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Nasolacrimal Duct Obstruction (nasolacrimal + duct_obstruction)
Selected AbstractsSimultaneous bilateral external dacryocystorhinostomyACTA OPHTHALMOLOGICA, Issue 6 2007Bulent Yazici Abstract. Purpose:, To assess the outcome and complications of simultaneous bilateral external dacryocystorhinostomy (DCR) surgery. Methods:, The records of all patients who underwent bilateral external DCR in a single session between November 1999 and October 2005 were reviewed. Results:, The study cohort comprised 59 patients (50 females, nine males; age range: 6,72 years; mean age: 49 years). Nasolacrimal duct obstruction was acquired primarily in 54 patients, congenitally in three and secondary to sinonasal surgery in two. Thirteen eyes of eight patients had a history of unsuccessful lacrimal surgery. The operation was performed under local anaesthesia plus sedation in 54 patients (92%). Total intraoperative haemorrhage varied from 3 mL to 200 mL (median: 17 mL; mean: 37 mL). Excessive intraoperative haemorrhage (= 100 mL) occurred in five patients (9%). Total duration of surgery varied between 70 and 140 min, with an average of 89 min. Postoperatively, early bleeding requiring intranasal tamponade developed in one patient (2%) and bilateral wound infection in one patient (2%). Surgical success rate was 95%. Mean follow-up time was 8.8 months (range: 3,38 months). Conclusion:, This study supports that the simultaneous bilateral external DCR surgery may not adversely affect surgical success and complication rates. [source] Surveillance of vision and ocular disorders in children with Down syndromeDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 7 2007Elma Stephen MBBS MD MRCPCH Children with Down syndrome have a high prevalence of ocular disorders. The UK Down's Syndrome Medical Interest Group (DSMIG) guidelines for ophthalmic screening were locally implemented into a protocol that included neonatal eye examination by an opthalmologist and a comprehensive ophthalmological examination (cycloplegic refraction, ophthalmoscopy, and orthoptic assessement) by at least the age of 3 years, followed by preschool follow-up as indicated. We audited retrospectively surveillance for ocular disorders before and after the DSMIG-based guidelines were locally adopted in 1995. Results were compared for children born before and after the implementation of screening guidelines. A total of 81 children (43 females, 38 males) with Down syndrome were identified. After the DSMIG protocol, 34/36 children received a full ophthalmological examination in the neonatal period, compared with 9/27 children before 1995 (p<0.001). Neonatal screening resulted in the detection of cataracts in three infants. Mean age of first comprehensive ophthalmic screening outside the neonatal period was similar in the two groups (1y 6mo before guidelines vs 1y 9mo after), as were the proportion of children receiving preschool eye checks (27/30 before; 17/18 after). Overall, 65.7% children were screened in accordance with the guidelines, improving to 100% in recent years. At school age, 43% of the study population had significant refractive errors, with 27% having hypermetropia and astigmatism. Earlier prescription of glasses for refractive errors was seen (mean age 5y 6mo before guidelines; 3y 6mo after; p<0.001). Prevalence of other ocular disorders included strabismus (34/72, 47%), nasolacrimal duct obstruction (26/73, 35.6%), cataracts (5/64, 7.8%), and nystagmus (12/72, 16%). Establishment of the DSMIG-based local protocol has streamlined ocular surveillance. It is anticipated that this will improve developmental and functional outcomes in Down syndrome. [source] Management of congenital nasolacrimal duct obstructionACTA OPHTHALMOLOGICA, Issue 5 2010Yasuhiro Takahashi Abstract. Our review aims to provide an update of management protocols for congenital nasolacrimal duct obstruction (CNDO). Although early probing performed before the age of 1 year was traditionally recommended, many reports have since confirmed high frequencies of spontaneous resolution during the first year of life. Accordingly, a ,wait-and-see' approach, combined with conservative therapies, is judged to be the best option in infants aged < 1 year. By contrast, persistent obstruction beyond 1 year of age warrants probing as a first-line interventional therapy. However, the optimal timing for probing remains controversial. Although there remains a high possibility of spontaneous resolution after the first year of age, this must be balanced against the decrease in success rates for probing that accompanies advancing age. If conservative management fails, persistent CNDO beyond 1 year of age should be managed either by further observation or by primary probing according to the severity of symptoms. In patients in whom probing fails, advanced treatment such as balloon catheter dilation, silicone tube intubation or dacryocystorhinostomy may be considered. [source] Efficacy of dye disappearance test and tear meniscus height in diagnosis and postoperative assessment of nasolacrimal duct obstructionACTA OPHTHALMOLOGICA, Issue 3 2010Joon Ho Roh Abstract. Objective:, To evaluate the efficacy of the fluorescein dye disappearance test (FDDT) and measurement of tear meniscus height (TMH) in the diagnosis and postoperative assessment of nasolacrimal duct obstruction (NLDO). Methods:, The study group included 42 eyes of 42 patients who had a diagnosis of primary acquired nasolacrimal duct obstruction (PANDO) or functional nasolacrimal duct obstruction (FNDO) and underwent endoscopic transnasal dacryocystorhinostomy. The control group included 38 eyes of 38 people without tearing. The values of the FDDT, TMH and tearing symptom score (TSS), which was evaluated in five levels based on patients' history taking, were measured before surgery, and 1 day, 2 weeks, 1, 3 and 6 months after surgery. The values of the FDDT, TMH and TSS in the study group were compared with those of the control group. Results:, The preoperative values of the FDDT, TMH and TSS were 0.7 ± 0.4, 0.22 ± 0.08 mm and 1.6, respectively, in the control group and 3.0 ± 0.8, 0.53 ± 0.15 mm and 4.4, respectively, in the study group. These differences were statistically significant. Also, at each follow-up, the postoperative values of the FDDT and TMH decreased significantly compared to their preoperative values in the study group. The postoperative TSS decreased significantly compared to the preoperative values at each follow-up except at postoperative 1-day follow-up. There were no significant differences in the preoperative values of the FDDT, TMH and TSS between the types of NLDO. The TSS had positive correlations with the FDDT and TMH before and after surgery. Conclusion:, These results suggest that the FDDT and TMH measurement might be effective in the diagnosis and postoperative assessment of NLDO. [source] A retrospective comparison of endonasal KTP laser dacryocystorhinostomy versus external dacryocystorhinostomyCLINICAL OTOLARYNGOLOGY, Issue 5 2002S. Mirza We retrospectively reviewed all primary external dacryocystorhinostomies (DCRs) and endonasal KTP laser DCRs performed for epiphora as a result of nasolacrimal duct obstruction in our unit between 1993 and 2000. Forty-nine patients underwent an external approach and 76 endonasal laser procedures were performed. The success rate of the external group was 94% with a mean follow-up of 9 months. In contrast, the endonasal group's success rate was 64% with a mean follow-up of 12 months. This difference reached statistical significance (P = 0.0002). However, when including revision procedures, the success rate in the endonasal group increased from 64% to 82%. The success rate in the endonasal group improved from 50% in the first 38 cases to 79% in the last 38 cases (P = 0.0084), thereby demonstrating a learning curve. Our study confirms external DCR as the ,gold standard' for a successful outcome. However, the endonasal technique has significant advantages, including being a quicker procedure with less morbidity, no cutaneous scar, and being more amenable to a bilateral procedure, daycase surgery and local anaesthetic. We are persisting with the endonasal technique because of its advantages but have moved towards more ,cold steel' techniques in an effort to improve results and emulate other series. In conclusion, for nasolacrimal duct obstruction, the endonasal technique is our approach of choice, with revision surgery if necessary, and the external technique is held in reserve. [source] | ||||||||||