Endoscopic examination of the nasolacrimal duct in ten horses

Reasons for performing study: No endoscopic examination of the nasolacrimal duct has been described before. In contrast with other imaging techniques, endoscopy provides a direct inspection of the intralumen and ductal mucosa in standing sedation. Objectives: To provide a reference against which the endoscopic and clinical features of obstructive nasolacrimal disease in the horse may be compared. Methods: Endoscopic examination of the nasolacrimal duct was performed in 10 French Thoroughbred bay mares with a 3 mm shaft diameter flexible fibrescope. The duct was divided into 3 zones (1, 2 and 3) from the nostril to the lacrimal sac. Results: Endoscopic examination of the nasolacrimal duct appeared to be quite easy to perform in Zones 1 and 2, while the ease or difficulty of examining Zone 3 depended on the weight and size of the horse for the position of the endoscope in the lacrimal canal. Conclusions: Endoscopic inspection has provided the possibility of a novel diagnostic approach to conditions of the nasolacrimal duct in horses. Potential relevance: Endoscopic examination of the nasolacrimal duct could help to diagnose and treat nasolacrimal diseases by performing sample withdrawal and duct irrigation.     

Bilateral nasolacrimal duct atresia in a cria

A 2-month-old, male alpaca had a 1-month history of mucoid ocular discharge from the left eye. Signalment, history and clinical findings were suggestive of a congenital nasolacrimal outflow obstruction. A dacryocystorhinogram confirmed bilateral nasolacrimal duct atresia, which involved the distal half of both nasolacrimal ducts. In order to establish alternative outflow, a conjunctivomaxillosinusotomy and conjunctivorhinostomy were performed on the right and left eye, respectively. The surgical openings remain patent after 11 months, and there have been no clinical signs of nasolacrimal disease.     

Endoscopic-guided diagnosis of and interventional stent placement for nasolacrimal duct obstruction in a horse

Objective

To describe the successful use of endoscopy to visualize and place a soft canine ureteral stent to relieve a chronic nasolacrimal duct (NLD) obstruction in a horse.

Animal Studied

A 7-year-old, Quarter horse gelding.

Procedure

Under general anesthesia, retrograde nasolacrimal endoscopy was performed using an 8.5 Fr Storz Flex XC ureteroscope through the nasal punctum (NP). An obstructive web of fibrous tissue was visualized approximately 20 cm proximal to the NP. A 0.035″/150 cm hydrophilic guidewire was passed normograde from the ventral lacrimal punctum and used to puncture the stenotic tissue. Then, a 5.0Fr/70 cm open-end ureteral catheter was threaded normograde over the guidewire and NLD patency was re-established. The catheter confirmed a NLD length of 30 cm and was then removed. A 5.0Fr/22–32 cm Universa© Soft Ureteral Stent was threaded normograde over the guidewire until the loops of the stent were exposed at each end. The guidewire was removed and the stent loops were sutured in place.

Results

The stent was withdrawn 1 month after the procedure. Telephone follow-up with the client reported significant improvement in the amount of ocular discharge and decreased sensitivity around the face and ears.

Conclusion

Endoscopy is a safe and effective procedure allowing for definitive diagnosis of NLD obstruction and to assist in interventional procedures. Placement of a canine indwelling ureteral stent seems to be an effective alternative treatment option for equine NLD obstruction compared to conventional invasive surgical procedures.     

Nasolacrimal obstruction caused by root abscess of the upper canine in a cat

A 10‐year‐old, castrated male domestic short hair cat was presented to the Small Animal Clinic at the Western College of Veterinary Medicine with a presenting complaint of chronic, ocular discharge from the left eye. Ocular examination confirmed epiphora and mucopurulent discharge but there were no apparent reasons for the ocular discharge, and nasolacrimal obstruction was suspected. The cat had swelling of the left side of the face, severe periodontal disease and a fractured upper left canine tooth with pulpal exposure. Dacryocystorhinography revealed narrowing of the nasolacrimal duct above the root of the fractured upper left canine and dental radiographs showed a severe periapical lucency at the apex of the upper left canine tooth. The fractured canine tooth was removed. Subsequently, the ocular discharge and facial swelling resolved. After 2 years, the epiphora has never reoccurred. This is a noteworthy case because a suspected root abscess resulted in extralumenal compression of the nasolacrimal duct, which shows the importance of a thorough oral examination when nasolacrimal obstruction is evident.     

CASE REPORT: Anomalous nasolacrimal openings in a 2‐year‐old Morgan filly

This case report describes the clinical, diagnostic, computed tomography findings, and surgical treatment of a 2‐year‐old Morgan filly with bilateral, proximal, and distal anomalous nasolacrimal duct openings.     

Visual evidence of progression and eventual resolution of nasofrontal suture exostosis over 27 months in a gelding

A 22-year-old Thoroughbred gelding presented with a noticeable external firm and nonpainful swelling over the location of the frontal sinuses. Further radiographic investigation of the swelling identified soft tissue facial swelling, new bone formation and a radiolucent line between two areas of bone remodelling. The horse was diagnosed with a nasofrontal suture exostosis. This is a relatively rare disease of the head but is one of the more common reasons for facial swelling. It is reported that these horses are not painful and that the swelling and bony reaction will resolve over 12–18 months with no treatment needed. It is well described in the current literature what the initial presentation should look like; however, there is a void when it comes to demonstration of the clinical course of the disease. This report provides veterinarians and owners with a visual reference to a relatively typical course of disease, where swelling can enlarge over time and still resolve within 2 years.     

Surgical removal of a dermoid cyst from the bony part of the nasolacrimal duct in a Scottish highland cattle heifer

The ophthalmologic, radiologic and surgical findings of a 2-year-old Scottish Highland Cattle heifer with a dermoid cyst within the bony part of the nasolacrimal duct and the successful treatment are presented.     

The nasolacrimal duct of the mule: Anatomy and clinical considerations

This study investigated the location of the nasolacrimal orifice (NLO) and course of the nasolacrimal duct in the mule using visual examination, gross dissection and computed tomography (dacryocystography [CT‐DCG]) and concluded that the location of the NLO is distinct from that described for horses and donkeys and is easily located, by visual examination alone, within the internal cutaneous tissue of the lateral wall of the external nares. The course of the nasolacrimal duct caudal to the nasal vestibule is similar to that of the horse.     

A review of swellings of the frontal region of the equine head

Gross swellings of the equine frontal area are most commonly caused by the poorly understood disorder of nasofrontal suture line periostitis that is usually self‐resolving, sinus cysts that are highly amenable to treatment, sinus tumours that in contrast usually respond poorly to treatment and facial trauma that may later lead to nasofrontal suture line periostitis. Other causes of conchofrontal sinus disease such as intrasinus progressive ethmoid haematoma, primary sinusitis and dental sinusitis seldom cause gross swellings of the overlying bones.     

Purulent dacryocystitis (nasolacrimal duct drainage) secondary to periapical tooth root infection in a donkey

Periapical tooth disease in the equid has been extensively described. Rostral cheek tooth abscessation usually leads to external facial swelling, and in some cases, nasal drainage. Periapical infection of the caudal cheek teeth usually results in maxillary empyema and sinusitis. This case report describes a donkey with periapical tooth root infection of the left 3rd maxillary premolar (207) diagnosed with computed tomography, which drained exclusively into the adjacent/collateral nasolacrimal duct.     

Fixation of chronic suture exostosis in a mature horse

This case report describes the clinical findings, diagnosis and treatment of a 14‐year‐old Warmblood gelding with suture exostosis. The horse was referred to our clinic because of bilateral swelling in the region of the frontal and nasal bone junction and bilateral epiphora. Epiphora was the main concern for the owner and the reason for further investigation and treatment. Radiographic examination showed extensive bone proliferation on the dorsal frontal and nasal bones. Computed tomographic (CT) images further characterised the periosteal proliferation as new bone formation and localised it along the frontonasal and frontolacrimal suture lines. Computed tomographic images also showed pathological changes of both lacrimal ducts. A chronic fracture was suspected to be the cause of the periosteal proliferation, and surgical treatment using 2 small 2.4 Unilock plates was chosen to stabilise the suture between the frontal and nasal bones. The swelling decreased and the epiphora resolved by 6 months post operatively. A CT examination 2 years later showed complete healing.     

The osteopathic treatment of somatic dysfunction causing gait abnormality in 51 horses

Over a 19‐year period, 51 horses showing chronic lameness or gait abnormality that was not fully responsive to veterinary treatment at other referral clinics were referred to us for further treatment. All had either failed to have a diagnosis made, or treatment for the diagnosed conditions had shown only partial response. After further examination, we concluded that they showed abnormal function of the neck or back, but there was no obvious pathological cause. A diagnosis of ‘somatic dysfunction’ was made, characterised by altered muscle tone, tenderness or subtle changes in gait, similar to the condition recognised in human medicine. These cases subsequently underwent osteopathic treatment under sedation. Forty‐six cases (90.2%) responded to treatment in the short term (6 months after treatment). Seventeen (53.1%) were working at the same level or better than previously at least a year after treatment. Ten (31.2%) worked at a reduced level for between 1.5 and 10 years. Nineteen cases were lost to long‐term follow‐up. The findings of this study suggest that neck and back problems may be overlooked when investigating chronic lameness. When no pathology can be pinpointed as a cause of lameness, a diagnosis of somatic dysfunction as a primary problem should be considered. The presence of somatic dysfunction as a secondary complicating factor should not be overlooked. Stiffness and/or low grade pain in the spine of horses can result in persistent abnormal posture, gait, or behaviour, similar to ‘somatic dysfunction’ seen in the human patient. The cause is neuromuscular in origin, rather than resulting from tissue pathology. The diagnosis made clinically can be confirmed with thermography. This study confirms that osteopathic manipulation of the spine of horses can be a valuable treatment for cases of lameness that do not respond fully to standard veterinary treatments.     

Congenital hypodontia in three horses diagnosed by computed tomography

Dental agenesis is a congenital disease defined as failure of formation of one or more teeth, which has been extensively described in human literature and that has been documented in several other species including cats, dogs, seals and sea lions, mice, and ungulates. The aim of this study was to review the clinical and computed tomographic (CT) features of tooth agenesis in a population of horses. Retrospective review of the imaging records from the Langford Equine Hospital was performed, including all horses that underwent head CT between January 2015 and June 2017. Of a total number of 167 CT scans, three horses with hypodontia were found. All three cases had agenesis of the maxillary 08s and one case had additional agenesis of the 307 and 308 teeth. Delayed resorption of the corresponding deciduous teeth was reported in all cases. The empty space left by the absent teeth was filled either by heterogeneous bone tissue alone (two cases) or by a combination of bone and soft tissue (one case). Alignment between teeth was preserved, and there was no displacement of the neighbouring teeth adjacent to the agenesis site. All three horses presented a symmetric pattern of dental agenesis within the maxillary arcades. The maxillary 08s, which are the latest to erupt, were the most affected teeth. This was similar to that reported in human literature, where the teeth that form later during development are the most vulnerable to dental agenesis.     

Differential diagnoses,investigation, and management of a periocular swelling close to the nasolacrimal duct in a horse – A case report of Dacryops

To describe the differential diagnoses, investigation, and management of a periocular swelling close to the nasolacrimal duct in a horse that was consistent with a nasolacrimal duct dacryops (lacrimal cyst). A 16‐year‐old gelding, Connemara cross presented with a history of a periocular swelling rostroventral medial to the right eye that had been sampled by the referring veterinary surgeon. A cystic lesion was diagnosed following standing computed tomography. Surgical removal of the cystic lesion was performed, and the tissue was submitted for histopathologic and immunohistochemical examination. Surgical removal of the cyst was curative, and there was no recurrence of clinical signs 7 months later. There was a small amount of mineralized material in the center of the cyst. Histopathologic and immunohistochemical examination confirmed a nasolacrimal duct cyst. Dacryops can form in horses as well as other species and appears to have a favorable outcome if surgically removed.     

Calcification associated with the nasolacrimal system of a horse: case report and mineralogic composition

A 12-year-old Paso Fino mare was evaluated for a chronic nasal and ocular discharge. A calcification was identified eroding through the nasal mucosa of the middle meatus. Differential considerations for this mass included dacryolith, nasal calculus, or calcified tooth root abscess. Anatomical location and case history and progression supported a dacryolith. Following removal, the calculus was submitted for mineralogic analysis. The calculus was primarily carbonate hydroxylapatite (Ca10(PO4)3(CO3)3(OH)2) with a minor NaCl halite constituent. Dacryoliths, or nasolacrimal calculi, are an uncommon occurrence in animals, and sparsely reported in humans. The etiopathogenesis of dacryolith formation is unknown. The objective of this article was to report the first case report of an equine nasolacrimal system dacryolith and its mineralogic composition.