[Treatment of lacrimal canal stenoses by canaliculoplasty]

An attempt to make a canaliculoplasty for 53 cases with canalicular stenosis gave a functional favorable result for 40 cases; Microsurgery is essential. By pass procedures were performed only in case of failure in several cases. Our rules for canaliculoplasty were: a large DCR osteotomy systematically associated, direct exposure of the stenosis (modified DCR cutaneous incision), interrupted sutures with extramucosal not, restitution of a mucosal continuity between the punctum and the nose without stretch, long term (one year) or permanent bicanalicular silicone tubing, the different procedures are discussed: reimplantation of the common canaliculus in the lacrimal sac (9 cases); resection + direct suture for minimal stenosis (13 cases), Turning inside out of the lacrimal sac + large nasal mucosal flap (22 cases)... We emphasize the third procedure which provides in our hands much satisfactory results (18 successes and 4 failures) for 4 or 6 millimeters (sometimes 8 or more) canalicular stenosis when the natural punctum is still present: the lacrimal mucosa of the sac is turned inside out and provides the posterior flap of the new pathway. The anterior flap is provided by a very large nasal mucosal flap. Both flaps are sutured to the safe canalicular extremity.