Multi-Detector CT Instillation Dacryocystography and Its Role in the Diagnosis of Lacrimal Drainage System Blocks.

To assess the use of Multi-detector computed tomography instillation dacryocystography (MDCT-DCG) and its role in the diagnosis of lacrimal drainage system (LDS) blocks. It is a prospective evaluation of Twenty-five cases presenting with symptoms with NLDO (nasolacrimal duct obstruction) assessed by MDCT-DCG. The study was conducted in LN medical college and JK hospital Bhopal (M.P) territory centre between January 2016 and January 2017. Various levels of LDS obstruction were detected, Lower canaliculus 12% common canaliculus in 20% patients, lacrimal sac in 12% junction between lacrimal sac and NLD in 40% and NLD obstruction in 16% patients. The most common CTDCG findings were dilated opacified lacrimal sac with no opacification of the nasolacrimal duct (NLD) in 40% patients. CTDCG is a non-invasive, quick, patient friendly, indispensable in the assessment of NLDO procedure that adds benefit in documentation and preoperative planning.

Comparison of the Efficacy of Carboxymethylcellulose 0.5%, Hydroxypropyl-guar Containing Polyethylene Glycol 400/Propylene Glycol, and Hydroxypropyl Methyl Cellulose 0.3% Tear Substitutes in Improving Ocular Surface Disease Index in Cases of Dry Eye.

PURPOSE: To compare the efficacy of carboxymethylcellulose 0.5% (CMC), hydroxypropyl-guar containing polyethylene glycol 400/propylene glycol (PEG/PG), and hydroxypropyl methylcellulose 0.3% (HPMC) as tear substitutes in patients with dry eye. METHODS: A retrospective evaluation of cases presenting with symptoms of dry eye from July 2014 to June 2015 was done. Patients with Ocular Surface Disease Index (OSDI) scoring >12 were included in the study. Parameters such as age, gender, Schirmer test (ST), and tear film breakup time (TBUT) were recorded on day 0, week 1, and week 4. For analysis, cases were divided into three groups; Group 1 - CMC, Group 2 - PEG/PG, and Group 3 - HPMC. RESULTS: Overall, 120 patients were included in the study. Demographic data and baseline characteristics were comparable among the groups. Group 2 had significant improvement in percentage change in OSDI (weeks 0-1, 0-4, and 1-4, P = 0.00), TBUT (weeks 0-1, P = 0.01; 0-4, P = 0.006; and 1-4, P = 0.007), and in ST (weeks 0-1, P = 0.02; 0-4, P = 0.002; and 1-4, P = 0.008) compared to Group 1 at all follow-ups. Group 3 had improvements similar to Group 2, but it was not at all follow-ups (improvement in percentage change OSDI [weeks 0-1, 0-4, and 1-4, P = 0.00], TBUT [weeks 0-1, P = 0.10; 0-4, P = 0.03; and 1-4, P = 0.04], and in ST [weeks 0-1, P = 0.007; 0-4, P = 0.03; and 1-4, P = 0.12]). No significant difference was found between Groups 2 and 3. CONCLUSIONS: Hydroxypropyl-guar containing PEG/PG and HPMC as tear substitutes are better than CMC. While HPMC was comparable to PEG/PG in subjective improvement, the objective improvement was not consistent.

Primary Endonasal DCR Without Stent: Our Experience and Case Series Analysis.

Endonasal dacryocystorhinostomy is widely accepted and effective treatment option for nasolacrimal duct obstruction. It can be done with or without the use of stents. This study was carried out to evaluate the results of endonasal DCR surgery and to access efficacy of this procedure without stenting. This is a prospective clinical study conducted in Departments of ENT and Ophthalmology, L.N. Medical College and J.K. Hospital, Bhopal from October 2008 to April 2012. A total of 90 patients with epiphora as evidenced by nasolacrimal duct blockage on syringing were included in the study. These patients underwent endoscopic DCR without stenting. The cases were followed up to 18 months postoperative. Surgical success was defined as anatomical patency and symptomatic relief at the end of the follow up period. Failure was defined as no symptomatic relief, and/or acute dacryocystitis, and/or non patent lacrimal drainage system. Surgical success was observed in 80 of 90 (88.89 %) patients. Incidence of complication was low as only 6 patients had minor complication of bleeding, synechie and granulation tissue formation. It was concluded that high success rates could be achieved in case of nasolacrimal duct obstruction by endoscopic DCR. Thus, we can minimize complications, discomfort, the cost of stenting and follow up visits after endonasal DCR surgery.