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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.

ZusammenfassungHintergrund Die Rekanalisierung und bikanalikuläre Schienung der Tränenwege mit Silikonschlauch stellt bei erworbenen Tränenwegsstenosen eine Therapieoption dar, nach der häufig Restenosierungen beobachtet werden. Ziel war die Analyse des Therapieerfolges der Oggel-Sonden-Implantation nach Tränenwegsspülung und -sondierung, Erfassung weiterer Beschwerdemerkmale sowie ein Literaturvergleich.Patienten/Material und Methodik Die retrospektive Datenerhebung erfolgte mithilfe von Patientenakten sowie Fragebogen an Patienten und deren behandelnde Augenfachärzte, in denen die subjektive Beschwerdefreiheit sowie weitere Beschwerdemerkmale zu 3 Zeitpunkten nach Oggel-Sonden-Explantation eruiert wurden: unmittelbar, nach 1 Monat und 1 Jahr. Eingeschlossen wurden 82 durchgeführte Eingriffe an der Augenklinik des Universitätsklinikums Ulm zwischen 2006 und 2015. Der Einfluss von Risikofaktoren auf den Therapieerfolg wurde statistisch mittels logistischer Regressionsanalyse und Mann-Whitney-U-Test bestimmt. Ein Untergruppenvergleich wurde mit dem Pearson-Chi-Quadrat-Test und dem Exakten Fisher-Test auf signifikante Unterschiede sowie mit einer Kaplan-Meier-Analyse determiniert.Ergebnisse Direkt nach Oggel-Sonden-Explantation lag die Beschwerdefreiheit bei 80,8%, nach 1 Monat sank sie auf 61,6% und nach 1 Jahr betrug sie 42,5% im Patientenkollektiv (n = 82). Es zeigten sich keine signifikanten Unterschiede bez. Stenoselokalisation, Patientenalter oder Geschlecht. Ebenso konnte kein signifikanter Einfluss des Patientenalters, der präoperativen Beschwerdedauer sowie von Risikofaktoren, die für Tränenwegsstenosen prädisponieren, nachgewiesen werden. Eine Kaplan-Meier-Analyse lieferte für den Zeitraum eines Jahres eine Wahrscheinlichkeit der Beschwerdefreiheit von 52,2% für das Patientenkollektiv sowie eine mittlere Dauer der Beschwerdefreiheit von 34,2 Wochen.Schlussfolgerung Die Ergebnisse ermöglichen eine prognostische Einschätzung des Therapieerfolges bei fehlenden signifikanten Unterschieden in den Untergruppen. Der Therapieerfolg nach Oggel-Sonden-Implantation lag im unteren Drittel vergleichbarer Studien. Die Ergebnisse des zeitlich progredient abnehmenden Therapieerfolges bestätigen die Beobachtungen anderer Studien. Der Literaturvergleich gestaltete sich methodisch erschwert aufgrund abweichender Studienmerkmale, für zukünftige Studien wäre eine Vereinheitlichung sinnvoll.

The purpose of this study was to evaluate the correlation between the lacrimal syringing test (LST) and dacryoscintigraphy (DSG) in patients with epiphora. The authors retrospectively reviewed the clinical records of patients who underwent both LST and DSG from March 2016 to February 2018. From this, 636 eyes of 336 patients with a mean age of 61.20 ± 11.93 years (range, 22-86 years) were included. The concordance rate between LST and DSG was 43.7% (278 eyes). The sensitivity of DSG was 68.78%, and specificity was 30.99%. Factors of age and sex were analyzed in terms of concordance. The authors categorized age into 2 groups of younger and older than 65 years. Only sex was found to affect the results, with a much higher concordance rate in the female group than the male group. The lack of correlation between the tests indicates that the LST and DSG methods are complementary to each other. There is no single reliable method for testing patency of the lacrimal drainage system. Therefore, physicians should refer to these tests as complementary in a clinic setting.

Chronic dacryocystitis is a chronic infection of the lacrimal sac. In chronic dacryocystitis, there is obstruction of the nasolacrimal duct at the junction of lacrimal sac followed by stasis in the lacrimal sac, causing watering and discharge from the eye. In the present case report, a 24-year-old female patient suffered from this disease. She presented with the chief complaints of watering from both eyes for 6 months and mild swelling and pain over the lacrimal sac area in both eyes for 5 days. She was treated with Triphala Guggulu and Triphaladi Netra Parisheka, along with Mardana in lacrimal sac area for 1 month. After 1 month of treatment, the patient got relief from all the complaints. In lacrimal syringing, there was no any obstruction or regurgitation found. On analysis of all the data, it can be concluded that Ayurvedic management with Triphaladi Netra Parisheka and T. Guggulu along with Mardana in the lacrimal sac area offers effective result in the treatment of chronic dacryocystitis.

Background/Context: Probing is a simple operative procedure, can be performed easily in adults under local anesthesia, and is associated with minimal postoperative morbidity. The study aimed to determine the efficacy of probing in adults with epiphora due to common canalicular block (CCB) and nasolacrimal duct obstruction (NLDO). Materials and Methods: A prospective, interventional study was conducted on 44 patients with epiphora. Probing was done through upper and lower canaliculus under local anesthesia in all patients with epiphora due to CCB and NLDO. Probing was considered successful if the epiphora had been resolved or reduced to an acceptable level and if the lacrimal system was patent on lacrimal syringing for 6 months. Results: Patients comprised 36 women and eight men with the age group between 25 and 80 years who had epiphora for 3–24 months. Twenty-six patients had common CCB and 18 had complete NLDO. Complete patency was achieved in 12 and 5 and partial patency in 9 and 6 patients with CCB and NLDO, respectively. Treatment was successful in 72.72% of the patients. Ten patients underwent uneventful cataract surgery and 12 failed cases needed dacryocystectomy. Conclusion: Since probing is a simple, quick, cost-effective, and daycare procedure with low morbidity and obviates the need for further nasolacrimal surgery, probing can be recommended as an initial treatment in adults with epiphora.

Introduction: Congenital nasolacrimal duct obstruction (CNLDO) is the most common abnormality of the lacrimal system in the early years of life. Aims and Objectives: To rationalize the applicability of lacrimal syringing alone in comparison to combined lacrimal probing and syringing for the treatment of congenital nasolacrimal duct obstruction in children. Material and Methods: The study was conducted on fifty patients suffering from congenital nasolacrimal duct obstruction randomly selected from the outpatient department of Regional Institute of Ophthalmology, Government Medical College, Amritsar. Results: Majority of cases could be cured by single attempt of combined probing and syringing and cure rate could be enhanced by repeated attempts within 1st two years of life. Conclusion: The overall assessment of the study indicates that although the success rate of gentle lacrimal syringing alone is low yet it is worthwhile to try this least traumatic procedure in each and every child reporting with congenital nasolacrimal duct obstruction under 1 year of age. If lacrimal syringing as a first hand procedure fails, then lacrimal probing along with syringing should preferentially be attempted and may be repeated 2-3 times at a minimum interval of 2 weeks each till the patency of nasolacrimal duct is restored.

Purpose To evaluate the relationship between tear meniscus height (TMH) values measured by optical coherence tomography (OCT) and the severity of epiphora (Munk scoring). Methods In this prospective cross-sectional study, consecutive patients with epiphora were studied. All patients underwent Munk epiphora scoring, lacrimal syringing, and detailed ophthalmological examination. Using OCT, the TMH (i.e., the line intersecting level of tear meniscus and lower eyelid) values were calculated. The relationship between TMH and epiphora was analyzed by comparing TMH values across various grades of epiphora using Kruskal-Wallis test. Results A total of 38 patients (56 eyes) were included. The mean age was 55 ± 11.1 years with equal distribution of males and females. The mean TMH values were 238 ± 141.3, 396.6 ± 159.5, 707.1 ± 288.8, and 809.5 ± 419.4 μm in grades 1, 2, 3, and 4 of epiphora, respectively. A significant difference in TMH was found among grades 2, 3, and 4 (P = 0.0007). On post hoc analysis, only grade 2 was significantly different from grades 3 and 4 (P = 0.0008 and P = 0.002 respectively), but grades 3 and 4 were comparable (P = 0.62). Conclusion Levels of TMH were found to increase with increasing severity of epiphora. TMH values were comparable in Munk grades 3 and 4.

Lacrimal surgery aims to provide a low-resistance tear drainage passage. An assessment of lacrimal resistance guides decisions on surgery. We present results of a modified tear duct irrigation system that reliably measures lacrimal outflow resistance. Patients in a specialist lacrimal clinic had a full work-up to the point of tear duct syringing. The tear ducts were irrigated using a manometric system, which applied a fixed, known head of fluid pressure to a lacrimal cannula. Fluid flow is recorded and the lacrimal resistance derived as fluid pressure/fluid flow (units cmH20 secml-1, for simplicity presented as drops per minute, dpm). Patient groups were: A: Asymptomatic, A1: subgroup where the fellow symptomatic eye had a visible cause for watering, B: external visible cause for watering (ocular surface/lid/punctum), C: no externally visible cause, D: post op DCR, E: post syringing and probing, F: mixed/other. 444 tear ducts were examined. Mean flows (dpm) were: A1 (n = 19) 55; B (n = 183) 46; C (n = 142) 22: D (n = 38) 52. Excluding complete obstruction (n = 29), tear duct syringing only detected 48% of those with impaired manometric flow. Of those with a normal tear duct syringing, 53% had impaired manometric flow; 34% had a flow of 0 dpm. Differences in A1 versus C; B versus C and pre versus post dacryocystorhinostomy were all statistically significant (p0.05). The manometric system presented reliably measures lacrimal resistance and provides a substantial increase in sensitivity and specificity over conventional lacrimal syringing.

Background: Endoscopic endonasal dacryocystorhinostomy (EN DCR) has now become a procedure of choice for nasolacrimal duct obstruction or in chronic dacryocystitis. Lots of debate is still going on regarding stent placement following surgery. The purpose of this study is to analyse the subjective and objective success following EN DCR with stents.Methods: In this single centre study, 30 patients underwent EN DCR surgery from May 2011 to March 2013, out of those 20 eligible patients with 26 nasolacrimal duct obstructions underwent EN DCR with stents, and they were included in the study. Success rates were determined with subjective assessment of the patient symptoms and objective evaluation by lacrimal syringing. Results: 80.7% patients underwent primary surgery and 19.2% patient’s revision surgery, overall success rates was 88.4% out of which 95.2% success rate for primary surgery and 60% success rates of revision surgery. 11.5% of patients complained of persistent symptoms and success rate of ENDCR with stents was observed in 95.2% of patients after primary surgery and in 60% of patient’s after revision surgery. Stent removal was done on 4-6 weeks (mean duration- 5 weeks) and patients follow up time was 6 months.Conclusions: Whether to stent or to not still remain a topic of debate in EN DCR surgery, however ENDCR with stents represents the procedure of choice for treating nasolacrimal duct obstructions.

Aims and objectives: To compare the outcome of dacryocystorhinostomy surgery with and without the intraoperative use of Mitomycin C. Methods: Our study is a prospective comparative case study in which 50 patients of primary acquired nasolacrimal duct obstruction were divided on the basis of random sampling into the conventional dacryocystorhinostomy group and the Mitomycin C group in which Mitomycin C 0.2 mg/ml was used intraoperatively. Patients were followed on 1st postoperative day, 1st, 3rd, 6th weeks, 3rd and 6th months. Patient symptoms and satisfaction were noted. Patency of lacrimal passage was assessed by lacrimal syringing and tear meniscus height was recorded on each follow-up. Results: At the end of 6 months of follow-up, 96% of patients were asymptomatic in the Mitomycin C group whereas 80% patients in the conventional group were asymptomatic. On lacrimal syringing 24 (96%) eyes had patent passage in the Mitomycin C group where as only 1 (4%) patient had complete block with regurgitation of mucopurulent fluid. In the conventional group 20 (80%) eyes had patent passage, 4 (16%) eyes had complete block with regurgitation of mucopurulent fluid and 1 (4%) eye had partially patent passage on lacrimal syringing. Out of 25 eyes, 24 had normal tear meniscus height, and 1 had high tear meniscus height in the Mitomycin C group in comparison to the conventional group in which out of 25 eyes 20 eyes had normal, 1 had moderate and 4 eyes had high tear meniscus height. Intraoperative and postoperative complications in both the groups were identical. Conclusion: Although the difference between the two groups was not statistically significant, a distinctly higher success was achieved in patients undergoing dacryocystorhinostomy with intra operative Mitomycin C as compared to conventional dacryocystorhinostomy. Keywords: Dacryocystorhinostomy, Mitomycin C, Lacrimal syringing

Background: The purpose of our study was to evaluate outcome of Endoscopic dacryocystorhinostomy without preservation of mucosal flap for the management of acquired nasolacrimal duct obstruction Methods: A retrospective review of 26 patients were performed on patients who underwent Endoscopic dacryocystorhinostomy without preservation of mucosal flap from March 2007 to November 2010 at our hospital. Twenty six patients were operated and followed up postoperatively for five to six weeks with lacrimal syringing by ophthalmologists and diagnostic endoscopy done at third month and followed up until the formation of well formed ostium and patients became asymptomatic. Main outcome were subjective improvement in epiphora and persistence of anatomic patency of ostium. Result: There were 26 patients operated, one is male and all others were female. The age of patients were ranging within 20 to 78 years (mean 36.65years).Every patients were followed up in the range of four months to two years (mean 6.2 months). Septoplasty was required in only one patient prior to DCR. Anatomic patency were confirmed by nasal endoscopy in twenty four patients (92%), remaining two had synechiae without ostium. One patient among 24 patients had ostium and lacrimal flow with intermittent epiphora. Our overall success rate with anatomical patency and without symptoms of epiphora is 88%. Conclusion: Our results with endoscopic dacryocystorhinostomy are comparable with previously published outcomes. Our data suggest that endoscopic dacryocystorhinostomy without preservation of mucosal flap may be performed DOI: http://dx.doi.org/10.3329/bjo.v19i1.11728 Bangladesh J Otorhinolaryngol 2013; 19(1): 41-45

Objective To evaluate the effect of voluntary blinking and use of diluted fluorescein dye on fluorescein dye disappearance test (FDDT) in terms of diagnostic ability and test time. Design Prospective, nonrandomized case series. Participants Thirty-nine patients who visited Hadong Seoul Eye Clinic between April 2009 and September 2009. Methods All participants underwent FDDT and a lacrimal syringing test, and were divided into 2 groups according to the lacrimal syringing test results. FDDT was performed using 3 protocols: conventional FDDT (2% FDDT), FDDT with voluntary blinking (2% FDDTb), and FDDT with voluntary blinking using diluted fluorescein (0.25% FDDTb). The results were assessed by comparing initial tear meniscus height and those at 5 (2% FDDT) or 3 minutes (2% FDDTb, 0.25% FDDTb) after dye instillation. Results were considered "normal" when the tear meniscus decreased to less than 50% of its initial height, and "delayed" when it decreased to≥50%. In cases with a normal result, a half-period of dye disappearance was also recorded. Results Regarding diagnostic ability, the 0.25% FDDTb test had highest sensitivity and specificity among 3 protocols (100% and 80%, respectively). The half-period of dye disappearance was 3.17±1.72 minutes for 2% FDDT, 1.82±0.64 minutes for 2% FDDTb, and 1.04±0.69 minutes for 0.25% FDDTb, and showed significant difference among 3 tests ( P = 0.001). Conclusions The FDDT with voluntary blinking using 0.25% fluorescein had comparable diagnostic ability with the conventional FDDT, and allowed the test time to be significantly reduced.

External dacryocystorhinostomy (DCR) is the gold standard surgical technique for the treatment of primary acquired nasolacrimal duct obstruction (PANDO). However, new techniques such as endoscopic DCR and transcanalicular dacryocystorhinostomy (T-DCR) are being studied in an attempt to reduce surgical time, avoid external scarring and preserve the lacrimal pump while achieving the same efficacy. The purpose of this study was to compare the efficacy between conventional T-DCR and modified transcanalicular dacryocystorhinostomy (MT-DCR) in patients with PANDO. MT-DCR is performed to remove nasal mucosa prior to laser osteotomy. This is a comparative, prospective, interventionist and randomized study. Patients with PANDO were selected to undergo MT-DCR or T-DCR by blocked randomization. PANDO was diagnosed based on clinical presentation, dye disappearance test and dacryocystography. All of the procedures were performed by the same surgery team members. Anatomical success outcome was defined as positive lacrimal syringing and functional success outcome was defined as the absence or improvement of epiphora. A total of 44 surgical procedures were performed (22 MT-DCR and 22 T-DCR). In the case of MT-DCR, the anatomical and functional success rates after 12 months were 90 and 86%, respectively. After T-DCR, these rates were 77 and 72%, respectively (p = 0.162). MT-DCR and T-DCR are both safe and fast procedures with low morbidity and well-tolerated.

Purpose To assess the value of an abnormal fluorescein dye disappearance test (FDDT), lacrimal syringing, and Jones test for patients with epiphora who are clinically patent to syringing. Methods Prospective cohort study of 68 consecutive patients with epiphora who were clinically patent to syringing and otherwise normal to examination. Patients were assessed using FDDT and lacrimal syringing, as well as the Jones test comparing either single- or multiple-drop technique. FDDT and canalicular reflux on lacrimal syringing were subjectively graded. Results Success was defined as nil or only mild epiphora after surgery. Surgery was performed on 68 patients with a successful result in 64 (94%). The majority of these patients had severely delayed FDDT (90%), > or = 50% reflux on lacrimal syringing (78%), or were Jones I negative (81%). There was no significant difference between outcomes of the single- and multiple-drop tests. In patients examined with the single-drop Jones test, patients with a Jones I negative result had a statistically significant better surgical outcome (p = 0.04). This comparison was highly significant when the subgroup of patients with severely delayed/nonclearing FDDT and > or = 50% reflux was examined (p = 0.005). The results were not significant for the multiple-drop group. Conclusions These findings show that a negative single-drop Jones I test is predictive of symptomatic improvement after dacryocystorhinostomy surgery in patients with epiphora who are clinically patent to syringing. Lacrimal syringing and the FDDT, on their own, were not predictive of surgical outcome. Jones testing was of significant value in patients, but only when the traditional single-drop test was used.

AIM: To evaluate the efficacy of Fluorescein Dye Disappearance Test in the Diagnosis of Lacrimal System Outflow Obstruction in comparison to Lacrimal Syringing . SETTING AND DESIGN: Prospective Non - randomized Non - interventional Case Series of 1000 eyes of 500 patients at a Tertiary Eye Care Hospital in South India over 6 months from June 2013 to November 2013. METHODS AND MATERIALS: Out - patient and inpatients posted for cataract surge ry including those with complaints of epiphora were subjected to a Fluorescein Dye Disappearance Test (FDDT) followed by a Regurgitation on Pressure over the Lacrimal Sac Area (ROPLAS Test) and Lacrimal Syringing. The FDDT grade (Zappia and Milder Classifi cation) and ROPLAS and lacrimal syringing results of each eye were recorded and tabulated and results compared to determine the efficacy of Fluorescein Dye Disappearance Test. RESULTS: Mean age of the patients included in our study was 59. 6 years (SD±14.3 years). History of e piphora was present in 272 (27. 2%) of 1000 eyes in our study. ROPLAS was positive in 19(7%) of the 272 eyes with epiphora. Lacrimal syringing demonstra ted a patent system in 904 (90. 4%) of 1000 eyes. Sensitivity and Specificity of FDDT in the detection of lacrimal outflow system obstruction in our study was calculated to be 100% and 86. 62% (p value

Objective To evaluate the incidence and associated factors of functional failure of anatomically patent external dacryocystorhinostomy (DCR). Design Prospective, nonrandomized case series. Participants Thirty-four consecutive patients who underwent external DCR at the oculoplasty clinic in the Department of Ophthalmology, Seoul National University Hospital between December 2008 and July 2009. Methods All patients underwent external DCR for primary acquired nasolacrimal duct obstruction. The silicone tubes were removed around 6 months after the DCRs, and patients were examined 1 month after tube removal. Anatomical patency was evaluated by a nasal endoscopic dye test and lacrimal syringing test. Tearing symptoms were evaluated using Munk’s scoring system. Patients were divided into 2 groups according to the presence of epiphora symptom; a functional success and functional failure group, and the incidence of functional failure were calculated. Potential associated factors were also compared between 2 groups. Results This study involved 50 eyes of 34 patients, and 8 eyes of 6 patients showed significant epiphora in spite of anatomical patency (16% functional failure). We compared associated factors between 42 functionally successful and 8 functionally failed DCRs. Among variables studied, demographic factors and intraoperative surgical findings were not statistically different between the 2 groups. With respect to intranasal endoscopic findings, the shape of the rhinostomy showed significant differences between the 2 groups (p = 0.03, Fisher’s exact test). In the functional failure group, there were no flat shape rhinostomies. Three showed alcove shape rhinostomies, and the other 5 showed cavern shape rhinostomies. Conclusions Among anatomically patent DCRs, the incidence of persistent epiphora was 16%. The shape of rhinostomy is a possible associated factor for functional failure after external DCR.

In a prospective observational study, the sensitivity and specificity of an epiphora score, in predicting a patent sac washout following dacryocystorhinostomy are determined. Patients were examined in a joint otolaryngology/ophthalmology clinic for lacrimal syringing and nasal endoscopy. They completed a 0-10 visual analogue score to grade post operative symptoms. We conclude that due to the high specificity and low sensitivity of the score it is not a good predictor of patency following surgery and therefore no substitute for examining the patient.

Purpose: To examine the results of minimal stitch on the restoration of tissue after canalicular laceration. Methods: We have operated using sutures of tissues around canalicular laceration by inserting bicanalicular silicone stents and minimal horizontal mattress sutures with 8-0 Vicryl in cases of canalicular laceration instead of the existing method for the past 6 years. The ages of patients ranged from 2 to 76 years (average age 39.8 ±17.4 years), with most patients in their thirties (12 patients, 40%), 30 cases underwent canalicular repair with minimal stitch and bicanalicular silicone stent insertion within 24 hours after trauma. The silicone stent was removed 3 months after the operation if the patient did not complain of epiphroa while the canalicular remained open. Results: Twenty-five eyes (83.3%) showed symptom improvement and good passage in lacrimal syringing test in 4～12 months (average: 6.8±2.2 months) of follow-up study. Complications included one case each of fistula formation, stent prolapse, and wound infection, and two cases of canalicular stenosis. Conclusions: We recommend this method because of its satisfying success ratio.