Transcanalicular microendoscopy of the lacrimal system has brought great advantages in knowledge and our understanding of the pathophysiology of the lacrimal system. It has now been confirmed that the causes of most primary idiopathic stenoses are often spot-like stenoses located at the site of anatomically preformed folds in the efferent tear ducts. Minimally invasive procedures of rechanneling have been developed, such as laser dacryoplasty and microdrill dacryoplasty, which preserve lacrimal pump function, result in much less stress for the patient and for a first-step procedure have an acceptable success rate of 80%.
Lacrimal surgery has been characterised by multiple rapid changes within the last 20 years. The understanding of the development and existence of lacrimal stenoses has changed considerably. New morphological (endoscopy of the lacrimal system) and anatomic-functional aspects have been added. In the field of surgery the frequency of DCR has dropped within the last years, but still, with proper indications, this method has its significance, as well as irrigation of the lacrimal system. On the other hand microendoscopic canalicular surgery has been almost fully replaced by microendoscopic transcanalicular laser dacryoplasty and microdrill dacryoplasty. For the surgical treatment of injuries of the lacrimal system no changes have been implemented. As a spin-off effect from gastroduodenoscopy and ERCP superfine endoscopes have been developed, and have opened the possibility to inspect the mucosa and directly evaluate the lumen of the lacrimal system. Following the development of laser dacryoplasty and microdrill dacryoplasty as well as miniaturised drill systems, surgery can be performed less invasively today. Future developments of lacrimal surgery will be strongly influenced by the ongoing developments of microendoscopic transcanalicular techniques and modulation in wound healing.
Symptomatic epiphora is predominantly present in the elderly It is caused either by hypersecretion in ocular surface disorders, mostly as a reflex, by decreased tear transport and mechanical stenosis of the efferent tear ducts. These three different causes have to be taken into consideration by differential diagnosis and lead to different forms of therapy. Ocular surface disorders (wet dry eye) are treated by topical medication, lid malfunctioning and dacryostenosis by surgery and possibly by topical adjuvant anti-inflammatory medication. The present article reviews the current concepts on epiphora as an age-associated symptom and the epidemiology and pathogenesis of dacryostenosis and dacryolithiasis.
The authors report on long-term observations of patients who underwent surgery for congenital glaucoma between 1961 and 1976. It was possible to perform follow-up examinations in 46 out of 100 patients. In 66 out of 73 eyes (90%), intraocular pressure was regulated to below 22 mm Hg appl. after periods ranging from 5 to 22 years, in 16 eyes with additional local treatment with beta-blockers. Over 60% of the cases had central vision better than 0.4, and only 2 of the patients had to be educated in special schools. All of the others were at least capable of attending elementary school and 50 percent of them were even able to go on to higher schools.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.