Antegrade balloon dilatation of nasolacrimal duct obstruction in adults

Abstract

Aims: To determine the efficacy of antegrade balloon dilatation of postsaccal lacrimal stenosis in adults.

Methods: Balloon dilatation was performed in a series of 30 patients with complete nasolacrimal duct obstructions and epiphora. Obstruction was diagnosed by canalicular irrigation and transcanalicular endoscopic examination of the lacrimal pathway. Except for four cases in which general anaesthesia was applied, the procedure was performed under local anaesthesia. The Lacricath balloon catheter set was used. Silicone intubation was performed simultaneously. The time at which the tubes were removed depended on the findings at postoperative follow up but was, at the earliest, 3 months postoperatively.

Results: Success was objectified by irrigation and was evaluated subjectively at each follow up examination according to Munk's scale. In all cases the procedure could be performed with subsequent silicone intubation. Three months postoperatively 89.9% of all cases were positive on simple irrigation, and subjective success was also registered (Munk's grade 0 or 1). At 6 months 70% of all cases were positive on irrigation, again with subjective success (Munk's grade 0 or 1). One year postoperatively 73.3% of all procedures showed subjective success (two successful redilatations would raise the success rate to 79.9%).

Conclusion: Retrograde as well as antegrade dilatation has been reported to be more or less successful in partial nasolacrimal obstruction. Although the procedure is used as primary treatment in cases of complete obstruction, it can still be performed under local anaesthesia on an outpatient basis. Long term observation will be required to prove the sustained effect of this procedure.

Figures

Figure 1

The Lacricath will be advanced until the upper mark has reached the superior punctum. This will be the most advanced position of the balloon.

Figure 2

Inflated balloon catheter just reaching the nasal cavity, blue prolene thread behind the catheter.

Figure 3

View from the lacrimal sac through the reopened nasolacrimal duct into the nose. Blue prolene thread passing through the nasolacrimal duct.

Figure 4

Preoperative and postoperative Munk's classification in numbers and percentages of procedures.

Figure 5

The course of the mean preoperative Munk's value compared with follow up examinations 3, 6, and 12 months postoperatively.