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Rhinosinusitis and Lacrimal Disorders
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Dacryocystocoele is a congenital swelling at medial canthus due to trapped fluid inside the lacrimal sac and nasolacrimal duct. It is tense, blue, and not pulsatile. MRI is helpful in excluding other pathology.Surgery is reserved if there is lack of spontaneous improvement in 2 weeks or the patient develops acute dacryocystitis or respiratory difficulties.
Commensal Flora
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Gallstones can lead to biliary stasis, bacterial overgrowth causing cholangitis and cholecystitis and bacterial translocation. Bacteria involved are predominantly Enterobacterales. Nasolacrimal duct obstruction can cause infection of the lacrimal sac, also called dacryocystitis. The main pathogens are S. pneumoniae and S. aureus.
Central nervous system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
The lacrimal system comprises the lacrimal gland, which secretes tears, the lacrimal sac and the ducts through which the tears pass into the nasal cavity (Figs 11.59a–c). The lacrimal gland lies anteriorly in the upper outer quadrant of the orbit and communicates with the lacrimal sac via the lacrimal canaliculi. Tears wash over the surface of the eye and drain through the lacrimal canaliculi into the lacrimal sac through two openings, the puncta lacrimalia, which are situated on the medial aspects of the upper and lower eyelids. The lacrimal sac drains into the nasolacrimal duct, which runs vertically through the lateral nasal wall on the medial aspect of the maxillary antrum. The nasolacrimal duct opens into the nasal cavity below the inferior nasal conchus.
Multi-resistant Enterobacter cloacae dacryocystitis and preseptal cellulitis: case and review of literature
Published in Orbit, 2023
Michael Kvopka, Ezekiel Kingston, Daniel D.H. Nguyen, Jessica Y. Tong, Hayden L. Kirk, Claudia M. Whyte, James D. Dalgliesh, Jennifer J. Danks
Dacryocystitis involves inflammation of the lacrimal sac, often secondary to obstruction of the nasolacrimal duct.1 Acquired dacryocystitis is an uncommon presentation which is most frequently found in Caucasian females over the age of 40 years.2 Pathogens frequently responsible for acute dacryocystitis include Staphylococcus aureus, Pseudomonas spp., and Streptococcus pneumoniae.1 To the authors’ knowledge, this is the first reported case of concurrent dacryocystitis and preseptal cellulitis secondary to Enterobacter cloacae (E. cloacae). It is also the first case of E. cloacae dacryocystitis which failed to respond to chloramphenicol, amoxicillin, and third generation cephalosporins. Our experience is a pertinent reminder of the ever-growing threat of multi-resistant bacteria that must be considered when treating infections such as dacryocystitis. Multidisciplinary input from infectious diseases specialists is often warranted. This report adhered to the ethical principles outlined in the Declaration of Helsinki as amended in 2013.
Placement of a PROPEL sinus implant during endoscopic dacryocystorhinostomy
Published in Orbit, 2022
Nishanth S. Iyengar, Ann Q. Tran, Victoria S. North, Erich P. Voigt, Eleanore T. Kim
A 57-year-old woman presented with right-sided epiphora and symptoms of bilateral chronic sinusitis nine months after rhinoplasty and bilateral functional endoscopic sinus surgery. Ophthalmologic examination revealed mucoid discharge, fullness of the lacrimal sac, and elevated tear film. Endoscopic examination revealed nasal mucosal scarring. Following probing and irrigation, the patient was diagnosed with right nasolacrimal duct obstruction and underwent endoscopic dacryocystorhinostomy (DCR) with placement of a bicanalicular Crawford stent. A PROPEL sinus implant (Intersect ENT, Inc., Menlo Park, CA, USA) was placed at the intranasal surgical site to provide a barrier between the nasal septum and the lateral nasal wall mucosal flaps (Panels A–D). The PROPEL sinus implant is a dissolvable stent-like device that delivers mometasone furoate to the surrounding mucosa in order to lessen inflammation and reduce the likelihood of post-surgical obstruction. Post-operatively, right-sided epiphora resolved and patency of the canalicular system was confirmed. At a three-month follow-up, endoscopic examination revealed patency of the ostium and that the implant had dissolved. The PROPEL sinus implant can be considered as a surgical adjunct to prevent septal adhesions in complex endoscopic DCR.
In vivo analysis of endocanalicular light pipe transillumination in endoscopic dacryocystorhinostomy: Anatomic considerations and cautions for the transitioning
Published in Orbit, 2022
Nina S. Boal, Elizabeth A.Z. Cretara, Benjamin S. Bleier, Allen C. Lam, Daniel R. Lefebvre
Dacryocystorhinostomy is used to relieve blockage of the distal lacrimal outflow tract by creating a new pathway between the lacrimal sac and the nasal cavity. Though endoscopic approaches were described more than a century ago by Caldwell1 and Mosher,2 the external transcutaneous approach described by Toti3 remained the surgical technique of choice over the years due to difficulties with visualization of the surgical site and effective removal of mucosa and bone endonasally. With advances in surgical instrumentation, such as the paranasal sinus endoscope and dedicated endosinus instrument sets, as well as delicate high-speed drills enabling removal of thicker bone, more surgeons have turned to endoscopic dacryocystorhinostomy (endo-DCR) in recent times for both primary surgeries and revision of failed cases.4–7