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Purpose: The aim of this study was to describe in detail the gross anatomy of the nasolacrimal apparatus in relation to the lateral nasal wall by the various steps of cadaver dissection and to measure the distances of surgically important landmarks from relevant structures to improve the safety and efficiency of endoscopic surgical procedures. Methods: Thirty-six half-heads of embalmed Korean adult cadavers were dissected under a surgical microscope. After removal of the nasal septum, the lateral wall of the nasal cavity was examined. Results: The orifice of the nasolacrimal duct (NLD) was most frequently observed in the form of a vertical sulcus in 14 cases (39%) and the lacrimal fold was present in 28 cases (77.8%). A total of 15 morphometric items between the orifice of the NLD and the adjacent anatomical structures were measured. The location of the orifice of the NLD was observed at a mean of 17.5 ± 3.1 mm from the limen nasi, 22.8 ± 4.8 mm from the anterior nasal spine, and 21.4 ± 3.5 mm from the axilla of the middle nasal concha. In the positional relationships, the most frequent finding was that the lacrimal sac was posterior to the axilla of the middle nasal concha in 23 cases (64%), and overlap of the NLD with the maxillary line was observed in 24 cases (67%). Conclusions: This study was conducted to accumulate anatomic data on the lacrimal sac and duct with regard to the positional relationships among the surrounding structures to establish the information for use in endoscopic dacryocystorhinostomy. [ABSTRACT FROM AUTHOR]

Purpose: To describe the anatomic characteristics of structures adjacent to the lacrimal sac fossa and the standardized osteotomy method for endonasal dacryocystorhinostomy in Asians., Design: Retrospective noncomparative observational case series study., Materials and Methods: One hundred fifty-two eyes of 76 patients who had normal orbit computed tomographic scans were enrolled. The relationships of the uncinate process, the operculum of the middle turbinate, and the agger nasi cell to the lacrimal sac fossa were analyzed. Bone thickness and proportion of the frontal process of the maxilla in the lacrimal sac fossa was also evaluated., Results: The uncinate process was attached to the lacrimal sac fossa in 152 cases (100%) at the lower level of the fossa. The operculum of the middle turbinate was attached to the lacrimal sac fossa in 142 cases (93.4%), with wide positional variation. The agger nasi cell was adjacent to the lacrimal sac fossa in 118 cases (77.6%). The descent of the operculum of the middle turbinate relative to the lacrimal fossa had a strong correlation with the descent of the agger nasi cell (P < .001). The height and length of the nasal bone had a significant negative correlation with the thickness of the frontal process of the maxillary bone (P < .001)., Conclusion: The uncinate process, operculum of the middle turbinate, and agger nasi cell should be removed for sufficient osteotomy in a significant portion of Asian patients during dacryocystorhinostomy. A thick frontal process of the maxilla can be anticipated for the patient with a low nasal bridge. Further studies on the variation in intranasal procedures and the success rate of endonasal dacryocystorhinostomy need to be established., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Purpose: To characterize the outcomes of initial and repeated office-based probing as a primary treatment for congenital nasolacrimal duct obstruction (CNLDO) in children., Methods: The medical records of patients who underwent nasolacrimal duct office-based probing for CNLDO between March 2004 and January 2008 were reviewed retrospectively. Nasolacrimal duct probing was performed on 244 eyes from 229 consecutive patients with CNLDO. Patients who were refractory to the first probing underwent a second probing 4 to 8 weeks later., Results: Based on exclusion criteria, 244 eyes from 229 patients (117 males and 112 females), aged 6 to 71 months (mean, 12.4 ± 8.36) were included. The success rate of the initial probing was 80% (196 of 244) for all patients, 82% (111 of 136) in the 6 to 12 month age group, 79% (64 of 81) in the 13 to 18 months age group, and 78% (21 of 27) among individuals older than 19 months (p = 0.868, Pearson chi-square test). The success rate of the second probing was 61% (25 of 41) for all patients, 74% (17 of 23) in the 6 to 12 months age group, 58% (7 of 12) in the 13 to 18 months age group, and 17% (1 of 6) among individuals older than 19 months (p = 0.043, Fisher's exact test)., Conclusions: While the success rate of initial nasolacrimal duct probing is not affected by age, the rate of success rate with a second probing was significantly lower in patients older than 19 months. Based on the results, authors recommend further surgical interventions, such as silicone tube intubation or balloon dacryocystoplasty, instead of repeated office probing for patients older than 19 months, if an initial office probing has failed.

Purpose: To study the clinical characteristics of acquired nasolacrimal duct (NLD) obstruction in Korean children., Methods: The records of 38 patients under the age of 15 years who had undergone silicone intubation or dacryocystorhinostomy (DCR) for acquired NLD obstruction were evaluated. Patients who had congenital NLD obstruction or a history of NLD obstruction due to trauma were excluded., Results: The mean age of the patients was 3 years (range, 1-8 years). The causes of the NLD obstruction were epidemic keratoconjunctivitis (EKC) in 32 patients, herpetic blepharitis in one, and idiopathic in five. In patients with a history of EKC, symptoms were observed at a mean age of 12.7 months (range, 3-51 months). These patients demonstrated multifocal features of obstruction, unlike those in the idiopathic group. Silicone intubation was performed in 32 patients, external DCR in three, and endonasal DCR in three. The lacrimal procedures were beneficial in 36 of the 38 patients. The mean follow-up period was 7.6 months., Conclusions: Acquired NLD obstruction in children was mostly caused by EKC in our study. It is important to suspect NLD obstruction in children with persistent epiphora that develops after EKC., ((c) Japanese Ophthalmological Society 2007)