Advertisement

La radiologia medica

, Volume 113, Issue 8, pp 1211–1218 | Cite as

Treatment of lacrimal stenoses obstructions with interventional radiology: immediate and 5-year follow-up results

  • P. Preziosi
  • M. Di Primio
  • T. Erdembileg
  • R. Mancino
  • G. D’Este
  • L. Cerulli
  • G. Simonetti
Head and Neck Radiology/Radiologia Del Capo e Del Collo
  • 46 Downloads

Abstract

Purpose

This study was undertaken to evaluate the effectiveness of the Song stent in patients with nasolacrimal duct obstruction.

Materials and methods

Between 2003 and 2007, we treated 76 consecutive nasolacrimal obstructions in 73 patients (mean age 56 years; range 19–81) with implantation of polyurethane stents. Indications were epiphora in 46 patients, dacryocystitis in 18 and recurrent conjunctivitis in three. Average follow-up was 1 year (3 months to 5 years).

Results

Technical success was achieved in 73 procedures (96%). Complications included pain in three cases, eyelid inflammation in four cases and severe bleeding in one case. Postprocedural mucocele was observed in five patients. Mean time without symptoms was 31 weeks. There were 24 cases of stent obstruction: 15 were treated with high-pressure 5% N-acetyl-cysteine and saline flush, achieving resolution in two cases; in three cases, attempts to recanalise the obstruction with a guidewire failed. The occluded stents were rsemoved in 22 patients: seven remained asymptomatic, 15 had recurrence of epiphora, nine received a new stent after dacryocystography and six underwent dacryocystorhinostomy.

Conclusions

Advantages of the procedure include the lack of anatomical alterations to the lacrimal ducts and a low short-term complication rate, whereas limitations include restricted duration of stent patency. The pathophysiological causes of stent obstruction should be clarified in order to relate them to stent morphology.

Keywords

Epiphora Lacrimal gland Nasolacrimal stenting 

Trattamento delle steno-ostruzioni delle vie lacrimali con radiologia interventistica: risultati immediati ed a 5 anni

Riassunto

Obiettivo

Valutare l’efficacia dello stent di Song in pazienti con ostruzione del dotto naso lacrimale.

Materiali e metodi

Settantasei ostruzioni naso-lacrimali trattate con stent in poliuretano in sala angiografica. Età media 56 anni (19–81), 46 pazienti con epifora, 18 dacriocistiti, 3 con congiuntiviti ricorrenti. Tempo medio di follow up 1 anno (3mesi-5 anni).

Risultati

Successo tecnico: 73 procedure (96%). Complicanze: dolore in 3 casi, infiammazione palpebrale in 4 casi e sanguinamento massivo in 1 caso. In 5 pazienti abbiamo riscontrato mucocele post procedurale. Tempo medio di asintomatologia: 31 settimane. Abbiamo rilevato 24 ostruzioni: 15 trattate con lavaggi ad alta pressione di N-acetil-cisteina 5% con soluzione fisiologica ottenendo completa guarigione in 2 pazienti, è stato effettuato un tentativo infruttuoso (3 casi) di ricanalizzare l’ostruzione con una guida. Rimozione di stent occlusi in 22 pazienti; 7 sono rimasti asintomatici, in 15 ricorrenza dei sintomi, 9 restenosi ritrattate con un nuovo stent dopo diagnostica dacriocistografica. In 6 casi gli oculisti hanno effettuato una dacriocistorinostomia.

Conclusioni

Vantaggi: procedura rispetta l’anatomia di deflusso delle vie lacrimali con basse complicanze a breve termine. Limiti: pervietà dello stent limitata. Prospettive: individuare gli eventi fisiopatologici che portano ad ostruzione e correlarli con la morfologia dello stent.

Parole chiave

Epifora Ghiandola lacrimale Stent nasolacrimale 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References/Bibliografia

  1. 1.
    Linberg JV, McCormick SA (1986) Primary acquired nasolacrimal duct obstruction: a clinicopathologic report and biopsy technique. Ophthalmology 93:1055–1063PubMedGoogle Scholar
  2. 2.
    Soler Machin J, Castillo Laguarta JM, De Gregorio Ariza MA et al (2003) sObstrucción de la vía lagrimal tratada mediante stent lacrimonasal. Arch Soc Esp Oftalmol 78:315–318PubMedCrossRefGoogle Scholar
  3. 3.
    Toledano Fernández N (2001) Manejo actual de las obstrucciones del conducto nasolagrimal. Ed. Sociedad Española de Oftalmología. Comunicación solicitada 77 Congreso de la S.E.O. BarcelonaGoogle Scholar
  4. 4.
    Becker BB, Berry FD (1989) Balloon catheter dilatation in lacrimal surgery. Ophthalmic Surg 20:193–198PubMedGoogle Scholar
  5. 5.
    Massaro BM, Gonnering RS, Harris GJ (1990) Endonasal laser dacryocystorhinostomy. Arch Ophthalmol 108:1172–1176PubMedGoogle Scholar
  6. 6.
    Welham RAN, Henderson P (1974) Failed dacryocystorhinostomy. Trans Am Acad Ophthalmol Otolaryngol 78:824–828Google Scholar
  7. 7.
    Blaylock WK, Moore CA, Linberg JV (1990) Antenor ethmoid anatomy facilitates dacryocystorhinostomy. Arch Ophthalmol 108:1774–1777PubMedGoogle Scholar
  8. 8.
    Dresner SC (1988) Outpatient dacryocystorhinostomy and anesthesia tehniques. In: Linberg JV (ed) Larimal surgery. Churchill Livingstone, New York, pp 143–149Google Scholar
  9. 9.
    Munk PL, Lin DTC, Morris DC (1990) Epiphora: treatment by means of dacryocystoplasty with balloon dilation of the nasolacrimal drainage apparatus. Radiology 177:687–690PubMedGoogle Scholar
  10. 10.
    Song HY, Ahn HS, Park CK et al (1993) Complete obstruction of the nasolacrimal system. I. Treatment with balloon dilation. Radiology 186:367–371PubMedGoogle Scholar
  11. 11.
    Song HY, Lee H, Ahn H et al (1998) Lacrimal system obstruction treated with lacrimal polyuretane stents: outcome of removal of occluded stents. Radiology 208:689–694PubMedGoogle Scholar
  12. 12.
    Song HY, Jin YH, Sung KB et al (1994) Nasolacrimal duct obstruction treated nonsurgically with use of plastic stents. Radiology 190:535–539PubMedGoogle Scholar
  13. 13.
    Song HY, Ahn HS, Park CK et al (1993) sComplete obstruction of the nasolacrimal system. Part II. Treatment with expandable metallic stents. Radiology 186:372–376PubMedGoogle Scholar
  14. 14.
    Allen K, Berlin AJ (1989) Dacryocystorhinostomy failure: association with nasolacrimal silicone intubation. Ophthalmic Surg 20:486–489PubMedGoogle Scholar
  15. 15.
    Lanciego C, De Miguel S, Padilla M et al (2006) Nasolacrimal stenting: toward improving outcomes with a simple modification of the Song stent. Cardiovasc Intervent Radiol 29:586–594PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2008

Authors and Affiliations

  • P. Preziosi
    • 1
  • M. Di Primio
    • 1
  • T. Erdembileg
    • 1
  • R. Mancino
    • 2
    • 4
  • G. D’Este
    • 3
  • L. Cerulli
    • 2
  • G. Simonetti
    • 1
  1. 1.Dipartimento di Diagnostica per Immagini, Imaging molecolare, Radiologia Interventistica, RadioterapiaPoliclinico Universitario “Tor Vergata”RomaItaly
  2. 2.Istituto di OculisticaPoliclinico Universitario “Tor Vergata”RomaItaly
  3. 3.UOC di Anestesia e RianimazionePoliclinico Casilino/Presidio Sanitario USL-BRomaItaly
  4. 4.Policlinico Casilino/Presidio Sanitario USL-BRomaItaly

Personalised recommendations