Dacryolithiasis diagnosis and treatment: a 25-year experience using nasal endoscopy

BackgroundDacryolith-induced epiphora is caused by a chronic obstruction of the nasolacrimal duct whose aetiology is often specified peroperatively. Dacryocystorhinostomy (DCR) has been often regarded as the gold standard to treat dacryolithiasis. Hasner’s valve (HV) incision is a technique to evacuate lithiasis through its physiological track. The purpose of this study was to describe clinical and radiological findings associated with presence of dacryoliths in patients who underwent surgery and to assess the efficacy of these two procedures.MethodsThis study was a comparative interventional multicentric retrospective study including patients referred for an epiphora. The primary endpoint was to determine clinical and endoscopic findings associated with dacryoliths. The secondary endpoints were to evaluate the performance of CT dacryocystography (CT-DG) in the diagnosis of dacryoliths and the success rate of the surgical treatment 6 months postoperatively.Results4677 nasolacrimal ducts (NLDs) (78.0% female, mean age 59.2) were included in the study. 3913 underwent DCR, and 764 underwent HV incision. 291 out of 4677 NLDs (6.2%) were found to have dacryoliths. Presence of mucocele associated to a permeable lacrimal system (OR 8.17 (95% 4.62 to 14.44), p<0.01) was associated with presence of lithiasis peroperatively. Success rates at 6 months were 95.6% for endonasal DCR and 94.6% for incision of HV in dacryolithiasis group (p<0.01). CT-DG had a negative predictive value of 96.3% to detect lithiasis (p<0.01).ConclusionStrong clinical and endoscopic findings may improve the imputability of dacryoliths in epiphora. Evacuation of dacryolithiasis through its physiological track was first described in this study in adults with similar results to DCR in patients presenting with dacryolithiasis.

The Frequency of Hand-to-Eye/Nose Contact can Increase the Risk of Ocular Symptoms in SARS-CoV-2-Infected Patients

PurposeSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has the capacity to use the eye for transocular entry. The characteristics of lacrimal drainage remind us to pay attention to the transmission route passing through the nasolacrimal ducts and then into the respiratory tract. The aim of this study was to assess ocular symptoms and hand-to-eye/nose contact behaviour in SARS-CoV-2-infected patients. MethodsA questionnaire was designed by brain storing method according to practical requirements, then the survey of ocular symptoms and hand-to-eye/nose contact behaviour in SARS-CoV-2-infected patients was administered in person. The patients answered the items under the guidance of a nurse. The data of ocular symptoms and basic information was collected analysed. The correlation between ocular symptoms and hand-to-eye/nose contact behaviour was evaluated.Results The most common ocular symptoms were increased discharge (in 53.19% of patients), foreign body sensation (44.68%), tearing (44.68%), conjunctival congestion (40.43%) and mild eye pain (40.43%). In total, 61.7% of patients had nasal obstruction and running. A total of 40.4% of patients blew their nose more frequently than usual because of nasal symptoms. A total of 63.8% of patients rubbed their eyes with their hands 1-5 times per day. Only 44.68% of patients washed their hands immediately when arriving at home more than 6 days per week. Increased frequencies of blowing noses (p=0.032), washing hands (p=0.025), and rubbing eyes (p=0.005) can affect ocular symptoms. The frequency and the way of face washing had no correlation with ocular symptoms.ConclusionsOcular symptoms in SARS-CoV-2-infected patients are much more common than currently reported but nonspecific. This prompt us pay more attention to the true incidence of conjunctivitis in SARS-CoV-2-infected patients. The frequency of hand-to-eye/nose contact can increase the risk of presenting ocular symptoms. However, hand washing can decrease the risk. These results provide direct evidence of behaviour change and smooth the concerns for many people.

No remnants of nasolacrimal ducts in any Desmognathini salamanders indicates loss early in their evolutionary history

Previous studies demonstrated that nasolacrimal ducts were present in the ancestral plethodontid lineage. Two lineages within Plethodontidae contain individuals that do not possess nasolacrimal ducts: Desmognathus and Eurycea. Earlier works examined only two species of Desmognathus, D. fuscus and D. monticola. We obtained every Desmognathini (Phaeognathus + Desmognathus) species possible from novel collections and museum collections and assessed presence or absence of nasolacrimal ducts using contrast-enhanced computed tomography and routine histological procedures. The goal was to test the hypothesis that nasolacrimal ducts were lost on the evolutionary branch leading to Desmognathus. We rejected our hypothesis by finding that nasolacrimal ducts were absent in all Desmognathus that we examined and Phaeognathus hubrichti; thus, we recovered the absence of nasolacrimal ducts on the evolutionary branch leading to Desmognathini.

Congenital nasolacrimal duct obstruction continues trend for spontaneous resolution beyond first year of life

PurposeTo investigate spontaneous resolution of congenital nasolacrimal duct obstruction (CNLDO) beyond 12 months of age in Japanese infants.MethodsRetrospective, observational case series. We retrospectively reviewed the clinical records of patients diagnosed with CNLDO beyond 12 months of age at Kyoto Prefectural University Hospital, Kyoto, Japan. This study involved 155 cases of CNLDO in 133 Japanese infants diagnosed with CNLDO. All patients chose intervention with either dacryoendoscopic guided probing and stenting or conservative management. The proportion and age of patients who had spontaneous CLNDO resolution were analysed.ResultsThe patients were divided into two groups: (1) 62 patients with 70 obstructed nasolacrimal ducts (45%) in whom spontaneous resolution occurred and (2) 71 patients with 85 obstructed nasolacrimal ducts (55%) who underwent dacryoendoscopic guided probing and stenting. The mean age of spontaneous resolution was 17.8±5.3 months (range: 12.0–35.4 months). Dacryoendoscopic guided probing and stenting were successful in 83/85 (97.6%) of cases.ConclusionsSpontaneous resolution of CNLDO can occur in 45% of infants over the age of 12 months. Dacryoendoscopic guided stenting also has high success rates in this patient group, and both treatment options can be proposed to caregivers.

Clinical and histological effects of the temporary occlusion of the rabbit nasolacrimal duct and point using cyanoacrylate adhesives

The objective of this study was to evaluate the clinical and histological effects of occluding the nasolacrimal ducts and points of rabbits. For this study, 20 adult New Zealand rabbits, both males and females, weighing 3.2±0.4kg were allocated into two groups for n-butyl-cyanoacrylate occlusion (GB, n=10) or 2-octyl-cyanoacrylate occlusion (GO, n=10). The contralateral eyes served as the controls. The persistence of tears was evaluated daily using the Schirmer I test. Discomfort, eye discharge, epiphora, and conjunctival hyperemia were assessed prior to the procedure (T0) and during the 14 subsequent days (T1-T14). On days seven and 14, five animals from each group were euthanized, and their nasolacrimal ducts were collected, processed and analyzed by histology. In the GB group, the Schirmer test values differed from that at T0 at all of the subsequent time points, whereas there was no difference in the values observed from the GO group. Compared with the corresponding controls, the GO and GB groups differed significantly at almost all of the time points. When comparing the treatment groups, differences were found at T6, T7, T9, T10, T11, T12 and T14, with higher Schirmer values in the GB group. Epiphora was observed in the GB group from T1 to T8 and in the GO group from T1 to T6. Within seven days post-occlusion, histology revealed a moderate foreign body reaction, with marked necrosis and sloughing of the canalicular epithelium, in the GO group, which was absent at day 14. In the GB group, a marked inflammatory reaction and a mild foreign body reaction were found at day seven, and the foreign body reaction was prevalent at day 14. This study demonstrated that both adhesives were effective in obstructing the nasolacrimal ducts and points of rabbits and that their application and handling are easy and free of complications. However, both adhesives promoted inflammatory and foreign body reactions that evolved to repair and regeneration at day 14 of evaluation.