Dacryoendoscopic Examination of the Lacrimal System



Fig. 9.1
A dacryoendoscope



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Fig. 9.2
Closer view of the side port


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Fig. 9.3
Endoscopic viewing system


Dacryoendoscopy can be performed in an anterograde or a retrograde manner. In the anterograde, evaluation sequence starts at the puncta and subsequently the canaliculus, lacrimal sac, and the nasolacrimal ducts are studied. This is technically demanding and bumping into the mucosal walls is not uncommon especially for the beginners. In the retrograde technique, the punctum is dilated with a Nettleship’s punctum dilator (Fig. 9.4), the dacyroendoscope is gently passed into the horizontal canaliculus from the upper punctum on an outstretched eyelid (Fig. 9.5) and gently turned 90° just as in probing and descends down till the inferior meatus (Fig. 9.6). Now the scope is gently retracted back very slowly to study each part of the lacrimal drainage system. Gentle forward and backward movements are continued all through to help evaluate the system thoroughly. The retrograde technique is much easier in technical terms. It is important to know that illumination may need to vary in different parts of the lacrimal system. For example, the illumination needs to be more while examining the interiors of lacrimal sac as compared to the nasolacrimal duct or canaliculi.

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Fig. 9.4
Punctal dilatation


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Fig. 9.5
Canalicular pass of the dacryoendoscope


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Fig. 9.6
Vertical pass of the dacryoendoscope. Note the saline syringe to side port



Indications


The indications for which dacryoendoscopy is gaining popularity are as follows [110], but by no means this list is exhaustive or complete.

1.

Acquired internal punctal stenosis

 

2.

Incomplete punctal canalizations (IPC) [11]

 

3.

Canalicular explorations following IPC membranotomy

 

4.

Canalicular wall dysgenesis (CWD) [12]

 

5.

Canalicular stenosis

 

6.

Patchy or multifocal canalicular strictures

 

7.

Partial and complete canalicular obstructions

 

8.

Dacryoendoscopic guided canalicular trephination

 

9.

Laser dacryoplasty

 

10.

Microdrill canaliculoplasty

 

11.

Balloon canaliculoplasty

 

12.

Confirmation of complete canalicular recanalizations

 

13.

Assessment of the mucosal folds across the lacrimal system

 

14.

Lacrimal sac inflammations

 

15.

Focal and suspicious mucosal elevations ± guided punch biopsy

 

16.

Residual lacrimal sac septum

 

17.

Lacrimal sac diverticula

 

18.

Chronic dacryocystitis to assess intrasac synechiae

 

19.

Lacrimal sac entrapments following bony trauma

 

20.

Dacryocele

 

21.

Lacrimal drainage system tumors

 

22.

Assessment of unusual types of sac discharges

 

23.

Assessment of foreign bodies and migrated punctal plugs

 

24.

Dacryolithiasis—assessment and guided removal

 

25.

Assessment of lacrimal fistulas

 

26.

Etiopathogenesis of congenital nasolacrimal duct obstructions

 

27.

Functional nasolacrimal duct obstructions (to rule out anatomical issues)

 

May 26, 2017 | Posted by in OPHTHALMOLOGY | Comments Off on Dacryoendoscopic Examination of the Lacrimal System
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