Effects in Lumen Width of Nasolacrimal Drainage System After Adrenergic Drug Irrigation

Young Min Kim; Dong-Eun Oh

doi:10.3341/jkos.2010.51.8.1039

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Kim and Oh: Effects in Lumen Width of Nasolacrimal Drainage System After Adrenergic Drug Irrigation

Original Article

J Korean Ophthalmol Soc 2010;51(8):1039-1046.

Published online: 7 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.8.1039

Effects in Lumen Width of Nasolacrimal Drainage System After Adrenergic Drug Irrigation

Young Min Kim, MD, Dong-Eun Oh, MD

Department of Ophthalmology, Seoul Veterans Hospital, Seoul, Korea

Address reprint requests to Dong-Eun Oh, MD Department of Ophthalmology, Seoul Veterans Hospital #6-2 Doonchon 2-dong, Gangdong-gu, Seoul 151-890, Korea. Tel: 82-2-2225-1884, Fax: 82-2-2225-1485, E-mail: Ezer75@hanmail.net

Received 18 February 2010 Accepted 29 June 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The lacrimal sac and nasolacrimal duct are surrounded by a wide cavernous system of veins and arteries, and the blood vessels of the cavernous body are innnervated by the autonomic nervous system. The purpose of this study was to determine the effect of an adrenergic agonist on the lumen width of the nasolacrimal drainage system.

Methods

Dacryocystography was performed on 35 patients with only epiphora and not nasolacrimal duct obstruction. The anteroposterior (AP) diameters and the oblque diameters of the nasolacrimal ducts were measured. Next, 18 patients were infused with 0.5 ml Alphagan-P^® (α-2 adrenergic receptor agonist), 17 patients were infused with 0.5 ml DL methylephedrine hydrochloride (α-1 and α-2 adrenergic receptor agonist), and dacryocystography was performed again to determine the change in the lumen width of the nasolacrimal drainage system.

Results

The α-adrenergics caused a significant increase in the lumen width of the nasolacrimal drainage system, and the changes were more pronounced in the nasolacrimal duct than in the lacrimal sac. Although the nasolacrimal duct widening was more notable in the Alphagan-P^® infusion group than the DL methylephedrine hydrochloride infusion group, there was no significant statistical difference. Patients'subjective symptoms improved in both groups.

Conclusions

The α-adrenergics constrict the blood vessels of the cavernous body, leading to the increase in the lumen width of the nasolacrimal drainage system. This effect was more significant in the Alphagan-P^® infusion group. In conclusion, infusion of α-adrenergics in patients with functional nasolacrimal duct obstruction can be considered as an alternative to surgical management.

Keywords: Adrenergic agonist, Autonomic nervous system, Cavernous system, Dacryocystography, Nasolacrimal duct

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Figure 1.

Measure points; point 1 in the internal position of common canaliculus, point 5 in the valve of Hasner.

Figure 2.

Dacryocystographic images of the nasolacrimal drainage system before and after Alphagan-P^® irrigations. AP images in the upper photographs and oblique images in the lower photographs (The white arrows show the area of the biggest interval change).

Figure 3.

Comparison of the lumen widths of the nasolacrimal drainage system at 5 points before and after Alphagan-P^® and DL methylephedrine hydrochloride irrigations.

Figure 4.

Dacryocystographic images of the lumen width of nasolacrimal drainage system before and after DL methylephedrine hydrochloride irrigations. AP images in the upper photographs and obliques image in the lower photographs (The white arrows show the area of the biggest interval change).

Table 1.

Result of the lumen width changes in the nasolacrimal drainage system at 5 points before and after Alphagan-P^® irrigations (Group A)

variable	Anteroposterior Imaging		Increasing rate (%)	Oblique Imaging		Increasing rate (%)
variable	Before^*	After^*	Increasing rate (%)	Before^*	After^*	Increasing rate (%)
P1	7.87 ± 2.14	8.77 ± 2.94^†^‡	10.4	10.94 ± 3.89	11.82 ± 4.19^†^‡	8.6
P2	4.29 ± 2.05	5.43 ± 1.98^†^‡	33.9	4.84 ± 1.86	5.91 ± 2.06^†^§	27.4
P3	5.72 ± 2.24	7.90 ± 3.21^†^§	39.6	7.09 ± 3.83	9.22 ± 4.10^†^§	36.8
P4	10.63 ± 4.51	15.10 ± 6.40^†^§	44.0	11.02 ± 4.87	16.66 ± 6.61^†^§	55.5
P5	5.88 ± 2.15	8.52 ± 2.80^†^§	48.3	6.57 ± 2.50	9.31 ± 3.29^†^§	46.4

^* pixel

^† paired t-test

^‡ p<0.01

^§ p<0.0001.

Table 2.

Result of the lumen width of the nasolacrimal drainage system at 5 points before and after DL methylephedrine hydrochloride irrigations (Group B)

variable	Anteroposterior Imaging		Increasing rate (%)	Oblique Imaging		Increasing rate (%)
variable	Before^*	After^*	Increasing rate (%)	Before^*	After^*	Increasing rate (%)
P1	8.38 ± 2.93	9.22 ± 3.24^†^‡	10.4	10.51 ± 3.51	11.63 ± 3.97^†^‡	11.0
P2	4.33 ± 2.39	5.63 ± 2.61^†^‡	33.9	4.40 ± 1.44	5.94 ± 2.02^†^‡	38.0
P3	6.31 ± 3.19	8.64 ± 4.61^†^§	39.4	6.58 ± 2.97	8.33 ± 3.43^†^‡	27.6
P4	10.28 ± 5.68	13.20 ± 6.52^†^§	29.1	9.86 ± 6.23	13.77 ± 6.88^†^§	46.6
P5	5.41 ± 1.26	7.41 ± 2.24^†^§	36.0	5.79 ± 1.59	7.99 ± 2.50^†^§	38.1

^* pixel

^† paired t-test

^‡ p<0.01

^§ p<0.0001

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