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Dacryoliths: nonsurgical fluoroscopically guided treatment during dacryocystoplasty
K E Wilhelm1, U Hofer, H J Textor
1Department of Radiology, University Hospital Bonn, Germany. wilhelm@uni-bonn.de
Purpose:
To evaluate dacryocystoplasty with fluoroscopically guided nonsurgical removal of dacryoliths in the treatment of dacryolithiasis.
Materials And Methods:
Ten patients with severe epiphora due to partial (n = 8) or complete (n = 2) obstruction of the nasolacrimal duct system associated with dacryolithiasis underwent fluoroscopically guided removal of dacryoliths during dacryocystoplasty. Balloon dilation was performed initially to widen the nasolacrimal duct obstructions and to fragment dacryoliths. This was followed by forced irrigation with saline solution through the canaliculi. In patients with incomplete dacryolith washout, a 6.3-F sheath was advanced in a retrograde fashion into the nasolacrimal sac, and forced irrigation was repeated with aspiration of the fragments through the sheath. In two patients with therapy-resistant dacryoliths, additional fragmentation of the concrements was performed with a gooseneck snare.
Results:
Removal of dacryoliths was technically successful in all patients (complete removal, n = 6; partial removal, n = 4). During a follow-up period of up to 18 months, complete resolution of epiphora was achieved in five patients, and five patients showed partial resolution of their symptoms.
Conclusion:
Fluoroscopically guided removal of dacryoliths during dacryocystoplasty is a feasible nonsurgical therapy with good clinical results and may be used as an alternative to dacryocystorhinostomy.