Endoscopic-guided diagnosis of and interventional stent placement for nasolacrimal duct obstruction in a horse.

OBJECTIVE: To describe the successful use of endoscopy to visualize and place a soft canine ureteral stent to relieve a chronic nasolacrimal duct (NLD) obstruction in a horse. ANIMAL STUDIED: A 7-year-old, Quarter horse gelding. PROCEDURE: Under general anesthesia, retrograde nasolacrimal endoscopy was performed using an 8.5 Fr Storz Flex XC ureteroscope through the nasal punctum (NP). An obstructive web of fibrous tissue was visualized approximately 20 cm proximal to the NP. A 0.035″/150 cm hydrophilic guidewire was passed normograde from the ventral lacrimal punctum and used to puncture the stenotic tissue. Then, a 5.0Fr/70 cm open-end ureteral catheter was threaded normograde over the guidewire and NLD patency was re-established. The catheter confirmed a NLD length of 30 cm and was then removed. A 5.0Fr/22-32 cm Universa© Soft Ureteral Stent was threaded normograde over the guidewire until the loops of the stent were exposed at each end. The guidewire was removed and the stent loops were sutured in place. RESULTS: The stent was withdrawn 1 month after the procedure. Telephone follow-up with the client reported significant improvement in the amount of ocular discharge and decreased sensitivity around the face and ears. CONCLUSION: Endoscopy is a safe and effective procedure allowing for definitive diagnosis of NLD obstruction and to assist in interventional procedures. Placement of a canine indwelling ureteral stent seems to be an effective alternative treatment option for equine NLD obstruction compared to conventional invasive surgical procedures.

Stenting of a partially obstructed nasolacrimal duct using a steerable angle-tipped hydrophilic guidewire in a cat.

OBJECTIVE: This case report describes the successful correction of partial obstruction of the NL duct in a cat by means of a modified retrograde NL duct cannulation using a steerable angle-tipped hydrophilic guidewire (AH guidewire) following a paranasal incision. ANIMAL STUDIED: A 2-year-old neutered male American domestic shorthair cat was referred to the Purdue University Veterinary Hospital (PUVH) for chronic epiphora suspected secondary to nasolacrimal (NL) system obstruction. PROCEDURES: At the first visit, the cat had epiphora OD and facial dermatitis but no other abnormalities on physical and ophthalmic examinations. Computed tomography (CT)-dacryocystorhinography revealed partial obstruction of the NL duct secondary to stenosis near the distal root of the right maxillary third premolar (107). A digital three-dimensional (3D) model of the right maxilla and NL duct was created for inspection and virtual cannulation of the NL. The model was 3D printed and cannulation of the NL duct was rehearsed with various stent materials. Retrograde NL stenting with the guidance of a steerable angle-tipped hydrophilic guidewire was conducted following a paranasal incision. A urethral catheter was cannulated over the guidewire and maintained for 44 days. RESULTS: The epiphora resolved immediately after stenting. At 21 days post-stenting, the cat developed acute bullous keratopathy secondary to self-trauma which was treated with a third eyelid flap. On the final follow-up communication with the owner at 210 days post-stenting, no epiphora or any other concerns were reported. CONCLUSION: To the authors' knowledge, this is the first report of successful NL stenting and resolution of epiphora in a cat with a partial NL system obstruction.

Dacryocystitis in dogs caused by foreign bodies-Diagnosis and therapy in 14 Cases.

OBJECTIVE: To describe foreign bodies (FBs) in the nasolacrimal sac of dogs, the history, and simple diagnostic and therapeutic approaches. Animals studied Fourteen dogs of different breeds, ages, and sexes were presented with unilateral dacryocystitis and had been treated without success for over 1-8 months. PROCEDURES: Patient history, including prior treatment, was obtained from medical records. Slit-lamp examination was performed in all cases (SL 17, Kowa Company Ltd.). Jones tests 1 and/or 2 were performed in 13/14 cases. Dacryocystotomy was initiated with an incision into one canaliculus until the lacrimal sac was exposed and could be explored. After extracting the FB from the nasolacrimal sac, the surgical wound and canaliculus were left open. Aftercare included the administration of antibiotic eye drops with or without dexamethasone and systemic analgesia. RESULTS: All 14 dogs were mesocephalic. Four of them were Dachshunds. Dacryocystotomy revealed plant-related FBs in all cases. The purulent discharge disappeared immediately after removal and did not recur during follow-up. CONCLUSIONS: A simple dacryocystotomy is recommended for dogs with a strong suspicion of a foreign body in the lacrimal drainage system. Dacryocystorhinography appears to be an optional tool in these cases.

Fluoroscopically guided neocanalization for treatment of nasolacrimal atresia in two horses.

CASE DESCRIPTION: A yearling Thoroughbred stallion and an 8-year-old Saddlebred mare were evaluated for persistent mucoid ocular discharge. CLINICAL FINDINGS: Examination of both horses revealed copious yellow-tan mucoid ocular discharge with a negative Jones I test, absent nasal punctum, and unsuccessful anterograde nasolacrimal duct (NLD) irrigation. Clinical abnormalities were present on the right side only in one horse and bilaterally in the other. Computed tomography (CT) with contrast confirmed nasolacrimal duct atresia in both horses. TREATMENT AND OUTCOME: Under general anesthesia, the affected NLD was catheterized anterograde and contrast injected. Using fluoroscopic guidance, retrograde access to the distal NLD was obtained for through-and-through wire access. Over the wire, the stoma was dilated and a temporary stent placed for 4-8 weeks. After the procedure, both horses were comfortable and free of ocular discharge at the minimum time of last follow-up, 9 months postoperatively. CLINICAL RELEVANCE: Fluoroscopically guided neocanalization is a viable alternative to traditional surgical approaches for NLD atresia, especially when access to the site of obstruction is limited.

Dacryocystomaxillorhinostomy for chronic dacryocystitis in a dog.

A 10-year-old female spayed Vizsla had intermittent mucoid ocular discharge from the right eye for 7 years. History, clinical findings, imaging studies, and culture and histopathology results confirmed chronic dacryocystitis with granuloma. A dacryocystomaxillorhinostomy was performed to preserve the functional portions of the nasolacrimal system remaining in this patient, as well as to promote healing of the lacrimal sac granuloma and secondary infection. Complete resolution of the clinical abnormalities was achieved, and the dog remains healthy 3 years postoperatively.

Repair of anomalous nasolacrimal duct in a bull by use of conjunctivorhinostomy.

A proximal nasolacrimal duct anomaly, believed to be congenital, in a bull was repaired by use of conjunctivorhinostomy. Initial attempts at correction, using prolonged nasolacrimal duct catheterization, were unsuccessful. Trephination from the medial canthus to the ventral nasal meatus, combined with long-term catheterization of this new passage, was successful in resolving clinical signs of disease.