Probing for congenital nasolacrimal duct obstruction in older children

The purpose of this study was to evaluate the role of probing in congenital nasolacrimal duct obstruction in children age 2 years and older and to establish factors predictive of the outcome. A prospective study was conducted on consecutive patients older than 24 months with congenital nasolacrimal duct obstruction. All patients were treated with a simple nasolacrimal duct probing as primary treatment. Outcome measures included an ophthalmologic examination plus a parental history of residual symptoms at one and 6 months after surgery. A total of 82 children with a mean age of 34.5 months [range, 24 months to 60 months] underwent nasolacrimal duct probing. The complete response rate was 54%. Partial response and failure were observed in 25% and 20.8% of the eyes, respectively. Bilateral obstruction was associated with failure of probing [P = 0.007, Odds Ratio: 5.76]. However, age older than 36 months was not associated with the failure rate. Primary probing maintains a high success rate without any age related decline in congenital nasolacrimal duct obstruction

An Atypical Case of Lacrimal Sac Fistula Located on the Temporal Side of the Lateral Canthus

We report a case of congenital lacrimal sac fistula located on the temporal side of the lateral canthus. A systemically healthy 1-year-old girl came to the outpatient clinic with a complaint of tearing on the temporal side of the right lateral canthus since birth. On examination, a small orifice was found in the skin on the temporal side of the lateral canthus. There was no evidence of inflammation or swelling within the opening. Surgeons carried out an operation under general anesthesia. They passed a probe through the lacrimal orifice and advanced it toward the lacrimal sac. Next, they introduced saline to the inferior punctum and found that it drained to the lateral fistula. The lower lid stretched as the dissected fistula was pulled. After the operation, the patient was free of the symptom. This paper is to report a case of congenital lacrimal sac fistula located on the temporal side of the lateral canthus.

Epífora congênita nos pacientes com síndrome de Down / Congenital epiphora in patients with Down syndrome

OBJETIVO: Identificar as causas de epífora congênita em pacientes com síndrome de Down. MÉTODOS: Foram analisados os prontuários de 695 pacientes com epífora congênita, atendidos no Ambulatório de Vias Lacrimais da Clínica Oftalmológica da Santa Casa de Misericórdia de São Paulo, de outubro de 1989 a julho de 2005. Todos foram previamente submetidos a exame oftalmológico completo e apresentavam como queixa principal epífora e/ou secreção ocular constante, uni ou bilateral, desde o nascimento. Os pacientes foram divididos em: grupo A, 30 pacientes com síndrome de Down, e grupo B, 665 pacientes controle. A avaliação das vias lacrimais foi realizada com a prova de irrigação sob anestesia geral. RESULTADOS: Os grupos A e B são semelhantes estatisticamente quanto à idade (p=0,07), sexo (p=0,63) e raça (p=0,68). As queixas bilaterais foram mais freqüentes no grupo A (p=0,0008). A obstrução anatômica das vias lacrimais foi encontrada em 32,73 por cento do grupo A e em 85,51 por cento do grupo B (p<0,0001). CONCLUSÃO: A maioria das causas de epífora congênita em pacientes com síndrome de Down é decorrente de bloqueio funcional da bomba lacrimal. A hipotonia da musculatura palpebral e as alterações palpebrais, comuns à síndrome de Down, são as principais hipóteses para essa disfunção, mas são necessários estudos posteriores para confirmação.

PURPOSE: To describe the causes of congenital epiphora in patients with Down syndrome. METHODS: Retrospective study of 695 patients with congenital epiphora, of the Lacrimal Sector of the Department of Ophthalmology, São Paulo "Santa Casa", Brazil, between October 1998 and July 2005. This study analyzed: the main symptom of continuous epiphora or mucous discharge, which affected one or both eyes, since birth. Subjects were separated in to two groups: group A, with 30 patients with Down syndrome and group B, with 665 control patients. The lacrimal evaluation was performed by the throw irrigation test after general anesthesia. RESULTS: Both groups were statistically similar regarding age (p=0.07), sex (p=0.63) and race (p=0.68). Bilateral symptoms were more frequent in group A (p=0.0008). Anatomic obstruction of the lacrimal canal was present in 32.73 percent of group A and in 85.51 percent of group B (p<0.0001). CONCLUSIONS: The most frequent cause of congenital epiphora in Down syndrome is due to functional block of the lacrimal pump. Eyelid muscle hypotony and eyelid changes, common in Down syndrome, is the main hypothesis of lacrimal dysfunction, but further studies will be necessary for confirmation.

Fístula lagrimal congénita / Congenital lacrimal fistula

Presentamos una paciente que consulta por una fístula lagrimal congénita, entidad que es infrecuente y raramente diagnosticada en la consulta dermatológica. Los pacientes pueden ser asintomáticos o presentar lagrimeo desde el orificio de la fístula. Con respecto al tratamiento se recomienda la dacriocistorrinostomía con disección de los canalículos comunes; excisión de la fístula e intubación canicular en todos los pacientes sintomáticos, para facilitar el drenaje desde la misma y para prevenir así la obstrucción de los canalículos comunes

Congenital lacrimal amniotocele

To report a very rare congenital lacrimal /disorder with controversy regarding its origin, difficulty in differential diagnosis, and management. Patients and methods: Six newborns with age range between two days and one month, were seen between 1986 and 1996. All had pinkish swellings inferior to the medial canthal tendon. One case was treated by hot soaks, massage, and local antibiotic. Two cases were seen with complicated mucoceles, and had developed erythema of the tissues overlying their distended lacrimal sacs. Those three patients were probed and irrigated under general anesthesia. The first of those three patients had bilateral congenital cataract, the other who presented with pointing infected sacs which were drained percutaneously Cultures from the aspirates of all sacs were done. None of the patients developed epiphora or needed probing later on. There was no fistula formation for those who were drained. In order to avoid inappropriate investigations and hasten treatment, congenital amniotocele must be diagnosed early and differentiated from other congenital masses in the area. Initially, amniotocele must be treated conservatively in the same way as congenital nasolacrimal duct obstruction, but if the conservative treatment fails or if the patient is referred with infected sac, probing is recommended

Sondaje de la vía lagrimal en la obstrucción congénita / Catheterization of the lacrimal tract in congenital obstruction

El objeto de este trabajao es recordar las indicaciones precisas y el tiempo mas adecuado en que se debe realizar el sondaje de la via lagrimal en niños con patología obstructiva. Se estudian los pacientes atendidos en la Clínica Oftalmológica de Cochabamba entre los años 1987 y 1990. No se pretende en este trabajo valorar el comportamiento nuestro referente a la patológia global obstructiva del sistema nasolagrimal; sino mas bien se intenta valorar nuestra conducta en el momento de realizar el sondaje, valorando el motivo principal de dicha maniobra, la metodología del acto quirúrgico, resultados finales y complicaciones.