1/125. Reduction of nasal orbital fractures and simultaneous dacryocystorhinostomy.A technique for restoration of structure and function in naso-orbital fractures has been described. Three case reports demonstrate a few of the final results. The case reports also indicate that many of these fractures require late definitive surgery in spite of optimal surgical treatment immediately subsequent to injury.- - - - - - - - - - ranking = 1keywords = duct (Clic here for more details about this article) |
2/125. Lacrimal bypass surgery in patients with sarcoidosis.PURPOSE: To examine the results of lacrimal bypass surgery in patients with sarcoidosis. methods: patients with sarcoidosis who underwent dacryocystorhinostomy (DCR) or conjunctivodacryocystorhinostomy (CDCR) in two practice settings from 1986 through 1995 were identified and their medical records reviewed. RESULTS: Twelve patients, of whom eight were women, underwent bilateral DCR or CDCR to treat nasolacrimal duct obstruction associated with sarcoidosis. The initial diagnosis of sarcoidosis was established in four patients from a biopsy specimen obtained during DCR. The ages of the patients at diagnosis of sarcoidosis ranged from 39 to 64 years (mean, 49.6 years; median, 45.5 years), whereas their ages at the time of surgery ranged from 42 to 72 years (mean and median, 55 years). The average duration of postoperative follow-up evaluation was 44 months (median, 38.5 months; range, 10 to 82 months). All patients received local corticosteroids postoperatively, and nine patients (75%) were treated with prednisone. Of the 24 lacrimal procedures, 23 (95.8%) were patent to irrigation at the last follow-up examination, and all patients were asymptomatic. CONCLUSION: Lacrimal drainage obstruction may be the initial manifestation of sarcoidosis, and tissue obtained during DCR may help to establish the diagnosis. A successful surgical outcome may require intensive and occasionally long-term therapy with local and systemic corticosteroids.- - - - - - - - - - ranking = 211.47319447585keywords = duct obstruction, obstruction, duct (Clic here for more details about this article) |
3/125. Lacrimal canaliculitis.Lacrimal canaliculitis is an infection of the lacrimal duct system. The classic features of lacrimal canaliculitis are mild to severe swelling of the canaliculus, mucopurulent discharge from the punctum, and a red, pouting punctum. Canaliculotomy with systemic or topical antibiotics is the most appropriate treatment for this disorder.- - - - - - - - - - ranking = 0.25keywords = duct (Clic here for more details about this article) |
4/125. nasolacrimal duct obstruction and orbital cellulitis associated with chronic intranasal cocaine abuse.OBJECTIVE: To report the association of acquired nasolacrimal duct obstruction and orbital cellulitis in patients with a history of chronic intranasal cocaine abuse. methods: Retrospective, consecutive case series. Results of imaging, histopathologic examinations, and clinical courses of these patients were studied. RESULTS: Five women and 2 men (mean age, 41 years) with a history of chronic intranasal cocaine abuse (mean, 11 years; range, 5-20 years) presented with epiphora and in some cases acute onset of periorbital pain, edema, and erythema associated with fever. The suspicion of intranasal cocaine abuse was made on anterior rhinoscopy with the detection of an absent nasal septum and inferior turbinate. Computed tomographic and magnetic resonance imaging findings in 4 patients included extensive bony destruction of the normal orbital wall architecture, opacification of the sinuses, and the presence of an intraorbital tissue mass. Histopathologic examination of the nasolacrimal duct in 2 patients and of the orbital mass in a third patient revealed marked chronic inflammation with fibrosis causing secondary nasolacrimal duct obstruction. Six patients were treated with systemic antibiotics followed by dacryocystorhinostomy in 3 patients, and a pericranial flap to insulate the exposed orbit in 1 patient. CONCLUSIONS: Chronic intranasal cocaine abuse can result in extensive bony destruction of the orbital walls with associated orbital cellulitis, and should be included in the differential diagnosis of acquired nasolacrimal duct obstruction. Anterior rhinoscopy is very helpful in establishing the correct diagnosis in these patients.- - - - - - - - - - ranking = 1476.7336652447keywords = duct obstruction, obstruction, duct (Clic here for more details about this article) |
5/125. nasolacrimal duct obstruction secondary to ectopic teeth.OBJECTIVE: To describe two patients with nasolacrimal duct obstruction (NLDO) caused by ectopic eruption of teeth. The literature concerning nasal and other unusual ectopic sites of tooth eruption is reviewed. DESIGN: Two interventional case reports and literature review. PARTICIPANTS: A 3-year-old girl with epiphora and recurrent dacryocystitis of the right eye. Previous medical and surgical management was unsuccessful. A 32-year-old female with a long history of right eye discomfort and epiphora. Previous examinations and workup were negative. INTERVENTION: A computed tomographic (CT) scan of the orbits and sinuses was performed in both patients. The ectopic teeth were surgically removed. MAIN OUTCOME MEASURES: Nasolacrimal system function and response to treatment at the last follow-up were recorded. RESULTS: In the first patient, CT imaging disclosed two teeth within the right inferior meatus compressing the nasolacrimal duct. In the second patient, CT revealed a large dental structure in the maxillary sinus compressing the nasolacrimal duct. Endoscopic tooth extraction and nasolacrimal duct probing in the first patient and surgical removal of the dental structure in the second patient effected complete resolution of symptoms. Both patients were symptom free at last follow-up. CONCLUSIONS: These cases suggest that ectopic eruption of teeth should be added to the differential diagnosis of NLDO. Surgical removal of the ectopic teeth compressing the nasolacrimal duct results in resolution of the lacrimal drainage obstruction.- - - - - - - - - - ranking = 1056.1781460443keywords = duct obstruction, obstruction, duct (Clic here for more details about this article) |
6/125. Lacrimal drainage surgery in Wegener's granulomatosis.AIM: To examine the results of open lacrimal surgery in patients with Wegener's granulomatosis. methods: A retrospective review of patients with Wegener's granulomatosis who underwent lacrimal surgery over a 17 year period. RESULTS: 11 patients were identified and a total of 14 primary dacryocystorhinostomies (DCR) and one revisional DCR were performed; symptomatic relief was achieved in 13/14 operations and one patient required revisional surgery for persistent symptoms. There were no intraoperative and few postoperative complications. CONCLUSIONS: In contrast with some previous reports, open DCR appears to be a safe procedure and it is recommended as a treatment for lacrimal obstruction in patients with Wegener's granulomatosis, but an increase of perioperative immunosuppression is recommended in certain cases.- - - - - - - - - - ranking = 0.54695658374388keywords = obstruction (Clic here for more details about this article) |
7/125. nasolacrimal duct obstruction and dacryocystocele associated with a concha bullosa mucocele.PURPOSE: To describe the rare occurrence of a concha bullosa mucocele producing secondary nasolacrimal duct obstruction and dacryocystocele. DESIGN: Case report. PARTICIPANT: Forty-two-year-old man with 6-month history of left medial canthal mass. INTERVENTION: Clinical evaluation with lacrimal testing, computed tomography and surgical exploration, including biopsy, dacryocystorhinostomy, and excision/marsupialization of the middle turbinate concha bullosa mucocele were performed. RESULTS: The medial canthal mass was confirmed to be a dacryocystocele associated with nasolacrimal duct obstruction and bone destruction caused by concha bullosa mucocele. CONCLUSIONS: Concha bullosa mucoceles are uncommon and even more rarely can produce secondary nasolacrimal duct obstruction and dacryocystocele formation. The clinical and radiologic features may mimic a lacrimal sac malignancy.- - - - - - - - - - ranking = 1476.4836652447keywords = duct obstruction, obstruction, duct (Clic here for more details about this article) |
8/125. Tear lipid layer interference changes after dacryocystorhinostomy.PURPOSE: Specular images of the tear film in the central cornea were examined in patients with nasolacrimal duct obstruction to observe changes before and after dacryocystorhinostomy (DCR). methods: We observed the specular images in 4 patients (5 eyes) by a noncontact observation device and recording system. Observed patterns were classified into five grades. The specular images and tear meniscus height (TMH) were recorded. RESULTS: Three of the 4 eyes with TMH values over 0.4 mm before DCR showed decreased TMH postoperatively. The 1 eye with a TMH value of 0.2 mm showed no change after DCR. Using specular images, 4 eyes were classified grade 1 or 2, and 1 eye was classified grade 4 before DCR. After DCR, the 5 eyes were classified as grade 3 or grade 4. CONCLUSION: The results indicated that the eye after DCR has a thicker lipid layer than the eye before DCR.- - - - - - - - - - ranking = 210.92623789211keywords = duct obstruction, obstruction, duct (Clic here for more details about this article) |
9/125. Lacrimal duct stenosis and other ocular toxicity associated with adjuvant cyclophosphamide, methotrexate and 5-fluorouracil combination chemotherapy for early stage breast cancer.Certain side-effects of chemotherapy are well recognized but ocular toxicity is often underestimated. This retrospective study was undertaken after we became aware of a case of irreversible lacrimal duct stenosis in a woman receiving adjuvant chemotherapy for early stage breast cancer. Using the chemotherapy records, 128 patients who received adjuvant cyclophosphamide, methotrexate and 5-fluorouracil combination chemotherapy for early stage breast cancer over a 2 1/2-year period were identified. The case notes of these patients were reviewed and an 18% incidence of ocular side-effects, including four other cases of epiphora, was identified. The epiphora resolved fully on completion of chemotherapy in these four patients but not in the index patient. The optimal management of these side-effects is unclear but it needs to be tailored to the particular toxicity experienced by the patient.- - - - - - - - - - ranking = 1.25keywords = duct (Clic here for more details about this article) |
10/125. Stenosis of the lachrymal system in rubinstein-taybi syndrome.In this article the authors describe a case of atypical stenosis of the lachrymal excretory system in rubinstein-taybi syndrome (RTS) characterised by morphologic anomalies of the lachrymal bag and by alterations of the osseous structure of the nose. A 9-year-old girl, with typical findings of RTS, was affected by recurrent acute dacryocystitis and tearing. Ocular examination revealed bilateral reflux with mucous and purulent material flowing back after digital pressing: low and bilateral nose-lachrymal duct obstruction was the main cause of the reflux as confirmed by orifice probing, lachrymal drainage system irrigation and spiral CT examination using hydrosoluble contrast medium. The multiplanar reconstruction obtained from CT scanning shows that the right lachrymal sac has an abnormal shape ('grape-bunch' image) and that the left one has various bulgings, or swellings, in its shape. The 'grape-bunch' lachrymal bags are the most unusual features of our patient's lachrymal system and it is important to consider the difficulties that could occur during surgery because of the abnormal bag shape and because of the increased bone thickness in RTS patients. The 'grape-bunch' lachrymal sac is a truly unusual anatomical feature and, most probably, it could be distinctive of this syndrome.- - - - - - - - - - ranking = 210.92623789211keywords = duct obstruction, obstruction, duct (Clic here for more details about this article) |
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