showed lacrimal patency (89.8%). The preoperative TMH, TMA, and HOAs values were 1.55 ± 0.96 mm, 0.11 ± 0.14 mm², and 0.37 ± 0.27 µm, respectively, and the final postoperative TMH, TMA, and HOAs values were 0.97 ± 0.74 mm (p < 0.0001), 0.06 ± 0.11 mm² (p = 0.02), and 0.29 ± 0.16 µm (p = 0.001), respectively. The results showed a significant improvement. The changes in HOAs before and after surgery were positively correlated with the changes in TMH (r = 0.3476, p = 0.0241) and TMA (r = 0.3653, p = 0.0174).

CONCLUSION

SG-BCI for lacrimal passage obstruction resulted in a significant decrease in measured HOAs. The decrease in HOAs was correlated with decreases in tear meniscus dimensions.

Improvement in Dacryoendoscopic Visibility after Image Processing Using Comb-Removal and Image-Sharpening Algorithms

Recently, a minimally invasive treatment for lacrimal passage diseases was developed using dacryoendoscopy. Good visibility of the lacrimal passage is important for examination and treatment. This study aimed to investigate whether image processing can improve the dacryoendoscopic visibility using comb-removal and image-sharpening algorithms. We processed 20 dacryoendoscopic images (original images) using comb-removal and image-sharpening algorithms. Overall, 40 images (20 original and 20 post-processing) were randomly presented to the evaluators, who scored each image on a 10-point scale. The scores of the original and post-processing images were compared statistically. Additionally, in vitro experiments were performed using a test chart to examine whether image processing could improve the dacryoendoscopic visibility in a turbid fluid. The visual score (estimate ± standard error) of the images significantly improved from 3.52 ± 0.26 (original images) to 5.77 ± 0.28 (post-processing images; p < 0.001, linear mixed-effects model). The in vitro experiments revealed that the contrast and resolution of images in the turbid fluid improved after image processing. Image processing with our comb-removal and image-sharpening algorithms improved dacryoendoscopic visibility. The techniques used in this study are applicable for real-time processing and can be easily introduced in clinical practice.

Dacryoendoscopic recanalization of lacrimal passage obstruction/stenosis after radioiodine therapy for differentiated thyroid carcinoma

Purpose

Radioiodine therapy, a standard treatment for differentiated thyroid carcinomas, is associated with several adverse events including lacrimal drainage system obstruction. Herein, we describe the first case of duct lumen recanalization using dacryoendoscopy for lacrimal passage obstruction and stenosis after radioiodine therapy.

Observations

A 48-year-old female treated with radioiodine therapy for differentiated thyroid carcinoma 5 years prior presented with epiphora in both eyes. Dacryocystography showed nasolacrimal duct stenosis in the right eye and nasolacrimal duct obstruction in the left eye. Dacryoendoscopic examination revealed right common canalicular polyps, fibrosis in the right lacrimal sac, right nasolacrimal duct stenosis, and left upper and common canaliculus stenosis. Lacrimal passage recanalization with the insertion of a nasolacrimal stent tube using dacryoendoscopy was performed on the right eye. This successfully resolved the epiphora.

Conclusions and importance

Dacryoendoscopic examination for epiphora after radioiodine therapy may help detect early-stage nasolacrimal passage obstruction/stenosis. This condition can be resolved by recanalization and insertion of a lacrimal tube, without the need for a more invasive surgical approach such as dacryocystorhinostomy.

Improvement in Contrast Sensitivity Function after Lacrimal Passage Intubation in Eyes with Epiphora

This prospective case series aimed to investigate the contrast sensitivity function before and after lacrimal passage intubation (LPI) in eyes with epiphora due to lacrimal passage obstruction. We included 58 eyes of 51 patients who underwent LPI for lacrimal passage obstruction. The best-corrected visual acuity (BCVA), contrast sensitivity function, and lower tear meniscus were compared before LPI and one month after lacrimal duct stent removal. The area under the log contrast sensitivity function (AULCSF) was calculated for the analyses. Lower tear meniscus was assessed using anterior segment optical coherence tomography. The BCVA was comparable (p = 0.61) before and after LPI, while AULCSF increased significantly after treatment (before LPI: 1.29 ± 0.17, after LPI: 1.37 ± 0.14, p < 0.0001). Treatment resulted in a significant increase in contrast sensitivity at all spatial frequencies, 3–18 cycles/degree (p < 0.01 for 3, p < 0.01 for 6, p < 0.0005 for 12, p < 0.05 for 18 cycles/degree). The lower tear meniscus parameters improved significantly after treatment (p < 0.005); however, no correlation between the changes in the tear meniscus and those of the AULCSF was found. The contrast sensitivity significantly improved after LPI in eyes with epiphora due to lacrimal passage obstruction.