Clinical Effects of Intranasal Steroid Application after Silicone Tube Intubation in Nasolacrimal Duct Obstruction

Seok Jae Lee; Ho Yoon Kim; Young Min Park; Jong Soo Lee

doi:10.3341/jkos.2016.57.8.1199

Journal List > J Korean Ophthalmol Soc > v.57(8) > 1010356

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Lee, Kim, Park, and Lee: Clinical Effects of Intranasal Steroid Application after Silicone Tube Intubation in Nasolacrimal Duct Obstruction

Original Article

J Korean Ophthalmol Soc 2016;57(8):1199-1204.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.8.1199

Clinical Effects of Intranasal Steroid Application after Silicone Tube Intubation in Nasolacrimal Duct Obstruction

Seok Jae Lee, MD¹, Ho Yoon Kim, MD¹, Young Min Park, MD^2,³, Jong Soo Lee, MD, PhD¹

¹Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea

²Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea

³Department of Ophthalmology, Gyeongsang National University Changwon Hospital, Changwon, Korea

Address reprint requests to Jong Soo Lee, MD, PhD Department of Ophthalmology, Pusan National University Hospital, #179 Gudeok-ro, Seo-gu, Busan 49241, Korea Tel: 82-51-240-7326, Fax: 82-51-240-7341 E-mail: jongsool@pusan.ac.kr

Received 25 February 2016 Revised 28 May 2016 Accepted 12 July 2016

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 investigate the effects of intranasal steroid spray after silicone tube intubation in nasolacrimal duct obstruction.

Methods

We included 73 patients (73 eyes) who had undergone silicone tube intubation with partial nasolacrimal duct obstruction and who had been followed-up for more than 6 months. We divided them into two groups: Group 1 (37 patients, 37 eyes), who used intranasal steroid spray twice a day for 4 weeks after silicone tube intubation, and Group 2 (36 patients, 36 eyes), who did not use intranasal steroid spray. A retrospective medical record review was performed to analyze the clinical features of epiphora improvement and complications in the two groups.

Results

No significant difference was found in epiphora improvement after surgery between the two groups (33 eyes [89.2%] in Group 1, 31 eyes [86.1%] in Group 2) (p = 0.736). In addition, the difference in success rate between the two groups was also not statistically significant (33 eyes [89.2%] in Group 1, 28 eyes [77.8%] in Group 2) (p = 0.221). Group 1 (5/37 [13.5%] eyes) and Group 2 (12/36 [33.3%] eyes) complained of ocular discomfort during the period of silicone tube intubation (p = 0.045). The complication rate of Group 1 (5/37 [13.5%] eyes) was significantly lower than that of Group 2 (13/36 [36.1%] eyes) (p = 0.024).

Conclusions

Silicone tube intubation is an effective treatment option for adults diagnosed with partial nasolacrimal duct obstruction, and postoperative intranasal steroid application may contribute to improvement of ocular symptoms after the surgery. There may be a merit of using intranasal steroid spray for adjuvant therapy to prevent postoperative complications, but it needs further study considering various factors.

Keywords: Intranasal steroid spray, Nasolacrimal duct obstruction, Silicone tube intubation

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Figure 1.

The rate of epiphora improvement and clinical success outcome in patients used cicleosonide after silicone tube intubation. (A) Epiphora improvement rate, (B) Clinical success outcome rate. But there was no significant difference between group 1 and group 2 (p = 0.736 [A], p = 0.221 [B], Fisher's exact test).

Table 1.

Baseline characteristics of nasolacrimal duct obstruction patients

Baseline characteristic	Group 1 (silicone tube intubation + intranasal spray)	Group 2 (silicone tube intubation)	p-value
Total No. of patients	37	36
Sex (M/F)	6/31	12/24	0.109^*
Age (years)	63.54 ± 10.62	62.25 ± 8.53	0.570^†
Mean BCVA at diagnosis (log MAR)	0.15 ± 0.14	0.14 ± 0.12	0.969^†
Hypertension (n, %)	11 (29.7)	8 (22.2)	0.322^*
Diabetic mellitus (n, %)	5 (13.5)	5 (13.9)	0.614^*
Duration of symptom (months)	14.4 ± 22.7	12.9 ± 24.8	0.686^†
Duration of intubation (months)	5.52 ± 0.81	5.14 ± 0.72	0.786^†

Values are presented as mean ± SD unless otherwise indicated.

BCVA = best corrected visual acuity.

^* Fisher's exact test

^† Independent t-test.

Table 2.

Comparative complications after silicone tube intubation between two groups

	Group 1 (Silicone tube intubation + Intranasal spray)	Group 2 (Silicone tube intubatio	n) p-value^*
Complication (n, %)
Mucoplurent discharge	1 (2.7)	4 (11.1)	0.199
Granuloma	0 (0.0)	3 (8.4)	0.115
Conjunctivitis	2 (5.4)	3 (8.4)	0.674
Corneal erosion	1 (2.7)	1 (2.8)	1.000
Canaliculitis	1 (2.7)	2 (5.6)	0.615
Total	5 (13.5)	13 (36.1)	0.024

^* Fisher's exact test.

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