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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., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Purpose: 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., Method: 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., Results: 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%) (p<10(-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%) (p<10(-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) (p<0.05), a history of acute noninfectious dacryocystic retention (38.2% vs 9.5%) (p<10(-5)), partial obstruction of the lacrimal pathway (LP) (61.8% vs 30.5%) (p<10(-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., Conclusion: 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.

Fluoroscopic nonsurgical placement of an expandable polyurethane stent is less invasive than surgery for the treatment of epiphora due to obstruction of the nasolacrimal duct. It needs to be performed with the collaboration of an ophthalmologist, using a high resolution digital subtraction imaging unit.

Objectives: 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., Patients and Methods: 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., Results: 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%., Conclusion: 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.

Introduction: 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., Material and Method: 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., Results: 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., Conclusion: 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.

The etiology of the nasolacrimal duct obstruction usually reported is: idiopathic, infectious, traumatic, congenital, tumoral and others. The nasolacrimal duct stenosis after intranasal surgery is rarely reported in the literature. We describe 5 cases of iatrogenic nasolacrimal duct stenosis found in our series of 41 patients treated the last 2 years for nasolacrimal duct obstruction and we propose how to avoid this complication of intranasal surgery.

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.

Changes in canalicular permeability following the insertion of punctum plugs was studied. This occlusive method was used to treat dry eye syndrome in 43 patients over a period of 32 months. All had normal canalicular patency, confirmed on the day of implantation. One hundred and five large plugs were used (2.4 plugs per patient). Twenty seven (25.7%) impassable acquired canalicular stenoses were seen in 15 patients. The canalicular site of the 27 stenoses was the same: junction between the vertical and horizontal portions. Among the 27 stenoses: 4 plugs had disappeared at an unknown time, with follow-up probing taking place after a mean interval of 7.5 (months range: 1 to 15 months); 17 plugs had been expelled after being in place for an average of 5 months (range: 1 to 12 months; standard deviation 3.47), with follow-up examination taking place on average 12 months after insertion (range: 6 to 17 months; standard deviation 3.4); and 6 plugs were still in place after a mean of 7 months (range: 2 to 15 months; standard deviation 4.73) and the stenosis was discovered when they were removed. They were intact. These 6 Cases eliminate any possibility of intra-canalicular migration of the prosthesis--of all or part--of the prosthesis. Stenoses appeared to develop rapidly: 45% of cases were discovered during the first 3 months. 16/27 (59%) of stenoses were investigated a second time, 6 months later on average (range: 2 to 12 months): these 16 canaliculi all remained impassable.

The present attitude towards the treatment of obstruction of the lacrimal ducts should be based on traditional methods, but modified to take into account recent advances which allow "modern surgery" to be applied. These new procedures are based on two relatively recent new acquisitions: 1) A precise knowledge of the physiology of the lacrimal pump, mainly due to the work of Lester T. Jones. It is important to know hen this pump has been destroyed as any attempt at repair is doomed to fail. We do not yet know how to reconstruct this pump. If minor damage has occurred however, attempts at repair operations may be successful. 2) Simplification of the operative procedure, both for dacryocystorhinostomies and lacodacryocystorhinostomies. Complex reconstructive procedures which often failed have been replaced by the application of a tube made of an inert material, and this is much simpler and gives much more constant results.

The affection is often undiagnosed at the first stage. The second stage is characterized by a chronic suppurative canaliculitis with intra-canalicular concretions involving in many cases the lower canaliculus. Our 6 cases have been treated by a posterior canaliculotomy, a microsurgical evacuation of the concretions and a lacrimal tubing. It is not a fungal infection but a bacterial disease due to Actinomyces. Surgical treatment is very effective.