The reconstruction of the lacrimal pathway in the common canaliculus surgery

We describe a new technique for restoring lacrimal pathway anatomy in common canaliculus surgery. Fourteen patients (4 men and 10 women), with a mean age of 59 +/- 19 years, suffering from chronic epiphora caused by common canaliculus stenosis were operated on (18 procedures: 14 unilateral, 4 bilateral). We used a modified Dupuy-Dutemps technique. The anterior face of the lacrimal sac was cut as a flap, which was secured with the posterior nasal mucosal flap for the posterior anastomosis plane. The common canaliculus stenosis and the external face of the lacrimal sac were excised guided by the operating microscope so as to put in place a bicanalicular device, which was left for 6 months. The anterior plane of anastomosis was made of a Goretex((R)) patch or PTFE((R)) (Polytetrafluoroethylene((R))) placed under the deep face of the orbicularis muscle. The procedure was successful in 15 of the 18 cases (success rate: 83.3%). Among the three failures, two were due to the early loss of the bicanalicular stent and one to anastomosis fibrosis. This technique made it possible to restore lacrimal pathway anatomy, which was severely modified by the dacryocystorhinostomy procedure and to protect the anastomosis from fibrosis by the surrounding tissues. Biomaterials such as Goretex((R)) and PTFE((R)) are valuable tools for this technique. In common canaliculus stenosis, restoring the lacrimal pathway with biomaterials such as Goretex((R)) or PTFE((R)) improves the functional results.