Primary tubercular dacryocystitis - a case report and review of 18 cases from the literature.

Tuberculosis is an airborne communicable disease primarily affecting lungs. Primary tuberculosis of the lacrimal sac is very rare. A 15-year-old girl presented with bilateral epiphora for 8 months. Examination revealed bilateral nasolacrimal duct obstruction. During dacryocystorhinostomy, bone over lacrimal sac was found partially eroded. Lacrimal sac was found filled with caseous white material. Biopsy from the lacrimal sac revealed tubercular granulomas. Patient improved after anti-tubercular therapy. Abbreviations: PCR: polymerase chain reaction; NAAT: nucleic acid amplification test.

Effects of ostium granulomas and intralesional steroid injections on the surgical outcome in endoscopic dacryocystorhinostomy.

PURPOSE: To determine the effect of granuloma formation in the ostium and intralesional steroid injections (ISIs) on the surgical outcome after endoscopic dacryocystorhinostomy (DCR) in patients with primary acquired nasolacrimal duct obstruction (PANDO). METHODS: One hundred and eighty-three cases involving 142 patients were enrolled. The ostium granulomas were classified according to their location relative to the internal common opening (superior, anterior, and posterior positions) and to the vicinity of the ostium (inner, edge, and extra types). If an ostium granuloma was observed during the follow-up and its size increased, ISIs were performed using 0.3 ml of 40 mg/ml triamcinolone acetonide. The surgical outcomes were compared between cases with and without ostium granulomas and also between each granuloma position and type. RESULTS: Ostium granulomas occurred in 71 (38.8%) of the 183 cases, and an ISI was applied in 65 cases with a mean of 2.1 injections. All of the granulomas regressed successfully after ISIs, with the success rate not differing between the cases with (85.9%) and without (83.9%) granuloma. There was no association between granuloma location and surgical outcome. However, the functional outcome was worse (60%) for inner granulomas (which are located within the ostial base) than for extra (87.8%) and edge (98%) granulomas. CONCLUSIONS: ISIs can be easily applied by a surgeon to help regress an ostium granuloma and improve the ostial patency after DCR. Inner ostium granulomas are associated with a worse functional outcome, and the initiation of an early corrective intervention such as an ISI should be considered.

Correction of Tear Trough Deformity With a Cohesive Polydensified Matrix Hyaluronic Acid: A Case Series.

The tear trough or infraorbital hollow is a challenging area to treat, and only a few fillers are suitable for this delicate area. We report on a European case series of six subjects with mild to severe tear troughs who received treatment with cohesive polydensified matrix (CPM®) technology hyaluronic acid gel (Belotero® Balance). The product was injected as small depots (up to ten small boli 0.2 mL maximum each per side) at the supraperiosteal level along or below the orbital rim. Follow-up visits took place at 1, 3, 6, and 9 months after injection for independent evaluation of the clinical effect using the Merz Aesthetics Scale™ for infraorbital hollows and the Global Aesthetic Improvement Scale. Adverse events were also recorded. Mean hollowness scores were considerably improved compared with baseline in all subjects. In all women, the improvements remained throughout the 9-month study, with none reverting to their baseline score. Subjects' satisfaction with treatment was very high throughout the study, and all women stated that they would repeat treatment with the same product. The CPM hyaluronic acid gel was well tolerated. CPM hyaluronic acid gel is a safe and effective treatment for the tear trough area.

Circumostial injection of mitomycin C (COS-MMC) in external and endoscopic dacryocystorhinostomy: efficacy, safety profile, and outcomes.

PURPOSE: To evaluate the safety and efficacy of a new technique of circumostial mitomycin C (COS-MMC) injection in dacryocystorhinostomy (DCR) and to evaluate the outcomes. METHODS: A prospective, interventional consecutive case series involving 110 DCR surgeries performed over a period of 1 year using the COS-MMC technique were evaluated. All patients were operated by a single surgeon (M.J.A.). After fashioning of the mucosal flaps, all patients underwent an intramucosal injection of 0.02% MMC at 4 points (0.1 ml at each point) along the edges of the freshly created ostium. All patients were intubated, and stent removal was done at 12 weeks following the surgery. All patients underwent regular monitoring of the ostium to look for any complications. A minimum follow up of 6 months after stent removal was considered for final analysis. The outcome measures analyzed were anatomical and functional success, complications, and ostium. RESULTS: The mean age at presentation was 39.91 years. The diagnosis was primary acquired nasolacrimal duct obstruction in 60.9% (67/110) and persistent congenital nasolacrimal duct obstruction in 9.1% (10/110) of the patients. Twenty-six patients were known cases of failed DCR and underwent a revision DCR. Of the total patients, 19.1% (21/110) had a history of acute dacryocystitis, of which, 73% (80/110) of the surgeries were performed by an external approach and 27% (30/110) by endoscopic endonasal route. Anatomical success was noted in 97.3% (107/110) and functional success in 96.4% (106/110). All the 4 failures were due to cicatricial closure of the ostium. None of the patients were noted to have mucosal burns in the area where MMC was injected, and none of the Ostia showed any features of necrosis, infection, or any other complications. CONCLUSIONS: COS-MMC is a safe and effective adjunctive modality in DCR. No adverse effects on the ostium were noted. The technique appears to be promising for the success of cases with high risk of failures like revision DCR and traumatic secondary acquired nasolacrimal duct obstruction.

Dacryocystitis secondary to intranasal cocaine abuse: a case report and literature review.

PURPOSE: To report a case of dacryocystitis secondary to intranasal cocaine abuse and to review the literature on the effects of cocaine on sinus, nasal and lacrimal structures. METHODS: Case report and literature review. RESULTS: A 33-year-old male presented with unilateral epiphora and discharge, and clinical examination was consistent with dacryocystitis. He had a 2-year history of intranasal cocaine use. Computed tomography revealed extensive bilateral intranasal and sinus destruction, consistent with cocaine abuse. He was treated with antibiotics followed by dacryocystorhinostomy with silicone intubation. He had 2 recurrences of dacryocystitis and underwent one additional lacrimal surgery. CONCLUSIONS: Cocaine abuse and its accompanying intranasal and sinus destruction should be considered when determining the etiology of nasolacrimal obstruction and dacryocystitis. A medical and social history with specific questions about drug abuse may be useful. Computed tomography is helpful in delineating damage to the sinuses, nose and lacrimal system. Management with antibiotics and dacryocystorhinostomy surgery may result in resolution of symptoms.

Lacrimal drainage obstruction in gastric cancer patients receiving S-1 chemotherapy.

BACKGROUND: This study was conducted to determine the incidence and clinical characteristics of lacrimal drainage obstruction (LDO) in patients receiving S-1 chemotherapy. PATIENTS AND METHODS: Consecutive 170 patients with gastric cancer who underwent curative surgery and received adjuvant S-1 chemotherapy were enrolled. S-1 was administered orally (40 mg/m2 b.i.d. on days 1-28 every 6 weeks) for 1 year. Ophthalmologic examinations were carried out on patients complaining of epiphora. RESULTS: Thirty-one patients (18%) developed epiphora. Among 31 patients, 25 underwent ophthalmologic examinations and 22 (88%) were diagnosed with LDO. The median time to the onset of LDO was 2.9 months. The most common site of obstruction was the nasolacrimal duct [86% (19/22)]; punctal [23% (5/22)] and canalicular obstruction [14% (3/22)] were also noted. In multivariate analysis, total gastrectomy [versus partial gastrectomy: hazard ratio (HR), 2.9; P=0.014] and creatinine clearance<50 ml/min (versus ≥50 ml/min: HR, 2.9; P=0.038) were independent risk factors for the development of LDO. CONCLUSION: Considering the high incidence of LDO in patients receiving S-1 chemotherapy, oncologists should be alert to epiphora and cooperate with ophthalmologists in the early stages to improve the quality of life of patients and avoid more complicated ophthalmologic procedures.

Postoperative application of mitomycin-C in endocanalicular laser dacryocystorhinostomy.

PURPOSE: To determine the safety and efficacy of the multiple postoperative applications of mitomycin-C (MMC) after endocanalicular laser dacryocystorhinostomy. METHODS: Prospective interventional case series of 125 endocanalicular laser dacryocystorhinostomies using the diode laser. Mitomycin-C was placed intra-operatively in all cases. Application of MMC was also done postoperatively at 1 week, 2 weeks, and 3 weeks. The main outcome measure for success was resolution or improvement of epiphora, the patency of the osteum and the presence or absence of complications from the MMC application. Patients were followed up for at least 12 months. RESULTS: A total of 125 consecutive endocanalicular laser dacryocystorhinostomies on 114 patients (102 women, 12 men, mean age 60 years) were done from January 2002 to January 2005. The success rate at 12 months postoperatively was 92.8%. All failures were due to cicatricial closure of the osteum. No significant intra-operative and postoperative nasal complications from the MMC were recorded. CONCLUSION: Multiple postoperative applications of MMC appears to be a safe and effective adjunctive modality after endocanalicular laser dacryocystorhinostomy in primary acquired nasolacrimal duct obstruction.

Nonlaser endoscopic endonasal dacryocystorhinostomy with adjunctive mitomycin C in nasolacrimal duct obstruction in adults.

PURPOSE: To determine the outcome and safety of nonlaser endonasal dacryocystorhinostomy (NLEN-DCR) with the use of adjunctive mitomycin C (MMC) in congenital, traumatic, and primary acquired nasolacrimal duct obstruction in adults. DESIGN: Retrospective, nonrandomized, noncomparative, case series. PARTICIPANTS: One hundred ninety-three consecutive adult patients underwent NLEN-DCR with the use of adjunctive MMC. Thirty-one patients had a simultaneous bilateral procedure performed. METHODS: All patients underwent a standardized procedure, with an endonasal approach to the lacrimal sac, surgical removal of nasal mucosa, lacrimal bone, and a fragment of the frontal process of the maxilla. The medial wall of the lacrimal sac was removed completely, and a neurosurgical cottonoid soaked in MMC at 0.5 mg/ml was placed at the osteotomy site for 10 minutes. All patients underwent bicanalicular silicone intubation. MAIN OUTCOME MEASURES: Resolution of epiphora, absence of discharge, and patency of the ostium confirmed by irrigation at 6 months. RESULTS: The NLEN-DCR procedure with adjunctive MMC was successful in 212 (95%) cases. The mean follow-up was 18.2 months. Intubation of more than 3 months was associated with a higher rate of obstruction (P<0.00018, Fisher exact test), with 9 eyes of 8 patients losing patency. Age, diagnosis, side operated, or infection at the time of surgery had no influence on the final outcome. No significant complications were encountered. CONCLUSIONS: Results suggest that NLEN-DCR with MMC is a safe and successful procedure for the treatment of congenital, traumatic, and primary acquired nasolacrimal duct obstruction in adults. It has the advantage of leaving no scar and of preserving the medial canthal structures. It can be performed successfully as a simultaneous bilateral procedure.

Comparing anatomical pattern of topical anti-glaucoma medications associated lacrimal obstruction with a control group.

PURPOSE: To compare the anatomical pattern of lacrimal drainage system obstruction (LDSO) associated with topical anti-glaucoma medications (AGM) with a control group. METHODS: In a cross-sectional controlled study, case group included patients on topical anti-glaucoma medications and control group included patients with no history of glaucoma, free of ocular disease, and not using topical medications. Data recording, eye examination, and categorization of patients into case and control groups were performed by a senior ophthalmology resident. Diagnostic probing and irrigation test was performed by an oculoplastic surgeon who was masked to the patients' data. Chi-square (X(2)) and tests were used to assess the effect of sex and systemic diseases, as well as logistic regression analysis with intra-cluster correlation for the effect of topical anti-glaucoma medications on lacrimal drainage system, and then independent sample t-tests to compare the mean ages, plus the binary logistic regression test for the effect of increasing age on LDSO. RESULTS: There were 128 eyes of 96 patients in the case and 277 eyes of 172 patients in the control group. Two groups were similar regarding to the age, sex, and associated systemic disorders (0.3

Alpha-Adrenergic Agonists Stimulate Fluid Secretion in Lacrimal Gland Ducts.

Purpose: The role of adrenergic innervation in the regulation of lacrimal gland (LG) ductal fluid secretion is unknown. The Aim of the present study was to investigate the effect of adrenergic stimulation on fluid secretion in isolated LG duct segments and to study the underlying intracellular mechanisms. Methods: Fluid secretion of isolated mouse LG ducts was measured using video-microscopy. Effect of various adrenergic agonists (norepinephrine, phenylephrine, and isoproterenol) on fluid secretion as well as inhibitory effects of specific antagonists on adrenergic agonist-stimulated secretory response were analyzed. Changes in intracellular Ca2+ level [Ca2+i] were investigated with microfluorometry. Results: Both norepinephrine and phenylephrine initiated a rapid and robust fluid secretory response, whereas isoproterenol did not cause any secretion. Phenylephrine-induced secretion was completely blocked by α1D-adrenergic receptor blocker BMY-7378. The endothelial nitric oxide synthase (eNOS) inhibitor L-NAME or guanylyl cyclase inhibitor ODQ reduced but not completely abolished the phenylephrine-induced fluid secretion, whereas co-administration of Ca2+-chelator BAPTA-AM resulted in a complete blockade. Phenylephrine stimulation induced a small, but statistically significant elevation in [\(Ca_i^{2 + }\)]. Conclusions: Our results prove the direct role of α1-adrenergic stimulation on LG ductal fluid secretion. Lack of isoproterenol-induced fluid secretory response suggests the absence of ß-receptor mediated pathway in mouse LG ducts. Complete blockade of phenylephrine-induced fluid secretion by BMY-7378 and predominant inhibition of the secretory response either by L-NAME or ODQ suggest that α-adrenergic agonists use the NO/cGMP pathway through α1D receptor. Ca2+ signaling independent from NO/cGMP pathway may also play an at least partial role in α-adrenergic induced ductal fluid secretion.

Topical glaucoma therapy as a risk factor for nasolacrimal duct obstruction.

PURPOSE: To investigate a possible association between primary open-angle glaucoma (POAG) and primary acquired nasolacrimal duct obstruction (PANDO). DESIGN: Retrospective, comparative study. METHODS: The study group consisted of 209 consecutive eyes (178 patients) whose lacrimal system had PANDO in patients more than 50 years of age during the 10-year study period. The control group consisted of 183 consecutive eyes (183 patients) that underwent cataract surgery during the same period. The main outcome measures were prevalence of POAG in study and control groups and the effect of topical glaucoma therapy use profile on PANDO prevalence. Medical records of all patients included in the study were reviewed. Data collected included demographic details and history and characteristics of POAG treatment. RESULTS: The prevalence of POAG in the PANDO group (23%) was significantly higher than that of the control group (6%; P < .0001). The average history of POAG was longer in the PANDO group (14.10 +/- 5.59 years) compared with the control group (9.55 +/- 7.23 years; P = .025). The average number of topical glaucoma therapy drugs per glaucomatous eye in the PANDO group (1.58 +/- 0.92) was significantly higher than that of the control group (0.73 +/- 0.90; P = .002). Bilateral nasolacrimal duct obstruction (NLDO) was more common among glaucoma patients in the PANDO group (38.23%) compared with nonglaucoma patients in the same group (11.80%; P = .0002). A significantly higher percentage of glaucoma patients in the PANDO group (69%) were treated with timolol, compared with glaucoma patients in the control group (18%; P = .005). CONCLUSIONS: Chronic use of timolol-containing topical glaucoma therapy preparations in glaucoma patients is associated with an increased risk for the development of NLDO. Large-scale prospective studies are needed to ascertain this association.

Nonlaser endoscopic endonasal dacryocystorhinostomy with adjunctive mitomycin C in children.

PURPOSE: To determine the outcome and safety of pediatric endonasal dacryocystorhinostomy with the use of adjunctive mitomycin C. METHODS: A prospective, nonrandomized and noncomparative interventional case series study was performed in 71 consecutive procedures. Sixty patients 16 years of age and younger underwent nonlaser endonasal dacryocystorhinostomy with the use of adjunctive mitomycin C. Eleven patients had a simultaneous bilateral procedure performed. All patients underwent a standardized procedure, with an endonasal approach to the lacrimal sac and surgical removal of nasal mucosa, lacrimal bone, and a fragment of the frontal process of the maxilla. The medial wall of the lacrimal sac was completely removed and a neurosurgical cottonoid soaked in mitomycin C at 0.5 mg/ml placed at the osteotomy site for 5 minutes. All patients underwent bicanalicular or monocanalicular silicone intubation. RESULTS: The main outcome measures were the resolution of epiphora, lacrimal discharge, and patency of the ostium confirmed either by endoscopic visualization and/or irrigation at 6 months or a normal dye disappearance test. Thirteen patients' (18%) final evaluation was via telephone survey. The mean follow-up was 12.3 months. Nonlaser endonasal dacryocystorhinostomy with adjunctive mitomycin C was successful in 67 cases (94.4%). African descent was strongly associated with a higher rate of obstruction (p < 0.001). Infection at the time of surgery (p = 0.051) and less than 3 months intubation (p = 0.059) were also borderline significant. Previous trauma, gender, age, and side operated had no influence on the final outcome. No significant complications were encountered. CONCLUSIONS: Nonlaser endonasal dacryocystorhinostomy with mitomycin C is a safe and successful procedure for the treatment of congenital nasolacrimal duct obstruction in children. It has the advantage of leaving no scar and of preserving the medial canthal structures. It can be successfully performed as a simultaneous bilateral procedure.

Effects of beta-adrenergic antagonist on width of nasolacrimal drainage system lumen.

AIMS: The aims of this study were to determine the effect of a beta-adrenergic antagonist on the width of the nasolacrimal drainage system lumen. METHODS: The asymptomatic sides of 18 patients (14 women and 4 men) with unilateral stenosis or obstruction of the nasolacrimal drainage system were studied. The tear meniscus height on the asymptomatic side was normal and the nasolacrimal drainage system was patent, as revealed by dacryocystography. The nasolacrimal drainage system on the asymptomatic side was infused with 100 microL of 0.5% timolol maleate, and dacryocystography was performed to determine the width of the lumen of the nasolacrimal drainage system. RESULTS: Timolol reduced the width of the lumen significantly, and the changes were more marked in the nasolacrimal duct (NLD), especially the middle and lower regions. The width of the lacrimal sac was not significantly changed. CONCLUSIONS: The decrease in the width of the nasolacrimal drainage system lumen, especially the NLD, by a beta-adrenergic antagonist suggests that the drainage of tears through the NLD may be influenced, in part at least, by the autonomic nervous system.

Obstrução lacrimal pós-tratamento oncológico: revisão de literatura / Lacrimal drainage system obstruction after cancer treatment: a literature review

RESUMO A obstrução de via lacrimal é uma possível complicação decorrente de tratamentos oncológicos sistêmicos e locais. A epífora crônica gera grande impacto na qualidade de vida desses pacientes, e, como a fibrose terminal da via lacrimal pode necessitar de procedimentos complexos para sua resolução, é importante estarmos atentos a esse efeito adverso, com o objetivo de reconhecê-lo e tratá-lo precocemente, ou mesmo preveni-lo. Nesta revisão da literatura, os autores analisam todos os agentes quimioterápicos e radioterápicos associados à obstrução lacrimal e descrevem os mecanismos, a frequência, os tratamentos e a profilaxia. Os tratamentos oncológicos associados à obstrução lacrimal foram: radioterapia em cabeça e pescoço (dosagem acima de 45 a 75Gy), radioiodoterapia (dosagem acima de 150mCi) e quimioterapia com 5-FU, S-1, capecitabine e docetaxel. A obstrução lacrimal pode ser irreversível, e a intubação profilática das vias lacrimais é uma possibilidade descrita de tratamento profilático em casos de radioterapia e uso do 5-FU, S-1 e docetaxel. O tratamento cirúrgico de todos os casos é a dacriocistorrinostomia.

ABSTRACT Lacrimal duct obstruction can be a side effect of systemic and/or local cancer treatments. Chronic epiphora has a great impact on the quality of life of oncological patients. Since terminal fibrosis of the lacrimal system may require complex procedures, it is important to be aware of this adverse effect in order to recognize and treat it, or even prevent it. A literature review was performed to identify all types of systemic cancer treatment associated with lacrimal obstruction and to describe the mechanisms, frequency, treatment, and prophylaxis. The oncological treatments associated with lacrimal obstruction were head and neck radiotherapy (dosage above 45-75 Gy), radioiodine therapy (dosage above 150 mCi), and chemotherapy with 5-FU, S-1, Capecitabine and Docetaxel. Depending on the dose, this complication may be irreversible. Prophylactic intubation of the lacrimal system is an option for prophylaxis in cases of radiotherapy, use of 5-FU, S-1, and Docetaxel. Final surgical treatment is dacryocystorhinostomy.

Efficacy of mitomycin C in modified transcanalicular diode laser dacryocystorhinostomy / Eficácia da mitomicina C na dacriocistorrinostomia transcanalicular com laser diodo modificada

ABSTRACT Objective: To evaluate the efficacy of mitomycin C in anatomical and functional success after modified transcanalicular diode laser dacryocystorhinostomy. Methods: A prospective, double-blinded, randomized placebo-controlled study compared the effect of topical mitomycin C on modified transcanalicular diode laser dacryocystorhinostomy. Group 1 had modified transcanalicular diode laser dacryocystorhinostomy with topical saline, while Group 2 had modified transcanalicular diode laser dacryocystorhinostomy with topical mitomycin C. Success was defined as anatomical patency and relief of symptoms at the end of 6 months. Results: Six months after surgery, Group 1 (30 patients) showed anatomical and functional success rates of 86.7% and 83.3%, respectively. Group 2 (32 patients) showed anatomical and functional success rates of 87.5% and 84.3%, respectively. There was no statistically significant difference between the groups 1 and 2 (p = 1.000). Conclusion: The use of mitomycin C did not improve the anatomical and functional success rates of modified transcanalicular diode laser dacryocystorhinostomy compared to placebo.

RESUMO Objetivo: Avaliar a eficácia da mitomicina C no sucesso anatômico e funcional após dacriocistorrinostomia transcanalicular com laser de diodo. Métodos: Estudo prospectivo, duplo-cego, randomizado e controlado por placebo. Comparou o efeito da mitomicina C tópica na dacriocistorrinostomia transcanalicular com laser de diodo. No Grupo 1, foi utilizada apenas solução salina tópica, enquanto no Grupo 2 foi utilizada mitomicina C tópica. O sucesso foi definido como permeabilidade da via lacrimal e alívio dos sintomas ao final de 6 meses. Resultados: Seis meses após a cirurgia, o Grupo 1 (30 pacientes) apresentou taxas de sucesso anatômico e funcional de 86,7% e 83,3%, respectivamente. O Grupo 2 (32 pacientes) apresentou taxas de sucesso anatômico e funcional de 87,5% e 84,3%, respectivamente. Não houve diferença estatística significante entre os Grupos 1 e 2 (p=1,000). Conclusão: O uso de mitomicina C não melhora as taxas de sucesso anatômico e funcional do dacriocistorrinostomia transcanalicular com laser de diodo em comparação ao placebo.

Botulinum neurotoxin injection for the treatment of epiphora in nasolacrimal duct obstruction.

PURPOSE: Retrospective long-term study to evaluate the efficacy of botulinum neurotoxin A (BoNT/A) therapy for epiphora due to non-surgical nasolacrimal duct obstruction. INTRODUCTION: BoNT/A has been used successfully since 2000 in axillary hyperhidrosis to reduce secretory disorders. Some isolated cases of hyperlacrimation or crocodile tear syndrome have been treated on this basis. We used BoNT/A to decrease lacrimal secretion in cases of epiphora. METHODS: We reviewed the qualitative and quantitative degree of improvement of epiphora after botulinum neurotoxin injections in the palpebral lobe of the lacrimal gland, carried out in an ophthalmic centre between 2009 and 2016. Epiphora was graded using a questionnaire, Munk scores and Schirmer tests before and after injections. Severity of side effects was recorded. RESULTS: Twenty-seven palpebral lacrimal glands of twenty patients with epiphora, mean age 65±13, were treated with BoNT/A (Botox® or Xeomin®) from April 2009 to April 2016. The epiphora was induced by persistent nasolacrimal duct stenosis after surgical treatment. No conventional medical nor surgical treatment was effective at this time. The technique of injection, dilution and dosage were specific. We re-injected 14/27 cases on an as-needed basis, 7/27 cases three times, 3/27 cases four times, and 2/27 cases (same patient both glands) five times. The Schirmer test measured a decrease of lacrimal secretion in 24/27 (89%) lacrimal glands after neurotoxin injection. Side effects were ptosis in 4 cases and transient esotropia in 2 cases. The authors describe the injection techniques, the dosage, the volume and concentration of BoNT/A. CONCLUSION: Patients with epiphora can be treated effectively with BoNT/A to reduce lacrimal secretion of the principal lacrimal gland in its palpebral portion. Ninety percent of the patients were very satisfied, with few side effects (ptosis or mild diplopia lasting from 3 days to 3 weeks). More studies are needed to delineate which types of epiphora can be treated with BoNT/A.

Changes in lumen width of nasolacrimal drainage system after adrenergic and cholinergic stimulation.

PURPOSE: To determine the effect of an adrenergic agonist and a cholinergic agonist on the lumen width of the nasolacrimal drainage system. DESIGN: Prospective, nonrandomized, clinical trial. METHODS: The asymptomatic sides of 33 patients (23 women, 10 men) with unilateral stenosis/obstruction of the nasolacrimal drainage system were studied. The tear meniscus height of the asymptomatic side was normal, with a patent lacrimal system as revealed by dacryocystography. The nasolacrimal drainage system of the asymptomatic side was infused with 100 microL of 5% phenylephrine hydrochloride (an alpha-1 adrenoceptor agonist) or 100 microL of 2% pilocarpine hydrochloride (a cholinergic agonist), and dacryocystography was performed to determine the lumen width of the nasolacrimal drainage system. RESULTS: Phenylephrine caused a significant increase of the lumen width of the nasolacrimal drainage system, and the changes were more marked in the nasolacrimal duct (NLD), especially the upper and middle regions, than in the lacrimal sac. In contrast, pilocarpine reduced the lumen width of the NLD significantly, especially in the middle and lower regions, and the lumen width of the lacrimal sac was not significantly changed. CONCLUSION: The alterations of the lumen width of the nasolacrimal drainage system, especially the lumen width of the NLD by adrenergic and cholinergic agonists, suggest that the lumen width can be changed by the autonomic nervous system.

Efficacy of adjunctive mitomycin C in transcanalicular diode laser dacryocystorhinostomy in different age groups.

PURPOSE: To evaluate the efficacy of adjunctive mitomycin C (MMC) in transcanalicular multidiode laser dacryocystorhinostomy (TCL-DCR) in different age groups. METHODS: Ninety-six eyes of 96 patients who underwent TCL-DCR for the treatment of nasolacrimal duct obstruction were included in this retrospective, comparative study. Patients were divided into 4 groups based on age and intraoperative use of MMC: group 1, TCL-DCR without MMC in the 20- to 44-year age group; group 2, TCL-DCR with MMC in the 20- to 44-year age group; group 3, TCL-DCR without MMC in the 45- to 76-year age group; group 4, TCL-DCR with MMC in the 45- to 76-year age group. The postoperative evaluation consisted of calculating and comparing the success rates between groups. RESULTS: Success rates at the final visit were 50% for group 1, 66.66% for group 2, 79.16% for group 3, and 84.61% for group 4. The differences between group 1 and group 4, and group 1 and group 3, were significant (p = 0.01 and p = 0.038, respectively). Logistic regression showed that age group had significant effect on success rate (p = 0.013). However, use of MMC had no significant effect on success rate (p = 0.23). CONCLUSIONS: The success rates of the TCL-DCR with MMC application were found to be higher than those of TCL-DCR without MMC in different age groups. However, the differences did not reach statistical significance. In addition, our study demonstrated that age may be a significant factor influencing the surgical outcome of TCL-DCR.