Nasolacrimal duct stenting

Abstract

The lacrimal drainage system extends from the puncta to the lower end of the nasolacrimal duct in the wall of the inferior nasal meatus. Epiphora usually results from obstruction of the lacrimal drainage system. Although there are many causes of obstruction of the lacrimal drainage system, most cases are due to idiopathic inflammation and scarring. Epiphora rarely resolves spontaneously, except in infants, in whom the cause is usually congenital obstruction. Once epiphora has been established in adults, medical management, including probing, irrigation, and antibiotic therapy, is futile. Dacryocystorhinostomy with or without silicone intubation remains the treatment of choice, but it usually requires general anesthesia and leaves a facial scar; failure still occurs in 6% to 21%. Recently, fluoroscopic nonoperative balloon dilation and stent placement have been used in the treatment of epiphora. Several articles have been published showing the feasibility, efficacy, indications, follow-up, and complications of the procedures. It has been also reported that a lacrimal system with recurrent symptoms after stent placement could be recanalized by removing the occluded stents and saline irrigation through the puncta. The following article addresses the techniques, indications, results of stent placement, and stent removal in the treatment of obstruction of the lacrimal drainage system.