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Endoscopic dacryocystorhinostomy as treatment for lower lacrimal pathway obstructions in adults: Review article.

Penttilä E, Smirnov G, Tuomilehto H, Kaarniranta K, Seppä J - Allergy Rhinol (Providence) (2015)

Bottom Line: Conservative treatments only achieve temporary relief of symptoms, thus surgery is the treatment of choice.The aim of this operation is to create a bypass between the lacrimal sac and the nasal cavity.This article reviews the published literature about the technical issues associated with the success of EN-DCR, and clarifies the pros and cons of different pre- and postoperative procedures in adults with lower lacrimal pathway obstructions.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology, and University of Eastern Finland, and Kuopio University Hospital, Finland.

ABSTRACT
Obstruction of the lacrimal pathway is manifested by epiphora, infection, and blurred vision as well as ocular and facial pain. Conservative treatments only achieve temporary relief of symptoms, thus surgery is the treatment of choice. Dacryocystorhinostomy (DCR) is recognized as the most suitable treatment for patients with obstructions of the lacrimal system at the level of the sac or in the nasolacrimal duct. The aim of this operation is to create a bypass between the lacrimal sac and the nasal cavity. During the past 2 decades, advances in rigid endoscopic equipment and other instruments have made it possible to obtain more information about the anatomic landmarks of the nasolacrimal system, which led to the development of less-invasive and safer endoscopic techniques. However, many parts of the treatment process related to endoscopic endonasal dacryocystorhinostomy (EN-DCR) still remain controversial. This article reviews the published literature about the technical issues associated with the success of EN-DCR, and clarifies the pros and cons of different pre- and postoperative procedures in adults with lower lacrimal pathway obstructions.

No MeSH data available.


Related in: MedlinePlus

Location of obstruction by irrigating the lower lacrimal system: 1, no obstruction; 2, presaccal obstruction (stenosis of the inferior canaliculus); 3, presaccal obstruction (stenosis of the common canaliculus); 4, saccal or postsaccal obstruction (stenosis in the lower lacrimal pathway)
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Figure 2: Location of obstruction by irrigating the lower lacrimal system: 1, no obstruction; 2, presaccal obstruction (stenosis of the inferior canaliculus); 3, presaccal obstruction (stenosis of the common canaliculus); 4, saccal or postsaccal obstruction (stenosis in the lower lacrimal pathway)

Mentions: The Schirmer tear test provides information about the tear secretion.15 Tear break-up time determined by biomicroscopy evaluates the stability of the tear film. Diagnostic probing and syringing of the lacrimal pathway are usually sufficient to evaluate the function of the lacrimal drainage system or to determine the location and extent of the obstruction in patients with epiphora. If the nasolacrimal pathway is open, then the solution flows freely into the nose. In cases of canalicular stenosis, the cannula cannot contact the bony wall of the lacrimal sac, and this results in reflux through the irrigated punctum. If the stenosis is in the common canaliculis or in the lower lacrimal pathway, then reflux will occur via the opposite punctum (Fig. 2).


Endoscopic dacryocystorhinostomy as treatment for lower lacrimal pathway obstructions in adults: Review article.

Penttilä E, Smirnov G, Tuomilehto H, Kaarniranta K, Seppä J - Allergy Rhinol (Providence) (2015)

Location of obstruction by irrigating the lower lacrimal system: 1, no obstruction; 2, presaccal obstruction (stenosis of the inferior canaliculus); 3, presaccal obstruction (stenosis of the common canaliculus); 4, saccal or postsaccal obstruction (stenosis in the lower lacrimal pathway)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4388871&req=5

Figure 2: Location of obstruction by irrigating the lower lacrimal system: 1, no obstruction; 2, presaccal obstruction (stenosis of the inferior canaliculus); 3, presaccal obstruction (stenosis of the common canaliculus); 4, saccal or postsaccal obstruction (stenosis in the lower lacrimal pathway)
Mentions: The Schirmer tear test provides information about the tear secretion.15 Tear break-up time determined by biomicroscopy evaluates the stability of the tear film. Diagnostic probing and syringing of the lacrimal pathway are usually sufficient to evaluate the function of the lacrimal drainage system or to determine the location and extent of the obstruction in patients with epiphora. If the nasolacrimal pathway is open, then the solution flows freely into the nose. In cases of canalicular stenosis, the cannula cannot contact the bony wall of the lacrimal sac, and this results in reflux through the irrigated punctum. If the stenosis is in the common canaliculis or in the lower lacrimal pathway, then reflux will occur via the opposite punctum (Fig. 2).

Bottom Line: Conservative treatments only achieve temporary relief of symptoms, thus surgery is the treatment of choice.The aim of this operation is to create a bypass between the lacrimal sac and the nasal cavity.This article reviews the published literature about the technical issues associated with the success of EN-DCR, and clarifies the pros and cons of different pre- and postoperative procedures in adults with lower lacrimal pathway obstructions.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology, and University of Eastern Finland, and Kuopio University Hospital, Finland.

ABSTRACT
Obstruction of the lacrimal pathway is manifested by epiphora, infection, and blurred vision as well as ocular and facial pain. Conservative treatments only achieve temporary relief of symptoms, thus surgery is the treatment of choice. Dacryocystorhinostomy (DCR) is recognized as the most suitable treatment for patients with obstructions of the lacrimal system at the level of the sac or in the nasolacrimal duct. The aim of this operation is to create a bypass between the lacrimal sac and the nasal cavity. During the past 2 decades, advances in rigid endoscopic equipment and other instruments have made it possible to obtain more information about the anatomic landmarks of the nasolacrimal system, which led to the development of less-invasive and safer endoscopic techniques. However, many parts of the treatment process related to endoscopic endonasal dacryocystorhinostomy (EN-DCR) still remain controversial. This article reviews the published literature about the technical issues associated with the success of EN-DCR, and clarifies the pros and cons of different pre- and postoperative procedures in adults with lower lacrimal pathway obstructions.

No MeSH data available.


Related in: MedlinePlus