Clinical Efficacy of Lacrimal Endoscopy in Patients with Epiphora

Sung Woong Lim; Young Je Sung; Helen Lew

doi:10.3341/jkos.2017.58.5.495

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Lim, Sung, and Lew: Clinical Efficacy of Lacrimal Endoscopy in Patients with Epiphora

Original Article

Journal of the Korean Ophthalmological Society 2017; 58(5): 495-502.

Published online: 15 May 2017

DOI: https://doi.org/10.3341/jkos.2017.58.5.495

Clinical Efficacy of Lacrimal Endoscopy in Patients with Epiphora

Sung Woong Lim, MD, Young Je Sung, MD, Helen Lew, MD, PhD

Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.

Address reprint requests to Helen Lew, MD, PhD. Department of Ophthalmology, CHA Bundang Medical Center, #59 Yatap-ro, Bundang-gu, Seongnam 13496, Korea. Tel: 82-31-780-5326, Fax: 82-31-780-5333, slclsrndi@hanmail.net

Received 16 February 2017 Revised 15 March 2017 Accepted 21 April 2017

(open-access):

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 clinical efficacy of lacrimal endoscopy in patients with nasolacrimal duct obstruction (NLDO) and to compare the dacryocystography (DCG) and lacrimal endoscopic findings between patients with epiphora.

Methods

We conducted a retrospective chart review of 31 eyes of 23 patients who underwent an irrigation test, DCG, and lacrimal endoscopy from December 2014 to February 2016. We compared the clinical characteristics, and dacryocystographic findings, and lacrimal endoscopic findings of the patients, and analyzed whether or not these findings agree.

Results

Thirty-one eyes showed complete obstruction (13 eyes, 41.9%), partial obstruction (7 eyes, 22.6%), or patency (11 eyes, 35.5%) on irrigation test. Thirteen eyes with complete obstruction on irrigation test presented with complete obstruction (11 eyes, 84.6%) or secondary dilation (2 eyes, 15.4%) of the lacrimal sac at DCG. In terms of the level of obstruction, there was no difference between the two examinations. However, twelve eyes with complete obstruction at DCG; showed narrowing (4 eyes, 33%), granulation tissue (3 eye, 25%), mucus occlusion (2 eyes, 17%), stones (1 eye, 8%), or mucosal edema (2 eyes, 17%) on lacrimal endoscopy. Nineteen eyes with partial obstruction at DCG showed narrowing (6 eyes, 32%), mucus (5 eye, 26%), granulation tissue (4 eyes, 21%), or stones (4 eyes, 21%) on lacrimal endoscopy.

Conclusions

Lacrimal endoscopy allowed real-time observation inside the lacrimal passage that cannot be detected using DCG. Both methods provide comprehensive investigations of the nasolacrimal passage system, and these methods are complementary to understand the pathophysiology of nasolacrimal duct obstruction as well as planning treatment. Lacrimal endoscopy is very useful in investigating the lacrimal drainage passage in patients with NLDO, and this method is comparable to DCG.

Keywords: Dacryocystography, Lacrimal endoscopy, Nasolacrimal duct obstruction

Figures and Tables

Figure 1

Lacrimal endoscopy (RUIDO fiberscope, Fibertechco., Tokyo, Japan). (A) Probe, Bent type, 0.9 mm diameter. (B) Peripheral device: the fibersope, monitor, recording system, imaging system. (C) The feature that applied to patient.

Figure 2

Representative figures of dacryocystography. (A) Images according to obstruction level; canalicular, sac, lacrimal duct. (B) Images according to the type of obstruction; complete, partial. (C) Other findings of lacrimal sac and nasolacrimal duct; secondary dilation, beaded pattern.

Figure 3

Representative photographs of lacrimal endoscopy. (A) The mucus occluding the lumen of the lacrimal canaliculus. (B) The stone inside of the lacrimal sac. (C) The granulation tissue occuping the lacrimal sac. (D) The stenosis of the nasolacrimal duct.

Figure 4

Correlation of dacryocystography (DCG) and lacrimal endoscopy (LE) findings based on the irrigation test in patients with nasolacrimal duct obstruction. The patients were divided into three groups according to the results of the syringing test, and categorized by DCG findings and lacrimal endoscopy findings.

Figure 5

The result of lacrimal endoscopic findings according to the dacryocystgraphic finding in nasolacrimal duct obstruction patients. (A) 12 eyes with complete obstruction at dacryocystography (DCG); mucus (2 eyes, 17%), stone (1 eyes, 8%), granulation (3 eyes, 25%), narrowing (4 eyes, 33%). (B) 19 eyes with partial obstruction at DCG; mucus (5 eyes, 27%), stone (4 eyes, 21%), granulation (4 eyes, 21%), narrowing (6 eyes, 31%).

Figure 6

Result of dacryocystographic findings according to the lacrimal endoscopic finding in nasolacrimal duct obstruction patients. (A) 19 eyes with mucus at lacrimal endoscopy; narrowing (5 eyes, 26%), stone (3 eye, 16%), beaded pattern (3 eyes, 16%). (B) 14 eyes with granulation at lacrimal endoscopy; narrowing (6 eyes, 43%), no specific findings (6 eye, 43%), stone (1 eyes, 7%), beaded pattern (1 eyes, 7%). (C) 7 eyes with stone at lacrimal endoscopy; stone (3 eyes, 43%), no specific findings (3 eye, 43%), narrowing (1 eyes, 14%). (D) 21 eyes with narrowing at lacrimal endoscopy; narrowing (12 eyes, 57%), no specific findings (8 eye, 38%), beaded pattern (1 eyes, 4%).

Table 1

Lacrimal endoscopic findings in the patients with complete obstruction in irrigation test or dacryocystography

DCG = dacryocystography; F= female; M = male; R = right; L = left; LD = lacrimal duct.

Notes

This study was presented as a narration at the 115th Annual Meeting of the Korean Ophthalmological Society 2016

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