Endoillumination-guided intranasal microscopic dacryocystorhinostomy for difficult cases

This prospective study explores the efficacy of a combined approach by intranasal microsurgical dacryocystorhinostomy and fiberglass endoillumination of the tear passage for difficult cases of lacrimal sac or nasolacrimal duct obstruction.

Microscopic dacryocystorhinostomy was performed in 67 patients with lacrimal obstruction and for revision of external dacryocystorhinostomy. Improved endonasal visualization by microscope and combination with endoillumination of the tear passage allows instant identification and opening of the lacrimal nasal sac without skin incision. Silicon tubes were used for bicanalicular intubation. The patients were prospectively observed for at least 1 year.

The operation was well tolerated by all patients. In 95%, a persistently open tear passage was successfully established. No serious complications were observed.

Endoillumination of the lacrimal sac is useful for locating the sac precisely and refining the endonasal operation technique.