Using Healon to identify the lumen of the sac in dacryocystorhinostomy

Sodium hyaluronate (Healon) injected into the lacrimal sac, facilitates a full-thickness cut of the lacrimal sac in cases in which it is difficult to identify the lumen of the sac. The sodium hyaluronate does not stain tissues, is effective for hemostasis, and is easily irrigated. A full-thickness cut of the lacrimal sac is required to ensure exact mucosal suturing in dacryocystorhinostomy. However, in cases involving a hypertrophic sac wall, a small lumen of the sac, or earlier perforation of the sac, it is sometimes difficult to identify the lumen during surgery. We describe how sodium hyaluronate, injected into the sac via a canaliculus, can facilitate identifying the lumen in this situation.