Outcome of Endonasal Dacryocystorhinostomy with Nasal and Lacrimal Sac Mucosal Flaps

Purpose@#In patients with nasolacrimal duct obstruction, the outcomes of surgery were evaluated according to the type or presence of flaps. @*Methods@#In total, 509 eyes were compared retrospectively: 178 eyes in patients treated without flaps, 126 eyes in patients treated using nasal mucosa flaps, and 205 eyes in the patient group using nasal and lacrimal sac mucosal flap were compared retrospectively. We analyzed the factors of success according to the surgical method by comparing granulation and bony ostium obstruction at 1, 3, and 6 months after surgery in each group. @*Results@#At 6 months after surgery, granulation was found in 6 eyes (2.93%) in the nasal and lacrimal sac mucosal flap group, 5 eyes (3.96%) in the nasal mucosal flap group, and 15 eyes (8.42%) in the group treated without flaps. Bony ostium obstruction was found in 3 eyes (1.46%) in the nasal and lacrimal sac mucosal flap group, 4 eyes (2.38%) in the nasal mucosal flap group, and 6 eyes (2.81%) in the group treated without flaps. The anatomical surgical success rate of patients treated with nasal and lacrimal sac mucosal flaps was 95.61%, which was higher than those of patients treated with nasal mucosal flaps (92.86%) and without flaps (88.20%). The functional and anatomical surgical success rate was 94.15% in the group treated with nasal and lacrimal sac mucosal flaps, 88.89% in the group treated with nasal mucosal flaps, and 84.83% in the group treated without flaps. @*Conclusions@#Endonasal dacryocystorhinostomy using the nasal and lacrimal sac mucosal flap is an effective method that minimizes the risk of granulation and bony ostium obstruction.

Outcome of Endonasal Dacryocystorhinostomy with Nasal and Lacrimal Sac Mucosal Flaps

Purpose@#In patients with nasolacrimal duct obstruction, the outcomes of surgery were evaluated according to the type or presence of flaps. @*Methods@#In total, 509 eyes were compared retrospectively: 178 eyes in patients treated without flaps, 126 eyes in patients treated using nasal mucosa flaps, and 205 eyes in the patient group using nasal and lacrimal sac mucosal flap were compared retrospectively. We analyzed the factors of success according to the surgical method by comparing granulation and bony ostium obstruction at 1, 3, and 6 months after surgery in each group. @*Results@#At 6 months after surgery, granulation was found in 6 eyes (2.93%) in the nasal and lacrimal sac mucosal flap group, 5 eyes (3.96%) in the nasal mucosal flap group, and 15 eyes (8.42%) in the group treated without flaps. Bony ostium obstruction was found in 3 eyes (1.46%) in the nasal and lacrimal sac mucosal flap group, 4 eyes (2.38%) in the nasal mucosal flap group, and 6 eyes (2.81%) in the group treated without flaps. The anatomical surgical success rate of patients treated with nasal and lacrimal sac mucosal flaps was 95.61%, which was higher than those of patients treated with nasal mucosal flaps (92.86%) and without flaps (88.20%). The functional and anatomical surgical success rate was 94.15% in the group treated with nasal and lacrimal sac mucosal flaps, 88.89% in the group treated with nasal mucosal flaps, and 84.83% in the group treated without flaps. @*Conclusions@#Endonasal dacryocystorhinostomy using the nasal and lacrimal sac mucosal flap is an effective method that minimizes the risk of granulation and bony ostium obstruction.

Silicone Intubation and Postoperative Mitomycin Application for Partial Nasolacrimal Duct Obstruction in Adults

PURPOSE: This study nasolacrimal duct (NLD) stenosis in adult, evaluated the clinical results of treatment with topical 0.04% mitomycin C (MMC) eyedrops after silicone tube intubation. METHODS: Prospectively, we analysed the clinical results from 29 eyes of 25 adult patients with epiphora due to NLD stenosis who underwent this procedure. RESULTS: The mean follow-up periods was 9.3 months. Twenty-two eyes (76%) showed no epiphora and complete passing into the cavity by lacrimal irrigation. Four eyes (13.7%) showed intermittent epiphora but improvement relative to preoperative state. Three eyes (10.3%) showed persistent epiphora and no improvement. In total, 26 eyes (89%) showed improvement of symptoms. Complications were silicone tube prolapse in 5 eyes (17.2%) and dacryocystitis in 2 (6.9%) CONCLUSIONS: Silicone tube intubation with topical MMC eyedrops for treatment of patients with tearing due to NLD stenosis is effective, safe and easy. This technique can be tried before DCR if the surgeon has a thorough of nasal cavity anatomy and probing.

Surgical Management of the Lacrimal Drainage System

Ahigh percentage of patients with disorders of the lacrimal drainage system present to the ophthalmologists with the complaint of epiphora. These patients complain of the blurred vision due to tear, and "mattering" and pain of the eyes due to secondary conjunctivitis and acute or chronic dacryocystitis. The aim of surgery on the lacrimal drainage system to relieve epiphora or acute and chronic inflammations of the eye and the lacrimal system. Although the causes of congenital and acquired obstructions are different, the accurate knowledge on the anatomy, the causes of obstruction, and the diagnostic methods is essential in the evaluation of patients with epiphora and for the optimal management of obstruction of the lacrimal drainage system. In this article the author will discuss the surgical managements of disorders of the lacrimal drainage system associated with age, focusing on the degree and position of obstruction from a review of the published data.

The Clinical Evaluation of Congenital Lacrimal Fistula

PURPOSE: To evaluate the surgical results and clinical characteristics of congenital lacrimal fistula. METHODS: Fourteen patients were diagnosed with congenital lacrimal fistula and received simple fistulectomy. Three patients received anterior lamella reposition operation simultaneously due to epiblepharon. We retrospectively reviewed the medical records and conducted telephone interviews. RESULTS: In 15 eyes of the 14 patients, epiphora through lacrimal fistula disappeared. Two eyes of 2 patients showed a little epiphora only outdoors but there was no need of further treatment. All patients accepted the surgical results cosmetically. Histologically, stratified squamous epithelial change with keratinization was remarkable by aging. In adults, hair follicles with increased keratinization were contained and the result with skin was similar. CONCLUSIONS: Simple fistulectomy was a useful technique for congenital lacrimal fistula.

The Effect of Upper and Lower Lid Blepharoplasty for Patients with Corneal Problems due to Medial Upper and Lower Eyelash

PURPOSE: Epicanthal folds and epiblepharon which often develop in oriental children are congenital anomalies of eyelids. These may need surgical correction because corneal irritation may develop by medial upper and lower eyelash besides cosmetic problems. V-Y plasty and Mustarde's method are standards for correction of epicanthal folds, but not usually performed because of cosmetic scar formation. METHODS: This study included 26 patients, 52 eyes (19 females, 38 eyes; 7 males, 14 eyes) with corneal irritation due to medial upper and lower eyelash. We performed upper and lower lid blepharoplasty simultaneously and analyzed their results and complications through medical records. RESULTS: Epiblepharon associated with epicanthus tarsalis was found in 22 patients, 22 eyes, epicanthus palpebralis in 4 patients, 8 eyes. At the time of surgery mean age was 7 years old (3.7~10.3 years old). During the follow-up more than 6 months, double fold asymmetry was found in 1 patient, double fold loosening in 1 patient, 2 eyes, lower eyelid undercorrection in 2 patients, 3 eyes. CONCLUSIONS: These findings suggest that simultaneous upper and lower lid blepharoplasty for patients with corneal problems due to medial upper and lower eyelash is more unsatisfactory in the cosmetic result than standard method, but has advantage of less scarring, and thought to be a good method to relieve corneal irritation.