Search

The primary cause of congenital epiphora, congenital nasolacrymal duct obstruction (CNLDO) affects 5 to 20% of newborns. In children over 12 months, it is currently recommended to treat with primary probing and intubation of the nasolacrymal duct under general anesthesia. The purpose of this study is to compare "pulled" monocanalicular intubation (Monoka) versus "pushed" monocanalicular intubation (Masterka).This retrospective study included 73 children between 2014 and 2017 who presented with CNLDO with membranous (mucosal) obstruction. All procedures were performed under general anesthesia with endotracheal intubation. Children with CNLDO underwent either monocanalicular silicone intubation (Monoka) with classic nasal recovery or pushed monocanalicular intubation (Masterka) inserted via the canthus. Treatment success was defined as complete resolution of epiphora at two months after the procedure.Surgical outcomes were assessed in 53 eyes with Monoka and 20 eyes with Masterka intubation. The mean age at treatment was 25 months (range, 12-69 months) for the two groups. Treatment success was achieved in 19 of 20 eyes (95.0%) in the Masterka group compared with 50 of 53 eyes (94.0%) in the Monoka group. A tube loss occured in 14% of cases in both groups.In children over 12 months of age, the Masterka "pushed" monocanalicular intubation technique is an effective treatment for congenital nasolacrymal duct obstruction.

To objectively analyze the cutaneous scar after external dacryocystorhinostomy and to compare the cosmetic result of a nasal incision and an inferior eyelid incision.All patients consecutively operated between January 2007 and December 2009 were notified of an examination. The cutaneous scar was photographed and de visu analyzed by the two authors who gave marks : 20, no visible scar ; 10, visible scar but cosmetically considered not detrimental ; 0, visible scar and considered unesthetic.Eighteen of the 60 patients notified came for examination. One hundred percent of ten patients operated via an inferior eyelid incision were graded 20 versus 25% of eight patients operated via a nasal incision. Of these patients, 62.5% were graded 10. Only one patient was marked 0 (nasal incision).The inferior eyelid incision seemed to give much better cosmetic results than the nasal incision.

We report a rare case of periorbital necrotizing fasciitis following a dacryocystorhinostomy procedure. We describe the common features of this rare infection of the skin and subcutaneous tissues and discuss the different management strategies as well as the controversial role of anti-inflammatory medication in treating this condition.

A 68-year-old woman presented with a painless inflammation of the right superior eyelid that had started several weeks before. The clinical diagnosis concluded in canaliculitis and the solid concretions were surgically extracted from the superior canalicula. The anaerobic bacteria Fusobacterium nucleatum sp. nucleatum was isolated. Signs dramatically regressed two weeks after surgery followed by one course of oral amoxicillin and clavulanic acid associated with topical tobramycin. The clinical signs had disappeared two months later.

External dacryocystorhinostomy (DCR) surgery is highly advantageous in that it can be performed under local anesthesia associated with sedation. We aimed at verifying the efficiency of the anesthesia, studying the general behavior of the patient and the quality of the surgery.A prospective study of a local anesthetic protocol associated with sedation was conducted in our Oculoplastic Department on 34 patients (71.5+/-8.3 years of age) between may 2007 and march 2008. The anesthetic protocol consisted of blocking four nerves based on the analysis of the anatomy of facial innervation. The including criteria were patient antecedents such as arterial hypertension, cardiac or lung problems, diabetes, and no contraindications for local anesthesia. The hemodynamic constants, variability of the Ramsay score, and complications such as bleeding or pain were studied. The progress of the surgery was simultaneously evaluated by the patients, anesthesiologists, and surgeons.Both the hemodynamic constants and the Ramsay score remained stable intra- and postoperatively. In addition, the visual analog scale (VAS) scores remained low. Both surgeon and patient satisfaction was excellent (88.4 % of the patients declared that they were ready to choose the same anesthetic protocol if new surgery were to be performed). The surgery's success rate was 79.3 % (no watering at 3 months) versus 82 % for the patients operated under general anesthesia.The protocol of local anesthesia associated with sedation for external DCR is therefore safe and efficient.

Congenital nasolacrimal duct obstruction affects more than 6% of newborns. Whereas some recommend nasolacrimal probing under general anesthesia from 1 year of age when the condition does not spontaneously resolve, some decide in favor of early probing from 4 to 6 months of age with topical anesthesia. We present nasolacrimal probing with inhalation of MEOPA, an equimolar mixture of nitrous oxide and oxygen, as a therapeutic alternative.We conducted a descriptive, prospective study including 63 children (75 eyes) who had nasolacrimal duct probing with inhalation of MEOPA between March 2005 and March 2006, in consultation. Efficacy was estimated by the observation of medical staff and parents and by the feasibility of the probing procedure.Children were 4-28 months old (mean age, 11.5 months). Symptoms resolved spontaneously in 79% of cases after only one probing. No incident was observed. In case of failure, probing with nasolacrimal intubation with nasal endoscopy and general anesthesia was done (21% of cases, mean age, 17.5 months).Administration of MEOPA, by inhalation with a facial mask, is already used for minor pediatric surgical procedures. It is simple to use, fast, low-risk, inexpensive, and effective.Use of MEOPA in nasolacrimal duct probing in children could be a good alternative, making it possible to alleviate pain in the youngest children and general anesthesia in the oldest.

Video-assisted endonasal endoscopic surgery is used for a constantly increasing number of indications, replacing more invasive external approaches. Indications include chronic bacterial and fungal sinusitis, nasosinus polyposis, mucocele, inverted papilloma, and lacrimal duct stenosis. This microinvasive technique offers the advantage of preserving the physiological properties of the mucosa while assuring proper ventilation of the nasal and sinus cavities. We discuss the technical basis of this new surgical option used by ear-nose-throat specialists and maxillofacial surgeons. We focus on turbinai, septal, maxillary, and lacrimal surgery but do not discuss the more specific rhinology areas such as ethmoidectomy, sphenoidotomy or frontal surgery. The main procedures are described together with indications and expected results.

The microsurgical treatment of canalicular stenosis is indicated in localized stenosis. The goal is to restore lacrymal mucosa continuity in order to re-establish spontaneous lacrymal drainage. Stenosis located close to the puncti can be reached by the direct approach, those close to the lacrymal sac require an approach via the common canaliculus. The surgical indications and techniques are developed, with particular attention given to common canaliculus repair and the new surgical approach to reach it.

A persistent, symptomatic lacrimal duct stenosis is treated by dacryocystorhinostomy (DCR), with external (EX) or endonasal (EN) access. The basic indication is the same in all cases and either route can be used. The EX route seems better in terms of speed of surgery, learning curve and cost. It is logical to use the external route to treat the disorder when it is associated with a lacrimal sac diverticulum, an irreducible stenosis of the union canal, or a canthopexy. The EN route has been shown to be worth consideration whenever there is a nasal sinus disorder that can be repaired at the same time. Moreover, it is indicated in a rare case of lacrimal abscess that cannot be treated medically, where the risk of scarring would contraindicate standard surgery, or when DCR is recurrent. A series of prospective randomized studies is needed to determine whether the route materially influences the outcome. Until then, it is best to have both methods available for an unbiased case-by-case decision.

Mitomycin C (MMC) has been described as having a positive effect in different types of dacryocystorhinostomy (DCR) surgery such as external DCR, endonasal and transcanalicular DCR. MMC, an antineoplastic antibiotic, acts as an alkylating agent by inhibiting DNA, RNA and protein synthesis. Topical use of MMC can modulate the scarring process, which is useful in glaucoma surgery and pterygium excision. In DCR, MMC is also useful because it reduces the scarring process and thus prevents the occlusion of the osteotomy site related to the fibroblast activity. An increase in the success rate for long-term results has been observed by different authors, resulting from a larger osteotomy size as well as a decrease in the density and cellularity of the mucosa. No complications have been seen with topical use of MMC.

The dacryo-cysto-rhinostomy via the external approach is indicated for obstruction of the lacrymal duct. It consists in the creation of short-circuit between the lacrymal sac and the external nasal wall. The operation stages starts by paracanthal incision, the subperiosteal dissection stops anteriorly to the posterior insertion of the medial canthal ligament (to preserve lacrymal function). An ostectomy is performed between the maxillary bone and the unguis. A stomy is created by individualizing two mucosal flaps. The bicanaliculonasal intubation is systematic and maintained for 10 to 12 weeks.

The purpose of this study was to assess the value of two new clinical findings for the diagnosis of dacryolithiasis discovered with nasal endoscopy: anatomical abnormalities of the Hasner valve (HV) and mucopurulent discharge visible at this valve. The value of these findings is compared with other clinical and radiological signs of dacryolithiasis. A hypothesis is developed as to the responsibility of the HV in the formation of dacryolithiasis.This study was prospective and based on 797 operations performed for epiphora: 647 endonasal dacryocystorhinostomies and 150 meatotomies of the HV, with systematic preoperative nasal videoendoscopy. Ninety dacryocystographies (DCGs) and 129 lacrimal computed tomographies (LCT) were preoperatively performed.Dacryoliths were found in 55 of 797 patients (6.9%). The HV could be examined in 48 patients in the lithiasis group and in 687 patients in the control group. Mucopurulent discharge was observed in 22 patients with lithiasis (45.8%) and in 40 patients (5.8%) (p10(-6)) of the control group. Anatomical abnormalities of the HV were found in 40 patients with dacryolithiasis (83.3%) as compared to 82 patients ing the control group (11.4%) (p10(-6)). In 13 patients, the VH was very small (2 mm), in 12 patients it was very long (15 mm), and in 15 patients both abnormalities were observed. Other clinical signs were young age (mean, 48.2 years vs 59.1% in the control group) (p0.05), a history of acute noninfectious dacryocystic retention (38.2% vs 9.5%) (p10(-5)), partial obstruction of the lacrimal pathway (LP) (61.8% vs 30.5%) (p10(-5)). The 28 LCTs that were performed in subjects who had lithiasis made it possible to diagnose 19 cases of dacryolithiasis and confirmed abnormalities of the HV causing narrowing of the LP in 20.Dacryolithiasis is frequent and often misdiagnosed. When dacryolithiasis is suspected, a nasal videoendoscopic exam must be done to seek HV abnormalities and mucopurulent discharge at this valve. This latter finding, i.e., the association of mucopurulent discharge with a patent lacrimal system, has high specificity. The finding of numerous anatomical abnormalities of the HV may be an indication that congenital malformation of the HV is the cause of many cases of lithiasis.

The congenital impermeability of see lacrymal is frequent affection of new born. Whimpering is the master symptom. We propose a retrospective study with 492 cases of congenital imperforations treated in our ophthalmology department in Sfax, between 1990 and 2000. We showed the clinical characteristics of our study and therapeutic result. For these children, various therapeutic methods were used: the washing of the lacrymal ways with or without pressure. A survey is undertaken on first, second and third time if necessary; in the event of failure we do lacrymal pathway intubation or the dacryocystorhinostomy at a more advanced age. The naso-lacrymal repermeability is obtained in 92.9% (457 cases), spontaneous repermeabilisation in 112 cases; 84 cases by washing and 293 cases by single or multiple survey. This study is encouraging collaboration between pediatrics and ophthalmologists to consult early when whimpering is noted.

Malignant tumors of the lacrimal sac are uncommon, and primary non-Hodgkin lymphomas are rare. We report the case of an 80-year-old woman presenting with epiphora and swelling of the left lacrimal area. A dacryocystorhinostomy was programmed, but within few weeks a painful tumor appeared with cervical nodes. Pathological studies of the mass revealed diffuse malignant lymphoma with large B cells. The lymphoma was classified as stage IIE using Ann Arbor staging after clinical, biological and radiological examination. Six CHOP systemic chemotherapy were proposed. After 12 months and only 4 cures because of hematological complications and cardiac toxicity, the patient was disease-free. Primary non-Hodgkin lymphoma of the lacrimal sac is extremely rare. Collaboration between the ophthalmologist, anatomopathologist and oncologist allowed us to determine the type and the extension and to propose an aggressive but successful treatment in this highly malignant and very localized lymphoma.

Dacryographies and CT dacryographies are usually performed after catheterization of a lacrimal canaliculus. We evaluated the quality of opacification on CT scan after simple instillation of contrast medium, without any catheterization.39 patients (78 nasolacrimal ducts) were examined for lacrimal pathways obstruction by CT scan after instillation of diluted contrast medium. Additional CT scan imaging was performed after catheterization when the first study did not provide adequate opacification.CT dacryography after instillation is a well tolerated technique. In our study, it allowed detection of all pathologic lacrimal ducts; 7 normal lacrimal pathways (after catheterization) were not opacified after instillation (false positives). The sensitivity of the method was 100%, its specificity 84%.CT dacryography after instillation is a physiologic, simple and sensitive method to evaluate lacrimal obstruction. We propose it as a first step, catheterization being used only in the absence of opacification after instillation.

To assess the results of the first procedures of endoscopic endonasal dacryocystorhinostomy (ENL DCR). To study the efficiency of diode laser in this operation versus electrocautery instruments (ECI).Prospective study; comparative study.Intraoperative comparison between ECI and diode laser is based on 422 ENL DCR achieved between June 1997 until June 2000. Three hundreds and sixty three procedures were diode laser assisted and 59 procedures were done with the use of an ECI. The diode laser was only used to vaporize nasal mucosa laying on the osteotomy site, to realize partial turbinectomy and to vaporize polyps and synechiae. Intraoperative comparison was based on the followings: frequency and extent of bleeding, quality of visibility, perception of pain during the use of the instrument and duration of the operation. Postoperative comparison is based on 318 procedures. Comparison was based on: frequency of granuloma formation in the nasal mucosa at the site of the osteotomy, frequency of acquired nasal synechiae, frequency of important crusting reaction of the nasal mucosa; success rates after a minimum follow up of 6 months.Intraoperative haemorrhages were fewer and smaller in the diode laser assisted procedures than in ECI assisted procedures; visibility was better with the diode laser; the use of the diode laser was painless versus 24% of patients complaining of pain during the use of electro-cautery. The duration of the procedure was shorter with the diode laser (29'30 vs 37'). In the postoperative follow-up frequency of granuloma formation was equal with the two instruments, synechiae were fewer with the diode laser (11% vs 22%) just like crusting reaction of the nasal mucosa (7% vs 36%). Success rates were similar (diode laser: 91.94% vs EC: 86.66%).Because of the effeciency of the vaporization and coagulation, the diode laser, in comparison with the ECI, allows to shorten mean operative time, to improve the visibility and to decrase bleeding. Contrary to EC it's use is painless. Fewer important crusting reactions and fewer synechiae after diode laser assisted procedures tend to prove than postoperative inflammation and surgical trauma are smaller than with ECI. There is no statiscally signifant difference between the success rates of ENL laser diode assisted procedures and ENL ECI assisted procedures.

The main symptoms of chronic obstruction of lacrymal pathways are epiphora and chronic dacryocystitis occurring mostly in elderly women. The aim of the surgery is to perform intranasal drainage of the lacrymal sac. The authors performed 30 dacryocystorhinostomies (DCR) in 26 patients with an intranasal endoscopic approach. 24 DCR with a mean follow-up of 25 months and a success rate of 91.7% after one single procedure are discussed. Among three current surgical techniques, the endonasal approach has been shown to be a safe and effective method with many advantages compared to the external transcutaneous way.

To assess the efficacy of transcanalicular dacryocystorhinostomy for the revision of other procedures. The results are analyzed following the use of two different types of laser: the Neodymium: YAG (Nd: YAG) laser and the Holmium: YAG (Ho: YAG) laser. To study the efficacy of using two antimetabolite drugs in this context: mytomycin-C (MMC) and 5-fluoro-uracile (5-FU).One hundred and fourteen patients were operated on. Of these, 88 had already undergone one procedure, 25 two procedures, and 5 three procedures. The Nd: YAG laser was used in 78 procedures, the Ho: YAG in 30 procedures, and both lasers in 10 procedures. Twenty patients were treated with an application of MMC and 25 patients with an application of 5-FU.The results are based on 106 procedures. The total success rate was 49.06% after one revision and 58.49% after two or three revisions. There is no statistically significant difference between the Nd: YAG and Ho: YAG lasers. The use of antimetabolites did not improve the success rate.Transcanalicular dacryocystorhinostomy is a very useful method because it does not cause cutaneous scarring and it has a low rate of morbidity given that it causes very little surgical traumatism. The revision of other dacryocystorhinostomy methods using the transcanalicular approach is theoretically a positive indication because it does not dissect scarring tissues and because the osteotomy has already been performed. However, the success rate is lower than for the external and endonasal approaches. The success rate is not modified by the use of antimetabolites or by the type of laser.

Tearing in infants and young children is a subject of controversy. A logical succession of questions and answers is helpful in developing a consensual attitude.

Nasolacrimal duct obstruction (NLDO) is a common clinical problem (5 to 6% of newborns). Dacryostenosis is a partial or complete block in the nasolacrimal duct.The records of 68 patients (92 cases) of NLDO with/without mucocele were reviewed. The probing was performed early and according to the same technique.The age at the time of probing ranged from 0 to 7 months (mean 4.6 months). The cure rate was 91.3% and the failure rate was 8.70%.Our results are consistent with other reports in the literature. The cure rate was higher with a earlier probing and was good after a second tentative of probing. A multiple obstruction of nasolacrimal system was cause of a failure. This was not the case with mucocele. The optimal timing of the probing is discussed in this report and we preferred to perform the probing to 4 at 6 months.We showed a high cure rate with early probing in our series. These results should be confirmed by a prospective randomised study (in process in our institution).

Endonasal dacryocystorhinostomy is technically more difficult than the classic method and apparently less rational. The nasal fossa is a variable and potentially dangerous anatomic region. The uncinate process "opens the door" to the middle meatus and covers, in almost all cases, the junction between the lacrymal bone and maxillary concha. A marker almost always found. Uncinate process resection is a natural way to access the lacrymal apparatus. Associated with transillumination of the lacrymal duct, uncinate process resection, is in our opinion, a reliable and, most importantly, reproducible method for an endonasal approach to the lacrymal sac. With resection, endonasal dacryocystorhinostomy becomes a simple, safe and rapid procedure.

To analyze the interest of protected drills to perform endoscopic endonasal DCR.[corrected] Fifty patients suffering from chronic epiphora were operated successively. None of those patients had had prior nasal surgery. The same surgeons (BF and ER) did the surgical procedure for all the cases. The technical steps were: endoscopic visualization of the middle meatus and evaluation of the anatomic variations of the nose; identification of the lacrymal bag with a 1 mm light in the canaliculus; unciformectomy; the maxillary bone was drilled with a 3.2 mm bit (straightshot Xomed), protected and irrigated; the lacrymal bag was opened by cissors and the flap was pushed in the ethmoid and coagulated.The suction-irrigation system was efficient to clean the surgical site, with a good endoscopic control. The protected bit didn't damage the 4-mm optics and the septal wall mucosa, even in narrow noses. The staightshot bit (Xomed) was tough enough to drill the maxillary bone in only 68 % of the surgical cases. In 28 % the drilling was unsatisfactory and in 4 % it was inefficient. The functional results at 6 month were good in 85 %. There was no difference between normal and narrow noses.The concept of protected bits perfectly matches the endoscopic endonasal DCR. The visual comfort and security of the surgical procedure are increased. Short term results are equivalent to external DCR, but are rather inefficient and expensive.

To study the anatomic structure and the endoscopic aspect of the lacrimal drainage system and to evaluate the efficacy of the Erbium laser with microendoscope in lacrimal obstruction.Twenty lacrimal ducts from ten fresh cadaver heads were used to lead a special rigid probe of 1.1. mm diameter (Endognost Schwind). This probe combined a flexible endoscopic probe of 500 mu, an Erbium laser fiber of 375 mu and an irrigation. The probe was introduced through the inferior canaliculus. Progressing in the lacrimal system, all the images were analysed. Then, we used the laser fiber to open the lacrimal sac mucosa and the lacrimal bone.The anatomo-endoscopic analysis was performed using endoscopic data. We appreciated essentially the walls of valves and sinuses that appeared only functional when increasing the irrigation flow. The laser could easily open the mucosa and the lacrimal bone but not the maxilla.The small size of the cannula allows to use the system for the diagnosis of lacrimal obstructions. The combined laser allows to treat at same time canalicular obstructions and lower obstructions.The endocanalicular study of the lacrimal drainage system can diagnose the type of obstruction and can treat it. A clinical study is requested to confirm these results.

Endonasal dacryocystorhinostomy (DCR) with endoscopic guidance is one of the therapeutic answers for low obstructions of the lacrimal system and is of renewed interest thanks to modern optical and surgical endoscopic means.Nine DCRs were performed on patients aged from 27 to 86 years, with a dual ENT-Ophthalmologist team, using transillumination of the lacrimal sac and the fitting of a two-canal probe for 3 months.Only the first case operated was a failure. The average success for lacrimal irrigation was 89% with a follow up of 3 to 15 months (average 8 months). In one case owing to a dacryolith, it was extracted with the endonasal approach.Peroperative transillumination of the lacrimal sac is the best guide to performing the stomy. The two-canal probe kept for 3 months in the neo-ostium perhaps ensures correct mucous healing. The technique is safe, efficient and not very traumatic: it should be a technique of first intention, capable of replacing the cutaneous approach.

To compare the efficacy and tolerance between silicone tube and treated polymer surface (PVP) tube of the bicanalicular intubation.A randomized prospective study was performed in 50 patients (coated between March 96 and July 97) with chronic tearing. 25 classic intubations (silicone) and 25 with PVP was used. Intubations were performed for 2 months. Functional signs and objectives parameters at the medial canthus and the nasal mucous membrane were compared.There was no difference about functional signs between the 2 groups of patients. Objective signs (hyperemia, secretions) observed in the medial canthus and the nasal mucous membrane were less pronounced with the treated polymer surface tube.This study confirms the great potential of treated polymer surface tube.

The authors report on endonasal dacryocystorhinostomy: 19 operations have been done (5 pre-saccal stenosis and 14 post-saccal stenosis). Operations on pre-saccal pathways allow to reduce significantly the tearing, without suppressing it completely. Surgery of the post-saccal pathways gives the best results, with the suppression of the tearing or/and of the superinfection in almost all cases. The pathology of the excretory lacrymal pathways, the surgical technique and the detailed results will be presented.

Endonasal dacryorhinocystostomy is a surgical procedure performed to re-establish continuity of the lacrimal duct by partial diversion followed by dilatation. A simultaneous rhinologic and ophthalmologic approach is used. This simple and elegant procedure that results in no residual scarring is indicated for any blockage of the lacrimal duct due to congenital or acquired causes. Except for children under 6 years of age and in patients in poor general condition, contra-indications are uncommon. Operative and postoperative complications are rare. After a review of the relevant anatomy the authors of this report describe the equipment and basic techniques used to perform dacryorhinocystostomy. Endonasal dacryorhinocystostomy was performed in 15 patients presenting chronic (n = 14) or acute (n = 1) dacryocystitis in Madagascar. At six months follow-up the procedure was successful in 14 cases and unsuccessful in one case due a cutaneous fistula. Because it is simple and well-tolerated and results in no residual scarring, endonasal dacryorhinocystostomy is the method of choice for treatment of lacrimal duct obstruction in tropical areas in general and in Black Africa in particular.

We report the results of 26 Holmium-Yag transcanalicular DCR made in 23 outpatients, under topical anaesthesia. Success rate was 47% (follow-up: 1 to 7 months). Failures occurred within the first month.

Endocanalicular dacryocystorhinostomy is a recent surgical procedure for stenosis of the naso-lacrymal duct, thanks to a laser filter fitted into the heart of 800 mu diameter metallic pin constituting a rigid armed laser probe. We create a lacrymo-nasal orifice from inside the lacrymal bag towards the nose, using the laser fiber. The Nd YAG used is the solid state mobilisable Ophtalas sp 32 giving out infrareds at 1064 nm or green at 532 nm. The indications are the stenosis of the naso-lacrymal duct, the failed classical dacryocystorhinostomy, the conjunctivodacryocystorhinostomy and the stenosis of the common canaliculus. This surgical procedure compared to the classical surgical technics appears to the very promising due to its simplicity, innocuousness, time saving. Our results, still inferior to the classical technique for all indications (success rate: 70%) are very good for the idiopathic stenosis of the naso-lacrymal duct (success rate: 87.5%).

Acute infection and inflammation of the nasolacrimal sac may complicate congenital obstruction of the nasolacrimal duct. Acute dacryocystitis is uncommon later and tuberculosis is exceptionally responsible for it.A 4 1/2 year-old boy was admitted because he suffered from acute left dacryocystitis with fever and cervical adenitis. Involvement of both lacrymal gland and lymph node persisted despite antibiotic and corticosteroid therapy. Needle biopsy of the lymph node showed presence of Mycobacterium tuberculosis and excision revealed caseating granulomas. The tuberculin skin test was positive while pulmonary tuberculosis was discovered in the patient's father. The patient was successfully given izoniazid, rifampin for 9 months and pyrazinamide for 2. Drainage of the sac area was necessary after 1 month of treatment followed by dacryocystorhinostomy.This rare case of tuberculous dacryocystitis permits to delineate the difficulties of ophthalmologic therapy.

We describe a new technique of dacryocystorhinostomy (DCR) and we present our first clinical cases. The principle of this technique is to create a fistula between the lacrimal sac and the nose with a quartz fibre advanced through a canaliculus and connected to a Neodymium:YAG.An 800 microns outer diameter metallic pipe was inserted through a lacrimal canaliculus up to bone contact. An optical fibre light probe was inserted through the pipe in order to locate the lacrimal sac in the nasal fossa by translumination using a nasal video-endoscope. The optical fibre light probe was then replaced with a laser fibre and a lacrimo-nasal fistula (approximately 5 mm diameter) was created in a few minutes by juxtaposition of twenty or more 10 watt energy pulses. Finally, a silicone stent was positioned for 6 months.We have operated 41 DCR using this transcanalicular method with the Nd:YAG laser. Our mean follow-up was 6 months (max 16 months). Indications were stenosis of the naso-lacrimal duct, failed classical DCR, abscesses of the lacrimal sac uncurable by antibiotherapy and canaliculary stenosis.Success rate was 75%, both for primary procedures and for operations after failed classical DCR.The advantages of this method are its simplicity, its atraumatic feature, minimal bleeding, the absence of scar and its ability to treat obstructions located at all levels of the excretory lacrimal system. Minimal operating traumatism makes it a very convenient method for out patient clinic.

The authors report two cases of postoperative lagophthalmos immediately following ab externo dacrycystorhinostomy (DCR). Two female patients, aged 67 and 62 years, underwent under general analgesia for chronic dacryocystitis with mucocele. An inferior surgical approach, sparing the inner canthal ligament was chosen in both cases. Lagophthalmos was observed on the operated side on the first postoperative day. Normal lid occlusion was present on the contralateral side. Impairement of palpebral occlusion was predominant in the nasal portion of the lid fissure. Upon voluntary and reflex blinking, a reduction in the downward movement of the superior lid was observed. This reduction was not as apparent when the patients were asked to produce a forced blink. Lagophthalmos disappeared progressively over 3 postoperative months in both cases. Neither epiphora nor any corneal complications were observed. Lagophthalmos following DCR via an inferior approach is a previously unreported complication and may be related to the disinsertion of the nasal portion of the orbicularis muscle and periosteum at the time of periosteal cleavage. Recovery of normal lid function may be due to reattachment of the periosteum.

Lacrimal ducts are exposed to surgical wounds during cosmetic surgery of the nose because of the anatomic situation. Beside minor and transitory injuries exist major injuries needing a surgical solution. The authors report a case of an acute dacryocystitis after an aesthetic rhinoplasty. After reviewing the literature and studying the possible traumatic mechanisms, the authors propose to treat the lacrymal injury by a bicanaliculonasal intubation before than performing a dacryocystorhinostomy.

Although external dacryocystorhinostomy is still preferred by most ophthalmologists, the authors describe the endonasal approach. They comment their preliminary results with 25 endonasal dacryocystorhinostomies.

The authors report two cases of postoperative lagophthalmos immediately following ab externo dacryocystorhinostomy (DCR). Two female patients, aged 67 and 62 years, underwent under general analgesia for chronic dacryocystitis with mucocele. An inferior surgical approach, sparing the inner canthal ligament was chosen in both cases.

A series of 95 intranasal dacryocystorhinostomies for ophthalmologic problems were performed. The operative technique as well as the results are discussed. Success rate is about 95.8%, of which 82.1% with immediate results. Even if the results of both intranasal and external approaches are equivalent, the intranasal one presents a little advantage. No intraoperative complications are observed.

The dacryocystorhinostomy is an operation that connects directly the lacrymal sac to the nasal cavity. In 1904, Toti described the external approach but one had to wait until the development of the sinus surgery to have a new interest in the endonasal approach. It appears to be a safe, efficacious and a less traumatizing procedure preserving the lacrymal function without skin incision. It allows a procedure in a non-scarred field. A good relationship between the ENT and the ophthalmologist is required.

Increasingly today, dacryocystorhinostomy seems to be the common obligatory path to functional surgery in case of traumatic lesions of the lacrimal ducts. The endonasal approach provides direct access to the nasolacrimal canal, while permitting to avoid the cutaneous approach through tissues that may be coming apart. The use of optic endoscopes renders the operation easier and provides access to the dome of the lacrimal sac, which is impossible under conventional endonasal microscopy. Monitoring and postoperative care are carried out with the same instrument, thereby improving the quality of the end result. The operation usually takes place under potentiated local anesthesia and lasts one hour, on average. The various surgical steps are described and particular attention is given to endonasal localization of the lacrimal ducts and to the technique of marsupialization.

Lacrimal scintillography, a simple, non traumatic, and physiological method, has been for a long time an useful exploration in the study of lacrimal excretory pathology. It allows an accurate diagnosis especially in the case of functional stenosis and, due to its ability to indicate the exact seat of obstruction, this technique is able to determine the surgical treatment required. This study underlines the contribution of lacrimal scintillography in the control of surgical anastomosis permeability, because of a modification in the initial technique: the use of scintillography in employing the lateral view rather than the front view, usually used, permits a better visualisation of the new surgically created excretory passage, particularly in the posterior area of nasal fossae.

Description of monocanaliculonasal and true monocanalicular intubation. The authors describe the advantages and indications of these methods.