RESUMO
A 47-year-old Japanese woman presented with a 1-year history of right-sided epiphora. On initial consultation, the patient had a high right tear meniscus height. CT images revealed bilateral soft tissue opacification in the nasal cavity and maxillary, frontal, and ethmoid sinuses. The lesion in the right nasal cavity and maxillary sinus involved the right lacrimal sac and nasolacrimal duct. Blood test results showed elevated eosinophil count. Endoscopic sinus surgery and excisional biopsy of the nasolacrimal duct were performed. Histopathological examinations of the excised right nasolacrimal duct and nasal polyps from the nasal cavity and maxillary sinus showed high levels of eosinophilic inflammatory infiltrates. The definite diagnosis of eosinophilic chronic rhinosinusitis was made, based on clinical, radiological, and histopathological findings. At 1.5-year follow-up, tear meniscus height was normal, the lacrimal drainage system remained patent, and the rhinosinusitis did not recur.
Assuntos
Eosinofilia , Obstrução dos Ductos Lacrimais , Ducto Nasolacrimal , Rinite , Sinusite , Tomografia Computadorizada por Raios X , Humanos , Feminino , Pessoa de Meia-Idade , Sinusite/diagnóstico , Sinusite/complicações , Doença Crônica , Rinite/diagnóstico , Rinite/complicações , Ducto Nasolacrimal/patologia , Ducto Nasolacrimal/diagnóstico por imagem , Obstrução dos Ductos Lacrimais/diagnóstico , Obstrução dos Ductos Lacrimais/etiologia , Eosinofilia/diagnóstico , Eosinofilia/complicações , Endoscopia , RinossinusiteAssuntos
Hamartoma , Doenças do Aparelho Lacrimal , Ducto Nasolacrimal , Humanos , Hamartoma/diagnóstico , Ducto Nasolacrimal/patologia , Ducto Nasolacrimal/diagnóstico por imagem , Ducto Nasolacrimal/cirurgia , Doenças do Aparelho Lacrimal/diagnóstico , Doenças do Aparelho Lacrimal/cirurgia , Dacriocistorinostomia/métodos , Masculino , Feminino , Doenças Raras , Obstrução dos Ductos Lacrimais/diagnósticoRESUMO
PURPOSE: To explore the endoscopic and histopathologic characteristics of the lacrimal sac (LS) and the nasolacrimal duct in cases with punctal agenesis presenting with LS swellings. METHODS: This is a prospective, interventional study of 13 LSs of 8 patients presenting with punctal agenesis and LS swellings over a 5-year study period (June 2018-July 2023). Complete ophthalmic examination was performed along with CT scans of the orbits. The LS was exposed with an anterior lacrimal crest incision and explored. The exterior and interior of the sac swelling were examined and LS flaps were sent for histopathological analysis. RESULTS: The mean age of the patients was 23 years with a male:female ratio of 5:3. All patients presented with swelling in the LS region. Occasional epiphora was the presenting feature in 6 patients. All patients had both upper and lower punctal agenesis on the affected side with associated LS swelling. CT scans showed a hypodense cystic swelling with expansion of the LS fossa and bony nasolacrimal duct ending abruptly short of the inferior meatus. Intraoperatively, the LS had thin, translucent walls with mucoid secretion and an absence of common canalicular opening. Histopathological analysis showed epithelium consistent with LS with less robust development of the sac walls and poorly structured lacrimal drainage-associated lymphoid tissue with scanty stromal inflammation. CONCLUSIONS: The development of LS and the nasolacrimal duct is structurally affected in patients with punctal agenesis. Retrograde approaches for epiphora resolution are not logical in such cases but conjunctivodacryocystorhinostomy with Jones tube can be a feasible option.
Assuntos
Doenças do Aparelho Lacrimal , Aparelho Lacrimal , Ducto Nasolacrimal , Tomografia Computadorizada por Raios X , Humanos , Masculino , Feminino , Estudos Prospectivos , Adulto , Aparelho Lacrimal/anormalidades , Aparelho Lacrimal/diagnóstico por imagem , Aparelho Lacrimal/cirurgia , Adulto Jovem , Ducto Nasolacrimal/anormalidades , Ducto Nasolacrimal/cirurgia , Ducto Nasolacrimal/diagnóstico por imagem , Adolescente , Doenças do Aparelho Lacrimal/diagnóstico , Doenças do Aparelho Lacrimal/cirurgia , Pálpebras/anormalidades , Pálpebras/cirurgia , Endoscopia/métodos , CriançaRESUMO
PURPOSE: To evaluate the outcomes of endoscopy-assisted modified Weber-Ferguson's approach in the management of primary lacrimal sac tumors with extension into the neighboring tissues. METHODS: A retrospective interventional study was performed on all patients with lacrimal sac tumors treated with the endoscopy-assisted modified Weber-Ferguson approach between January 2010 and June 2022 at the Shanghai Ninth People's Hospital, China. Data assessed include demographics, clinical presentations, imaging features, surgical techniques, histopathology, adjuvant modalities of management, complications, and outcomes. RESULTS: A total of 13 patients were included in the analysis. Epiphora and palpable mass lesion were the presenting complaint in 84.6% (11/13) of the patients. Nearly half of the patients (46.1%, 6/13) were misdiagnosed as lacrimal duct obstruction. All the lacrimal sac tumors in the present series showed uneven enhancement on T1-weighted MRI imaging. Postoperatively, 84.6% (11/13) patients recovered well with excellent esthetics and were disease-free after a mean follow-up of 58.6 months. Two patients who underwent additional exenteration developed recurrence and succumbed (at 41 and 96 months follow up) while they were on palliative chemoradiation. CONCLUSION: The endoscopic-assisted modified Weber-Fergusson surgical approach is effective in providing better visibility and accessibility to lacrimal sac tumors with extension into neighboring tissue.
Assuntos
Dacriocistorinostomia , Doenças do Aparelho Lacrimal , Aparelho Lacrimal , Obstrução dos Ductos Lacrimais , Ducto Nasolacrimal , Humanos , Ducto Nasolacrimal/diagnóstico por imagem , Ducto Nasolacrimal/cirurgia , Dacriocistorinostomia/métodos , Estudos Retrospectivos , China/epidemiologia , Endoscopia/métodos , Obstrução dos Ductos Lacrimais/terapia , Doenças do Aparelho Lacrimal/diagnóstico , Doenças do Aparelho Lacrimal/cirurgia , Doenças do Aparelho Lacrimal/patologia , Aparelho Lacrimal/patologiaRESUMO
PURPOSE: To describe a novel endoscopic technique to approach the maxillary sinus (MS), the Modified Anterior Medial Maxillary Approach (MAMMA), preserving the inferior turbinate (IT) and the nasolacrimal duct (NLD). To perform radiological measurements and describe a case series to study the feasibility and limits of MAMMA. METHODS: Computed tomography (CT) scans (n = 150 nasal cavities) were used to calculate areas of the MAMMA to define surgical limits and extensions. Measurement of distances to critical anatomy landmarks and total area for the MAMMA were calculated. An instructional case illustrating the surgical technique and outcome was also included. RESULTS: Radiological analysis showed a mean distance from the Piriform Aperture (PA) to the anterior limit of the NLD of 1.03 ± 0.18 cm (range 0.59-1.48) and a mean distance from de PA to the posterior limit of the NLD of 1.57 ± 0.22 cm (range 1.02-2.11). The mean distance from the nasal floor to the Hasner's valve was 1.61 ± 0.27 cm (range 1.06-2.52) and the distance from the nasal floor to the insertion of the IT was 2.20 ± 0.36 cm (range 1.70-3.69). Finally, the mean total area for the MAMMA was 4.04 ± 0.52 cm2 (range 3.17-5.53). No complications or recurrence of the pathology were observed in operated patients. CONCLUSION: The MAMMA provides a wide surgical field of the MS walls comparable to more aggressive techniques, with preservation of the sinonasal and lacrimal function. MAMMA is an effective alternative to treat different MS pathologies including benign recurrent maxillary sinus tumors.
Assuntos
Neoplasias do Seio Maxilar , Ducto Nasolacrimal , Papiloma Invertido , Humanos , Seio Maxilar/diagnóstico por imagem , Seio Maxilar/cirurgia , Seio Maxilar/anatomia & histologia , Endoscopia/métodos , Conchas Nasais/diagnóstico por imagem , Conchas Nasais/cirurgia , Conchas Nasais/patologia , Cavidade Nasal/patologia , Ducto Nasolacrimal/diagnóstico por imagem , Ducto Nasolacrimal/cirurgia , Papiloma Invertido/patologia , Neoplasias do Seio Maxilar/cirurgiaRESUMO
PURPOSE: To exclusively report the clinical category of mechanical secondary acquired lacrimal duct obstruction (SALDO) secondary to the caruncle and plica hypertrophy. METHODS: Prospective interventional case series involving 10 consecutive eyes with megalocaruncle and plica hypertrophy were enrolled in the study. All patients presented with epiphora secondary to a demonstratable mechanical obstruction of the puncta. All patients underwent high magnification slit-lamp photography and Fourier-domain ocular coherence tomography scans (FD-OCT) of the tear meniscus height (TMH) pre- and post-operatively at 1-month and 3-months. Caruncle and plica size, position, and their relationship to the puncta were noted. All patients underwent partial carunculectomy. Primary outcome measures were demonstrable resolution of the mechanical obstruction of the puncta and the reduction in the tear meniscus height. The secondary outcome measure was the subjective improvement of the epiphora. RESULTS: The mean age of the patients was 67 years (range: 63-72 years). The average TMH was 843.1 (range: 345-2049) microns pre-operatively and 195.1(91-379) microns at 1-month follow-up. All patients reported significant subjective improvement in epiphora at 6-months follow-up. One patient had bilateral granuloma at the surgical site at two weeks and was managed by simple excision and topical tapering steroids. Histopathology revealed hyperplastic epithelium with goblet cells with chronic inflammatory cells in the sub-epithelial region and the stroma. CONCLUSION: The role of the caruncle in the causation of mechanical SALDO needs to be carefully assessed in patients beyond the sixth decade. Excellent objective and subjective outcomes can be achieved by a partial carunculectomy and plica semilunaris excision.
Assuntos
Dacriocistorinostomia , Aparelho Lacrimal , Obstrução dos Ductos Lacrimais , Ducto Nasolacrimal , Humanos , Pessoa de Meia-Idade , Idoso , Obstrução dos Ductos Lacrimais/etiologia , Obstrução dos Ductos Lacrimais/patologia , Estudos Prospectivos , Olho , Ducto Nasolacrimal/diagnóstico por imagem , Ducto Nasolacrimal/cirurgia , Ducto Nasolacrimal/patologia , Dacriocistorinostomia/métodos , Aparelho Lacrimal/cirurgiaRESUMO
Despite an obvious interest in the processes occurring in the lacrimal passages in their obstruction, there is few articles analyzing their biometric parameters. PURPOSE: The study investigates the biometric characteristics of the lacrimal passages in healthy individuals and in patients with nasolacrimal duct obstruction. MATERIAL AND METHODS: The study included 81 cases of partial nasolacrimal duct obstruction and 38 cases without tear drainage insufficiency. All patients underwent computed tomography with dacryocystography. Analysis of the biometric parameters involved calculation of the length, volume, and average sectional area of the nasolacrimal duct and the nasolacrimal bony canal. The ratio R4/16l was calculated (where R is the radius of the nasolacrimal duct; l is the length of the nasolacrimal duct). The normality of values was assessed using the Shapiro-Wilk test. Intergroup differences were assessed using the Mann-Whitney test and t-statistics for independent samples. Correlation analysis was performed according to the Spearman method. ROC analysis was carried out. Differences were considered significant at p≤0.05. RESULTS: There were significant differences in the volume (p=0.004) and the average sectional area of the nasolacrimal duct (p=0.014), as well as in the length of the nasolacrimal canal (p=0.034). Relationships were established between the age of patients without tear drainage insufficiency and the length of the nasolacrimal canal (p=0.042); the length of the nasolacrimal canal and the volume of the nasolacrimal duct (p=0.034), as well as the volume of the nasolacrimal duct and the nasolacrimal canal in partial nasolacrimal duct obstruction (p=0.017). The AUC of the R4/16l ratio in the ROC analysis was 0.653 (p=0.007). CONCLUSION: In addition to the obvious differences, it was found that the length of the nasolacrimal bony canal significantly differed in the subjects of both study groups. We considered the tear ducts as a hydrodynamic system obeying Poiseuille's law, so we calculated the ratio R4/16l. The value of this ratio varied (p=0.016), and the ROC analysis showed high sensitivity and specificity of the criterion. This makes it possible to use this ratio as a diagnostic criterion for partial nasolacrimal duct obstruction.
Assuntos
Dacriocistorinostomia , Aparelho Lacrimal , Obstrução dos Ductos Lacrimais , Ducto Nasolacrimal , Humanos , Obstrução dos Ductos Lacrimais/diagnóstico , Ducto Nasolacrimal/diagnóstico por imagem , Estudos Retrospectivos , Biometria , Dacriocistorinostomia/métodosRESUMO
PURPOSE: To assist in planning before the endoscopic prelacrimal recess (PLR) approach, we aimed to investigate the relationship between morphometry and variations of PLR in maxillary sinus (MS) pneumatizations. METHODS: Retrospective analysis of the paranasal sinus computed tomography images of 150 patients was conducted to determine the pneumatization patterns of the MS, PLR variations, and the applicability of the PLR approach. The results were compared based on lateralization, gender, and age groups. RESULTS: The PLRwidth, the anteroposterior diameter of the nasolacrimal duct (NLD), the vertical and horizontal diameters of the MS were the highest in hyperplasic MS, and decreased significantly with increasing age (p = 0.005, p = 0.017, p = 0.000), respectively. Most of the morphometric measurements were higher in hyperplasic MS, while the medial wall thickness of PLR was higher in hypoplasic MS. The PLRwidth for feasibility of the PLR approach were Type I (48%) in hypoplasic MS and Type III (80%) in hyperplasic MS (p < 0.001), respectively. The PLR medial wall thickness was higher in Type I, while the piriform aperture angle (PAA), MS volume, length, and slope of the NLD were higher in Type III PLRwidth (p = 0.000), respectively. The highest anterior and separation-type variations of the PLR were observed in hyperplasic MS, whereas 31.0% of hypoplasic MS had no PLR (p < 0.001). CONCLUSION: This study revealed that PLRwidth and PAA were the highest in hyperplasic MS, which allows the endoscopic PLR approach to be performed more easily. For safer and uncomplicated surgery, surgeon should be aware of the PLR anatomy in different MS pneumatization patterns.
Assuntos
Seio Maxilar , Ducto Nasolacrimal , Humanos , Seio Maxilar/diagnóstico por imagem , Seio Maxilar/cirurgia , Seio Maxilar/anatomia & histologia , Estudos Retrospectivos , Ducto Nasolacrimal/diagnóstico por imagem , Ducto Nasolacrimal/cirurgia , Ducto Nasolacrimal/anatomia & histologia , Tomografia Computadorizada por Raios X/métodos , Endoscopia/métodosRESUMO
Purpose: Secondary acquired lacrimal duct obstruction (SALDO) is one of the complications of radioiodine therapy. SALDO is formed a few months after therapy if there is a sufficient uptake of radioactive iodine by the nasolacrimal duct. To date, risk factors leading to SALDO are unclear. The objective was to determine the correlation between the tear production level and radioactive iodine-131 uptake in the lacrimal ducts. Methods: Basal and reflex tear production was studied in 64 eyes prior to the therapy with radioactive iodine-131 after drug-induced hypothyroidism. The condition of the ocular surface was assessed using the Ocular Surface Disease Index (OSDI) questionnaire. Seventy-two hours after the radioactive iodine therapy, scintigraphy was performed, which determined the presence or absence of iodine-131 in the lacrimal ducts. T-statistics and the Mann-Whitney criterion were used to identify the differences between the groups. The differences were considered significant at P ≤ 0.05. The current tear production level in patients receiving radioiodine therapy was determined using a mathematical model. Results: A statistically significant difference between the basal (p = 0.044) and reflex (p = 0.015) tear production levels was found in cases with and without iodine-131 uptake by the lacrimal ducts. The probable current tear production level corresponds to the sum of basal and 10-20% of reflex tear production. The uptake of iodine-131 was found regardless of the OSDI results. Conclusion: The probability of iodine-131 uptake by the lacrimal ducts rises as the tear production level increases.
Assuntos
Aparelho Lacrimal , Obstrução dos Ductos Lacrimais , Ducto Nasolacrimal , Neoplasias da Glândula Tireoide , Humanos , Aparelho Lacrimal/diagnóstico por imagem , Radioisótopos do Iodo/efeitos adversos , Ducto Nasolacrimal/diagnóstico por imagem , Obstrução dos Ductos Lacrimais/diagnóstico , Obstrução dos Ductos Lacrimais/etiologiaRESUMO
This study was designed to investigate the influence of primary nasolacrimal duct obstruction (PANDO) on the structure and function of the Meibomian gland and to examine whether it is related to functional failure after dacryocystorhinostomy surgery. Medical records of patients diagnosed as PANDO from August 2021 to February 2022 were retrospectively studied. Results of slit lamp examination, lacrimal drainage test, tear break-up time, anterior segment optical coherence tomography, and meibography were collected. Tear meniscus height, tear break-up time, meiboscore, and lipid layer thickness of tear membrane were parameters compared between the eyes with complete PANDO and the control group. Medical records of 44 patients, therefore 88 eyes were collected, and there were 28 eyes with complete PANDO (total obstruction group), while normal eyes (control group) were 30. Mean tear meniscus height was significantly higher than that of the control group ( P value<0.001), but tear break-up time ( P value=0.322), lipid layer thickness ( P value=0.755), and meiboscore ( P value=0.268) were not significantly different. However, in the cases with moderate and severe meibomian gland destruction, the lipid layer thickness of the total obstruction group was significantly thinner than the control group. Lipid secretion of meibomian glands was less in eyes with PANDO than in eyes without PANDO, under moderate to severe meibomian gland destruction. It can lead to persistent epiphora after dacryocystorhinostomy due to a compensatory response against evaporative dry eye disease. Patients should be educated before the decision to undergo surgeries about the possibilities of persistent epiphora. Further studies are needed to prove the mechanism of meibomian gland function disturbance in PANDO.
Assuntos
Síndromes do Olho Seco , Lacerações , Obstrução dos Ductos Lacrimais , Disfunção da Glândula Tarsal , Ducto Nasolacrimal , Humanos , Ducto Nasolacrimal/diagnóstico por imagem , Ducto Nasolacrimal/cirurgia , Estudos Retrospectivos , Lágrimas/química , Lágrimas/fisiologia , Lipídeos/análiseRESUMO
PURPOSE: To investigate the topographic and anatomical features of secondary acquired nasolacrimal duct obstruction (SALDO) due to radioiodine therapy. METHODS: Dacryocystography-computed tomography (DCG-CT) scans of the nasolacrimal ducts in 64 cases with SALDO due to radioiodine therapy and in 69 cases with primary acquired nasolacrimal duct obstruction (PANDO) were studied. The anatomical site of obstruction was located, and morphometric characteristics of the nasolacrimal ducts were calculated: volume, length, and average sectional area. The statistical analysis was performed using the t-criterion, ROC analysis, and the odds ratio (OR). RESULTS: The mean nasolacrimal section area was 10.7 ± 0.8 mm2 in patients with PANDO and 13.2 ± 0.9 mm2 in patients with SALDO due to radioiodine therapy (p = 0.039); the AUC value in ROC analysis for this parameter was 0.607 (p = 0.037). The development of "proximal" obstruction including lacrimal canaliculi obstruction and obstruction at the site of the lacrimal sac was 4.076 times more likely (CI: 1.967-8.443) in patients with PANDO than in patients with SALDO due to radioactive iodine exposure. CONCLUSIONS: By comparing CT scans of the nasolacrimal ducts, we observed that in SALDO obstruction due to radioactive iodine therapy is predominantly "distal," while in PANDO it is more often "proximal." The development of obstruction within SALDO is followed by more pronounced suprastenotic ectasia.
Assuntos
Dacriocistorinostomia , Obstrução dos Ductos Lacrimais , Ducto Nasolacrimal , Neoplasias da Glândula Tireoide , Humanos , Obstrução dos Ductos Lacrimais/diagnóstico , Obstrução dos Ductos Lacrimais/etiologia , Ducto Nasolacrimal/diagnóstico por imagem , Radioisótopos do Iodo/efeitos adversos , Dacriocistorinostomia/métodosRESUMO
The article summarizes the results of research conducted over the past decade concerning the current problems of dacryology, analyzes the improvements made to the methods of diagnostics used in disorders of lacrimal passages on the basis of modern imaging and functional studies, describes the techniques aimed at improving the clinical effectiveness of the intervention, as well as drug and non-drug methods of intraoperative prevention of excessive scarring in the area of the artificial ostium. The article also analyzes the experience of using balloon dacryoplasty in relapses of tear duct obstruction after dacryocystorhinostomy, and presents the modern minimally invasive surgical techniques, including nasolacrimal duct intubation, as well as balloon dacryoplasty and endoscopic plastic surgery of the ostium of the nasolacrimal duct. Additionally, the work lists the fundamental and applied tasks of dacryology and outlines promising directions of its development.
Assuntos
Dacriocistorinostomia , Aparelho Lacrimal , Obstrução dos Ductos Lacrimais , Ducto Nasolacrimal , Humanos , Dacriocistorinostomia/efeitos adversos , Dacriocistorinostomia/métodos , Obstrução dos Ductos Lacrimais/diagnóstico , Obstrução dos Ductos Lacrimais/etiologia , Obstrução dos Ductos Lacrimais/terapia , Ducto Nasolacrimal/diagnóstico por imagem , Ducto Nasolacrimal/cirurgia , Aparelho Lacrimal/diagnóstico por imagem , Aparelho Lacrimal/cirurgia , Resultado do TratamentoRESUMO
SPECT/CT is a powerful tool for assessing unexpected concentrations of radioiodine resulting from benign uptake in organs with sodium-iodide symporter (NIS) expression. We report a case of accumulation of 131Iodine in the nasolacrimal sac/duct after radioiodine therapy for papillary thyroid cancer. A whole-body scan was taken 3 days after the administration of 5.5 GBq of 131Iodine. SPECT/CT images localized the focal tracer uptake in the nasolacrimal sac/duct likely due to nasolacrimal duct obstruction secondary to prior radioiodine or iodine therapies. Hybrid SPECT/CT allows precise anatomical localization and help differentiate benign mimics of disease, which can alter patient management.
Assuntos
Obstrução dos Ductos Lacrimais , Ducto Nasolacrimal , Neoplasias da Glândula Tireoide , Humanos , Câncer Papilífero da Tireoide/diagnóstico por imagem , Câncer Papilífero da Tireoide/radioterapia , Ducto Nasolacrimal/diagnóstico por imagem , Radioisótopos do Iodo/uso terapêutico , Obstrução dos Ductos Lacrimais/etiologia , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/radioterapiaRESUMO
INTRODUCTION: Obstruction of the lacrimal drainage represents a common ophthalmologic issue. The blockage may interest any level of the lacrimal drainage pathway, and it is important to find the site of obstruction to plan the most appropriate treatment. In this study, findings from magnetic resonance (MR) dacryocystography were compared with findings from endoscopic and surgical procedures to evaluate the accuracy of MR dacryocystography in localizing the site of nasolacrimal duct obstruction. METHODS: We enrolled twenty-one patients with clinical suspicion of nasolacrimal duct obstruction who underwent dacryoendoscopy and surgery. MR dacryocystography was performed with a heavily T2-weighted fast spin echo sequence in the coronal planes. Before the MRI was performed, a sterile 0.9% NaCl solution was administered into both conjunctival sacs. For each examination, two independent readers (with 8 and 10 years of experience in head and neck imaging) evaluated both heavily 3D space T2-weighted and STIR sequences. RESULTS: Stenosis/obstruction of nasolacrimal duct or lacrimal sac was diagnosed in all 21 patients who underwent MRI dacryocystography. In particular, the site of the obstruction was classified as lacrimal sac in 12 (57%) patients, nasolacrimal duct in 6 (29%) patients, and canaliculi in 3 (14%) patients by both readers. By comparison with the evidence resulting from the endoscopy, there were differences between MRI dacryocystography and dacryoendoscopy in the evaluation of the obstruction's site in three patients, with an overall accuracy of 85.7%. CONCLUSION: MR dacryocystography allows a non-invasive evaluation of the lacrimal drainage pathway, valid for the planning of the most appropriate treatment.
Assuntos
Dacriocistite , Obstrução dos Ductos Lacrimais , Ducto Nasolacrimal , Humanos , Obstrução dos Ductos Lacrimais/diagnóstico por imagem , Dacriocistografia , Ducto Nasolacrimal/diagnóstico por imagem , Ducto Nasolacrimal/cirurgia , Imageamento por Ressonância Magnética/métodos , Espectroscopia de Ressonância MagnéticaRESUMO
BACKGROUND: Our study aims to compare non-invasive imaging such as topical computed tomography dacryocystography (CTD) and topical magnetic resonance dacryocystography (MRD) in patients with epiphora. PURPOSE: To evaluate the practicability of topical contrast media during helical CTD and topical saline during MRD to reveal obstruction in the nasolacrimal drainage system (NLDS). MATERIAL AND METHODS: Twenty participants with nasolacrimal duct obstruction were observed for two years. Ten participants underwent CTD and the other 10 participants underwent MRD. Images were analyzed by two radiologists. Participants were also asked about the level of discomfort of the contrast material versus the saline solution. RESULTS: The NLDS was seen on both CTD and MRD. Very good agreement between the two observers (κ value > 0.81) was seen according to the κ statistics. CTD multiplanar and 3D images allowed for precise diagnosis of the point of obstruction whereas, the MRD did not require any contrast material and showed the point of obstruction. Saline was more comfortable for the patients than topical contrast (P < 0.05). CONCLUSION: Topical CTD and MRD are non-invasive techniques that can visualize the degree and level of obstruction in the NLDS than conventional invasive cannulation dacryocystography. CTD is useful in visualizing the point of obstruction and smaller drainage structures. However, it is a source of ionizing radiation to the lens. The benefit of MRD is that it requires no contrast or radiation; however, it is poor in depicting the bone anatomy and smaller drainage structures. Finally, saline was better tolerated by patients than topical contrast.
Assuntos
Obstrução dos Ductos Lacrimais , Ducto Nasolacrimal , Humanos , Obstrução dos Ductos Lacrimais/diagnóstico por imagem , Obstrução dos Ductos Lacrimais/patologia , Meios de Contraste , Dacriocistografia , Ducto Nasolacrimal/diagnóstico por imagem , Ducto Nasolacrimal/patologia , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: Several non-lacrimal lesions can present with lacrimal sac area swelling mimicking a dacryocystocele or mucocele with a possibility of misdiagnosis. This study investigates the clinic-radiologic characteristics of the mimicking conditions compared to true lacrimal sac distension. DESIGN: Retrospective, comparative, interventional case series. PARTICIPANTS: Patients referred by primary care ophthalmologists between January 2015 and October 2021 with a misdiagnosis of dacryocystocele or lacrimal sac mucocele (n = 39) and an age-matched group of proven true lacrimal sac swelling (TLS group, n = 44). METHODS: Data collected included demographics, presenting features, investigations, management, histopathology, and outcomes. Both groups were statistically compared for several clinical and radiological variables. RESULTS: Final diagnoses in the mimicking group were skin/subcutaneous swellings (14/39, 35.9%), vascular malformations (10/39, 25.6%), inferomedial anterior orbital cysts (7/39, 17.9%), sino-orbital masses (5/39, 12.8%). Female gender (<0.001), epiphora (p = 0.001), and discharge (p < 0.001) were significantly more frequent in the TLS group. The mimicking group was more likely to be associated with a longer swelling duration (p < 0.001), a swelling extending beyond the lacrimal sac area (p <0.001), orbital signs (p <0.001), and periorbital abnormality. Non-patent lacrimal irrigation (p < 0.001) was significantly more frequent in the TLS group. On imaging, all swellings in the mimicking group were separate from the lacrimal pathway and 94.9% (37/39) extended beyond the lacrimal sac fossa. CONCLUSION: Various cutaneous, subcutaneous, vascular, inferomedial orbital cystic, and sinonasal pathologies can present with lacrimal sac area swelling and mimic a TLS. A high index of suspicion, a thorough clinical evaluation and proper imaging are essential to avoid a misdiagnosis.
Assuntos
Anormalidades do Olho , Doenças do Aparelho Lacrimal , Obstrução dos Ductos Lacrimais , Mucocele , Ducto Nasolacrimal , Doenças Orbitárias , Humanos , Feminino , Mucocele/diagnóstico por imagem , Mucocele/patologia , Ducto Nasolacrimal/diagnóstico por imagem , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Obstrução dos Ductos Lacrimais/diagnóstico , Doenças do Aparelho Lacrimal/diagnóstico , Doenças do Aparelho Lacrimal/patologia , Doenças Orbitárias/diagnóstico , Doença Crônica , Anormalidades do Olho/patologiaRESUMO
OBJECTIVES: To ascertain the success of endo-DCR in nasolacrimal duct stenosis (NLDS) versus nasolacrimal duct obstruction (NLDO). METHODS: Consecutive adult patients with epiphora attending a tertiary lacrimal clinic from February 2012 to February 2021 were reviewed. NLDS was diagnosed by patent lacrimal syringing and combined dacryocystography (NLD stenosis) and dacryoscintigraphy (post-sac delay) findings in all eyes. Cases with evidence of canalicular stenosis or other identifiable causes of epiphora were excluded. The epiphora resolution and improvement rates following endo-DCR were compared between NLDS and complete NLDO cases. RESULTS: DCRs in 24 NLDS (23 patients, 69.6% females, mean age 61.0 ± 17.07) and 58 NLDO (56 patients, 69.6% females, mean age 61.9 ± 17.4) were included. Resolution of epiphora was achieved in 10 (41.7% [95% CI 0.24-0.61]) of the NLDS cases compared to 40 (69.0% [95% CI 0.56-0.79]) in NLDO (p = 0.021). Improvement of epiphora (i.e., either improvement or resolution) was noted in 17 (70.8% [95% CI 0.51-0.85]) of NLDS and 53 (91.4% [95% CI 0.81-0.96]) of NLDO cases (p = 0.034). Three patients (12.5%) with NLDS had subsequent lacrimal procedures (one DCR revision, two Jones tube) at a median of 14 (range 11-21) months. 71.4% of the NLDS patients responded to a phone questionnaire at a median of 93 months postoperatively. Of these, 46.7% reported resolution or significant improvement, and 33.3% reported slight improvement. 64.3% said they would recommend DCR to others suffering from epiphora. CONCLUSION: Endo-DCR may benefit approximately 70% of patients with NLDS. The success of endo-DCR in complete NLDO may be higher.
Assuntos
Dacriocistorinostomia , Obstrução dos Ductos Lacrimais , Ducto Nasolacrimal , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Idoso , Masculino , Obstrução dos Ductos Lacrimais/terapia , Dacriocistorinostomia/métodos , Ducto Nasolacrimal/diagnóstico por imagem , Ducto Nasolacrimal/cirurgia , Constrição Patológica/complicações , Constrição Patológica/cirurgia , Resultado do TratamentoRESUMO
We report two rare cases of bilateral acquired canaliculops. A 67-year-old woman and an 89-year-old man showed cystic lesions in the medial-upper eyelid on both sides. In both of the cases, re-canalization using dacryoendoscopy was failed because of firm obstruction at the canaliculus and/or junction between the lacrimal sac and nasolacrimal duct. Although 15 cases with canaliculops had been reported previously, only one congenital case showed bilateral canaliculops. The results of our study indicate more complex obstruction in cases with bilateral canaliculops compared to those with unilateral canaliculops.
Assuntos
Dacriocistorinostomia , Obstrução dos Ductos Lacrimais , Ducto Nasolacrimal , Masculino , Feminino , Humanos , Idoso , Idoso de 80 Anos ou mais , Ducto Nasolacrimal/diagnóstico por imagem , Ducto Nasolacrimal/cirurgia , Pálpebras , Obstrução dos Ductos Lacrimais/diagnóstico por imagem , Obstrução dos Ductos Lacrimais/terapia , Dacriocistorinostomia/métodosRESUMO
BACKGROUND: Dacryolith-induced epiphora is caused by a chronic obstruction of the nasolacrimal duct whose aetiology is often specified peroperatively. Dacryocystorhinostomy (DCR) has been often regarded as the gold standard to treat dacryolithiasis. Hasner's valve (HV) incision is a technique to evacuate lithiasis through its physiological track. The purpose of this study was to describe clinical and radiological findings associated with presence of dacryoliths in patients who underwent surgery and to assess the efficacy of these two procedures. METHODS: This study was a comparative interventional multicentric retrospective study including patients referred for an epiphora. The primary endpoint was to determine clinical and endoscopic findings associated with dacryoliths. The secondary endpoints were to evaluate the performance of CT dacryocystography (CT-DG) in the diagnosis of dacryoliths and the success rate of the surgical treatment 6 months postoperatively. RESULTS: 4677 nasolacrimal ducts (NLDs) (78.0% female, mean age 59.2) were included in the study. 3913 underwent DCR, and 764 underwent HV incision. 291 out of 4677 NLDs (6.2%) were found to have dacryoliths. Presence of mucocele associated to a permeable lacrimal system (OR 8.17 (95% 4.62 to 14.44), p<0.01) was associated with presence of lithiasis peroperatively. Success rates at 6 months were 95.6% for endonasal DCR and 94.6% for incision of HV in dacryolithiasis group (p<0.01). CT-DG had a negative predictive value of 96.3% to detect lithiasis (p<0.01). CONCLUSION: Strong clinical and endoscopic findings may improve the imputability of dacryoliths in epiphora. Evacuation of dacryolithiasis through its physiological track was first described in this study in adults with similar results to DCR in patients presenting with dacryolithiasis.
Assuntos
Dacriocistorinostomia , Obstrução dos Ductos Lacrimais , Litíase , Ducto Nasolacrimal , Adulto , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Obstrução dos Ductos Lacrimais/etiologia , Litíase/diagnóstico , Litíase/cirurgia , Litíase/complicações , Estudos Retrospectivos , Dacriocistorinostomia/métodos , Ducto Nasolacrimal/diagnóstico por imagem , Ducto Nasolacrimal/cirurgia , Endoscopia/efeitos adversos , Resultado do TratamentoRESUMO
BACKGROUND: The middle turbinate axilla (MTA) has always been used as a stable anatomic landmark for endoscopic surgeons to locate the lacrimal sac on the lateral nasal wall. Yet, little is known about whether the lacrimal sac size will affect the positioning effect of MTA on lacrimal sac. The aim of this study was to investigate the regularity of lacrimal sac size and lacrimal sac localization through the reference position of the MTA on computed tomographic dacryocystography (CT-DCG) images. METHODS: A series of 192 endoscopic dacryocystorhinostomy (DCR) surgeries were performed. All the patients had been diagnosed as unilateral nasolacrimal duct obstruction and received CT-DCG examinations. According to the maximum transverse diameter of the lacrimal sac on CT-DCG, the patients were classified into three groups. Measurements were taken on CT-DCG parasagittal images. RESULTS: The average distance from the sac superior fundus (SSF) to the MTA was 7.52 mm ± 3.23 mm, and it increased with the increase of the maximum transverse diameter of the sac among groups (p < 0.01). The average distance from the common canaliculus (CC) to the MTA was 3.95 mm ± 2.49 mm. No significant difference was observed among the groups (p = 0.11). The average distance from the CC to the SSF was 3.41 mm ± 1.31 mm, and it increased with the increase of the sac transverse diameter among groups (p < 0.01). CONCLUSIONS: The lacrimal sac can be accurately located on the lateral nasal wall by the reference position of the MTA on CT-DCG images. The distance of the SSF to the MTA and the SSF to the CC is related to the lacrimal sac size. The relative position of the CC to the MTA is relatively stable on CT-DCG images, which make it possible to locate the lacrimal sac of different sizes and the corresponding nasal mucosa incision design in endoscopic DCR.