Stenting of a partially obstructed nasolacrimal duct using a steerable angle-tipped hydrophilic guidewire in a cat

This case report describes the successful correction of partial obstruction of the NL duct in a cat by means of a modified retrograde NL duct cannulation using a steerable angle-tipped hydrophilic guidewire (AH guidewire) following a paranasal incision.

A 2-year-old neutered male American domestic shorthair cat was referred to the Purdue University Veterinary Hospital (PUVH) for chronic epiphora suspected secondary to nasolacrimal (NL) system obstruction.

At the first visit, the cat had epiphora OD and facial dermatitis but no other abnormalities on physical and ophthalmic examinations. Computed tomography (CT)-dacryocystorhinography revealed partial obstruction of the NL duct secondary to stenosis near the distal root of the right maxillary third premolar (107). A digital three-dimensional (3D) model of the right maxilla and NL duct was created for inspection and virtual cannulation of the NL. The model was 3D printed and cannulation of the NL duct was rehearsed with various stent materials. Retrograde NL stenting with the guidance of a steerable angle-tipped hydrophilic guidewire was conducted following a paranasal incision. A urethral catheter was cannulated over the guidewire and maintained for 44 days.

The epiphora resolved immediately after stenting. At 21 days post-stenting, the cat developed acute bullous keratopathy secondary to self-trauma which was treated with a third eyelid flap. On the final follow-up communication with the owner at 210 days post-stenting, no epiphora or any other concerns were reported.

To the authors' knowledge, this is the first report of successful NL stenting and resolution of epiphora in a cat with a partial NL system obstruction.