[Pediatric acute dacryocystitis due to frontoethmoidal mucocele]. / Akute Dakryozystitis im Kindesalter bei frontoethmoidaler Mukozele.

BACKGROUND: Pediatric acute dacryocystitis typically develops due to persistence of Hasner's membrane. Pediatric paranasal mucoceles are rare entities. In contrast, chronic dacryocystitis in cases of congenital dacryostenosis is one of the most frequent pediatric ophthalmologic issues. METHODS: The case report of a 10-year-old girl suffering acute dacryocystitis is presented. RESULTS: The area around the left lacrimal sac showed a painful swelling with edema and hyperemia. Systemic and local antibiotic therapy resulted in only slight improvement. Dacryoendoscopy detected acute dacryocystitis with significant stenosis of the nasolacrimal duct. The nasolacrimal duct was widened dacryoendoscopically and autostable bicanalicular nasolacrimal intubation was performed. Nevertheless, the lacrimal ducts were blocked subtotally and a widening of the ethmoid on the left side was shown by rhinoscopy. Magnetic resonance imaging confirmed a frontoethmoidal mucocele which was treated by marsupialization. During the 24-month follow-up there was no recurrence of acute dacryocystitis. There were no signs of sinusitis. CONCLUSION: Paranasal mucoceles, e. g., ethmoidal mucoceles, can compress the lacrimal pathways and cause acute lacrimal inflammation in childhood. Paranasal mucoceles should thus be excluded in cases of unclear masses in the lacrimal region.

[Diagnostics and treatment of lacrimal duct diseases : A structured patient-centred care concept]. / Diagnostik und Therapie von Tränenwegserkrankungen : Ein strukturiertes patientenzentriertes Versorgungskonzept.

BACKGROUND: The cardinal symptom of lacrimal stenosis is epiphora and a subjective high level of discomfort due to continuous dacryorrhea. OBJECTIVE: The aim of the current paper is to present a structured review of common diagnostic and therapeutic strategies for lacrimal stenosis. MATERIALS AND METHODS: The most important diagnostic and therapeutic approaches are analysed using the existing literature and by reporting the authors' own experiences. RESULTS: A detailed patient history is crucial for diagnosis of lacrimal disorders. Precise inspection and palpation of the lacrimal and lid region may confirm lacrimal stenosis. Examinations of tear production, tear quality and the properties of the ocular surface are helpful. The most important diagnostic tool is lacrimal duct probing and syringing. Therapy is guided by underlying pathologies. Treatment of congenital lacrimal stenosis follows a staged concept. Epiphora in adults without signs of dacryocystitis should be treated with dacryoendoscopy. Dacryoendoscopy is also a therapeutic option for chronic dacryocystitis, but dacryocystorhinostomy may also be required. Lacrimal trauma should be reconstructed rapidly after the incident by lacrimal intubation. Neoplasia of the lacrimal excretory system requires histological classification to enable multidisciplinary management. CONCLUSION: Basic ophthalmologic diagnostics are complemented by special symptom-based examinations. Due to ongoing improvement of available diagnostic and therapeutic options, patients' care is becoming increasingly individualised.

[Dacryoliths and Iatrogenic Foreign Bodies as Classical Triggers for Inflammatory Pseudotumors of the Lacrimal Drainage System]. / Dakryolithen und iatrogene Fremdkörper als klassische Auslöser entzündlicher Pseudotumoren der ableitenden Tränenwege.

BACKGROUND: Tumors of the lacrimal duct are rare. Inflammatory pseudotumors do not represent neoplasias as such. Chronic inflammation may lead to an angiomatous granulation tissue. PATIENTS: The first case presents a 53-year-old male patient suffering a mass of the mediocaudal orbit after an acute dacryocystitis has been cured. Using diagnostic dacryoendoscopy, a large dacryolith was detected. Removing the concrement, via external dacryocystorhinostomy, a polypous tissue appeared which was resected as well. The second case concerns a 29-year-old female patient. She had a lacrimal surgery with stenting seven years prior to surgery. The patient's history revealed recurrent mucous secretion of the tear duct and tenderness of the lacrimal sac. An intrasaccal silicon foreign body could be confirmed by dacryoendoscopy. An external dacryocystorhinostomy was performed and the material was extracted. Hereby, an inflammatory tissue mass filling the whole efferent tear duct was removed. RESULTS: In both patients, external dacryocystorhinostomy was performed complication-free. Surgery enabled the reconstruction of the nasolacrimal duct. Temporary autostable silicon intubation was inserted into the nasolacrimal duct (case 1 and 2), as well into osteotomy (case 2). Histologically, reactive granulation tissue was confirmed. During the follow-up of 9 months (patient 1) and 12 months (patient 2), patients were free of complaints. Lacrimal stentings were removed uneventfully and completely. CONCLUSIONS: Dacryoliths and intrasaccal foreign bodies may cause a chronic dacryocystitis. Due to inflammation, reactive tissue proliferation can be initiated. In these cases, a hypertrophic granulation arose. Endogenous (dacryoliths) and exogenous (iatrogenic foreign bodies) triggers may be underlying reasons. Histological examination is essential for differentiating other inflammatory pathologies or tumors.

[Minimally invasive diagnostics and therapy of congenital nasolacrimal duct obstruction]. / Minimalinvasive Diagnostik und Therapie der konnatalen Tränenwegsstenose.

BACKGROUND: One of the most frequent issues in pediatric ophthalmology concerns congenital nasolacrimal duct obstruction (CNLDO). Typically, irritation of the medial eyelid angle occurs during the first days of life and later increased epiphora appears as tear production is still reduced in young infants. In the case of intrasaccal or postsaccal nasolacrimal duct stenosis, a chronic dacryocystitis develops. METHODS: Modern minimally invasive diagnostics and therapy of CNLDO are reviewed by means of a search of the recent literature and reflection of own experiences. RESULTS: An early diagnosis of CNLDO is desirable. If conservative therapeutic approaches fail, invasive procedures have to be considered. Probing and high pressure syringing of the nasolacrimal ducts remains the therapy of choice. Further therapy options, such as balloon dacryoplasty and dacryoendoscopy are also available. Additionally, due to improvement of the surgical techniques a minimally invasive approach is possible even for dacryocystorhinostomy; nevertheless, this procedure should be considered only as a last resort. CONCLUSION: Precise classification of CNLDO and knowledge about the possible treatment options are important. Lacrimal surgery in childhood is dominated by transcanalicular procedures. Advanced minimally invasive techniques, such as dacryoendoscopy or modern autostable intubation sets have to be emphasized. All therapeutic interventions can be summarized using a staged therapeutic concept, which should be used individually and patient-centered.

[Prognostic value of lacrimal duct diagnostics after tube removal : Retrospective analysis of risk of relapse during the first postoperative year after transcanalicular lacrimal duct surgery with silicone tubing]. / Prognostische Aussagekraft der Tränenwegsdiagnostik nach Intubatentfernung : Retrospektive Analyse des Rezidivrisikos im ersten postoperativen Jahr nach transkanalikulärer Tränenwegschirurgie mit Silikonschlauchintubation.

BACKGROUND: Transcanalicular lacrimal duct surgery has become more important over the past two decades. OBJECTIVES: The aim of the study was to prove the prognostic value of postoperative lacrimal syringing and the testing of spontaneous drainage of lacrimal fluid immediately after tube removal. METHODS: A total of 110 cases with postoperative lacrimal syringing and 183 cases with verification of the postoperative lacrimal fluid drainage performed between January 2001 and August 2008 were retrospectively evaluated. The indication for postoperative diagnostics was set by the investigator. The prognostic value of these two procedures was determined by using prognostic parameters (positive predictive value, PPV; negative predictive value, NPV) and analyzing recurrence nonexistence via Cox regression and Kaplan-Meier estimator. The observation period was limited to 12 months. Predominantly, recurrence was defined on the patient's satisfaction and absence of symptoms, which was determined with the help of a questionnaire. RESULTS: Postoperative verification of the lacrimal syringing is a suitable instrument to estimate surgical success within the first year after lacrimal surgery with a PPV of 92.31%. Testing of the spontaneous drainage of lacrimal fluid after tube removal reached a PPV of 63.33%. CONCLUSION: The proven prognostic value shows that syringing of the lacrimal duct and verification of spontaneous drainage should be integrated into postoperative care in a standardized manner. Hereby, early information for the patient about the expected result of the surgical procedure is enabled.

[Chemical and Thermal Eye Burns]. / Verätzungen und Verbrennungen des Auges.

Background: This review gives a therapeutic approach for the early treatment of chemical and thermal burns of the ocular surface (CTOS). Method: Based on a review of international literature, the experiences of University Hospital Aachen and Halle/Saale, Eye Clinic Cologne as well as experimental data of the research institute (An-Institut) at RWTH Aachen University are considered and discussed. Results: As the risk depends on the stage of CTOS, recommendations are given for acute treatment for different stages. Pathophysiological considerations will be discussed. Special treatment options for exceptional situations and for late phase CTOS are demonstrated. Conclusion: According to the latest data, the most important clinical recommendation for the acute phase of CTOS is the application of a suitable rinsing solution. Furthermore, anti-inflammatory treatment is of central importance. For the therapy of severe CTOS, approved and advanced surgical methods need to be applied. In this way, anti-inflammatory and tissue-protecting mechanisms are activated simultaneously.

[Concretions and iatrogenic foreign bodies in the lacrimal system : Treatment recommendations]. / Konkremente und iatrogene Fremdkörper der ableitenden Tränenwege : Therapeutische Empfehlungen.

BACKGROUND: Deposits (dacryoliths or foreign bodies) inside the lacrimal system can cause chronic inflammation and recurrent lacrimal stenosis. Furthermore, dacryoliths can occur due to chronic inflammation. OBJECTIVE: Considering typical clinical courses, the different localizations and surgical options for removing deposits from the lacrimal system are demonstrated. MATERIALS AND METHODS: A retrospective analysis of 1451 lacrimal surgeries in 1131 patients was performed. Fourteen representative lacrimal surgeries of 11 patients were retrospectively analyzed in terms of current complaints, prior surgery, and the performed surgical intervention. In three cases, histologic findings of removed dacryoliths were assessed. The surgical approaches are described using precise photodocumentation. RESULTS: In 220 lacrimal surgeries (15.2 %), dacryoliths were detected. Iatrogenic foreign bodies were found in 0.8 % (n = 12). All chosen patients suffered painful chronic inflammation of the lacrimal system. Localization was either intrasaccular or intracanalicular. In 10 eyes, surgery was performed using a transcanalicular dacryoendoscope, either alone or in combination with another method. An external approach (transcutaneous/transconjunctival) was performed in 4 patients. Regarding the whole study population, dacryoliths were found in 16.9 % (n = 91) of dacryocystorhinostomies, in 14.6 % (n = 77) of dacryoendoscopies, and in 35.6 % (n = 52) of canaliculotomies. CONCLUSION: Foreign bodies and dacryoliths are important differential diagnoses in the treatment of chronic dacryocystitis. Different surgical approaches are possible and should be available for treatment. Patients' history often reports prior lacrimal surgery.

[Medical and psychological aspects of the treatment of connatal dacryostenosis : Parental evaluation of their own and their child's stress]. / Medizinpsychologische Aspekte bei der Behandlung kindlicher Tränenabflussstörungen : Elterliche Beurteilung eigenen und kindlichen Stresserlebens.

BACKGROUND: Lacrimal probing and syringing for connatal dacryostenosis can be performed under local (LA) and general anesthesia (GA). In cases of invasive medical procedures, pain and anxiety can be distressing for children and their parents. MATERIALS AND METHODS: Using questionnaires (n = 65), parents were asked to evaluate their own stress and that of their child during lacrimal probing and syringing. Analyzing different subgroups, the impact of the kind of anesthesia (LA vs. GA), trust in medical treatment, therapeutic success, prior experiences with GA, parental educational level, age of parents and children, number of children, and time between the intervention and the interview on the stress was examined. Stress level was evaluated on a scale from 1 (no stress) to 10 (maximal stress). RESULTS: Mean children's age was 8.5 ± 7.42 months. Mean age of the parents was 30.8 ± 6.17 years. Treating children under LA, parents reported moderate to severe stress levels for themselves (mean, M = 7.15) and for their children (M = 7.82). Children's stress levels were significantly higher when the treatment was performed under LA (n = 47; M = 7.34) in comparison to GA (n = 18; M = 6.06; p < 0.05). Parents having two or more children reported significantly lower stress levels than those with only one child. Furthermore, prior experiences with GA led to significantly higher parental stress levels when their children were treated under GA. Other factors did not show any impact on parent's and children's stress levels. CONCLUSIONS: Parents might have been influenced by hearing the children's reaction (e. g., crying) during the intervention under LA. Nevertheless, parents had a higher acceptance of this type of intervention (LA) in comparison to GA. This effect was even stronger among parents with prior experience of GA.

[The Interdisciplinary Conference on Lacrimal System Disorders of ophthalmic and ENT surgeons at the University Hospital Halle : An analysis of present patient material]. / Die interdisziplinäre Tränenwegskonferenz von Ophthalmo- und Rhinochirurgen am Universitätsklinikum Halle (Saale) : Eine Auswertung des bisherigen Krankenguts.

BACKGROUND AND AIM: The lacrimal system (LS) crosses regions of ocular adnexa, the nose, and the paranasal sinuses. Surgery of disorders requires a targeted ophthalmologic and otolaryngologic examination. Since 2013, an Interdisciplinary Conference on Lacrimal System Disorders (ICLSD) has existed at the University Hospital Halle. First results of our experiences with this cooperation between ophthalmic and ENT surgeons are presented. METHODS: In a retrospective study at the Department of Ophthalmology, University Hospital Halle, all patients aged 22-80 years (n = 43, 10 with bilateral manifestation; mean age 65.1 years) having had a consultation in ICLSD between February 2013 and May 2015 were analyzed. Thereby, 53 LS were included in the descriptive evaluation. RESULTS: The main relevant pathology in terms of ophthalmologic manifestation was chronic dacryocystitis and its complications (n = 42), whereas nasal septum deviation (n = 11) and chronic rhinosinusitis (n = 10) were the most frequent otorhinolaryngologic pathologies. Prior to consultation, ENT (n = 34) and/or ophthalmic surgery (n = 40) had been performed. During ICLSD, an individualized therapeutic regime for each patient was developed. Surgery was required in 43 out of 53 LS. Of these, 32 were mainly ophthalmic, 11 mainly ENT interventions. At the time of evaluation (median 3 months; range 1 to 24 months), 29 out of 38 patients (76.3 %) were free of complaints. CONCLUSION: Since 2013, competences of ophthalmic and ENT surgeons have been integrated in ICLSD for advanced diagnosis and therapy of lacrimal disorders at the University Hospital Halle. Encouraging functional results are shown in this study, as most patients have had a long and complicated history of lacrimal system disorders. ICLSD enables interdisciplinary patient care.

[Congenital nasolacrimal duct obstruction from an ophthalmologist's point of view : Causes, diagnosis and staged therapeutic concept]. / Die konnatale Dakryostenose aus ophthalmologischer Sicht : Ursachen, Diagnostik und therapeutisches Stufenkonzept.

BACKGROUND: Congenital nasolacrimal duct obstruction (CNLDO) is one of the most frequent issues in pediatric ophthalmology. There are different therapeutic options, including conservative treatments as well as surgical interventions. These strategies can be classified using a staged therapeutic concept. OBJECTIVE: What are the therapeutic strategies for CNLDO from an ophthalmologist's point of view? METHODS: In this review, different kinds of CNLDO are described. Existing therapeutic interventions are dedicated to the different forms of CNLDO and summarized in a staged therapeutic concept. RESULTS: CNLDO is not a homogeneous disease. Different and also combined pathologies exist. According to symptoms and localization of stenosis, different therapeutic interventions are available. The most common CNLDO manifestation is a persistent Hasner's membrane. If conservative approaches have failed, pressurized probing and syringing of the nasolacrimal duct is the method of choice. This can usually be done under local anesthesia. Since some children show persisting symptoms, other therapies (probing and syringing under general anesthesia with nasolacrimal duct intubation, external dacryocystorhinostomy) have to be considered. Here, dacryoendoscopy offers additional diagnostic and therapeutic options. CONCLUSION: The precise classification of CNLDO and knowledge concerning possible therapeutic interventions are essential. Due to ongoing development of surgical approaches, an increasingly individualized therapy is possible. A gradual therapeutic regimen is available for CNLDO, which has to be adapted individually.

[External Dacryocystorhinostomy--Analysis of Patient Material of the University Hospital Halle from 2000 to 2011]. / Die externe Dakryozystorhinostomie--eine Analyse des Krankenguts der Universitäts-Augenklinik Halle der Jahre 2000-2011.

BACKGROUND: The aim of this retrospective study was to collect additional data on the long-term success (LTS) of external dacryocystorhinostomy (ext-DCR) and the impact of pre-, intra- and postoperative factors on the surgical outcome. This was intended to increase the precision of the indication for DCR. METHOD: A retrospective, non-comparative study was conducted on 637 ext-DCR due to dacryocystitis performed at the Department of Ophthalmology, University Hospital Halle. This included all surgical interventions on patients of at least 11 years of age. Using standardised questionnaires and patient records, 60.75 % (n = 387) of patients were surveyed. Follow-up was 1.0 to 12.0 years (mean, 4.0 years). RESULTS: Analysis of patient satisfaction showed satisfactory (20.2 %) and very satisfactory (74.2 %) results. LTS was 94.4 % (n = 365). Factors negatively influencing postoperative outcome were prior surgical interventions of nose and/or sinus, previous ext-DCR and transcanalicular lacrimal surgery. Surgical outcome was positively influenced by lacrimal sac size and lacrimal stenting. Large saccus lacrimales and use of monocanalicular intubates improved LTS. CONCLUSIONS: LTS of ext-DCR shows very good results, thus underlining its superiority to other surgical approaches. Special attention should be paid to diseases and previous surgical interventions on the nose and/or sinus that effect the lacrimal duct system. Therefore, a special committee of ENT physicians and ophthalmologists has been established at the Department of Ophthalmology, University Hospital Halle. From the surgical point of view, it is important to create an adequate mucosal anastomosis using lacrimal and nasal mucosa. Restoration is possible with lacrimal stent materials. The indication for ext-DCR was restricted by competition with transcanalicular endoscopic interventions to preserve physiological lacrimal drainage.

[Treatment of congenital lacrimal duct obstruction: A prospective clinical cohort study]. / Behandlung kindlicher Tränenwegsstenosen : Eine prospektive klinische Kohortenstudie.

BACKGROUND: Pressurized probing and irrigation is the method of choice for congenital lacrimal duct obstruction after conservative therapeutic strategies have failed. The aim of this study was to evaluate age dependence and success rates of different therapeutic options. MATERIAL AND METHODS: A prospective cohort study of children with congenital lacrimal duct obstruction was performed. All children treated during the period between May 2009 and June 2010 were included. Surgical success was defined as the absence of epiphora and mucous discharge for a postoperative follow-up of 3 months. Odds ratios (OR) and 95 % confidence intervals (CI) of different variables were estimated using logistic regression. RESULTS: A total of 111 children (137 eyes) underwent treatment for congenital lacrimal duct obstruction. The mean age of the children was 7.7 months (range 1-30 months). The success rate of probing under local anesthesia was 85.5 % (n = 100). Probing under general anesthesia without intubation of the lacrimal pathway was successful in 28.6 % (n = 2). Treatment under general anesthesia with intubation of the lacrimal pathway had a success rate of 94.2 %. If the primary treatment was complicated the OR was 1.9 (95 % CI: 0.7-5.1), for males the OR was 1.7 (95 % CI: 0.8-3.5) and in cases of a positive family history the OR was 1.5 (95 % CI: 0.7-3.3). With every increasing month of age the risk not to be treated successfully increased (OR: 1.3, 95 % CI: 1.2-1.5). CONCLUSION: Syringing under local anesthesia is an effective therapy. The highest success rates were found at the ages of 1-6 months. Therapy with additional silicone tube intubation was highly successful.