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Purpose: To assess whether the duration of disease may influence the surgical success of Endonasal Endoscopic DCR (EE-DCR) in patients affected by nasolacrimal duct obstruction (NLDO). Methods: Single-center observational retrospective analysis on EE-DCR via posterior trans-ethmoidal approach. Consecutive patients were enrolled in 2021–2024 and evaluated with proper questionnaires; resolution of epiphora and dacryocystitis were analyzed after 1 (T1) and 6-months (T2) from surgery. Surgical success was defined as anatomical (patency at irrigation, no recurring dacryocystitis) or complete (zeroing of Munk score). Also, patients were asked to complete the Hospital Anxiety and Depression Scale (HADS) at each timepoint. The sample was divided based on the duration of disease (group A: ≤ 24 months, group B: > 24 months). Results: Ninety-one patients were included. At baseline no differences were observed between the two groups. At both timepoints, Munk score was significantly lower in Group A compared to Group B, while a difference in dacryocystitis rate was observed only at T2. Anxiety scores differed significantly at T2, although no differences were observed for depression. At paired analysis, all groups improved significantly at T1 compared to baseline, whereas no further improvement was observed between T2 and T1. A significantly higher improvement was observed in group A for the Munk and HADS-A scores over timepoints, whereas there was no significance for dacryocystitis rate and HADS-D. Also, group A showed a higher complete success rate compared to group B (p = 0.041). Finally, linear regression confirmed a positive relationship between Munk and anxiety scores and the duration of disease at T2. Conclusions: Our findings showed that long-lasting NLDO symptoms may be associated with worse EE-DCR surgical outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To identify anatomical factors affecting the outcome of dcryocystorhinostomy (DCR). Methods: The study included the results of dacryocystography in 73 patients after DCR: 37 cases of failed DCR and 36 cases of successful DCR. Biometric characteristics of the formed ostium were evaluated: the horizontal size of the bony "window" and the soft tissue part of the ostium, the vertical size of the bony "window" and soft tissue ostium, the height of the fragment of the remaining bone above and below the line of the common canaliculus, and the height of the "pocket" formed below the lower edge of the ostium. Statistical analysis was performed using parametric and non-parametric statistical methods. Differences were considered significant at p ≤ 0.05. Results: Intergroup differences were identified in the values of the maximum horizontal size of the bony "window" (p = 0.015), the maximum horizontal size of the soft tissue "window" (p < 0.001), the maximum vertical size of the soft tissue "window" (p < 0.001), and the height of the fragment of the remaining bone below the level of the common canaliculus to the edge of the formed ostium (p = 0.004). Conclusion: The stage of forming the bony "window" influences the success of DCR. Not only the position of the "window" is important, but also the geometric properties of the formed ostium. [ABSTRACT FROM AUTHOR]

A 17 year old male patient presented with bilateral preauricular sinus, right sided second branchial cleft sinus and bilateral hearing deficit. He has previous history of right congenital cataract surgery and right dacryocystorhinostomy at the age of 8 year. He was operated for branchial sinus. No family history with similar complaint was observed. According to all these features this case was the variant of branchio-oto-renal spectrum disorder with de novo mutation. According to literature search this will be a unique and rare case report of BORSD published till date in India. [ABSTRACT FROM AUTHOR]

Background/Aims: Data regarding the effectiveness of prophylactic systemic antibiotics (PSA) in lacrimal surgery is scarce. Therefore, we determined the postoperative surgical site infection (SSI) rate in lacrimal surgery without PSA. Methods: We retrospectively analysed files of patients who underwent external (extDCR) or endoscopic endonasal dacryocystorhinostomy (endoDCR). We excluded patients with incomplete data (n = 68), acute a priori infection with the need for antibiotics (n = 15) and PSA post‐operatively for other reasons (n = 28). Indications for surgery were canalicular stenosis (n = 51, 18.6% endoDCR vs n = 131, 19.5% extDCR), nasolacrimal duct obstruction (n = 118, 43.2% endoDCR vs n = 480, 64.3% extDCR) and mucocele/chronic dacryocystitis (n = 52, 19.0% endoDCR vs n = 187, 25.0% extDCR). Results: In this study, 1020 DCR surgeries were performed in 899 patients. Postoperative SSI was diagnosed in eight patients (0.8%); exclusively after extDCR (1.1% of all extDCR). No SSIs were found in endoDCR cases. The prevalence between SSI in extDCR versus endoDCR did not prove significant (n = 8/747 0.8% vs n = 0/273 0%, p = 0.13). All patients diagnosed with SSI were successfully treated with systemic oral antibiotics. Conclusion: The prevalence of SSI after DCR is low and was effectively treated with oral antibiotics. In our study, SSI occurred rarely after extDCR and was not observed after endoDCR. We conclude that lacrimal surgery is safe without the routine administration of PSA. [ABSTRACT FROM AUTHOR]

Background: Paraffinoma is a rare and intriguing condition in medicine. In this disorder, an orbital lipogranulomatosis reaction is caused by the penetration of mineral oils (particularly paraffin) into the tissues surrounding the eye. Methods: In this report, we discuss six cases of paraffinoma affecting the eye socket following sinus surgery. For previous cases literature review, we obtained articles from searching in the PubMed, Scopus, Scholar Google and, Science of Web databases. Results: After the reporting of 6 paraffinoma cases and literature review, the data related to the disease were categorized into the categories of disease definition, differential diagnosis, clinical manifestation, radiological manifestation, and histopathological diagnosis and treatment methods. Conclusions: Paraffinoma is a rare and time-delayed diagnosis after various surgeries and therefore may challenge the physician to make the correct diagnosis at first. It is necessary for ophthalmologists to consider this diagnosis in cases of masses around the eyelid and orbit in patients with a history of sinus and nose surgery in other differential diagnoses. [ABSTRACT FROM AUTHOR]

Propose: This study aims to present long-term outcomes in a specific patient population experiencing epiphora due to low-level nasolacrimal duct obstruction (NLDO) following endonasal endoscopic nasolacrimal duct rhinostomy, and to propose a surgical selection paradigm for varying locations of NLDO. Methods: Between September 1, 2017 and February 28, 2023, a retrospective analysis was conducted on 26 patients diagnosed with primary acquired nasolacrimal duct obstruction (PANDO) who underwent endonasal endoscopic nasolacrimal duct rhinostomy for low-level NLDO (defined as obstruction below the plane of the superior border of the inferior turbinate attachment). The study assessed surgical success through objective measures of anatomical patency and subjective measures of functional patency during a postoperative follow-up period of at least six months. Additionally, any complications that arose during this follow-up period were documented. Results: The study included a cohort of 26 patients, consisting of 24 women and 2 men, with a mean age of 47.58 ± 3.09 years (range: 8–75). All patients underwent endoscopic nasolacrimal duct rhinostomy, with 10 eyes having previously undergone tear duct recanalization procedures. Anatomical patency was achieved in 88.5% (23/26) of cases, while functional patency was achieved in 80.8% (21/26) after an average follow-up period of 41.9 ± 22.1 months. No significant complications were observed in any of the patients during the follow-up period. Conclusion: Endonasal endoscopic nasolacrimal duct rhinostomy is effective in treating epiphora in over 80% of cases with low-level NLDO. Tailoring the surgery to the location of the obstruction can improve outcomes and minimize damage. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionsTo determine the risk factors impacting the surgical success of endonasal dacryocystorhinostomy (eDCR) in pediatric patients.This is a retrospective interventional case series of patients 18 years and younger treated over a 16-year period via eDCR for nasolacrimal duct obstruction (NLDO). Data were extracted on surgical outcomes, follow-up duration, and comorbidities (i.e. punctal agenesis, trisomy 21, dacryocystitis). Functional success was defined as the resolution of NLDO symptoms postoperatively.Of 356 cases in 281 patients (median age: 3.32 years), 78.9% of cases in 79.0% of patients achieved functional success after initial eDCR. The median follow-up duration without tearing symptoms as observed by an ophthalmologist and non-ophthalmology trained clinician was 11.0 months and 62.1 months, respectively. Patients with punctal agenesis and those requiring bilateral surgery had significantly higher rates of failure (p = .01; p < .001, respectively). Age at operation was not significantly associated with failure (p = .30). Excluding cases of trisomy 21 and punctal agenesis, functional success was achieved in 82.7% of 295 cases.Endonasal DCR is effective in resolving NLDO symptoms in pediatric patients, with success rates comparable to the adult population and to an external approach. Despite a higher reoperation rate in patients with trisomy 21 and punctal agenesis, trisomy 21 and age at operation were not significant risk factors for failure. [ABSTRACT FROM AUTHOR]

Dacryocystitis, inflammation and infection of the lacrimal sac, is most commonly caused by infection from Staphylococcus and Streptococcus species. This report highlights a rare case of chronic dacryocystitis due to the atypical pathogen Mycobacterium abscessus. A 62-year-old woman presented with several months of left medial canthal pain, tenderness, and discharge. Exam demonstrated a left tender medial nodule, and imaging showed left lacrimal sac dilation and fluid collection consistent with dacryocystitis. She underwent external dacryocystorhinostomy with drainage and culture of the abscess, which was positive for M. abscessus. Her post-surgical treatment required an extended course of antibiotics, including omadacycline and azithromycin, with slow but progressive symptomatic improvement. This case is only the second reported case of dacryocystitis due to M. abscessus and suggests a role for culturing lacrimal sac abscesses intraoperatively due to the need for extended antibiotic therapy for atypical infections that may have high antibiotic resistance. [ABSTRACT FROM AUTHOR]

The editorial delves into the history and development of oculoplastic surgery training in Europe, highlighting key figures and the establishment of training programs while addressing disparities in training standards across European countries. It emphasizes the importance of standardizing training requirements and raising awareness about oculoplastic surgery as a subspecialty. The article also explores the potential of artificial intelligence in improving patient care, surgical training, and clinical research, along with ethical considerations in AI and open access publishing. Francesco M. Quaranta-Leoni, the author, is an expert in ophthalmoplasty and orbital and adnexal services, affiliated with institutions in Italy. [Extracted from the article]

Background: The aim of our study was to determine the success of endoscopic endonasal dacryocystorhinostomy using powered instrument (microdebrider) and removing the nasal mucosal and posterior saccal flaps. Methodology: A prospective hospital based case study was conducted in patients attending ENT, Head & neck surgery department of Government Medical college hospital between April 2023 to April 2024 with complaint of epiphora including nasolacrimal duct obstruction. A total of 30 cases of epiphora secondary to nasolacrimal duct obstruction were operated using endoscopic endonasal DCR technique. Result: Complete resolution of epiphora was reported in 28 patients of the 30 procedures, (93.3% success rate) with patent ostia on syringing. None of the patients developed recurrence, 2 patients developed synechiae and mucosal overgrowth over the canalicular sight post operatively. There were no intra-operative or post-operative complications. Conclusion: The technique of endoscopic dacryocystorhinostomy with creation of wide bony ostium around the medial aspect of the lacrimal sac by drilling out the bony borders and removing mucosal and posterior saccal flaps with the help of powered instrument (microdebrider and drill) has shown good longterm results comparable with other studies. It also has the additional advantage of less granulation tissue formation, less chance of redundant flap obstructing the ostia and practically no synechiae formation. The technique is relatively easy with favourable outcome. [ABSTRACT FROM AUTHOR]

Dacryocystorhinostomy (DCR) stands as an essential surgical procedure for addressing the persistent challenge of dacryocystitis—a condition marked by inflammation of the lacrimal sac due to nasolacrimal duct obstruction. A hospital-based retrospective study was conducted in a tertiary care hospital, spanning the years 2018 to 2023, involving 34 patients who underwent Endoscopic Dacryocystorhinostomy. The study involved the examination of their clinical presentations, surgical techniques employed, and resulting outcomes along with causes of failure. Our study included 34 patients who had presented with persistent watering of eyes. The maximum number of cases was in the age group of 46–60 years (38%), with a minimum age of 7 years and a maximum age of 68 years. Among those 34 patients, 5 underwent a revision DCR. Fifteen patients underwent stenting. Thirteen of the fifteen patients, who underwent stenting came for regular postoperative follow up and stent removal was done 6 to 8 weeks later. The two patients who were lost to follow-up presented after 4 years of their initial surgery with persistent symptoms. The success rate of endoscopic DCR was 94% in our study. Endoscopic Dacryocystorhinostomy has emerged as a practical solution for addressing nasolacrimal duct obstruction. Despite numerous surgical modifications documented over time, the endoscopic DCR technique consistently demonstrates excellent outcomes with minimal patient morbidity. This study underscores the significance of thorough preoperative assessment, making informed decisions regarding stenting during both the preoperative and intraoperative period, employing proper surgical techniques, and recognizing the importance of regular post-operative follow-up. [ABSTRACT FROM AUTHOR]

Epiphora is an annoying symptom, embarrassing the patient both socially and functionally. The two widely accepted treatment modalities of epiphora resulting from obstruction of the nasolacrimal ductus are external and endoscopic dacryocystorhinostomy (DCR). To compare the outcome of endonasal endoscopic dacryocystorhinostomy with stent and without stent prospectively and to compare the outcome of endonasal endoscopic dacryocystorhinostomy with stent and without stent with external dacryocystorhinostomy retrospectively. This retrospective and prospective clinical interventional study was done in the Department of Otorhinolaryngology and Institute of Ophthalmology, Jawaharlal Nehru Medical College, A.M.U., Aligarh from July 2012 to September 2017. 110 patients of epiphora participated in the study and were divided into three groups: Group I: Endoscopic endonasal dacryocystorhinostomy with stent. Group II: Endoscopic endonasal dacryocystorhinostomy without stent. Group III: External dacryocystorhinostomy. Out of them 60 patients were for Endoscopic dacryocystorhinostomy (30 patients with stent and 30 patients without stent) and 50 patients were for External dacryocystorhinostomy. 71 (65%) were females while 39 (35%) were males (p < 0.05) with age ranging from ranging 8–60 years (mean 34.96 years) with predominance of symptoms in left eye (p < 0.01). A lower complication rate was observed in the endoscopic group, with minimal morbidity and shorter operative time compared with the external approach. Follow up was done at postoperative day 1st and 7th, at 2 weeks, 4 weeks and 3 months for assessing complications of operation, symptomatic relief of epiphora and syringing for anatomical patency. In our study, Success rate was 93.30% in Group I and 96.60% in Group II while 90% in group III. The avoidance of a cutaneous scar has been a strong impetus to further the success and improve outcomes of endonasal DCR. Endonasal DCR without stent has lesser incidence of post-operative fibrosis and higher patient's acceptance. [ABSTRACT FROM AUTHOR]

A bibliometric analysis concluded that the evaluation of post-operative outcomes of endoscopic dacryocystorhinostomy in Indonesia had yet to be done. Hence, this study aims to assess the postoperative outcomes of endoscopic dacryocystorhinostomy, focusing on ostium granulation, intranasal synechiae, membranous obstruction, and ostium stenosis after a three-month follow-up in our Indonesian center. A longitudinal study (2017–2023) at our Indonesian center included cases with a minimum of three-month follow-up. Nasal endoscopy assessed ostium granulation, intranasal synechiae, membranous obstruction, and ostium stenosis. 28 cases were successfully followed up for three months. At three months, ostium granulation was present in 42.9% of cases, membranous obstruction in 14.3% of cases, with no intranasal synechiae or ostium stenosis observed. Out of 28 cases, 13 were successfully followed for six months, revealing ostium granulation in 7.7%, membranous obstruction in 38.5%, and ostium stenosis in 23.1%. Ostium granulation predominates, followed by membranous obstruction at three-month follow-up. Ostium stenosis, a minimal occurrence, manifests after six months. [ABSTRACT FROM AUTHOR]

Pre-saccal obstructions of the lacrimal duct can be solved with a conjunctivodacryocystorhinostomy while saccal or post-saccal obstructions are restored with an external, endoscopic or laser dacryocystorhinostomy (DCR). The aim of the present study is to review the indications for each technique and to compare the results achieved. Retrospective review of 335 patients in whom 440 surgeries of the lacrimal duct were performed, with at least 4 months of follow-up. Outcomes in terms of symptoms and endoscopic findings during follow-up were considered. Successful results understood as resolution of symptoms were observed in 85% of cases treated with endoscopic DCR and in 62% of cases after laser DCR (p < 0.001). Among patients with recurrence of epiphora after surgery, 32% showed a visible ostium during endoscopy. Sixty-eight conjunctivodacryocystorhinostomies were performed, 68% of which required a tube replacement due to obstruction or extrusion. The mean duration of the tubes replaced was 10 months (range 3 days – 95 months). Endoscopic DCR shows better success rates than laser DCR. A considerable percentage of failures after DCR surgery present a visible ostium on endoscopic examination. This fact should lead to reconsider the initial diagnosis, ruling out functional problems or canalicular obstructions. [ABSTRACT FROM AUTHOR]

This article provides an overview of the historical contributions made by the Babylonians, Ancient Egyptians, Medieval Arabs, and Persians to the understanding and treatment of lacrimal drainage disorders. It highlights the Code of Hammurabi, which contains laws related to lacrimal sac abscesses, and the Ebers Papyrus, which documents treatments for lacrimal sac inflammations. The text also discusses the works of physicians like Al-Razi and Ibn-Sina, who made significant contributions to ophthalmology in the Middle Ages. It emphasizes the importance of understanding these ancient descriptions in their historical context and acknowledges that our understanding of lacrimal diseases has evolved over time. The author concludes by stating that there is still much to learn in this field. [Extracted from the article]

Purpose: Sinonasal mucoceles (SM) are benign, expansive neoformations which require surgical marsupialization to prevent severe complications. The present study reports the larger case history ever published: a 28-years expertise in the surgical management of SM. Methods: A retrospective study was conducted on patients surgically treated for SM at the Departments of Otorhinolaryngology of Varese and Pavia, between 1994 and 2022. Results: 398 patients were reported. An endoscopic endonasal marsupialization of SM was performed in 92,5% of cases. 7% of patients underwent a combined approach while 0,5% required an exclusive open surgery. The average follow-up after surgery was 10–60 months. SM overall recurrence was observed in 11,4% of cases. Conclusion: Endonasal endoscopic SM marsupialization is a feasible technique which allows the preservation of the anatomy and physiology avoiding the surgical invasiveness of the external approaches. The well-established surgical expertise in the endonasal endoscopy together with technological improvements widened the indication range of the exclusive endoscopic technique over the traditional open surgery. [ABSTRACT FROM AUTHOR]

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This is a rare case of a patient who developed a relapse of dacryocystitis and maxillary sinusitis although previous dacryocystectomy. We decided to perform an external dacryocystorhinostomy to remove the scar and the residual part of the lacrimal sac combined with endoscopic sinus surgery (ESS) to solve the symptoms. [ABSTRACT FROM AUTHOR]

Abstract Background Paraffinoma is a rare and intriguing condition in medicine. In this disorder, an orbital lipogranulomatosis reaction is caused by the penetration of mineral oils (particularly paraffin) into the tissues surrounding the eye. Methods In this report, we discuss six cases of paraffinoma affecting the eye socket following sinus surgery. For previous cases literature review, we obtained articles from searching in the PubMed, Scopus, Scholar Google and, Science of Web databases. Results After the reporting of 6 paraffinoma cases and literature review, the data related to the disease were categorized into the categories of disease definition, differential diagnosis, clinical manifestation, radiological manifestation, and histopathological diagnosis and treatment methods. Conclusions Paraffinoma is a rare and time-delayed diagnosis after various surgeries and therefore may challenge the physician to make the correct diagnosis at first. It is necessary for ophthalmologists to consider this diagnosis in cases of masses around the eyelid and orbit in patients with a history of sinus and nose surgery in other differential diagnoses.

AIM: To compare surgical outcomes between the conventional endoscopic dacryocystorhinostomy (DCR) and a modified endoscopic DCR for the treatment of nasolacrimal duct obstruction (NLDO), and evaluate factors associated with the surgical success rate. METHODS: Medical records of patients who underwent primary DCR surgery between January 2016 and July 2020 at the Otorhinolaryngology Department of Eye and Ear International Hospital, Lebanon were reviewed. RESULTS: The study group consisted of 50 consecutive modified endoscopic DCR and the control group consisted of 138 consecutive conventional endoscopic DCR. The success rates at 1y were 98.0% (49 out of 50) for modified DCR, significantly higher compared to 84.8% (117/138) for the conventional DCR; there was no significant difference in the success rate throughout the years in terms of both surgical techniques. The modified surgery vs traditional [adjusted odds ratio (aOR)=14.96] and having an adjunctive septoplasty surgery vs not (aOR=3.99) were significantly associated with higher odds of success. CONCLUSION: Mucosal flap preservation and apposition shows significant improvement in the surgical success rate. Moreover, there is no statistically significant difference found in terms of complication rate and mean operative time between the conventional and the modified techniques.

AIM: To report the clinical profile, endoscopic dacryocystorhinostomy (En-DCR) management, and acute dacryocystitis (AD) outcomes in China. METHODS: Clinical data of 554 adult AD patients (554 eyes) who presented in 7 tertiary eye care centers for 10y from Jan 2010 to Mar 2020 were retrospectively analyzed. Clinical profile, En-DCR management, and outcomes of all cases were recorded. The anatomical and functional success were evaluated for 12mo post-operation. RESULTS: The analysis included 149 males and 368 females with a median age of 55.2y (range: 18-84y). There were 459 eyes with a history of epiphora or purulent secretion. The time between a symptom of lacrimal duct obstruction and acute onset was 1 to 540 (66.1±58.2)mo. Fifty-nine eyes had a history of the previous acute attack. Seventy-four eyes developed a cutaneous fistula, while 11 eyes had post septal cellulitis pre-operation. En-DCR with an anatomical success of 91.7% and functional success of 90.1%. The success rate of the patients with a history of acute episodes and the preoperative fistula was lower than the overall success rates. CONCLUSION: En-DCR can be performed during an acute episode in AD with a success rate of over 90%.

Abstract Background To determine the paranasal changes and inflammatory markers that may cause primary acquired nasolacrimal duct obstruction (PANDO) and to determine their relationship with success rates on different types of surgeries. Main body We retrospectively reviewed the blood sample and computed tomography (CT) results on 92 patients who underwent dacryocystorhinostomy (DCR) surgery for PANDO and 82 healthy controls. Age, gender, paranasal abnormalities, hemogram values, International Normalized Ratio (INR) values, type of surgery, and recurrence rate were recorded; systemic Immune-inflammation Index (SII), neutrophil-to-lymphocyte ratio (NLR), monocytes-to- lymphocyte ratio (MLR) and platelet-to-lymphocyte ratio (PLR) were calculated in both groups. In the case group, total white blood cells, monocytes, and INR values were significantly lower (p 0.05). There was no significant difference in the CT results between the groups (p > 0.05). No correlation was found between CT findings and inflammatory markers. Dacryocystitis (DC) was seen in 20% of patients and they were all in the case group. No correlation was found between recurrence rate and age, gender, type of surgery, CT findings, and blood results (p > 0.05). The recurrence rate was significantly higher in patients with bilateral PANDO and with DC (p

AIM: To investigate the effects of placement of the absorbable packing material Nasopore around the anastomosis site on postoperative re-bleeding, discomfort, and on the success rate of endoscopic dacryocystorhinostomy(En-DCR).METHODS: Prospective randomized controlled study. A total of 101 patients(101 eyes)diagnosed with chronic dacryocystitis that underwent En-DCR in the ophthalmology department, Renmin Hospital, Hubei University of Medicine from November 2020 to October 2021 were collected. The patients were randomly divided into two groups according to whether they were packed with Nasopore at the end of operation, namely, the packed group(49 eyes)and the non-packed group(52 eyes). The postoperative follow-up was 9 mo, the degree of re-bleeding, discomfort, and postoperative success rate(including anatomical success rate and functional success rate)were compared between the two groups of patients.RESULTS: This study included 94 patients, including 45(45 eyes)and 49(49 eyes)in packed group and non-packed group, respectively. The En-DCR was performed successfully in all patients. Postoperative re-bleeding occurred in 1 eye(2%)in the packed group, and 9 eyes(18%)in the non-packed group(P0.05). The postoperative functional success rate was 89%(40/45)in the packed group and 86%(42/49)in the non-packed group(P>0.05). Other complications such as orbital fat prolapse, cerebrospinal fluid leakage, sinusitis, visual impairment and double vision were not observed in all patients during the follow-up.CONCLUSION: Nasal packing absorbable material Nasopore around the anastomosis at the end of En-DCR operation can reduce postoperative re-bleeding and postoperative discomfort of patients, and it has no obvious effect on the postoperative success rate.

AIM: To investigate the effect of a new type of rhinodacryocystostomy combined with fluticasone propionate on patients with chronic dacryocystitis.METHODS: A total of 100 patients(100 eyes)with chronic dacryocystitis who admitted to our hospital between January 2021 and December 2022 were enrolled in the prospective study. The patients in the study were divided into a control group(n=50)and an observation group(n=50)based on their admission order and number. Patients in the control group were treated with novel rhinodacryocystostomy, while patients in the observation group were treated with a new type of rhinodacryocystostomy combined with fluticasone propionate. The preoperative and postoperative best corrected visual acuity(BCVA), quality of life score, and recurrence of chronic dacryocystitis were compared between the two groups of patients.RESULTS: All patients completed the postoperative 6 mo follow-up, and the total effective rate of patients in the observation group was better than that of patients in the control group(98% vs 84%, P=0.001). There was no significant difference in preoperative and postoperative BCVA between the two groups(P>0.05). Preoperatively, there was no significant difference in the quality of life scores between the two groups of patients(P>0.05); At 6 mo postoperatively, the quality of life scores of patients in the control group, including physical function, psychological function, social function, and material life status, were lower than those in the observation group(all P

Abstract This study aimed to elucidate the regression process of ostium granulomas under the usage of intranasal steroid after primary endoscopic dacryocystorhinostomy (DCR). The authors retrospectively reviewed 57 patients (a total of 72 ostia) who had ostium granulomas after primary endoscopic DCR between 2011 and 2015. Topical intranasal steroid spray was applied in all the patients since postoperative day 1. Adjunctive intralesional triamcinolone acetonide injections were administered for extensive and large-sized granulomas that caused impending ostium blockage. Sequential regression of the ostium granulomas and success rates of DCR were assessed using endoscopic photos. The granulomas completely disappeared in 69 (95.8%) ostia, and the average time interval from the surgery to the disappearance was 6.9 ± 2.8 months. Anatomical and functional surgical success rates were 90.3% and 84.7%, respectively. Intralesional steroid injections for ostium granulomas did not alter the outcomes compared to topical intranasal steroid usage significantly (p = 0.445). In conclusion, we observed that, by continuing the usage of intranasal steroids, ostium granulomas disappear gradually at postoperative 6 months. The intranasal surgical manipulation of granulomas, which results in more mucosal cicatricial change and impedes patient satisfaction, can be successfully avoided.

PurposeMethodsResultsConclusionsThis study aimed to quantify the proportion of patients with bilateral epiphora and suspected nasolacrimal obstruction who self-reported improved epiphora bilaterally following unilateral dacryocystorhinostomy and investigate predictive factors.A retrospective cohort study of patients from an Australian lacrimal clinic was performed. Eligible patients were at least 18 years of age, complained of bilateral epiphora, underwent unilateral dacryocystorhinostomy between 2012 and 2022 and followed-up. Outcome groups were created by grouping self-reported epiphora improvement levels for each eye. Two-sided confidence intervals were calculated for the proportion of participants in each outcome group. Ordinal elastic net regression identified clinical features associated with outcome groups and estimated their effect sizes.Of 243 patients, the median post-operative follow-up duration was 3 months. Fifty-eight percent (95% CI 52–64%, n = 141) reported significant improvement (≥50% ipsilateral and any contralateral improvement), 5% (95% CI 3–9%, n = 13) reported small improvement (<50% ipsilateral and any contralateral improvement) and 26% (95% CI 20–31%, n = 62) reported ipsilateral improvement only. Eleven percent had functional or anatomical failure. Older age (OR 1.01), contralateral nasolacrimal duct narrowing (OR 1.37), contralateral nasolacrimal duct obstruction (OR 0.93) and longer follow-up time (OR 0.85) predicted outcome groups.After unilateral DCR, many patients with bilateral epiphora and suspected nasolacrimal obstruction report an improvement of their symptoms bilaterally in the early postoperative period. Contralateral nasolacrimal system diagnosis, patient age and follow-up duration were associated with outcomes. Further study using validated epiphora assessment tools may quantify this observation, and we suggest a potential underlying mechanism of contralateral effects after unilateral treatment. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionsTo compare the long-term outcomes of mucosal-sparing mechanical endoscopic dacryocystorhinostomy (MMED) for primary acquired nasolacrimal duct obstruction (PANDO) with or without silicone intubation.An 11-year follow-up study of the Silicone intubation in Endoscopic Dacryocystorhinostomy (SEND) randomized controlled trial (RCT) was conducted at a university-affiliated dacryology clinic from December 2019 to March 2023. Questionnaires on symptoms, anterior segment examination, endoscopic examination with functional endoscopic dye test (FEDT) and FICI grading, and ostial size measurements using Image J software were performed by a masked ophthalmologist. The primary outcome was surgical success, defined by Munk’s score ≤1 and a positive fluorescein endoscopic dye test. Secondary outcomes included risk factors for failure and outcomes of revision surgeries.Fifty-three of the original 118 patients were evaluated at 155 ± 21 (136–218) months postoperatively. Seventy-seven percent (46/60) ostia remained successful, including 70% (19/27) of unstented and 82% (27/33) of stented ostia (p = .3). Stented ostia had larger size (p = .003), but this did not confer higher success (p = .14). Successful ostia had higher FICI scores and better ostial dynamicity (p < .05). Ostium movement was the only parameter associated with surgical success on multivariate analysis (OR 13.1, p = .01). Four (1 stented) underwent revision MMED, intraoperative mitomycin-C, and 12-week intubation. All revision ostia were functional after 141 ± 43 months.Surgical success of MMED after 11-years was 77%, a notable reduction compared to 96% success at 1-year. Statistical advantage of silicone intubation for primary MMED was not demonstrated, though clinically, stented ostia had a higher success (82% vs 70%). The presence of a dynamic internal common opening was highly associated with long-term surgical success. [ABSTRACT FROM AUTHOR]

Background/Objectives: The aim of the study was to compare dacryocystectomy (DCT) versus dacryocystorhinostomy (DCR) in patients with dacryocystitis in terms of tearing complaints. Methods: We conducted a retrospective and comparative study on 19 patients. The main outcome measure was defined as an improvement by 1 point of the Munk score postoperatively. Results: A total of 19 patients were included with 10 in the DCR group and 9 in the DCT group. The primary endpoint was reached in 7 (70%) and in 6 (67%) patients in the DCR and DCT groups, respectively (p > 0.999). All DCR procedures were performed under general anesthesia (GA), while almost all DCT procedures were performed under local anesthesia (LA) (p < 0.001). There was a higher need for hospitalization in the DCR group (p < 0.001). Conclusions: Our preliminary results indicate that DCR is not always the solution in the case of dacryocystitis. DCT is a viable surgical procedure, especially in elderly patients without any tearing complaint and with underlying dry eye disease. [ABSTRACT FROM AUTHOR]

Laser dacryocystorhinostomy (LDCR) is a surgical procedure designed to treat obstructions in the lacrimal duct system, which can cause excessive tearing, infections, and discomfort. This technique involves creating a new passage for tear drainage, thereby restoring normal tear flow and alleviating symptoms associated with duct obstruction. A retrospective study was conducted on 48 patients who underwent the LDCR procedure, amounting to 56 eyes. The primary outcome measured was the anatomical success rate, defined as the restoration of duct patency. Patients were examined postoperatively from 6 months to 3.5 years. The LDCR method demonstrated a 95% success rate, encompassing both anatomical and functional outcomes. The procedure's effectiveness was determined by achieving a patent osteotomy and resolving symptoms. Anatomical success was measured by the creation of a viable drainage pathway, while functional success pertained to the resolution of symptoms such as epiphora. The efficacy of the procedure was found to be independent of both age and gender. Among patients with successful anatomical outcomes, there was a statistically significant improvement in their Munk scores. The LDCR method is highly effective in treating lacrimal duct obstruction. These findings highlight the importance of the Munk score as a predictive indicator of procedural success in LDCR. [ABSTRACT FROM AUTHOR]

Background: Utilizing expanded endoscopic approaches to the maxillary sinus for the endonasal management of a variety of tumors is increasing in popularity. The nasolacrimal duct (NLD) may be injured inadvertantly or need to be removed during tumor resection or to augment visualization. Management of the NLD can take the form of transection alone, transection with stenting, or performing a formal dacryocystorhinostomy to avoid postoperative sequelae of injury. The purpose of this study was to review the literature and determine the optimal management of the NLD during expanded maxillary sinus approaches. Methods: A systematic review of Ovid, Embase, Medline, and Cochrane databases was performed to identify studies involving expanded approaches to the maxillary sinus and that explicitly reported the status of the NLD and postoperative outcomes. Results: Nineteen studies were included in the analysis and divided into two groups: NLD-preserving (n = 9 studies; n = 191 patients in aggregate) and NLD-involving (n = 10 studies; n = 296 patients in aggregate). In the NLD-preserving subgroup, one patient out of a subgroup aggregate of 191 patients (0.5%) developed epiphora. In the NLD-involving subgroup, sharp transection alone was the most common method of NLD removal and was associated with a low rate of epiphora (study rates: 0 to 18.2%; aggregated subgroup rate: 7.0%, 21 / 296). Spontaneous resolution of symptoms was common (60%-100% cases). Conclusions: The NLD should be preserved when feasible from an exposure and tumor-control perspective. When pathology or approach requires the removal of the NLD, rates of persistent epiphora are very low, regardless of surgical technique. When expanded maxillary approaches are employed, particularly for benign tumors, and require removal of the NLD, sharp transection is the simplest method of removal, provides a low rate of postoperative epiphora, and is supported by the available literature. [ABSTRACT FROM AUTHOR]

Leprosy, also known as Hansen disease, is an airborne spread disease caused by Mycobacterium leprae (M. leprae) which commonly presents with skin lesions, peripheral neuropathy, and ocular involvement. This report describes a patient who presented with epiphora secondary to chronic nasolacrimal duct obstruction four years after completing antimicrobial treatment for tuberculoid leprosy. At the time of endoscopic dacryocystorhinostomy (DCR), the lacrimal sac demonstrated chronic dacryocystitis with granulomatous inflammation and a Fite positive staining bacterial rod-like structure. Pathological examination of the surgical specimen demonstrated numerous non-necrotizing granulomas in a perivascular and neural distribution, compatible with sequelae of previously treated M. leprae infection. The patient has remained symptom free six months after surgery. [ABSTRACT FROM AUTHOR]

Background: To determine the paranasal changes and inflammatory markers that may cause primary acquired nasolacrimal duct obstruction (PANDO) and to determine their relationship with success rates on different types of surgeries. Main body: We retrospectively reviewed the blood sample and computed tomography (CT) results on 92 patients who underwent dacryocystorhinostomy (DCR) surgery for PANDO and 82 healthy controls. Age, gender, paranasal abnormalities, hemogram values, International Normalized Ratio (INR) values, type of surgery, and recurrence rate were recorded; systemic Immune-inflammation Index (SII), neutrophil-to-lymphocyte ratio (NLR), monocytes-to- lymphocyte ratio (MLR) and platelet-to-lymphocyte ratio (PLR) were calculated in both groups. In the case group, total white blood cells, monocytes, and INR values were significantly lower (p < 0.05). Platelet, lymphocyte, neutrophil, PLR, MLR, NLR, and SII values did not differ significantly between the control and case groups (p > 0.05). There was no significant difference in the CT results between the groups (p > 0.05). No correlation was found between CT findings and inflammatory markers. Dacryocystitis (DC) was seen in 20% of patients and they were all in the case group. No correlation was found between recurrence rate and age, gender, type of surgery, CT findings, and blood results (p > 0.05). The recurrence rate was significantly higher in patients with bilateral PANDO and with DC (p < 0.05). Short conclusion: The incidence of PANDO may not be directly related to paranasal abnormalities and systemic inflammation. Low INR values may cause obstruction in the nasolacrimal duct. Age, gender, type of surgery, CT findings, and inflammation level do not affect the success of the surgery. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to evaluate the impact of treatment on psychological well-being by looking at changes in anxiety and depression levels in patients receiving treatment for tear duct obstruction. Materials and Methods: Forty patients who had been diagnosed with tear duct obstruction and receiving dacryocystorhinostomy (DSR) were included in our prospective cohort study. The Beck Anxiety and Depression Inventory, two standardized psychometric measures, were used to measure the individuals' levels of anxiety and depression both before and after DSR treatment. Results: The study comprised 40 patients in total, 16 (40%) of whom were male and 24 (60%) of whom were female. The number of patients in the "minimal anxiety" class climbed to 37 (92.5%) after DSR, compared to 22 (55%) patients in the class prior to DSR, based on the patients' anxiety levels. There was a significant change (p<0.001) in the median Beck anxiety scores before and after DSR. The median was 0 after it was 6.5 previously. There was a significant change (p<0.001) between the median Beck depression ratings before and after DSR. The median after was 13, compared to the prior median of 14. The results indicate that the scores for anxiety and depression decreased in a way that was statistically significant. Conclusion: In summary, this study represented a significant advancement in our understanding of the anxiety and sadness experienced by patients having DSR for tear duct obstruction. The study's noteworthy reduction in the levels of depression and anxiety implies that DSR might be beneficial for psychological as well as physical health. [ABSTRACT FROM AUTHOR]

Aim: We aimed to investigate the effective factors to increase treatment options in patients with congenital nasolacrimal duct obstruction (LDO). Materyal and Methods: Our study was planned retrospectively. The patients admitted to Erzurum Regional Training and Research Hospital Family Medicine Outpatient Clinic with symptoms such as watering, burring, swelling in the sac area, chronic conjunctivitis < In 200 children under 4 years of age, information on maternal age, mode of conception, gender, birth weight, mode of delivery, presence of multiple pregnancies, sibling history, duration of hospitalization, need for invasive mechanical ventilation, maternal pre-eclampsia, gestational DM, and bilateral or unilateral occlusion, need for surgery, number of surgeries, presence of anisometropia, when epiphora started and when it ended were collected and evaluated. Results: Of the children included in the study, 52% (n=103) were male and 48% (n=95) were female. It was shown that complaints such as watering, redness, and burring due to congenital nasolacrimal duct obstruction mostly started in the first weeks (7.1%), and most of these complaints were relieved by massaging the sac area and topical drops (90.3%) without surgical intervention. There were no significant statistical differences between children with and without congenital epiphora in terms of gender, multiple pregnancies, mode of delivery, delivery week, need for postnatal intensive care, mother’s mode of conception, maternal age and chronic diseases (p>0.05). Significant differences were found in birth weight and the presence of positive sibling history (p<0.05). Conclusion: This study was conducted to evaluate the association of congenital epiphora with possible antenatal and perinatal risk factors. It was concluded that low birth weight and positive sibling history may be involved in the etiopathogenesis of epiphora, but it was concluded that studies on this subject should be conducted by reaching large populations. [ABSTRACT FROM AUTHOR]

To evaluate results and failure factors in endonasal surgery in a private outpatient setting in a tropical environment. A single-center observational study included 337 patients consecutively undergoing endonasal surgery in a private hospital on Réunion Island, a French overseas administrative Département in the Indian Ocean between 2019 and 2021. The main objective was to assess the success rate of the outpatient pathway. Secondary objectives comprised analysis of complications and identification and management of factors for failure of outpatient management. The study was conducted according to the STROBE editorial guideline. The 337 surgeries notably comprised 112 septoplasties (37.5%), 104 meatotomies (30.3%), 15 unilateral total ethmoidectomies (4.6%), 48 bilateral total ethmoidectomies with sphenoidotomy (14.3%), and 18 Draf procedures (5.5%). Seventy-five percent of patients (252/337) were operated on as outpatients, with a success rate of 90% (227/252 patients). The rate of severe intraoperative complications was 1.5% (5/337). On multivariate analysis, 3 variables were identified as influencing risk of failure of the outpatient pathway: emergency analgesia in the operating room [odds ratio (OR): 91.61; 95% confidence interval (CI): 22.8–540.3], operating time (OR: 1.05; 95% CI: 1.01–1.09), and recovery room time (OR: 1.02; 95% CI: 1.01–1.03). Our study in a tropical environment found eligibility and success rates for outpatient endonasal surgery similar to those in metropolitan France. This makes surgical and anesthesiological training a key factor in the success of outpatient care, while the location of the care structure and the climate seem to have little impact. [ABSTRACT FROM AUTHOR]

Objective: To report the techniques and outcomes of virtual reality (VR) and mixed reality (MR)‐assisted powered endoscopic dacryocystorhinostomy (DCR) in extremely complex lacrimal drainage obstructions. Methods: A prospective, non‐randomized clinical study was performed in complex syndromic congenital nasolacrimal duct obstruction (CNLDO) and post‐traumatic secondary acquired lacrimal duct obstruction (SALDO) in the setting of Le Fort fractures. All patients underwent preoperative planning in VR and intraoperative planning with a step ahead with MR assistance during the surgery. Surgery was supported by mixed reality intraoperative guidance with the use of the prearranged 3D models and real‐time‐rendered digital models. Parameters assessed include demographics, clinical presentation, complexities of the nasolacrimal duct obstruction, preoperative and intraoperative utility of VR and MR models, surgical techniques, complications, and outcomes. Results: The technique is described as a proof of concept in challenging situations with Apert syndrome and traumatic SALDOs with gross malposition of the sac, and gross nasal and lacrimal anatomical deformities. The VR models helped the surgeon to assess the details of the altered anatomy preoperatively to plan an appropriate approach. Intraoperatively, MR models were present in the surgeon's view without disturbing the endoscopic procedure. Intermittently, the surgeon could pull any of the models virtually present in the operating room, slice them, rotate them, and intricately study the alterations in a stepwise manner, as the surgery proceeds. Conclusion: Virtual reality and mixed reality‐assisted powered endoscopic DCR can be an alternate approach reserved for extremely challenging cases of complex syndromic CNLDOs and post‐traumatic SALDOs. Level of Evidence: 4 Laryngoscope, 134:3508–3515, 2024 [ABSTRACT FROM AUTHOR]

This study aimed to elucidate the regression process of ostium granulomas under the usage of intranasal steroid after primary endoscopic dacryocystorhinostomy (DCR). The authors retrospectively reviewed 57 patients (a total of 72 ostia) who had ostium granulomas after primary endoscopic DCR between 2011 and 2015. Topical intranasal steroid spray was applied in all the patients since postoperative day 1. Adjunctive intralesional triamcinolone acetonide injections were administered for extensive and large-sized granulomas that caused impending ostium blockage. Sequential regression of the ostium granulomas and success rates of DCR were assessed using endoscopic photos. The granulomas completely disappeared in 69 (95.8%) ostia, and the average time interval from the surgery to the disappearance was 6.9 ± 2.8 months. Anatomical and functional surgical success rates were 90.3% and 84.7%, respectively. Intralesional steroid injections for ostium granulomas did not alter the outcomes compared to topical intranasal steroid usage significantly (p = 0.445). In conclusion, we observed that, by continuing the usage of intranasal steroids, ostium granulomas disappear gradually at postoperative 6 months. The intranasal surgical manipulation of granulomas, which results in more mucosal cicatricial change and impedes patient satisfaction, can be successfully avoided. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsDiscussionTo assess a novel Virtual Reality (VR) tool designed to enhance understanding of the nasal anatomy in patients eligible for DCR surgery.Preoperative Computed Tomography (CT) scans of the orbit were obtained and loaded as DICOM (Digital Imaging and Communications in Medicine) files onto the D2P software (3D Systems Inc. Littleton, CO) for tissue segmentation and 3D model preparation. Segmentation was performed on several anatomical structures, including the skull, lacrimal sac, nasal septum, inferior and middle turbinate. The resulting 3D model was visualized using a VR headset. After completing the segmentation procedure, ten cases were evaluated by a panel of six surgeons, including both senior and resident physicians from ENT and oculoplastic specialties.The dataset under examination comprised images from 10 preoperative CT scans of the orbits of patients eligible for Endo-DCR. When evaluating the CT using the VR tool, in 73.3% of the cases ENT surgeons were right about the side of pathology, while only 43.3% ophthalmologists were right (chi-square, p = .018). In 72.8% of the cases ENT surgeons were evaluated right that there is a septum deviation, while only in 47.2% of the cases the ophthalmologists were right (chi-square, p = .094).When evaluating the CT using the VR tool, in 60% of the cases consultants were right about the pathology, while 57.7% of the residents were right (chi-square, p = .853). In 81.7% of the cases consultants were evaluated right that there is a septum deviation, while only in 58.3% of the cases the ophthalmologists were right (chi-square, p = .198).ENT surgeons, as well as consultants, interpreted the CT better than the ophthalmologists and residents. Surprisingly, the VR system did not help them to interpret the CT better. Further, more extensive studies should be done to build a VR system that assists in the correct interpretation of the preoperative CT before DCR surgery as well as during DCR surgery. [ABSTRACT FROM AUTHOR]

Background: Large and giant pituitary adenomas (defined as tumors of maximal diameter ≥ 3–3.9 cm and ≥ 4 cm, respectively) present considerable surgical challenges regarding the extent of resection and perioperative morbidity. Endoscopic endonasal resection is considered the most effective treatment for pituitary adenomas. It allows for better visualization, maneuverability, and access to distant and lateral tumor compartments, ultimately enhancing the extent of resection. This article evaluates our initial experience with endoscopic endonasal resection of large and giant pituitary adenomas. The clinical outcomes, perioperative complications, and extent of tumor resection would be specifically addressed. Patients and methods: The primary goal of surgery was to decompress the optic pathways, and the secondary goals were to achieve maximal safe resection and hormonal control in hormone-secreting adenomas. The degree of tumor resection was classified as gross-total resection (100%), near-total resection (90–100%), subtotal resection (70–90%), and partial resection (< 70%). Results: 42 patients were included in this study. A good visual outcome achieved with 80% improvement in visual symptoms. Gross-total resection (GTR) was achieved in 19 patients (45.2%), near-total resection (NTR) was achieved in 12 patients (28.6%), subtotal resection (STR) in 6 patients (14.3%), and partial resection in the remaining 5 patients (11.9%). Subgroup analysis revealed that GTR, NTR rates were higher in large, compared to giant tumors. GTR, NTR rates of large adenomas were 59.3%, and 29.6%, compared to 20%, and 26.7% in giant adenomas respectively (p-value: 0.01428). Surgical complications were observed in 19 patients (45.2%) with CSF leakage being the most common complication (11 patients, 26.2%). Post-operative diabetes insipidus was observed in 5 patients (11.9%), major vascular injury in one case (2.4%), transient post-op 6th nerve palsy observed in 3 patients (7.1%), while two patients (4.8%) presented with post-operative paranasal sinuses infection. Conclusions: Endoscopic endonasal transsphenoidal resection of large and giant pituitary adenomas is a safe and efficient procedure. Large adenomas (3–3.9 cm) have excellent resection rates and lower complications than giant adenomas (≥ 4 cm), which may require extending our approach to achieve more tumor resection rates in the future. However, only adequate resection of these giant adenomas can be enough to achieve the main surgical goals of visual improvement, hormonal control, and decompression of surrounding structures. [ABSTRACT FROM AUTHOR]

Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) through ducts B2 or B3 is effective in most patients with biliary obstruction, because B2 and B3 commonly join together. However, in some patients, B2 and B3 do not join each other due to invasive hilar tumors; therefore, single-route drainage is insufficient. Here, we investigated the feasibility and efficacy of EUS-HGS through both B2 and B3 simultaneously in seven patients. We decided to perform EUS-HGS through both B2 and B3 to achieve adequate biliary drainage because these two ducts were separate from each other. Here, we report a 100% technical and overall clinical success rate. Early adverse effects were closely monitored. Minimal bleeding was reported in one patient (1/7) and mild peritonitis in one patient (1/7). None of the patients experienced stent dysfunction, fever, or bile leakage after the procedure. EUS-HGS through both B2 and B3 simultaneously is safe, feasible, and effective for biliary drainage in patients with separated ducts. [ABSTRACT FROM AUTHOR]

To investigate the utility of a hand-held digital otoscope for nasal endoscopy and as a pedagogy tool for residents and fellows in patients undergoing external dacryocystorhinostomy (DCR) surgery A digital otoscope (MS450-NTE, Teslong Inc., USA) comprising a digital screen device and a connectible camera probe was used for performing nasal endoscopy. Inspection of nasal cavities was performed pre-, intra-, and post-operatively in sequential patients with nasolacrimal duct obstruction, who underwent DCR or lacrimal probing. Images (1920 × 1080 pixels) and videos (1280 × 720 pixels) were captured. The device was also used for training residents and fellows in performing nasal endoscopy, and to teach basic concepts. The digital otoscope could be used for routine outpatient nasal examination and for performing minor procedures. 53.8% (n = 13) of ophthalmology trainees had never observed nasal endoscopy and 84.6% could not identify more than one major structure correctly prior to the current training. Post-training, all trainees could independently perform nasal endoscopy with the device and 76.9% identified all structures correctly. A digital otoscope with a camera probe is a handy tool for nasal endoscopy and pedagogy. Low-cost gadgets such as this device can effectively be used for performing outpatient nasal endoscopy when expensive endoscopes are unavailable and in peripheral healthcare centers. [ABSTRACT FROM AUTHOR]

False positive radioiodine uptake may pose difficulties in diagnosis and subsequent management of thyroid cancer. Combined imaging techniques, such as SPECT/CT, play a crucial role in accurately identifying the specific location of radioiodine uptake, thereby avoiding potential diagnostic error. This is particularly important in situations where unexpected uptake could lead to unnecessary treatment interventions such as surgery or radioiodine treatment. In this study, we discuss a case involving a 38-year-old female with a history of thyroid cancer and I-131 treatment. Approximately six years later, her course was complicated by left sided epiphora leading to dacryocystorhinostomy and subsequently elevation of thyroglobulin (Tg) levels prompting retreatment by radioiodine. The post-therapy whole-body scan revealed false-positive radioiodine uptake on the left side of the skull, conclusively confirmed through SPECT/CT imaging to be localized in the patient's left eye. [ABSTRACT FROM AUTHOR]

Background: No widely accepted, validated instrument currently exists to measure clinical outcomes in patients who undergo dacryocystorhinostomy (DCR) for treatment of epiphora. Objective: To develop a patient-reported outcome measure applicable to this population. Methods: Psychometric evaluations, consultation with experts, and review of the literature informed item generation of a 12-question questionnaire to incorporate the most relevant symptoms experienced by patients with nasolacrimal duct obstruction. This questionnaire, known as the Tearing Assessment and Rating Scale-12 (TEARS-12), was administered to 32 patients before and after intervention, in the form of endoscopic DCR. Statistical analysis was performed to measure internal consistency, responsiveness, and test-retest reliability. Results: Pre-operative and post-operative TEARS-12 scores (28.2 [standard error (SE) 3.19] vs 11.8 [SE 3.25], respectively, P = 0.001) demonstrated improved patient outcome within 6 weeks following endoscopic DCR. Cronbach's alpha for the questionnaire was 0.90, indicating high overall reliability. Additionally, each question demonstrated internal reliability, with a corrected item-total correlation greater than 0.30. The intraclass correlation between the two pre-operative scores was 0.858 (P < 0.001), indicating high test-retest reliability. Conclusion: TEARS-12 is a statistically valid, easy-to-administer instrument to measure clinical outcomes in patients who undergo endoscopic DCR. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of intravenous tranexamic acid administered prior to external dacryocystorhinostomy (DCR) surgery to decrease intraoperative bleeding under general anesthesia. Methods: This was a double-blinded randomized placebo-controlled trial. A total of 70 patients (35 intervention and 35 control) with nasolacrimal duct obstruction (NLDO) who were selected for DCR surgery between September 2021 and September 2022 were included. After clinical examinations and laboratory tests, patients were randomly classified into intervention and control groups. The intervention group received 10 mg/kg intravenous tranexamic acid to a maximum dose of 1 gr 30 minutes before the surgery. Controls received normal saline solution as a placebo. The amount of intraoperative bleeding and surgical time were compared between the two groups. Results: The intervention group included 21 men (60%) and 14 women (40%), while the control group included 19 men (54.3%) and 16 women (45.7%). The mean ages of the participants were 55.46 ±10.8 years and 58.06 ±11.28 years in the intervention and control groups, respectively. A significant difference was observed between the two groups in the surgical time analysis (control group: 37.74 ±9.52 minutes vs intervention: 26.03 ±10.5 minutes; P <0.001). Additionally, there was a significant difference in the bleeding volume between the intervention (70.66 ±48.19 ml) and control (47.74 ±60 ml) groups (P <0.001). Conclusion: Intravenous tranexamic acid administration before the DCR procedure can successfully control bleeding during the surgery. [ABSTRACT FROM AUTHOR]

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Purpose: To investigate the effects of hydroxybutyl chitosan (HBCS) with and without 5-fluorouracil (5-FU) during endoscopic endonasal dacryocystorhinostomy (Endo-DCR). In addition, the present study observed the impact of HBCS and 5-FU on the functions of the nasal mucosal cell population in vivo. Methods: Patients were randomized into HBCS (group A), HBCS combined with 5-FU (group B), and gelatin sponge control group (group C). 16S rRNA high-throughput sequencing technology examined the conjunctival sac and nasal flora changes. In addition, CCK8, cell scratching, and flow cytometry were used to investigate the effects of HBCS and 5-FU on the nasal mucosal cell populations. Results: Subjects in groups A, B, and C had anastomotic areas of 21.83 ± 12.69 mm2, 21.57 ± 14.53 mm2, and 12.45 ± 8.16 mm2, respectively (P = 0.0359). Group A had less severe epiphora than the other two groups at 1-, 2-, and 12-week postoperative follow-up (P < 0.05). Complications around the anastomosis in group A were the least severe of the three groups (P = 0.0259). After surgery, the proportion of pathogenic bacteria in the conjunctival sac and nasal cavity was higher in groups A and B than in healthy adults. At the 2-week follow-up, the structure of nasal flora in group A was more similar to that of the healthy adults compared to group B. Conclusion: Intraoperative use of HBCS at the anastomose improves the postoperative outcome of En-DCR. 5-FU cannot give better postoperative results in En-DCR and is detrimental to the normalization of the postoperative flora in patients with chronic dacryocystitis. At the cellular level, both HBCS and 5-FU inhibit the migration of nasal mucosal cell populations, and 5-FU inhibits proliferation but does not promote apoptosis.

Purpose: In this study, we aimed to compare closure of the incision for external dacryocystorhinostomy (ext-DCR) by suturing with 6-0 Prolene versus closure with 2-octyl cyanoacrylate and assess the results in terms of the aesthetic and functional aspects of the scar, operating time, postoperative symptoms and complications, and the economic cost of the two techniques. Methods: Sixty-three patients with distal lacrimal obstruction and indication of ext-DCR were initially enrolled in a longitudinal prospective cohort study. Patients underwent ophthalmologic evaluations including lacrimal probing, external examination with photograph, measurement of the surgical wound, timing the cutaneous closure phase of the surgery, recording postoperative wound pain using visual analog scale (VAS), and recording the patient’s and clinician’s subjective satisfaction with the scar using Patient and Observer Scar Assessment Scale (POSAS) at 6 months postsurgery. The 63 eyes were divided into two groups: the wounds in group 1 were closed with 6-0 Prolene using continuous locking suture and the wounds in group 2 were closed with 2-octyl cyanoacrylate. Results: There was no difference in baseline characteristics (age, sex, and race), and no statistically significant differences were found in wound length, POSAS score, VAS score, or serious complications of the wound between the two groups. There were differences in surgery time and economic cost for group 2 compared to group 1 of -2.39 min and -€5.37/operation, respectively. Conclusion: This is the first study in the literature that compares 6-0 Prolene versus Dermabond®. The latter one presents advantages compared to Prolene, given that it reduces the length of surgery, reduces costs, and allows for greater flexibility in postoperative follow-up visits.

The editorial discusses Johann Gottfried Zinn (1727-1759) and his anatomical treatise of 1755, focusing on the lacrimal system. Zinn's treatise, 'Descriptio Anatomica Oculi humani iconibus illustrata,' was a comprehensive study of ocular anatomy, with a chapter dedicated to the lacrimal system. Zinn's observations on the lacrimal gland, canaliculi, lacrimal sac, and nasal duct opening were groundbreaking for his time and continue to hold value in understanding lacrimal drainage disorders. [Extracted from the article]