Postoncological lacrimal duct reconstruction: A practical classification system for reconstructive planning and short-term results of a case series

Burink, Max V. van; Rakhorst, Hinne; Couwelaar, G.M. van; Schmidbauer, U.

doi:10.1016/j.bjps.2018.07.024

Cited by 10 publications

(9 citation statements)

References 32 publications

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“…Postoperative epiphora rates were calculated based on this. From these studies, the median epiphora rate was 12.5% (range 0%–100%) 10–12 14–29. The 100% was from a case report with a single patient.…”

Section: Resultsmentioning

confidence: 98%

“…The literature is heterogenous regarding the definitions of epiphora and of success. Some studies use the Munk grading scale to quantify the degree of epiphora,10 16 which includes minor degrees of epiphora 30. Others excluded epiphora if it was ‘not to excess’11 or conversely included it but quantified it by stating it was ‘not interfering with daily life’ 13.…”

Section: Discussionmentioning

confidence: 99%

“…The majority are case series or a small subset of patients in larger retrospective cohort studies that examine either a specific reconstructive method to the skin and medial canthal area or lacrimal system obstruction due to a variety of causes. [10][11][12][13][14][15][16] Marsupialisation of the remnant canaliculus is a relatively straightforward procedure. It can be easily incorporated into the reconstruction of the eyelid following tumour resection.…”

Section: What This Study Addsmentioning

confidence: 99%

“…Lacrimal system reconstruction following medial canthal tumour resection is not well studied. The majority are case series or a small subset of patients in larger retrospective cohort studies that examine either a specific reconstructive method to the skin and medial canthal area or lacrimal system obstruction due to a variety of causes 10–16. Marsupialisation of the remnant canaliculus is a relatively straightforward procedure.…”

Section: Introductionmentioning

confidence: 99%

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Holding back the tears: is there a role for marsupialisation?

2022

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ObjectiveMedial eyelid tumours may result in the loss of the proximal lacrimal system during staged excision and delayed reconstruction, to achieve tumour margin clearance. The remnant canaliculus was marsupialised during reconstruction. The aim was to understand how many patients experienced symptomatic epiphora as a consequence of this.Methods and analysisA retrospective study including patients over a 15-year period with medial eyelid tumours, where the proximal lacrimal system was sacrificed to achieve tumour margin clearance. Included were all who had marsupialisation of the remnant distal stump as part of their delayed reconstruction. All who had pre-existing epiphora were excluded. The primary objective was the rate of epiphora following the procedure. A systematic literature review of postoperative epiphora occurring in patients with lid tumours requiring lacrimal system injury/sacrifice during tumour excision.ResultsThere were 22 eyes (22 patients). All were basal cell carcinomas except for 1 (4.5%) tarsal conjunctival squamous cell carcinoma. All cases involved the lower lid. There were two (9.1%) patients who developed epiphora. One patient underwent a superior three-snip punctoplasty, botulinum toxin to the lacrimal gland and conjunctivodacryocystorhinostomy with Lester Jones tube insertion. The other patient was not overly troubled and did not require further treatment. The literature review showed the median postoperative rate of epiphora in these patients was 12.5% (range 0%–100%).ConclusionMarsupialisation of the remnant canaliculus during delayed reconstruction is a straightforward and effective surgical option, which may help prevent postreconstruction epiphora when the proximal lacrimal system is sacrificed for tumour margin clearance.Trial registration number10391.

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Section: Resultsmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: What This Study Addsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Holding back the tears: is there a role for marsupialisation?

2022

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“…The lacrimal drainage system includes the upper and lower puncta, which are openings on the nasal eyelid margin at their junction with the inner canthus [46], which lead to the lacrimal canaliculi, the lacrimal sac, culminating in the nasolacrimal duct, and the nose [47][48][49]. Fibers of the tarsal orbicularis oculi muscles, innervated by CNVII, surround the canalicular system and lacrimal sac.…”

Section: Lacrimal Drainage System and Tear Productionmentioning

confidence: 99%

Neurostimulation for dry eye disease

London

Pincovich

Solomon

2022

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of reviewTo review the neuroanatomy and physiology of the basal and reflex tearing and present the available and developing therapies using the concept of neurostimulation in dry eye disease (DED). Recent findingsThe most prevalent current DED treatments seek to supplement low tear volume and tear components or reduce inflammation. Neurostimulation is a unique approach gaining momentum in recent years, geared toward increasing the production of all basal tear components by stimulating the nerves responsible for producing the various tear components. The neuroanatomy of the lacrimal unit provides several possible access points to stimulate tear production through two arms of the sensory trigeminal nerves. Modes of stimulation include chemical or energy in electrical or magnetic form. Research thus far has shown that neurostimulation can achieve lacrimal, goblet cell, and meibomian gland stimulation. Subjectively it improves symptoms of DED. Clinically, neurostimulation has improved the signs and symptoms of DED by increasing basal tear production and tear volume.

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