Endoscopic-guided diagnosis of and interventional stent placement for nasolacrimal duct obstruction in a horse.

OBJECTIVE: To describe the successful use of endoscopy to visualize and place a soft canine ureteral stent to relieve a chronic nasolacrimal duct (NLD) obstruction in a horse. ANIMAL STUDIED: A 7-year-old, Quarter horse gelding. PROCEDURE: Under general anesthesia, retrograde nasolacrimal endoscopy was performed using an 8.5 Fr Storz Flex XC ureteroscope through the nasal punctum (NP). An obstructive web of fibrous tissue was visualized approximately 20 cm proximal to the NP. A 0.035″/150 cm hydrophilic guidewire was passed normograde from the ventral lacrimal punctum and used to puncture the stenotic tissue. Then, a 5.0Fr/70 cm open-end ureteral catheter was threaded normograde over the guidewire and NLD patency was re-established. The catheter confirmed a NLD length of 30 cm and was then removed. A 5.0Fr/22-32 cm Universa© Soft Ureteral Stent was threaded normograde over the guidewire until the loops of the stent were exposed at each end. The guidewire was removed and the stent loops were sutured in place. RESULTS: The stent was withdrawn 1 month after the procedure. Telephone follow-up with the client reported significant improvement in the amount of ocular discharge and decreased sensitivity around the face and ears. CONCLUSION: Endoscopy is a safe and effective procedure allowing for definitive diagnosis of NLD obstruction and to assist in interventional procedures. Placement of a canine indwelling ureteral stent seems to be an effective alternative treatment option for equine NLD obstruction compared to conventional invasive surgical procedures.

Calcification and osseous metaplasia of the meibomian glands of a horse.

OBJECTIVE: To report the clinical history, surgical management, and histologic findings of meibomian gland calcification and osseous metaplasia in a horse. ANIMAL STUDIED: A 21-year-old Selle Français gelding presented with a 9 months history of blepharitis, blepharospasm, and epiphora affecting the right eye. The horse was diagnosed with meibomianitis and impaction with associated granulomas, but not treated surgically for 6 years. PROCEDURES: Physical and ophthalmic examinations, and systemic bloodwork were performed. A diamond burr debridement was performed on a corneal ulceration, and meibomian gland nodules were excised and examined histologically. RESULTS: Multiple firm concretions were associated with the palpebral conjunctiva of each eyelid. The largest nodule (5 × 4 × 10 mm) was excised from the lower right eyelid. Histology revealed dilated meibomian ducts with mineralized inspissated secretions surrounded by fibrosis and osseous metaplasia. Following nodule excision and corneal ulcer resolution, no blepharospasm or epiphora recurred for a follow-up period of 15 months. CONCLUSION: Calcification and osseous metaplasia of the meibomian glands was identified in a Selle Français gelding. It is suspected that inspissated meibomian secretions led to a local granulomatous reaction with secondary dystrophic calcification and osseous metaplasia.

Stenting of a partially obstructed nasolacrimal duct using a steerable angle-tipped hydrophilic guidewire in a cat.

OBJECTIVE: This case report describes the successful correction of partial obstruction of the NL duct in a cat by means of a modified retrograde NL duct cannulation using a steerable angle-tipped hydrophilic guidewire (AH guidewire) following a paranasal incision. ANIMAL STUDIED: A 2-year-old neutered male American domestic shorthair cat was referred to the Purdue University Veterinary Hospital (PUVH) for chronic epiphora suspected secondary to nasolacrimal (NL) system obstruction. PROCEDURES: At the first visit, the cat had epiphora OD and facial dermatitis but no other abnormalities on physical and ophthalmic examinations. Computed tomography (CT)-dacryocystorhinography revealed partial obstruction of the NL duct secondary to stenosis near the distal root of the right maxillary third premolar (107). A digital three-dimensional (3D) model of the right maxilla and NL duct was created for inspection and virtual cannulation of the NL. The model was 3D printed and cannulation of the NL duct was rehearsed with various stent materials. Retrograde NL stenting with the guidance of a steerable angle-tipped hydrophilic guidewire was conducted following a paranasal incision. A urethral catheter was cannulated over the guidewire and maintained for 44 days. RESULTS: The epiphora resolved immediately after stenting. At 21 days post-stenting, the cat developed acute bullous keratopathy secondary to self-trauma which was treated with a third eyelid flap. On the final follow-up communication with the owner at 210 days post-stenting, no epiphora or any other concerns were reported. CONCLUSION: To the authors' knowledge, this is the first report of successful NL stenting and resolution of epiphora in a cat with a partial NL system obstruction.

Case series: Computed tomography (CT) demonstrates lacrimal canal involvement in koalas (Phascolarctos cinereus) with maxillary incisor dental disease.

Dental disease is common in wild and captive koalas. Effective treatments are limited and dental disease may not be recognised until it is quite severe. We describe the appearance of varying severities of dental disease on computed tomography (CT) images in a case series of six koalas. This case series demonstrates the use of CT to detect both mild and severe dental disease in koalas. The study also documents the normal CT appearance of the nasolacrimal duct in the koala. The only clinical abnormality in koalas with the mildest dental disease was ocular discharge. Computed tomography findings associated with ocular discharge were periapical lysis of first maxillary incisors, lacrimal canal remodelling and subsequent nasolacrimal duct obstruction. Dental disease should be a differential diagnosis for ocular discharge in koalas and CT examination enables visualisation of early stages of dental disease.

Anatomy of the nasolacrimal duct in Persian cats determined by computed tomographic dacryocystography.

OBJECTIVE: This study sought to describe the anatomical characteristics of the nasolacrimal duct of Persian cats as observed by computed tomographic dacryocystography. ANIMAL STUDIED: Ten cats weighing 3-6 kg (three live cats and seven cadaveric specimens). PROCEDURES: The animals were submitted to bilateral computed tomographic dacryocystography, totaling 20 nasolacrimal ducts. Dorsal, sagittal, and transverse planes were studied. Two additional skulls were also dissected following latex injection into the nasolacrimal duct. The length and width of the nasolacrimal duct and lacrimal canaliculi, and the distance between the nasolacrimal duct and the root of the upper canine tooth at the point of closest proximity were measured. RESULTS: The nasolacrimal duct followed a convoluted course, particularly in the middle and rostral portions. Duct stenosis (width reduction equal to or >75%) and dilations (width increase equal to or >50%) were also detected, particularly in the rostral portion. Nasolacrimal duct length and width ranged from 1.3 to 1.5 cm and 1.5 to 2.3 mm, respectively. Mean lacrimal canaliculus length and width corresponded to 3.1 mm and 0.4 mm, respectively. Mean distance from the nasolacrimal duct to the canine tooth was 2.4 mm. The root of this tooth interfered with the course of the nasolacrimal duct. CONCLUSION: This study provided anatomical information for clinical assessment of the nasolacrimal drainage system in Persian cats.

Comparison of conjunctival microbiota of clinically normal Persian cats with and without nasolacrimal duct obstruction.

OBJECTIVE: This study was performed to determine the conjunctival microbiota of Persian cats with and without nasolacrimal duct obstruction (NLDO). ANIMALS STUDIED: Twenty-five Persian cats: 15 with bilateral NLDO (Group A) and 10 with no NLDO (Group B). PROCEDURES: All fifty eyes were assessed. Sterile swab applicators were used for the collection of specimens, which were cultured. PCR was performed on conjunctival swab and blood samples for the detection of Mycoplasma spp. and feline herpesvirus 1(FHV-1), respectively. RESULTS: FHV-1 was detected in two cats in Group A. Twelve eyes from Group A and four from Group B were Mycoplasma spp. positive based on the PCR results. Moreover, fungal culture was positive in six eyes from Group A and three eyes from Group B. The dominant fungus isolated was Aspergillus spp. (6 out of 11 fungal isolates). Other isolated fungi were Alternaria spp. and Cladosporidium spp. Twenty-three eyes had positive bacterial culture in Group A, while twelve eyes were positive in Group B. The most commonly isolated bacteria were Staphylococcus epidermidis (15 out of 38 bacterial isolates). ß-hemolytic Streptococcus spp., Corynebacterium spp., and Staphylococcus aureus were isolated in similar proportions in both groups. Escherichia coli was also present in both groups. CONCLUSIONS: Results of this study revealed same isolated fungal and bacterial spp. and in similar proportions in Persian cats with and without NLDO.

Left-sided dacryostenosis in a dog.

A 1.5-year-old neutered male black Labrador retriever dog was presented to a referral teaching hospital for evaluation of chronic, continuous, mucoid discharge and associated conjunctivitis of the left eye. Nasolacrimal flush revealed a patent duct on the right side but not on the left side. Computed tomography (CT) with a dacryocystogram identified severe stenosis or atresia of the left nasolacrimal duct. The patient was referred to a veterinary ophthalmologist for a reconstruction of the left nasolacrimal system. Ultimately, a conjunctivobuccostomy was performed and resolved all ocular clinical signs. Key clinical message: Dacryostography, a procedure in which the lacrimal punctum is cannulated, and iodinated contrast is instilled into the nasolacrimal system was combined with CT to enable excellent visualization and evaluation of the nasolacrimal canal.

Dacryosténose unilatérale gauche chez un chien. Un chien Labrador noir mâle castré âgé de 1,5 ans fut présenté à un hôpital vétérinaire d'enseignement pour évaluation d'un écoulement mucoïde chronique continu associé à une conjonctivite de l'oeil gauche. Un rinçage naso-lacrymal a révélé un canal fonctionnel du côté droit mais pas sur le côté gauche. Un examen par tomodensitométrie (CT) avec un dacryocystogramme identifia une sténose sévère ou une atrésie du canal naso-lacrymal gauche. Le patient fut référé à et un ophtalmologiste vétérinaire pour une reconstruction du canal naso-lacrymal gauche. Ultimement, une conjonctivobuccostomie fut réalisée et a permis de résoudre tous les signes cliniques oculaires.Message clinique clé :La dacryostographie est une procédure par laquelle le punctum lacrymal est canulé, et du milieu de contraste iodé est instillé dans le système naso-lacrymal combiné avec l'examen par CT a permis une excellente visualisation et évaluation du canal lacrymal.(Traduit par Dr Serge Messier).

Canaliculorhinostomy as a treatment for nasolacrimal duct obstruction in dogs and cats.

OBJECTIVES: To create a replacement nasolacrimal system, using the puncta and canaliculi, with prolonged implant retention and minimal use of Elizabethan collars or other restraint devices. MATERIALS AND METHODS: The method was used in 11 dogs and two cats. Silicone tubing was placed through both canaliculi and, via a drill hole, into the nasal cavity. Distally, the tubing ends were tied in a subcutaneous pocket lateral to the premaxilla. Tubing retention time was 4 to 7 months. Elizabethan collars were used only until skin suture removal at 2 weeks. RESULTS: In all animals, a functional nasolacrimal system was re-created and remained patent over prolonged follow-up periods. Adverse effects and complications were mild. CLINICAL SIGNIFICANCE: The described method is relatively straightforward, thereby making relief of tear outflow problems widely accessible.

Use of 3-dimensional printing in surgical exploration of a nasolacrimal duct obstruction in a dog.

A 1.5-year-old spayed female English setter dog was presented because of mucopurulent discharge emanating from the left medial canthal region of 8-months duration despite medical management and repeated nasolacrimal flushing. Dacryocystorhinography demonstrated obstruction at the level of the lacrimal sac. Three-dimensional (3-D) modelling software was used to print a 3-D construct of the facial bones and a drill guide over the region of obstruction. The 3-D prints were sterilized and utilized during surgery to facilitate access to the lacrimal sac. The left lacrimal sac was identified, explored, and flushed. Patency was re-established, and the dog was asymptomatic 7 months after surgery.

Utilisation d'une imprimante 3-dimensions dans l'exploration chirurgicale d'une obstruction du canal naso-lacrymal chez un chien. Une chienne stérilisée de race Setter anglais âgée de 1,5 ans fut présentée à cause d'un écoulement muco-purulent provenant de la région du canthus médial gauche qui dure depuis 8 mois malgré une gestion médicale et des drainages naso-lacrymaux répétés. Une dacryocystorhinographie a démontré l'obstruction au niveau du sac lacrymal. Un logiciel de modélisation en trois dimensions (3-D) fut utilisé pour imprimer un construit en 3-D des os faciaux et un guide-mèche de la région au-dessus de l'obstruction. Les impressions 3-D furent stérilisées et utilisées durant la chirurgie afin de faciliter l'accès au sac lacrymal. Le sac lacrymal gauche fut identifié, exploré et drainé. La perméabilité fut ré-établie, et le chien était asymptomatique 7 mois après la chirurgie.(Traduit par Dr Serge Messier).

Trauma-induced exostosis of multiple suture lines causing partial bilateral nasolacrimal duct obstruction in a 7-year-old Thoroughbred mare.

A definitive diagnosis of extensive suture line exostoses affecting the nasofrontal, nasolacrimal, nasomaxillary, frontolacrimal, lacrimozygomatic and lacrimomaxillary suture lines in a 7-year-old Thoroughbred mare with chronic bilateral epiphora and facial deformation was achieved using standing computed tomography (CT) examinations. Positive contrast dacryocystorhinography using CT revealed partial bilateral obstruction of the nasolacrimal ducts. Minimally displaced depression fractures of the right nasal bone, the right maxillary bone and right frontal bone were also demonstrated. The cosmetic appearance of the periosteal reaction associated with the suture line exostosis and epiphora significantly improved within 3 months of diagnosis and treatment.

Fluoroscopically guided neocanalization for treatment of nasolacrimal atresia in two horses.

CASE DESCRIPTION: A yearling Thoroughbred stallion and an 8-year-old Saddlebred mare were evaluated for persistent mucoid ocular discharge. CLINICAL FINDINGS: Examination of both horses revealed copious yellow-tan mucoid ocular discharge with a negative Jones I test, absent nasal punctum, and unsuccessful anterograde nasolacrimal duct (NLD) irrigation. Clinical abnormalities were present on the right side only in one horse and bilaterally in the other. Computed tomography (CT) with contrast confirmed nasolacrimal duct atresia in both horses. TREATMENT AND OUTCOME: Under general anesthesia, the affected NLD was catheterized anterograde and contrast injected. Using fluoroscopic guidance, retrograde access to the distal NLD was obtained for through-and-through wire access. Over the wire, the stoma was dilated and a temporary stent placed for 4-8 weeks. After the procedure, both horses were comfortable and free of ocular discharge at the minimum time of last follow-up, 9 months postoperatively. CLINICAL RELEVANCE: Fluoroscopically guided neocanalization is a viable alternative to traditional surgical approaches for NLD atresia, especially when access to the site of obstruction is limited.

Use of 1% polidocanol and pre- and post-computed tomography for treatment of a suspected nasolacrimal duct cyst in a dog.

OBJECTIVE: To describe the efficacy of the sclerosing agent 1% polidocanol in the treatment of a suspected nasolacrimal duct cyst in a dog. ANIMAL STUDIED: A 5-year-old castrated male Golden Retriever with chronic epiphora of the right eye. PROCEDURES: Ocular examination revealed epiphora and a negative Jones test of the right eye and was otherwise normal. Computed tomography with dacryocystography confirmed a cystic structure in the right ventral orbit that extended into the caudal nasal cavity adjacent to the orbit, causing partial physical obstruction of the right nasolacrimal duct. Cytologic analysis of fluid from the lesion was supportive of a diagnosis of a cyst. One percent polidocanol (compounded, People's Custom Rx, Memphis, TN) was injected into the cyst. RESULTS: Epiphora was resolved by two weeks post-injection. Repeated computed tomography with dacryocystography was performed 8 months post-injection, revealing complete resolution of the cyst and demonstrating mild enophthalmos of the right globe. CONCLUSIONS: Intralesional 1% polidocanol therapy was successful in resolving a suspected nasolacrimal duct cyst in a dog.

Punctal stenosis in 6 dogs following the long-term use of topical neomycin-polymyxin B-dexamethasone.

Six dogs were diagnosed with punctal stenosis following the long-term use of topical neomycin-polymyxin B-dexamethasone (NPD). All patients were initially presented for ophthalmic diseases requiring ongoing anti-inflammatory therapy. Five of the 6 dogs had previously or concurrently been treated with topical anti-inflammatory medications other than NPD. One patient exclusively received topical NPD prior to the diagnosis of punctal stenosis. The onset of punctal stenosis following therapy with NPD was variable among patients, ranging from 4 months to over 1 year. Diagnosis of punctal stenosis was made based upon the presence of epiphora and visualization of fibrotic tissue over the nasolacrimal puncta.

A multidisciplinary, minimally invasive approach combining lacrimoscopy and fluoroscopically guided stenting for management of nasolacrimal apparatus obstruction in dogs.

OBJECTIVE To describe and evaluate outcomes of a multidisciplinary, minimally invasive approach combining lacrimoscopy and fluoroscopically guided stenting for management of nasolacrimal apparatus (NLA) obstruction in dogs. DESIGN Prospective, nonrandomized clinical trial. ANIMALS 16 client-owned dogs with confirmed NLA obstruction. PROCEDURES Dogs underwent CT contrast dacryocystorhinography, rhinoscopy, and lacrimoscopy. Whenever possible, the NLA was stented, typically with fluoroscopic guidance. RESULTS Median duration of clinical signs prior to treatment was 3.2 months (range, 0.2 to 14 months). Causes of NLA obstruction were a foreign body (n = 5), dacryocystitis (4), stenosis secondary to fibrosis (3), granulation tissue (1), or granulation tissue in association with a small foreign body (1); a cause was not identified in 2 dogs. Stents were placed in 14 of 16 (88%) dogs for a median duration of 5.6 weeks (range, 1.3 to 9.4 weeks). Stenting was not possible in 2 dogs with stenosis of the NLA secondary to granulation tissue or fibrosis. Owners of all 16 dogs reported at least 60% clinical improvement with median improvement rated as 95%, and owners of 8 dogs reporting complete resolution of signs. Two dogs required antimicrobial administration because of dacryocystitis that persisted after stent removal; a foreign body was not found in either dog. CONCLUSIONS AND CLINICAL RELEVANCE Overall clinical response and owner-rated improvement for dogs with NLA obstruction that underwent lacrimoscopy and fluoroscopically guided stenting were high, especially given that these dogs had failed to respond to conventional treatment.

Dacryocystitis following a nasolacrimal duct obstruction caused by an ectopic intranasal tooth in a dog.

PURPOSE: To describe a nasolacrimal duct (NLD) obstruction secondary to an ectopic tooth in a 5-year-old male Border collie. The dog was presented with a 1-month history of mucopurulent discharge from the left eye (OS) preceded by a lifelong history of epiphora OS. Treatment with neomycin/polymyxin B/dexamethasone ophthalmic solution had not improved the clinical signs, and the NLD was not patent when irrigated by the referring veterinarian. METHODS: A complete ophthalmologic examination was performed followed by dacryocystorhinography and computed tomography (CT). RESULTS: The ophthalmologic examination revealed marked mucopurulent discharge, mild conjunctivitis, slightly elevated STT measurements, and a negative Jones test OS. Both nasolacrimal puncta OS could be cannulated without resistance for approximately 1.5 cm. Upon irrigation, copious amounts of mucopurulent discharge were exited through the corresponding punctum, while no fluid could be detected at the nares. Dacryocystorhinography was performed. Radiographs revealed an ectopic left canine tooth within the left nasal cavity. A cystic dilation of the NLD was observed proximal to the ectopic tooth. Computed tomography was performed to determine the exact position of the tooth and possible involvement of adjacent structures; CT confirmed the previous imaging findings. Treatment with systemic antibiotics, NSAIDs, and ofloxacin ophthalmic solution led to resolution of the clinical signs within several days. Surgery was declined by the owner. CONCLUSION: This is the first case report describing a blocked NLD due to an ectopic tooth in a dog. Ectopic teeth should be included as a differential diagnosis in cases of dacryocystitis and chronic epiphora in dogs.

Iatrogenic nasolacrimal duct obstruction following tooth extraction in a cat.

A 10-year-old DSH cat was referred for a dental evaluation and extraction procedure. Subsequently, the animal developed an acute onset of ocular discharge. Ophthalmologic examination revealed presence of unilateral ocular mucoid discharge leading to a diagnosis of epiphora secondary to nasolacrimal duct obstruction. Dacryocystorhinography was performed and confirmed the presence of a nasolacrimal duct obstruction, presumably acquired after an invasive dental procedure. Additionally, a vinyl cast in situ study of the nasolacrymal apparatus was performed to demonstrate the route of the nasolacrimal duct in the cat and its relationship to oral dental structures. This report documents an unusual case in which excessive inflammation/edema following tooth extraction caused acute epiphora secondary to extraluminal compression of the distal nasolacrimal duct.

Congenital nasolacrimal atresia in 4 alpacas.

Four alpacas, 2 wk to 1 y of age, were diagnosed with congenital atresia of the nasal puncta of the nasolacrimal duct. Dacryocystorhinography confirmed and localized the atresia. All animals were treated successfully by surgical creation of nasal puncta and patency was ensured by placement of a surgical stent for several weeks.

Nasolacrimal obstruction caused by root abscess of the upper canine in a cat.

A 10-year-old, castrated male domestic short hair cat was presented to the Small Animal Clinic at the Western College of Veterinary Medicine with a presenting complaint of chronic, ocular discharge from the left eye. Ocular examination confirmed epiphora and mucopurulent discharge but there were no apparent reasons for the ocular discharge, and nasolacrimal obstruction was suspected. The cat had swelling of the left side of the face, severe periodontal disease and a fractured upper left canine tooth with pulpal exposure. Dacryocystorhinography revealed narrowing of the nasolacrimal duct above the root of the fractured upper left canine and dental radiographs showed a severe periapical lucency at the apex of the upper left canine tooth. The fractured canine tooth was removed. Subsequently, the ocular discharge and facial swelling resolved. After 2 years, the epiphora has never reoccurred. This is a noteworthy case because a suspected root abscess resulted in extralumenal compression of the nasolacrimal duct, which shows the importance of a thorough oral examination when nasolacrimal obstruction is evident.

Dacryops (lacrimal cyst) in three young labrador retrievers.

This case series constitutes a report of dacryops in multiple Labrador retrievers and the use of smooth-muscle actin immunostaining to confirm the lacrimal duct origins of the cyst wall. Three Labrador retrievers were presented with a history of a slowly enlarging mass adjacent to the left medial canthus. Ultrasonography of the masses revealed they were each spherical, thin-walled cystic structures. Aspiration cytology was performed in two cases revealing mixed inflammation and absence of detectable microorganisms. Dacryocystorhinography of the left nasolacrimal system performed in two cases revealed a normal nasolacrimal system that was closely associated, but not communicating with, the cystic mass in both cases. Surgical excision of all cysts was curative. Histopathology and positive immunohistochemical staining for smooth-muscle actin confirmed a diagnosis of dacryops in all cases.

Bilateral nasolacrimal duct atresia in a cria.

A 2-month-old, male alpaca had a 1-month history of mucoid ocular discharge from the left eye. Signalment, history and clinical findings were suggestive of a congenital nasolacrimal outflow obstruction. A dacryocystorhinogram confirmed bilateral nasolacrimal duct atresia, which involved the distal half of both nasolacrimal ducts. In order to establish alternative outflow, a conjunctivomaxillosinusotomy and conjunctivorhinostomy were performed on the right and left eye, respectively. The surgical openings remain patent after 11 months, and there have been no clinical signs of nasolacrimal disease.