Is dacryocystectomy effective in reducing epiphora?

Purpose: To study the efficacy of dacryocystectomy (DCT) in reducing epiphora in cases of primary acquired nasolacrimal duct obstruction. Methods: This was a prospective, nonrandomized, interventional study conducted over a period of 12 months. All cases who either opted or satisfied our criteria for DCT in primary acquired nasolacrimal duct obstruction (age above 70 years) were included in the study. Patients with secondary nasolacrimal duct obstruction and those undergoing revision surgeries were excluded. Patients were asked to report the percentage improvement in postoperative watering subjectively. Munk score and fluorescein dye disappearance test (FDDT) were recorded pre? and postoperatively. Wilcoxon signed ranked test was used for analysis. Results: Eighty?two eyes of 65 patients were included. Most of the patients (46, 70.8%) were females. The mean age was 68.46 ± 5.7 years (range: 60–85 years). The mean subjective improvement in watering was 86.8%. The P value for preoperative and postoperative difference in Munk score and FDDT score was highly significant (P = 0.00001). Conclusion: Apart from providing relief from ocular discharge, DCT also provides significant improvement in watering. Patients can be preoperatively counseled regarding chances of reduction in epiphora following surgery

The electromyographic analysis of orbicularis oculi muscle in epiphora

Purpose: Functional epiphora is a clinical condition that presents with the complaint of watery eyes, but without anatomical stenosis in the lacrimal drainage system. Although the mechanism is not clear, there are various possibilities involving the movement of the orbicularis oculi muscle, especially its deeper segment (Horner’s muscle). We aimed to evaluate the function of the orbicularis oculi muscle in patients with patent, but dysfunctional lacrimal drainage system using a quantitative motor unit potential (MUP) analysis. Methods: Twenty?eight patients with functional epiphora (mean age = 59 years) and a control group of 28 volunteers were included in the study. Inclusion criteria were persistent and symptomatic epiphora or wiping >10 times per day and diagnosis confirmation by lacrimal irrigation test. Electromyography (EMG) was performed on the deeper segment of the orbicularis oculi muscle (medial and lateral parts). MUP parameters (duration time, amplitude, number of phases, number of turns, area, rise time, and thickness) were evaluated in both groups. Any increase in amplitude, prolongation time (>14 ms), number of turns, and satellite potential was taken as characteristic of the neurogenic type of epiphora, whereas shortened motor unit duration time, increased phase number, and low amplitude are the features of myopathic type. Results: Upon MUP analysis of the medial and lateral orbicularis oculi muscle, the increase in duration and thickness values in the medial part and the increase in duration, amplitude, area, and thickness values of the lateral part were found to be statistically significant in the patient group compared to the control group (P < 0.001). In the evaluation of the patients’ medial and lateral orbicularis oculi muscle, the increase in phase values and decrease in amplitude, area, and rise time values were found to be statistically significant (P = 0.024, P < 0.001, P < 0.001, and P = 0.010, respectively). Conclusion: These data show that functional epiphora is due to neurogenic damage of the orbicularis oculi muscle and should be investigated in more detail

Preliminary study on the correlation between primary lacrimal punctal stenosis and epiphora by using AS-OCT / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To quantify the lacrimal punctum using anterior segment optical coherence tomography(AS-OCT)and analyze the correlation between the epiphora and primary punctal stenosis.METHODS: A cross-sectional study. There were 43 healthy volunteers(57 eyes)and 44 patients(62 eyes)with primary lacrimal punctal stenosis and epiphora enrolled in the Lacrimal Center of the Third Medical Center of PLA General Hospital from September 2020 to January 2021. The inferior punctum of all subjects were scanned by AS-OCT, and the images were quantified in order to observe the AS-OCT image features. The outer punctal diameter, punctal depth, tear well diameter and tear well depth were all measured simultaneously. The inferior punctum's punctal reserve and punctal reserve ratio were estimated according to the available parameter data.RESULTS: 1)The measured parameters conforming to normal distribution were expressed as mean±standard deviation. The observation group's outer punctal diameter, tear well diameter, tear well depth, and punctal reserve ratio were 458.19±63.58μm, 200.34±84.69μm, 188.95±87.50μm and 0.32±0.18, respectively, while the control group's outer punctal diameter, tear well diameter, tear well depth and punctal reserve ratio were 655.53±82.62μm, 230.26±107.02μm, 275.30±144.34μm, 0.46±0.23, respectively. The parameters in observation group were all lower than those of control group(P&#x003C;0.05); 2)Parameter data that did not conform to normal distribution were expressed as medians and quartiles, and the results were as follows: the punctal depth in the observation group was 265.50μm(interquartile range 204.25-328.77)μm and the punctal reserve was 71.53μm(interquartile range 46.12-111.37)μm, respectively, while the punctal depth in the control group was 468.76μm(interquartile range 420.50-588.88)μm and the punctal reserve was 182.16μm(interquartile range 131.36-309.84)μm. This difference was statistically significant(P&#x003C;0.05); 3)In the observation group, there was a negative correlation between the epiphora and the outer punctal diameter(r=-0.448, P&#x003C;0.05), a positive correlation between the epiphora and tear well depth(r=0.335, P&#x003C;0.05), and a negative correlation between the epiphora and the punctal reserve and punctal reserve ratio coefficient(r=-0.520, -0.566, P&#x003C;0.05).CONCLUSION: The AS-OCT can aid in enhancing punctal morphology cognition; The outer punctal diameter and tear well depth are related to the epiphora; The primary punctal stenosis patients with smaller outer punctal diameters are more likely to have the symptom of epiphora, and in patients with punctal stenosis, the greater the potential capacity of the punctum to hold tears, the lesser the degree of epiphora.

Clinical Study on Surgical Outcomes of Endoscopic Dacryocystorhinostomy (DCR) between Powered and Non-Powered Techniques.

Dacryocystorhinostomy (DCR) is a bypass operation for tear drainage system which involves removal of bone adjacent to lacrimal sac and incorporating lacrimal sac with nasal mucosae. The operative approaches to lacrimal apparatus are external and endoscopic. In recent times advances in surgical technique and better standing of anatomy have made several changes in endoscopic DCR all aiming to improve results, reduce complications, and reduce operative time. Both costly powered and cost affective non-powered instruments are commonly used to make bone windows in endoscopic DCR. The aim of this study is to compare merits and demerits of powered instrument (Drill) and non-powered (Kerrison’s punch) DCR. METHODSA randomized comparative study of 60 patients in the age group of 21-70 yrs. who attended our outpatient department regularly and underwent endoscopic DCR procedure at our institution from June 2017 until Aug. 2019 was conducted. Patients were categorised into two groups of 30 patients each, one group which had patients who were operated conventionally by Kerrison’s punch and the group with patients who were operated by powered drill. Operative technique, surgical outcome and complications were compared between the two groups. RESULTSA total of 60 endoscopic endonasal DCRs were performed during the period. Male: female ratio; 1:5. 36 (60%) patients presented with watering of eye. Procedure success rate among Kerrison’s punch group was 93.33 % vs. 90% in powered drill group (p= 0.476). The complications rate in Kerrison’s punch group was 10% compared 20% in powered drill group (p= 0.032). The mean operating time among Kerrison punch group was 33.3 min which was significantly lower than that of powered drill group which was 78.3 min. CONCLUSIONSEndoscopic DCR is keyhole minimal invasive magic surgery. In a comparative study, Kerrison’s punch was found to be better tool for making bony window in terms of cost, operating time and complications when compared to powered drill. In terms of success rate of surgery and other factors, there was no significant difference between the two groups.

A Study of the Clinical and Epidemiological Profile of Patients with Congenital Dacryocystitis

Introduction: The most common functional abnormality ofthe infant’s lacrimal apparatus is the congenital blockage ofthe nasolacrimal duct. Non-canalisation of the duct, presenceof epithelial debris, mucous plug and bony occlusion are someof the possible causes of blockage. This was a prospectivestudy to identify the etiological agents, predisposing factorsand clinical profile of patients with congenital dacryocystitis.Material and Methods: A prospective observationalhospital based study was conducted on 72 eyes of 61 childrenpresenting with congenital dacryocystitis, in the age group 0-4years, attending the ophthalmology outpatient department in atertiary care teaching hospital.Results: Congenital dacryocystitis was common in agegroup of 0-3 months (31.15%). The incidence of disease inage group 4-6 months was 24.59% and 7-12 months was13.11%. 55.74% of males were affected. 83.61% of patientshad unilateral congenital dacryocystitis. 80.33% of thechildren had a normal delivery. 66.66% of cases presentedwith epiphora and discharge. 31.95% of cases presented withepiphora only. Epiphora with mucopurulent discharge was themost common presentation. Regurgitation test was positive in88.89% of cases. The nature of regurgitate was mucopurulentin 42.19% of cases.Conclusion: Congenital dacryocystitis usually presents at anearly age with epiphora and mucopurulent discharge. Earlydiagnosis helps in management.

Puntoplastia en dos cortes modificada en estenosis de puntos y canalículos lagrimales inferiores / Modified two-snip punctoplasty for stenosis of inferior lacrimal points and canaliculi

RESUMEN Objetivo: Determinar los resultados alcanzados con la utilización de la puntoplastia en dos cortes modificada en el manejo de los pacientes con estenosis de los puntos y canalículos lagrimales inferiores. Métodos: Se realizó un estudio descriptivo y retrospectivo de una serie de casos, en el Hospital Universitario Clínico Quirúrgico "Comandante Manuel Fajardo", desde enero del año 2016 a diciembre de 2018. La muestra quedó conformada por 22 pacientes (38 ojos), sometidos a la técnica quirúrgica, y fue caracterizada de acuerdo con la edad, el sexo, el color de la piel, la bilateralidad, la localización anatómica de la obstrucción, los antecedentes patológicos personales, las complicaciones y la evaluación funcional final. Resultados: De un total de 22 pacientes, 17 estuvieron entre las edades de 60 y 79 años, el 72,7 por ciento del sexo femenino y el 86,4 por ciento con piel de color blanco. La blefaritis fue el principal antecedente oftalmológico encontrado (18,2 por ciento), la obstrucción fue bilateral en el 72,7 por ciento de los casos, y fundamentalmente a nivel del punto lagrimal (16 casos). El 86,8 por ciento no mostró complicaciones posoperatorias; 3 casos presentaron extrusión del tutor de silicona, los cuales estuvieron en relación con el fallo en el resultado final. En el 92,1 por ciento se constató el éxito de la cirugía. Conclusiones: La estenosis de la vía lagrimal se produce principalmente en mujeres, de raza blanca, mayores de 60 años y sin antecedentes patológicos referidos. La afectación es más frecuente a nivel del punto lagrimal. Con la técnica quirúrgica se logra un resultado excelente y con complicaciones mínimas(AU)

ABSTRACT Objective: Determine the results achieved by modified two-snip punctoplasty in the management of patients with stenosis of inferior lacrimal points and canaliculi. Methods: A retrospective descriptive study was conducted of a case series at Comandante Manuel Fajardo Clinical Surgical University Hospital from January 2016 to December 2018. The sample was 22 patients (38 eyes) undergoing the surgical technique. The variables studied were age, sex, skin color, bilaterality, anatomical location of the obstruction, personal pathological antecedents, complications and final functional evaluation. Results: Of the total 22 patients, 17 were in the 60-79 years age group, 72.7 percent were female and 86.4 percent were white. Blepharitis was the main ophthalmological antecedent (18.2 percent). Obstruction was bilateral in 72.7 percent of the cases, fundamentally at the lacrimal punctum (16 cases). 86.8 percent did not have any postoperative complication, whereas 3 presented extrusion of the silicone tutor. These were related to failure in the final result. Surgery was successful in 92.1 percent of the cases. Conclusions: Lacrimal duct stenosis prevails in white skin women aged over 60 years without reported pathological antecedents. The disorder is more common at the lacrimal punctum. The surgical technique used achieves excellent results with minimum complications(AU)

Canaliculitis / Canaliculitis

RESUMEN La canaliculitis es una entidad rara, con frecuencia mal diagnosticada por su similitud con otras enfermedades. Se reporta una paciente femenina, de 56 años de edad, remitida a la Consulta de Oculoplastia del Instituto Cubano de Oftalmología "Ramón Pando Ferrer", por secreciones purulentas y epífora del ojo izquierdo. Al examen se observó hiperemia conjuntival, secreción purulenta, punto lagrimal inferior hiperémico, dilatado, y se constató salida de concreciones por este al comprimir el canalículo. Se confirmó el diagnóstico de canaliculitis aguda supurada con concreciones. Se indicó tratamiento quirúrgico, que consistió en la canaliculotomía con remoción de las concreciones. Un examen clínico detallado, con adecuado conocimiento de la vía lagrimal excretora, permitió el diagnóstico certero, con un tratamiento quirúrgico eficaz y una evolución satisfactoria(AU)

ABSTRACT Canaliculitis is an uncommon infectious disease. It is often misdiagnosed due to its overlapping presentation to other common entities. A 56-year-old female patient is reported. She was referred to Ramón Pando Ferrer Cuban Ophthalmologic Institute, Ocular Plastic Surgery consultation, suffering from punctal swelling, discharge, and epiphora. At ocular examination was described conjunctival hyperemia, pouting punctum and mucopurulent discharge. Punctal regurgitation of concretions appears under syringing. It was confirmed acute canaliculitis with concretions in the left eye. A canaliculotomy was performed, and the concretions were removed. Routine clinical examinations helped to get a right diagnosis of canaliculitis and the surgical result was satisfactory(AU)

A clinicobacteriological study of dacryocystitis in children

Background: Congenital Dacryocystitis occurs due to the congenital blockage of the nasolacrimal duct, which results from incomplete canalization of the nasolacrimal duct. It is a significant cause of ocular morbidity in children. When not treated early, complications such as recurrent conjunctivitis, acute on chronic dacryocystitis, lacrimal abscess and fistula formation can occur. It is also a threat to the integrity of the eye by becoming the source of infection to orbital cellulitis and panophthalmitis. In the era of antibiotic resistance, the microbiological workup of congenital dacryocystitis is very useful for subsequent treatment. Aim of the study was to determine the microbial profile of congenital dacryocystitis and the appropriate antimicrobial agents based on the sensitivity pattern of the isolated microorganisms.Methods: A total of 25 clinically diagnosed cases of dacryocystitis in children less than 5 years of age attending the outpatient department were included in the study. Samples were collected from these patients and processed by standard microbiological techniques. All the bacterial isolates obtained were subjected to antimicrobial susceptibility testing by using Kirby-Bauer disc diffusion method.Results: Culture positivity was noted as 56% in this study.' It is observed that Gram-positive bacteria were the predominant isolates of 86%. The predominant organism isolated was Streptococcus pneumoniae 43%, followed by Staphylococcus aureus 29%, Staphylococcus epidermidis 14% and Pseudomonas aeruginosa 14%. All Gram-positive organisms were highly sensitive to Gatifloxacin and least sensitive to Ciprofloxacin. All Gram-negative organisms were highly sensitive to Tobramycin and least sensitive to Ciprofloxacin and Gentamicin.Conclusions: Streptococcus pneumoniae was the common pathogen in congenital dacryocystitis. Gatifloxacin and Tobramycin are the most effective drugs. Microbial culture and sensitivity should be performed in all dacryocystitis cases. This would contribute to the choice of appropriate and effective antimicrobial agents.

Result of Probing for Congenital Nasolacrimal Duct Obstruction in Children Less than 1 Year Versus Children Greater than 1 Year

Congenital obstruction of nasolacrimal duct is a very common cause of epiphora in new born children.Controversy exists regarding the natural course and management of children with congenital nasolacrimalduct obstruction. The present study was undertaken on 80 children of congenital nasolacrimal duct obstructionwith no previous intervention. They were divided into two groups of 40 each. Group 1 had children aged lessthan 1 year and Group 2 comprised of children older than 1 year. Probing was done under general anesthesia.The mean age of the patients in Group 1was 8.35±2.65 months and that of the children in Group 2 was27.5±11.98 months. The overall success rate of probing was 78.75%. Success rates in Group 1 and Group2 were 85% and 72.5%, respectively. The difference between the two groups was statistically insignificant.However, there was a significant difference in the success rate of probing depending on the type of obstruction(p<0.05). Membranous obstruction of NLD was associated with increased success rates of probing ascompared to firm obstruction of NLD (p=0.001230, Yates corrected Chi square =0.0009578). Probing is asafe option of treating congenital nasolacrimal duct obstruction. Probing is beneficial in older children althoughthe success rate of probing tends to decline with increasing age. Firm anatomical obstruction in nasolacrimalduct is associated with a decline in the success rate of probing.

Epiphora drainage by DCR – Long-term results

Background: Dacryocystorhinostomy (DCR) refers to the surgical procedure that is used to relieve the chronic obstruction of the nasolacrimal duct obstruction (NLDO). In a maxillofacial setting, NLDO may arise subsequent to a facial trauma or orthognathic surgery. There is a dearth of literature from this part of the world. This article intends to provide a single maxillofacial center experience in DCR. Materials and Methods: This is a retrospective, noncomparative, noninterventional, record audit type of study of all consecutive patients fulfilling inclusion and exclusion criteria. All patients with epiphora and diagnosed with lacrimal apparatus damage between 1 January 2008 and 31 December 2017 requiring DCR were considered for the study. Details of demographics, phase of treatment (primary/retreatment), types of bones involved, age, complications, period suffering from epiphora, and follow-up were obtained. All data were entered and analyzed using the Statistical Package for the Social Service (version 16; IBM). Descriptive statistics of the frequency and mean ± standard deviation (SD) as appropriate were presented. Chi-square test and one-way analysis of variance were used appropriately. P ≤ 0.05 was taken to be statistically significant. Results: In all, 83 patients fulfilled the inclusion and exclusion criteria. It is more common in males (n = 56, 67.47%) with a mean ± SD of 32.24 ± 10.80 (18–59 years) with 27 (32.53%) of them presenting primarily after fractures. Fracture was the most common pathology seen in 81.93% (n = 68) of cases, while the rest were as a result of orthognathic cases. Le Fort II and III set of bones contributed to 59% of cases, while the orbitonasal complex contributed to only three cases. NLD obstruction was seen in 68 (81.9%) of cases. On an average, the patients suffered for 9.3 ± 6.74 months (range 0.5–22 months) before seeking treatment and the average follow-up was 31.07 ± 11.69 months (range 15–54 months). Discussion and Conclusion: Fractures and surgeries involving nasal bones carry an innate risk of damaging the NLD system. The pattern of need for DCR and occurrence of NLDO in this part of the world have been described. The extent of the anatomical variations and need for proper surgical planning are highlighted.

Bilateral simultaneous endoscopic dacryocystorhinostomy: outcome and impact on the quality of life of the patients

Introduction: Bilateral simultaneous endoscopic dacryocystorhinostomy (endo-DCR) has received little attention in the literature, thus many surgeons continue to address bilateral nasolacrimal duct obstruction at two stages, rather than in the same setting. Objective: To evaluate the feasibility and the outcome of simultaneous bilateral Endo- DCR and its impact on the quality of life of the patients. Methods: We have conducted a retrospective analysis of patients who underwent bilateral simultaneous endo-DCR between March 2013 and February 2017 at our tertiary care institution. The reviewed data included clinical presentation; operative details; success rate; pre and postoperative evaluation of the symptoms of the patients, using the Nasolacrimal Duct Obstruction Symptom Score Questionnaire; satisfaction of the patients, and improvement in the quality of life, assessed by the Glasgow Benefit Inventory (GBI) questionnaire. Results: Out of 128 cases in which endo-DCRs were performed, 13 were bilateral (26 sides). Postoperative success was documented in 24 of the 26 sides (92.3%), with a mean follow-up duration of 16.2 months. The two failed sides were reported in the same case. The preoperative symptom score ranged between 12 and 80 (mean ± standard deviation [SD]: 38.23 ± 15.7). The postoperative symptom score was significantly lower (mean ± SD: 5.4 ± 12.9). The success rates in unilateral and bilateral cases were comparable, with no statistically significant difference. A notable improvement in the quality of life of the patients was also reported, with a mean GBI score of 81.38 ± 12.37. Conclusion: Our results support that a simultaneous bilateral endo-DCR is a safe procedure that offers a high success rate, spares the patient from the stress of a second surgery, provides the patient with a bilateral resolution of the symptoms, and confers an immediate improvement in the quality of life of the patients (AU)

Development of Predictive Models in Patients with Epiphora Using Lacrimal Scintigraphy and Machine Learning / 대한핵의학회잡지

PURPOSE: We developed predictive models using different programming languages and different computing platforms for machine learning (ML) and deep learning (DL) that classify clinical diagnoses in patients with epiphora. We evaluated the diagnostic performance of these models.METHODS: Between January 2016 and September 2017, 250 patients with epiphora who underwent dacryocystography (DCG) and lacrimal scintigraphy (LS) were included in the study. We developed five different predictive models using ML tools, Python-based TensorFlow, R, and Microsoft Azure Machine Learning Studio (MAMLS). A total of 27 clinical characteristics and parameters including variables related to epiphora (VE) and variables related to dacryocystography (VDCG) were used as input data. Apart from this, we developed two predictive convolutional neural network (CNN) models for diagnosing LS images. We conducted this study using supervised learning.RESULTS: Among 500 eyes of 250 patients, 59 eyes had anatomical obstruction, 338 eyes had functional obstruction, and the remaining 103 eyes were normal. For the data set that excluded VE and VDCG, the test accuracies in Python-based TensorFlow, R, multiclass logistic regression in MAMLS, multiclass neural network in MAMLS, and nuclear medicine physician were 81.70%, 80.60%, 81.70%, 73.10%, and 80.60%, respectively. The test accuracies of CNN models in three-class classification diagnosis and binary classification diagnosis were 72.00% and 77.42%, respectively.CONCLUSIONS: ML-based predictive models using different programming languages and different computing platforms were useful for classifying clinical diagnoses in patients with epiphora and were similar to a clinician's diagnostic ability.

Spectral domain optical coherence tomography for measuring tear film meniscus height and its relationship with epiphora

Purpose: To evaluate the relationship between tear meniscus height (TMH) values measured by optical coherence tomography (OCT) and the severity of epiphora (Munk scoring). Methods: In this prospective cross-sectional study, consecutive patients with epiphora were studied. All patients underwent Munk epiphora scoring, lacrimal syringing, and detailed ophthalmological examination. Using OCT, the TMH (i.e., the line intersecting level of tear meniscus and lower eyelid) values were calculated. The relationship between TMH and epiphora was analyzed by comparing TMH values across various grades of epiphora using Kruskal–Wallis test. Results: A total of 38 patients (56 eyes) were included. The mean age was 55 ± 11.1 years with equal distribution of males and females. The mean TMH values were 238 ± 141.3, 396.6 ± 159.5, 707.1 ± 288.8, and 809.5 ± 419.4 ?m in grades 1, 2, 3, and 4 of epiphora, respectively. A significant difference in TMH was found among grades 2, 3, and 4 (P = 0.0007). On post hoc analysis, only grade 2 was significantly different from grades 3 and 4 (P = 0.0008 and P = 0.002 respectively), but grades 3 and 4 were comparable (P = 0.62). Conclusion: Levels of TMH were found to increase with increasing severity of epiphora. TMH values were comparable in Munk grades 3 and 4.

Zepto-rhexis: A new surgical technique of capsulorhexis using precision nano-pulse technology in difficult cataract cases

Several techniques are used to make a capsulorhexis in white mature cataract cases as needle cystotome, Utrata capsulorhexis forceps, microincision capsulorhexis forceps, femtosecond Laser, etc. Zepto precision nano-pulse capsulotomy device (Mynosys Cellular Devices; Fremont, CA, USA) is Food and Drug Administration approved, a disposable capsulotomy device that uses low-energy pulses to create a precise central capsulorhexis, independent of pupil size, corneal clarity, or lens density. In this article, the authors report their experience of performing anterior circular curvilinear capsulorhexis with Zepto precision nano-pulse capsulotomy device in challenging cataract cases done at our center. The Zepto handpiece device was inserted through 2.8 mm clear corneal incision. Results of our study in 3 cataract cases (intumescent cataract, morgagnian cataract, and cataract with small pupil) revealed that the precision pulse capsulotomy technology mechanically and simultaneously cleaves all 360� of the apposed capsule of without cauterizing it, creating CCC of 5.2 mm size.

Functional success evaluation of lacrimal drainage system by dacryoscintigraphy after transcanalicular diode laser dacryocystorhinostomy

Purpose: The purpose of the study was to evaluate the functional success rates using dacryoscintigraphy (DSG) after transcanalicular diode laser dacryocystorhinostomy (TDL-DCR). Methods: In this retrospective study, we investigated the records of 56 patients who underwent TDL-DCR for unilateral primary acquired nasolacrimal duct obstruction and anatomic patency was achieved. The lacrimal drainage systems of the other eyes of the patients were normal and were selected as control group. The functional success was evaluated with tear transit time (TT) on DSG and epiphora complaints' score (ECS) at postoperative 6 months. Results: Twenty-two (39%) of the patients were male and 34 (61%) were female, with a mean age of 46.6 (21�). The dacryoscintigraphic findings of the operated and healthy eyes showed that there was statistically insignificant prolongation in the tear TT at the operated side at postoperative 6th month (P > 0.05). The mean ECS of operated eyes was 0.89. Functional success was achieved in 43 (76.8%) patients when the ECS of 0 and 1 was accepted as successful. A statistically significant delay in drainage was observed in DSG in all of the cases with epiphora score of 2 and 3 (P < 0.05). The tear TT was prolonged with the age increase (P < 0.05), but there was no significant difference concerning the gender. Conclusion: DSG is an effective tool to evaluate the functional success of TDL-DCR.

Bilateral herpes simplex keratitis reactivation after lacrimal gland botulinum toxin injection

Botulinum toxin A (BTA) injections into lacrimal gland are being used for refractory epiphora due to intractable lacrimal disorders with success rates reported from 18% to 86%. Most common side effects are transient ptosis and diplopia. We report a case of a 59-year-old female injected with 2.5 units of BTA injection in each lacrimal gland for functional epiphora. The patient had a history of herpes simplex viral keratitis that was quiescent for more than 2 years. After 3 weeks, she developed reactivation of viral keratitis bilaterally, which was successfully managed with antivirals and topical steroids. Reactivation of quiescent herpes simplex keratitis is a possibility after lacrimal gland BTA and caution should be exercised in such cases.

Actinomycetes canaliculitis complicating congenital nasolacrimal duct obstruction in an infant

Actinomyces israelii is a Gram-positive anaerobic organism commonly associated with canaliculitis in adults. Pediatric canaliculitis is relatively rare, especially in infancy. We report the case of an 11-month-old boy who presented with co-existing canaliculitis and congenital nasolacrimal obstruction. The presenting signs included epiphora, discharge, conjunctival congestion, and matting of lashes. On examination, punctual pouting, regurgitation, and yellow canaliculiths were noted. A punctoplasty and canalicular curettage were performed along with nasolacrimal probing. Microbiological tests confirmed the organisms to be A. israelii. We discuss the clinical features and management of Actinomyces-associated canaliculitis and review the available literature on pediatric canaliculitis.

Éxito del sondaje en la obstrucción congénita de la vía lagrimal: Diez años de experiencia / Success in probing for congenital nasolacrimal duct obstruction: Ten years experience

Introducción. La obstrucción congénita de la vía lagrimal es una patología común, de poca morbilidad, pero no exenta de complicaciones sin el diagnóstico y manejo correcto. Población y métodos. Estudio retrospectivo de 2005 a 2015 en pacientes que fueron sometidos a un procedimiento de sondaje. Se identificó edad al momento del procedimiento, género, lateralidad y presencia o ausencia de éxito con el procedimiento. Resultados. Se analizaron 137 ojos. La mediana de edad fue de 17 meses y la tasa de éxito total fue del 85,4%. Conclusión. La obstrucción congénita de la vía lagrimal con adecuado manejo conservador inicial tiene alta tasa de resolución espontánea y, en pacientes mayores de 12 meses, el sondaje tiene una alta tasa de éxito.

Introduction. The congenital nasolacrimal duct obstruction is a common pathology, with low morbidity, but not exempt of complications without the correct diagnosis and management. Methods. Retrospective study from 2005 to 2015 in patients who were submitted to a probing procedure. We identified age at procedure, gender, laterality and presence or absence of success with the procedure. Results. One hundred thirty-seven eyes were analyzed. The median age was 17 months and the total success rate was 85.4%. Conclusion. In congenital nasolacrimal duct obstruction there is a high rate of spontaneous resolution with the proper initial conservative management and, in patients older than 12 months, probing has a high rate of success.

Management of Nasolacrimal Duct Obstruction: ENT Surgeon's Perspective / 대한이비인후과학회지

Epiphora is an overflow of tears onto the face and mainly occurs secondary to abnormal excretory system such as nasolacrimal duct obstruction (NLDO), which could be congenital or acquired. In past years, patients with NLDO have been usually managed by ophthalmologists using external dacryocystorhinostomy (EX-DCR) which has been considered the gold standard of treatment. Recently, the advancement of nasal endoscope and endoscopic sinus surgery has contributed to perform endoscopic DCR (EN-DCR), which now offers comparable success rate to EX-DCR with many advantages. ENT surgeons are familiar with intranasal anatomy and nasal endoscope handling rather than ophthalmologists. Therefore, these advantages lead to more ENT surgeons performing endoscopic DCR. However, the learning curves exist to reach a favorable success rate because surgical technique should be delicate in the narrow nasal cavity. This paper attempts to describe management of epiphora from ENT perspective, focus on surgical anatomy, evaluation modalities and update on endoscopic technique and surgical outcome compared with EX-DCR. This present review would serve as a guide for beginners and increase their confidence with endoscopic anatomy and correct management of epiphora including EN-DCR procedures.