Patient has met acute inpatient psychiatric criteria but does not meet continued acute inpatient care criteria Patient requires step-down to sub-acute inpatient level of care with 24 hour supervised psychiatric care as indicated by 1 or more of the following:
A mucocele of the lacrimal sac, or Chronic dacryocystitis or conjunctivitis due to lacrimal sac obstruction, or Congenital nasolacrimal duct obstruction that can not be cured by probing members should be over 1 year of ageor Epiphora excessive tearing due to acquired obstruction within the nasolacrimal sac and duct, or Lacrimal sac infection that must be relieved before intra-ocular surgery.
Aetna considers balloon dacryocystoplasty experimental and investigational for all other indications, including treatment of nasolacrimal duct obstruction associated with the following conditions for which balloon dacryocystoplasty has not been proven to be effective because of insufficient evidence in the peer-reviewed literature: Anatomic malformations in the lacrimal duct or bony lacrimal canal Dacryocystolithiasis Recurrent episodes of active dacryocystitis Sarcoidosis Tumor e.
Aetna considers osteopathic manipulation experimental and investigational for the treatment of congenital nasolacrimal duct obstruction because its effectiveness for this indication has not been established. Aetna considers the use of silicone stenting in balloon dacryocystoplasty experimental and investigational because of insufficient evidence of this approach.
Congenital nasolacrimal duct obstruction is usually caused by a persistent membranous obstruction at the lower end of the nasolacrimal duct, and can often lead to dacryocystitis.
Symptoms include epiphora tearing and discharge of mucus and pus. Conservative treatments of CNDO include simple lid cleaning and when there is clinical evidence of infection, appropriate antibiotics.
The role of lacrimal sac massage in the management of CNDO needs to be further investigated. Probing of the nasolacrimal duct is not usually recommended before the infant is 12 months of age. Dacryocystoplasty, a non-surgical treatment, is performed as an outpatient procedure after topical anesthesia.
If unsuccessful, this procedure still allows a dacryocystorhinostomy to be employed later. Available scientific literature has demonstrated that balloon dacryocystoplasty is effective in treating CNDO.
Adults, especially individuals over 40 years of age, as well as children can also suffer from nasolacrimal duct obstruction s that may result in dacryocystitis.
For chronic dacryocystitis, symptoms include chronic tearing and discharge, infection, pain and discomfort around the eye. Although the standard method for treating obstruction of lacrimal duct in adults is dacryocystorhinostomy, balloon dacryocystoplasty has been used increasingly for this purpose.
Studies have indicated that balloon dilation of the nasolacrimal duct is effective in treating this condition. In a systematic review, Posadzki et al evaluate the effectiveness of osteopathic manipulative treatment OMT as a treatment of pediatric conditions.
A total of 11 databases were searched from their respective inceptions to November Only randomized clinical trials RCTs were included, if they tested OMT against any type of control in pediatric patients.
Study quality was critically appraised by using the Cochrane criteria. A total of 17 trials met the inclusion criteria; 5 RCTs were of high methodological quality. Of those, 1 favored OMT, whereas 4 revealed no effect compared with various control interventions.
Replications by independent researchers were available for 2 conditions only, and both failed to confirm the findings of the previous studies. Seven RCTs suggested that OMT leads to a significantly greater reduction in the symptoms of asthma, congenital nasolacrimal duct obstruction post-treatmentdaily weight gain and length of hospital stay, dysfunctional voiding, infantile colic, otitis media, or postural asymmetry compared with various control interventions.
Seven RCTs indicated that OMT had no effect on the symptoms of asthma, cerebral palsy, idiopathic scoliosis, obstructive apnea, otitis media, or temporo-mandibular disorders compared with various control interventions. Three RCTs did not perform between-group comparisons.
The majority of the included RCTs did not report the incidence rates of adverse effects. The authors concluded that the evidence of the effectiveness of OMT for pediatric conditions remains unproven due to the paucity and low methodological quality of the primary studies.
Huang et al noted that dacryocystorhinostomy DCR is commonly performed for epiphora, dacryocystitis and during tumor surgery. High level evidence from comparative cohorts was sought to compare outcomes. Secondary outcomes were scarring, infection and post-operative bleeding. The search identified 3, studies and were reviewed after screening.
Full text review yielded 19 studies 4 RCTs and 15 cohorts. The rates of reported revision surgery were similar. The authors concluded that DCR is a procedure with high success rates.
Indications are expanding beyond primary acquired nasolacrimal duct obstruction to include DCR revisions, acute lacrimal sac abscesses, nasolacrimal duct obstructions in patients who have received chemotherapy or radiation, and common canalicular obstructions.
There is limited evidence that intubation with silicone stents improves the outcomes. Concomitant procedures, such as septoplasty and anterior middle turbinectomy, are sometimes needed in primary as well as revision EN-DCR to achieve high success rates.
There is increasing evidence that silicone stents are of limited benefit, whereas mucosal flap formation has been of benefit in case series. The authors concluded that with innovations and improvements in the endonasal approach, EN-DCR has become a viable alternative to external DCR for primary acquired nasolacrimal duct obstruction; EN-DCR has the distinct advantages of no surface scar and a lack of damage to the pump mechanism that often occur with external DCR.
They stated that recent evidence indicated a comparable success rate to external DCR. Feng et al examined possible differences in success rates of primary DCR with and without silicone intubation, and to find out whether the use of silicone tubes is beneficial.MBA, BM Uploaded by Naveen Sharma.
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