Anatomic position of the common canaliculus in patients with a large lacrimal sac.

Abstract:

PURPOSE:To study the canalicular anatomy in patients with an enlarged sac secondary to nasolacrimal duct obstruction. METHODS:This study included 76 lacrimal drainage systems (LDS) of 41 adult patients with a palpable sac, which were visualized using posteroanterior digital subtraction macrodacryocystography. In 42 LDS, there was a palpable enlarged sac secondary to nasolacrimal duct obstruction. In 20 LDS, the sac enlargement was associated with a valve-type canalicular obstruction preventing retrograde reflux of the sac content, and in 22 LDS, there was no associated canalicular obstruction. Thirty-four LDS were either normal or had a nasolacrimal duct obstruction without a palpable sac. RESULTS:Dacryocystography showed a common canaliculus in all LDS. In 35 (83%) of 42 LDS with a palpable sac (17 LDS with and 18 LDS without canalicular obstruction), the anatomic orientation of the common canaliculus in the superior-inferior direction showed a consistent change. The common canaliculus was bending inferiorly with a sharp angle as it was coursing to the sac. In all LDS with a nonpalpable sac, the common canaliculus had an approximately direct, horizontal, or slightly upward course to the sac. CONCLUSIONS:Lacrimal sac enlargement secondary to nasolacrimal duct obstruction changes the anatomic orientation of the common canaliculus. The canaliculus shows an acute, inferior angulation from the superior-to-inferior direction while coursing to the sac in most instances. This anatomic variation should be considered during lacrimal interventions.

authors

Yazici B,Yazici Z

doi

10.1097/IOP.0b013e3181647d01

subject

Has Abstract

pub_date

2008-03-01 00:00:00

pages

90-3

issue

2

eissn

0740-9303

issn

1537-2677

pii

00002341-200803000-00002

journal_volume

24

pub_type

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