[Minimally invasive endoscopic surgery of the lacrimal drainage system--two case reports]

Dacryoendoscopy is a standard procedure to directly evaluate the lacrimal system. The existence and localisation of dacryostenosis and mucosal changes as well as rare diseases in the drainage system, such as intracanalicular foreign bodies or dacryoliths, can be reliably detected and treated by minimally invasive endoscopic surgery.

A patient treated by canaliclulodacryozystorhinostomy with silicone tube intubation 5 years ago had a long symptom-free period but now shows tearing (epiphora) and occasional mucous secretion. During endoscopy residues of a silicone tube coated with a biofilm could be removed over the lacrimal canaliculus and then tested for microbiological contamination. A second patient with tearing, light mucous secretion and positive nasolacrimal duct irrigation was initially diagnosed with a tear-film disorder. Dacryoendoscopy showed a dacryolith in the saccus lacrimalis. This was consequently fragmented using a microdrill system and fully removed through the nasolacrimal duct as well as the lacrimal canaliculus.

Endoscopy of the proximal and distal lacrimal system allows the assessment of intracanalicular structures and a reliable detection or exclusion of disorders in the draining system. This method is of great diagnostic importance as symptoms are frequently non-specific and the causes are multiple. Through endoscopy in combination with the use of a microdrill system the lacrimal system can be reopened and adequately reconstructed.