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Novel Evidence Concerning Lacrimal Sac Movement Using Ultra-High-Frequency Ultrasound Examinations of Lacrimal Drainage Systems

Bohman, Elin ; Berggren, Johanna LU ; Bunke, Josefine LU ; Albinsson, John LU ; Engelsberg, Karl LU ; Dahlstrand, Ulf LU ; Hult, Jenny LU ; Hasegawa, Hideyuki LU ; Cinthio, Magnus LU and Sheikh, Rafi LU (2020) In Ophthalmic Plastic and Reconstructive Surgery
Abstract

PURPOSE: Current hypothesis regarding the mechanism of active tear drainage is based on studies performed ex vivo or under nonphysiological conditions. Novel ultra-high-frequency ultrasound has the advantage of generating images with superior resolution, enabling measurements of low flow in small vessels, and the tracking of tissue motion in real time. The purpose of this study was to investigate the lacrimal drainage system and active drainage using this modality.

METHODS: The upper lacrimal drainage system was investigated with 40-70 MHz ultrasound in 22 eyes in 13 patients. Irrigation confirmed a lacrimal obstruction in 10 eyes. Motion tracking was used to map movement of the lateral lacrimal sac wall and to measure flow when... (More)

PURPOSE: Current hypothesis regarding the mechanism of active tear drainage is based on studies performed ex vivo or under nonphysiological conditions. Novel ultra-high-frequency ultrasound has the advantage of generating images with superior resolution, enabling measurements of low flow in small vessels, and the tracking of tissue motion in real time. The purpose of this study was to investigate the lacrimal drainage system and active drainage using this modality.

METHODS: The upper lacrimal drainage system was investigated with 40-70 MHz ultrasound in 22 eyes in 13 patients. Irrigation confirmed a lacrimal obstruction in 10 eyes. Motion tracking was used to map movement of the lateral lacrimal sac wall and to measure flow when possible.

RESULTS: The anatomy of the upper lacrimal drainage system was mapped in vivo, including the proximal canaliculi, which have not previously been imaged. The lacrimal sac lumen is slit shaped in its resting state but is distended when irrigated or if a nasolacrimal duct obstruction is present. Thus, the healthy lacrimal sac is not a cavity, and the medial retinaculum does not act against a stretched structure. Motion tracking visualized the "lacrimal pump," showing that the direction of motion of the lateral lacrimal sac wall is mainly in the sagittal plane during blinking.

CONCLUSIONS: Ultra-high-frequency ultrasound allows detailed physiological monitoring of the upper lacrimal drainage system in vivo. Our findings suggest that current theories of active tear drainage need to be reappraised.

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Contribution to journal
publication status
epub
subject
in
Ophthalmic Plastic and Reconstructive Surgery
publisher
Lippincott Williams & Wilkins
external identifiers
  • pmid:33156146
ISSN
1537-2677
DOI
10.1097/IOP.0000000000001865
language
English
LU publication?
yes
id
76b7e80d-db28-4649-931e-18af9b68429d
date added to LUP
2020-11-12 22:34:27
date last changed
2020-11-13 14:41:33
@article{76b7e80d-db28-4649-931e-18af9b68429d,
  abstract     = {<p>PURPOSE: Current hypothesis regarding the mechanism of active tear drainage is based on studies performed ex vivo or under nonphysiological conditions. Novel ultra-high-frequency ultrasound has the advantage of generating images with superior resolution, enabling measurements of low flow in small vessels, and the tracking of tissue motion in real time. The purpose of this study was to investigate the lacrimal drainage system and active drainage using this modality.</p><p>METHODS: The upper lacrimal drainage system was investigated with 40-70 MHz ultrasound in 22 eyes in 13 patients. Irrigation confirmed a lacrimal obstruction in 10 eyes. Motion tracking was used to map movement of the lateral lacrimal sac wall and to measure flow when possible.</p><p>RESULTS: The anatomy of the upper lacrimal drainage system was mapped in vivo, including the proximal canaliculi, which have not previously been imaged. The lacrimal sac lumen is slit shaped in its resting state but is distended when irrigated or if a nasolacrimal duct obstruction is present. Thus, the healthy lacrimal sac is not a cavity, and the medial retinaculum does not act against a stretched structure. Motion tracking visualized the "lacrimal pump," showing that the direction of motion of the lateral lacrimal sac wall is mainly in the sagittal plane during blinking.</p><p>CONCLUSIONS: Ultra-high-frequency ultrasound allows detailed physiological monitoring of the upper lacrimal drainage system in vivo. Our findings suggest that current theories of active tear drainage need to be reappraised.</p>},
  author       = {Bohman, Elin and Berggren, Johanna and Bunke, Josefine and Albinsson, John and Engelsberg, Karl and Dahlstrand, Ulf and Hult, Jenny and Hasegawa, Hideyuki and Cinthio, Magnus and Sheikh, Rafi},
  issn         = {1537-2677},
  language     = {eng},
  month        = {11},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {Ophthalmic Plastic and Reconstructive Surgery},
  title        = {Novel Evidence Concerning Lacrimal Sac Movement Using Ultra-High-Frequency Ultrasound Examinations of Lacrimal Drainage Systems},
  url          = {http://dx.doi.org/10.1097/IOP.0000000000001865},
  doi          = {10.1097/IOP.0000000000001865},
  year         = {2020},
}