The Effectiveness of Topical Steroid Instillation in Patients with Recently Developed Nasolacrimal Drainage Stenosis

Yong Dae Kim; Nam Ju Kim; Ho Kyung Choung; Sang In Khwarg

doi:10.3341/jkos.2014.55.10.1418

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Kim, Kim, Choung, and Khwarg: The Effectiveness of Topical Steroid Instillation in Patients with Recently Developed Nasolacrimal Drainage Stenosis

Original Article

J Korean Ophthalmol Soc 2014;55(10):1418-1425.

Published online: 2 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.10.1418

The Effectiveness of Topical Steroid Instillation in Patients with Recently Developed Nasolacrimal Drainage Stenosis

Yong Dae Kim, MD¹, Nam Ju Kim, MD^1,², Ho Kyung Choung, MD^1,³, Sang In Khwarg, MD^1,⁴

¹Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea

²Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea

³Department of Ophthalmology, Seoul Municipal Government–Seoul National University Boramae Medical Center, Seoul, Korea

⁴Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea

Address reprint requests to Nam Ju Kim, MD, Department of Ophthalmology, Seoul National University Bundang Hospital, #82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 463-707, Korea, Tel: 82-31-787-7376, Fax: 82-31-787-4057 E-mail: resourceful@hanmail.net

Received 5 April 2014 Revised 18 April 2014 Accepted 5 September 2014

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

To evaluate the effectiveness of topical steroid instillation and associated factors in patients with recently developed nasolacrimal drainage stenosis.

Methods

The medical records of 108 eyes of 56 patients who received topical steroid for nasolacrimal drainage stenosis between January 2010 and June 2013 and who developed epiphora of a three-month duration were retrospectively reviewed. Evaluations were performed at 1, 3, and 6 months after instillation of topical steroid. Subjective symptoms, tear meniscus height, and fluorescein dye disappearance test results were noted at every follow-up visit; nasolacrimal irrigation and canalicular probing were also performed as needed.

Results

The cumulative improvements were 42.0% at 1 month and 51.0% at 3 months after treatment, and the mean period of symptomatic improvement was 3.8 ± 1.9 weeks (range, 3-12 weeks). At the final follow-up visit, 56 (51.9%) of 108 eyes showed improved epiphora. Final improvement was observed in 63% (12 of 19 eyes) of idiopathic nasolacrimal drainage stenosis patients, in 100% (10 of 10 eyes) of docetaxel-treated patients, and in 43% (34 of 79 eyes) of S-1-treated patients.

Conclusions

Instillation of topical steroids can be effective for nasolacrimal drainage stenosis and may prevent the need for invasive surgical treatment.

Keywords: Docetaxel, Epiphora, Nasolacrimal drainage stenosis, S-1, Topical steroid

References

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Figure 1.

The cumulative incidence of epiphora improvement after treatment of topical steroid.

Figure 2.

The cumulative incidence of epiphora improvement after treatment of topical steroid, grouped by the etiology of nasolacrimal drainage stenosis. Differences of cumulative incidence of improvement between subgroups were not significant (p = 0.305, log rank test).

Table 1.

Demographic characteristics of 56 patients (108 eyes) with recently developed nasolacrimal drainage stenosis

	Idiopathic (eye, n = 19)	Docetaxel (eye, n = 10)	S-1 (eye, n = 79)	Total (eye, n = 108)
Age (years)	58.3	47.2	62.6	60.3
Sex (M:F)	5:6	0:5	28:12	33:23
Mean duration of epiphora (months)	1.3	1.6	0.9	1.1
Mean follow-up period (months)	6.0	5.4	6.2	6.0
Coexistance of canalicular stenosis (eye, %)	2 (10.5)	2 (20)	8 (10.1)	12 (11.1)
Coexistance of punctal stenosis (eye, %)	1 (5.3)	3 (30)	4 (5.1)	8 (7.4)
Dry eye (eye, %)	8 (42.1)	0 (0)	26 (32.9)	34 (31.2)
Discharge (eye, %)	2 (10.5)	2 (20)	28 (35.4)	32 (29.4)

Table 2.

Factors affecting improvement of epiphora after instillation of topical steroid in subgroup of idiopathic nasolacrimal drainage stenosis

	Improved	Not improved	p-value^*
	(eye, n = 12)	(eye, n = 7)	p-value^*
Female (eye, %)	5 (41.7)	4 (57.1)	0.650
Dry eye (eye, %)	4 (33.3)	4 (57.1)	0.377
Discharge from the eye (eye, %)	2 (16.7)	0 (0.0)	0.509
Tear meniscus height ≥ moderate degree (eye, %)	9 (75.0)	6 (85.7)	1.000
FDDT ≥ Gr3 (eye, %)	5 (41.7)	4 (57.1)	0.650
Reflux on lacrimal irrigation (eye, %)	2 (16.7)	4 (57.1)	0.129
NLD dilation on DCG (eye, %)	6 (50.0)	4 (57.1)	0.656
Canalicular stenosis (eye, %)	1 (8.3)	1 (14.3)	1.000
Development of epiphora in winter (eye, %)	5 (41.7)	3 (42.9)	1.000

FDDT = fluorescein dye disappearance test; NLD = nasolacrimal duct; DCG = dacryocystography.

^* Fisher's exact test.

Table 3.

Factors affecting improvement of epiphora after instillation of topical steroid in subgroup of S-1 related nasolacrimal drainage stenosis

	Improved	Not improved	p-value^*
	(eye, n = 34)	(eye, n = 45)	p-value^*
Female (eye, %)	16 (47.1)	7 (15.6)	0.003
Dry eye (eye, %)	14 (41.2)	12 (26.7)	0.228
Discharge from the eye (eye, %)	12 (35.3)	16 (35.6)	1.000
Tear meniscus height ≥ moderate degree (eye, %)	29 (85.3)	34 (75.6)	0.399
FDDT ≥ Gr3 (eye, %)	9 (26.5)	20 (44.4)	0.157
Reflux on lacrimal irrigation (eye, %)	14 (41.2)	16 (35.6)	0.133
NLD dilation on DCG (eye, %)	17 (50.0)	29 (64.4)	1.000
Canalicular stenosis (eye, %)	3 (8.8)	7 (15.6)	0.502
Epiphora development within 3 months of chemotherapy (eye, %)	20 (58.8)	27 (60.0)	1.000

FDDT = fluorescein dye disappearance test; NLD = naso-Lacrimal duct; DCG = dacryocystography.

^* Fisher's exact test.

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