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Modified Horner-Duverney’s muscle plication in the treatment of functional epiphora

  • Oculoplastics and Orbit
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Background

The orbicularis oculi muscle, especially its part (Horner–Duverney’s muscle), which is surrounded by the pericanalicular and located deep in the lacrimal sac, is of primary importance in all stages of tear fluid flow.

Purpose

This study aimed to demonstrate that tightening the pretarsal-preseptal orbicularis oculi and Horner–Duverney muscles may improve the function of the lacrimal pump and may be a surgical alternative for treating functional epiphora.

Material and methods

This was a prospective interventional case series of 28 patients with functional epiphora. During surgery, sutures were used to perform the intervention, and these were first passed through the upper and lower eyelid pretarsal-preseptal orbicular muscles, through the Horner–Duverney’s muscle, and finally, through the dacriocystorhinostomy incision and tightened. Each patient completed the Lac-Q questionnaire and Munk scale prior to surgery, as well as six weeks and six months later. Before surgery, a fluorescein dye disappearance test was performed, which was repeated at follow-up appointments. Pre- and post-operative data were analyzed and compared at the most recent visit.

Results

Twenty-eight patients (10 males and 18 females) with a mean age of 59 ± 35 years were included in this study. The severity of epiphora and its tearing effect on daily life significantly improved following the operation. The fluorescein dye disappearance test result was significantly improved after 6 weeks of followup in %89.3 of eyes and at 6 months followup in 92.9% of eyes. The Lac-Q questionnaire's mean social impact scores improved significantly postoperatively, from 3.76 to 0.77 (p < 0.001). The changes in total scores (7.29 before surgery to 1.71 after 6 months) were statistically significant (p < 0.001). The Munk score success rate was 64.3% and 85.7%, respectively. No significant complications or adverse effects were observed.

Conclusion

Our findings suggest that a beneficial and seemingly simple, safe, and easy procedure to reduce functional epiphora is to tighten the preseptal-pretarsal orbicularis and Horner–Duverney’s muscles.

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References

  1. Burkat CN, Lucarelli MJ (2005) Tear meniscus level as an indicator of nasolacrimal obstruction. Ophthalmology 112(2):344–348

    Article  PubMed  Google Scholar 

  2. Cuthbertson FM, Webber S (2004) Assessment of functional nasolacrimal duct obstruction—a survey of ophthalmologists in the southwest. Eye 18(1):20–23

    Article  CAS  PubMed  Google Scholar 

  3. Jones LT, Linn ML (1969) The diagnosis of the causes of epiphora. Am J Ophthalmol 67(5):751–754

    Article  Google Scholar 

  4. Conway ST (1994) Evaluation and management of “functional” nasolacrimal blockage: results of a survey of the American Society of Ophthalmic Plastic and Reconstructive Surgery. Ophthalmic Plast Reconstr Surg 10(3):185–187

    Article  CAS  PubMed  Google Scholar 

  5. O’Donnell B, Shah R (2001) Dacryocystorhinostomy for epiphora in the presence of a patent lacrimal system. Clin Exp Ophthalmol 29(1):27–29

    Article  PubMed  Google Scholar 

  6. Perry JD (2012) Dysfunctional epiphora: a critique of our current construct of “functional epiphora”. Am J Ophthalmol 154(1):3–5

    Article  PubMed  Google Scholar 

  7. Cheung LM, Francis IC, Stapleton F, Wilcsek G (2007) Symptom assessment in patients with functional and primary acquired nasolacrimal duct obstruction before and after successful dacryocystorhinostomy surgery: a prospective study. Br J Ophthalmol 91(12):1671–1674

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Demirci H, Elner VM (2008) Double silicone tube intubation for the management of partial lacrimal system obstruction. Ophthalmology 115(2):383–385

    Article  PubMed  Google Scholar 

  9. Moscato EE, Dolmetsch AM, Silkiss RZ, Seiff SR (2012) Silicone intubation for the treatment of epiphora in adults with presumed functional nasolacrimal duct obstruction. Ophthalmic Plast Reconstr Surg 28(1):35–39

    Article  PubMed  Google Scholar 

  10. Vick VL, Holds JB, Hartstein ME, Massry GG (2004) Tarsal strip procedure for the correction of tearing. Ophthalmic Plast Reconstr Surg 20(1):37–39

    Article  PubMed  Google Scholar 

  11. Rose GE, Verity DH (2011) Functional nasolacrimal duct obstruction–a nonexistent condition? Concepts in lacrimal dynamics and a practical course of treatment. Expert Rev Ophthalmol 6(6):603–610

    Article  Google Scholar 

  12. Becker BB (1992) Tricompartment model of the lacrimal pump mechanism. Ophthalmology 99(7):1139–1145

    Article  CAS  PubMed  Google Scholar 

  13. Ali MJ, Paulsen F (2020) Horner’s muscle or Horner-Duverney’s muscle. Ophthalmic Plast Reconstr Surg 36(2):208

    Article  PubMed  Google Scholar 

  14. Kakizaki H, Zako M, Miyaishi O, Nakano T, Asamoto K, Iwaki M (2005) The lacrimal canaliculus and sac bordered by the Horner's muscle form the functional lacrimal drainage system. Ophthalmology 112(4):710–716

    Article  PubMed  Google Scholar 

  15. Ali MJ, Zetzsche M, Scholz M, Hahn D, Gaffling S, Heichel J, Bräuer L, Paulsen F (2020) New insights into the lacrimal pump. Ocul Surf 18(4):689–698

    Article  PubMed  Google Scholar 

  16. Adenis JP, Longueville E (1991) Horner's muscle plication using an anterior approach. Orbit 10(4):187–191

    Article  Google Scholar 

  17. Singh S, Nair AG, Kamal S (2019) A review on functional epiphora-current understanding and existing lacunae. Expert Rev Ophthalmol 14(3):169–177

    Article  CAS  Google Scholar 

  18. Munk PL, Lin DT, Morris DC (1990) Epiphora: treatment by means of dacryocystoplasty with balloon dilation of the nasolacrimal drainage apparatus. Radiology 177(3):687–690

    Article  CAS  PubMed  Google Scholar 

  19. Mistry N, Rockley TJ, Reynolds T, Hopkins C (2011) Development and validation of a symptom questionnaire for recording outcomes in adult lacrimal surgery. Rhinology 49(5):538

    Article  CAS  PubMed  Google Scholar 

  20. Wesley RE (1994) Lacrimal disease. Curr Opin Ophthalmol 5(5):82–88

    Article  Google Scholar 

  21. Hurwitz JJ, Cooper PR, McRae DL, Chenoweith DR (1977) The investigation of epiphora. Canadian Ophthalmol J Canadien d'ophtalmologie 12(3):196–198

    CAS  Google Scholar 

  22. Lelli GJ, Zoumalan CI, Nesi FA (2012) Basic principles of ophthalmic plastic surgery. Smith and Nesi’s Ophthalmic Plastic and Reconstructive Surgery, pp 61–79

    Google Scholar 

  23. Lu H, Liu PD, Yao X, Wang ZF, Gao LF, Wang SP (2020) Diagnostic value of orbicularis oculi muscle electromyography in functional epiphora. World J Clin Cases 8(14):3000

    Article  PubMed  PubMed Central  Google Scholar 

  24. Sahlin S, Rose GE (2001) Lacrimal drainage capacity and symptomatic improvement after dacryocystorhinostomy in adults presenting with patent lacrimal drainage systems. Orbit 20(3):173–179

    Article  PubMed  Google Scholar 

  25. Delaney YM, Khooshabeh R (2002) External dacryocystorhinostomy for the treatment of acquired partial nasolacrimal obstruction in adults. Br J Ophthalmol 86(5):533–535

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Ozturker C, Purevdorj B, Karabulut GO, Seif G, Fazil K, Khan YA, Kaynak P (2022) A Comparison of transcanalicular, endonasal, and external dacryocystorhinostomy in functional epiphora: a minimum two-year follow-up study. J Ophthalmol 2022

  27. Lee MJ, Park J, Yang MK, Choi YJ, Kim N, Choung HK, Khwarg SI (2020) Long-term results of maintenance of lacrimal silicone stent in patients with functional epiphora after external dacryocystorhinostomy. Eye 34(4):669–674

    Article  CAS  PubMed  Google Scholar 

  28. Salour H, Khosravifard K, Bagheri A, Abrishami Y, Kheiri B, Tavakoli M (2016) Efficacy of tightening of orbicularis oculi muscle in patients with functional nasolacrimal duct obstruction. Orbit 35(1):11–15

    Article  PubMed  Google Scholar 

  29. Rodríguez BM, Stoica BTL, Fernández NT, Saavedra IG (2022) Treatment for functional epiphora with botulinum toxin-A versus lateral tarsal strip in a randomized trial. Arch Soc Esp Oftalmol 97(10):549–557

    Google Scholar 

  30. Bagheri A, Tavakoli M, Rafaati N (2012) Diplopic mechanical restrictive strabismus due to orbital medial wall fracture and medial rectus muscle entrapment after endoscopic dacryocystorhinostomy, with optic nerve deficit. Binocul Vis Strabolog Q Simms Romano 27(2):122–128

    PubMed  Google Scholar 

  31. Simon GJB, Joseph J, Lee S, Schwarcz RM, McCann JD, Goldberg RA (2005) External versus endoscopic dacryocystorhinostomy for acquired nasolacrimal duct obstruction in a tertiary referral center. Ophthalmology 112(8):1463–1468

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Ophthalmology, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Turkey

    Murat Oklar, Titap Yazıcıoglu & Mustafa Talan

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  1. Murat Oklar
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  2. Titap Yazıcıoglu
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  3. Mustafa Talan
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Corresponding author

Correspondence to Murat Oklar.

Ethics declarations

Research involving human and animal right

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Approval was granted by the Ethics Committee of Kartal Dr. Lütfi Kırdar City Hospital (Institutional Review Board No. 2021/514/196/3). Written informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Oklar, M., Yazıcıoglu, T. & Talan, M. Modified Horner-Duverney’s muscle plication in the treatment of functional epiphora. Graefes Arch Clin Exp Ophthalmol 261, 2971–2978 (2023). https://doi.org/10.1007/s00417-023-06090-5

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  • DOI: https://doi.org/10.1007/s00417-023-06090-5

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