Evaluation of Bicanalicular Nasolacrimal Duct Intubation as an Adjunct in Surgical Ectropion Correction.

Background and Objectives: We aimed to analyze and compare the outcomes of conventional ectropion surgery procedures with and without concurrent bicanalicular nasolacrimal duct intubation to identify if the combination of procedures could serve as a novel surgical approach to treat lower eyelid ectropion. Materials and Methods: A retrospective review of all patients who underwent surgical correction for lower eyelid ectropion at the Cantonal Hospital of Aarau between January 2019 and December 2020 was performed. Patient medical records were examined for etiology, surgical correction technique and intra- and postoperative complications. The postoperative punctal position, the pre- and postoperative epiphora and reoperation rate were also documented. Two study groups consisting of cases with isolated and combined procedures were compared, with respect to postoperative punctual and lower lid position. Results: A total of 53 lower eyelids (35 patients) were included in this study. Six months postoperatively, the correct punctum position (p = 0.1188) and improvement of epiphora (p = 0.7739) did not significantly differ between the two groups. More complications were seen in the nasolacrimal duct intubation group (p = 0.0041), which consisted of cheese wiring and one tube dislocation. Conclusion: In our study, bicanalicular nasolacrimal intubation during ectropion surgery does not seem to improve the outcome of ectropion surgery and is, therefore, not recommended on a routine basis.

[Rare cases of lacrimal stent dislocation]. / Redkie sluchai dislokatsii lakrimal'nogo implantata.

Intubation of lacrimal passages is a relatively frequent procedure performed as either independent intervention, or as a part of a complex surgery. Although complications after intubation of lacrimal passages occur rarely, and their detailed description is easily found in literature, cases of stent dislocation often become difficult for the surgeon. The article presents two clinical cases belonging to the type of lacrimal stent dislocation not previously described in literature. In the first case, intrapalpebral arc of the stent was in the right position, while its nasal ends could not be found in the nasal cavity. Endoscopic stent reposition was performed using an endoscope with a 30-degree viewing angle. In the second case, intrapalpebral arc of the stent could not be determined, but its heel was removed from the lover nasal passage using an endoscope. This seems to have been preceded by intraluminal disruption of stent's integrity. The authors also analyze cases of lacrimal stent dislocation described in literature and reach a conclusion that endonasal endoscopy with the application of optics with different viewing angles is suitable for efficient visualization of a dislocated lacrimal stent and its reposition.

[Selection of optimal method of general anesthesia for intubation of nasolacrimal duct in young children]. / Vybor optimal'nogo metoda obshchei anestezii pri zondirovanii sleznogo kanala u detei mladshego vozrasta.

PURPOSE: comparative assessment of safety and clinical efficacy of Sevoflurane and Halothane in general anesthesia for nasolacrimal duct intubation in children. MATERIAL AND METHODS: Clinical results of nasolacrimal duct intubation in 288 children with persistent obstruction of tear duct were analyzed. A newly developed method of general anesthesia in the supine position was used for all cases. General anesthetic Phthorothanum was used in 146 children; general anesthesia with Sevoflurane - in 142 children. RESULTS AND DISCUSSION: A new safe and efficient method of general anesthesia for nasolacrimal duct intubation was developed. In the first group, aspiration complications (coughing) occurred in 7 patients under the age of 1 year and short apnea - in 2 children. In the second group, depression of respiration was seen in a three-year-old child caused by the action of the anesthetic, and coughing - in one patient under the age of 1 year during the final phase of intubation. CONCLUSIONS: The newly developed method of general anesthesia in the supine position with oropharyngeal aspiration for nasolacrimal duct intubation in children was effective because it helped avoid aspiration complications at a more physiological position (on the back) in children of both groups. Comparative analysis of safety and efficacy of mask anesthesia with Sevoflurane and Halothane for nasolacrimal duct intubation in children in the supine position showed Sevoflurane to be more preferable. The advantages of Sevoflurane anesthesia for nasolacrimal duct intubation in children in the supine position are higher anesthesia induction speed, absence of respiratory tract irritation, cardiodepressive effects or suppression of laryngeal reflexes, and minimum time between the end of anesthesia and awakening.

Analysis of Lacrimal Duct Morphology from Cone-Beam Computed Tomography Dacryocystography in a Japanese Population.

Purpose: The dacryoendoscope is a practical instrument for the examination and the treatment of lacrimal duct obstruction. Nevertheless, as it is a rigid fiberscope, manipulation of the endoscope is somewhat affected by the patient's lacrimal duct alignment and the skeletal structure of the face. The morphology and inclination of the lacrimal duct vary among individuals and ethnic groups. We aimed to evaluate the alignment of the lacrimal duct from the perspective of endoscopic maneuverability in a Japanese population. Methods: This retrospective study analyzed the cone-beam computed tomography dacryocystography (CBCT-DCG) images of 102 patients diagnosed with unilateral primary acquired nasolacrimal duct obstruction (PANDO) at Ehime University Hospital from December 2015 to May 2021. The following parameters of the lacrimal duct on the contralateral side of unilateral PANDO were investigated: (1) angle formed by the superior orbital rim-internal common punctum-nasolacrimal duct opening, (2) angle formed by the lacrimal sac and the nasolacrimal duct, (3) length of the lacrimal sac, and (4) length of the nasolacrimal duct. Results: Measurements of the above parameters were (1) 10.2° ± 7.8° (range, -11° to +27°), (2) -6.3° ± 14.1° (range, -43° to +40°), (3) 8.9 ± 2.3 mm (range, 4.3-17.1), and (4) 13.2 ± 2.7 mm (range, 5.7-20.7), respectively. The Shapiro-Wilk test demonstrated that the values of all parameters, except (3), followed a normal distribution (p = 0.55, 0.30, 0.0002, and 0.39, respectively). No significant difference was found between the female and male groups (p > 0.05). Conclusion: This study reported anthropometric analysis data of the morphology of the lacrimal ducts using CBCT-DCG in a Japanese population. In our cohort, the line from the superior orbital rim through the internal common punctum to the nasolacrimal duct opening inclined anteriorly in 92% of the patients.

Insertion of a preloaded Monoka™ stent for congenital nasolacrimal obstruction: Intraoperative observations. A preliminary study.

STUDY OBJECTIVE: To study the intraoperative deployment of a pre-loaded probe for a "pushed" monocanalicular nasolacrimal intubation. STUDY DESIGN: Non-randomized study of consecutive cases. MATERIALS AND METHODS: Description: A classical Monoka™ silicone stent with the silicone tube attached at right angles to the punctal plug is contained entirely inside an introducer connected to a piston. Insertion: The procedure begins with intubation of the nasolacrimal duct with the metallic introducer. Traction on the piston retracts the metallic introducer inside the handpiece. This relative shortening progressively ejects the stent, starting with its free end at the bottom of the introducer. The operation was observed endoscopically under single-blind conditions. RESULTS: Twenty-eight preloaded Monoka™ stents were placed consecutively, in 28 congenital nasolacrimal duct intubations in 22 patients (28 sides). Endoscopic examination showed that the free part of the stent was progressively ejected from the introducer during retraction of the piston. Insertion of this pushed stent into the nasal cavity was effective in 23/28 cases (82.1%). A total of 28 preloaded stent insertions were attempted and 23 were correctly deployed. DIFFICULTIES ENCOUNTERED: At the end of nasolacrimal duct intubation, contact between the punctal plug and the lacrimal punctum was problematic in four cases (4/28=14.2%). At the beginning of stent placement, premature ejection of the punctal plug within the end of the introducer occurred in five cases (5/28=17.8%). These five stents failed to insert properly into the nasal cavity. At the end of insertion, retention of the punctal plug in the introducer occurred in two cases (2/28=7.1%). COMPLICATIONS: No cases of intraoperative or postoperative epistaxis were observed. CONCLUSIONS: Intraoperative nasal endoscopy validated the concept of the preloaded Monoka stent and its deployment. Reproducibility and improved reliability may require a change in stenting technique and a design modification.

Preventing silicone tube extrusion after nasolacrimal duct intubation in children.

Herein we report our experience with a simple technique for reducing the rate of silicone tube extrusion after nasolacrimal duct (NLD) intubation for congenital NLD obstruction. Medical records of children older than 2 years, with or without history of failed probing, who had undergone NLD intubation with a Crawford silicone tube over a period of 4 years were reviewed. In all subjects, one end of the Crawford tube was passed through a piece of scalp vein tubing followed by applying one or two knots. All Crawford tubes were removed after 3 months. Main outcome measures included complications such as tube extrusion, nasal discharge, crust formation and pyogenic granuloma formation. Fifty-seven patients, including 49 unilateral and 8 bilateral cases with mean age of 3.8±1.6 (range, 2 to 11.5) years were operated. No complications such as tube dislodgement, significant nasal discharge, crust or pyogenic granuloma formation occurred prior to Crawford tube removal. All silicone tubes were successfully removed from the nasal cavity. In conclusion, passing one end of the Crawford tube through a small piece of scalp vein tubing before knotting it in the nasal cavity seems to decrease the rate of tube extrusion which is the most common complication following NLD intubation in children.