Dacriocistorrinostomía endoscópica: experiencia de 4 años del Hospital Clínico de la Universidad de Chile / Endoscopic dacryocystorhinostomy: four years experience at the Clinical Hospital of the University of Chile

Introducción: La dacriocistorrinostomía abierta es el gold estándar para el tratamiento de la obstrucción nasolacrimal, patología manifestada como epífora crónica, dacriocistitis y conjuntivitis recurrente. Desde el desarrollo del abordaje endonasal, se ha considerado como una alternativa terapéutica eficaz con notorias ventajas respecto a la técnica abierta y que además ofrece la posibilidad de corregir otras alteraciones de la nariz y cavidades paranasales en el mismo tiempo quirúrgico. Objetivo: Evaluar los resultados de la técnica quirúrgica endoscópica según la realidad del Hospital Clínico de la Universidad de Chile, durante los años 2010-2014. Determinar la etiología de la obstrucción en los pacientes intervenidos. Material y método: Se realizó un estudio de cohorte retrospectivo con revisión de fichas clínicas de pacientes con diagnóstico de obstrucción de la vía lacrimal sacular y postsacular sometidos a dacriocistorrinostomía endoscópica. Se incluyeron 27pacientes entre los cuales se realizaron 33 cirugías, ya que 22,2% de ellos (6/27) fueron sometidos a intervención bilateral. Resultados: El éxito quirúrgico objetivo y subjetivo se presentó en 75,8% (25/33) y 65,4% (17/26) respectivamente. El 7,4% (2/27) presentaron complicaciones intraoperatorias (falsa vía y extrusión de grasa orbitaria) y 18,5% (5/27) complicaciones posoperatorias (sinequias y fibrosis). Dentro de las causas destacan: idiopática 66,7% (18/27), postraumática 14,8% (4/27), secundaria a utilización de radioyodo 11,1% (3/27), granulomatosis de Wegener3,7% (1/27)y congénita 3,7% (1/27). La sonda instalada se mantuvo por un promedio de 3,5 meses, y el seguimiento se realizó por un periodo de 7,4 meses. Conclusión: La dacriocistorrinostomía endoscópica resulta ser una excelente herramienta quirúrgica para el manejo de pacientes con diagnóstico de obstrucción nasolacrimal, siendo un procedimiento exitoso, seguro, con baja tasa de complicaciones y una muy buena evolución posoperatoria, recomendado para todos aquellos casos con mala respuesta a las terapias médicas.

Introduction: Open dacryocystorhinostomy is the gold standard for the treatment of nasolacrimal obstruction, pathology manifested as chronic epiphora, recurrent dacryocystitis and conjunctivitis. Since the development of endonasal approach, it has been considered as an alternative therapy with notable advantages over the open technique and offers the possibility to correct other abnormalities of the nose and paranasal sinuses in the same surgical time. Aim: To evaluate the results of endoscopic surgical technique according to the reality of the Clinical Hospital of the University of Chile, during the years 2010-2014. Determine the etiology of the obstruction in patients undergoing surgery. Material and method: A retrospective cohort study was performed with review of clinic files of patients diagnosed with lacrimal duct obstruction submitted to an endoscopic dacryocystorhinostomy. 27 patients were included and 33 surgeries were performed, as 22.2% of them (6/27) underwent bilateral intervention. Results: Objective and subjective surgical success occurred in 75,8% (25/33) and 65,4% (17/26) respectively. 7,4% (2/27) had intraoperative complications (false passage and orbital fat extrusion) and 18,5% (5/27) postoperative complications (fibrosis and synechiae). Among the causes are: idiopathic 66,7% (18/27), postraumatic 14.8% (4/27), history of radioiodine use 11.1% (3/27), Wegener's granulomatosis 3.7% (1/27) and congenital 3.7% (1/27). Probe Installed was kept for an average of 3,5 months, and the follow-up was performed for 7,4 months. Conclusions: Endoscopic dacryocystorhinostomy is an excellent surgical tool for the management of patients with nasolacrimal obstruction. It's a successful procedure, with low rate of complications and good postoperative outcome, recommended for those cases with poor response to medical therapies.

A Case of Pseudomonas fluorescens Infection after Dacryocystorhinostomy and Silicone Tube Intubation

PURPOSE: To report a case of Pseudomonas fluorescens infection following endoscopic dacryocystorhinostomy and silicone tube intubation in a healthy patient who was using steroid nasal spray. In addition, a literature review is conducted. CASE SUMMARY: A 72-year-old female patient came to our clinic with tearing and hyperemia in the right eye. Ten months prior, she had undergone endoscopic dacryocystorhinostomy and silicone tube intubation due to nasolacrimal duct obstruction in the right eye. Six months after the first operation, dacryocystorhinostomy revision with silicone tube exchange was performed due to obstruction of the nasal bony orifice. In addition, the patient was using a steroid nasal spray. On slit lamp examination, conjunctival injection, marked inflammation and punctal edema around the tube were observed. The silicone tube was removed and the tube cultured. Pseudomonas fluorescens was isolated from the tube contents. The patients was treated with topical 0.3% gatifloxacin 4 times a day, methylol cephalexin lysinate 1000 mg 3 times a day and the nasal spray was discontinued. Two weeks later, all symptoms were resolved after treatment with antibiotic treatment. CONCLUSIONS: A case of Pseudomonas fluorescens canaliculitis which occurred in healthy patient who was using steroid nasal spray is presented with a literature review. Pseudomonas fluorescens canaliculitis can be treated by using proper antibiotics.

Computed tomography dacryocystography research of nasolacrimal duct of unilateral congenital nasolacrimal obstruction / 中华实验眼科杂志

BackgroundThe three-dimensional configuration of the nasolacrimal canal is highly variable with age,gender,and race.But enlargement of the nasolacrimal canal has sparsely been reported in the literature.Objective Computed tomography dacryocystography was performed in patients with unilateral congenital nasolacrimal duct obstruction and normal children to analyze the difference of bilateral nasolacrimal canal.MethodsThis is a retrospective study.Axial scanwith sagittalandcoronalreconstructionwas appliedin computedtomography dacryocystography.Diameters of bilateral nasolacrimal canal of 20 unilateral congenital nasolacrimal duct obstruction patients and 20 normal children were measured.Written informed consent was obtained from each child ' s parents before examination.ResultsThe lacrimal sac,nasolacrimal duct and the peripheral tissue were clearly exhibited by computed tomography dacryocystography.The diameters of the origination,the middle part and the distal end of affected nasolacrimal duct were(5.5±1.4),(5.3±1.2),(5.3±1.6) mm,and normal ones were(3.9±0.8 ),(3.5± 0.8 ),( 3.9± 1.3 ) mm,respectively.These results were statistically significant ( t =5.200,6.967,2.932,P＜ 0.05 ).There was no statistically significant difference in bilateral nasolacrimal canal of normal children (t =0.346,0.281,0.312,P＞0.05 ).Conclusions Computed tomography dacryocystography can image lacrimal passage and their peripheral tissues clearly.The affected nasolacrimal canal diameters of unilateral congenital nasolacrimal duct obstruction were much larger than the fellow sides.The pathogenesis of this phenomenon need much research.

A Case of Congenital Dacryocystocele

A 6-day-old infant presented with a deeply bluish cystic mass below the right medial canthus. She had been born healthy. Under the impression of a hemangioma brain computed tomography was conducted. As a result, a diagnosis of congenital dacryocystocele was made. We present this case to show that it is important for a dermatologist to correctly identify congenital dacryocystoceles and appropriately refer the infant to a pediatric ophthalmologist prior to performing invasive measures.

Long-term Results of Silicone Tube Intubation in Incomplete Nasolacrimal Duct Obstruction (NLDO)

PURPOSE: To evaluate the results of long-term follow-up of silicone tube intubation in patients with acquired nasolacrimal duct obstruction (NLDO) that is incomplete. METHODS: A retrospective analysis was conducted of the outcomes of silicone intubation performed between 1998 and 2003. During that period, we performed silicone intubation on 109 eyes, but only 45 eyes that completed at least 6 months of follow-up were included in the analysis. RESULTS: The mean follow-up period was 30.4 months (6~76 months), and silicone tubes remained in place an average of 6.5 months (1~18months). The success rate, which is defined as the improvement of epiphora symptoms with patent nasolacrimal irrigation. CONCLUSIONS: Silicone tube intubation is a simple, cost-effective, and beneficial treatment for patients, but the recurrence rate increases over time, especially several years after the operation.

Evaluation of the Functional Nasolacrimal Duct Obstruction with Digital Subtraction Dacryocystography

PURPOSE: We evaluated the structural abnormality of the lacrimal drainage system by using digital subtraction dacryocystography in patients with functional nasolacrimal obstruction. METHODS: From April 2001 to March 2002, digital subtraction dacryocystography was performed in 17 eyes of 11 patients who had patent lacrimal systems on syringing with no known underlying cause of epiphora. RESULTS: Six eyes of 5 patients showed a diffuse incomplete nasolacrimal duct obstruction inferior to the lacrimal sac, and one eye of 1 patient had a filling defect in lacrimal sac. Fifteen eyes of 10 patients were received silicone tube intubation and one eye of 1 patient underwent dacryocystorhinostomy. CONCLUSIONS: There might be anatomical abnormalities in the lacrimal drainage system although it is clinically diagnosed as functional nasolacrimal obstruction. Digital subtraction dacryocystography will provide a better understanding on various causes of epiphora, and give a precise diagnosis and proper treatment.

Diagnosis of Functional Nasolacrimal Duct Obstruction Using Dacryoscintigraphy / 대한핵의학회잡지

PURPOSE: To evaluate the value of dacryoscintigraphy in the assessment of patients with a clinical diagnosis of functional nasolacrimal duct obstruction. MATERIALS AND METHODS: Dacryoscintigraphy was performed in symptomatic 35 lacrimal drainage systems in 18 patients (age range: 37~76, 8 males, 10 females) that were patent on syringing. RESULTS: Abnormalities were detected with dacryoscintigraphy in 75.8% of systems. The positive scintigrams were subdivided into those demonstrating prelacrimal sac delay (31.8%), delay at the lacrimal sac/junction (40.9%), or delay within the duct (27%). CONCLUSION: Dacryoscintigraphy is noninvasive useful technique in the assessment of the functional nasolacrimal duct obstruction and very sensitive at detecting abnormalities in patients with lid laxity caused by senile change and facial nerve palsy.