Balloon-Assisted Dacryoplasty in Adults

Abstract

In recent years, there has been an emerging interest in the development and application of alternative therapeutic approaches for the treatment of complete and incomplete nasolacrimal duct (NLD) obstructions (NLDOs). For complete NLDOs, it is generally accepted that an incisional dacryocystorhinostomy (DCR), because of its high rate of success (more than 90%), is the treatment of choice. Despite such effi cacy, controversies around anesthetic choices and rare, cosmetically signifi cant scarring have aroused interest in alternative treatment modalities. Increasing attention has recently focused on balloon dacryocystoplasty, a technique based on dilation of a completely or incompletely stenotic aperture along the NLD using a balloon catheter device similar to those used in vascular dilation. Balloon dacryocystoplasty initially emerged as a fl uoroscopicassisted retrograde technique aimed at dilating the stenotic NLD. This involved the use of a guide wire that cannulated the NLD and, subsequently, placed a balloon catheter through the area of stenosis. Over the past decade, the technique has undergone signifi cant innovations. Most notable is the transition from a retrograde to anterograde approach using specially designed lacrimal system balloon catheters. Balloon dacryoplasty has also been used in association with temporary silicone tube stenting of the NLD to increase the success rate. Lastly, a recent report also describes signifi cant effi cacy in combination with endoscopy. Despite these advances, varying degrees of success have been reported using this technique for complete or incomplete NLDO. In this chapter, the authors examine the effi cacy of balloon dacryocystoplasty for complete and incomplete NLDOs.