Objective: To describe the cytopuncture microbiopsy (CM) technique performed during transcanalicular endoscopic lacrimal duct recanalization (TELDR) in patients with primary acquired nasolacrimal duct obstruction (PANDO) as an alternative to open biopsy, the standard method used in collecting specimen. Methods: This is a noncomparative, interventional case series with histopathologic correlation. Patients diagnosed with complete PANDO who underwent TELDR with balloon dacryoplasty and silicone intubation with CM at University of Santo Tomas Hospital from October 2014 to January 2017 were included. Results: Twenty (20) tissue specimens from the lacrimal sac and nasolacrimal duct were obtained from 18 patients. There were 16 females and 2 males included in the study. Mean age was 57.5 years. All specimens revealed few clusters of benign epithelial cells with few degenerated mononuclear cells and lymphocytes, and singly scattered lymphocytes that are set in fibrinous background. Tissue cytology studies were negative for malignant cells. Conclusion CM is a minimally invasive procedure that offers an alternative to open biopsy technique that can be done routinely during TELDR.
Dacryocystorhinostomy ; Lacrimal Apparatus Diseases

Dacryocystorhinostomy ; Humans ; Lacrimal Duct Obstruction ; Nasolacrimal Duct/surgery*

BACKGROUND: Hasner valve incision has been recently introduced as a new treatment for ophthalmic patients with epiphora symptoms. The aim of this study was to examine whether surgical outcomes of Hasner valve incision for inferior nasolacrimal duct obstruction were different between pediatric and adult patients. METHODS: A total of 53 eyes of 52 patients who underwent Hasner valve incision in the Beijing Tongren Hospital from October 2016 to November 2019 were retrospectively observed. Patients were divided into two groups, including pediatric group (23 eyes of 22 patients, <18 years old) and adult group (30 eyes of 30 patients, ≥18 years old). Success rate of surgery was determined by both subjective measure (complete resolution of epiphora) and objective measure (lacrimal passage irrigation and tear meniscus height). Fisher exact test was conducted. RESULTS: By conducting Fisher exact test and comparing complete resolution of epiphora (P = 0.627), lacrimal passage irrigation (P = 0.663), measurement of Tear Meniscus Height (P = 0.561), and appearance of complication (P = 0.339), there was no statistically significant difference of surgical outcomes between pediatric and adult patients (P > 0.05). CONCLUSION Hasner valve incision was effective for both adult and children with inferior nasolacrimal duct obstruction, with no difference in surgical outcomes between the two groups.
Adolescent ; Adult ; Child ; Dacryocystorhinostomy ; Humans ; Lacrimal Duct Obstruction ; Nasolacrimal Duct ; Retrospective Studies ; Treatment Outcome

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

PURPOSE: We report a case of acute dacryocystitis diagnosed with abscess and rupture of lacrimal sac and fistula to posterior orbit during the operation. CASE SUMMARY: A 71-year-old woman visited our clinic with edema and pain in the eyelid from three days ago. For past four months, there was viscous of the left eye and tears. The patient had severe conjunctival chemosis and hyperemia, compared with the left eyelid edema and redness. Orbital CT scan showed orbital cellulitis, which was followed by systemic antibiotics and steroid therapy. On the 4th day of therapy, orbital abscess formation was observed in orbit MRI and surgical drainage was planned. During surgery, we found rupture of the posterior part of lacrimal sac and fistula to posterior orbit. Pseudomonas aeruginosa was identified in the bacterial cultures, and after the administration of appropriate antibiotics, the disease showed improved progress, and then additional dacryocystorhinostomy was performed. CONCLUSIONS: In our case, acute dacryocystitis rarely spread in orbit, which may lead to delayed diagnosis, orbital cellulitis and abscess, resulting in serious complications of vision threat. So, we think that it is necessary to consider surgical treatment more actively in the stage of chronic dacryocysitis.
Abscess ; Aged ; Anti-Bacterial Agents ; Dacryocystitis ; Dacryocystorhinostomy ; Delayed Diagnosis ; Drainage ; Edema ; Eyelids ; Female ; Fistula ; Humans ; Hyperemia ; Magnetic Resonance Imaging ; Nasolacrimal Duct ; Orbit ; Orbital Cellulitis ; Pseudomonas aeruginosa ; Rupture ; Tears ; Tomography, X-Ray Computed

We evaluated the effect of silicone stent use during endoscopic dacryocystorhinostomy on postoperative morbidities in comparison with versus without a silicone stent. Two authors independently searched six databases (PubMed, Embase, Scopus, the Web of Science, the Cochrane library, and Google Scholar) from inception of article collection to July 2017. The analysis included prospective randomized studies that compared intraoperative silicone stent insertion (silicone group) with no application of a silicone stent (control group), in which the outcomes of interest were success rate (lacrimal passage patent check with syringing, symptom relief, or endoscopic confirmation of fluorescein dye from the opening of Hasner's valve) and morbidities (e.g., postoperative bleeding, rhinostomy closure, granulation tissue, synechia, and eyelid problems) after certain follow-up periods (over 10 weeks). Nine studies involving a total of 587 participants were included. Functional success rates tended to be higher in the silicone group than in the control, but there was no statistically significant difference in success rates (odds ratio, 1.45; 95% confidence interval, 0.77 to 2.73). According to the surgical type such as mucosal removal and mucosal flap surgery, the results from types didn't demonstrate any significant effect, but the mucosal flap technique seemed to be more beneficial. Regarding postoperative morbidities, although the outcomes of the groups did not present any statistically significant difference, eyelid problems and postoperative bleeding tended to occur more frequently in the silicone group, but rhinostomy closure tended to occur more frequently in the control group. Success and morbidity rates showed no difference between the silicone stent group and control group in the meta-analysis. However, additional analyses revealed that the success rate of endonasal dacryocystorhinostomy using silicone intubation with mucosal flap has shown an improving trend, and morbidities such as granulation and synechia showed decreasing trends compared with the group without silicone intubation.
Dacryocystorhinostomy* ; Eyelids ; Fluorescein ; Follow-Up Studies ; Granulation Tissue ; Hemorrhage ; Intubation ; Prospective Studies ; Silicon* ; Silicones* ; Stents* ; Treatment Outcome*

OBJECTIVES: Insertion of a silicone stent during endoscopic dacryocystorhinostomy (DCR) is the most common procedure to prevent rhinostomy closure. It has been claimed that silicone intubation improves the surgical outcomes of endoscopic DCR. However, many reports have documented an equally high success rate for surgery without silicone intubation. Accordingly, we conducted a systematic review and meta-analysis to clarify the outcomes of endoscopic DCR with and without silicone intubation and determine whether silicone intubation is actually beneficial for patients. METHODS: PubMed, Embase, and Cochrane Library databases were searched to identify relevant controlled trials evaluating endoscopic DCR with and without silicone intubation. The search was restricted to English articles published between January 2007 and December 2016. Relevant articles were reviewed to obtain information pertaining to interventions and outcomes. We also performed a meta-analysis of the relevant literature. RESULTS: In total, 1,216 patients included in 12 randomized controlled trials were pooled. A total of 1,239 endoscopic DCR procedures were performed, and silicone stents were used in 533 procedures. The overall success rate for endoscopic DCR was 91.9% (1,139/1,239), while the success rates with and without silicone intubation were 92.9% (495/533) and 91.2% (644/706), respectively. There was no statistically significant heterogeneity among the included studies. A meta-analysis using a fixed-effects models showed no significant difference in the success rate between endoscopic DCR with silicone intubation and that without silicone intubation (OR, 1.38; 95% CI, 0.89 to 2.12; P=0.148; z=1.45). Furthermore, there were no significant differences with regard to surgical complications such as synechia, granulation, and postoperative bleeding. CONCLUSION: The findings of our meta-analysis suggest that the success rate and postoperative complication rate for endoscopic DCR is not influenced by the use of silicone intubation during the procedure.
Dacryocystorhinostomy* ; Endoscopy ; Hemorrhage ; Humans ; Intubation* ; Population Characteristics ; Postoperative Complications ; Silicon* ; Silicones* ; Stents

PURPOSE: We report a case of a young female patient who was diagnosed with a marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT lymphoma) of the lacrimal sac which mimicked dacrocystitis. CASE SUMMARY: A 23-year-old female suffered from epiphora for 3 years in the right eye. She had swelling and a painful lesion at the lacrimal sac 4 months prior and was referred to our hospital due to nasolacrimal duct obstruction and dacryocystitis. Lacrimal irrigation was performed with no passing and regurgitation with mucoid discharge. We performed orbital computed tomography and magnetic resonance imaging which showed a suspected tumor of the lacrimal sac in the right eye. We then performed excision and biopsy of the tumor through the skin approach. The patient was diagnosed with a MALT lymphoma with no systemic involvement. After six cycles of chemotherapy involving rituximab with cyclophosphamide, vincristine, and prednisone, the lesion of the mass and the painful symptoms decreased, which was regarded as a complete response. However, epiphora and eye discharge persisted, showing a nasolacrimal duct obstruction, so we performed endoscopic dacryocystorhinostomy with a lacrimal sac biopsy. The histological examination showed chronic inflammation, but not lymphoma. There was no recurrence of lymphoma at one year postoperatively. CONCLUSIONS: If there is an epiphora and palpable lesion in the lacrimal sac area, MALT lymphoma mimicking dacyocystitis may be suspected. After the lymphoma is first diagnosed by excision and biopsy, systemic chemotherapy with dacryocystorhinostomy could be an effective treatment.
Biopsy ; Cyclophosphamide ; Dacryocystitis ; Dacryocystorhinostomy ; Drug Therapy ; Female ; Humans ; Inflammation ; Lacrimal Apparatus Diseases ; Lymphoid Tissue ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone ; Magnetic Resonance Imaging ; Nasolacrimal Duct ; Orbit ; Prednisone ; Recurrence ; Rituximab ; Skin ; Vincristine ; Young Adult

PURPOSE: Various absorbable anti-adhesion agents have been used to prevent postoperative synechia formation after endonasal surgery. The purpose of this study was to evaluate the anti-adhesion effects of HyFence and Mediclore after endonasal dacryocystorhinostomy (DCR) compared to a mixed solution of hyaluronic acid and sodium carboxymethylcellulose (Guardix-Sol). METHODS: In this retrospective study, endonasal DCR and silicone tube intubation were performed on 198 eyes of 151 patients. Three different anti-adhesion adjuvants were applied to the osteotomy site in the nasal cavity after standard endonasal DCR procedures. The subjects were classified into three respective groups: group A (71 eyes, Guardix-Sol 1.5 g), group B (89 eyes, HyFence 1.5 mL), and group C (38 eyes, Mediclore 1 cc). The three groups were evaluated by asking patients about subjective symptoms and by performing lacrimal irrigation tests and endoscopic examinations. RESULTS: There were no statistically significant differences in age, sex, timing of tube removal, or follow-up period among the three groups. There were no statistically significant differences in success rates among the three groups (p = 0.990, 91.5% [65 / 71], 92.1% [82 / 89], and 92.1% [35 / 38], respectively). CONCLUSIONS: HyFence and Mediclore are safe and effective adjunctive modalities following endonasal DCR compared to Guardix-Sol. Therefore, these agents can be considered good alternatives to Guardix-Sol to increase the success rate of endonasal DCR in treating patients with poor prognosis.
Carboxymethylcellulose Sodium ; Dacryocystorhinostomy* ; Follow-Up Studies ; Humans ; Hyaluronic Acid ; Intubation ; Nasal Cavity ; Osteotomy ; Prognosis ; Retrospective Studies ; Silicon ; Silicones

PURPOSE: To compare the clinical effects of the single wide-diameter bicanalicular silicone tube and the double bicanalicular silicone tube in endonasal dacryocystorhinostomy (DCR) with canalicular trephinization for canalicular obstruction. METHODS: We retrospectively reviewed the records of 121 patients with monocanalicular or common canalicular obstruction who had undergone endonasal DCR with random bicanalicular insertion of either double silicone tubes (insertion of two tubes into each canaliculus) or a single wide-diameter (0.94 mm) silicone tube. The tubes were removed at around 3 months after surgery. RESULTS: This study included 79 eyes of 61 patients in the double-tube intubation group and 68 eyes of 60 patients in the single wide-diameter tube intubation group. Anatomical success, evaluated by syringing, was achieved in 72 of the 79 eyes (91.1%) in the double-tube intubation group and 60 of the 68 eyes (88.2%) in the single wide-diameter tube intubation group. Functional success was achieved in 65 of the 79 eyes (82.3%) in the double-tube intubation group and 61 of the 68 (89.7%) eyes in the single wide-diameter tube intubation group. There were no significant differences in the success rates of surgery between the two groups. One patient in the double-tube intubation group underwent conjunctivodacryocystorhinostomy (CDCR) and two in the wide-diameter tube intubation group underwent CDCR or reintubation to treat recurrence. CONCLUSIONS: Intubation using a single wide-diameter tube during endonasal DCR is as effective as double-tube intubation for the treatment of canalicular obstruction, with a lower rate of complications such as inflammation or patient discomfort.
Canaliculitis ; Dacryocystorhinostomy ; Humans ; Inflammation ; Intubation ; Lacrimal Duct Obstruction ; Recurrence ; Retrospective Studies ; Silicon* ; Silicones*