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Purpose: To correlate fluorescein dye disappearance test (FDDT) grades and endoscopic dye transit times (EDTT) in patients with patent osteotomies after nasolacrimal duct obstruction surgery (NLDO)., Design: Cross-sectional study., Methods: All adult patients with patent osteotomies post-external dacryocystorhinostomy (Ex-DCR) or post-endoscopic dacryocystorhinostomy (EDCR) for NLDO were included in this cross-sectional investigation. Patients with dry eye and endoscopically unidentified osteotomy sites were excluded from the study. The FDDT grade, EDTT and lacrimal symptom questionnaire (Lac-Q) scores were documented for all patients., Results: This study included 39 patients. Nineteen had undergone EDCR, twenty Ex-DCR. The FDDT grade and EDTT were positively correlated (r=0.32, P=0.045). The mean Lac-Q score was not correlated with FDDT grade (r=-0.01, P=0.951) or EDTT (r=0.07, P=0.669). There were no significant differences in the FDDT grade, EDTT, Lac-Q score or ostial characteristics between Ex-DCR and EDCR., Conclusion: FDDT grading correlates with EDTT, suggesting that these tests may be used interchangeably based on the clinician's ease of access and instrumentation. There was no correlation between the symptoms of lacrimal outflow obstruction with objective evidence of drainage., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

In addition to being a drainage system, the lacrimal ducts actively defend the eye through the action of the lacrimal pump, the presence of resident flora (lacriome) and the mucosa-associated immune tissue. Infection occurs when mucosal immune functions are overwhelmed. Lacrimal infection is a vicious circle, in which infection leads to inflammation and post-inflammatory sequelae, themselves a source of occlusion and stagnation, which in turn encourages infection. Whatever the initial trigger - post-traumatic occlusion, inflammation (e.g. allergic) or infestation by a virulent germ, the management of lacrimal duct infection must take account of this vicious circle. When infection sets in, changes in the mucosa can range from submucosal inflammatory infiltrates to pseudocysts, and in the most severe cases to metaplasia, dysplasia and squamous cell carcinoma. Histological sampling is therefore imperative in the case of surgery on a chronically infected mucosa. Clinical assessment, aided if necessary by a dacryoscan, must be able to detect differential diagnoses (lacrimal sac carcinoma, dacryocystocele in children) and serious forms (gonococcal ophthalmia neonatorum, peridacryocystitis), look for signs of dacryoliths, and differentiate between acute and chronic infection. Antibiotic treatment should be adapted to the identified or presumed organism involved or used sparingly in cases of chronic infection. Dacryoliths can be removed by curettage in the case of canaliculitis with concretions, but surgery is required for larger dacryoliths (canaliculotomy, or dacryocystorhinostomy in the case of lacrimal sac dacryoliths). Antibiotic prophylaxis for lacrimal surgery is recommended only in cases with associated rhinosinusitis, inflammation of the lacrimal sac, or a history of infected mucocele or dacryocystitis., (Copyright © 2024 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Décrire les rapports anatomiques de la voie d'abord rétro-caronculaire ainsi que des ses applications cliniques en oculoplastique à partir d'une étude conduite au laboratoire d'anatomie. Huit orbites provenant de 4 cadavres frais ont été disséquées au laboratoire d'anatomie de la faculté de médecine de Nice entre octobre 2018 et janvier 2019. Les principaux rapports anatomiques rencontrés sont le muscle de Duverney-Horner et le sac lacrymal en avant, les artères ethmoïdales antérieures, postérieures et l'ethmoïde en arrière, la poulie du muscle oblique supérieur vers le haut, le canal lacrymo-nasal et le tendon d'insertion du muscle oblique inférieur vers le bas. La voie d'abord rétro-caronculaire permet d'aborder l'orbite postérieurement au sac lacrymal et au muscle de Duverney-Horner permettant une meilleure protection de ces derniers. La voie d'abord rétro-caronculaire permet la réalisation de plusieurs procédures oculoplastiques : la dacryocystorhinostomie, la réparation des fractures orbitaires médiales, la décompression de la paroi médiale de l'orbite, la biopsie de tumeurs extraconiques médiales et la pexie périostée du globe oculaire en cas de paralysie complète du III. La voie d'abord rétro-caronculaire est une voie fiable permettant de s'affranchir d'une cicatrice cutanée. Elle permet un abord large de la portion médiale de l'orbite même si le champ opératoire est plus réduit que celui obtenu en cas d'abord cutané. Elle nécessite une connaissance anatomique précise et une courbe d'apprentissage accrue. To describe the anatomical landmarks of the retro-caruncular approach and its clinical applications based on a cadaveric study. A dissection of 8 orbits providing from 4 fresh cadavers was carried out at the anatomical laboratory of the University Hospital of Nice, France between October 2018 and January 2019. Main anatomical relationships encountered are anteriorly the Duverney-Horner muscle and the lacrimal sac, posteriorly the anterior and posterior ethmoidal arteries, superiorly the pulley of the superior oblique muscle, inferiorly the lacrimonasal duct and the tendon of the inferior oblique muscle. The retro-caruncular approach allows a safe surgical access behind the lacrimal sac and Duverney-Horner muscle. Many oculoplastic surgical procedures can be performed through this approach: dacryocystorhinostomy, medial orbital fractures repair, "médial" orbital "décompression", biopsy of medial and extraconal tumours, medial periosteal fixation in third-nerve palsy. The retro-caruncular approach is a safe procedure avoiding skin incision. It allows a wide surgical space even if it is reduced compared to a more conventional skin route. It requires a great anatomical knowledge and a longer surgical learning curve. [ABSTRACT FROM AUTHOR]

Purpose: To study the structural and dynamic alterations in the lacrimal sac vasculature of patients with congenital, primary, and secondary acquired nasolacrimal duct obstructions (CNLDO, PANDO, SANDO) and patients with acute dacryocystitis (AD) and failed dacryocystorhinostomy (DCR)., Methods: A prospective study was performed on 65 consecutive lacrimal sacs following their complete exposure during endoscopic dacryocystorhinostomy. High magnification chromo endoscopy and changes in effective spectral response was achieved using the Storz professional image enhancement system (SPIES®). Structural characteristics studied include vascular arrangement, superficial and deep vessels, vessel calibers on cut section, abnormal branching, localized and generalized dilatations and pathologies like varices. Flow characteristics in different caliber vessels and their alterations were assessed in Spectra A mode of SPIES®., Results: Distinct vascular alterations were noted in several lacrimal disorders. Vascular dilatations differed between the fundus and the body segments of the lacrimal sac, except in cases of traumatic SANDO and prior failed DCRs. 23% (7/30) of PANDO sacs showed peri sac varices and severe tortuosity. The flow in the dilated vessels was either very slow or showed intermittent backflow. Moderate dilatation of peri sac venous plexus with distinct surface linear vessels was noted in CNLDO. The cut surface of the sac wall and luminal surface differentially demonstrated several vascular patterns like speckled, scattered, branched loops, and skip areas in various diseased states., Conclusion: The present study found distinct alterations of lacrimal sac vasculature in several lacrimal drainage disorders and provides impetus to the vascular theory for pathogenesis of PANDO., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

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Introduction: Although several studies have tried to identify the causes of failure of dacryocystorhinostomy (DCR) surgery, the ethmoid sinus remains an underestimated and little described source of failure., Objective: To study anatomical relationship between the ethmoidal sinus, particularly the "Agger nasi" cell, with the lacrimal fossa in the North African population, little described in the literature. This study is based on the results of preoperative analysis of dacryo-computed tomography., Patients and Methods: Analysis of preoperative computed tomography images of patients undergoing dacryocystorhinostomy over a 7-year period from January 2011 to December 2017. Anatomical relationships were studied according to the following classification: type I: No ethmoid cells located anteriorly to the posterior lacrimal crest on transverse images; type II: ethmoidal cells extending anteriorly to the posterior lacrimal crest, but not reaching the anterior edge of the lacrimal bone; Type III: ethmoidal cells located anterior to the lacrimal bone suture., Results: Two hundred and fifteen preoperative computed tomography images were analyzed. The morphology of the ethmoid sinus was classified as type 1 in 33.5%, type 2 in 42.32% and type 3 in 24.18%. Computed tomography analysis was symmetrical in 87.5% and asymmetrical in 12.5%., Conclusion: During dacryocystorhinostomy, the surgeon must take into consideration type III, which can be present in 25% of cases. In the case of surgical failure, a dacryo-CT must be performed to rule out such anterior positioning of the ethmoid cells., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Introduction: Endonasal dacryocystorhinostomy (DCR) is a surgical procedure that aims to increase tear drainage to treat epiphora caused by nasolacrimal obstruction by creating a bypass through the bone between the lacrimal sac and the nasal cavity. A silicone stent is temporarily put in place for 2 months to avoid early obstruction of the rhinostomy. One of the causes of surgical failure is related to progressive stenosis of intranasal ostium, due to fibrosis and new bone growth, inducing a relapse of epiphora and/or dacryocystitis. Few studies have described changes in the size of the intranasal ostium on direct post-DCR measurement or kinetics of its shrinkage. The purpose of this study is to determine whether changes in the size of intranasal ostium might be a predictor of final functional efficacy., Materials and Methods: A prospective cohort of eighteen consecutive patients undergoing endonasal DCR for chronic epiphora or chronic dacryocystitis between January 2017 and April 2018 was analyzed. Eight patients who underwent bilateral DCR, and twenty-six intranasal ostia were finally analyzed. Follow-up took place every two months for 1 year, with the silicone tube removed at 2 months. Functional success was defined as absence of recurrent epiphora or dacryocystitis. Ostium size was systematically measured on photos taken during intranasal endoscopy performed every 2 months for 1 year., Results: At 2 months after endonasal DCR, 23 of the 26 ostia (88.5%) were functional, but only 19 (73.1%) of them were directly measurable. The mean horizontal diameter at 2 months was 1.44 (SD 0.61) mm, and the mean vertical diameter was 0.86 (SD 0.37) mm, which corresponded to a mean area of 10 (SD 0.84)mm 2 . We noted a statistically significant decrease in ostium size and area between 2 and 4 months after the procedure (P -0.001), followed by a stabilization period with no statistical correlation between the size of the ostium and its final functional efficacy. At 6 months after DCR, of the 7 ostia that were not initially measurable, 3 were immediately non-functional at 2 months, 3 had a relapse of epiphora at 4 months, and 1 had a relapse of dacryocystitis at 6 months, i.e., 100% clinical failures at 6 months. The other procedures all remained functional after 1 year of follow-up., Conclusion: The intranasal ostium of an endonasal DCR shrinks significantly within the 2 months after removal of the silicone tube and remains stable thereafter. There is no correlation between the size or area of intranasal ostium and its final functional efficacy. However, when the ostium is not measurable at the time of 2-month stent removal, all patients experienced a relapse of epiphora or dacryocystitis within 6 months., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Introduction: The goal of this study was to assess the efficacy of transcanalicular diode laser assisted dacryocystorhinostomy (TDL-DCR) for the treatment of primary acquired nasolacrimal duct obstruction., Material and Methods: This was a single center retrospective study. We included all patients who underwent TDL-DCR between July 2015 and October 2017 for chronic epiphora or chronic dacryocystitis. All procedures were performed under local anesthesia with sedation. The anatomical and functional success rates were studied as a function of each operative indication., Results: Thirty-seven patients were included (18 had chronic epiphora and 19 had chronic dacryocystitis). All but one patient had bicanalicular silicone stent intubation. Irrigation of the lacrimal system demonstrated postoperative patency in 78% of patients operated for chronic epiphora and 76% of those with chronic dacryocystitis. The functional success of the surgery (as defined by the Munk score) was higher if the operative indication was chronic dacryocystitis (62%) (whereas it was only 41% for the indication of chronic epiphora)., Conclusion: TDL-DCR has a lower anatomical and functional success rate than those reported in the literature for external or endonasal dacryocystorhinostomy. However, it retains a place in the treatment of primary acquired nasolacrimal duct obstruction (in particular when it is complicated by chronic dacryocystitis), especially if there is an absolute or relative contraindication to the two other dacryocystorhinostomy techniques., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Objective: The objective of this study was to confirm that the standardized endonasal dacryocystorhinostomy (DCR) technique routinely performed in adults can be used in children., Materials and Methods: A consecutive series of children undergoing endonasal DCR between 2003 and 2017 was analysed. The surgical procedure consisted of: preoperative CT scan, anatomical localization of the ideal surgical zone, access to the nasal cavity via an optional planned enlargement, creation of a mucoperiosteal flap, osteotomy with rongeurs and equatorial resection of the medial wall of the lacrimal sac. This pediatric series was compared to a series of adult patients operated according to the same standardized technique., Results: A total of 20 DCRs (17 patients, with a mean age of 8 years (range: 4-16)) were included. Anatomical localization was effective in 100% of cases without the need for transillumination. With a mean follow-up of 4 years, the success rate was 95%, and no major complications were observed. Comparison with the same surgical technique in adults revealed similar results., Discussion: Our experience suggests that standardized endonasal DCR can be adapted to the nasal cavities of children. Anatomical localization is effective. The physiologically narrow nasal cavity does not constitute a major obstacle with the use of slightly smaller instruments. The results and complications are similar to those observed in adults., Conclusion: The same standardized endoscopic endonasal DCR surgical technique can be used in adults and children with a similar good success rate., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Introduction: The formation of a fistula between the lacrimal sac and the skin is a classic outcome of resistant lacrimal sac abscesses. There is currently no consensus about treatment in such cases. The goal of this study was to describe the natural history of acquired fistulas between the lacrimal sac and the skin, occurring before planned endonasal dacryocystorhinostomy (DCR) and without any treatment of the fistula., Materials and Methods: This prospective study was only descriptive and included patients between 1999 and 2012. The patients included were adults with a nasolacrimal duct (NLD) obstruction that was planned to be treated with endonasal DCR. A resistant lacrimal sac abscess appeared a few days before the planned surgery, and fistulized spontaneously despite medical treatment. The surgery was not delayed. The DCR was endoscopic. Nothing was done for the fistula. Its healing was spontaneous. The exclusion criteria were the following: congenital fistulas, post-traumatic and/or iatrogenic fistulas, fistulas which had regressed by the day of the surgery, postoperative follow-up less than 5 months, post-traumatic and/or iatrogenic fistulas, any history of previous DCR or any other lacrimal surgery, children., Results: Twenty adults (25 cases) were included in the analysis. Mean age was 79 years old (from 41 to 90). The mean follow-up was 41 months (from 5 to 108 months). The fistula spontaneously disappeared in all cases, less than one month after it had appeared and in a permanent fashion. No unsightly scar developed., Discussion: Spontaneously acquired fistulas between the lacrimal sac and the skin may occur in the natural course of abscessed acute dacryocystitis. Our study showed spontaneous healing of the fistula post-endoscopic DCR., Conclusion: Fistula excision in fistulous acute dacryocystitis does not seem essential to its healing. The laisser-faire approach appears adequate for aesthetic outcomes as well as for functional outcomes of DCR., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Purpose: To report a case of anterior ethmoid mucocele with atypical location and ophthalmic symptomatology., Case Report: A 18-year-old patient presented with epiphora and swelling of the left medial canthus; craniofacial scan revealed an ethmoid mucocele. We describe a surgical technique for the treatment of mucoceles, illustrated with CT and endoscopy images., Conclusion: Mucoceles present with various clinical and radiological manifestations, and in particular may have an ophthalmologic impact. Treatment is surgical, with various techniques available. Epiphora may be an unusual presentation of an ethmoid mucocele, due to lacrimal duct compression., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)