Congenital lacrimal fistula

PURPOSE: Congenital lacrimal fistula is a rare abnormality of the lacrimal system. The patients may be asymptomatic but treatment of those with symptoms such as epiphora and dacryocystitis is still controversial. METHODS: The clinical findings, methods of surgical treatment and results were evaluated in seven patients (four male, three female) with congenital lacrimal fistula. Three were asymptomatic, types of surgical treatment were fistula excision with dacryocystorhinostomy (DCR) (two cases), fistula excision with conjunctival DCR (one case) and closed fistula excision alone (one case). RESULTS: Three of the four patients who underwent surgery had relief of symptoms. The fistula recurred in the case that had undergone fistula excision alone. CONCLUSIONS: It is difficult to design controlled studies to detect which method is superior for the treatment of lacrimal fistula, considering the small number of cases in the literature. We recommend treating each case according to its own characteristics.     

Congenital fistula of the lacrimal sac

Fistulas of the lacrimal sac are visible as small openings in the skin of the medial canthus. They can cause inflammations and serous or mucous secretions. Additional canaliculi of this type can be demonstrated by dacryocystographic techniques. Under the operating microscope the fistula is exposed as far as the lacrimal sac and then excised. The lacrimal sac and the nasolacrimal duct are examined. If there is no further stenosis a dacryocystorhinostomy is not necessary. After bicanalicular silicone intubation the wound is closed layer by layer. If primary healing occurs without complications dense closure results and there is no danger of fistulas of the lacrimal sac redeveloping.     

Congenital lacrimal fistula associated with Down syndrome

Background

The aim of this work is to investigate the prevalence and clinical characteristics of congenital lacrimal fistula in Down syndrome patients.

Methods

The medical records of 198 Down syndrome patients who were referred to a tertiary ophthalmology clinic from 2000 to 2010 were retrospectively reviewed to identify patients with congenital lacrimal fistula. The demographic data, clinical features, clinical management, and clinical outcomes were recorded. The main outcome measures were the presence and laterality of fistula, accompanying adnexal and oculomotor abnormalities including congenital nasolacrimal duct obstruction (NLDO), the type of surgery performed, and surgical outcome. The prevalence of congenital lacrimal fistula in Down syndrome patients was calculated upon this data.

Results

Congenital lacrimal fistula was identified in 8/198 (4.04?%) patients, 4 (2.02?%) of whom presented with bilateral lacrimal fistula. All patients that had lacrimal fistula complained of tearing from their eyes. Congenital NLDO was observed in seven of eight patients with lacrimal fistula. Five patients underwent excision of the lacrimal fistula for the improvement of cosmesis, and three of these patients also underwent lacrimal silicone intubation for NLDO. Another patient received lacrimal silicone intubation for NLDO without excision of the lacrimal fistula. Excision of the lacrimal fistula was successful in all patients; however, tearing persisted after surgery in two patients with uncorrected NLDO.

Conclusions

Congenital lacrimal fistula occurs more frequently in Down syndrome patients and therefore these patients should be thoroughly examined for this abnormality. Down syndrome patients with congenital lacrimal fistula should be also examined for NLDO, because this condition is frequently observed in these patients.     

Congenital lacrimal fistula: A major review

The purpose of this article is to review and summarize the etiopathogenesis, symptomatology, systemic associations, management, complications and clinical outcomes of congenital lacrimal fistulae. The authors performed an electronic database (PubMed, MEDLINE, EMBASE and Cochrane Library) search of all articles published in English on congenital lacrimal fistulae. Congenital subsets of patients from series of mixed lacrimal fistulae were included in the review. These articles were reviewed along with their relevant cross-references. Data reviewed included demographics, presentations, investigations, management, complications and outcomes. The prevalence of congenital lacrimal fistulae is reported to be around 1 in 2000 live births. They are frequently unilateral, although familial cases tend to be bilateral. Lacrimal and systemic anomalies have been associated with lacrimal fistulae. Exact etiopathogenesis is unknown but mostly believed to be an accessory out budding from the lacrimal drainage system during embryogenesis. Treatment is indicated when significant epiphora or discharge is present and is mostly achieved by various fistulectomy techniques with or without a dacryocystorhinostomy. Congenital lacrimal fistulae are a distinct clinical entity with unique features. Surgical management can be challenging and successful outcomes are usually achieved with widely accepted protocols.     

泪囊瘘管切除联合泪道双硅胶管植入治疗慢性泪囊炎合并泪囊瘘管的疗效

目的：：探讨泪囊瘘管切除联合泪道双硅胶管植入治疗慢性泪囊炎合并泪囊瘘管的疗效。方法：回顾性分析25例25眼慢性泪囊炎合并泪囊瘘管患者,分为两组：双硅胶管组13例13眼行泪囊瘘管切除联合泪道双硅胶管植入术,传统组12例12眼行传统外路鼻腔泪囊吻合术,分析两组疗效。结果：双硅胶管组：治愈12例12眼,好转1例1眼,治愈率92.3%,有效率100%。传统吻合组：治愈11例11眼,有效1例1眼,治愈率91.7%,有效率100%,两组患者比较差异无统计学意义(P>0.05)。结论：泪囊瘘管切除联合泪道双硅胶管植入治疗慢性泪囊炎并泪囊瘘管效果与传统外路鼻腔泪囊吻合术相当,但更微创、无面部瘢痕,可减少患者痛苦,满足患者美容的需求。     

Congenital lacrimal sac fistula: intraoperative visualization by polyvinyl siloxane cast

We report the intraoperative use of polyvinyl siloxane impression material to demonstrate the anatomy of the lacrimal sac, canaliculi, and lacrimal duct in a case of congenital lacrimal sac fistula. A 1-week-old boy was examined for tearing since birth. Examination revealed a left congenital lacrimal sac fistula. After a failed surgery to close the fistula with silicone intubation at 6 months of age, the patient underwent endonasal dacryocystorhinostomy performed at 14 months of age, aided by intraoperative injection of polyvinyl siloxane (trade name Reprosil) to mark and protect the nasolacrimal sac and facilitate endonasal visualization. A polyvinyl siloxane cast demonstrated the anatomy of the accessory canaliculus causing nasolacrimal duct obstruction. Postoperatively, the epiphora resolved and the fistula remained closed. The polyvinyl siloxane cast provides a 3-dimensional "ex vivo " model of the lacrimal sac, upper duct, and canalicular anatomy, and can be used in dacryocystorhinostomy surgery to identify and protect the lacrimal sac.     

Hereditary lacrimal fistula

Hereditary lacrimal fistula is a rare developmental anomaly. We report three patients with congenital lacrimal fistulae in the same family. Only one of our cases had bilateral lacrimal fistula while two had unilateral lacrimal fistulae. No other systemic or ocular anomaly was found in the affected subjects. In the absence of significant symptoms, we did not feel the necessity of any treatment for these lacrimal fistulae. The presence of a lacrimal fistula is an indication for the search for a variety of systemic and ocular associations in affected patients.     

Congenital lacrimal duct obstructions

If typical congenital nasolacrimal obstruction symptoms occur during the first few days of life immediate treatment is necessary. At the latest within two weeks the benefits of medication and massages of the lacrimal sac should be exploited to treat these conditions. It should be pointed out in particular that persisting membranes may perforate spontaneously. Should this treatment fail, high-pressure syringing and probing with Bangerter probes under local anesthesia must be performed very early. Due to the fact that the less complicated high-pressure syringing is often unsuccessful it is followed without delay by probing. If the ophthalmic surgeon is skilled, proceeds with care, and observes certain technical details complications can be avoided. The treatment described only fails in exceptional cases.     

泪道瘘管临床分析

目的 分析泪道(?)管的臨床特征和形成原因。方法 對13例泪道(?)管進行回顧性臨床分析。结果 13例泪道(?)管中10例為泪囊瘼,3例為泪小管(?),前者主要由先天、炎症和手術處理不當所致,治療可酌情予保守或手術治療;后者多由外傷引起,治療多用手術。結論 泪道(?)管少見,多為泪囊(?),主要與先天、感染、外傷和手術有關;治療以手術為主。