Clinical Study of Lacrimal Drainage Obstruction Diseases Using Dacryoendoscopy
Condition: Lacrimal Duct Obstruction
MeSH terms: Lacrimal Duct Obstruction
Study type: Interventional

Summary: 
      Nasolacrimal duct obstruction (NLDO) can manifest as epiphora or recurrent infections with
      mucopurulent discharge and may even cause social embarrassment. Dacryoendoscopic-assisted
      laser dacryoplasty with silicone intubation (DLDI) offers direct therapy to the obstructed
      site, leading to minimal collateral damage external to the target zone. Although the silicone
      intubation using dacryoendoscopy has increased the success rates, the success rates vary from
      a low of 51% to a high of 90%. The difference in success rates seems to depend on the site of
      obstruction, differences in the surgical technique, stringency of definitions of success, and
      duration of follow-up. The aim of our study was to report the results of DLDI for the
      management of NLDO, and to identify factors associated with DLDI failure.
    

Detailed description: 
      Lacrimal drainage obstruction can manifest as epiphora or recurrent infections with
      mucopurulent discharge and may even cause social embarrassment. Obstruction can occur at any
      level along the lacrimal drainage system: punctum, canaliculus, nasolacrimal duct, or nasal
      ostium. It is seen more often in females, especially in postmenopausal women. The
      etiopathogenesis of lacrimal passage obstruction appears to be multifactorial. Chronic
      inflammation has been suggested to be the most causal. Dacryocystorhinostomy (DCR) is a
      standard surgical procedure used to treat nasolacrimal duct obstruction (NLDO), with a
      reported success rate of more than 90%.

      Knowledge concerning the morphological characteristics of lacrimal passage obstruction using
      traditional diagnostic methods (e.g., lacrimal irrigation, probing, dacryocystography) is
      limited. Dacryoendoscopy was originally described in 1979 and has recently matured for use in
      lacrimal drainage system imaging. It has been proved to be a useful instrument not only for
      understanding differences in the etiology of obstructions but also for treating LD
      obstructions. On the other hand, semiconductor diode laser can achieve more effective tissue
      dissection than direct probing technique with minimal hemorrhage and improved intraoperative
      view. Hence, dacryoendoscopic-assisted laser dacryoplasty with silicone intubation (DLDI)
      offers direct therapy to the obstructed site, leading to minimal collateral damage external
      to the target zone. In addition, this procedure can be performed under local anesthesia as an
      outpatient procedure in the office, and it has advantages such as short surgery time and less
      risk of bleeding during surgery, resulting in its increasingly widespread use in China.
      Although the silicone intubation using dacryoendoscopy has increased the success rates, the
      success rates vary from a low of 51% to a high of 90%. The difference in success rates seems
      to depend on the site of obstruction, differences in the surgical technique, stringency of
      definitions of success, and duration of follow-up.

      A greater understanding of factors associated with treatment failure may allow us to glean
      insights regarding patient selection and ultimately improve treatment outcome. The aim of our
      study was to report the results of DLDI for the management of NLDO, and to identify factors
      associated with DLDI failure.
    

Intervention name(s): Dacryoendoscopic-assisted laser dacryoplasty with silicone intubation
Intervention type(s): Procedure
Intervention description(s): The dacryoendoscopy was inserted into the lacrimal duct through the upper or lower lacrimal punctum. When the dacryoendoscopy reached the postsaccal obstruction, laser dacryoplasty (FOX diode laser, A.R.C. Laser, Nürnberg, Germany) was performed by widening the stenotic or obstructed section. After removing the dacryoendoscopy, a silicone tube inserted into lacrimal passage. Double bicanalicular silicone intubation was performed as previously described.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Lacrimal Duct Obstruction; Dacryoendoscopy; Dacryoplasty