Mixed Reality-Assisted Endoscopic Dacryocystorhinostomy for Post-Traumatic Nasolacrimal Obstruction with Extremely...

To describe the diagnostic workflow and clinical outcomes of a mixed reality (MR)-assisted endoscopic dacryocystorhinostomy (EnDCR) using the Magic Leap 2 (ML2) headset, performed for a patient with secondary acquired nasolacrimal duct obstruction resulting from extremely distorted post-traumatic maxillofacial anatomy.

A 40-year-old male with a history of massive maxillofacial trauma 10 years earlier presented to the Department of Ophthalmology of Jozef Strus City Hospital with recurrent dacryocystitis and a dacryocele. Physical examination showed a marked post-traumatic groove over the left orbit, inferior dislocation of the left globe, paralytic strabismus, ptosis, and a large left dacryocele. Nasal endoscopy demonstrated severe bilateral septal deformities obscuring visual access to the nasal cavity. Endoscopic septoplasty was done to obtain surgical access, followed by EnDCR assisted with MR. Preoperative planning included patient-specific 3D prints reconstructed from CT (OsiriX MD^TM), refined (MeshLab^TM, Blender^TM), exported as GLB files, and visualized on ML2; an ML Spectator mobile phone app documented the procedure. MR was used preoperatively and intraoperatively as a non-dynamic 3D image reference tool (no instrument tracking) to enable the surgeon to maintain a consistent spatial orientation for the lacrimal sac fossa and adjacent bones during septoplasty and EnDCR. Over 9 months post-operation, the patient reported no symptoms (Munk score: 0), lacrimal irrigation confirmed a widely patent ostium, and no further dacryocystitis occurred.

This case supports the use of MR in preoperative and intraoperative planning in extremely complex anatomical distortions.