Skip to main content
SpringerLink
Log in

The postsaccal, idiopathic dacryostenosis — experimental and clinical aspects

  • Published:
Documenta Ophthalmologica Aims and scope Submit manuscript

Abstract

The ‘idiopathic’ dacryostenosis has not yet been cleared up in its aetiological aspects. For further explanation of aetiology and pathomechanisms an experimental, anatomical study was made. Its object was to define the angles and measurements within the bony lacrimal structures and to establish possible connections between the development of the postsaccal stenosis and certain bony constellations of the lacrimal system. The main goal of these examinations was to determine the angle between the lacrimal fossa and the main direction of the nasolacrimal canal, as well as the angles which are found in the course of the nasolacrimal canal. Macerated half skulls obtained from anatomical dissection courses were used for this study. After cleaning the bony lacrimal passages, the distal orifice of the nasolacrimal canal was closed with bone wax. The canal and the lacrimal fossa were filled with epoxy resin. After hardening the preparations were radiographed in order to make sure that the whole system was completely filled with resin. Then the surrounding bone was removed chemically and the resin casts were laid free. They were photographed and the photographs were traced and measured.

A trigonometric method was then used for constructing the maximum angle between the lacrimal fossa and nasolacrimal canal. This angle was mainly directed dorsomedially and showed a considerable amount of variation. A bony system with a large angle increases the possibility of acquiring a postsaccal dacryostenosis. The bony angle is one of many factors facilitating an ascending inflammation in the lacrimal mucosa. Clinically we have to differentiate the acute, fresh dacryocystitis from the chronic, recurrent dacryocystitis. The main symptoms are epiphora, pain and inflammation in the medial canthal area and headache. The most important diagnostic examinations are the slitlamp examination of the eyelids, of the lacrimal puncta and of the anterior segment of the globe, the ‘lacrimal punctum excursion test’, the diagnostic rinse of the lacrimal passages, the dacryocystography and the rhinological examination.

The result of a successful treatment of the acute, beginning dacryocystitis is to open the incomplete, transitory, distal stenosis of the nasolacrimal duct. The stenosis is caused by an ascending inflammation from the nose and by the swelling of the lacrimal mucosa. The blockage can be solved by massage after application of vasoconstrictory drops. The therapy of a complete, postsaccal lacrimal stenosis always has to be a dacryocystorhinostomia externa (‘Toti-operation’).

The Kaleff-Hollwich modification proved successful and is extended by a fibrin sealing method. The operation technique is described and the results are reported. The experimental data and clinical findings are correlated; in conclusion they point out, that an ascending inflammation is mainly responsible for the development of the idiopathic dacryocystenosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Adenis JP, Leboutet MJ, Loubet A, Loubet R, Robin A (1980) Les cellules ciliées du systeme lacrymale. Ultrastructure comparée de la muqueuse lacrymale. J Fr Ophtal 3:343–348

    Google Scholar 

  • Adenis JP (1985a) Electron microscopy of the lacrimal passages epithelium. Paper presented at the 5th Int Congress of Orbital Disorders (ISOD) Amsterdam, September

  • Adenis JP, Lebraud P, Leboutet MJ, Loubet R and Loubet A (1985b) A human embryologic study of the lacrimal system. Chibret Int J Ophthal 3 2:2–10

    Google Scholar 

  • Anel D (1713) Observiation singulière sur la fistule lacrymale, Turin, Cit: Hirschberg J Geschichte der Ophthalmologie. In: Graefe-Saemisch, Handbuch der gesamten Augenheilkunde. Leipzig, Engelmann, 1877, Bd VII, p 356

    Google Scholar 

  • Aubaret E (1911) Emploi de la radiologie dans la semeiologie des voies lacrymales. Bull Mem Soc Fr Ophthal 28:125

    Google Scholar 

  • Bangerter A (1953) Sondenkanüle zur Behandlung der angeborenen Tränenkanalstenose. Aus der Praxis für die Praxis. Ophthalmologica 125:398–399

    Google Scholar 

  • Bennett JE (1980) The lacrimal drainage system. In: Clinical Ophthalmology, ed Duane TD, New York, Harper and Row, Vol 5, Ch 11: 3–4

    Google Scholar 

  • Blaskovics-Kreiker (1959) Eingriffe am Auge. Stuttgart, Enke, pp 174–180

    Google Scholar 

  • Brunetti (1930) Atti Cong Iral Radiol Med 2:25 Cit: Duke-Elder and MacFaul: Lacrimal, Orbital and para-orbital diseases. In: Duke-Elder, System of Ophthalmology, Vol XIII, pt 2, London, Kimpton, 1974, p 682

    Google Scholar 

  • Bowman W (1857) On the treatment of lacrimal obstruction. Ophthal Hospit Reports 1:10–20; Ann Oculist 34:70–83

    Google Scholar 

  • Burian M, Steinkogler FJ, Lischka M and Mayr R (1984) Form und Maβe des Canalis nasolacrimalis und deren Bedeutung für die Klinik. Soc. Suisse d'Anatomie, d'Histologie et d'Embryologie. 46. Reunion Annuel, Lausanne, October 1984

  • Busse H and Müller KM (1977) Zur Entstehung der idiopathischen Dacryostenose (Klinische und pathologisch- anatomische Befunde). Klin Mbl Augenheilk 170: 627–632

    Google Scholar 

  • Busse H and Hollwich F (1978) Erkrankungen der ableitenden Tränenwege und ihre Behandlung. Bücherei des Augenarztes, Heft 74, Stuttgart, Enke

    Google Scholar 

  • Busse H, Jünemann G and Mewe L (1979) Dacryocystographische Befunde und therapeutische Konsequenzen. Ber Dtsch Ophthal Ges 76:101–105

    Google Scholar 

  • Busse H, Müller RM and Kroll P (1980) Radiological and histological findings of the lacrimal passages of newborns. Arch Ophthal 98:528–532

    Google Scholar 

  • Cassady JV (1952) Developmental anatomy of nasolacrimal duct. Arch Ophthal 47: 141

    Google Scholar 

  • Cibis GW and Jatzby BU (1979) Nasolacrimal duct probing in infants. Ophthalmology 86:1488–1491

    Google Scholar 

  • Duke-Elder S (1974) System of Ophthalmology, Vol XIII, pt 2, London, Kimpton

    Google Scholar 

  • Dupuy-Dutemps L and Bourguet J (1921) Precède plastique de dacryocysto-rhinostomie. Ann Oculist 158:241

    Google Scholar 

  • Eisler P (1930) Die Anatomie des menschlichen Auges. In: Kurzes Handbuch der Ophthalmologie, eds. Schieck F, Brückner A, Berlin, Springer

    Google Scholar 

  • Fischer F (1918) Die Entwicklung der ableitenden Tränenwege beim Menschen. Berlin, Karger

    Google Scholar 

  • Freyler H and Klemen U (1978) Fibrinklebung in der Hornhautchirurgie. Graefes Arch Klin Exp Ophthal 207:27–39

    Google Scholar 

  • Gray H (1980) Gray's Anatomy, 36 ed, Eds. Williams PL, Warwick R. Neurology Edinburgh, Churchill Livingstone, p 1189

    Google Scholar 

  • Guibor P (1975) Canaliculus intubation set. Trans Amer Acad Ophthal Otolaryng 79:419–420

    Google Scholar 

  • Gullotta U and Denffe HV (1980) Dacryocystography. An Atlas and Textbook. Stuttgart, Thieme.

    Google Scholar 

  • Hatt M (1981) Technik der Intubation der ableitenden Tränenwege. Klin Mbl Augenheilk 178:153–154

    Google Scholar 

  • Hefel F (1954) Erfahrungen mit der Dacryocystorhinostomia externa. Ophthalmologica (Basel) 128:61–69

    Google Scholar 

  • Helveston EM and Ellis FD (1980) Pediatric Ophthalmology Practice. St. Louis, Mosby 104–107

    Google Scholar 

  • Henle J (1865) Zur Anatomie der Tränenwege und zur Physiologie der Tränenleitung. Z Rat Med XXIII, 3:264, ref: Klin Mbl Augenheilk III, 242

    Google Scholar 

  • Hirschberg J (1911) Geschichte der Augenheilkunde. In: Graefe-Saemisch, Handbuch der gesamten Augenheilkunde, Bd XII-XIV. Leipzig, Engelmann

  • Hollwich F (1977) Über eine Modifikation der Totische Operation Klin Mbl Augenheilk 170:633–636

    Google Scholar 

  • Hurwitz JJ and Rodgers KJA (1983) Management of acquked dacryocystitis. Can J Ophthal 18:213–216

    Google Scholar 

  • Jones LT (1966) The lacrimal secretory system and its treatment. Amer J Ophthal 62:47–60

    Google Scholar 

  • Jünemann G and Schulte D (1974) Erkrankungen des Tränenapparates. EFA X, Essen, March 1974

  • Jünemann G and Busse H (1977) Konservative und operative Behandlung der Störungen der Tränenwege. EFA XII, Essen, February 1977

  • Kaleff R (1937) Eine vereinfachte Modifikation der Dacryocystorhinostomia externa. Z. Augenheilk 91:140

    Google Scholar 

  • Kopylow B (1930) Ein neues Verfahren zur Darstellung des Canalis nasolacrimalis. Röntgenpraxis 2:686

    Google Scholar 

  • Kraft SP and Crawford JS (1982) Silicone tube intubation in disorders of the lacrimal system in children. Amer J Ophthal 94:290–299

    Google Scholar 

  • Krause (1956) Evaluation of current treatment of stricture of the valve of Krause. Cit: Foster J: Ann Roy Coll Surg 18:143

    Google Scholar 

  • Kuhnt H (1914) Notiz zur Technik der Dacryocystorhinostomie nach Toti. Z Augenheilk 31:379

    Google Scholar 

  • Lang J (1979) Kopf, Teil B: Gehim -und Augenschädel. In: Praktische Anatomie Teil 1, eds. Lanz T, Wachsmuth W, Berlin, Springer, p 576

    Google Scholar 

  • Lauber H and Kolmer W (eds) (1936) Handbuch der mikroskopischen Anatomie des Menschen III, Auge. Berlin, Springer, pp 598–501

    Google Scholar 

  • Mackenzie (1840) A practical treatise on the diseases of the eye, 3rd ed, London p 249. In: Duke-Elder System of Ophthalmology, Vol XII, ppt 2. London, Kimpton, p 700

  • Melanová J (1969) Diverticulum of lacrimal sac. Csl Oftal 25–47

  • Meller J (1929) Diseases of the lacrimal apparatus. Trans Ophthal Soc UK 49:233

    Google Scholar 

  • Müller F (1975) Erkrankungen der Tränenorgane, In: Velhagen K: Der Augenarzt, Bd III. Leipzig, Thieme

    Google Scholar 

  • Müller KM, Busse H and Osmers F (1978) Anatomy of the nasolacrimal duct in newborns: Therapeutic considerations. Eur J Paediat 129:83–92

    Google Scholar 

  • Murube des Castillo J (1981) Dacriologia basica, Ponencia oficial de la Sociedad Espanola de Oftalmologia, Las Palmas pp 287–293

  • Ohm J (1921) Bericht über 70 Totische Operationen. Z Augenheilk 46:37

    Google Scholar 

  • Porteder H, Steinkogler FJ and Rausch E (1985) Die Jochbeinfraktur in Beziehung zur Augenhöhle. Z Stomatol 82:365–372

    Google Scholar 

  • Putterman AM (1980) Basic oculoplastic surgery. In: Principles and Practice of Ophthalmology, eds. Peyman GA, Sanders DR, Goldberg MF. Philadelphia, Saunders, Vol 3:2277–2279

    Google Scholar 

  • Quickert MH and Dryden RM (1970) Probes for intubation in lacrimal drainage. Trans Amer Acad Ophthal Otolaryng 74:431

    Google Scholar 

  • Radnot M and Böles S (1971) Die Feinstruktur der Epithelzeilenoberfläche des Tränen-sackes. Klin Mbl Augenheilk 159:158–164

    Google Scholar 

  • Radnot M (1972) Ultrastructure of the lacrimal sac. Ann Ophthal 4:1050–1060

    Google Scholar 

  • Rochels R, Lieb W and Nover A (1984) Echographische Diagnostik bei Erkrankungen der ableitenden Tranenwege. Klin Mbl Augenheilk 185:243–249

    Google Scholar 

  • Ruiz-Barranco R (1966) Pathogenia de las dacriocistitis hapel des conducte nasal. Arch Soc Oftal Hisp-Amer. 26:133. Ref: Zbl Ges Ophthal 97 (1966/67) 584

    Google Scholar 

  • Ruiz-Barranco F and Quiles Morillia A (1977) Estudio radiologico de las vias lacrimales: caracteristicas, diferencias entre ambos sexos, y parametros que influyen en la patogenia de las dacriostenosis. Arch Soc Canaria Oftal 2:61–82. Ref: Zbl Ges Ophthalmol 117 (1979) 59

    Google Scholar 

  • Schnyder F (1920) Über familiäres Vorkommen resp. die Vererbung von Erkrankungen der Tränenwege. Z Augenheilk 44:257

    Google Scholar 

  • Sevel D (1982) Insufflation treatment of nasolacrimal apparatus in the child. Ophthalmology 80: 329–334

    Google Scholar 

  • Slezak H, Bettelheim H, Braun F and Prammer G (1977) Fibrinklebung (Orientierende Tierversuche). Klin Mbl Augenheilk 170:450–453

    Google Scholar 

  • Soll DB (1978) Silicons intubation: An alternative to dacryocystorhinostomy. Ophthalmology 85:1259–1266

    Google Scholar 

  • Steinkogler FJ, Burian M, Mayr R and Lischka M (1985) Morphological observations of the nasolacrimal canal. Paper presented at the 4th meeting of ESOPRS, Amsterdam, September, (in press)

  • Steinkogler FJ and Haddad R (1986) Experimental experiences with fibrin-glued heterogenic pericardium in conjunctival surgery. In: Fibrin sealant in ophthalmic-and neurosurgery. eds. Schlag G, Redl H. Heidelberg, Springer, Vol 7 (in press)

    Google Scholar 

  • Steinkogler FJ (1986a) The use of fibrin sealant in lid surgery. In: Fibrin sealant in ophthalmic- and neuorsurgery, eds. Schlag G, Redl H. Heildelberg, Springer, Vol 7 (in press)

    Google Scholar 

  • Steinkogler FJ (1986b) Fibrin tissue adhesive for the repair of lacerated canaliculi lacrimales. In: Fibrin sealant in ophthalmic- and neurosurgery, eds. Schlag G, Redl H. Heidelberg, Springer, Vol 7 (in press)

    Google Scholar 

  • Summerskill WH (1956) Problems of lacrimal obstruction. The rhinological approach. Trans Ophthal Soc UK 76:385

    Google Scholar 

  • Sundmark E (1964) Instruments for the temporary application of plastic tubes in the treatment of lacrimal obstruction. Acta Ophthal 42:528–532

    Google Scholar 

  • Szily A v (1914) Die Pathologic des Tränensackes und des Ductus nasolacrimalis im Röntgenbild. Klin Mbl Augenheilk 52:847–854

    Google Scholar 

  • Toth Z (1932) Über Vertikalaufnahme des Tränenkanals. Klin Mbl Augenheilk 89: 555

    Google Scholar 

  • Toth Z (1933) Lotrechte Röntgenaufnahme des Tränennasenkanals. Klin Mbl Augenheilk 91:390

    Google Scholar 

  • Toti A (1904) Dacryocistorhinostomia. La clinica moderna X 33–34

  • Toti A (1910) Zum Prinzip, zur Technik und zur Geschichte der Dacryocystorhinostomie, Z Augenheilk 23:2–32

    Google Scholar 

  • Traquair HM (1941) Chronic dacryocystitis: its causation and treatment. Arch Ophthal 26:165

    Google Scholar 

  • Werb A (1985) A lacrimal perspective 1985. Ophthal Plast Reconstr. Surg. 1:81–82

    Google Scholar 

  • West JM (1918) Eine Probe zur Feststellung der Funktions-fähigkeit des Tränenröhrchens und ihre klinische Bedeutung. Z Augenheilk 39:260

    Google Scholar 

  • Whitnall (1932) Die Anatomie des Ductus und Canalis nasolacrimalis. Cit: Praktische Anatomie Teil 1, eds. Lanz T, Wachsmuth W. Berlin, Springer, 1989

    Google Scholar 

  • Zabel (1900) Die Maβe des Canalis nasolacrimalis In: Handbuch der mikroskopischen Anatomie des Menschen, III, Auge, eds. Lauber H, Kollmer W. Berlin, Springer, 1936, pp 598–601

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. 2nd University Eye Clinic, Alserstraβe 4, A-1090, Vienna, Austria

    Franz Josef Steinkogler

Authors
  1. Franz Josef Steinkogler
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Steinkogler, F.J. The postsaccal, idiopathic dacryostenosis — experimental and clinical aspects. Doc Ophthalmol 63, 265–286 (1986). https://doi.org/10.1007/BF00160761

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00160761

Key words

Search

Navigation