Localização topográfica da emergência do condóito nasolagrimal medido em tomografia como reparação anatômica para procedimentos de cirurgia maxilofacial / Topographic location of the nasolagrimal conduit emergence measured on ct scans as an anatomical repair for maxillofacial surgery procedures / Ubicación topográfica de la emergencia del conducto nasolagrimal medida en tomografías como reparo anatómico para procedimientos de cirugía maxilofacial

Contexto: Na cirurgia maxilofacial existem procedimentos que envolvem o ducto nasolacrimal, pelo que esta medida é um ponto de referência para evitar a sua lesão. Artigos anteriores tomam como referência o fenótipo anglo-saxão e não a população latino-americana, o que é uma grande limitação quando se extrapola para a cirurgia maxilofacial. Objetivo: Medir a distância do ducto nasolacrimal às estruturas anatômicas adjacentes em uma amostra de tomografias computadorizadas do Hospital Universitário San Ignacio em Bogotá, Colômbia, em 2021. Métodos: Foi realizado um estudo observacional retrospetivo com base em tomografias computadorizadas do HUSI. Foi utilizada uma amostragem não probabilística, na qual foram identificadas 150 tomografias computadorizadas. Informações sobre sexo, idade e distância do ducto nasolacrimal em milímetros foram coletadas em um banco de dados em planilha Excel, tendo como marcos anatômicos o entalhe piriforme, o forame infraorbitário e o assoalho da fossa nasal em cortes axiais, sagitais e coronais. Resultados: A análise das medidas mostrou que nenhuma das distribuições de medidas se comportou de forma diferente da distribuição normal. Em relação à comparação das medidas por sexo, a idade foi semelhante entre homens e mulheres, enquanto nas comparações por idade foram evidenciadas diferenças significativas. Conclusão: Os resultados são consistentes com os dados publicados em estudos anteriores. Em termos de distribuição por sexo, o comprimento do ducto nasolacrimal é maior nos homens do que nas mulheres, e a distribuição por idade indica que, à medida que a idade aumenta, a distância do ducto a estas estruturas diminui... (AU)

Background: In maxillofacial surgery there are procedures that involve the nasolacrimal duct, so this measure is a reference point to avoid its injury. Previous articles take as reference the Anglo-Saxon phenotype and not the Latin American population, which is a great limitation when extrapolating it to maxillofacial surgical procedures. Objective: To measure the distance of the nasolacrimal duct to adjacent anatomical structures in a sample of CT scans from the Hospital Universitario San Ignacio in Bogotá- Colombia in 2021. Methods: A retrospective observational study was performed based on CT scans from HUSI. A non-probabilistic sampling was used in which 150 CT scans were identified. Information on sex, age and distance of the nasolacrimal duct in millimeters was collected in an Excel spreadsheet database, taking as anatomical landmarks the piriform notch, the infraorbital foramen and the floor of the nasal fossa in axial, sagittal and coronal sections. Results: The analysis of the measurements showed that none of the measurement distributions had a behavior different from the normal distribution. In relation to the comparison of the measurements by sex, age was similar in men and women, while significant differences were evidenced in the comparisons by age. Conclusion: The results coincide with the data published in previous studies. Regarding the distribution by sex, the length of the nasolacrimal duct is greater in men than in women, and the distribution by age indicates that as age increases the distance of the duct to these structures decreases... (AU)

Antecedentes: En cirugía maxilofacial existen procedimientos que involucran el conducto nasolagrimal, por lo cual esta medida es un punto de referencia para evitar su lesión. Artículos previos toman como referencia el fenotipo anglosajón y no la población Latinoamericana, lo cual supone una gran limitante al extrapolarlo a intervenciones quirúrgicas maxilofaciales. Objetivo: Medir la distancia del conducto nasolagrimal a estructuras anatómicas adyacentes en una muestra de tomografías del Hospital Universitario San Ignacio en BogotáColombia en 2021. Métodos: Se realizó un estudio observacional retrospectivo basado en tomografías del HUSI. Se utilizó un muestreo no probabilístico en el que se identificaron 150 tomografías. En una base de datos en hoja de cálculo en Excel se recolectó información sobre sexo, edad y distancia del conducto nasolagrimal en milímetros, teniendo como reparo anatómico la escotadura piriforme, el agujero infraorbitario y el piso de la fosa nasal en los cortes axial, sagital y coronal. Resultados: El análisis de las mediciones realizadas mostró que ninguna de las distribuciones de medición tuvo un comportamiento distinto a la distribución normal. En relación con la comparación de las medidas por sexo la edad fue similar en los hombres y mujeres, mientras que se evidenciaron diferencias significativas en las comparaciones por edad. Conclusión: Los resultados coinciden con los datos publicados en estudios previos. En cuanto a la distribución por sexo, la longitud del conducto nasolagrimal es mayor en hombres que en mujeres, y la distribución por edad indica que conforme aumenta la edad la distancia del conducto a estas estructuras disminuye... (AU)

Anatomy of the nasolacrimal duct in Persian cats determined by computed tomographic dacryocystography.

OBJECTIVE: This study sought to describe the anatomical characteristics of the nasolacrimal duct of Persian cats as observed by computed tomographic dacryocystography. ANIMAL STUDIED: Ten cats weighing 3-6 kg (three live cats and seven cadaveric specimens). PROCEDURES: The animals were submitted to bilateral computed tomographic dacryocystography, totaling 20 nasolacrimal ducts. Dorsal, sagittal, and transverse planes were studied. Two additional skulls were also dissected following latex injection into the nasolacrimal duct. The length and width of the nasolacrimal duct and lacrimal canaliculi, and the distance between the nasolacrimal duct and the root of the upper canine tooth at the point of closest proximity were measured. RESULTS: The nasolacrimal duct followed a convoluted course, particularly in the middle and rostral portions. Duct stenosis (width reduction equal to or >75%) and dilations (width increase equal to or >50%) were also detected, particularly in the rostral portion. Nasolacrimal duct length and width ranged from 1.3 to 1.5 cm and 1.5 to 2.3 mm, respectively. Mean lacrimal canaliculus length and width corresponded to 3.1 mm and 0.4 mm, respectively. Mean distance from the nasolacrimal duct to the canine tooth was 2.4 mm. The root of this tooth interfered with the course of the nasolacrimal duct. CONCLUSION: This study provided anatomical information for clinical assessment of the nasolacrimal drainage system in Persian cats.

Epiphora due to a supernumerary lacrimal punctum treated with lacrimal plugs. Case presentation and literature review.

ANTECEDENTES: Los puntos lagrimales supernumerarios son una malformación congénita poco común y con una variabilidad anatómica importante. En muchas ocasiones pueden ser sintomáticos y cursar con epífora. CASO CLÍNICO: Se describe el caso de un paciente de 45 años con epífora secundaria a un punto lagrimal supernumerario sin otra patología lagrimal asociada tratado exitosamente con el uso de tapones de vías lagrimales. CONCLUSIONES: Los tapones de vías lagrimales para el tratamiento de la epífora secundaria a puntos lagrimales supernumerarios pueden ser utilizados en pacientes con variantes anatómicas adecuadas. BACKGROUND: Supernumerary lacrimal punctum is a rare malformation of the lacrimal apparatus with a highly variable anatomical presentation. In many cases this can be symptomatic and cause tearing. CASE PRESENTATION: The case of a 45 year old male with a supernumerary lacrimal punctum and tearing without any other associated lacrimal system anomaly treated successfully with lacrimal plugs. CONCLUSIONS: Lacrimal plugs can be used as an alternative treatment in selected cases of symptomatic supernumerary lacrimal punctum with epiphora.

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)

Ophthalmic manifestations of arbovirus infections in adults. / Manifestaciones oftálmicas de las infecciones arbovirales en adultos.

INTRODUCTION AND OBJECTIVES: Emerging arbovirus infections have classic symptoms such as fever, arthralgia, or rash. As some of them have ophthalmic symptoms/signs, the main objective is to evaluate whether these findings could help to clarify the clinical diagnosis. MATERIAL AND METHODS: A descriptive and retrospective study was conducted, in which cases of adults who attended an evaluation in 2016. The general and ophthalmic symptoms were analysed on those meeting the definition of dengue, Zika, and chikungunya. RESULTS: A total of 10,327 cases of arbovirosis were recorded, of which 5,388 (52.2%) were Dengue, 3,529 (34.1%) Zika, and 1,410 (13.6%) were Chikungunya. The main symptoms and signs of Dengue were: fever, headache/retro-orbital pain, arthralgia, rash, and nausea/vomiting. For Zika cases they were: exanthema, swollen glands, headache, arthralgia, and conjunctivitis, and for Chikungunya cases: rash, fever, arthritis, headache, and náusea/vomiting. The group with the most ophthalmic signs/symptoms was Zika, predominantly non-purulent conjunctivitis and retro-orbital pain, epiphora, episcleritis, anterior uveitis, as well as neurological syndromes such as isolated cranial nerve palsy (III and IV) or Miller Fisher syndrome. CONCLUSIONS: Ophthalmic signs/symptoms of Zika infection can help the clinical diagnosis of these arbovirosis.

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.

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)

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.

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

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.

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.

A comparative study of modified transcanalicular diode laser dacryocystorhinostomy versus conventional transcanalicular diode laser dacryocystorhinostomy.

External dacryocystorhinostomy (DCR) is the gold standard surgical technique for the treatment of primary acquired nasolacrimal duct obstruction (PANDO). However, new techniques such as endoscopic DCR and transcanalicular dacryocystorhinostomy (T-DCR) are being studied in an attempt to reduce surgical time, avoid external scarring and preserve the lacrimal pump while achieving the same efficacy. The purpose of this study was to compare the efficacy between conventional T-DCR and modified transcanalicular dacryocystorhinostomy (MT-DCR) in patients with PANDO. MT-DCR is performed to remove nasal mucosa prior to laser osteotomy. This is a comparative, prospective, interventionist and randomized study. Patients with PANDO were selected to undergo MT-DCR or T-DCR by blocked randomization. PANDO was diagnosed based on clinical presentation, dye disappearance test and dacryocystography. All of the procedures were performed by the same surgery team members. Anatomical success outcome was defined as positive lacrimal syringing and functional success outcome was defined as the absence or improvement of epiphora. A total of 44 surgical procedures were performed (22 MT-DCR and 22 T-DCR). In the case of MT-DCR, the anatomical and functional success rates after 12 months were 90 and 86%, respectively. After T-DCR, these rates were 77 and 72%, respectively (p = 0.162). MT-DCR and T-DCR are both safe and fast procedures with low morbidity and well-tolerated.

Avaliação da epífora de cães usando dacriocistografia e tomografia computadorizada / Epiphora assessment of dogs with dacryocystography and computed tomography

A avaliação da epífora pode ser feita por exames clínicos, testes de excreção lacrimal, exames contrastados, como avaliação radiológica e estudo tomográfico; estes dois últimos permitem análise minuciosa das estruturas. O presente estudo teve como objetivo avaliar a via lacrimal excretora com uso de radiografia e tomografia computadorizada contrastadas, feitas em animais com epífora, comparando-se com animais sadios, sem essa afecção. Foram utilizados 20 cães, de raças e pelagens variadas, machos e fêmeas, com peso de 1 a 20 kg, com 0,7 a 8 anos de idade, apresentando epífora (grupo epífora - GE). Como grupo de controle (GC), foram utilizados 15 cães, sem alterações clínicas de drenagem do sistema lacrimonasal de raças e pelagens variadas, machos e fêmeas, pesando 1 a 20 kg, com 0,7 a 8 anos. Foi proposta a divisão do sistema de drenagem lacrimal em quatro regiões. Na região 1, o GE teve 29 (76,3%) animais com dilatação visibilizada pelo R-X e 32 (84,2%) pela TC; no GC, 4 (12,5%) no R-X e 1 (3,1%) na TC demonstraram dilatação. Na região 3, 13 (34,2%) cães evidenciaram dilatação do DLN no R-X e 14 (36,8%) na TC; e 21 (55,3%) comunicação do ducto lacrimonasal com o seio nasal pelo R-X e 28 (73,7%) pela TC. Já no GC, 15 (46,9%) pelo R-X e 22 (68,7%) pela TC possuíam comunicação do ducto lacrimonasal com o seio nasal. Concluiu-se que: dilatações também podem ser observadas em alguns cães sem sinal clínico da afecção; comunicação do ducto lacrimonasal com o seio nasal não indica alteração causadora de epífora, pois está presente em animais com e sem afecção; os dados do presente estudo confirmam que o exame DCG por si pode dar importantes informações, de forma semelhante à TC, devendo-se recorrer à ela apenas quando houver dúvidas sobre lesões ósseas, fraturas e corpos estranhos não detectados pelo primeiro.(AU)

Epiphora evaluation can be done through clinical exams, lachrymal excretion tests, contrasted exams, like radiologic evaluation and tomography studies; those last two allow a detailed analysis of the structures. The present study had as the objective to evaluate the lacrimal drainage system through radiography and contrasted computed tomography, which were made with animals presenting epiphora, comparing them to healthy animals, without the mentioned condition. Twenty dogs were used for tests, from a variety of breeds and coatings, males and females, weight varying from 1kg to 20kg, ages varying from 0.7 to 8 years old, presenting epiphora (epiphora group - GE*). As a control group (GC*) 15 dogs were used, with no clinical alterations of naso-lachrymal drainage system, from different breeds and coatings, males and females, weighing from 1kg to 20kg and ages varying from 0.7 to 8 years old. It was propoused the division of the lacrimal drainage system in four regions. On region 1, the GE had 29 (76.3%) animals with dilation visualized by the RX and 32 (84.2%) by CT, the GC, 4 (12.5%) in the RX and 1 (3.1% ) CT showed dilation. In region 3, 13 (34.2%) dogs showed dilatation of the DLN in RX and 14 (36.8%) on CT, and 21 (55.3%) nasolacrimal duct communication with the sinus and the X-ray 28 (73.7%) by CT. For the CG, 15 (46.9%) the X-ray and 22 (68.7%) by CT had nasolacrimal duct communication with the nasal sinus. It has been concluded that dilations can also be observed in some dogs with no clinical signs of disease; nasolacrimal duct communication to sinus does not indicate epiphora causing alteration, as it is present in animals with and without affection; the present study data confirm that DCG itself can provide important informations, in a similar manner to CT, and should resort to it just in case of doubts about bone lesions, fractures and foreign bodies undetected at first.(AU)

Manejo de obstrucción de vía lagrimal en niños mediante intubación con sonda Monoka®: experiencia inicial en HCUCh / Management of lacrimal duct obstruction in children by intubation with Monoka®: initial experience at HCUCh

Introducción: La obstrucción congénita del ducto nasolacrimal (DNL) es motivo de consulta frecuente en menores de un año. Se encuentra en 6% de los recién nacidos, la mayoría de las veces secundario a la persistencia de una membrana mucosa en la porción distal del DNL (membrana de Hassner). Generalmente se presenta como epífora patológica, es decir, presente después del 3º mes de vida. Esta obstrucción puede evolucionar con resolución espontánea los primeros 12 meses de vida, requerir terapias complementarias o resolución quirúrgica. Objetivo: Analizar los casos de obstrucción de la vía lagrimal en población pediátrica usando sonda Monoka® en pacientes intervenidos en el Hospital Clínico de la Universidad de Chile, que consultaron por epifora; verificando tasas de éxito, complicaciones del procedimiento y seguimiento. Material y método: Se realizó un estudio descriptivo retrospectivo, incluyendo todos aquellos pacientes con diagnóstico de obstrucción de vía lagrimal, mayores de 24 meses de edad, que consultaron en el HCUCh entre julio 2012 y marzo 2014, que requiriesen resolución quirúrgica de su cuadro. Se realizó instalación de sonda Monoka® con la participación conjunta de oftalmología y otorrinolaringología. Resultados: Se reunieron 7 pacientes, obteniendo éxito de 85,7% (6) y 100% de mejoría respecto a los síntomas iniciales. Un paciente presentó una complicación intraoperatoria, definida como un sondeo frustro. La sonda permaneció instalada un promedio de 7,7 meses y fue retirada sin complicaciones. Conclusión: La instalación de sonda Monoka® como procedimiento quirúrgico destinado a la resolución de la obstrucción de vía lagrimal es una técnica sencilla, de fácil acceso, moderado costo y que constituye una solución exitosa para aquellos pacientes afectados. Presenta excelentes resultados a mediano plazo, sin recidiva de la obstrucción de la vía lagrimal y con baja tasa de complicaciones. Es una técnica exitosa que, luego de esta experiencia, podría ser considerada de primera línea en nuestro hospital para aquellos pacientes con diagnóstico de epífora patológica, mayores de 24 meses.

Introduction: Congenital nasolacrimal duct obstruction (DNL) is frequent complaint in under a year. It is found in 6% of infants, the most often secondary to the persistence of a mucous membrane in the distal portion of the nasolacrimal duct (Hassner membrane). It usually occurs as pathological epifora present after the 3rd month of life. This obstruction can evolve spontaneously resolved the first 12 months of life, require complementary therapies or surgical treatment. Aim: To analyze where we have used the Monoka® probe in pediatric population operated in the Clinical Hospital of the University of Chile, who consulted for pathological epiphora; verifying success rates, procedure complications and monitoring. Material and method: A retrospective descriptive study, which were included all patients with the diagnosis of pathological epiphora over 12 months old, who consulted in the HCUCH between July 2012 and March 2014, that required surgical resolution of their condition. Monocanalicular installation silicone catheter was used with the joint participation of ophthalmology and otorhinolaryngology. Results: We had a total of 7 patients with a success rate of 85.7% (6) and 100% improvement over the initial symptoms. Only one patient presented an intraoperative complication, defined as failed intubation. The probe remained installed an average of 7.7 months and was removed without complications. Conclusions: The installation of Monoka® probe as surgical intervention to resolve the pathological epiphora is a simple, easily accessible and amoderate cost procedure. It's a successful solution for those patients affected. It has excellent mid-term results, no recurrence of obstruction of DNL and low complication rate. It is a successful technique that would be considered frontline in our hospital for patients diagnosed with pathological epiphora over 12 months old.

Avaliação da epífora de cães usando dacriocistografia e tomografia computadorizada / Epiphora assessment of dogs with dacryocystography and computed tomography

A avaliação da epífora pode ser feita por exames clínicos, testes de excreção lacrimal, exames contrastados, como avaliação radiológica e estudo tomográfico; estes dois últimos permitem análise minuciosa das estruturas. O presente estudo teve como objetivo avaliar a via lacrimal excretora com uso de radiografia e tomografia computadorizada contrastadas, feitas em animais com epífora, comparando-se com animais sadios, sem essa afecção. Foram utilizados 20 cães, de raças e pelagens variadas, machos e fêmeas, com peso de 1 a 20 kg, com 0,7 a 8 anos de idade, apresentando epífora (grupo epífora - GE). Como grupo de controle (GC), foram utilizados 15 cães, sem alterações clínicas de drenagem do sistema lacrimonasal de raças e pelagens variadas, machos e fêmeas, pesando 1 a 20 kg, com 0,7 a 8 anos. Foi proposta a divisão do sistema de drenagem lacrimal em quatro regiões. Na região 1, o GE teve 29 (76,3%) animais com dilatação visibilizada pelo R-X e 32 (84,2%) pela TC; no GC, 4 (12,5%) no R-X e 1 (3,1%) na TC demonstraram dilatação. Na região 3, 13 (34,2%) cães evidenciaram dilatação do DLN no R-X e 14 (36,8%) na TC; e 21 (55,3%) comunicação do ducto lacrimonasal com o seio nasal pelo R-X e 28 (73,7%) pela TC. Já no GC, 15 (46,9%) pelo R-X e 22 (68,7%) pela TC possuíam comunicação do ducto lacrimonasal com o seio nasal. Concluiu-se que: dilatações também podem ser observadas em alguns cães sem sinal clínico da afecção; comunicação do ducto lacrimonasal com o seio nasal não indica alteração causadora de epífora, pois está presente em animais com e sem afecção; os dados do presente estudo confirmam que o exame DCG por si pode dar importantes informações, de forma semelhante à TC, devendo-se recorrer à ela apenas quando houver dúvidas sobre lesões ósseas, fraturas e corpos estranhos não detectados pelo primeiro...

Epiphora evaluation can be done through clinical exams, lachrymal excretion tests, contrasted exams, like radiologic evaluation and tomography studies; those last two allow a detailed analysis of the structures. The present study had as the objective to evaluate the lacrimal drainage system through radiography and contrasted computed tomography, which were made with animals presenting epiphora, comparing them to healthy animals, without the mentioned condition. Twenty dogs were used for tests, from a variety of breeds and coatings, males and females, weight varying from 1kg to 20kg, ages varying from 0.7 to 8 years old, presenting epiphora (epiphora group - GE*). As a control group (GC*) 15 dogs were used, with no clinical alterations of naso-lachrymal drainage system, from different breeds and coatings, males and females, weighing from 1kg to 20kg and ages varying from 0.7 to 8 years old. It was propoused the division of the lacrimal drainage system in four regions. On region 1, the GE had 29 (76.3%) animals with dilation visualized by the RX and 32 (84.2%) by CT, the GC, 4 (12.5%) in the RX and 1 (3.1% ) CT showed dilation. In region 3, 13 (34.2%) dogs showed dilatation of the DLN in RX and 14 (36.8%) on CT, and 21 (55.3%) nasolacrimal duct communication with the sinus and the X-ray 28 (73.7%) by CT. For the CG, 15 (46.9%) the X-ray and 22 (68.7%) by CT had nasolacrimal duct communication with the nasal sinus. It has been concluded that dilations can also be observed in some dogs with no clinical signs of disease; nasolacrimal duct communication to sinus does not indicate epiphora causing alteration, as it is present in animals with and without affection; the present study data confirm that DCG itself can provide important informations, in a similar manner to CT, and should resort to it just in case of doubts about bone lesions, fractures and foreign bodies undetected at first...

[Lacrimal sac tumors presenting as lacrimal obstruction. Retrospective study in Mexican patients 2007-2012]. / Tumores del saco lagrimal que se presentan como obstrucción de la vía lagrimal. Estudio retrospectivo en la población mexicana durante 2007-2012.

OBJECTIVE: To determine the demographic and clinical data of primary tumors of the lacrimal sac presenting as lacrimal obstruction. METHODS: Retrospective and descriptive study was conducted between the years 2007 to 2012 on all patients undergoing surgery for low lacrimal obstruction at Dr. Luis Sanchez Bulnes Hospital, an Association for the prevention of blindness in Mexico IAP. RESULTS: Primary tumors of the lacrimal sac represented 2.5% of all lacrimal obstructions, being more common in women than in men (8:1). The large majority (89%) of the cases were non-epithelial, with lymphoid lesions being the most frequent. Benign tumors were presented at a younger age (50 years old) than malignant (70 years old). One-third (33%) of cases were unexpected findings during surgery (100% benign). Just over half (55%) were malignant tumors (1.4% of obstructions), all of them lymphoproliferative lesions. The most frequent clinical tumor was in the inner edge, either with or without epiphora. The progression time varied according to the degree of aggressiveness of the lymphoma (3 months-10 years). CONCLUSIONS: Lacrimal sac tumors are rare, but they must be taken into account in patients with an unusual clinical presentation of lacrimal obstruction.

Afecção e tratamento do sistema de drenagem lacrimal canino / Diseases and treatment of the canine lacrimal drainage system

O aparelho de drenagem lacrimal canino é composto por punctas (punctum lacrimales) ductos lacrimais, sacos lacrimais e ductos nasolacrimais. Alteração no funcionamento desse sistema resulta em extravasamento do filme lacrimal que é denominado epífora, sinal clínico referido com freqüência na rotina oftalmológica, cujo diagnóstico muitas vezes é subestimado. As afecções do aparelho de drenagem lacrimal se dividem em congênitas e adquiridas e o objetivo do tratamento é proporcionar uma melhora na drenagem lacrimal, seja por meio da formação de um novo trajeto ou pela desobstrução do trajeto já existente. As maiores dificuldades encontradas nos tratamentos estão relacionadas às recidivas no pós-operatório, muitas vezes tornando o processo frustamente para o clínico e o proprietário. Este trabalho é uma revisão de literatura sobre as afecções do sitema lacrimal, métodos diagnósticos e terapêutica(AU)

The canine nasolacrimal system is compound by punctas and lacrimal ducts, lacrimal sac and nasolacrimal ducts. Functional disordrs of nasolacrimal system results in tear flm outflow denominated epiphora, a clinical manifestation commonly referred which diagnosis is many times underestimated. Nasolacrimal system diseases are either congenital or acquired and its treatment intend to improve lacrimal drain by forming a new drainage way or by performing nasolacrimal flushing. The biggest difficulties met on the treatment are related to post-operative recurrence often defeating clinicians and owners. This is a literature revision about nasolacrimal system diseases, diagnostic procedures and therapeutic management(AU)

Afecção e tratamento do sistema de drenagem lacrimal canino / Diseases and treatment of the canine lacrimal drainage system

O aparelho de drenagem lacrimal canino é composto por punctas (punctum lacrimales) ductos lacrimais, sacos lacrimais e ductos nasolacrimais. Alteração no funcionamento desse sistema resulta em extravasamento do filme lacrimal que é denominado epífora, sinal clínico referido com freqüência na rotina oftalmológica, cujo diagnóstico muitas vezes é subestimado. As afecções do aparelho de drenagem lacrimal se dividem em congênitas e adquiridas e o objetivo do tratamento é proporcionar uma melhora na drenagem lacrimal, seja por meio da formação de um novo trajeto ou pela desobstrução do trajeto já existente. As maiores dificuldades encontradas nos tratamentos estão relacionadas às recidivas no pós-operatório, muitas vezes tornando o processo frustamente para o clínico e o proprietário. Este trabalho é uma revisão de literatura sobre as afecções do sitema lacrimal, métodos diagnósticos e terapêutica

The canine nasolacrimal system is compound by punctas and lacrimal ducts, lacrimal sac and nasolacrimal ducts. Functional disordrs of nasolacrimal system results in tear flm outflow denominated epiphora, a clinical manifestation commonly referred which diagnosis is many times underestimated. Nasolacrimal system diseases are either congenital or acquired and its treatment intend to improve lacrimal drain by forming a new drainage way or by performing nasolacrimal flushing. The biggest difficulties met on the treatment are related to post-operative recurrence often defeating clinicians and owners. This is a literature revision about nasolacrimal system diseases, diagnostic procedures and therapeutic management

O papel terapêutico da dacriocistografia em pacientes com epífora: relato de três casos / The therapeutic role of the dacryocystography in patients with epiphora: three cases report

Neste artigo são descritos três casos de pacientes que apresentavam epífora, os quais foram submetidos à realização de estudo dacriocistográfico e se tornaram assintomáticos, sem a necessidade de qualquer outro procedimento ou medicamento. Ressalta-se o potencial terapêutico do método, pois a literatura sobre este assunto é escassa em crianças e nenhuma em adultos.

We describe three cases of patients that presented epiphora having been submitted the accomplishment of dacryocystographic study, which ones turned asymptomatic after the accomplishment of the exam, without any other procedure or medicine. The therapeutic potential of the method is stood out, once the literature onthis subject is scarce in children and none in adults.

Cefaleas de localización y compromiso oculares / Headches with ocular localization and involvement

SE REVISAN las cefaleas primarias más frecuentes que comprometen las estructuras oculares y vecinas al globo ocular, las variantes de la migraña y las alteraciones propias del nervio óptico que alteran la función visual y que se acompañan no solamente de síntomas dolorosos sino también de trastornos vasomotores debidos a alteraciones del sistema nervioso autónomo que suelen ser comunes en algunos procesos neurálgicos llamados ahora cefaleas con compromiso disautonómico. En este artículo se comentan los elementos epidemiológicos de las diferentes enfermedades craneales, faciales y oculares que cursan con cefalea; las diferencias clínicas entre las mismas y su presentación semiológica, al igual que algunos elementos terapéuticos. Se discuten además algunos elementos fisiopatológicos de gran utilidad en el análisis de los procesos dolorosos craneofaciales y el perfil temporal de los mismos; también se comentan algunas cefaleas secundarias que comparten con las primarias elementos que se prestan a confusión en la clínica. Finalmente, se hace un análisis de las neuralgias faciales comunes.

The most frequent primary headaches, including migraine variants, and intrinsic optic nerve disorders that produce headache, are reviewed. The latter are often accompanied by autonomic nervous system alterations which lead to vasomotor changes, frequently present in neuralgic processes known as headaches with disautonomic involvement. Epidemiological, semiological, clinical, and therapeutical aspects of different cranial, facial and ocular diseases that produce headache are included. Some physiopathological elements that may help to analyze painful craniofacial processes are discussed. Secondary headaches and common facial neuralgias, on the other hand, are also considered because they may confuse the differential diagnosis.

Dacriocistorrinostomia modificada no tratamento da epífora crônica em cães e gatos braquicefálicos / Modified dacryocystorhinostomy for the treatment of chronic epiphora brachycephalic breeds of dogs and cats

A epífora é um sinal ocular de ocorrência muito comum na clínica veterinária e pode ser caracterizada por um extravasamento do filme lacrimal pela região subocular, causando conjuntivites recorrentes, dermatites, fistulações e pigmentação subocular do pêlo. A epífora pode ser causada por anomalias congênitas ou adquiridas que promovem um estreitamento ou obstrução em algum nível do sistema excretor lacrimal. O presente trabalho relata e propõe uma nova técnica de dacriocistorrinostomia, utilizando a sonda tipo “Tom Cat” para o tratamento da epífora crônica em cães e gatos braquicefálicos(AU)

Epiphora is an ocular sign that is very frequent in veterinary practive it can be characterized by na overflow of the preocular tear filmo n the medial eye cantus, causing recurrent conjuctivitis, dermatitis, blepharitis, fistulae and hair staining. The Epiphora can be caused by congenital or acquired anomalies, which promote a stricture or obstruction in any level of the lacrimal excretor apparatus. The present paper describes a new technique for Dacryocystorhinostomy with a “Tom Cat” canula, for the treatment of choronic Epiphora in brachycephalic breeds of dogs and cats(AU)