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Professor Zhang Jiang: Application of nasal endoscopy in diagnosis and treatment of lacrimal duct disease in children

Posting time:2022-12-02 05:58:07

Professor Zhang Jiang: Application of nasal endoscopy in diagnosis and treatment of lacrimal duct disease in children

Editor's note Congenital naso lacrimal duct obstruction (CNLDO) is a common eye disease in children. The main clinical manifestation is persistent epiphora shortly after birth, which may be accompanied by pus, with an incidence rate of 5% to 20%. %, most of the reasons are that the Hasner membrane at the end of the nasolacrimal duct is not open, and some CNLDOs can be cured by themselves or by non-invasive methods such as lacrimal sac massage. Some children need to be cured by probing the lacrimal duct. For experienced doctors, the success rate of one-time lacrimal duct probing in outpatient clinics is not less than 90%, and there are still a few cases where probing fails. For the failed probing cases, the previous view was attributed to bony obstruction and deformity, and CT angiography of the dacryocyst was usually performed clinically, but the changes in the nasolacrimal duct due to probing were not enough to explain the problem. Ophthalmologists often ignore factors other than eye diseases, such as hypertrophy of the following turbinates. Due to the adjacent positional relationship and the application of ophthalmic endoscopy in the field of lacrimal duct, there is increasing evidence that hypertrophic inferior turbinate is one of the main reasons for the failure of congenital nasolacrimal duct probing. At the VC 2022 conference, Professor Zhang Jiang from Wuhan Aier Eye Hospital shared a case of nasal endoscopy in the diagnosis and treatment of lacrimal duct disease in children, and shared with everyone. The basic situation of the child The child, Zhou, a boy, 11 months old. The epiphora from the left eye usually starts one week after birth, and the intermittent medication and lacrimal duct massage treatment did not heal. After the consultation, outpatient probing was arranged. The probing was not smooth, and in case of bone resistance, the probing was stopped and admitted to the hospital. Nasal endoscopy-assisted lacrimal duct placement was planned. During the operation, the inferior turbinate was hypertrophied, the inferior turbinate was crowded and the inferior turbinate was corrected, and the membranous tissue of the inferior nasal meatus was pushed open by the medial displacement, and the membranous tissue was pushed open. open, so there is no need for a lacrimal duct catheter. The above picture explains an important problem in clinical work. Children with probing sometimes have bone resistance, sometimes accompanied by rustling noises, and the cause of inferior turbinate hypertrophy should be considered, which can be judged by nasal endoscopy or lacrimal sac CT examination. Choose endoscopic-assisted lacrimal duct probing, catheter placement, or DCR. Expert Profile Zhang Jiang Member of the Ophthalmology Group for Systemic Diseases of the Ophthalmology Branch of the Chinese Medical Doctor Association, Wuhan Aier Eye Hospital; Member of the Ophthalmic Endoscopic Minimally Invasive Surgery Group of the Cross-Strait Medical and Health Exchange Association; Executive Group Leader of the Lacrimal Pathology Group of Aier Eye Hospital Group ; Director of the lacrimal duct/eye and nose related specialist department of Aier Eye Hospital Affiliated to Wuhan University; References (swipe up and down to view) 1 Ophthalmology and Orbitology Group of Ophthalmology Branch of Chinese Medical Association. Expert consensus on diagnosis and treatment of congenital nasolacrimal duct obstruction in China (2021)[J]. Chinese Journal of Ophthalmology, 2021, 57(11): 814-818.2 Badakere A, Veeravalli TN, Iram S, et al. Unilateral congenital nasolacrimal duct obstruction and amblyopia risk factors. Clin Ophthalmol 2018;12:1255-12573 Moscato EE, Kelly JP, Weiss A. Developmental anatomy of the nasolacrimal duct: implications for congenital obstruction. Ophthalmology 2010;117(112):2430-24344 Elsawaby EA, El Essawy RA, Abdelbaky SH, et al. pushed monocanalicular intubation versus probing as a primary management for congenital nasolacrimal obsturction. Clin Ophthalmol 2016;10:1487-14935 Vagge A, Ferro Desideri L, Nucci P, et al. Congenital Nasolacrimal Duct Obstruction (CNLDO): A Review. Diseases 2018;6(4):96

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