Transcanalicular approach to adult lacrimal duct obstruction: A review of instruments and methods

Developments in fiberoptic technology and increasing interest in minimally invasive surgery have fueled advances in transcanalicular surgery. This article presents a review of instruments and methods for diagnostic and therapeutic approaches to adult lacrimal drainage obstruction. Available endocanalicular probes, microendoscopes, lasers, microdrills, trephines, and antegrade lacrimal balloon catheters are discussed and compared. Developments in microendoscopy, laser transcanalicular dacryocystorhinostomy, laser canaliculoplasty, transcanalicular drilling and trephination, and transcanalicular balloon dacryoplasty are also discussed in detail. Transcanalicular surgery provides a minimally invasive approach to adult lacrimal drainage obstruction that may also address the pathology causing the obstruction. Long-term success rates of transcanalicular dacryocystorhinostomy appear to be improving, but cost and a paucity of data on long-term results continue to limit the use of transcanalicular surgery.Paul A. Athanasiov, Venkatesh C. Prabhakaran, Geva Mannor, John J. Woog and Dinesh Selv

Paediatric endoscopic endonasal dacryocystorhinostomy in congenital nasolacrimal duct obstruction

The original publication can be found at www.springerlink.comObjectives 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.Igal Leibovitch, Dinesh Selva, Angelo Tsirbas, Edward Greenrod, John Pater and Peter J. Wormal