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Updated: Jul 6, 2026
Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction
Published on: October 13, 2017
Congenital lacrimal sac fistula: intraoperative visualization by polyvinyl siloxane cast
Aparna Bhatnagar1, Lauren A Eckstein, Raymond S Douglas
1Orbital and Ophthalmic Plastic Surgery Division, Jules Stein Eye Institute, UCLA, Los Angeles, CA, USA. draparnab@gmail.com
Insights
Polyvinyl siloxane material effectively visualized lacrimal sac anatomy in a congenital fistula case. This technique aided surgery and improved patient outcomes by clearly showing the obstruction.
Area of Science:
- Ophthalmology
- Surgical Anatomy
- Pediatric Surgery
Background:
- Congenital lacrimal sac fistula presents a surgical challenge.
- Previous treatment with silicone intubation failed to close the fistula.
- Endonasal dacryocystorhinostomy was considered for persistent epiphora.
Observation:
- A 1-week-old male infant presented with congenital tearing and a left lacrimal sac fistula.
- Intraoperative injection of polyvinyl siloxane (Reprosil) was used during endonasal dacryocystorhinostomy.
- The material facilitated visualization and protection of the nasolacrimal sac.
Findings:
- A polyvinyl siloxane cast revealed an accessory canaliculus causing nasolacrimal duct obstruction.
- The 3D cast provided detailed ex vivo anatomy of the lacrimal sac and ductal system.
- The technique aided in identifying and protecting critical structures during surgery.
Implications:
- Polyvinyl siloxane impression material can serve as a valuable tool for intraoperative anatomical demonstration in dacryocystorhinostomy.
- This method enhances surgical precision and may improve outcomes for complex lacrimal drainage anomalies.
- The technique offers a novel approach to visualizing and managing congenital nasolacrimal duct obstruction.
Abstract:
We report the intraoperative use of polyvinyl siloxane impression material to demonstrate the anatomy of the lacrimal sac, canaliculi, and lacrimal duct in a case of congenital lacrimal sac fistula. A 1-week-old boy was examined for tearing since birth. Examination revealed a left congenital lacrimal sac fistula. After a failed surgery to close the fistula with silicone intubation at 6 months of age, the patient underwent endonasal dacryocystorhinostomy performed at 14 months of age, aided by intraoperative injection of polyvinyl siloxane (trade name Reprosil) to mark and protect the nasolacrimal sac and facilitate endonasal visualization. A polyvinyl siloxane cast demonstrated the anatomy of the accessory canaliculus causing nasolacrimal duct obstruction. Postoperatively, the epiphora resolved and the fistula remained closed. The polyvinyl siloxane cast provides a 3-dimensional "ex vivo " model of the lacrimal sac, upper duct, and canalicular anatomy, and can be used in dacryocystorhinostomy surgery to identify and protect the lacrimal sac.
