Early Endonasal Dacryocystorhinostomy for Acute Dacryocystitis: A Systematic Review and Meta-Analysis.

OBJECTIVE: The aim of this meta-analysis is to compare the outcomes of early endonasal dacryocystorhinostomy (DCR) with delayed DCR in the treatment of acute dacryocystitis (AD). METHODS: A comprehensive electronic search of PubMed, Embase, Web of Science, and the Cochrane Library databases was conducted up to November 11, 2023. Data synthesis was performed using Review Manager 5.4, and forest plots were generated for each outcome measure. Potential publication bias was assessed using funnel plots and Egger's test. RESULTS: Six studies involving 288 patients were included in the meta-analysis. Overall, the success rate of early endonasal DCR was comparable to that in the delayed DCR group (odds ratio [OR] = 1.52, 95% confidence interval [CI]: 0.81-2.85, P = .19). Furthermore, in comparison with the delayed DCR group, early endonasal DCR significantly reduced the time for medial canthus swelling resolution (mean differences [MD] = -4.92, 95% CI: -5.46 to 4-.37, P < .00001) and complete resolution of symptoms (MD = -17.70, 95% CI: -23.88 to -11.52, P < .00001). CONCLUSION: Primary early endonasal DCR seems to be a promising and favorable approach for managing AD with comparable efficacy and faster relief of symptoms compared to conventional delayed DCR.

The efficacy of endoscopic dacryocystorhinostomy in the treatment of dacryocystitis: A systematic review and meta-analysis.

BACKGROUND: This article aimed to discuss the efficacy and safety of endoscopic dacryocystorhinostomy (EDCR) versus external dacryocystorhinostomy (EX-DCR) for the treatment of dacryocystitis by meta-analysis. METHODS: All randomized controlled trials that met the inclusion and exclusion criteria were collected by searching the following databases: PubMed, Web of Science, China National Knowledge Infrastructure, and Wanfang, from the establishment of the database to June 2023. Meta-analysis was performed using Stata 17.0 software and review manager 5.4 software. In the collected trials, the observation group was treated with EDCR, whereas the control group was treated with EX-DCR. RESULTS: A total of 10 studies involving 969 patients were included in this analysis. There was a similar surgical success rate in the treatment of dacryocystitis between the 2 groups (RR = 1.021, 95% CI [0. 803, 1.297], P = 0. 865). However, compared with the control group, patients in the observation group had a higher total effective rate of treatment (RR = 1. 195, 95% CI [1. 063, 1.343], P = .003), and shorter operative time (WMD = -23.640, 95% CI [-35.533, -11.747], P < .001), and less intraoperative blood loss (WMD = -50.797, 95% CI [-80.339, -21.255], P = .001), shorter length of hospital stays (WMD = -4.570, 95% CI [-5.992, -3.148], P < .001), and lower incidence of adverse events (RR = 0.295, 95% CI [0.173, 0.504], P < .001). CONCLUSION: EDCR is an effective and safe surgical procedure for the treatment of dacryocystitis and can be used as an alternative to EX-DCR.

Analysis of the safety and effectiveness of endoscopic nasal dacryocystorhinostomy in the remedy of chronic dacryocystitis.

To estimate the safety and effectiveness of endoscopic nasal dacryocystorhinostomy in the remedy of chronic dacryocystitis. The clinical data of 105 subjects with chronic dacryocystitis enrolled into our hospital were analyzed retrospectively. The subjects were distinguished into nasal endoscopic group (endoscopic dacryocystorhinostomy; i.e., 51 cases) according to their surgical methods and external-route group (external-route dacryocystorhinostomy; i.e., 54 cases). The therapeutic effect, lacrimal gland secretion function, tear film stability, degree of epiphora, lacrimal passage patency, complications, and recurrence rate were contrasted between the 2 groups. The nasal endoscopic group exhibited a higher effective remedy rate (98.04%) compared with the external-route group (83.33%). Three months postoperation, both groups showed improvements in lacrimal gland secretion function and tear film stability, with the nasal endoscopic group demonstrating more significant enhancement in lacrimal gland secretion function than the external-route group. Six months postoperation, a reduction in the degree of epiphora was observed in both groups, with the nasal endoscopic group displaying a more pronounced decrease in epiphora severity and a higher lacrimal passage patency rate than the external-route group. Furthermore, the nasal endoscopic group experienced lower incidences of postoperative complications and recurrence rates. Endoscopic dacryocystorhinostomy is safe and effective in the remedy of chronic dacryocystitis.

The Whitnall Barrier: A Technique for the Management of Lacrimal Gland Prolapse.

BACKGROUND: The Whitnall barrier procedure, a modified Beer and Kompatscher surgical technique to reposition the lacrimal gland, is presented alongside a case series of patients demonstrating excellent aesthetic and functional outcomes. METHODS: The Whitnall barrier procedure is illustrated procedurally and accompanied by a case series of 20 consecutive patients treated in a single institution by a single surgical team between December of 2016 and February of 2020. Lid contour and function were assessed postoperatively, as was patient satisfaction. RESULTS: Thirty-seven eyes of 20 patients were included. All patients were women, with an average age of 50 years. Fourteen patients underwent surgery for cosmesis, four had inactive thyroid eye disease, and two had lacrimal gland enlargement secondary to dacryoadenitis. The degree of lacrimal gland prolapse was described as mild in two eyes and moderate in 35 eyes. All patients had one or more additional surgical procedures. Mean follow-up duration was 11 months, with complete resolution of lacrimal gland prolapse in 34 eyes. The patient who did not have complete resolution had dacryoadenitis and required ongoing immunosuppressive therapy. Two patients were discharged on topical lubricants: one with thyroid eye disease and one cosmetic patient who underwent upper and lower lid blepharoplasties at the same time. There were no intraoperative complications and no incidences of infection, dehiscence, or damage to the lacrimal gland ductules. CONCLUSIONS: The Whitnall barrier technique is a safe and effective surgical procedure to restore the anatomic location of the lacrimal gland. It provides excellent aesthetic and functional outcomes.

Transcutaneous (External) Dacryocystorhinostomy with Reconstruction of the Ductus nasolacrimalis. / Transkutane (externe) Dakryozystorhinostomie mit Rekonstruktion des Ductus nasolacrimalis.

BACKGROUND: Dacryocystorhinostomy (DCR) is regarded as the gold standard for the treatment of chronic dacryocystitis (CDC). Different modifications of the surgical procedure have been developed over the years. METHODS: Patients with CDC due to postsaccal lacrimal stenosis and under treatment with DCR have been included in this retrospective study. Two groups of different surgical procedures were analysed: firstly DCR without reconstruction of the ductus nasolacrimalis (DNL, group 1) and secondly patients with reopening the DNL (group 2). Criteria for success were absence of permanent epiphora, absence of inflammation of the lacrimal sac (functional success), and no recurrent surgery with free patency of the lacrimal duct (anatomical success). This was obtained by questionnaire after a follow-up of at least 12 months. The impact of gender, ectasia of the lacrimal sac, dacryoliths, and prior lacrimal surgeries was analysed. RESULTS: Overall, 248 surgeries were enrolled in this trial. Mean age in group 1 was 68 years (range: 22 to 92 years) and gender ratio was 3.2 to 1 (female : male). In that group, 68 operations could be followed up. In group 2, 62 operations on patients of a mean age of 63 years (range: 24 to 89 years) and a gender ratio of 2.9 to 1 (female : male) were observed. Complete success occurred in 75.0% in group 1 and 75.8% in group 2. Recurrent operations were necessary in one case of group 2 (1.6%) and 4 cases of group 1 (5.9%). Gender (group 1 p = 1; group 2 p = 0.115; between groups p = 0.511), ectasia of the lacrimal sac (group 1 p = 0.877; group 2 p = 0.674; between groups p = 0.878), dacryolith (group 1 p = 1; group 2 p = 0.465; between groups p = 1), and prior lacrimal surgery (group 1 p = 0.092; group 2 p = 0.051; between groups p = 0.520) did not influence the success rates in each group or between groups. Significantly more dacryoliths were found during operations of group 2 (p = 0.010). CONCLUSION: Reconstruction of the DNL during DCR is a possible and easy modification, with a slightly better success rate in curing CDC. Intraoperatively, dacryoliths might not be apparent remain in the deeper parts of the lacrimal ducts. Therefore, these segments should be inspected during surgery.

Comparison of the surgical outcomes of endoscopic dacryocystorhinostomy in chronic dacryocystitis with or without previous bicanalicular silicone tube intubation.

AIMS: To compare the outcomes of endoscopic dacryocystorhinostomy (En-DCR) in chronic dacryocystitis (CD) with or without previous bicanalicular silicone tube intubation (BSTI), and investigate whether previous BSTI influenced postoperative outcomes. METHODS: We conducted a retrospective review of medical records of CD patients (group A) who had previously undergone BSTI for nasolacrimal duct stenosis and an age- and sex-matched control group of CD patients (group B) without previous intubation receiving En-DCR from November 2017 to January 2022. Sixty-one patients (61 eyes) were included in group A and age- and sex-matched 122 patients (122 eyes) in group B. Dacryocystic parameters were measured by computed tomography-dacryocystography and surgical findings were recorded during surgeries. The surgical success rates of the two groups were compared at 12 months post-operation. RESULTS: The mean horizontal, sagittal, and vertical lengths were 6.06 ± 1.24, 6.03 ± 1.44, and 8.05 ± 2.00 mm, respectively, in group A and 6.33 ± 1.25, 6.26 ± 1.19, and 10.40 ± 2.45 mm, respectively, in group B. There were no differences in the horizontal or sagittal parameters between the two groups. The vertical parameter in group A was significantly lower than that in group B. Scar formation in the sac was observed in 54 patients in group A but was absent in group B. At 12 months postoperatively, the anatomical and functional success rates were 88.52 % and 85.25 %, respectively, in group A and 92.62 % and 89.34 %, respectively, in group B, with no difference between the two groups. CONCLUSION: Previous BSTI reduced dacryocyst vertical parameter and caused dacryocyst scar formation but did not affect postoperative En-DCR efficacy.

Long-term Follow-up Results of Primary Canaliculitis Patients.

Objectives: To evaluate the demographic characteristics, clinical presentation, microbiologic profile, and treatment results of patients with primary canaliculitis. Materials and Methods: Patients diagnosed and treated for primary canaliculitis between May 2014 and May 2021 were analyzed retrospectively. Results: There were 26 patients with primary canaliculitis, including 17 females (65.4%) and 9 males (34.6%) with a mean age of 50.6±16.4 years (range: 9-80 years). Canaliculitis affected the right eye in 11 patients, the left eye in 13 patients, and bilateral involvement was seen in 2 patients. Inferior canaliculus involvement was more frequent (73%). The most common complaint was epiphora (46.1%). Five patients (19.2%) were wrongly diagnosed as chronic conjunctivitis. The time interval between the beginning of symptoms and canaliculitis diagnosis was 18.2±14.3 months (range: 1-60 months). Canaliculotomy and curettage of canalicular content with dacryolith removal were performed in 23 patients. After surgery, antibiotic irrigation of the canaliculus was added to the treatment regimen in 12 of these 23 patients. Intracanalicular antibiotic therapy was administered to the remaining 3 patients. The most cultured organism was Actinomyces (6 patients). Gemella (1 patient), Porphyromonas (1 patient), Candida parapsilosis (1 patient), Citrobacter koseri (1 patient) were also grown in culture. The follow-up time of patients was 26.2±23.7 months (range: 6-83 months). All symptoms and findings resolved in all patients in one month. In two patients, recurrence occurred at 4 and 16 months after surgical treatment. With appropriate treatment, no further recurrence was seen in either patient over 24-month follow-up. One patient presented with iatrogenic canaliculus blockage during follow-up. Conclusion: Primary canaliculitis is often overlooked and can be misdiagnosed. The most common symptom was epiphora. All patients with epiphora and chronic conjunctivitis should be examined carefully for canaliculitis.

Microbial distributions in the conjunctiva and lacrimal sacs of patients with chronic dacryocystitis in a tertiary hospital.

BACKGROUND: The aim was to clarify the distributions of bacteria in the conjunctival sac and lacrimal sac in patients with chronic dacryocystitis. METHODS: In total, 297 (322 eyes) chronic dacryocystitis patients who underwent nasal endoscopic dacryocystorhinostomy (EN-DCR) were included. Conjunctival sac secretions from the affected eye were collected preoperatively, and lacrimal sac retention fluid from the affected side in the same patient was collected intraoperatively. Bacterial culture and drug sensitivity testing were performed to determine bacterial distributions. RESULTS: In total, 127 bacterial isolates (49 species) were detected in 123 eyes in the conjunctival group, with a positivity rate of 38.2% (123/322); 85 bacterial isolates (30 species) were detected in 85 eyes in the lacrimal sac group, with a positivity rate of 26.4% (85/322). The positivity rates were significantly different (P = 0.001) between two groups. The gram-negative bacilli proportion in the lacrimal sac group (36/85, 42.4%) was significantly higher than that in the conjunctival sac group (37/127, 29.2%) ( P = 0.047). Positive conjunctival sac secretion culture (123/322) was significantly associated with increased ocular secretion (281/322, 87.3%) (P = 0.002). Among the culture-positive bacteria in the conjunctival sac group and the lacrimal sac group, 30/127, 23.6% and 43/127, 26.7% and 21/85, 24.7% and 20/85, 23.5% were resistant to levofloxacin and tobramycin, respectively. CONCLUSIONS: This study illustrated differences in bacterial distributions between conjunctival sac secretions and retained lacrimal sac fluid in chronic dacryocystitis patients, with a higher proportion of gram-negative bacilli in lacrimal sac secretions. The ocular surface flora in chronic dacryocystitis patients is partially resistant to levofloxacin and tobramycin, which need to be considered by ophthalmologists.

Hallazgos nasosinusales por tomografía computada en dacriocistitis crónica pediátrica.

OBJECTIVE: To evaluate the preoperative tomographic characteristics of the nose and paranasal sinuses of children with chronic dacryocystitis. METHOD: Prospective, observational, cross-sectional, and descriptive study. CT scans of the paranasal sinuses of patients candidates for endoscopic dacryocystorhinostomy were evaluated for two years. Demographic characteristics, radiological findings, inflammatory processes and anatomical variants were identified using the Lund-Mackay classification. Statistic analysis. Stata 10.0, descriptive analysis, Student's t: mean difference and χ2. Logistic studies to estimate the probability between variables. RESULTS: 27 men and 11 women (n = 38) were included. Of these, 22 had unilateral and 16 bilateral nasolacrimal duct involvement. Lund-Mackay score range: 2-20. Eleven patients had associated pathology. The most affected were anterior and maxillary ethmoidal sinus (69%), osteomeatal complex (68%), posterior ethmoidal (51%). Patients with severe rhinosinusitis are 12 times more likely to develop dacryocystitis than patients with < 12 points. Men presented greater severity, affectation, and clinical repercussion. CONCLUSIONS: There is radiological rhinosinusal involvement in dacryocystitis, which must be evaluated and treated preoperatively to avoid postoperative complications or reinfections.

OBJETIVO: Evaluar las características tomográficas preoperatorias de la nariz y los senos paranasales de niños con dacriocistitis crónica. MÉTODO: Estudio prospectivo, observacional, transversal y descriptivo. Se evaluaron tomografías de senos paranasales de pacientes candidatos a dacriocistorrinostomía endoscópica, durante 2 años. Se identificaron características demográficas, hallazgos radiológicos, procesos inflamatorios y variantes anatómicas, utilizando la clasificación Lund-Mackay. Análisis estadístico con Stata 10.0, análisis descriptivo con t de Student: diferencia medias y χ2. Estudios logísticos para estimar la probabilidad entre variables. RESULTADOS: Se incluyeron 27 hombres y 11 mujeres (n = 38). De ellos, 22 tenían afección del conducto nasolagrimal unilateral y 16 bilateral. Rango de puntuación de Lund-Mackay: 2-20. Once pacientes tuvieron patología asociada. Seno etmoidal anterior y maxilar más afectados (69%), complejo osteomeatal (68%), etmoidal posterior (51%). La probabilidad de que los pacientes con rinosinusitis grave puedan presentar dacriocistitis es 12 veces mayor que en los pacientes con < 12 puntos. Los hombres presentaron mayor gravedad, afectación y repercusión clínica. CONCLUSIONES: Existe afección rinosinusal radiológica en la dacriocistitis, que debe ser evaluada y tratada en el preoperatorio para evitar complicaciones o reinfecciones posquirúrgicas.

Efficacy of Hyaluronic Acid in Endoscopic Dacryocystorhinostomy: A Systematic Review and Meta-Analysis.

OBJECTIVE: The aim of this meta-analysis is to compare the surgical results of endoscopic dacryocystorhinostomy (Endo-DCR) for chronic dacryocystitis (CD) with and without intraoperative hyaluronic acid (HA) application. METHODS: An electronic literature search was performed using the PubMed, Embase, Cochrane Library, CNKI, and Wan Fang databases in April 1, 2022. Review Manager software version 5.4 was used for data synthesis and a forest plot was generated for each outcome measure. RESULTS: Seven randomized control trials (RCTs), which involved 739 eyes, were included in this meta-analysis. Overall, compared with the control group, intraoperative HA application significantly enhance the success rate (odds ratio [OR] = 3.27, 95% confidence interval [CI]: 2.15-4.98, P < .00001), promote re-epithelization (OR = 2.93, 95% CI: 1.83-4.68, P < .00001), reduce granulation (OR = 0.41, 95% CI: 0.21-0.80, P = .008), and scar (OR = 0.39, 95% CI: 0.22-0.68, P = .001) formation after Endo-DCR. CONCLUSION: Intraoperative HA application seems to be a useful adjuvant that could enhance success rate by promoting re-epithelization and inhabiting granulation and scar formation around the ostium.

Outcome of transcanalicular laser dacryocystorhinostomy with endonasal augmentation in acute versus post-acute dacryocystitis.

OBJECTIVE: To study the outcomes of transcanalicular laser dacryocystorhinostomy (TCL-DCR) with endonasal augmentation in acute versus post-acute dacryocystitis and compare it with external DCR in post-acute settings. METHODS: A prospective, randomised study was conducted in 90 adult cases of Acute dacryocystitis. All the patients were started on systemic antibiotics and a 4 mm × 4 mm osteotomy was created using TCL-DCR. The osteotomy was enlarged to 8 mm × 8 mm by endonasal augmentation at the same sitting in group 1, after 10 days in group 2 and after 10 days with external DCR in group 3. The cases were assessed for symptomatic relief and complications. Success was defined as functional and anatomical patency at 36 months. RESULTS: The mean age was 45.33 ± 15.06 years and the male: female ratio was 1:2. The presenting complaints were painful swelling (100%), epiphora or discharge (88.8%), fistula (33%) and fever (6%). The average number of acute episodes was 2.96. The intra-group pain reduction from day 1 to day 4, was significant in all three groups (p = 0.000). Intra-operative (p = 0.015, χ2 = 8.37) and post-operative complications (p = 0.002, χ2 = 0.002) were higher in group. Anatomical success was achieved in all the three groups, however, the functional success in Group 3, Group 2 and Group 1 was 100%, 86.7% and 66.7% respectively (p = 0.002, χ2 = 12.86). CONCLUSIONS: The creation of osteotomy using TCL-DCR provides early relief in symptoms. Single-stage surgery in inflamed tissues is associated with higher complication rates. External DCR in post-acute settings gives the best outcomes with minimal complications, endoscopic augmentation requires a close follow-up.

Endoscopic and radiological evidence refuting intra-abscess septae.

PURPOSE: To investigate the presence of septae within the lacrimal abscess and to explore simple aspiration as an alternative to the traditional management by incision and drainage. METHODS: Prospective, interventional pilot study involved eight lacrimal sac abscesses of eight patients over a period of three months. All patients underwent a pre-operative MRI with surface coils followed by aspiration of the abscess (n = 4) or incision and drainage of the abscess (n = 4). An intra-sac endoscopic evaluation was performed during the abscess drainage. Primary outcome measures - presence or absence of septae on MRI scan images and endoscopic evaluation of the abscess cavity. Secondary outcome measures - relief from pain and symptoms following aspiration and anatomical patency following definitive management. RESULTS: Eight patients underwent either aspiration (n = 4) or incision and drainage of the abscess (n = 4). Mean age of the patients 43.3 years and male to female ratio was 1:1. Left eye involvement was more common (Right: left = 1:3). Average duration of acute symptoms - 3.75 days. High resolution MRI showed a well- defined abscess cavity with few undulations which on endoscopic evaluation correlated with oedematous mucosal folds. There was absence of a loculi or septae within the abscess cavity. Definitive surgery in the form of endoscopic DCR was performed for all the patients with post-operative FICI grading was +5. CONCLUSION: The present study refutes the presence of septae within the abscess cavity and proposes aspiration of the lacrimal sac abscess as a minimally invasive procedure with minimal logistics and a shallow learning curve.

Anterior Segment Optical Coherence Tomography for Canaliculitis.

Canaliculitis is an uncommon inflammation of the lacrimal canaliculi, and it is often misdiagnosed as conjunctivitis or dacryocystitis. There are no gold-standard methods to diagnose canaliculitis, therefore newer methods such as ulrasound biomicroscopy are being introduced. Anterior segment optical coherence tomography (OCT) is being utilized to evaluate punctum and canaliculus, but no previous study has applied anterior OCT for canaliculitis. One case of canaliculitis with canaliculith was diagnosed by anterior segment OCT noninvasively, by successful detection of canaliculith. Pouting of the punctum and detection of canaliculith as hyper-reflective signals by OCT were checked, which was impossible with other conventional methods. Surgical incision and drainage confirmed the presence of stones. This article is meaningful as a first study about the diagnosis of canaliculitis with canaliculith using anterior segment OCT. Presence of canaliculith in vertical canaliculus, and the status of punctal epithelium and canalicular mucosa was possible in this study.

A prospective study comparing mini-invasive and conventional canaliculotomy of punctum-sparing canaliculotomy for primary canaliculitis treatment.

PURPOSE: To compare outcomes of mini-invasive canaliculotomy with those of conventional canaliculotomy conducted using the punctum-sparing approach for the treatment of primary canaliculitis. METHODS: A prospective, comparative, and interventional case series study was conducted on 118 individuals with unilateral inferior primary canaliculitis. These patients were randomly divided into two groups, each with 59 cases. Group A underwent mini-invasive canaliculotomy (minor incision ~3 mm), whereas group B received conventional canaliculotomy (long incision ~6-8 mm). Punctum-sparing and canaliculus-reconstructing procedure was used to treat all patients. Both groups had silicone tube intubations and were retained in the lacrimal passages for one month. Both groups' surgical success rates and postoperative complications were measured at the last follow-up of 12 months after surgery. RESULTS: A total of 108 patients were finally included in the study, 53 in group A and 55 in group B. There were 79 females and 29 males with a median age of 57 ± 13.4 years. The anatomical success rates for groups A and B were 96.2% and 92.7% (P = 0.679), respectively. Functional success rate was accomplished by considerably more patients in group A (50/53, 94.3%) compared to group B (45/55, 81.8%) (P = 0.046). No recurrences were seen during follow-up visits in any of the participants. CONCLUSIONS: The two procedures employed in this study to treat primary canaliculitis achieves excellent clinical effects with no incidence of recurrence. The mini-invasive canaliculotomy is worthy to be recommended for its higher functional success rate with mini-invasion of canaliculus and intact lacrimal punctum.

Epstein-Barr virus-related dacryocystitis: a case report.

BACKGROUND AND OBJECTIVE: Acute dacryocystitis is an atypical and rare manifestation of pediatric mononucleosis still widely underdiagnosed in clinical practice. We report this rare condition and describe challenges in its diagnosis and treatment on the basis of a presented case. CASE PRESENTATION: A 6-year-old Caucasian girl without any ophthalmic history was admitted for right preseptal cellulitis requiring intravenous antibiotic therapy. During hospitalization, she developed a fluctuating lump in the nasolacrimal region which resembled an abscess, both clinically and radiologically. There was no spontaneous purulent discharge. Serology was positive for acute mononucleosis and Epstein-Barr virus-related dacryocystitis was diagnosed. Following multidisciplinary discussion, she was treated conservatively with digital lacrimal sac massages and intravenous antibiotic therapy with an excellent outcome. DISCUSSION: This rare form of Epstein-Barr virus is poorly documented in the literature, and thus barely known. As initial symptoms are nonspecific (rhinitis, fever, eyelid edema and erythema lack of purulent discharge, and moderate bilateral cervical lymphadenopathy), diagnosis is often difficult. Nevertheless, differentiating between dacryocystitis and abscess is crucial to select the appropriate treatment and avoid unnecessary, potentially harmful surgery. Conservative management of dacryocystitis appears to be the gold standard of treatment. CONCLUSION: Acute dacryocystitis in children free of ophthalmic history should raise suspicion of primary Epstein-Barr virus infection. With conservative treatment, prognosis appears to be excellent; therefore, surgery should be avoided as much as possible.

Explainable Prediction of Dacryocystitis From Noninvasive Ocular Indicators Using Deep Stacked Network and The Shapley Additive Explanations Approach.

ABSTRACT: Dacryocystitis diagnosis is important for preventing rapid blurring and vision loss. Existing state-of-the-art methods focus on routine clinical examinations and objective scattering index-based statistical analysis. Such approaches are invasive operations or lack quantitative indicators, and their application is limited. in addition, little attention has been paid to the explainability and clinical utility of models. This paper proposes an explainable dacryocystitis prediction model from noninvasive ocular indicators. The proposed model is based on an deep stacked network with 4 improvements: a multivariable feature extraction module, obtaining comprehensive predictive factors including the quantitative ocular indictors, conventional texture features, and deep learning features from shallow to deep convolutional layers; a multifeature fusion and attribute selection module based on the ReliefF method, guiding the network to focus on useful information at variables; Decision curve analysis the model is introduced into the model to evaluates the risks and benefits; and appending a SHapley Additive exPlanations (SHAP) module to the framework to automatically and efficiently interpret the prediction of the models. By integrating the above improvements in series, the models' performances are gradually enhanced. Real labeled data samples are used to train and test the model, and our model achieves high accuracy and reliability.

Microdebridement of Intranasal Cysts Associated With Congenital Dacryocystoceles.

PURPOSE: The surgical management of congenital dacryocystoceles has evolved in recent decades. The aim of this study was to explore the effectiveness of endoscopic examination and powered microdebridement in the management of nasal cysts associated with congenital dacryocystoceles. METHODS: In this retrospective case series, all patients with congenital dacryocystoceles who underwent surgical intervention under general anesthesia at a single institution over a 12-year period (2009-2020) were included. RESULTS: Thirty-seven lacrimal drainage systems from 29 patients were included, 8 patients (28%) had bilateral dacryocystoceles. Twenty-two (76%) were females, and 5 (17%) patients had a history of prematurity. Mean (±SD) age at diagnosis was 15 ± 28 days, and 1.4 ± 1.7 months at surgical intervention. Mean follow-up was 7.5 months. The right side was more commonly involved (20 [69%] OD vs. 17 [59%] OS). Dacryocystitis was diagnosed at presentation in 23 lacrimal drainage systems (62%). Intraoperatively, intranasal cysts were observed in 32 lacrimal drainage systems (86%), and a powered microdebrider was used to excise each cyst. In 6 of the 21 supposed unilateral cases (29%), a contralateral cyst was identified and treated. The average birth age of patients with intranasal cysts was 39 weeks versus 36 weeks of patients without ( p = 0.03). Surgical success was found in 36 of 37 sides treated (97%); one case (3%) underwent unilateral endoscopic dacryocystorhinostomy during the follow-up period due to persistent symptoms. CONCLUSIONS: Congenital dacryocystoceles are associated with intranasal cysts in most cases. Surgical intervention with microdebrider is associated with a favorable outcome. Bilateral endonasal examination is ideal in all cases.

Factors involved in the success and failure of endoscopic dacryocystorhinostomy from our experience.

INTRODUCTION: Chronic dacryocystitis is the condition secondary to permanent lacrimonasal duct stenosis (LNDS) that generates epiphora and recurrent conjunctivitis. Endoscopic dacryocystorhinostomy (EDCR) is a more natural route than the external route and offers higher success rates than the laser technique. We value this centre's experience in this procedure. PATIENTS AND METHODS: A retrospective review was carried out in our centre of the medical records of adult patients undergoing EDCR due to LNDS between 1995 and 2019. The minimum follow-up period required after surgery was 6 months. RESULTS: Over 297 months, 167 EDCR procedures were performed on 156 patients, with an average age of 65.7 ±â€¯11.6 years and a male/female ratio of 1/1.98. The functional improvement was 86%, with an anatomical success rate of 87%. Lack of clinical improvement statistically significantly correlated with the age of the patient and the time since onset of the LNDS, the presence of concomitant systemic (especially diabetes mellitus) or ophthalmological disease, the intraoperative finding of a thickened tear sac and absence of drainage of the tear sac when marsupialised. Longer-term stent carriers in the rhinostomy had poorer outcomes. There were no postoperative complications of interest. CONCLUSIONS: EDCR is an effective and safe technique, based on stable anatomical references. Failure rate seems to be multifactorial and should be considered in older, multipathological patients, with a long duration of the condition.

Dacryocystitis in dogs caused by foreign bodies-Diagnosis and therapy in 14 Cases.

OBJECTIVE: To describe foreign bodies (FBs) in the nasolacrimal sac of dogs, the history, and simple diagnostic and therapeutic approaches. Animals studied Fourteen dogs of different breeds, ages, and sexes were presented with unilateral dacryocystitis and had been treated without success for over 1-8 months. PROCEDURES: Patient history, including prior treatment, was obtained from medical records. Slit-lamp examination was performed in all cases (SL 17, Kowa Company Ltd.). Jones tests 1 and/or 2 were performed in 13/14 cases. Dacryocystotomy was initiated with an incision into one canaliculus until the lacrimal sac was exposed and could be explored. After extracting the FB from the nasolacrimal sac, the surgical wound and canaliculus were left open. Aftercare included the administration of antibiotic eye drops with or without dexamethasone and systemic analgesia. RESULTS: All 14 dogs were mesocephalic. Four of them were Dachshunds. Dacryocystotomy revealed plant-related FBs in all cases. The purulent discharge disappeared immediately after removal and did not recur during follow-up. CONCLUSIONS: A simple dacryocystotomy is recommended for dogs with a strong suspicion of a foreign body in the lacrimal drainage system. Dacryocystorhinography appears to be an optional tool in these cases.

Diagnosing an atypical case of tuberculosis presenting as dacryocystitis: Sac biopsy and GeneXpert.

Objective: To present an atypical case of tuberculous dacryocystitis. Method: An adult female presented with long standing epiphora with gradual swelling over lacrimal sac region. On syringing, water was felt in throat with no regurgitation. CT-DCG and CECT orbit were done subsequently and simultaneously. Ill-defined, enhancing soft tissue surrounding and involving the lacrimal sac wall was identified. The sac wall outline was seen distorted with contrast in NLD. The histopathology was suggestive of non-specific chronic inflammation. GeneXpert analysis was shown to be very low positive for M. tuberculosis. Montoux test was strongly positive (40 x 40 mm). ATT was started. Results: The swelling and watering subsided over the next few months. Conclusion: Tuberculosis should be considered in cases of chronic granulomatous dacryocystitis. CECT with CT-DCG is essential imaging. GeneXpert is a new and sensitive tool with considerable specificity in cases in which histopathology is not conclusive. ATT is curative and DCR is reserved for only unresolved NLDO with persistent epiphora.