FIG 1 - uploaded by Hardeep Singh Mudhar
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Both colobomatous upper eyelids are adherent centrally to the globe and lack well-defined margins or lashes. Intact temporal remnants of upper eyelids are present. The lower eyelids and fornices are normal.
Source publication
A 60-year-old woman developed polyostotic fibrous dysplasia involving the right zygomatic and maxillary bones, which led to swelling along the right side of her nose that was associated with constant epiphora. A sac washout revealed a blocked right nasolacrimal duct, which was confirmed by CT dacryocystography. CT also showed signs of fibrous dyspl...
Citations
... Slow progression of the lesion in craniofacial bone may lead to several problems, such as facial asymmetry, chronic sinusitis, nasal obstruction, ocular proptosis, visual disturbance, epiphora, mandibular enlargement, dental problems including malocclusion, recurrent headache, and conductive-type hearing loss [5,7]. An uncommon presentation of the disease is involvement of the nasolacrimal system, which is usually associated with nasolacrimal duct or sac obstruction as a result of chronic dacryocys- titis and purulent epiphora [8,9]. Our two cases presented with recurrent purulent epiphora and swelling under the eye without vision disturbance. ...
Fibrous dysplasia of the paranasal sinuses is mostly asymptomatic, but sometimes may cause signs and symptoms depending on its location. We report two cases of maxillary fibrous dysplasia obstructing the lacrimal drainage system as a reason of chronic dacryocystitis, and reviewed the related literature. The first case underwent an endonasal endoscopic approach combined with external dacryocystorhinostomy. He had a patent lacrimal system at one-year follow-up. The lesion was completely removed via an endonasal endoscopic approach in the second case, wherein the patient was asymptomatic of the six-month follow-up period.
... Archives of Clinical and Experimental Surgery www.acesjournal.org titis and purulent epiphora [8,9]. Our two cases presented with recurrent purulent epiphora and swelling under the eye without vision disturbance. ...
Fibrous Dysplasia of the paranasal sinuses is mostly asymptomatic, but sometimes may cause signs and symptoms depending on its location. We report two cases of maxillary fibrous dysplasia obstructing the lacrimal drainage system as a reason of chronic dacryocystitis, and reviewed the related literature. The first case underwent an endonasal endoscopic approach combined with external dacryocystorhinostomy. He had a patent lacrimal system at one-year follow-up. The lesion was completely removed via an endonasal endoscopic approach in the second case, wherein the patient was asymptomatic of the six-month follow-up period
... 8 In this way, mitomycin-C soaking during DCR surgery is a useful modified procedure to improve the success rate of external DCR. 19 Recently, intraoperative application of mitomycin-C in Nonlaser Endoscopic Endonasal Dacryocystorhinostomy (NLEN-DCR) is proven to be useful in improving the success rate. 20,21 The main limitation of this study is its short follow-up. ...
Objective:
To compare the efficacy of external dacryocystorhinostomy (DCR) with and without intraoperative application of mitomycin-C in patients with chronic dacryocystitis.
Study design:
An experimental study.
Place and duration of study:
Department of Ophthalmology, Bahawal Victoria Hospital (BVH), Bahawalpur, from September 2009 to December 2010.
Methodology:
One hundred and sixty patients with chronic dacryocystitis undergoing external DCR were divided into two groups comprising of 80 patients each. Group A included patients, who underwent external DCR with intraoperative use of mitomycin-C. Group B included those patients who were not administered intraoperative mitomycin-C. Sociodemographic information and the data regarding the patency of the lacrimal drainage system by irrigation with normal saline were collected at the end of the third month after the surgery. Chi-square test was used, at 95% confidence level, as the test of significance to compare the success of surgery between the two groups.
Results:
Surgical success rate (efficacy) in group 'A' was found to be 97.5% and 86.25% in group 'B'. The difference in success rate was statistically significant (p=0.017).
Conclusion:
External dacryocystorhinostomy with intraoperative mitomycin-C is more efficacious in achieving lacrimal system patency than external dacryocystorhinostomy without mitomycin-C.
Fibrous dysplasia is a benign and pseudoneoplasic osteopathy with slow progression, characterized by the replacement of normal bone by an excessive proliferation of fibrous connective tissue cell, interspersed with irregular bone trabeculae. In general, it affects 1 between 4,000 to 10,000 individuals living births. This is a not familiar, congenital disorder, which produces around 2.5% of all bone tumors and more than 7% of all non-malignant bone tumors. This article aims to report a clinical case of monostotic fibrous dysplasia in jaw, proceeding with its surgical correction and to make a review of literature, describing the most important features and the major controversies.
Dacryocystorhinostomy (DCR) has been regarded as the gold standard for the treatment of nasal lacrimal duct obstruction for over a hundred years. Currently, the treatment of nasolacrimal duct obstruction has grown along with the advances in endoscopic techniques developing and in-depth understanding of the mechanisms of lacrimal drainage. Endoscopic dacryocystorhinostomy, en-dolacrimal laser and intubation, lacrimal endoscopic recanalization and lacrimal bypass surgery have been employed to substitute for external DCR as treatment for nasolacrimal duct obstruction. The endoscope, laser and minimally invasive techniques provide higher successful rates with minimal wounds, lower rates of both recurrence and complications and allow quicker recovery after surgery.
To determine the outcome and safety of nonlaser endonasal dacryocystorhinostomy (NLEN-DCR) with the use of adjunctive mitomycin C (MMC) in congenital, traumatic, and primary acquired nasolacrimal duct obstruction in adults.
Retrospective, nonrandomized, noncomparative, case series.
One hundred ninety-three consecutive adult patients underwent NLEN-DCR with the use of adjunctive MMC. Thirty-one patients had a simultaneous bilateral procedure performed.
All patients underwent a standardized procedure, with an endonasal approach to the lacrimal sac, surgical removal of nasal mucosa, lacrimal bone, and a fragment of the frontal process of the maxilla. The medial wall of the lacrimal sac was removed completely, and a neurosurgical cottonoid soaked in MMC at 0.5 mg/ml was placed at the osteotomy site for 10 minutes. All patients underwent bicanalicular silicone intubation.
Resolution of epiphora, absence of discharge, and patency of the ostium confirmed by irrigation at 6 months.
The NLEN-DCR procedure with adjunctive MMC was successful in 212 (95%) cases. The mean follow-up was 18.2 months. Intubation of more than 3 months was associated with a higher rate of obstruction (P<0.00018, Fisher exact test), with 9 eyes of 8 patients losing patency. Age, diagnosis, side operated, or infection at the time of surgery had no influence on the final outcome. No significant complications were encountered.
Results suggest that NLEN-DCR with MMC is a safe and successful procedure for the treatment of congenital, traumatic, and primary acquired nasolacrimal duct obstruction in adults. It has the advantage of leaving no scar and of preserving the medial canthal structures. It can be performed successfully as a simultaneous bilateral procedure.
