[Monoca silicone intubation of the lacrimal ducts after retrograde dilatation]

The causes of stenosis in the area of the nasolacrimal duct in adults are extremely variable. In general, the symptoms may vary, but most cases exhibit a common factor of circumstances in the prestenotic area which favor recurring inflammation. The treatment of these disorders is limited to either a conservative therapeutic approach to control inflammation, or surgically invasive measures. By using balloon catheters, which are usually applied in PTCA (percutaneous transluminal coronary angioplasty), dilatation of the relative postsaccal stenosis is obtained with the assistance of radiography. An exact diagnosis by means of various testing methods, including digital dacryocystography for the detailed localization and documentation of any pathological changes, is decisive for success. Only in cases of incomplete, postsaccal stenosis is retrograde balloon dilation of the distal nasolacrimal duct incated. The guide wire, designed for the PTCA balloon catheter set, is introduced via the canaliculus to the nasal cavity antegradely and caught with a thin hook and pulled from the naris. This is done under visual control using an image converter. The balloon catheter is retrogradely threaded over the guide wire. The balloon is then placed at the site of the pathological stenosis under X-ray control and dilated with high pressure. To assure permeability of the system, a monocanalicular silicone intubation has to be made immediately following this procedure. This procedure has been performed successfully on six patients; Follow-up time ranged from 6 to 22 months. The initial results are encouraging and sustain hope that this minimally invasive, interdisciplinary technique represents a new alternative in the treatment of incomplete, postsaccal lacrimal stenosis.