A dacryolith is a concretion within the lacrimal drainage system. Although it may cause intermittent epiphora without inflammation, dacryoliths are often underlying contributors to recurrent or chronic dacryocystitis. It may occur anywhere along the lacrimal drainage system, albeit most commonly in the lacrimal sac. We report an interesting case of a dacryolith presenting as a mass of inferior meatus, which was managed via endonasal endoscopic approach.
Dacryocystitis ; Dacryocystorhinostomy ; Drainage ; Inflammation ; Lacrimal Apparatus Diseases ; Lacrimal Duct Obstruction

PURPOSE: The correspondence between the canaliculus irrigation test, dacryocystography, and Jones test in patients with epiphora was investigated. METHODS: The study included 494 eyes of 359 patients who complained of epiphora and underwent both canaliculus irrigation test and dacryocystography from May 2001 to March 2006. Sixty-eight eyes from 34 patients diagnosed with functional lacrimal duct obstruction took Jones tests. Factors such as age, sex, duration of epiphora, and site of obstruction were analyzed in terms of correspondence of the tests. RESULTS: Between the canaliculus irrigation test and dacryocystography, correspondent rate was 55%. Correspondence had no relation to patient age, sex, duration of epiphora, or site of obstruction. Between Jones test and dacryocystography, the correspondent rate was 47%. Factors affecting the correspondences were not significantly found. CONCLUSIONS: A canaliculus irrigation test can give useful information with high correspondence rate of dacryocystography in the case of 'not pass' or 'pass without regurgitation'. Therefore dacryocystography should be utilized in "pass with regurgitation" cases by canaliculus irrigation test.
Humans ; Lacrimal Apparatus Diseases* ; Lacrimal Duct Obstruction

PURPOSE: We sought to evaluate the outcomes of external dacryocystorhinostomy (DCR) and mono-canalicular intubation in patients with total obstruction of one canalicus. METHODS: Sixteen eyes of 16 patients with nasolacrimal duct obstruction and a single canaliculus obstruction who had undergone external DCR and monocanalicular intubation of the intact canaliculus were retrospectively included in the present study. The monocanalicular tube (Mini Monoka) was left in place for at least two months. Munk epiphora grading for the evaluation of epiphora and irrigation was performed both preoperatively and at 6 months postoperatively. RESULTS: Mean patient age was 46 ± 14.2 (range, 18 to 76) years. The inferior canaliculus was obstructed in nine eyes (group A) and the superior canaliculus was obstructed in seven eyes (group B), respectively. Eight eyes had chronic dacryocystitis and two of these eyes also had a history of acute dacryocystitis attack. Mean preoperative Munk scores were 3.89 in group A and 4.0 in group B. Ocular surface irritation occurred in one eye in group A. Artificial eye drops were prescribed and early tube removal was not performed. Spontaneous tube dislocation was recorded in one eye in group B. No other corneal, punctal, or canalicular complications were found. At six months, irrigation of intact canaliculus was patent in all eyes. Mucoid discharge, conjunctival hyperemia, and chronic conjunctivitis were also resolved. Postoperative Munk scores were 1.11 ± 0.9 in group A and 0.86 ± 0.9 in group B. Of note, preoperative and postoperative Munk scores were significantly different in both groups (group A, p = 0.006; group B, p = 0.017). The postoperative Munk scores were not statistically different between the two groups (p = 0.606). CONCLUSIONS: In patients with nasolacrimal duct obstruction and a total of one canaliculus obstruction, external DCR and monocanalicular intubation of the intact canaliculus is an effective surgical option.
Conjunctivitis ; Dacryocystitis ; Dacryocystorhinostomy ; Dislocations ; Eye, Artificial ; Humans ; Hyperemia ; Intubation ; Lacrimal Apparatus Diseases ; Lacrimal Duct Obstruction ; Nasolacrimal Duct ; Retrospective Studies

Epiphora is one of the most common problems in ophthalmological practice, and is caused by dysfunction of the lacrimal pathway. The lacrimal drainage system is a continuous anatomical structure consisting of the lacrimal punctum, inferior and superior canaliculi, common canaliculus, lacrimal sac, and nasolacrimal duct. Lacrimal disease can be medically treated in case of acute inflammation or partial obstruction at the beginning of treatment, but surgical treatment is necessary in most cases. This paper discusses the etiology, clinical features, diagnosis, and surgical treatment of various lacrimal diseases through a selective review of the relevant literature. Advances in lacrimal duct surgery can now be performed in such a way that the structural integrity and normal physiological function of the entire efferent lacrimal pathway is preserved.
Dacryocystorhinostomy ; Diagnosis ; Drainage* ; Inflammation ; Lacrimal Apparatus ; Lacrimal Apparatus Diseases ; Lacrimal Duct Obstruction ; Nasolacrimal Duct

PURPOSE: The degree of laxity of the medial and lateral canthal tendon in Korean subjects with and without involutional entropion and epiphora was evaluated in the present study. METHODS: The present study included 180 normal subjects (360 eyes), 12 patients (15 eyes) with involutional entropion, and 41 patients (58 eyes) with epiphora. The degree of laxity of the medial and lateral canthal tendon, which grades the position of the inferior punctum, was measured using the lateral and medial distraction test. RESULTS: The mean degree of medial and lateral canthal tendon laxity was 1.83/1.08 in normal subjects. A statistical difference was not observed between sexes, and the mean degree of laxity tended to be higher in older patients. The mean degree of laxity was 2.78/2.18 and 2.28/1.22 in the involutional entropion group and the epiphora group, respectively. The involutional entropion group and the epiphora group underwent endoscopic endonasal dacryocystitis (D), medial spindle procedure (M), and endoscopic endonasal dacryocystitis with the medial spindle procedure and/or the tarsal strip procedure (T). The mean degree of laxity was 1.84/1.04 in group D, 3.00/1.20 in group M, 2.33/2.00 in group D + T, 3.20/1.40 in group D + M and 3.50/2.00 in group D + T + M before surgery. CONCLUSIONS: The results from the present study may aid in the selection of a basic treatment plan for Korean patients with involutional entropion or epiphora.
Dacryocystitis ; Entropion ; Humans ; Lacrimal Apparatus Diseases ; Tendons

OBJECTIVES: Many factors influence the outcome of endoscopic dacryocystorhinostomy (DCR). One of the most important prognostic factors is the level of obstruction in the lacrimal drainage system. The main objective of this report is to evaluate both the frequency of obstruction by anatomical region of the lacrimal drainage system on dacryocystography (DCG) and the surgical outcome of endoscopic DCR according to the obstruction level. METHODS: A retrospective series of 48 patients (60 eyes) who had undergone endoscopic DCR from January 2005 to November 2007 were enrolled. Preoperative evaluation consisted of a standard examination which included lacrimal irrigation, probing, DCG and osteomeatal unit (OMU) computed tomography. Patients were classified into four groups according to the obstruction level on DCG. Surgical outcome was evaluated postoperatively by subjective improvement of epiphora and patent rhinostomy opening on nasal endoscopic exam. RESULTS: Of 60 eyes, the levels of obstruction were the common canaliculus in 14 eyes (23.3%), the lacrimal sac in 13 eyes (21.7%), the duct-sac junction in 13 eyes (21.7%) and the nasolacrimal duct (NLD) in 20 eyes (33.3%). The ductsac junction obstruction was treated most successfully (100%), followed by NLD obstruction (90%), common canaliculus obstruction (78.6%) and saccal obstruction (69.2%). CONCLUSION: In patients with lacrimal drainage system obstruction, preoperative evaluation of obstruction level using DCG may be helpful for predicting the surgical outcome of endoscopic DCR. The saccal obstruction may have a worse prognosis than the other obstruction levels.
Dacryocystorhinostomy ; Drainage ; Eye ; Humans ; Lacrimal Apparatus Diseases ; Lacrimal Duct Obstruction ; Nasolacrimal Duct ; Prognosis ; Retrospective Studies

Congenital obstruction of the nasolacrimal drainage system commonly occurs, but rarely causes significant symptoms. A congenital nasolacrimal duct mucocele (NLDM) is an uncommon condition due to a distal and proximal obstruction of the nasolacrimal drainage system. It may presents an asymptomatic medial canthal mass, epiphora, dacryocystitis, periorbital cellulitis, sepsis and nasal obstruction. It is a rarely reported cause of respiratory distress in the newborn. Bilateral NLDSMs may cause severe respiratory distress in the newborn and must be required surgical intervention to relieve the obstruction. Nasal endoscopy, CT scan and MRI scan are used in the diagnostic work-ups to evaluate the condition. We report a case of bilateral nasolacrimal duct mucoceles which presented with respiratory distress in newborn.
Cellulitis ; Dacryocystitis ; Drainage ; Endoscopy ; Humans ; Infant, Newborn ; Lacrimal Apparatus Diseases ; Magnetic Resonance Imaging ; Mucocele* ; Nasal Obstruction ; Nasolacrimal Duct* ; Sepsis ; Tomography, X-Ray Computed

PURPOSE: To assess the clinical efficacy of monocanalicular lacrimal silicone intubation in the pediatric patients with lacrimal duct obstruction. METHODS: The medical records of 14 children with 14 eyes who underwent this procedure were reviewed retrospectively. RESULTS: Monoka(r) silicone tube was used in 3 eyes and Ritleng Self-threading Monoka(r) tube, in 11 eyes. Postoperatively, epiphora was resolved in all cases between one week and 7 months. Early postoperative extrusion of silicone tube occurred in 3 eyes(21.4%). Corneal erosion in 1 eye(7.1%), and granuloma formation in another eye(7.1%) were noticed but disappeared after removal of tubes. Removal of silicone tube was easily performed postoperatively between 3 and 7 months(mean, 4.6 months) in the clinic without sedation in all cases. CONCLUSIONS: Monocanalicular lacrimal intubation using especially Ritleng Self-threading Monoka(r) silicone tube is an easy technique for intubation and removal, and an effective method for the treatment of pediatric lacrimal duct obstruction.
Child ; Granuloma ; Humans ; Intubation* ; Lacrimal Apparatus Diseases ; Lacrimal Duct Obstruction* ; Medical Records ; Retrospective Studies ; Silicones*

BACKGROUND AND OBJECTIVES: Endoscopic intranasal dacryocystorhinostomy (DCR) has been used as a primary treatment of lacrimal obstruction and for revision of conventional dacryocystorhinostomy. The objective of this research is to look for the cause of DCR failure. MATERIALS AND METHOD: The endoscopic revision procedures were performed on 20 patients with recurrent epiphora after endoscopic DCR with anterior and posterior sac approach from 1995 to 2001. A retrospective review of 20 endoscopic revision procedures was done. RESULTS: Sixteen patients (80%) with recurrent epiphora showed granulation on intranasal opening. Most (14 of 16) began to show granulation at 6 postoperative weeks. The most common site of granulation formation was superior to intranasal opening. CONCLUSION: Because granulation formation was the most common cause of failure, it is important to extubate a silicone tube at 6 postoperative weeks.
Dacryocystorhinostomy* ; Endoscopes ; Humans ; Lacrimal Apparatus Diseases ; Lacrimal Duct Obstruction ; Recurrence* ; Retrospective Studies ; Silicones

PURPOSE: To report on the clinical manifestations, species and treatments of patients with chronic canaliculitis. METHODS: From August 2003 to February 2012, 77 eyes of 77 patients who were diagnosed with chronic canaliculitis at our hospital were retrospectively analyzed. RESULTS: The mean period from the onset of symptoms to diagnosis was 4.7 months. The most common systemic disease associated with chronic canaliculitis was diabetes (18 eyes, 23%), and 13 eyes (17%) were related to punctual plug insertion. Main symptoms consisted of epiphora with discharge and pouting punctum. In the culture results of 55 eyes, streptococci, staphylococci, and actinomyces among other bacteria were identified. Seventy-two eyes (94%) were cured with one-snip punctoplasty with curettage. CONCLUSIONS: Chronic canaliculitis is rare, and the clinical aspect can be obscured by chronic conjunctivitis, thus the diagnosis is often delayed. In patients who have systemic diseases such as diabetes or past history of punctual plug insertion, chronic canaliculitis should be differentiated by observing the punctum more closely. If the diagnosis is accurate at the time, chronic canaliculitis could be easily cured by a relatively simple procedure such as one-snip punctoplasty with curettage.
Actinomyces ; Bacteria ; Conjunctivitis ; Corneal Ulcer ; Curettage ; Dacryocystitis ; Eye ; Humans ; Lacrimal Apparatus Diseases ; Retrospective Studies ; Canaliculitis