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Introduction Endonasal and external dacryocystorhinostomy procedures have both been used for the treatment of post-saccular obstruction of the lacrimal system. Functional success of these surgeries depends on several factors. Objective To evaluate the status of the rhinostomy ostium with endonasal and external approaches in dacryocystorhinostomy operations and to determine the effect of ostium size on postoperative functional success. Methods The charts of the patients operated in our hospital between May 2017 and January 2019 were analyzed retrospectively (ethical approval number: 2018-12.04). The patients that were operated in the ophthalmology and otolaryngology departments were included in the study. Endoscopic rhinostomy ostium measurements, punctum lavage findings and complications were recorded at 8 weeks postoperative at the earliest. Results When the 64 patient charts were reviewed (76 operations), the mean ostium width was 1.85 ± 1.11 mm in the endonasal approach group and 3.60 ± 2.24 mm in the external approach group. The mean ostium areas in endonasal and external group were 14.61 ± 16.66 mm2 and 56.05 ± 60.41 mm2, respectively. The ostium was anatomically patent and punctum lavages were negative in 11 patients (6 patients in the endonasal approach group and 5 patients in the external approach group) and these cases were considered as functional failures. The rhinostomy ostium was significantly wider in the external approach group, but this was considered ineffective on functional outcomes. Conclusion Lacrimal duct stenosis can be successfully treated with endonasal and external methods. Tear drainage may be insufficient even in the presence of a patent ostium. Therefore, functional success should also be considered when evaluating the overall success of dacryocystorhinostomy. An anatomically patent ostium is definitely required, while it is believed that ostium size does not affect functional surgical success. Resumo Introdução Dacriocistorrinostomia endonasal e externa têm sido usados para o tratamento de obstrução pós‐sacular do sistema lacrimal. O sucesso funcional dessas cirurgias depende de vários fatores. Objetivo Avaliar o status do óstio da rinostomia nas abordagens endonasal e externa em dacriocistorrinostomias e a importância do tamanho do óstio no sucesso funcional pós‐operatório. Método Os prontuários de pacientes operados em nosso hospital entre maio de 2017 e janeiro de 2019 foram analisados retrospectivamente (número de aprovação ética: 2018-12,04). Foram incluídos no estudo os pacientes operados nos setores de oftalmologia e otorrinolaringologia. Medidas do óstio da rinostomia endoscópica, achados à irrigação do ponto lacrimal e complicações foram registrados a partir da 8ª semana de pós‐operatório. Resultados Foram avaliados prontuários de 64 pacientes (76 operações); a largura média do óstio era de 1,85 ± 1,11 mm no grupo endonasal e de 3,60 ± 2,24 mm no grupo externa. As áreas médias do óstio no grupo endonasal e externa foram 14,61 ± 16,66 mm2 e 56,05 ± 60,41 mm2, respectivamente. O óstio estava anatomicamente pérvio e as irrigações do ponto lacrimal foram negativas em 11 pacientes (6 pacientes no grupo endonasal e 5 pacientes no grupo externa) e esses casos foram considerados como falhas funcionais. O óstio da rinostomia foi significativamente maior no grupo externo, mas sem relação com a eficácia nos resultados funcionais. Conclusão A estenose do ducto lacrimal pode ser tratada com sucesso com métodos endonasais e externos. A drenagem lacrimal pode ser insuficiente mesmo na presença de óstio pérvio. Portanto, o sucesso funcional também deve ser considerado ao avaliar o sucesso do procedimento. Embora um óstio anatomicamente patente seja necessário, o tamanho do óstio não afeta o sucesso cirúrgico funcional.

Purpose: To compare the success rates of balloon dacryocystoplasty (BDP) and probing as a primary procedure in congenital nasolacrimal duct obstruction (CNLDO) and investigate the effect of age on both procedures.Methods: A total of 135 patients (171 eyes) with simple or incomplete complex CNLDO were included in this retrospective study; complete complex CNLDO cases were excluded. The success rates for primary BDP (118 eyes) and for probing (53 eyes) were compared as overall and among the age groups; Group 1 (12–24 months old), Group 2 (25–36 months old), and Group 3 (> 36 months old).Results: Mean age of the patients was 41.5±27.2 months for primary BDP, and 21.8±10.8 months for probing (pConclusion: Probing success decreased to a point where different treatment options such as primary BDP can be discussed with the patient’s parents after 18 months of age. The success of BDP decreased after 36 months, while it maintained a high success rate between 24-36 months as primary treatment.

Introduction Chronic dacryocystitis is the condition secondary to permanent lacrimonasal duct stenosis (LNDS) that generates epiphora and recurrent conjunctivitis. Endoscopic dacryocystorhinostomy (EDCR) is a more natural route than the external route and offers higher success rates than the laser technique. We value this centre's experience in this procedure. Patients and methods A retrospective review was carried out in our centre of the medical records of adult patients undergoing EDCR due to LNDS between 1995 and 2019. The minimum follow-up period required after surgery was 6 months. Results Over 297 months, 167 EDCR procedures were performed on 156 patients, with an average age of 65.7 ± 11.6 years and a male/female ratio of 1/1.98. The functional improvement was 86%, with an anatomical success rate of 87%. Lack of clinical improvement statistically significantly correlated with the age of the patient and the time since onset of the LNDS, the presence of concomitant systemic (especially diabetes mellitus) or ophthalmological disease, the intraoperative finding of a thickened tear sac and absence of drainage of the tear sac when marsupialised. Longer-term stent carriers in the rhinostomy had poorer outcomes. There were no postoperative complications of interest. Conclusions EDCR is an effective and safe technique, based on stable anatomical references. Failure rate seems to be multifactorial and should be considered in older, multipathological patients, with a long duration of the condition.

Purpose: To report the surgical outcomes of antegrade balloon dacryocystoplasty combined with pushed-type monocanalicular intubation as a primary surgical treatment in patients with congenital nasolacrimal duct obstruction. Methods: A retrospective cohort study was conducted at National Cheng Kung University Hospital. The medical records of all patients with congenital nasolacrimal duct obstruction who underwent antegrade balloon dacryocystoplasty followed by pushed-type monocanalicular intubation as the primary surgical treatment from January 2018 to July 2020 were included. The monocanalicular tube was removed 1 to 2 weeks after intubation. Surgical success was defined as resolved epiphora 1 month after the tube was removed. Results: A total of 62 eyes of 48 patients were involved in this study. The mean age of the total population was 24.1 months (range: 12 to 66 months). The mean duration of the tube indwelling in the nasolacrimal duct was 9.5 days (range: 4 to 15 days). A total of 60 of the 62 eyes (96.77%) reported surgical success. Early tube loss occurred in 2 eyes (3.23%); however, epiphora was not reported afterward. No complications other than tube loss were recorded. There were no recurrences in patients who had undergone successful surgery observed up to July 2020. Conclusions: Antegrade balloon dacryocystoplasty with short-term pushed-type monocanalicular intubation as a primary surgical treatment for congenital nasolacrimal duct obstruction may have high potential with a high success rate and a low complication rate. [ J Pediatr Ophthalmol Strabismus . 2021;58(6):365–369.]

Objective: To evaluate the analgesic potential of pregabalin in ambulatory dacryocystorhinostomy surgeries under general anaesthesia. Study Design: Quasi-experimental study. Place and Duration of Study: Tertiary Care Hospital Rawalpindi, from Nov 2019 to Sep 2020. Methodology: A total of 110 patients undergoing ambulatory dacryocystorhinostomy surgery at our hospital were included in the study. Participants were divided into two groups, group A (n=55) were administered 150 mg oral pregabalin, while a placebo was given to participants of group B (n=55). Post-operative pain was assessed at recovery, four and eight hours after surgery with the help of the visual analogue scale. Results: Mean age of participants was 43.05 ± 7.5 years. Gender wise distribution showed 62 (56.4%) males and 48 (43.6%) females. At recovery, four and eight hours after surgery the mean pain scores in group A (pregabalin) vs group B (placebo) were (2.98 ± 0.8 vs 4.98 ± 0.8, p

OBJECTIVE Many studies have evaluated the effectiveness of topical intraoperative mitomycin (MCC) usage in a wide range of otolaryngologic procedures with variable conclusions on effectiveness. This systematic review aims to provide a qualitative estimation of mitomycin C's treatment effectiveness in maintaining or preventing stenosis after surgical interventions. DESIGN AND SETTING Following the PRISMA guideline, a comprehensive systematic search of MEDLINE, EMBASE and CINAHL databases was performed including hand-searching and cross-reference checking. PARTICIPANTS The search was limited to humans, sample size greater than two and study designs including a comparative arm. MAIN OUTCOME MEASURES Outcome measures varied but included rates of restenosis, number of procedures, and post-surgical patency. RESULTS A total of 571 unique abstracts and 109 full articles were reviewed. Seventy-seven studies were included in the final analysis. The available evidence ranged from case series to randomized control studies. Meta-analysis was deemed inappropriate due to heterogeneity of study design. Thirty-eight studies assessed the effective of MCC in dacryocystorhinostomy, which is reported in a separate meta-analysis. All other studies were categorized into otolaryngologic site and pathology including choanal atresia (n = 5), endoscopic sinus surgery (n = 12), airway procedures (n = 9), esophageal procedures (n = 8) and other (n = 2). CONCLUSIONS The published literature on the effectiveness of MMC was mixed, but suggested topical MMC improved surgical outcomes in many otolaryngologic procedures compared to controls. This was the first review to assemble literature on MMC usage for different surgical procedures. Comprehensive interpretation of the data was limited due to heterogeneity in primary outcome, procedure type and study quality. High-quality prospective and randomized controlled studies are required to further confirm the positive effect of MMC use on surgical outcomes.

Purpose: To compare the efficacy of external dacryocystorhinostomy (DCR) and botulinum toxin-A in the management of functional epiphora. Materials and Methods: A prospective, comparative, interventional study included 45 patients with functional epiphora out of which 20 patients had undergone external dacryocystorhinostomy and 25 patients received 5 units of injection botulinum toxin in the palpebral lobe of lacrimal gland as per the patient’s preference. All patients underwent syringing and fluorescein dye disappearance testing before the procedure. Epiphora was graded subjectively with Munk scores obtained before and after intervention. Duration of side effects and severity were also noted. Results:This study showed functional epiphora common in elderly age group. Female constitued of 71.11% and male 28.89 % with female: male ratio of 2.4:1. Left eye (42.22%) predominantly involved. The overall success rate at 6 months after surgery for external DCR was 95% and that of injection botulinum was 91.17%. The overall success rate in both the group was not statistically significant(p>0.05%). Improvement in epiphora graded by Munk score was statistically significant after intervention in both the groups(p Conclusion: This study showed injection Botulinum toxin can be considered as an alternative management in case of functional epiphora for patient who do not want to undergo surgical intervention and for those with co-morbid conditions with high risk for surgical intervention like DCR. Keywords: Botulinum toxin A, External dacryocystorhinostomy, Fluorescein dye disappearance test, Functional epiphora

This article is to introduce office-based salvage revision of impending rhinostomy failure after endoscopic dacryocystorhinostomy (EN-DCR), using a microdebrider. The authors conducted retrospective medical chart review of 27 eyes of 26 patients who underwent microdebrider treatment for impending rhinostomy failure in an office setting. After local anesthesia, obstructive soft tissue, interfering with ostium function (granuloma, cicatrization, synechia), was treated with a microdebrider (Osseoduo s120, Bien-Air Surgery, Le Noirmont, Switzerland) within 6 months after primary EN-DCR. Anatomical improvement and functional relief of epiphora were evaluated after revision. The causes of impending rhinostomy failure were granuloma formation (17/27 eyes, 63.0%), cicatrization (8/27 eyes, 29.6%), and synechial formation (2/27 eyes, 7.4%). The surgery did not exceed 5 min in all cases, and partial damage to pre-placed silicone tubes occurred in the first two cases (7.4%). Salvage revision resulted in anatomical success in all eyes, based on patent syringing and a positive functional endoscopic dye test. All cases showed improvement of epiphora after revision surgery. Office-based salvage revision using a microdebrider provided effective management of impending rhinostomy failure during early follow-up period after primary EN-DCR. It enabled prompt management of excessive wound healing interfering with ostium function, while performing the routine postoperative nasal debridement.

The individual anatomic variation of the course of the lacrimal duct and surrounding structures requires the thorough knowledge of its three-dimensional configuration in order to perform the surgery in the safest and most efficient way. The aim of this study was to consider virtual surgical planning in order to improve dacryocystorhinostomies.Horos® was used as a viewer and manager of DICOM-format images for multiplanar, three-dimensional (3D) reconstruction when planning 148 first-time lacrimal operations and 26 reoperations by laser endonasal and endocanalicular DCRs.The 3D images of the CT dacryocystography were much better identified than the 2D ones, Horos® showing a statistically significant correlation (P .0001). Over 98.27% of the images match the programme reconstruction. Less than 1.73% of them showed some discordance due to study distortion. These cases were related to trauma. The intraopearative location of the lacrimal system was very accurate, avoiding complications.Viewing and studying 3D images, Horos® is a very useful tool for diagnosis and preoperative planning. It is very helpful in complex conditions by marking surgical references, locating the lacrimal sac and controlling the post-operative permeability of the lacrimal system. The information loss produced by the image selection is also avoided. Another great advantage is that the programme is free.

To evaluate the effectiveness of preoperative lacrimal endoscopic evaluation (LEE) of lacrimal duct system (LDS).Retrospective comparative case series METHODS: From March 2016 to February 2020, the charts of patients chosen to undergo endoscopic dacryocystorhinostomy (EDCR) or silicone tube intubation (STI) were reviewed retrospectively. Group 1 included patients that underwent EDCR, and group 2 included patients that underwent STI. Preoperative LEE was performed for all patients. In group 1, we compared the functional success rate for patients who had been converted to STI with the patients who had undergone EDCR. In group 2, we compared the functional success rate of STI with those who had had STI without LEE.In group 1, 19 (54.3%) eyes were converted to STI following LEE, and the functional success rate was 84.2%, which is not significantly different from that of the EDCR group following LEE (p = 0.608). The functional success rate of EDCR without LEE was not different from that of STI following LEE (p = 1.000). In group 2, five eyes (26.3%) were converted to EDCR following LEE. The group undergoing STI following LEE showed a significantly higher functional success rate (95.7%) than the group without LEE (66.6%, p = 0.023).Preoperative LEE enables direct visualization of the LDS and helps to obtain more accurate diagnosis. This allows for the best surgical option based on LEE findings, which can contribute to better results. Therefore, LEE would be expected to change the paradigm of the classical management of LDS.

Aims: To evaluate the long-term surgical success of transcanalicular dacryocystorhinostomy (TCDCR) with diode-laser in the treatment of epiphora due to isolated naive nasolacrimal duct obstruction (NLDO) in adults. Methods: This retrospective study included patients with isolated naive NLDO, who underwent diode laser-assisted TCDCR. No patients had pathology in the nasal region detected by an otorhinolaryngologist. The included patients had documented information about epiphora evaluation with lacrimal system irrigation with fluorescein dye, and annual direct imaging of osteotomy patency with nasal endoscopy. Success was defined as no postoperative epiphora, conjunctivitis or dacryocystitis, an open passage in the lacrimal system lavage, and patient satisfaction. Results: The study included 116 patients [mean age: 49.6±11.4 years, female: 67 (57.8%)]. The success rate was 84.5% in the first year, 80.2% in the second year, and 76.7% in the third year. Following the operation, 9 (7.8%) patients had epiphora, 8 (6.9%) patients were not satisfied, and 1 (0.8%) patient developed conjunctivitis/dacryocystitis in the first year. Three (2.6%) patients had dissatisfaction and 2 (1.7%) patients had the complaints of epiphora correlated with nasolacrimal lavage obstruction in the second year. Two (1.7%) patients were dissatisfied and 2 (1.7%) patients had epiphora complaints confirmed with nasolacrimal lavage in the third year. Conclusions: The present study showed that the treatment of epiphora due to isolated NLDO with diode laser-assisted TCDCR can provide long-term success in major outcomes in adult patients.

Purpose The COVID‐19 pandemic gave rise to renewed concerns of the transmission risks posed by surgeries on sites of high viral colonization such as the nasopharynx. Endoscopic dacryocystorhinostomy (DCR) involves the creation of a new tear duct from the lacrimal sac to the nasal cavity. The purpose of this project is to determine if endoscopic DCR is an aerosol generating procedure (AGP). Methods An optical particle sizer (OPS) was used to intraoperatively quantify aerosol concentrations during four cases of endoscopic DCR. The OPS sampled the air once every 60 seconds throughout the operations. The time of important operative steps were documented and correlated with OPS readings. Particle concentrations during each major surgical step were compared to baseline readings by the Mann Whitney U Test. Results There were statistically significant increases in median particle concentrations during laryngeal mask airway intubations for both particles 0.3 to 5.0 μm and >5.0 μm (P, An optical particle sizer quantified aerosols during key steps of endoscopic 42 dacryocystorhinostomy, showing increases in 0.3‐5.0 μm and >5.0 μm particles during 43 intubation, but no increases in particles associated with any of the surgical steps.

To assess the long-term outcomes of minimally invasive conjunctivodacryocystorhinostomy (MICDCR) with StopLoss™ Jones tubes. A retrospective interventional case series was performed on all patients who underwent a MICDCR with StopLoss™ Jones tubes (SLJT) over a period of 5 years. Patients were followed for a minimum of 1 year after surgery. The parameters studied include patient demographics, clinical presentation, indication for MICDCR, duration of surgery, SLJT length, standard Jones tube drainage classification, complications, and anatomical and functional successes. The variables influencing the outcomes were assessed. Anatomical success was defined as patent SLJT on irrigation, and functional success was defined as resolution of epiphora. Statistical analysis was performed using the R 4.0.4 (R Project, R Foundation). A total number of 44 eyes of 42 patients were studied. The mean age of patients was 61.81 years. Approximately 87% and 64% of the patients completed 2 years and 3 years of follow-up, respectively. The Jones tube drainage class dipped significantly from class I to others at the 3-month follow-up. Classes III and IV dominated the follow-up period between 3 and 18 months, and class II dominated at 24 months and beyond. The anatomical and functional successes at the end of 1-year follow-up were 77.2%. The success was not affected by age, gender, length of SLJT tube, or duration of the surgery. However, the middle turbinate reduction influenced the success (P

We aimed to recommend an efficient algorithm to detect the presence of specific pathologies of the lacrimal sac (LS). The charts of 296 patients who had undergone LS biopsy were reviewed retrospectively. The age, gender, history, examination and radiological findings, sac appearance, and pathology results of the patients were recorded. The power of our data to predict the presence of potential specific pathology was identified by regression analysis. After the causality evaluation of the statistical results, an algorithm was created to differentiate specific LS pathologies from chronic dacryocystitis. Our algorithm was mainly formed by deciding on radiological examination and biopsy according to the risk scoring created by the examination findings. A specific LS pathology was observed in 11 (3.7%) patients. When we applied the recommended algorithm to cases with a suspicion of specific pathology and/or found to have a specific pathology, 36.4% of the patients would not require radiological examination and 29.6% of them would not require a biopsy. On the other hand, 80% of the frozen biopsies had been conducted on cases without a specific pathology. Managing the cases according to our algorithm would mean that frozen biopsy would be recommended in only 1 (12.5%) case without a specific pathology. Besides, the detection of cases with a specific pathology would not be prevented and the necessary diagnostic procedures would continue to be performed. Specific LS pathologies can be detected adequately, whereas decreasing unnecessary examinations and procedures in cases without a specific pathology by using our algorithm.

Objectives To identify microbiological growth on bicanalicular silicone tubes (BST) placed during dacryocystorhinostomy (DCR) surgery and to analyze the association between culture results and surgical outcomes and BST removal time. Materials and methods A total of 80 lacrimal drainage systems of 68 patients who had external DCR with bicanalicular silicone intubation were included the study. Twenty-five tubes (31.3%) were removed up to 8 weeks, 28 tubes (35.0%) were removed between 9 and 11 weeks, and the remaining 27 tubes (33.7%) were removed 12 weeks or more after surgery. The tubes were transferred to Stuart medium and sent for microbiologic examination. The disc diffusion method was used to determine antibiotic resistance. Results Culture positivity was observed for 96.2% of the tubes. Among a total of 109 isolates, 63 were gram-positive bacteria (57.8%), 37 were gram-negative bacteria (34%), and 9 were fungi (8.2%). The most commonly isolated gram-positive and gram-negative bacteria were Staphylococcus aureus (66.6%) and Enterobacter spp. (29.7%), respectively. Penicillin, clindamycin, erythromycin, and tetracycline resistances were higher among gram-positive pathogens. Cephalothin, amoxicillin-clavulanic acid, and ampicillin resistances were higher among gram-negative pathogens. There was no significant difference in terms of the microbiological profile between the three groups of removed tubes. Haemophilus influenzae was isolated at a significantly higher rate in patients with surgical failure (p=0.04). Conclusion Although a variety of agents were isolated from removed BST, gram-positive organisms were more frequent than gram-negatives and fungi. S. aureus and Enterobacter were the most common gram-positive and gram-negative isolates. Later BST removal was associated with the isolation of significantly more bacterial strains per tube. There was no correlation between multiple infections and surgical failure. H. influenzae was more common in failed DCR cases.

Introduction: This study aimed to evaluate patient satisfaction over time in patients undergoing external dacryocystorhinostomy for primary nasolacrimal duct obstruction when done by a general ophthalmologist. Materials and methods: This prospective interventional case series was done in a secondary level eye hospital in the Midwestern region of Nepal from 1st January 2018 to 30th December 2018. Fifty-four consecutive adult patients diagnosed with primary nasolacrimal duct obstruction who underwent external dacryocystorhinostomy performed by a general ophthalmologist were included. The surgical success rate was determined at six months on the basis of the resolution of symptoms with patency on syringing. Postoperative patient satisfaction was evaluated 6 months after surgery with a standardized Glasgow Benefit Inventory and post-intervention questionnaire. Results: A total of 54 eyes were operated on within the study period and a larger number of surgeries were done in the age group 26-30 years. Female constituted 79.6 % and male 20.4% with a ratio of 3.9:1. Overall surgical success rate 6 months after surgery was 96.30%. The mean total Glasgow benefit inventory (GBI) score was 48.83 ± 23.87 (95% CI, 42.96- 56.95), mean general subscale score was 52.70± 23.28 (95% CI, 46.49-60.38), social support subscale was 49.69 ± 44.68 (95% CI, 41.15-60.35) and physical health subscale score was 37.07 ± 41.19 (95% CI, 27.48-49.26). Conclusion: The external dacryocystorhinostomy surgeries performed by general ophthalmologists achieved an excellent surgical success rate and good patient satisfaction proven by a validated questionnaire.

Introduction: Primary acquired nasolacrimal duct obstruction is a common ophthalmic condition and has conventionally been managed by external dacryocystorhinostomy. However this procedure is time consuming and involves making mucosal flaps. The aim of this study was to compare the surgical outcome in Arrugas bone trephine-assisted flapless dacryocystorhinostomy with Circumosteal - Mitomycin C versus conventional external dacryocystorhinostomy. Materials and methods: This is a retrospective non-randomized study of surgical outcome in patients of primary acquired nasolacrimal duct obstruction who underwent an Arrugas bone trephine assisted flapless dacryocystorhinostomy with Circumosteal - Mitomycin C (group A) versus those who underwent conventional external dacryocystorhinostomy (group B) in a teaching hospital in North India. Patients with previously failed dacryocystorhinostomy, lacrimal fistula, canalicular and common canalicular obstruction were excluded. Success was defined as patent syringing at the end of one year. Surgical time was calculated from skin incision to skin suturing. Results: There was complete resolution of epiphora with patent syringing in 43 out of 52 patients in group A, while in group B, 47 out of 55 patients had complete resolution of epiphora with patent syringing at the end of one year (p= 0.77). Mean surgical time was significantly lower in Group A than in Group B (p=

Distal acquired lacrimal obstruction is a common adulthood pathology whose primary treatment is represented by EXT-DCR and END-DCR. When considering their influencing factors, the role of the type of anaesthesia applied during these surgeries has a major role. The aim of this study is to systematically analyse the influence of general and local/regional anaesthesia on the final success rates of EXT-DCR and END-DCR. Primary EXT-DCR and END-DCR articles published later than 2000 with at least 50 single clinician procedures were selected. Exclusion criteria included acute dacryocystitis, tumours, studies focussing on revision surgeries, surgeries with adjunctive procedures, not clearly demarcated surgeons, mixed cohort study of acquired and congenital disorders. This systematic review was conducted in accordance with MOOSE guidelines; where feasible, a meta-analysis of the collected results was conducted. As a result, 11,445 articles were selected of which 2741 were examined after screening, and 16 included after full text review (0.6% of the initial papers). Among all papers included, the number of EXT-DCR was not enough to provide a solid analysis of the effect of anaesthesia; conversely, a significant difference of success rate was noted between local anaesthesia + sedation (85.1%, IC 77.8%–90.4%), and general anaesthesia (90.8%, IC 88.8%–92.4%) in END-DCR ( p = 0.048). In conclusion, END-DCR performed with general anaesthesia should be considered as the solution of choice; however, local anaesthesia, eventually associated with a sedation, can be used as an alternative in selected cases. No meaningful conclusions could be drawn for EXT-DCR, due to the lack of data.

To classify the acquired lacrimal fistulae (ALF) and assess the outcomes following surgical management.Retrospective, interventional study of all patients presenting with ALF over a 3.5-year period was performed. The fistulae were classified based on photographic evidence with respect to their location, size and nature. Primary outcome measures were complete healing of the fistulous opening and resolution of discharge or leakage from it. Secondary outcome measures were resolution of epiphora and patency of the lacrimal drainage system.84 eyes of 82 patients who had acquired lacrimal fistulae were analysed. The mean duration of the fistulae presence was 10.12 months. The etiology of ALF was spontaneous following lacrimal abscess rupture in 79 eyes and was secondary to incision and drainage in the remaining 5 eyes. Thirty eyes had fistulectomy along with definitive surgery for the associated nasolacrimal duct obstruction (NLDO), 15 eyes underwent definitive surgery without an additional fistulectomy and 4 fistulae healed spontaneously prior to intervention for NLDO. The resolution of ALF did not differ in between those who underwent fistulectomy versus those who did not. The exceptions were 2 chronic large fistulae with cutaneous lining which needed a definite fistulectomy for resolution along with surgery for NLDO.Most of the acquired fistulae heal by themselves irrespective of the nature, size and location and need no additional treatment in the form of fistulectomy. However, this is not true for those that are large and have a cutaneous lining.

Endonasal endoscopic dacryocystorhinostomy (DCR) is a common treatment for saccal and post-saccal stenosis of the lacrimal pathway or chronic dacryocystitis (DC). The main symptom is chronic epiphora (tearing) and dacryocystitis (infection). The objective of this study is to assess the short-term surgical result of this treatment based on possible prognostic factors; such as gender, age, the pathogen spectrum and the histopathological result as well as the influence of these parameters on hospital stay. It is a retrospective analysis, which includes 197 cases in 177 patients, who received an endonasal endoscopic DCR with a silicone tube between January 2009 and December 2016, as primary procedure. The follow-up was carried out 3 months after the surgery, with the silicone tube being removed as part of the last examination including a flushing of the tear ducts with saline. This procedure is part of determining to measure the short-term success of the intervention. The definition of success of the surgery is an absence of epiphora or an acute infection of the nasolacrimal duct system, as well as an absent reflux in case of flushing the tear duct. The success rate was 86.3% (N = 170). Higher incidence was seen in females (N = 146; 74.1%) and patients with a mean age of 65.4 (± 17.2). The presence of pathogens as well as the histopathological result do not have an impact on the short-term surgical success. Patients diagnosed with rheumatic diseases appear to have a worse prognosis with relation to procedure success. Also, the length of hospital stay was related to possible prognostic factors. Type II diabetes and glaucoma had a significant influence on a longer hospital stay. The endonasal endoscopic DCR is a surgical procedure with high success rate. Patients with rheumatic diseases should be aware of increased failure rates. Patients with glaucoma and Type II diabetes might need a more intense aftercare.

PURPOSE To assess the long-term quality of life outcomes of minimally invasive conjunctivodacryocystorhinostomy with StopLoss Jones tubes. METHODS A retrospective interventional case series was performed on all patients diagnosed with proximal bicanalicular obstruction who underwent a minimally invasive conjunctivodacryocystorhinostomy with StopLoss Jones tubes over a period of 5 years from October 2014 to September 2019. The procedure was performed as per standard published protocols of minimally invasive conjunctivodacryocystorhinostomy and StopLoss Jones tubes. Patients were followed for a minimum of 1 year after surgery. The tools employed to study were the "Jones tube satisfaction questionnaire" and the "Nasolacrimal duct obstruction-symptom score." These tools were employed at every step from the preoperative stage to each of the follow ups. Statistical analysis was performed using the R 4.0.4 (R Project, R Foundation). RESULTS A total number of 44 eyes of 42 patients were studied. Of these, 73.81% (31/42) were females. The mean age of patients was 61.81 years. Approximately 87% and 64% of the patients completed 2 and 3 years of follow up, respectively. For up to 2 months postoperative period, the outcomes were excellent, with the majority (76.74%, 33/43) reporting "moderately satisfied" outcomes on Jones tube satisfaction questionnaire. The dissatisfaction began at the 3-month follow up (4.55%, 3/44) and peaked at 6-month follow up (25%, 11/44), owing to tube-related complications. The mean ± standard deviation nasolacrimal duct obstruction-symptom score scores dipped from 19.98 ± 2.88 at baseline to 5.58 ± 2.99 at the 2-month follow up. Similar to Jones tube satisfaction questionnaire, the scores began worsening at 3-month follow up (9.8 ± 5.86) with the poorest scores at 6 months (12.34 ± 5.96), and these changes were significant as compared with the baseline (p < 0.001). The Jones tube satisfaction questionnaire and the nasolacrimal duct obstruction-symptom score scores showed significant improvements at 1-year follow up, owing to appropriate management of complications. The good outcomes were maintained for up to 3 years of postoperative period. CONCLUSIONS The long-term quality of life outcome following minimally invasive conjunctivodacryocystorhinostomy with StopLoss Jones tubes was good. The quality of life significantly suffers between 3 and 6 months following the surgery and improves equally well following appropriate management of complications.

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.

ObjectiveExternal dacryocystorhinostomy is thought to cause mucociliary dysfunction by damaging the mucosa, in turn affecting ciliary activity and mucus quality. This study investigated the effect of external dacryocystorhinostomy on sinonasal function.MethodsPatients scheduled for unilateral external dacryocystorhinostomy who underwent endoscopic nasal examination and paranasal sinus computed tomography were included in this study. A saccharine test was performed on the planned surgical side and the mucociliary clearance time was determined. The sinonasal quality of life was measured in all patients, pre-operatively and at six months post-operatively, using the Sino-Nasal Outcome Test-22. The Lund–Kennedy endoscopic score was also determined in all patients, both pre- and post-operatively.ResultsThe study comprised 28 patients (22 females and 6 males). A statistically significant difference was found between the pre- and post-operative saccharine test results (p = 0.006), but not between the pre- and post-operative Sino-Nasal Outcome Test-22 scores (p > 0.05).ConclusionThis study is one of only a few to investigate the effect of external dacryocystorhinostomy on sinonasal function. The results showed that external dacryocystorhinostomy impairs mucociliary clearance. The surgical procedure is well tolerated and does not significantly change nasal symptom scores.

Background Myriad open and endoscopic approaches are employed to resect maxillary sinus lesions, each with associated advantages and disadvantages. The inferior and anterior portion of the sinus remains a challenging space to access. Objectives To describe the extended anterior inferior approach to endoscopic medial maxillectomy (EAMM) as a novel and valuable addition to a stepwise approach for minimizing surgical morbidity without compromising tumor outcomes. To report the outcomes of patients treated with this approach. Methods A retrospective case series study of 9 patients who underwent EAMM between 2016 and 2019 at a tertiary care referral center was performed. The endoscopic technique is described. The duration of follow-up ranged from 1 to 53 months. Intraoperative steps, including transection of the nasolacrimal duct and execution of an intraoperative dacryocystorhinostomy, were reviewed. Postoperative outcomes, including patient symptoms at follow-up and tumor recurrence, were recorded. Results Adequate exposure with gross total tumor resection or margin-negative tumor resection was achieved in all cases. Sparing of the nasolacrimal duct was achieved in 2 patients. No patients reported persistent epiphora, empty nose syndrome, or changes in cosmesis such as alar or nasal tip collapse. One patient reported unilateral V2 hypoesthesia at 6 months postoperatively that had resolved by his next follow-up 18 months after surgery. Postoperative tumor surveillance was achieved by endoscopic examinations in all patients and there was no evidence of tumor recurrence at a median follow-up of 22 months. Conclusions The EAMM provides improved access to the inferior–posterior–medial maxillary sinus. This approach minimizes the risk of hypoesthesia and change in cosmesis present in other approaches, and obviates division of the nasolacrimal duct for inferior, posterior–medial attached lesions. This progressive escalation of approach for maxillary sinus lesions minimizes injury to nasal and nasolacrimal structures without compromising tumor outcomes.

To evaluate medium/long term outcomes and patient satisfaction through relief of symptoms and improved quality of life (QoL) after Jones tube conjunctivodacryocystorhinostomy (JT-CDCR) using the Naso Lacrimal Duct Obstruction symptom-score (NLDO-SS).We conducted a retrospective, non-comparative, multicentric study including patients with complete obstruction of the superior and inferior proximal lacrimal drainage system. All patients underwent JT-CDCR, and the patency of the tube was evaluated with saline irrigation and endoscopic examination. We assessed patient satisfaction and quality of life administering the NLDO-SS.We enrolled 16 patients, for a total of 21 eyes operated. The success rate for procedures was 81%. The success rate for single parameters was globally 95.9%; if considered separately, ocular symptoms and nasal symptoms were respectively 94.3% and 100%.JT-CDCR was a reliable procedure, able to solve symptoms in a majority of patients and guaranteed a good quality of life over a long period of time.L’applicazione di un questionario sui sintomi dopo congiuntivodacriocistorinostomia: risultati.Valutare gli esiti a lungo termine e la soddisfazione del paziente, attraverso la risoluzione della sintomatologia e il miglioramento della qualità della vita (QoL) dopo intervento di congiuntivodacriocistorinostomua e posizionamento di Tubo di Jones CDCR-JT, mediante l’utilizzo del questionario “Naso Lacrimal Duct Obstruction Symptoms-Score (NLDO-SS)”.Abbiamo condotto uno studio retrospettivo, non comparativo, multicentrico, includendo pazienti con ostruzione completa della lacrimale prossimale superiore e inferiore. Tutti i pazienti sono stati sottoposti a JT-CDCR, la pervietà del tubo di Jones è stata valutata con irrigazione di soluzione fisiologia ed endoscopia trans-nasale. A ciascun paziente è stato poi somministrato il questionario NLDO-SS.Abbiamo arruolato 16 pazienti, per un totale di 21 occhi operati. Il tasso di successo delle procedure è stato dell’81%. Il tasso di successo per i singoli parametri è stato globalmente del 95,9%; se considerati separatamente, i sintomi oculari e quelli nasali erano rispettivamente del 94,3% e del 100%.L’intervento di JT-CDCR ha dimostrato di essere in grado di risolvere i sintomi nella maggior parte dei pazienti e di garantire una buona qualità di vita per un lungo periodo di tempo.

Objective The aim of this study is to evaluate the effectiveness of anterior and posterior dacryorhinocystostomy (En-Dcr) by assessing the surgical outcome with a new objective technique, nose sinus manometry. Materials and methods Thirty adult patients presenting nasolacrimal duct obstruction were enrolled in this study and randomly divided in two groups. In group A patients underwent anterior endonasal dacryorhinocystostomy, group B underwent the posterior approach. All patients were evaluated through Nose Sinus Manometry, endoscopic dye disappearance functional test (EDFT) and subjective assessment three months post-op. Pearson test and T-student Test were used for evaluations. Results The mean differences in the pressure values were significantly different in the two groups of treatment, therefore, the patients of group B had strong improvement in pressure values compared with patients of group A. Conclusion This study confirms a relevant physical distinction between posterior En-Dcr outcomes compared to anterior En-Dcr and reveals a significant success rate difference between the two groups of patients. The posterior surgical technique shows better results than the anterior one, by providing an almost physiological post- operative endonasal outcome. These results also showed the effectiveness of Nose Sinus Manometry in assessing the post- operative outcomes after En-Dcr.

The goals of this study were to evaluate the results of endoscopic endonasal dacryocystorhinostomy (DCR) and to compare the surgical success rates of the different procedures (with or without mucosal flap) in patients with nasolacrimal duct obstruction. This prospective study investigated the results of 39 patients, they were 36 females (92.3%) and 3 males (7.7%). Endoscopic endonasal DCR was performed at the Basrah Teaching Hospital, Department of Otolaryngology in the period between July 2018 to July 2019. The patients were divided into two groups; with or without flap. During surgery, the mucosal flap was preserved in 13 patients (group B) and removed in 26 patients (group A). For all patients, silicone stents were put at the end of surgery. The silicone tube was removed within 6 months after surgery. After six months follow-up, the results were; patent ostium reported in 17 patients (81%) in group A and in 10 patients (90.9%) in group B. There was no statistically significant difference between the groups (P-Value 0.461). The overall incidence of crustation and adhesion is more in group A than in group B but it was also statistically not significant.In conclusion, endoscopic endonasal DCR carries no significant difference of success ratewhether it is with or without mucosal flap.Key words: Endoscopy, Dacryocyctorhinostomy, flap, Surgery.

One of the main reasons of failure in surgical treatment of dacryocystitis is cicatrical closure of the ostium. Considering controversial data on efficacy and safety of antifibrotic methods currently employed during dacrycystorhinostomy, searching for new ways to prevent fibrosis remains one of the main directions of research in dacryology. Pirfenidone, a small-molecule agent, was demonstrated to have a pronounced antifibrotic effect in experiments both in the eye and various other organs. Aim. To experimentally evaluate the antifibrotic effect of pirfenidone in dacryocystorhinostomy. Material and methods. 18 shinshilla rabbits were used in the current study. Subjects underwent modified dacryocystorhinostomy followed by 0,15 or 0,3 mg/ml pirfenidone injection circumostially. Animals were divided into groups based on pirfenidone dosage used. Control group animals received no injection. Rabbits were killed on the 7th (6 rabbits), 14th (6 rabbits) and 28th day (6 rabbits) following surgery. Ostium patency was evaluated using lacrimal irrigation and morphologically once the animal was killed. Ostium tissue samples were analyzed histologically. Results. Cicatrical closure of the ostium was observed in 4 subjects from control group on days 14 and 28 following surgery. The most pronounced fibrotic changes were also noted in tissue specimens obtained from these rabbits. Fibrotic changes in groups 1 and 2 were notably less severe than in control group. Conclusion. Data obtained in the current study evidences high antifibrotic efficacy of pirfenidone. This necessitates further research of pirfenidone use in dacryocystorhinostomy. Key words: dacryocystorhinostomy, ostium closure, dacryostoma, pirfenidone, antifibrotic therapy.

Purpose Silicone tube intubation is the most common method for treatment of nasolacrimal drainage disorder or repair of lacerated canaliculus. However, some cases are prolapsed earlier than expected, subsequently affecting the success rate of silicone tube intubation. The author introduced a successful reposition of the prolapsed silicone tube. Methods This study is a retrospective case series of 11 patients who were treated with reposition of prolapsed silicone tube using hole and lacrimal probe method. In all cases, the tubes were prolapsed within 2 months after the first surgery due to careless rubbing of the medial canthus by the patient. In all 11 cases, the development of a biofilm on tube was not observed at the time when the tube was prolapsed. All patients underwent immediate reposition of prolapsed tube without local anesthesia in the outpatient operating room on the day they visited. Results In all 11 cases, the prolapsed silicone tube was repositioned without any complications using this hole and lacrimal probe method. At 6-month follow-up examination, all patients presented with a well-positioned silicone tube up to the day of extubation without replacing it with a new silicone tube. Conclusions This hole and lacrimal probe method is effective for the repositioning of prolapsed silicone tube after bicanalicular intubation of lacrimal system. This procedure includes easy performance in a short time and without local anesthesia in the outpatient operating room.

Purpose: Localization of the lacrimal sac is a critical step during endoscopic dacryocystorhinostomy (endo-DCR). A "light pipe" can be used to transilluminate the lacrimal sac endonasally. We hypothesized that this may misguide the surgeon learning endo-DCR to create an osteotomy mostly posterior to the maxillary line if only the bone overlying the transillumination was to be removed, as the thinner lacrimal bone will transmit light more readily than the thicker maxillary bone of the frontal process of the maxilla that forms the anterior lacrimal sac fossa.Methods: The charts of 32 patients with primary acquired nasolacrimal duct obstruction in whom a lighted system was used during endo-DCR at Massachusetts Eye and Ear from April 2015 through October 2016 were reviewed. Patients with prior history of lacrimal surgery or trauma directly to the lacrimal sac fossa were excluded. Location of the maximal point of transillumination in relation to the maxillary line was observed and noted intraoperatively.Results: Of a total of 39 endo-DCR surgeries performed, the intraoperative transillumination point was entirely posterior to the maxillary line in 32 instances (82%).Conclusions: Use of an endocanalicular light pipe preferentially illuminates posterior to the maxillary line endonasally. The anterior lacrimal sac fossa (maxillary line and anterior as visualized endonasally) is rarely transilluminated, likely due to thicker bone in that region. Surgeons learning how to perform endo-DCR using a light pipe should be aware of this phenomenon.

Endonasal endoscopic dacryocystorhinostomy (EES-DCR) has gradually become the main surgical method for treating chronic dacryocystitis. Whether the placement of the lacrimal drainage tube during the operation can improve the operation’s success rate is an issue. This study observes the effect of an indwelling lacrimal drainage tube on the curative effect of EES-DCR in patients with chronic dacryocystitis. The cure rate of the Lacrimal duct drainage tube non-indwelling group A was 93.8% (46/49). The 3 cases failed because of the nasal cavity’s inflammation, which resulted in the adhesion of the anastomotic stoma and the middle turbinate. The cure rate of the Lacrimal drainage tube indwelling group B was 85.7% (42/49). The 7 cases failed because of the excessive proliferation of the tissue around the anastomosis, the hyperplasia of granulation tissue, the shedding of the lacrimal duct drainage tube, the crack of the lacrimal duct, and the premature removal of the lacrimal duct drainage tube caused the contraction of the mucosa around the anastomosis, resulting in the anastomosis obstruction. There was no obvious difference between the two groups (P > 0.05). At 6 months, 46 cases of the EES-DCR group A had gradually epithelialized anastomoses without granulation tissue growth with the follow up time extension. In the EES-DCR group B, 42 cases of anastomoses were gradually epithelialized without granulation tissue growth. Nasal endoscopic dacryocystorhinostomy combined with an indwelling lacrimal duct drainage tube can be used to treat chronic dacryocystitis, but an indwelling lacrimal duct drainage tube has no significant effect on the efficacy of chronic dacryocystitis.

Background and Objectives The conjunctivodacryocystorhinostomy (CDCR) is rarely performed in epiphora, which is caused by complete proximal bicanalicular obstruction. The purpose of this study is to analyze the characteristics, clinical results and complications of patients who underwent CDCR.Subjects and Method We enrolled 12 patients who underwent CDCR due to proximal canalicular obstruction from 2006 to 2019. We retrospectively analyzed the causes of epiphora, trauma history, the cause of revision operation and the clinical outcome.Results A total of 12 patients (7 males and 5 females) underwent CDCR (mean age 46 years). The causes of trauma were such as laceration (n=7, 58%) and iatrogenic (n=1, 8%), idiopathic obstruction (n=4, 33%). After the initial surgery, 5 patients (41%) were categorized in good outcome and the Jones tube was located well in 6 (50%) patients. Revision surgery was performed in 6 (50%) cases, with 4 cases having good outcome. The success rate of CDCR, including revision surgery, was increased to 83%. Most common cause of revision surgery was tube migration. In addition, the subjective outcome in patients with traumatic causes were worse but it had no statistical significance compared to that of patients with idiopathic and iatrogenic causes (p=0.07).Conclusion About a half of the patients had good recovery rate after the initial operation. The outcome increased to 83% after revision operation. The success rate of CDCR for traumatic patients was worse than for those with idiopathic and iatrogenic causes. It seems that accompanied eyelid damage in traumatic patients may have affected the result of success rate.

To report the clinical profile and management outcomes of a series of cases of malignant tumors of the lacrimal drainage system (LDS).A retrospective analysis of all cases diagnosed with LDS malignancy over the past 24 years (1995-2019) was done. Patient characteristics, tumor types, management, and outcomes were analyzed.A total of 14 patients were included. Thirteen cases were of primary malignancy, while one was a secondary lesion. The mean age was 42.5 years, with males and females being equally affected. A medial canthal mass was the most common (9, 64.2%) presentation. Six patients (42.8%) had undergone one or more dacryocystorhinostomy surgeries for nasolacrimal duct obstruction before presentation. Seven patients underwent wide local excision (50%) while 3 (21.4%) each underwent dacryocystectomy and exenteration. Adjuvant radiation was administered to 4 (28.5%) patients. Thirteen (92.8%) patients were diagnosed with epithelial malignancy while one (7.1%) was a case of small B cell lymphoma. Transitional cell carcinoma was the most common epithelial malignancy (4, 28.5%). Three (21.4%) patients had metastatic disease (2 lymph nodes and one angle of jaw). There was no mortality after a mean follow up of 40.7+_25.1 months (Median 26; Range 4-131).LDS malignancy is rare, with the epithelial variant being far more common than non-epithelial. Wide local excision with adjuvant radiotherapy is the preferred management. Long-term follow-up is essential to manage recurrences and to increase survival.

BACKGROUND Epiphora is a common annoying symptom, embarrassing the patient both socially and functionally and may even endanger the eye. Chronic Dacryocystitis is the most common cause of epiphora which arises from nasolacrimal duct occlusion. Dacryocystorhinostomy (DCR) is the procedure of choice in the management of Dacryocystitis. We wanted to study the final outcome following endonasal DCR for chronic dacryocystitis with or without using silicon stent, evaluate the causes of persistence of epiphora in patients with or without the use of lacrimal stents and identify the methods of overcoming them postoperatively. METHODS A case control study to compare the results of Endonasal DCR with and without stent was conducted among 96 patients of both genders aged above 20 years with symptoms and signs suggestive of nasolacrimal duct blockage. All the cases and controls were randomly selected and included as group A and group B. RESULTS 96 patients were included in this study and they were divided into two groups (Group A and Group B) with 48 patients in each group. More than 75 % of the patients were between 31 and 60 years of age with a mean age of 44.36 ± 3.15 years. In Group B, 72.91 % of the cases were between 31 and 60 years of age with a mean age of 45.50 ± 4.10 years. There was no statistically significant difference in both groups. In group A (DCR with stent) success rate or relief of symptoms was 96 % whereas in group B (DCR without stent) success rate or symptomatic relief was 80 %. CONCLUSIONS Endoscopic endonasal DCR with stent is a safe and minimally invasive procedure and is an effective treatment for patients who have failed primary endoscopic DCR without stent and also in cases of mucocele and pyocele of the sac. KEYWORDS Chronic Dacryocystitis, Dacryocysto-Rhinostomy, Nasolacrimal Duct and Endoscopic Dacryocysto-Rhinostomy

Open and minimally invasive tear duct surgery are among the common surgical indications; however, little is known so far about the respective influences on the quality of life.The aim of this study was to compare the subjective influence on the quality of life of patients after open and minimally invasive surgical techniques for recanalization of dacryostenosis.From the collective of patients who were surgically treated at the University Medical Center Hamburg-Eppendorf from 2015 to 2018, a total of 169 patients (111 dacryocystorhinostomy, DCR, 58 endoscopy) took part in the survey and answered 9 questions about subjective satisfaction, which were evaluated also comparatively.When asked about postoperative satisfaction, the patients were significantly more satisfied after DCR (p = 0.001) than the patients who underwent a lacrimal endoscopy. There was no significant difference in terms of postoperative complications (p = 0.348). The rate of reoperations, however, was significantly higher in the patient group who underwent lacrimal endoscopy (χIn summary it can be said that DCR is not inferior to lacrimal endoscopy in terms of patient satisfaction.HINTERGRUND: Die eröffnende und die minimal-invasive Tränenwegschirurgie gehören zu den häufigen Operationsindikationen. Jedoch ist bislang wenig über die jeweilige Beeinflussung der Lebensqualität bekannt.Mit dieser Studie soll die subjektive Beeinflussung der Lebensqualität von Patienten nach eröffnenden und minimal-invasiven Operationstechniken zur Rekanalisierung von Dakryostenosen vergleichend erfasst werden.Aus dem Kollektiv der Patienten, die von 2015 bis 2018 am Universitätsklinikum Hamburg-Eppendorf operiert wurden, nahmen 169 Patienten (111 DCR, 58 Endoskopie) an der Umfrage teil und beantworteten 9 Fragen zur subjektiven Zufriedenheit, welche wir – auch vergleichend – ausgewertet haben.Gefragt nach der postoperativen Zufriedenheit zeigten sich die Patienten nach DCR signifikant zufriedener (p = 0,001) als die Patienten, die eine Tränenwegsendoskopie erhielten. Es zeigte sich kein signifikanter Unterschied hinsichtlich der postoperativen Komplikationen (p = 0,348). Die Rate an Re-Operationen jedoch war in der Patientengruppe, welche eine Tränenwegsendoskopie erhielten, signifikant höher (Chi-Quadrat-Test, p = 0,004).Zusammenfassend lässt sich daher sagen, dass die DCR hinsichtlich der Patientenzufriedenheit einer Tränenwegsendoskopie nicht unterlegen ist.

Summary Study objective To study the performance of a pre-loaded Monoka stent in the management of congenital nasolacrimal duct obstruction (CNLDO). Study design Non-randomized study of consecutive cases. Materials and methods A preloaded classic Monoka silicone stent contained entirely inside its introducer (Lacrijet) was used to treat a consecutive series of subjects with CNLDO over an 11-month period (May 2019–March 2020). Only subjects with chronic symptomatic CNLDO were included. Subjects with intermittent tearing, canalicular pathology, trisomy 21, facial cleft, or history of lacrimal surgery were excluded. Intraoperative findings were recorded, including the degree and location of the nasolacrimal obstruction, successful metal to metal contact with the probe, any difficulties encountered by the Lacrijet device itself, procedure duration, tolerability of the fixation punctal plug, and finally, inspection of the stent after withdrawal of the inserter. Functional success was defined as disappearance of all symptoms of epiphora. Results A total of 45 preloaded Monoka Lacrijet stents (Lcj) were placed consecutively in 38 children. The mean age was 27.9 months (12–78 months). The mean procedural duration was 2.8 minutes (range: 1–10 min). The overall success with disappearance of all symptoms of epiphora was 88.8% (40/45). Surgery in cases of simple mucosal stenosis was successful in 92.2% (35/38) of cases, with a mean follow-up time of 7.9 months (range: 1 to 12 months). The duration of stent intubation was for this group was 32 days (range: 1–103). The surgical outcomes for the other 7 cases with more complex intraoperative findings are summarized in the publication. All withdrawn probes were intact. Conclusions The Lacrijet stent system is a simple and reliable pushed intubation device for CNLDO in appropriately selected cases where bony stenosis of the canal is minimal.

Purpose: To report the authors' experience with endoscopic unpowered dacryocystorhinostomy in the treatment of pediatric nasolacrimal duct obstruction, and to evaluate whether surgical site reassessment (after the appropriate healing period) affects clinical outcomes. Methods: This retrospective study included 47 children aged between 1.5 and 17.0 years (mean age: 6.9 years) who underwent endoscopic unpowered dacryocystorhinostomy between 2014 and 2019 at one tertiary care hospital. Twenty-six patients required unilateral and 21 required bilateral endoscopic dacryocystorhinostomy. The main outcome measures were duct patency on lacrimal irrigation (“anatomical success”) and resolution of symptoms (“clinical success”) over 6 months of postoperative follow-up. Results: Sixty-eight dacryocystorhinostomy procedures were performed. Surgical site reassessment during tube removal was performed in 52 of 68 cases. Five cases (9.6%) required treatment of local pathologies, only after which was symptomatic relief achieved. Overall anatomical success was observed in 49 (94.2%) of the 52 cases in which nasal endoscopy was performed, including the 5 cases treated during reevaluation. Clinical success was observed in 63 (92.6%) cases. Conclusions: Pediatric endoscopic dacryocystorhinostomy is an effective surgical procedure used to correct nasolacrimal system obstruction resistant to conservative measures. The unpowered endoscopic dacryocystorhinostomy technique is practical and safe in the pediatric population. Surgical site reassessment allows treating local pathologies threatening ostium patency and increases clinical success rates. [ J Pediatr Ophthalmol Strabismus . 2021;58(3):168–173.]

PURPOSE To compare the accuracy and positive predictive values of the air bubble test (ABT) and endoscopic Jones I test for assessment of anatomical and functional success after diode laser transcanalicular dacryocystorhinostomy (T-DCR). METHODS This cross-sectional study included 60 eyes of 56 patients who underwent T-DCR by a single surgical team from January 2016 to December 2018. All the 56 patients (60 eyes) underwent lacrimal syringing, endoscopic Jones I test, and ABT. Anatomical success was considered as a free passage of fluid with no reflux on the irrigation test. Functional success was defined as the resolution or improvement of epiphora (Munk score of 0 or 1). The results of irrigation test, endoscopic Jones I test, and ABT were used to calculate the accuracy and positive predictive values (PPVs) of ABT and endoscopic Jones I test for assessment of anatomical and functional success (Munk score of 0 or 1) after T-DCR. A value of p < 0.05 was considered statistically significant. All statistical evaluations were performed using SPSS software. RESULTS There were 60 T-DCR procedures in 56 patients (82.1% women; 46 patients) with a mean age of 56.4 years (standard deviation: 15.7; range from 29 to 92). The mean follow up was 8.1 months. Overall anatomical and functional success rates were 83.3% (50/60) and 73.3% (44/60), respectively. The PPV of endoscopic Jones I test in anatomical success and functional success was 100% and 88%, respectively. The accuracy of this test in anatomical and functional success was 100% and 81.25%, respectively. The PPV of ABT in anatomical success and functional success was 100% and 90.4%, respectively. The accuracy of this test in anatomical and functional success was 92% and 80.65%, respectively. CONCLUSIONS In conclusion, both endoscopic Jones I test and ABT showed PPV of 100% to detect anatomical success after T-DCR; the endoscopic Jones I test and ABT had 88% and 90.4% of PPV on evaluation of functional success, respectively. Both tests showed good accuracy in the assessment of anatomical and functional success after T-DCR. These outcomes may indicate that ABT could substitute Jones I test on postoperative DCR assessment.

In this population-based retrospective cohort study, the Optum claims dataset was used to identify children

Purpose: Sialoendoscope was used as a dacryoendoscope, high- definition images of the lacrimal drainage system (LDS) were captured and its performance in congenital nasolacrimal duct obstruction (CNLDO) is reported. Methods: Nasal endoscopy was done as the first in all the cases using a 0°, 2.7 mm nasal endoscope (Karl Stroz Tutlingan Germany). This was followed by Dacryoendoscopy (DEN) of the lacrimal drainage system from puncta till the valve of Hasner. DEN was performed under general anaesthesia in 26 children (including 17 primary and 9 failed probing cases). All cases were examined using 0.8 mm sialoendoscope (Karl Storz, Tuttlingen, Germany) with fibreoptic light transmission with a side port for irrigation. Results: We were able to obtain high-definition images of canaliculi, lacrimal sac, sac duct junction, proximal, mid and distal segments of nasolacrimal duct in all the children with CNLDO. In 17 primary cases 16 had distal membranous obstruction and I case had proximal canalicular obstruction. In nine children with history of failed probing, five had membranous obstruction, two had dacryoliths, two had NLD malformation at different levels. An overall success rate of 88.4% was achieved. Conclusion: Sialoendoscope can be used as high-definition dacryoendoscope for diagnostic and therapeutic use in CNLDO. Useful information can be obtained on dacryoendoscopy in complex CNLDO cases.

BACKGROUND Dacryocystitis is the most common pathology affecting lacrimal drainage system, representing 79 - 87 % of all lesions. This retrospective study was conducted to understand the clinical spectrum and management patterns of dacryocystitis in the past 5 years in a tertiary care hospital of coastal Karnataka. METHODS This is a five-year retrospective review of the case records of patients with dacryocystitis from the year 2015 to 2019. The records were retrieved from the electronic medical record system of the hospital using the International Statistical Classification (ICD) 10 codes. Data retrieved included, demographic profile, clinical history, presenting symptoms, past surgical interventions, examination findings, systemic comorbidities, pattern of management, medical or surgical management and complications if any. 45 cases that had completed medical records were included in the study. RESULTS The mean age of presentation was 49.37 (± 19.59). The condition was more common in females with a male to female ratio of 1:2.5. The condition was almost equal on both sides. 11 (24.44 %) had bilateral involvement. The patients were mostly from coastal areas or dry plains. Most common presentation was chronic dacryocystitis. Aggravated epiphora was the most common symptom (33) 73.3 %. Diabetes mellitus (15) and hypertension (10) were the most common systemic comorbidities. (22) 48.8 % had no comorbidities. The complications seen were (4) 8.9 % fistula, (1) 2.2 % lacrimal abscess, (2) 4.4 % conjunctivitis and (1) 2.2 % preseptal cellulitis. The patients who underwent nasal examination were (31) 68.9 % out of which, 26 had no abnormal finding in the nose. Surgical treatment was performed in 29 (64.4 %) mainly in the form of dacryocystectomy (DCT) 24 (53.3 %) while only 5 (11.1 %) underwent conventional dacryocystorhinostomy (DCR). CONCLUSIONS Chronic dacryocystitis is the most common form of presentation with higher incidence in the females in the fifth decade of life. Epiphora was the commonest symptom. Most patients who underwent a preoperative nasal examination did not have any pathology. DCT was the more commonly performed procedure. KEYWORDS Acute Dacryocystitis, Chronic Dacryocystitis, Dacryocystectomy, Dacryocystorhinostomy, Epiphora

Background To introduce a treatment option: dacryoendoscopy-assisted incision of Hasner’s valve under nasoendoscopy and assess its efficacy in treating membranous congenital nasolacrimal duct obstruction (CNLDO) in children older than 1 year with history of initial probing failure. Methods 52 eyes of 43 children with membranous CNLDO who underwent dacryoendoscopy-assisted incision of Hasner’s valve under nasoendoscopy between May 2012 and October 2020 were enrolled in this retrospective study. All participants were older than 1 year and all the eyes had gone through probing at least once but still had symptoms of epiphora and discharge. Surgical success was defined as a normal fluorescein dye disappearance test (FDDT) and the absence of pre-operation complaints, including epiphora, muco-purulent discharge, increased tear lake or the symptoms of acute infection such as acute dacryocystitis. Patients’ demographics, clinical features and follow-up outcomes were evaluated. Results Of all these operated cases, surgical success was achieved in 52/52 eyes without any early or late complications. The overall success rate was 100%. Conclusions Dacryoendoscopy-assisted incision of Hasner’s valve under nasoendoscopy is an effective and minimally invasive surgical treatment in membranous CNLDO patients with initial probing failure.

This study aimed to investigate the effect of the maxillary line (ML)-lacrimal sac anterior border (LSA) distance on the results of endoscopic dacryocystorhinostomy (EDCR) operation. The study was designed retrospectively. The distance between LSA and ML was measured from preoperative paranasal sinus computed tomography (PNSCT) images. Nasolacrimal duct obstruction symptom score (NLDO-SS) was calculated before and after surgery. The endoscopically proven of the transition of the 2% fluorescein drop instilled into the eye to the nasal passage accepted as a surgical success. 47 patients included in the study and eight of them underwent bilateral EDCR. The average age of the patients was 50.3 ± 14.8. The LSA-ML distance was 4.2 ± 1.0 mm in all patients. The duration of surgery was found as 38.1 ± 6.1 min for each side. The preoperative NLDO-SS mean was 54.9 ± 11.7 and 22.2 ± 12.1 postoperatively (p = 0.000, CI = 28.9–36.2). Six patients (11%) required revision surgery. A statistically significant high positive correlation was found between duration of surgery and LSA-ML distance (p = 0.000, r = 0.840). There was a significant negative correlation between the duration of surgery and postoperative NLDO-SS (p = 0.041, r = −0.276). The LSA-ML distance calculated in this study was found to be significantly associated with the decrease in the duration of surgery and the NLDO-SS score obtained after surgery. However, more valid results can be obtained if similar studies are carried out in larger samples containing a sufficient number of revision cases.

To assess the long-term outcomes of transcanalicular laser dacryocystorhinostomy in cases of primary acquired nasolacrimal duct obstruction (PANDO). Retrospective interventional case series was performed on all patients diagnosed with PANDO and who underwent a primary transcanalicular laser dacryocystorhinostomy from Jan 2014 to June 2016. The procedure was performed using 980 nm diode laser. All the patients additionally underwent intraoperative adjunctive procedures: mitomycin C application and silicone intubation. Patients were followed for up to 3 years after surgery. Anatomical success was defined as patent ostium on irrigation, and functional success was defined as resolution of epiphora. The parameters studied include patient demographics, clinical presentation, type of anesthesia, duration of surgery, laser energy delivered, complications, and anatomical and functional success. The variables influencing the outcomes were assessed. Statistical analysis was performed using the package Statistica (version 10.0, Statsoft, Poland). A total number of 205 patients were assessed. Of these, 73.17% (150/205) were females. The mean age of patients was 62.92 years. The mean laser energy used was 1060.09 J, and the mean operating time was 22.33 min. Approximately, 95% and 68% of the patients completed 1 year and 3 years of follow-up, respectively. The anatomical and functional success rates dropped significantly beyond the 3 months and 6 months postoperative period and maintained the lower success rates beyond 1-year follow-up for up to 3 years. The anatomical and functional success at the end of 3-year follow-up was 56.12% and 33.81%, respectively. The functional success was not affected by gender (P = 0.132), age (P = 0.956), laser energy (P = 0.626), or duration of the surgery (P = 0.906). However, the intraoperative pain scale was influenced by the laser energy (P < 0.001) and the duration of the surgery (P < 0.001). The anatomical and functional outcomes of primary transcanalicular laser dacryocystorhinostomy are suboptimal and not encouraging in the long term.

Purpose: To evaluate the success rates of transcanalicular diode laser-assisted dacryocystorhinostomy (TCL-DCR) during 3 years of follow-up and to find clinical factors that influence surgical outcomes.Methods: Major outcomes were the anatomical success defined as a patent neo-ostium tested by irrigation and the functional success defined as a patent osteotomy with the absence of epiphora, accessed at 6-month, 1, 2, and 3-year follow-up visits. To determine which factors influence success rates, patients were divided according to gender, age, previous lacrimal surgeries, nasosinusal anatomy, energy employed, treatment with topical prostaglandin analogs, and timing of extubation.Results: A total of 134 eyes were included. 55.2% of patients underwent peribulbar block. The surgical mean duration was 30.6 min. We obtained anatomical and functional success rates of 80.0% and 70.8% at 6 months; 69.3% and 61.4% at 1 year; 64.2% and 58.0% at 2 years; 56.4% and 46.2% at 3 years, respectively. Functional success was significantly higher in younger patients (p = .008). Bicanalicular intubation for 2 months improved anatomical and functional success rates (p = .028 and p = .001, respectively). No other factors showed a significant impact. 85.8% of patients didn´t experience any complications. Palpebral swelling was the most frequent complication.Conclusion: TCL-DCR is a minimally invasive, repeatable, and safe alternative to treat nasolacrimal duct obstructions. We found success rates comparable to literature and stated that younger patients and those intubated for 2 months show better results.

Background/aimsTo determine if nasolacrimal massage or topical antibiotics are associated with higher rates of resolution compared with observation alone in a population-based cohort of infants with congenital nasolacrimal duct obstruction (CNLDO).MethodsThe medical records of all children ResultsAmong 1958 infants diagnosed and followed for CNLDO, 516 (26.4%) were merely observed, 506 (25.8%) were prescribed massage alone, 485 (24.8%) were prescribed at least one course of topical antibiotics, 397 (20.3%) were prescribed both topical antibiotics and massage, and 54 (2.8%) had no documented therapy. Non-surgical resolution, occurring in 1669 (85.2%) during a median follow-up of 3.1 months (range: 1 week–248 months), was 74.6% for the merely observed, 89.7% for those prescribed digital massage, 87.0% for those prescribed antibiotics and 90.7% for those treated with both. This comparison was significant in unadjusted (pConclusionPrescribing topical antibiotics or digital massage for infants with CNLDO in this cohort, individually or in combination, was associated with a higher rate of spontaneous resolution than observation alone.

Background: Epiphora due to chronic dacryocystitis is extremely common in the ophthalmolmic practice across this country. The typical patient is often a female in her young or middle age, and the clinical pathology is usually obstruction of the naso lacrimal pathway located at the naso-lacrimal duct or beyond. Definitive treatment entails creation of an alternative pathway for fluid egress by a surgical procedure known as dacryocystorhinostomy (DCR). Aims and Objectives: To compare two commonly performed techniques of DCR – namely external and endonasal – in terms of surgical time, complications and outcomes. Materials and Methods: Seventy two patients were studied over a period of two years from April 2017 to May 2019 were divided in two equal groups. The first group (Group A, n=36) underwent external DCR which was done by an ophthalmic surgeon whereas the second group (Group B, n= 36) underwent endonasal DCR done by an ENT surgeon. All cases of both the groups were followed up for a period of six months. Both groups were compared in terms of surgical time, per and post operative complications and final surgical outcomes. Results: The study had 64 females and 8 males in total aged between 19 and 63 years. Mean surgical time in group A (31 females, 5 males) was 48 minutes whereas in Group B (33 females, 3 males) it was 44 minutes. Intra operative haemorrhage was seen in 16% (n= 6) patients of Group A and 11% (n= 4) of Group B. Patency at the end of six months was sustained in 91% (n= 33) patients in Group A and 86% (n= 31) patients in Group B. Conclusion: Both techniques offer viable surgical alternatives as far as correction of naso lacrimal obstruction is concerned. Keywords: Dacryocystitis, External DCR, Endonasal DCR.

This study aims to assess the bony lacrimal fossa changes in chronic cases of primary acquired nasolacrimal duct obstruction versus acute dacryocystitis.A prospective study was performed on 25 bony lacrimal fossae of 25 eyes of 15 patients who underwent endoscopic dacryocystorhinostomy at a tertiary care Dacryology service over a period of 6 months. Ten patients with chronic PANDO (1 year) with bilateral involvement and five patients of unilateral acute dacryocystitis were recruited in the study. None of the patients had a history of trauma or previous surgeries or nasal disease in the past. The bone samples from the frontal process of the maxilla and the lacrimal bone were obtained during the osteotomy and subjected to routine histopathological examination. Special stains used were von Kossa, Masson trichrome, periodic acid Schiff, and Alcian blue. Immunohistochemistry was performed using CD68 antibodies. Patient demographics, clinical presentation, duration of the disease, and bony changes were analyzed in different patient subsets.The mean disease duration in the chronic PANDO subset was 3.1 years, whereas acute dacryocystitis was 6.8 days. There was no correlation between the bony changes and the laterality in the chronic subset. Periosteal thickness and fibrosis were universal in the chronic group but not in the acute dacryocystitis. There were also differences in the number of osteocytes per sq mm, osteoblast, osteoclast, bony remodeling, bony canals structure, and intrastromal fibrosis between the subsets. These changes within the chronic group increased with the duration of the disease. Interestingly, there was no evidence of any bony inflammation across the subsets in all the samples studied.Characteristic bony changes can be demonstrated in patients with chronic PANDO but not in acute dacryocystitis. The lack of bony inflammatory infiltrates may provide clues in understanding the peri-sac disease pathogenesis in acute dacryocystitis.