Assessing patients with epiphora who are patent to syringing: clinical predictors of response to dacryocystorhinostomy

PURPOSE: To assess the value of an abnormal fluorescein dye disappearance test (FDDT), lacrimal syringing, and Jones test for patients with epiphora who are clinically patent to syringing. METHODS: Prospective cohort study of 68 consecutive patients with epiphora who were clinically patent to syringing and otherwise normal to examination. Patients were assessed using FDDT and lacrimal syringing, as well as the Jones test comparing either single- or multiple-drop technique. FDDT and canalicular reflux on lacrimal syringing were subjectively graded. RESULTS: Success was defined as nil or only mild epiphora after surgery. Surgery was performed on 68 patients with a successful result in 64 (94%). The majority of these patients had severely delayed FDDT (90%), > or = 50% reflux on lacrimal syringing (78%), or were Jones I negative (81%). There was no significant difference between outcomes of the single- and multiple-drop tests. In patients examined with the single-drop Jones test, patients with a Jones I negative result had a statistically significant better surgical outcome (p = 0.04). This comparison was highly significant when the subgroup of patients with severely delayed/nonclearing FDDT and > or = 50% reflux was examined (p = 0.005). The results were not significant for the multiple-drop group. CONCLUSIONS: These findings show that a negative single-drop Jones I test is predictive of symptomatic improvement after dacryocystorhinostomy surgery in patients with epiphora who are clinically patent to syringing. Lacrimal syringing and the FDDT, on their own, were not predictive of surgical outcome. Jones testing was of significant value in patients, but only when the traditional single-drop test was used.     

Inaccuracy of diagnosis in a cohort of patients on the waiting list for dacryocystorhinostomy when the diagnosis was made by only syringing the lacrimal system

PURPOSE: Accurate identification of the factors contributing to epiphora is essential in directing appropriate management and treatment strategies. The authors applied a methodical strategy of assessment for epiphora to patients who were already on the waiting list for dacryocystorhinostomy (DCR). The findings were compared to the original findings. METHODS: Forty-four eyes of 35 patients listed for DCR were re-examined. All canaliculi were examined using four tests: dye disappearance, Jones 1 (dye retrieval), probing using Bowman probes, and syringing of the nasolacrimal duct (NLD) under local anesthesia. Some patients were examined using an endocanalicular mini-endoscope. Patients with NLD obstruction underwent DCR and those with canalicular and NLD stenosis underwent intubation of the lacrimal system-canaliculus, lacrimal sac, and nasolacrimal duct-using silicone stents. The authors refer to this as canaliculodacryocystoplasty (CDCP). The patients were assessed for symptoms of epiphora at 12 months. Forty-four eyes had been listed for DCR. They had been originally diagnosed, by means of lacrimal syringing, as NLD obstruction (24 eyes) or stenosis (12 eyes), and functional blocks (8 eyes). RESULTS: Four out of the original 44 planned DCR surgeries were performed after re-evaluation. After re-examination, 28 lacrimal systems were found to have canalicular stenosis, 4 NLD stenosis, 4 NLD obstruction, 4 punctal phimosis, 3 ocular surface disease, and 1 patient was asymptomatic. Twenty-eight lacrimal systems underwent CDCP, 4 underwent DCR, 4 had punctoplasty, and 4 had probing alone. Three had treatment for ocular surface disease and one patient required no treatment. After a follow-up of 12 months, 41 (93%) systems had improvement or were free of their CONCLUSIONS: Syringing of the lacrimal apparatus may result in a high false positive diagnosis of NLD obstruction. Canalicular pathology is not uncommon in this cohort of patients and may be underdiagnosed.     

The course of epiphora after failure of silicone intubation for congenital nasolacrimal duct obstruction

Background One of the indications for dacryocystorhinostomy (DCR) in children with congenital nasolacrimal duct obstruction (CNLDO) is failure of silicone intubation. We evaluated the course of epiphora after failure of silicone intubation for CNLDO when DCR was not performed.Methods In a comparative cohort study carried out at a tertiary referral center, ten eyes of seven consecutive children who had failure of silicone intubation manifested as persistent epiphora over 2 months and whose parents refused DCR were followed up for an average of 50.4 months (range 33–70 months). Three lacrimal drainage systems of three other children who had failure of silicone intubation underwent uneventful DCR.Results In eight (80%) of the ten consecutive eyes with congenital nasolacrimal duct obstruction (six of the seven children, 86%), there was spontaneous complete resolution of the epiphora and normal dye disappearance test (DDT) at the end of the follow-up period. One child with Downs syndrome, allergic rhinitis, asthma and multiple site obstructions had improvement of symptoms but abnormal DDT. The epiphora in all three children who underwent DCR had disappeared by 6 months after surgery when the silicone tube was removed. No complications were noted during the follow-up.Conclusions Epiphora can spontaneously resolve after failure of silicone intubation in CNLDO, and DCR should no longer considered be compulsory in such cases unless complications evolve.The authors have no financial or proprietary interest in any of the products mentioned in this paper.Presented in part at the 107th American Academy of Ophthalmology Annual Meeting, Anaheim, CA, November 2003.     

Lacrimal drainage capacity and symptomatic improvement after dacryocystorhinostomy in adults presenting with patent lacrimal drainage systems

AIM. To determine the rate of symptomatic improvement after dacryocystorhinostomy (DCR) in patients with epiphora and insignificant obstruction to preoperative lacrimal syringing, and to measure the conductance of the postoperative lacrimal drainage anastomosis. METHODS. Retrospective cohort study of patients with symptomatic epiphora and patent tear ducts, with at least two-year follow-up after DCR. Patients underwent structured telephone interview together with clinical examination for lacrimal drainage capacity using the saline drop test.(1) RESULTS. Thirty-seven of 383 adult patients having had DCR were noted to have patent tear ducts at preoperative examination. Ten patients with previous surgery were excluded and two other patients were excluded because of other factors contributory to epiphora. Of the remaining 25 patients, 22 (aged 35-75 years at surgery; median 56 years) underwent a structured telephone interview: Of the 13 (60%) who felt that symptoms had improved, 9 (41%) were relieved of indoor epiphora and 11 (50%) thought the procedure was an overall success. Seventeen patients underwent clinical examination. The lacrimal drainage anastomosis was patent in all patients and the saline drop test result was well within the normal range in 3/4 patients who had persistent indoor epiphora. CONCLUSION. Of patients with epiphora due to minor nasolacrimal duct stenosis, open DCR produces a marked improvement or cure of symptoms in 50%. The lacrimal drainage capacity was well within the normal range in 3/4 patients with persistent postoperative lacrimal symptoms, suggesting that other factors (such as hypersecretion) may be significant in this group of patients with 'functional block'.     

External dacryocystorhinostomy for the treatment of acquired partial nasolacrimal obstruction in adults

AIM: To determine the long term success of external dacryocystorhinostomy (DCR) in adults with acquired partial nasolacrimal obstruction. METHODS: A retrospective study of 50 external dacryocystorhinostomies with silicone intubation performed for partial nasolacrimal obstruction, was undertaken. Preoperative lacrimal scintigraphy divided drainage abnormalities into presac or postsac delays. Postoperative success was determined by lacrimal patency to irrigation, a positive dye test on nasal endoscopy and subjective resolution of epiphora. Statistical analysis was performed using the Fisher exact test. RESULTS: A patent DCR system to irrigation and a positive dye test was achieved in 90% of procedures. At an average of 3.6 months' follow up, subjective success was reported in 84% of cases-91% for postsac and 67% for presac delays. At 3 years' follow up success had declined to 70% overall and to 80% and 47% for postsac and presac occlusions respectively. There was a statistically significant association between a presac delay and postoperative recurrence of epiphora, p = 0.04. CONCLUSION: External DCR with silicone intubation is an effective procedure for partial nasolacrimal obstruction. Presac delays do significantly less well and further studies are necessary to evaluate the best type of surgery for these patients.     

Assessment of functional nasolacrimal duct obstruction--a survey of ophthalmologists in the southwest

The term 'functional nasolacrimal duct obstruction' describes patients with epiphora where the tear duct is partially or completely patent to syringing. Delayed tear drainage is demonstrated with a fluorescein dye disappearance test (FDDT) or lacrimal scintigraphy. A dacrocystogram is also frequently abnormal.Studies show that selected patients with epiphora because of functional nasolacrimal duct obstruction have an 80-90% success rate with open or endonasal dacryocystorhinostomy. To find out if such patients were being considered for surgery, we sent a questionnaire to all ophthalmologists in the southwest. Of the 198 questionnaires, 163 were completed and returned (82%). In the assessment of epiphora, fewer than half those questioned (41%) regularly used an FDDT and only 51% syringe patients themselves. Most did not use lacrimal scintigraphy or dacrocystography if the drainage system was patent on syringing. This survey shows that many patients with epiphora who are patent to syringing are being incompletely assessed, and hence not considered for dacrocystorhinostomy. We recommend that an FDDT is performed on all patients, syringing is carried out by experienced staff, and more radiological investigations are undertaken, so patients with a highly treatable cause of epiphora can be offered dacrocystorhinostomy.     

Paediatric endoscopic endonasal dacryocystorhinostomy in congenital nasolacrimal duct obstruction

Objectives The objectives of this study were to report a series of paediatric patients who underwent endoscopic endonasal dacryocystorhinostomy (DCR) for primary congenital nasolacrimal duct obstruction (NLDO).Methods This is a retrospective, noncomparative review of all consecutive cases in two lacrimal clinics between January 1999 and October 2004. The main outcome measures were patients’ demographics, previous treatments, clinical presentation, operative and postoperative complications, postoperative follow-up and resolution of epiphora.Results Twenty-one patients (15 males) with a mean age of 6±3.5 years (range, 2–14 years) underwent 26 endoscopic DCR operations for congenital NLDO. Sixteen cases were unilateral, and five were bilateral. In 13 cases (50.0%), there was a history of epiphora and chronic dacryocystitis with or without a mucocele. Two cases (7.7%) presented with acute dacryocystitis, and 11 (42.3%) had only a history of epiphora. Previous procedures included probing and irrigation in 25 cases (96.2%) and insertion of Crawford tubes in 19 cases 973.1%). During a mean postoperative follow-up period of 18±8 months, the anatomical success rate (free flow of fluorescein sodium and patency of ostium on nasal endoscopy) was 100%, and the clinical success rate (resolution of epiphora) was 92.3%.Conclusion Endoscopic endonasal DCR is an effective treatment modality for congenital NLDO that compares favourably with the reported success rates of external DCR.     

Lacrimal silicone intubation for anatomically successful but functionally failed external dacryocystorhinostomy

PURPOSE: To investigate the efficacy of lacrimal silicone intubation for the management of epiphora in patients who have previously undergone anatomically successful dacryocystorhinostomy (DCR). METHODS: The authors recruited 13 patients (4 male, 9 female) who had persistent epiphora after an anatomically successful primary external DCR and conducted lacrimal silicone intubation through the dacryocystorhinostomy site. RESULTS: Mean patient age was 54.2 years (range 42-80) and mean follow-up was 13.8 months (range 6-30). Epiphora was resolved in all 13 patients following silicone intubation. Spontaneous tube extrusion occurred in three patients, but a new one was easily reintubated. CONCLUSIONS: Lacrimal silicone intubation is a simple safe and effective procedure for patients with epiphora even after anatomically successful DCR.     

Outcome of patients with nasolacrimal polyurethane stent implantation: do they keep tearing?

PURPOSE: To evaluate the results of nasolacrimal polyurethane stent implantation for the treatment of primary acquired nasolacrimal duct obstruction and the effects of obstructed nasolacrimal stent on subsequent dacryocystorhinostomy (DCR). METHODS: This study was designed as a nonrandomized, prospective clinical trial. Stent implantation was attempted in 53 obstructed lacrimal drainage systems of 47 patients. Stent placement was performed in a retrograde fashion through the external nare over a guide wire, which was introduced from the upper punctum. Occluded stents were removed either with nasal endoscopy or during DCR. External DCR surgery with silicone intubation was performed in cases with stent failure. RESULTS: The mean follow-up period was 23.4 months. The success rate of stent implantation was 60.4%, 37.5%, and 31.2% at 6-, 12-, and 18-month follow-up, respectively. Stent obstruction developed in 33 eyes. Twenty underwent external DCR with silicone intubation. During DCR surgery, varying degrees of chronic inflammatory reaction were detected in the lacrimal sac and nasolacrimal duct. The mean follow-up period after DCR was 10.3 months. Epiphora was relieved with DCR in all but one eye. CONCLUSIONS: The success rate of nasolacrimal polyurethane stent implantation for the treatment of primary acquired nasolacrimal duct obstruction is low and may induce inflammation and fibrous tissue formation. Although this may cause further difficulties in subsequent lacrimal surgery, epiphora could be relieved with meticulous technique.     

Endoscopic repair of failed dacryocystorhinostomy

Primary dacryocystorhinostomy (DCR) failure is commonly due to scarring at the rhinostomy site. Nasolacrimal duct obstruction due to scarring may also occur in patients who have had their lacrimal bone removed during maxillary sinus surgery. Five patients following DCR and 3 patients after sinus surgery, all with constant epiphora, underwent endoscopic reconstruction of their lacrimal drainage system. Preoperatively, patency of the bony ostium was determined either by computed tomographic (CT) scan or dacryocystography. Endoscopically, the lacrimal drainage system was reopened then intubated with a silastic stent. Any scar tissue was visualized endoscopically and resected. Seven of the 8 patients have been followed from 3 to 24 months after stent removal, and all have had relief of their epiphora. Endoscopic repair is a useful adjunct in the management of patients with DCR failure or patients with epiphora after removal of the lacrimal bone during sinus surgery. This brief procedure can be performed under local anesthesia, does not require a skin incision, and allows the evaluation and correction of intranasal pathology.     

Dacryocystorhinostomy for dacryocystitis caused by methicillin- resistant Staphylococcus aureus: report of four cases

BACKGROUND: To evaluate the outcome of dacryocystorhinostomy (DCR) for dacryocystitis caused by methicillin-resistant Staphylococcus aureus (MRSA). CASES: Four otherwise healthy patients with dacryocystitis caused by MRSA were studied (3 with chronic dacryocystitis; 1, acute dacryocystitis). Ophthalmic symptoms were epiphora with purulent discharge in 2 cases, with blepharoconjunctivitis in 1 case, and with lacrimal fistula in 1 case. Culture of the purulent discharge from the affected conjunctival sacs revealed MRSA infection. Initial treatment, which was unsuccessful, included intravenously administered common antibiotics, the use of topical antibiotics and povidone-iodine in the conjunctival sac and mupirocin ointment in the nasal cavity. Subsequently, standard DCR was performed with a bicanalicular silicone tube inserted under local anesthesia, accompanied by the administration of common antibiotics. OBSERVATION: Cultures from all patients were negative for MRSA as soon as 4 days after DCR. None of the patients had epiphora with pus, and the lacrimal passage became patent postoperatively. CONCLUSION: Dacryocystitis due to MRSA was resistant to conservative therapy. DCR subsequent to the conservative therapy resulted in almost immediate resolution of the lacrimal fistula and nasolacrimal obstruction, rapid control of dacryocystitis, and a decrease in the period of MRSA infection in the conjunctiva and the nasal cavity.     

Partial lacrimal carunculectomy: a simple procedure for epiphora

OBJECTIVE: To evaluate the effect of partial surgical excision of enlarged lacrimal caruncles, termed megalocaruncles, in patients with epiphora from functional lacrimal drainage obstruction. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: From May 1995 through December 1999, 88 patients (46 women and 42 men; mean age, 68 years) with epiphora, patent lacrimal drainage system on irrigation, and a megalocaruncle underwent a partial lacrimal carunculectomy procedure. In 26 patients, a bilateral partial lacrimal carunculectomy was performed. INTERVENTION: Lacrimal caruncular tissue, with its overlying mucosa, was partially excised, and the wound was closed with interrupted sutures. MAIN OUTCOME MEASURES: Symptomatology and patient satisfaction. RESULTS: After a partial lacrimal carunculectomy procedure, epiphora was subjectively improved in 77% of the patients, ranging from complete relief in 33% to significant improvement in 44% of the patients. Twenty-three percent of the patients had no change in symptoms. The mean follow-up was 12.7 months. CONCLUSIONS: Megalocaruncles can be the cause of epiphora in patients with functional lacrimal drainage obstruction, for whom a partial lacrimal carunculectomy is an effective surgical procedure in 77% of the cases.     

Laser-assisted dacryocystorhinostomy in nasolacrimal duct obstruction: 5-year follow-up

AIM: To evaluate the long-term sucess rate of laser-assisted dacryocystorhinostomy (L-DCR) in patients with nasolacrimal duct obstruction (NDO). METHODS: Forty-one eyes of forty patients aged between 21-85y (mean 56.7y) who underwent L-DCR for the treatment of NDO were included in this retrospective, non-randomized study. The follow-up time was 72mo. Functional sucess was defined as the disappearance of epiphora under normal conditions and the presence of a patent ostium on lacrimal irrigation. Anatomical success was defined as a patent lacrimal passage on syringing besides continuing epiphora. Surgical failure was defined as persistent epiphora and closed ostium. RESULTS: Twenty-seven of 40 patients (67.5%) were female and 13 of 40 patients (32.5%) were male. The NDO was right-sided in 17 (42.5%) patients and left-sided in 22 (55%) patients whereas 1 (2.5%) patient had undergone bilateral surgery. In 11 (27.5%) patients there were additional nasal abnormalities requiring simultaneous surgical approach. The average time for L-DCR was 26.50±4.9min (16-39min) and the average total amount of laser energy used was 287±27.9 J (239-367 J). At the 5y follow-up, anatomical sucess rate was 75.0% (30 patients) and functional success rate was 65.0% (26 patients), whereas surgical failure was seen in 25% (10 patients). Revision of surgery was performed in 10 cases (25.0%); failure of revision surgery was seen in 2 cases (5.0%). CONCLUSION: Transcanalicular L-DCR is a reliable and fast procedure in the treatment of NDO. It can be alternative to external DCR which is accepted as the gold standard currently. The functional and anatomical success rate is higher in the first months and years, but still satisfactory at fifth year.     

Endoskopisch kontrollierte Chirurgie mit dem Mikrobohrer und Intubation der Tränenwege

Purpose. Operative procedures to manage lacrimal outflow obstruction were made traditionally without endoscopic assistance. For dacryoendoscopy we previously used a 0.5-mm endoscope with a special wash cannula. We now use the microendoscope Vitroptic T for dacryoendoscopy and for endoscopically controlled surgery with a microdrill. Methods. In an attempt to perform microinvasive lacrimal surgery we use a 1.1-mm endoscope (Vitroptik T) with a wash cannula, a channel for the microoptic and a channel for a microdrill. We report on our initial experiences and on the results of eight patients with stenosis of the lacrimal outflow system who were treated with an endoscopic microdrill and silicone tubing. One patient had lacrimal stenosis after external dacryocystorhinostomy (DCR), and seven patients showed punctual stenosis in the nasolacrimal duct. Results. Using the dacryoendoscope (Vitroptic T) we were able to visualize pathologic changes of the lacrimal outflow system. Intraoperative situations during dacryoendoscopy are demonstrated. The Vitroptic T allows dacryoendoscopy and endoscopically controlled surgery of the lacrimal drainage system. Three months after surgery in six patients (75%) the lacrimal outflow system was patent with the silicone tube in place, and these patients had no epiphora. The patient with re-stenosis after external DCR showed patency. Conclusions. Dacryoendoscopy and endoscopic controlled surgery of the lacrimal drainage system enables atraumatic and minimally invasive surgery. The Vitroptik T with the microdrill allows endoscopically controlled microsurgery. Possible indications for the microdrill are punctual stenosis and re-stenosis after external DCR.     

Efficacy of tightening of orbicularis oculi muscle in patients with functional nasolacrimal duct obstruction

Purpose: To evaluate the efficacy of tightening of lateral portion of orbicularis oculi muscle in patients with functional nasolacrimal duct obstruction (FNLDO).Methods: This is an interventional cross-section study for evaluation of effect of orbicularis oculi tightening procedure in patients with FNLDO. Patients with unexplained epiphora, open lacrimal system in syringing and evidences of lacrimal pump weakness in lacrimal scintigraphy underwent surgery. In this procedure, a stripe of preseptal and pretarsal orbicularis muscle was dissected, slightly resected and secured to the periosteum of lateral orbital rim. Each subject completed a questionnaire about the intensity of epiphora before surgery and 1, 3 and 6 months after surgery. Furthermore, fluorescein dye disappearance test (FDDT) was performed before surgery and repeated in the follow-up visits. At last visit, the pre- and post-operative data were analyzed and compared.Results: Fifteen eyes of 12 patients (5 males and 7 females) with the mean age of 56.7 years included in the study. Severity of epiphora and tearing effect on daily life were significantly improved following the operation. FDDT result was improved significantly after 1 month follow-up in all eyes (15 eyes), at 3 months follow-up in 80% of eyes (12 eyes) and at the end of the 6th month in 66.7% of eyes (10 eyes). Subjective and objective success rates were 87% and 80%, respectively. No significant complications or side-effects were observed.Conclusion: Tightening of lateral portion of preseptal and pretarsal orbicularis muscle seems an effective, safe, and easy procedure to decrease epiphora in patients with FNLDO.     

Selective non-intubation of a silicone tube in external dacryocystorhinostomy

PURPOSE: To evaluate whether silicone tube insertion is always necessary in external dacryocystorhinostomy (DCR). METHODS: During external DCR for primary nasolacrimal duct obstruction carried out between January 2001 and October 2004, silicone intubation was not performed selectively if the lacrimal sac was large and the nasal cavity was not severely narrowed. RESULTS: Of a total of 166 DCR cases in 153 patients, no silicone tube was placed in 74 eyes of 69 patients (44.6%). Anatomic patency of rhinostomy was achieved in all non-intubation group eyes. However, four (6.7%) of these 69 eyes showed persistent epiphora even with anatomic patency. CONCLUSIONS: Silicone tubing can be avoided in about 50% of cases of external DCR without detrimentally affecting the success rate. Cases in which intubation was avoided had a large lacrimal sac and a wide nasal cavity.     

Endolacrimal laser assisted lacrimal surgery

AIMS: To utilise the improved optical qualities of newly developed lacrimal endoscopes and newly miniaturised laser fibres for diagnostic visualisation and laser surgery of the lacrimal system. METHODS: A KTP laser (wavelength 532 nm, 10 W energy) was used for laser assisted dacryocystorhinostomy (DCR) with endolacrimal visualisation in 26 patients. Bicanalicular silicone intubation was placed in all patients for at least 3 months. RESULTS: After 3-9 months of follow up, the silicone tube in all 21 patients who underwent KTP laser DCR are still patent, three patients have eye watering in extremely cold weather and two required a conventional DCR. CONCLUSIONS: The KTP laser generates enough power to open the bony window in DCR surgery. Precise endolacrimal visualisation via a specially designed miniendoscope is essential for surgical success.     

Long-term outcomes of labial mucosal graft in conjunctivo-rhinostomy surgery

Objective

To report the long-term outcomes of the conjunctivo-rhinostomy surgery with labial mucosal graft performed for the patients of proximal lacrimal drainage system disorders.

Functional and anatomic results after two types of endoscopic endonasal dacryocystorhinostomy: surgical and holmium laser

PURPOSE: To determine subjective and objective outcomes after two types of endoscopic endonasal dacryocystorhinostomy (DCR) and to evaluate the use of the functional endoscopic dye test (FEDT). DESIGN: Prospective, nonrandomized trial. PARTICIPANTS: Sixty-nine consecutive adult patients with primary acquired nasolacrimal duct obstruction. METHODS: Patients underwent primary endonasal surgical or laser (Holmium:yttrium-aluminum-garnet [YAG]) DCR with temporary silicone intubation. MAIN OBJECTIVE MEASURES: Data were collected 6 months after surgery (at least 3 months after removal of tubes). Subjective results were based on the patients' symptoms of epiphora. Objective results consisted of (1) lacrimal system irrigation, (2) FEDT-this test is positive when dye placed in the conjunctival fornix is observed to enter the nasal space via the DCR rhinostomy, and (3) rhinostomy appearance. RESULTS: Thirty-six patients had endosurgical and 33 had endolaser (Holmium:YAG) DCR. Symptomatic success was 83% after endosurgical and 71% after endolaser DCR. Lacrimal irrigation was a good test after surgery for identifying patients with successful or unsuccessful outcome (sensitivity, 98%; specificity, 87%). The FEDT had a few false negatives and small number of false positives (sensitivity, 83%; specificity, 91%). CONCLUSIONS: Endoscopic endonasal DCR performed surgically had better results than those achieved with Holmium:YAG laser alone (but did not reach statistical significance). The FEDT is useful in assessing rhinostomy patency and understanding the effects of surgery but was not as good as lacrimal irrigation in predicting symptomatic success.     

Endoscopically assisted balloon dacryoplasty treatment of incomplete nasolacrimal duct obstruction

PURPOSE: To report the success rate of endoscopically assisted balloon dacryoplasty (EADCP) for treatment of acquired incomplete nasolacrimal duct obstructions (NLDOs). DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Records of patients treated for incomplete NLDOs with EADCP by one of the authors (WLW) were reviewed. Diagnosis of incomplete NLDO was based upon subjective complaints of tearing, dye disappearance testing, clinical evidence of epiphora, and nasolacrimal duct irrigation. Endoscopically assisted balloon dacryoplasty was performed for incomplete obstructions identified. METHODS: One hundred forty-two nasolacrimal systems in 103 patients with incomplete NLDOs underwent EADCP for treatment of incomplete obstructions. A 3x15-mm balloon was utilized in all procedures, with silicone lacrimal tubes placed in 131 systems. Patients received postoperative topical antibiotic-steroid drops for 2 weeks and a 1-week tapering dosage of systemic methylprednisolone. MAIN OUTCOME MEASURES: Patients were assessed at their last postoperative visit by nasolacrimal system irrigation, dye disappearance testing, and subjective complaints of epiphora. RESULTS: Eighty systems (56%) experienced complete resolution of symptoms after surgery. Forty-eight additional systems (34%) showed improvement but still experienced periodic epiphora. Fourteen systems (10%) showed no improvement. The average time before follow-up was 7.5 months. CONCLUSION: Endoscopically assisted balloon dacryoplasty as a treatment for incomplete NLDOs provides complete relief or substantial improvement in a significant percentage of patients. Nasal videoendoscopy adds significantly to the understanding of this procedure and its potential for success. Endoscopically assisted balloon dacryoplasty should be considered an appropriate treatment option for selected patients with incomplete NLDOs.