Epiphora

This prospective, single-arm interventional clinical study aims to evaluate the short- and intermediate-term anatomical, functional, and quality-of-life outcomes of primary stentless endoscopic dacryocystorhinostomy (En-DCR) in adult patients with primary acquired nasolacrimal duct obstruction (PANDO). Endoscopic DCR bypasses the obstructed distal lacrimal drainage pathway by creating a permanent communication between the lacrimal sac and the nasal cavity. While silicone intubation is traditionally used to prevent early restenosis, its routine use remains controversial due to potential foreign-body morbidity, including canalicular trauma, granuloma formation, tube displacement, and the necessity for a secondary removal procedure. The rationale for this study is based on the concept that surgical success is determined by adequate osteotomy, wide sac marsupialization, mucosal flap preservation, and structured postoperative care, rather than the presence of a permanent foreign body. The study will recruit approximately 40 eligible adults (aged $\\ge$16 years) with objectively confirmed, symptomatic PANDO to undergo a standardized stentless En-DCR procedure. Participants will undergo rigorous postoperative clinical and endoscopic assessments at 1 week, 1 month, 3 months, 6 months, and 12 months. The primary endpoint is the overall composite success rate at 12 months, defined by both objective anatomical patency of the rhinostomy (verified via endoscopy and lacrimal irrigation) and clinically meaningful functional resolution of epiphora (Munk score 0-1). Secondary objectives include quantifying changes in disease-specific quality of life using the Lac-Q questionnaire, documenting postoperative endoscopic healing parameters, and evaluating the incidence and mechanisms of surgical failure or complications.

This study tests whether a very low concentration of atropine eye drops (0.005%) reduces excessive tearing (epiphora) in adults. Each participant will use two different eye drops, one at a time: the atropine drop and an identical-looking drop with no active ingredient (vehicle). Each drop is used once nightly for 7 days, with about 2 weeks between the two treatment periods. Neither the participant nor the study doctor will know which drop is being used during each period. The main measure is the change in how often participants need to wipe their eyes because of tearing. About 12 to 18 adults will take part.

Purpose: It is unknown whether instillation of a drop of anesthetic ophthalmic solution into the eye such as proparacaine hydrochloride 0.5% prior to probing and irrigation of the tear duct (lacrimal drainage) system improves participant comfort during the procedure. To date, there have been no formal studies evaluating the possible benefit of this pretreatment. Methods: Participants 18 years and older who present to the Louisiana State University or associated outpatient ophthalmology clinic(s) with a complaint of epiphora (excessive tearing) who necessitate bilateral lower lid probing and irrigation of the lacrimal drainage system will be enrolled in the study. One eye will be randomized to receive a drop of the anesthetic Proparacaine hydrochloride 0.5% and the other eye will receive a control drop of Balanced Salt Solution (BSS). Probing and irrigation will then be performed in the usual fashion. The participant will then be questioned via survey on a pain scale of 1-5 as to the amount of subjective pain experienced on each side during the procedure. Expected Results: Investigators expect participants will experience statistically significantly less pain in eyes that have received a drop of Proparacaine hydrochloride 0.5% prior to performance of probing and irrigation compared to the eyes which have received the control drop.