Indian survey on practice patterns of lacrimal & eyelid disorders (iSUPPLE): Report 3 – Cataract and nasolacrimal duct obstruction

Abstract

There is a general agreement on the need for pre-cataract screening for NLDO and a majority indicated that checking for ROPLAS was sufficient. Most surgeons prefer to perform a DCR in cases of NLDO and wait for 4 weeks before intraocular surgery. There is however, a lacuna in the literature on guidelines regarding the optimal interval between lacrimal surgery and subsequent intraocular surgery.

Self-regurgitation on pressure over lacrimal sac in cases of primary-acquired nasolacrimal duct obstruction: Correlation with physician examination and patients' perceptions

“…In a questionnaire-based study conducted by Nair et al ., it was seen that 59.6% of the clinicians felt that ROPLAS is sufficient to rule out NLDO before cataract surgery. [ 9 ] While this can be a good starting tool to ascertain the further direction of clinical assessments, it does not obviate the need for a complete lacrimal drainage evaluation. It is obvious that self-ROPLAS needs to be confirmed by lacrimal irrigation and probing before taking a surgical decision.…”

Nasolacrimal obstruction concomitant to cataract: diagnosis and management in the preoperative period of cataract surgery

“…However, many participants were not aware of the problem and did not investigate NLDO before cataract surgery. In India, nearly 8% of the respondents felt that it is not necessary to check for NLDO preoperatively (8) , which is, of course, not the ideal practice.Dacryocystorhinostomy or dacryocystectomy can be used to clear the lacrimal system. Brazilian cataract surgeons reported that dacryocystectomy is a much less preferred option, but this technique is an excellent option, particularly for older patients, as tear production declines with age.…”

“…Thus, 62% of Brazilian doctors consider 6 weeks as an adequate interval between lacrimal surgery and cataract surgery. In another region, only 19% of surgeons reported waiting for 6 weeks to proceed with the cataract surgery (8) .Clinical NLDO management using antibiotic eye drops before cataract surgery was the choice of almost half of the participants (47.2%). A Japanese study demonstrated temporary control of conjunctival bacterial flora using antibiotic eye drops during the 3 weeks before cataract surgery (9) .…”

The importance of endoscopy in lacrimal surgery

“…These technological breakthroughs are critical in ensuring that endoscopic lacrimal surgery become safer with better outcomes. With more ophthalmic plastic surgery fellowship programs incorporating structured training in endoscopic lacrimal surgery, the popularity and the safety of endoscopic lacrimal surgery by ophthalmologists is expected to increase [7,65,66].…”