Prevention and management of lacrimal duct injury

Due to the proximity of the lacrimal duct and sac to the uncinate process, occult injury to the lacrimal drainage system is common during uncinectomy and maxillary antrostomy. Fortunately, these injuries do not often progress to develop clinical symptoms as most either heal on their own, or drain into the middle meatus. In the event that injury to the lacrimal drainage system does become clinical evident, symptoms will present within the first two weeks following surgery. These symptoms may resolve over the ensuing weeks as the intranasal inflammation resolves. In cases of persistent epiphora, determination of the level of obstruction is critical for proper intervention. This can be achieved with several office-based studies as well as radiographic studies. If the obstruction is in the lacrimal duct, dacryocystorhinostomy is a highly successful surgical procedure. However, complications do occur with inadvertent violation of the orbit and cranial vault the subject of substantial publications while lacrimal duct injury (LDI) following FESS has been relatively neglected.