Primary Nasolacrimal Duct Obstruction Visualized on 123I Preablation Scan for Papillary Thyroid Carcinoma.

A 56-y-old man underwent total thyroidectomy and bilateral central and right lateral neck dissection for papillary thyroid carcinoma with lymph nodes metastases. Before radioiodine ablation, a 123I scan established the diagnosis of primary nasolacrimal duct obstruction (dacryostenosis).

Iodine-131 Therapy and Nasolacrimal Duct Obstructions: What We Know and What We Need to Know.

PURPOSE: The aims of the current review are to summarize the etiopathogenesis, symptomatology, management, complications, and outcomes of iodine-131-induced nasolacrimal duct obstructions, to propose a screening protocol and elucidate the potential avenues of future research. METHODS: The authors performed an electronic database (PubMed, MEDLINE, EMBASE, and Cochrane Library) search of all articles published in English on nasolacrimal duct obstructions following radioiodine therapy. These articles were reviewed along with their relevant cross references. Data reviewed included demographics, presentations, investigations, management, complications, and outcomes. In addition, based on relevant unanswered questions and current lacunae in literature, potential avenues for further research have been elucidated. RESULTS: The frequency of nasolacrimal duct obstruction is reported to range from 2.2% to 18% following I-131 therapy. They are mostly bilateral and noted in patients who receive more than 150 mCi radioiodine. Exact etiopathogenesis is unknown but radiotoxicity to lacrimal sac and nasolacrimal duct is believed to be mediated through a sodium-iodine symporter protein. Although uncommon, it is important to increase awareness among treating physicians and patients receiving radioiodine therapy about the potential side effect of nasolacrimal duct obstruction. Imaging modalities are useful adjuncts in the diagnosis. Dacryocystorhinostomy is the most common modality of management with good outcomes. CONCLUSIONS: Nasolacrimal duct obstruction following radioiodine treatment is a distinct clinical entity. Increased awareness would facilitate timely diagnosis, management, and an enhanced quality of life for the patients.

Experimental study on a new radioactive probe for the treatment of lacrimal duct stenosis.

Our aim was to study the treatment effect of a radioactive probe on lacrimal duct stenosis. We applied experimentally in 30 inbred white rabbits a lacrimal duct stenosis model and the rabbits were randomly divided into 3 groups: the stenosis group, the surgery group and the radioactive probe group. We also separated a blank control group of 5 rabbits. Rabbits in the surgery group and the radioactive probe group were examined by digital subtraction angiography (DSA) 10 min and 30 d after treatment before being sacrificed. Rabbits in the stenosis group and the control group were examined by DSA 60 min before they were sacrificed. Specimens of the lacrimal ducts at the stenosis site were collected immediately after the rabbits were sacrificed. Morphological changes were observed through haematoxyline-eosin staining, while lumen areas of lacrimal duct were observed through computer based photo analysis. For the surgery and the radioactive probe group, stenosis cure rates were 100% 10 min after treatment. Thirty days after treatment, the rates of stenosis were 40% and 5% for the above groups, respectively. Morphological observations showed that each layer of the lacrimal duct wall in the stenosis group became thicker with higher proliferation of cells. Each layer of the lacrimal duct wall in the surgery group was thinner than in the stenosis group; however, the extent of cell profileration was similar. In the radiation treatment group, the interstitial layers of the lacrimal duct epithelium, elastin and collagen fibers and other connective tissue components were thinner than in the surgery group. Cells proliferation was significantly weakened in the radiation treatment than in the stenosis and in the surgery groups. The average areas of lacrimal duct in the control, stenosis, surgery and the radioactive probe groups of the examined sites, were: 0.84±0.28 mm2, 0.26±0.13 mm2, 0.55±0.31 mm2 and 0.80±0.36 mm2, respectively. In conclusion, the radioactive lacrimal duct probe showed distinct therapeutic effects in curing lacrimal duct stenosis and in preventing restenosis after the operation.

Preparation of a prototype radioactive probe for treatment of lacrimal ducts stenosis and a study of its dose distribution.

Our aim was to prepare a radioactive lacrimal passages probe, study its dose distribution in a phantom and suggest security indexes and therapeutic effective doses for brachytherapy. We prepared the radioactive probes by laying 125I particles into plastic tubes. We conducted temperature tests, pressure tests, soak tests and shock tests, to obtain security indexes. The dose distributions in phantom and wax matrix were also detected, and the surface dose rates on different parts of the phantom and the dose absorbed by the operator were examined. The radioactive lacrimal passage probe demonstrated no form changes in temperature tests, pressure tests and soak tests when using a surface radioactive contamination dose lower than 185 Bq. The probe was waferinged in shock tests with a surface radioactive contamination dose lower than 185 Bq. The dose detection in the phantom and the wax matrix showed that for distances of 1 mm-12 mm off the tube, there were statistical differences of the absorbed dose (P<0.05). However, for the range of 12 mm-40 mm, there was no statistical difference (P>0.05). The dose rates administered by the radioactive probe used for radiotherapy to the lacrimal passages were within safe limits both for the phantom (Sichuan Keyi Corporation, China) and the operator. In conclusion, our study showed that this prototype lacrimal passages probe can be a useful and effective method for clinical brachytherapy of lacrimal ducts stenosis.

Recanalização do ducto nasolacrimal com radiofrequência: estudo preliminar / Recanalization of nasolacrimal duct with radio frequency: preliminary study

OBJETIVO: Avaliar a reconstituição do ducto nasolacrimal com o uso de radiofrequência para restabelecimento do fluxo lacrimal nos casos de obstrução da via lacrimal excretora. MÉTODOS: O procedimento foi realizado em 16 olhos de 16 pacientes (13 femininos e 3 masculinos) pelo mesmo cirurgião, utilizando aparelho de radiofrequência monopolar de 450 kHz e 150 W de potência, com anestesia local sob sedação. Os critérios de inclusão foram obstrução baixa da via lacrimal (confirmada por dacriocistografia) e idade superior a 18 anos. Os critérios de exclusão foram trauma prévio, dacriocistite aguda, fístula cutânea, mucocele, cirurgia prévia da via lacrimal e uso de marca-passo cardíaco. RESULTADOS: O seguimento mínimo foi de 120 dias, os pacientes realizaram retornos ambulatoriais para avaliação clínica (presença de epífora, secreção, refluxo à expressão do saco lacrimal, posicionamento do tubo de silicone) e teste de Milder. Aos 90 dias de pós-operatório, 13 pacientes apresentavam irrigação positiva (81,25%) com desobstrução do ducto nasolacrimal e 3 casos (18,75%) de insucesso com irrigação impossibilitada (sem passagem para cavidade nasal). CONCLUSÃO: A reconstituição do ducto nasolacrimal com radiofrequência mostrou-se eficaz no tratamento da obstrução da via lacrimal excretora.

PURPOSE: To evaluate the nasolacrimal duct reconstitution with radio frequency for restoration of lacrimal flow in cases of nasolacrimal duct obstruction. METHODS: The procedure was carried out in 16 eyes of 16 patients (13 women and 3 men) by the same surgeon, with monopolar high-frequency device at 450 kHz and 150 W, with local anesthesia under sedation. Inclusion criteria were lower lacrimal system obstruction (confirmed by dacryocystogram) and age over 18 years old. Exclusion criteria were previous trauma, acute dacryocystitis, cutaneous fistula, mucocele, previous lacrimal surgery and cardiac pacemaker. RESULTS: Patients were followed for at least 120 days, patients were clinically evaluated at outpatient clinics for the presence of secretion, epiphora, reflux at compression of the lacrimal sac, placement of silicone tube and Milder test. At the 90-day postoperative visit, 13 patients had positive irrigation (81.25%) with clearance of lacrimal duct and 3 cases (18.75%) presented irrigation failure. CONCLUSION: Nasolacrimal duct reconstitution with radio frequency was effective in treating nasolacrimal duct obstruction.

[Recanalization of nasolacrimal duct with radio frequency: preliminary study]. / Recanalização do ducto nasolacrimal com radiofrequência: estudo preliminar.

PURPOSE: To evaluate the nasolacrimal duct reconstitution with radio frequency for restoration of lacrimal flow in cases of nasolacrimal duct obstruction. METHODS: The procedure was carried out in 16 eyes of 16 patients (13 women and 3 men) by the same surgeon, with monopolar high-frequency device at 450 kHz and 150 W, with local anesthesia under sedation. Inclusion criteria were lower lacrimal system obstruction (confirmed by dacryocystogram) and age over 18 years old. Exclusion criteria were previous trauma, acute dacryocystitis, cutaneous fistula, mucocele, previous lacrimal surgery and cardiac pacemaker. RESULTS: Patients were followed for at least 120 days, patients were clinically evaluated at outpatient clinics for the presence of secretion, epiphora, reflux at compression of the lacrimal sac, placement of silicone tube and Milder test. At the 90-day postoperative visit, 13 patients had positive irrigation (81.25%) with clearance of lacrimal duct and 3 cases (18.75%) presented irrigation failure. CONCLUSION: Nasolacrimal duct reconstitution with radio frequency was effective in treating nasolacrimal duct obstruction.

[Low-intensity helium-neon laser in the treatment of patients after endonasal dacryocystorhinostomy]. / Primenenie nizkointensivnogo gelii-neonovogo lazera v lechenii bol'nykh posle éndonazal'noi dakriotsistorinostomii.

Described in the paper is an efficiency study of using, postoperatively, the low-intensity helium-neon laser (LIHNL) in patients with obstruction of the lacrimal tracts. Eighty patients were examined after endonasal dacryocystorhinostomy. They were shared between 2 groups with respect to a postoperative course: group 1--experimental, 40 patients, and group 2--control, 40 patients. The experimental patients received, apart from the traditional postoperative therapy, a course of LIHNL therapy. The controls received only the traditional postoperative treatment. The efficiency of postoperative treatment was evaluated by clinical, instrumental and laboratory examination methods. The study denoted that the use of LIHNL in the early postoperative period after endonasal dacryocystorhinostomy had a pronounced anti-inflammatory effect, speeded up the wound healing, prevented the growth of granulation tissues and the merging of the shaped lacrimal-sac fistula with the nasal cavity. LIHNL contributed to a complete recovery of the functional activity of the nasal mucous tunic. Thus, the LIHNL therapy essentially facilitates the postoperative management of patients, cuts the rehabilitation period and enhances the treatment results.