Endoscopic Dacryocystorhinostomy with Adjunctive Mitomycin C for Canalicular Obstruction

Abstract

Purpose to report our experience in treating distal and common canalicular obstruction by trephination followed by topical low-dose mitomycin C (0.03%) and silicone intubation during endoscopic dacryocystorhinostomy (DCR). Methods Noncomparative interventional case series of five eyes of five patients with epiphora and clinical evidence of distal or common canalicular obstruction. Only patients with canalicular obstruction at a distance of at least 7 mm distance from the punctum were offered this treatment. Treatment consisted of DCR and trephination under transnasal endoscopic view followed by topical mitomycin C. The major outcome was defined by the patients' subjective assessment of improvement and by objective evaluation of patency by endoscopic examination of the internal ostium, and the passage of fluorescein to the nose (Jones 1). Results Four patients were symptom free, and Jones 1 positive after a mean follow-up period of 15.4 months. One patient had recurrence of her distal canalicular narrowing and needed a Jones tube. No adverse reactions or complaints were reported during and following mitomycin C use. Conclusions Trephination of distal or common canalicular obstruction under endoscopic vision and adjunctive topical Mitomycin C should be considered as a possible viable approach to an external approach canaliculodacryocystorhinostomy.