Abstract ID: 26-333
Real-Time Dacryoendoscopic Analysis of Common Canalicular Anatomy and Its Impact on Chronic Dacryocystitis in 414 Eyes
Author: Jong hwa park Base Hospital / Institution: Inje University of Busan Paik Hospital
Presentation Type: ePoster Presentation
Purpose
To investigate the anatomical diversity of the common canaliculus (CC) and lacrimal sac using real-time in vivo dacryoendoscopy, and to evaluate how the hydrodynamic interaction between CC anatomical variations and obstruction levels affects the development of chronic dacryocystitis
Methods
A retrospective review of 414 eyes in patients with epiphora who underwent dacryoendoscopy-assisted silicone tube intubation. The lacrimal drainage system was evaluated in real-time from the canaliculus to the distal nasolacrimal duct (NLD). The CC anatomy opening into the sac was classified into Type A (distinct CC), Type B (sac-wall convergence without distinct CC), and Type C (separate upper/lower openings). This anatomical classification was intraoperatively re-confirmed with the silicone tube in situ. Generalized estimating equations (GEE) were used to account for paired-eye correlations.
Results
The anatomical distribution was Type A in 69.5% (n=289), Type B in 22.9% (n=94), and Type C in 7.6% (n=31). Chronic dacryocystitis was highly dependent on the level of obstruction. Pre-saccal (inflow) obstruction significantly reduced the risk of chronic dacryocystitis (OR 0.11, p<0.001). Conversely, post-saccal (outflow) obstruction, particularly at the sac-NLD junction (OR 5.17, p<0.001) and overall post-saccal area (OR 7.47, p<0.001), significantly increased the risk. In patients with post-saccal obstruction (where tear stagnation occurs), Type B anatomy demonstrated a clinical tendency for a higher occurrence of chronic dacryocystitis compared to Type A (OR 1.80, p=0.187), and was significantly associated with mucous discharge (OR 2.83, p=0.021).
Conclusion
To our knowledge, this is the first large-scale, real-time in vivo study demonstrating the diversity of CC anatomy. The development of chronic dacryocystitis is not merely random but requires the anatomical prerequisite of post-saccal (outflow) obstruction. Under such stagnant conditions, the Type B CC anomaly acts as an anatomical nidus that promotes mucus retention and exacerbates chronic inflammation.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Young Jin | Kim | Inje University of Busan Paik Hospital |
| Sung Hyuk | Moon | Inje University of Busan Paik Hospital |