Ahigh percentage of patients with disorders of the lacrimal drainage system present to the ophthalmologists with the complaint of epiphora. These patients complain of the blurred vision due to tear, and "mattering" and pain of the eyes due to secondary conjunctivitis and acute or chronic dacryocystitis. The aim of surgery on the lacrimal drainage system to relieve epiphora or acute and chronic inflammations of the eye and the lacrimal system. Although the causes of congenital and acquired obstructions are different, the accurate knowledge on the anatomy, the causes of obstruction, and the diagnostic methods is essential in the evaluation of patients with epiphora and for the optimal management of obstruction of the lacrimal drainage system. In this article the author will discuss the surgical managements of disorders of the lacrimal drainage system associated with age, focusing on the degree and position of obstruction from a review of the published data.
Conjunctivitis ; Dacryocystitis ; Drainage* ; Humans ; Inflammation ; Lacrimal Apparatus Diseases ; Tears

PURPOSE: To evaluate the surgical results and clinical characteristics of congenital lacrimal fistula. METHODS: Fourteen patients were diagnosed with congenital lacrimal fistula and received simple fistulectomy. Three patients received anterior lamella reposition operation simultaneously due to epiblepharon. We retrospectively reviewed the medical records and conducted telephone interviews. RESULTS: In 15 eyes of the 14 patients, epiphora through lacrimal fistula disappeared. Two eyes of 2 patients showed a little epiphora only outdoors but there was no need of further treatment. All patients accepted the surgical results cosmetically. Histologically, stratified squamous epithelial change with keratinization was remarkable by aging. In adults, hair follicles with increased keratinization were contained and the result with skin was similar. CONCLUSIONS: Simple fistulectomy was a useful technique for congenital lacrimal fistula.
Adult ; Aging ; Fistula* ; Hair Follicle ; Humans ; Interviews as Topic ; Lacrimal Apparatus Diseases ; Medical Records ; Retrospective Studies ; Skin

PURPOSE: This study nasolacrimal duct (NLD) stenosis in adult, evaluated the clinical results of treatment with topical 0.04% mitomycin C (MMC) eyedrops after silicone tube intubation. METHODS: Prospectively, we analysed the clinical results from 29 eyes of 25 adult patients with epiphora due to NLD stenosis who underwent this procedure. RESULTS: The mean follow-up periods was 9.3 months. Twenty-two eyes (76%) showed no epiphora and complete passing into the cavity by lacrimal irrigation. Four eyes (13.7%) showed intermittent epiphora but improvement relative to preoperative state. Three eyes (10.3%) showed persistent epiphora and no improvement. In total, 26 eyes (89%) showed improvement of symptoms. Complications were silicone tube prolapse in 5 eyes (17.2%) and dacryocystitis in 2 (6.9%) CONCLUSIONS: Silicone tube intubation with topical MMC eyedrops for treatment of patients with tearing due to NLD stenosis is effective, safe and easy. This technique can be tried before DCR if the surgeon has a thorough of nasal cavity anatomy and probing.
Adult* ; Constriction, Pathologic ; Dacryocystitis ; Follow-Up Studies ; Humans ; Intubation* ; Lacrimal Apparatus Diseases ; Methods ; Mitomycin* ; Nasal Cavity ; Nasolacrimal Duct* ; Ophthalmic Solutions ; Prolapse ; Prospective Studies ; Silicon* ; Silicones* ; Tears

PURPOSE: Epicanthal folds and epiblepharon which often develop in oriental children are congenital anomalies of eyelids. These may need surgical correction because corneal irritation may develop by medial upper and lower eyelash besides cosmetic problems. V-Y plasty and Mustarde's method are standards for correction of epicanthal folds, but not usually performed because of cosmetic scar formation. METHODS: This study included 26 patients, 52 eyes (19 females, 38 eyes; 7 males, 14 eyes) with corneal irritation due to medial upper and lower eyelash. We performed upper and lower lid blepharoplasty simultaneously and analyzed their results and complications through medical records. RESULTS: Epiblepharon associated with epicanthus tarsalis was found in 22 patients, 22 eyes, epicanthus palpebralis in 4 patients, 8 eyes. At the time of surgery mean age was 7 years old (3.7~10.3 years old). During the follow-up more than 6 months, double fold asymmetry was found in 1 patient, double fold loosening in 1 patient, 2 eyes, lower eyelid undercorrection in 2 patients, 3 eyes. CONCLUSIONS: These findings suggest that simultaneous upper and lower lid blepharoplasty for patients with corneal problems due to medial upper and lower eyelash is more unsatisfactory in the cosmetic result than standard method, but has advantage of less scarring, and thought to be a good method to relieve corneal irritation.
Blepharoplasty* ; Child ; Cicatrix ; Eyelids ; Female ; Follow-Up Studies ; Humans ; Male ; Medical Records

PURPOSE: To evaluate the surgical results of endonasal dacrocystorhinostomy with two silicone intubation in common canalicular obstruction. METHODS: Forty patients (57 eyes) who complained of tearing due to common canalicular obstruction underwent endonasal dacryocystorhinostomy. In this study, We randomly divided patients into two groups. One group underwent one-silicone tube intubation (29 eyes, group A) and the other group underwent two-silicone tube intubation (28 eyes, group B). After surgery, we compared the success rates and the causes of surgical failure between the two groups. RESULTS: There were no significant differences between the two groups with regard to age, sex, duration of silicone intubation, or follow-up time. The primary success rates of the group A and the group B were 65.5% (19/29) and 85.7% (24/28) [(P=0.078)], respectively. the final success rates after the revisional surgery were 76.4% (21/29) and 92.8% (26/28) [(P=0.043)] respectively. Primary causes of surgical failure in the group A were: membranous obstruction of the internal ostium (6), common canalicular re-obstruction (2), sump syndrome (1), and functional obstruction (1). The main causes of surgical failure in the group B were: membranous obstruction of the internal ostium (2), and granuloma formation (2). CONCLUSIONS: We believe that endonasal dacryocystorhinostomy with two-silicone tube intubation might be an excellent alternative treatment modality in order to improve success rates in common canalicular obstruction.
Dacryocystorhinostomy ; Follow-Up Studies ; Granuloma ; Humans ; Intubation ; Postcholecystectomy Syndrome ; Silicones*

PURPOSE: To evaluate the surgical results of tarsal fracture and anterior lamellar reposition in patients with cicatricial entropion. METHODS: The authors retrospectively analyzed the medical records of 9 patients (11 eyes) who had undergone tarsal fracture and anterior lamellar reposition for cicatricial entropion from October 2003 to September 2008. RESULTS: 6 eyes of 5 patients were male and 5 eyes of 4 patients were female. The patients' mean age was 63.4 (43.5~75.9) years. The mean follow-up period was 29.9 (7~67.6) months. After surgery, the ocular irritation disappeared in all patients. There were no recurrences or complications. CONCLUSIONS: Tarsal fracture and anterior lamellar reposition in patients with cicatricial entropion is a simple and cosmetically effective procedure without complications.
Entropion ; Eye ; Eyelids ; Female ; Follow-Up Studies ; Humans ; Male ; Medical Records ; Recurrence ; Retrospective Studies

PURPOSE: To report a rare case of juvenile xanthogranuloma in the lacrimal sac. CASE SUMMARY: An 8-year-old female presented to our hospital with epiphora and palpable mass on the left medial canthal area. As a symptom, a sticky and bloody discharge through the punctum had begun on occasion 3 months previously. When pressure was applied on the left medial canthal area, a mucoid discharge through the punctum occurred, and a solid mass was palpable. The mass localized in the lacrimal sac and upper nasolacrimal duct was observed on orbit CT. No invasion into the surrounding tissue was present. The authors of the present study decided to perform endonasal dacryocystorhinostomy, and subsequently a skin-colored mass was found in the lacrimal sac. The histopathological and immunohistochemical diagnosis was histiocytic proliferation, compatible with juvenile xanthogranuloma. Six months later, the patient complained of epiphora recurrence with palpable mass on medial canthal area. The tumor recurrence was confirmed with enhanced orbit CT finding 14 months after the first surgery. A second surgery using endonasal dacryocystorhinostomy was performed to remove the mass.
Child ; Dacryocystorhinostomy ; Female ; Humans ; Lacrimal Apparatus Diseases ; Nasolacrimal Duct ; Orbit ; Recurrence ; Xanthogranuloma, Juvenile

PURPOSE: To evaluate the effects of the modified medial spindle and the lateral tarsal strip procedure in involutional ectropion patients. METHODS: The lateral tarsal strip procedure with the modified medial spindle procedure that adjusts the size and the position of the spindle along the severity of lower eyelid eversion was performed on 17 eyes of 12 patients with involutional ectropion. The average follow-up period was 19.6 months. RESULTS: All 12 patients were male, and the mean age was 65.4 years (range 54 to 78 years). There was no recurrence in any of the 17 eyelids. However, a mild lower lid retraction and a mild punctal eversion not requiring reoperation occurred in the follow-up period. CONCLUSIONS: The lateral tarsal strip procedure combined with the modified medial spindle appears to be effective in the surgical treatment of involutional ectropion.
Ectropion ; Eye ; Eyelids ; Follow-Up Studies ; Humans ; Male ; Recurrence ; Reoperation

PURPOSE: We determined the effects of silicone tube tip fixation on the nasal wall using an absorbable suture during silicone tube intubation in patients with congenital nasolacrimal duct obstruction. METHODS: Patients (55:71 eyes) diagnosed with congenital nasolacrimal duct obstruction and who underwent silicone tube intubation were divided into two groups: those in which the silicone tube was fixed to the nasal wall using an absorbable suture (fixed group) or not (non-fixed group). We investigated the percentage of silicone tube displacement, the time for displacement, the success of surgery, and the method of removing the silicone tube after surgery. RESULTS: The mean age, percentage of early displacement within 1 month, time to displacement, and success rate of surgery were 2.4 years, 0% (0/35), 1.4 months, and 100% (35/35) in the fixed group (35 patients) and 1.8 years, 44% (16/36), 0.8 months, and 97% (35/36) in the non-fixed group (36 patients), respectively. Both groups were able to remove the silicone tube simply through lacrimal punctum at the outpatient clinic. CONCLUSIONS In patients with congenital nasolacrimal duct obstruction, silicone tube fixation at the nasal wall after silicone tube intubation can prevent early displacement of silicone tubes within 1 month. This is a simple and effective technique because it removes the silicone tube through the lacrimal punctum without general anesthesia or intravenous anesthesia.

Purpose: In patients with nasolacrimal duct obstruction, the outcomes of surgery were evaluated according to the type or presence of flaps. Methods: In total, 509 eyes were compared retrospectively: 178 eyes in patients treated without flaps, 126 eyes in patients treated using nasal mucosa flaps, and 205 eyes in the patient group using nasal and lacrimal sac mucosal flap were compared retrospectively. We analyzed the factors of success according to the surgical method by comparing granulation and bony ostium obstruction at 1, 3, and 6 months after surgery in each group. Results: At 6 months after surgery, granulation was found in 6 eyes (2.93%) in the nasal and lacrimal sac mucosal flap group, 5 eyes (3.96%) in the nasal mucosal flap group, and 15 eyes (8.42%) in the group treated without flaps. Bony ostium obstruction was found in 3 eyes (1.46%) in the nasal and lacrimal sac mucosal flap group, 4 eyes (2.38%) in the nasal mucosal flap group, and 6 eyes (2.81%) in the group treated without flaps. The anatomical surgical success rate of patients treated with nasal and lacrimal sac mucosal flaps was 95.61%, which was higher than those of patients treated with nasal mucosal flaps (92.86%) and without flaps (88.20%). The functional and anatomical surgical success rate was 94.15% in the group treated with nasal and lacrimal sac mucosal flaps, 88.89% in the group treated with nasal mucosal flaps, and 84.83% in the group treated without flaps. Conclusions Endonasal dacryocystorhinostomy using the nasal and lacrimal sac mucosal flap is an effective method that minimizes the risk of granulation and bony ostium obstruction.