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Tear fluid drains into the lacrimal passage after making preoccular tear film. Obstruction of the lacrimal passage induces epiphora. Most lacrimal passage obstructions are healed by porbing, direct silicone intubation and dacryocystorhinostomy and their combinations. The lacrimal passage consists of the upper and lower puncta, upper and lower canaliculi, common canaliculus, lacrimal sac and the nasolacrimal duct, which drains into the inferior nasal meatus. Therefore, it is necessary to see the opening of the nasolacrimal duct using an endoscope, inserting it into the inferior nasal meatus when performing the probing and/or direct silicone intubation. Oberbation of the rhinostomy using an endoscope is important for dacryocystorhinostomy. Also a necessity is irrigation, using endoscope not only for the examination during operation but also for the postoperative examination and treatment.

While various techniques have been proposed for the treatment of dry eye, there have been no studies published evaluating the efficacy of the following wet gauze eye mask (WGEM) treatment of dry eye. One or two gauze mask(s) (9 x 12 cm) wetted with tap water and wrung were placed over both eyes during sleep. The treatment was performed on 30 patients with dry eye. Of these, 22 performed the treatment actively. In 14 (63.6%) out of the 22 patients, dry-eye symptoms were eliminated by the WGEM all day or until the evening. Of these 14, 7 were freed from eye drop treatment by the WGEM procedure. The WGEM treatment is safe, effective, simple and economical, and can be performed by the patients themselves. Moisture aid by the WGEM and/or a humidifier should be performed before resorting to punctal-plug insertion which may induce canalicular obstruction.

The author reports a new bicanalicular intubation method using a Nunchaku-style silicone tubing (n-st) which consists of three pieces. One piece is the thinner central segment, and the other two are thicker bilateral segments. In the new method, there is no difficult procedure of retrieving the tip of a metal probe from the nasal cavity. The n-st requires no suture to secure it in position. The author believes the n-st makes bicanalicular intubation easier and leads to more frequent use, and results in a reduced number of major surgical interventions.

Mesoscopic structures of the lacrimal drainage pathway were observed under an operating microscope in six cases of 5 adult cadavers. In all these cases the upper and lower canaliculi fused to form the common canaliculus. Two cases with a large common canaliculus showed large projections of mucosa which reduced the inner space of the common canaliculus. The remaining 4 cases with a small common canaliculus did not show any projections. These findings indicate that the human lacrimal system can function physiologically through a small narrow space of the common canaliculus.

OBJECTIVE. The purpose of this study was to evaluate the clinical performance of newly implemented dynamic MR dacryocystography.CONCLUSION. Dynamic MR dacryocystography, which requires neither ionizing radiation nor chemical contrast media with high viscosity, may be a useful tool for depicting nasolacrimal obstructions.

The special silicone tube (50-120 mm in length) consists of three pieces. One piece is the thinner central segment [20-40 mm long, 0.64 mm outer diameter (OD), 0.30 mm inner diameter (ID)], and the other two are thicker bilateral segments (10-50 mm long, 0.94 mm OD, 0.51 mm ID). Both ends of the three-piece silicone tubing (TPST) were sealed by the silastic medical adhesive with or without the silicone rod (2 mm long, 0.5 mm diameter) and diagonally cut to taper the end. To push the TPST from the upper and lower puncta into the lacrimal passage, a thin metal probe (0.4-0.6 mm diameter) was inserted into both sides of the tube through a small cut. In this new technique, there is no difficult procedure of retrieving the tip of a metal probe from the nasal cavity. The TPST requires no suture to secure it in position. The success rates were 63.6% (7/11), 100% (5/5) and 50% (1/2) for nasolacrimal-duct obstruction, canalicular obstruction, and canalicular and nasolacrimal-duct obstructions, respectively (follow-up: 3.4-12 months, mean 5.3 months).

To understand better the regional anatomy of the bony nasal window in dacryocystorhinostomy (DCR), anatomical dissections were performed on 28 cadaver specimens with an average age of 80.1 years. The distance between the point which is located 10 mm posterior to the medial canthus and the anterior cranial fossa floor was measured. The distance ranged from 1 to 30 mm with an average of 8.3 mm. There was no difference between males and females. Six cadavers out of 28 (21.4%) showed 3 mm or less in the distance. When a chisel was inserted through the medial canthus, the tip appeared near the anterior cranial fossa floor in cases with a short distance and a small frontal sinus but not in cases with a long distance and a large frontal sinus. It is obvious that, if a posterior nasal window is enlarged more than 3 mm above the medial palpebral tendon, a bony opening will be formed in the anterior cranial fossa floor in these 6 cases, resulting in cerebrospinal fluid leakage. In conclusion DCR should be done without severing the medial palpebral tendon to make a bony nasal window under the tendon.

I have already reported the development of a method for measuring tear volume using a cotton thread (No. 82/3, about 0.2 mm in diameter). While this previous testing method proved useful, both in the diagnosis of lacrimal deficiencies, and in cases of slight to medium epiphora, it could not accurately measure the high volume of lacrimation produced in cases of strong epiphora because of the low absorption capacity of the thread. To overcome this shortcoming, I have developed a new system which utilizes a cotton thread enclosed in a soft, calibrated, silicone tubing. In subsequent testing of this new technique, eyes that exhibited a strong epiphora state gave a wetted length of 226.9 +/- 56.0 mm (mean +/- SD) in a 5- to 10-second test. This compares with 41.0 +/- 8.9 mm in tests using thread alone in a 5- to 10-second test (p less than 0.001).

Fine cotton thread is used instead of the filter paper of the Schirmer test. One end stained with fluorescein is inserted into the lateral upper conjunctival sac for 5-30 seconds. The length of the soaked portion is measured in millimeters and the two eyes are compared with each other. One test consists of several consecutive measurements. This new method has many advantages over the conventional Schirmer test: (1) It takes less time (5-30 seconds, compared to Schirmer's method which takes five minutes); (2) It is less injurious to the eye than the stiff and rather large absorbing paper; (3) A diagnosis of lacrimal deficiency must be based on several consecutive measurements and the comparison between two eyes in each measurement (the lacrimation normally is very irregular in the same person). It is difficult to measure consecutively with filter paper; (4) The fine thread itself acts as a potent mechanical trigeminal stimulator and as absorbing agent; (5) The thread maintains a stable position in the eye, while the filter paper which hangs on the lower lid sometimes shifts out of place; (6) The fluorescein dye disappearance and dilution tests can be performed simultaneously; (7) This method can be applied to children.