Evaluation of granulation tissue formation in lacrimal duct post silicone intubation and its successful management by injection of prednisolone acetate ointment into the lacrimal duct

Mimura, Masashi; Ueki, Mari; Oku, Hidehiro; Sato, Bunpei; Ikeda, Tsunehiko

doi:10.1007/s10384-016-0446-0

Cited by 10 publications

(6 citation statements)

References 21 publications

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“…However, prolonged intubation might increase the risk of complications, and previous studies have reported that the formation of granulated tissue on the puncta is the most common complication upon detailed clinical examination. 15 , 16 , 17 , 18 , 19 A previous study reported that lacrimal micro-endoscopy revealed that granulated tissue formation can occur not only on the puncta, but also along the entire lacrimal system, which can be caused by infection and/or mechanical stress. 17 In our current case, the granulated tissue might have been caused by inflammatory reaction due to both factors, as it disappeared rapidly after the settlement of dacryocystitis and tube removal.…”

Section: Discussionmentioning

confidence: 99%

“… 15 , 16 , 17 , 18 , 19 A previous study reported that lacrimal micro-endoscopy revealed that granulated tissue formation can occur not only on the puncta, but also along the entire lacrimal system, which can be caused by infection and/or mechanical stress. 17 In our current case, the granulated tissue might have been caused by inflammatory reaction due to both factors, as it disappeared rapidly after the settlement of dacryocystitis and tube removal. The findings in previous reports, as well as the findings in our current case, suggest that tissue granulation is reversible with proper treatment.…”

Section: Discussionmentioning

confidence: 99%

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A case of neglected silicone tube in lacrimal duct for 20 years

Mimura

Oku

Ueki

et al. 2018

American Journal of Ophthalmology Case Reports

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PurposeTo report a case of prolonged placement of a lacrimal silicone tube for 20 years, with evaluation of the lacrimal duct using lacrimal micro-endoscopy and inspection of deformation of the lacrimal tube.ObservationsThis study involved a case of dacryocystitis in which a silicone tube had been placed in the patient 20-years previous and that was treated conservatively. Although granulation tissue formation due to dacryocystitis in the lacrimal duct was observed under lacrimal micro-endoscopy, subjective and objective resolution of symptoms, including granulated tissue formation, was achieved after removal of the silicone tube and conservative medical treatment. Follow-up examinations performed over a 12-month period post treatment revealed no recurrence of epiphora or anatomical obstruction. Inspection of the lacrimal tube using the tension test revealed minimal changes in the tube in situ for 20 years.Conclusions and ImportanceThe findings in this case suggest both the lacrimal system and the silicone tube are tolerant to prolonged intubation, as long as the tube had been placed properly with careful observation. Our findings may encourage physicians to consider prolonged intubation for select cases of nasolacrimal duct obstruction.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A case of neglected silicone tube in lacrimal duct for 20 years

Mimura

Oku

Ueki

et al. 2018

American Journal of Ophthalmology Case Reports

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“…Higher NDO comprising inflammation of sac and duct with large membranous NLD at sac-duct junction was diagnosed from 73.2% of the patients, compared to the lower NDO of membranous obstruction around the Hasner valve [ 56 ]. Injection of prednisolone acetate ophthalmic ointment into the lacrimal passage have successfully treated the complication of granulation tissue formation occurred 10% of NDO patients followed by DE for 12 months [ 57 ]. However, lipogranuloma formation would be also considered after injection of the ointment into the subepithelium layer, which can occur after false passage by blind probing or after laser canaliculoplasty [ 58 ].…”

Section: Resultsmentioning

confidence: 99%

Clinical Implication of Dacryoendoscopy in the Patients with Tearing: A Systematic Review

Kim¹,

Park²,

Lew³

2023

Korean J Ophthalmol

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Purpose: A systematic review of the literature on diagnostic and therapeutic indications, techniques, and complications of dacryoendoscopy (DE) was performed. Methods: The authors performed a PubMed search of articles published in English on DE. Data was collected and classified according to the categories of the disease. And the clinical outcomes and limitations were particularly analyzed.Results: The lacrimal drainage system from the canaliculus to the inferior meatus could be examined based on the specific anatomical features by DE. The canalicular mucosa is smooth and brightly colored, the lacrimal sac shows covering mucosa with good vascularization and the nasolacrimal duct is lined with bright tubular mucosal folds. DE allows direct visualization of the detailed internal condition of the lacrimal disorders, to directly diagnose the site of obstruction with accuracy and address the causes and recanalize the lacrimal drainage system using assisted micro lacrimal surgical instruments in the tearing patients. Conclusions: Better visualization of the lacrimal canal with DE improves the understanding of physiology and precise identification of the obstructing lesions, both of which are the key to a comprehensive management for the tearing patients.

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“…Although the pathological changes of NLD mucosa after silicone intubation have not been clearly elucidated, several studies have suggested that an NLD mucosal inflammatory reaction to silicone material may occur. This reaction can lead to progressive fibrosis, granuloma, or granulation tissue formation [ 18 – 20 ], eventually resulting in recurrent obstruction of the NLD [ 21 ]. We attempted to maximally expand the NLD mucosal lumen using a sequential dilatation technique and to suppress inflammatory swelling of the NLD mucosa by topical steroids [ 22 ], but a smaller bony NLD may limit the mucosal luminal expansion.…”

Section: Discussionmentioning

confidence: 99%

Bony nasolacrimal duct size and outcomes of nasolacrimal silicone intubation for incomplete primary acquired nasolacrimal duct obstruction

Yang

Kim

et al. 2022

PLoS ONE

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Purpose To investigate the association between the bony nasolacrimal duct (NLD) size and outcomes of nasolacrimal silicone intubation for incomplete primary acquired nasolacrimal duct obstruction (PANDO). Methods Patients who underwent silicone intubation for incomplete PANDO and had undergone facial computed tomography (CT) were included. Surgical success was judged by both epiphora improvement and normalized tear meniscus height (TMH; < 300 μm) on anterior segment optical coherence tomography at 3 months after tube removal. The area, major axis diameter, and minor axis diameter of the elliptic bony NLD sections were measured in 1.0 mm-thick axial CT images. These bony NLD sizes were analyzed for associations with surgical success and TMH normalization. Results Eighty-one eyes of 48 patients were investigated. The smallest area and the smallest minor axis diameter were significantly larger in the success group (49 eyes), compared with those in the failure group (median smallest minor axis diameter: 4.7 mm vs. 3.8 mm, P = 0.008, Mann–Whitney U test). There was also a tendency for the TMH normalization rate to significantly increase as the smallest area and the smallest minor axis diameter increased (P = 0.028 and 0.037, respectively, Fisher’s 2 × 4 tests). Under multivariable logistic regression analysis using generalized estimating equation, a larger smallest minor axis diameter was associated with success of the nasolacrimal silicone intubation (odds ratio: 2.481, 95% confidence interval: 1.143–5.384). Conclusion Surgical success of the nasolacrimal silicone intubation in incomplete PANDO is associated with a larger smallest minor axis diameter of the bony NLD. This finding will help understand the pathophysiology of surgical failure after nasolacrimal silicone intubation.

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Evaluation of granulation tissue formation in lacrimal duct post silicone intubation and its successful management by injection of prednisolone acetate ointment into the lacrimal duct

Abstract: Complication by granulation tissue formation occurred in 10.6 % of the patients who underwent SI for PALDO, yet the injection of prednisolone acetate ophthalmic ointment into the lacrimal passage may have successfully treated the complication without removal of the silicone tube.

Cited by 10 publications

References 21 publications

A case of neglected silicone tube in lacrimal duct for 20 years

A case of neglected silicone tube in lacrimal duct for 20 years

Clinical Implication of Dacryoendoscopy in the Patients with Tearing: A Systematic Review

Bony nasolacrimal duct size and outcomes of nasolacrimal silicone intubation for incomplete primary acquired nasolacrimal duct obstruction

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