The Effects of Transcanalicular Diode Laser-Assisted Revision Surgery for Failed Dacryocystorhinostomy

PURPOSE: To determine the intranasal causes of failed dacryocystorhinostomy (DCR) and the effects of transcanalicular diode laser-assisted revision surgery. METHODS: Twenty-four patients (29 eyes) who underwent revision surgery for a failed DCR at the Department of Ophthalmology, Ansan Hospital, Korea University between March 2009 and February 2011 were included in the present retrospective study. The intranasal causes of failed DCR, the time of symptoms such as epiphora and discharge after DCR, success rates of revision surgeries and follow-up periods were evaluated. RESULTS: Membranous obstruction was found in 25 eyes (86.2%) and was accompanied with granuloma in 10 eyes; these were the most common causes of failed DCR. The mean time for symptom development after DCR was 14.6 months, the success rate of the first revision surgery was 82.1% and good results were obtained in 5 eyes after the second revision surgery. Recurrence developed in 2 eyes, but symptoms improved after the lateral tarsal strip procedure. CONCLUSIONS: Membranous obstruction was the most common intranasal cause of failed DCR and transcanalicular diode laser-assisted revision surgery produced good results. Additionally, in patients with persistent epiphora following anatomically-patent revisional surgery, lacrimal pump failure due to lower eyelid laxity should be considered and corrected.

Lateral Tarsal Strip Procedure and Silicone Tube Intubation on the Functional Nasolacrimal Duct Obstruction

PURPOSE: To compare the effects of the lateral tarsal strip procedure alone and the lateral tarsal strip procedure combined with silicone tube intubation in the treatment of functional lacrimal duct obstruction. METHODS: The present study investigated 27 eyes of 20 patients underwent lateral tarsal strip procedure (LTS) alone and 29 eyes of 18 patients underwent combined lateral tarsal strip procedure and silicone tube intubation and who were diagnosed with functional lacrimal duct obstruction. The authors retrospectively reviewed patients' medical records for information including age, gender, history, follow-up period, tear meniscus height (TMH), and symptoms. RESULTS: The average age of the LTS alone group was 60.3 years, and that of the combined groups was 65.9 years. The TMHs in the LTS only and combined operation groups were 0.62 +/- 0.23 mm and 0.62 +/- 0.19 mm before the operation and 0.43 +/- 0.20 mm and 0.26 +/- 0.09 mm after the operation, respectively. The postoperative improvement in epiphora was 74.1% after the LTS alone and 86.2% after combined LTS with silicone tube intubation. The postoperative improvement in epiphora and the operative technique of the lateral tarsal strip-canthus sparing or cantholysis were not relevant. CONCLUSIONS: Lateral tarsal strip combined with silicone tube intubation appeared useful in the treatment of epiphora patients without anatomic lacrimal duct obstruction. Determining which operative technique of lateral tarsal strip procedure should be chosen is difficult, and the preoperative syringing and snap back test may be helpful.

The Effects of Lateral Tarsal Strip Procedure on the Functional Nasolacrimal Duct Obstruction

PURPOSE: To evaluate the effects of the lateral tarsal strip procedure in the treatment of lacrimal pump dysfunction related to lower lid laxity. METHODS: This study investigated 46 eyes of 35 patients diagnosed with dysfunction of the lacrimal pump on which the lateral tarsal strip procedure was performed between June 2001 and February 2004. We retrospectively reviewed patients' medical records for information including age, gender, history, follow-up period, change of fluorescein dye disappearance test (DDT), tear meniscus height (TMH), symptoms, and complications. RESULTS: Improvement of tearing was noted in 26 patients (78.8%). Thirty-seven eyes (80.5%) were improved by more than 1 grade on DDT. Significant improvement above 2 grades was observed in 16 eyes (34.7%). With respect to age, 62.5% of 3rd-decade patients improved most effectively by more than 2 grades on DDT. Postoperative TMH compared with preoperative TMH measures were significantly lower according to statistics. The most common complication was discomfort or tenderness over the orbital rim (13.0%). CONCLUSIONS: Performance of the lateral tarsal strip procedure for tearing caused by dysfunction of the lacrimal pump and related to lower lid laxity improved patients' tearing, DDT and TMH status. We therefore expect the lateral tarsal strip procedure to be effective in the surgical treatment of lacrimal pump dysfunction secondary to lower eyelid laxity.

The Clinical Evaluation on the Patients Complaining of Epiphora

The clinical analysis on the etiologies was done along with frequency of the patient's complaints of epiphora.The etiologies of the fifty-four patients screened by fluorescein dye disappearance test were classified by the causative location of the lacrimal pathway. The average of the patient's ages was 48.7 years old and average duration of symptom was 26.1 months.The causative locations were punctum[35.2%], nasolacrimal duct, lacrimal pump and nasal cavity in following order.The most common causes of each group were senile lid laxity[5.6%] for lacrimal pump, conjunctivochalasis and punctual atresia[11.1%]for lacrimal pump, idiopathic narrowing[9.3%]for canaliculus and idiopathic narrowing[16.6%]for nasolacrimal duct.Probing was the most common past history[18.5%]and the kinds of treatment were dacryocystorhinostomy, punctoplasty, lid tightening, probing, and conjunctivod acryocystorhinostomy. These data are expected to be a useful guide of rapid diagnosis and appropriate treatment for the epiphora patients without complicate processes and discomfort.

Efficacy of Dacryoscintigraphy in Patients with Functional Block of Lacrimal Drainage System

To evaluate the diagnostic efficacy of dacryoscintigraphy, we examined Hones dye test and dacryoscintigraphy in 24 eyes of 18 patients who were suspected to have junctional block in lacrimal drainage system. Among 18 eyes that were negative to Jones I dye test, 3 showed punctal stenosis and 6 typical pattern of lax lid and 2 partial obsturction of nasolacrimal duct on dacryoscintigraphy. In evaluation of lacrimal drainage system, physiological aspect is as important as anatomical information since lacrimal pumping action of lid and tear flow as well as the patency of lacrimal passage contribute to the lacrimal drainage. Compared to Jones dye test, dacryoscintigraphy is more useful with certain advantages : It gives less discomfort to patients, provides anatomical information and does not depend on examiner`s skills.