Inferior Meatus Endoscopy and Treatment for Epiphora

Abstract

Objective Epiphora can result from obstruction anywhere along the nasolacrimal (NL) system. The inferior meatus (IM) is not routinely evaluated despite the ease of nasal endoscopy. We propose the IM pathology is common in patients with epiphora, and surgery can be directed at the IM. Methods Consecutive patients referred for epiphora between July 2006 and July 2007 underwent endoscopic evaluation of the IM. All patients then underwent intervention to address the NL duct orifice obstruction. Results There were 14 patients, 11 females, mean age 53 years. Four patients had bilateral epiphora, for 18 total lacrimal systems. Two patients were treated in clinic, one for a dacryolith and one, a thick mucoid plug. At the time of surgery, 4 NL duct orifices were obstructed by a cyst. The remaining 12 nasolacrimal ducts were obstructed by hypertrophied mucosa. In 4, hypertrophic mucosa was found proximal to Hasner's valve, and 3 of these had early recurrent symptoms requiring revision (2 DCR's). 13 of 14 sides with pathology at Hasner's valve had resolution or dramatic improvement with patent NL ducts with inferior meatal treatment alone. Mean follow-up was 5 months. Conclusions Routine endoscopic evaluation of the inferior meatus in epiphora uniformly identified pathology at the NL duct orifice. At the time of surgery, identification of pathology at the NL duct orifice and distal NL duct portends a better outcome with endoscopic treatment of the IM, whereas identification of proximal NL duct obstruction had a poorer outcome with treatment through the IM.