Duct Obstruction In Adults Research Articles

Simultaneous bilateral or sequential DCR? What to choose?

Dacryocystorhinostomy is used to treat nasolacrimal duct obstruction when conservative measures fail. It may be performed via an external or endoscopic-endonasal approach. The aim of this study was to compare the outcomes of patients with nasolacrimal duct obstruction treated with simultaneous bilateral or unilateral dacryocystorhinostomy. The database of a tertiary medical center was retrospectively reviewed for all patients treated for nasolacrimal duct obstruction in 2012-2017. The study sample was divided into six groups by surgery type and approach: adults (>18 years) - external or endoscopic-endonasal sequential unilateral or simultaneous bilateral dacryocystorhinostomy (four subgroups); children (18 years) - endoscopic-endonasal unilateral or simultaneous bilateral dacryocystorhinostomy (two subgroups). Data were collected on patient age and sex, surgery and anesthesia type and duration, and complications. The cohort included 95 adults and 27 children who underwent 111 and 41 surgical procedures, respectively. Among the adults, the durations of anesthesia and surgery were significantly longer in the external bilateral dacryocystorhinostomy group than the others, but no such differences were found between simultaneous bilateral endonasal dacryocystorhinostomy and unilateral dacryocystorhinostomy by either approach. Among the children, there was no significant between-group difference in surgery duration.In neither age population was bilateral endoscopic surgery associated with an excess of intraoperative or postoperative complications of hemorrhage, infection, and epiphora. The lack of intergroup differences in clinical, surgical, and outcome parameters suggests that in cases of bilateral nasolacrimal duct obstruction in adults and children, simultaneous bilateral endoscopic-endonasal dacryocystorhinostomy may yield excellent therapeutic results.

Lacrimal Duct Obstruction in Adults

The tearing eye (epiphora) is the guiding symptome of nasolacrimal duct obstruction. Depending on the localization of stenosis, mucopurulent lacrimal discharge occurs additionally. These symptoms induce alterations of the optical system and can cause severe complications such as acute phlegmonous dacryocystitis. The grade of suffering in these patients is very high. For the diagnosis, patient's history, ocular surface conditions and inspection (macro-/microscopically) as well as palpation of the lacrimal region are essential examinations. Moreover, functional and anatomical tests enable a classification of nasolacrimal duct obstruction regarding grade of stenosis (incomplete vs. complete), type (functional vs. mechanical), and localization (pre-, intra-, postsaccal). ENT consultation prior to lacrimal surgery is obligate. Through this, a purposeful therapeutic intervention is warranted. Surgical methods consist of minimally invasive transcanalicular procedures or anastomosing surgeries. Dependent on the clinical findings, these treatment options can be applied in a patient centered therapeutic concept.

OUTCOME OF INITIAL 100 CASES OF ENDOSCOPIC DACRYOCYSTORHINOSTOMY IN KIRKUK

This study aimed at determining the effect and safety of endoscopic dacryocystorhinostomy (ENDO-DCR) in initial 100 cases of nasolacrimal duct obstruction. This study was done in Kirkuk general hospital from 2010 to 2017 with a total of 100 cases. A standardized method was applied to all cases through employing an endonasal technique to the lachrymal sac. Then, an operative resection was applied to the mucosa of nose, lacrimal bone and a part of the anterior maxilla. Next, a complete removal of the medial wall of the lacrimal sac was done. A tube of canalicular silicone intubation was placed for 6 months after operation. The key results of such measures were epiphora resolution, lack of discharge and clearness of the ostium. The success of ENDO-DCR method with adjunctive tube of canalicular silicon intubation was demonstrated in 80 cases (80%) and 10 cases represented acceptable improvements. However, there were minor complications faced during or after operation period. Finaly Endoscopic dacryocystorhinostomy is a safe and effective method for treating nasolacrimal duct obstruction in adults and children with nasolacrimal duct obstruction and epiphora.

A COMPARATIVE STUDY IN DACRYOCYSTORHINOSTOMY WITH VERSUS WITHOUT SILICON TUBE INTUBATION IN NASOLACRIMAL DUCT OBSTRUCTION IN ADULTS

Background: Dacryocystorhinostomy (DCR) has been touted as the standard procedure fortreatment of acquired nasolacrimal duct obstruction; it can be performed through a cutaneousincision referred to as external DCR, or via a transnasal approach. Intubation with silicone tubes hasbeen widely used in lacrimal duct surgery. Objective: Toevaluate the role of silicon tube intubation inthe clinical outcomes of external and endonasal dacryocystorhinostomy in nasolacrimal ductobstruction in adults. Patients and Methods: This is a prospective, randomized; comparative studyincluded 80 cases of 74 patients who were diagnosed with postsaccal obstruction of the lacrimalpathway. The studied sample was randomly grouped into two main groups (n=40), group (I)undergoneexternal dacryocystorhinostomy (EX_DCR) and group (I) undergoneendonasaldacryocystorhinostomy (EN_DCR), then each group was subdivided into two subgroups (n=20)according to with or without silicon tube intubation. From all patients, full history was taken andthey received a complete ophthalmologic examination, ENT and systemic assessment. Afterundergoing the surgical procedure, patients were followed up at1stpostoperative day, 1week, 1, 3 &6 months, complications and outcome were assessed. Results: The overall success rate in externalDCR was 82.5% (33 cases), however, the overall success rate in endonasal DCR was 77.5% (31cases) with no significant difference between groups. The success rate was 85% for external DCRwith intubation, 80% for external DCR without intubation, 80% forendonasal DCR with intubation andwas 75% for endonasal DCR without intubation, with non significant differences among thesesubgroups (P=0.89). The results showed that DCRs without intubation recorded significantly loweroperative time compared to with indubation DCRs. Conclusion: The results of endoscopic andexternal DCR with silicone intubation were comparable to these result without intubation with nonsignificant differences. Using of silicone tube has no significant beneficial effect in the surgicalsuccess of primary DCR, while, it is associated with increasing cost, operative time and complicationrate, there is no need for its routine use. Further studies with larger sample size are warranted.

Współczesne metody operacyjnego leczenia niedrożności dróg łzowych u dorosłych

Współczesne metody operacyjnego leczenia niedrożności dróg łzowych u dorosłych

Study of the effect of different designs of nasal mucosal and lacrimal sac flaps on the success rate of external dacryocystorhinostomy

Purpose The aim of this study was to assess the effect of the designing of four types of mucosal flaps on the success rates of dacryocystorhinostomy. Patients and methods In this prospective randomized study, dacryocystorhinostomy was performed for 128 eyes with nasolacrimal duct obstruction in adults complaining of epiphora. Patients were subdivided into four groups: group 1included 32 eyes in which only anterior flaps were sutured; group 2 included 32 eyes in which anterior flaps were sutured together with excision of posterior flaps; group 3 included 32 eyes in which anterior and posterior flaps were sutured; and group 4 included 32 eyes in which no flaps were created. Patients of all groups were followed up for 6 months. Assessment of operative success depended on subjective patient satisfaction − that is, stoppage or reduction in epiphora. Objective patency of fistula was assessed by means of positive syringing and estimating the area of the fistula using ultrasound. All data of four groups were statistically compared to assess significance. Results The success rate in group 1 was 100% in the first week, 100% after 1 month, and 93.8% after 6 months. The success rate in groups 2 and 3 was 100% in the first week, 100% after 1 month, and 96.8% after 6 months. There was no statistical significance for this disparity. The success rate in group 4 was 87.5% in the first week owing to fibrosis, 81.2% after 1 month, and 65.6% after 6 months. Using B-mode ultrasonography, the mean osteotomy area was 400mm2 intraoperatively for all cases, 337.4 mm2 (84.3% of intraoperative size) for the successful cases on the second postoperative day, and 32.2 mm2 (8% of intraoperative size) 6 months after the operation. Osteotomy size in unsuccessful cases was 237 mm2 (59.2% of intraoperative size) on the second postoperative day and 3.3 mm2 (0.8% of intraoperative size) 6 months after the operation. Conclusion Suturing of anterior suspended flaps in daryocystorhinostomies increases the success rate as in groups 1, 2, and 3. The difference between suturing, removing, or leaving the posterior flaps was found statistically nonsignificant. Thus, it can be judged intraoperatively according to its redundancy, ease of access, and operation time. It is not recommended to remove anterior and posterior flaps as this decreases the success rate significantly. The use of B-mode ultrasonography for follow-up of the osteotomy size postoperatively is recommended as a safe, effective, and noninvasive procedure.

Endoscopic dacryocystorhinostomy: our experience

<p class="abstract"><strong>Background:</strong> The purpose of the study was to determine the outcome and safety of endoscopic dacryocystorhinostomy (ENDO-DCR) with the use of silicon stents in nasolacrimal duct obstruction.</p><p class="abstract"><strong>Methods:</strong> This study was done in the department of otorhinolaryngology and head and neck surgery, Navodaya Medical College and Research Centre, Raichur, from January 2013 to June 2015, with a total of 82cases (10 cases with bilateral disease) underwent a standardized procedure, with an endonasal approach to the lacrimal sac, surgical removal of nasal mucosa, lacrimal bone, and a fragment of the frontal process of the maxilla. The medial wall of the lacrimal sac was removed completely and canalicular silicone intubation tube was placed for six weeks post operatively. Main outcome measures were resolution of epiphora, absence of discharge, and patency of the ostium confirmed by irrigation and endoscopic evaluation of neo osteum at 6 weeks.</p><p class="abstract"><strong>Results: </strong>The ENDO-DCR procedure with adjunctive canalicular silicon intubation tube was successful in 78 (95%) cases. No significant complications were encountered during or after operative period</p><p><strong>Conclusions:</strong> Endoscopic dacryocystorhinostomy with canalicular silicon intubation for shorter duration (6 weeks) is a safe and successful procedure for the treatment of nasolacrimal duct obstruction in adults as well as in children with a success rate of 95%.</p>

Nasolacrimal Duct Obstruction in Adults

Nasolacrimal Duct Obstruction in Adults

Retrograde intubation procedure in the treatment of nasolacrimal duct obstruction

Objective To investigate the influence of bony lacrimal passage anatomy in the management of nasolacrimal duct obstruction treated by retrograde intubation procedure.Methods 75 eyes of 71 cases of primary nasolacrimal duct obstruction in adults were studied.The patients underwent three-dimensional CT imaging before surgery to detect the length and minimum diameter of bony lacrimal passage.The Y shape silicone tubes were intubated in lacrimal passages retrogradely.The tubes were removed at 3 months after surgery.The patients were followed up for over 1 year.Results The tubes were intubated successfully by one surgery in all cases.When the tubes were removed,saline irrigation revealed complete free passages in 67 eyes (89.33％) and some blockage in 8 eyes (10.67％).At 1-3 months after removal of the tubes,canalicular obstructions were found in 14 eyes.These 14 cases were regarded as the uncured group and other 61 eyes were regarded as the cured group.The average lengths of bony lacrimal passage were (13.40 ± 0.51) mm in the cured group and (13.71 ± 0.41) mm in the uncured group.The minimum diameters of bony lacrimal passage were (3.47 ±0.34) mm in the cured group and (3.23 ±0.28) mm in the uncured group.The differences of average lengths and minimal diameters of bony lacrimal passage in two groups were statistically significant (t =4.81,P ＜ 0.01 ; t =5.64,P ＜ 0.01).Conclusion Retrogarde intubation procedure has good clinical efficacy in the treatment of nasolacrimal duct obstruction.The individual operation should be designed based on the three-dimensional CT imaging of bony lacrimal passage to increase the success rate of surgery. Key words: Obstruction, nasolacrimal duct; Intubation, retrograde; Study, clinical

Efficacy of endoscopic guided anterograde 3 mm balloon dacryoplasty with silicone intubation in treatment of acquired partial nasolacrimal duct obstruction in adults

AimTo report the outcomes of endoscopic guided anterograde 3mm balloon dacryoplasty with silicone intubation in patients with acquired partial nasolacrimal duct obstructions in adults. MethodsRetrospective case series, included 21 eyes with partially obstructed nasolacrimal ducts of 12 patients. All the 21 ducts were initially probed and the probe confirmed with an endoscope in the inferior meatus. After confirming the presence of probe in the inferior meatus, a 3mm balloon was used for dilating the distal and proximal portions of nasolacrimal duct, followed by stenting of ducts with Crawford tubes. Main outcome measures were anatomical patency of the passage and resolution of epiphora. ResultsOf the 12 patients, 9 had bilateral and 3 had unilateral acquired partial nasolacrimal duct obstructions. All the patients underwent bicanalicular stenting under endoscopic guidance which were retained for a period of 12weeks. A minimum follow up of 6months following stent removal was considered for final analysis. 15 of the 21 ducts (71%) were freely patent on irrigation but 13 of the 21 reported improvement of epiphora. Two nasolacrimal ducts showed similar partial regurgitation and partial patency on syringing as before with no improvement of symptoms. Four nasolacrimal ducts were completely obstructed with complete regurgitation of fluid on syringing with worsening of the epiphora. Two eyes persisted with symptoms of epiphora despite patent nasolacrimal duct with grade 2 dye retention on dye disappearance test. Conclusions3mm balloon dacryoplasty is an alternative and safe way to manage partial nasolacrimal duct obstructions with an anatomical success in 71% and functional success in 62% of the patients. Further studies with a large sample size and longer follow-up are required to ascertain the long term benefits.

Anatomical and Morphometric Study of the Bony Nasolacrimal Canal Using Computed Tomography

Aims: To determine the diameters, angles and sectional area of the bony nasolacrimal canal using computed tomography for obtaining detailed anatomical knowledge of the drainage system and utilizing these measurements in planning interventions for nasolacrimal duct obstruction in adults and children. Methods: Using standard computed tomographic images, we measured the diameters, angles and sectional area of the bony nasolacrimal duct in 228 patients without nasolacrimal duct disease. Results: There was no statistically significant difference in other parameters between males and females. In particular, age had a significant effect on the angle between the bony nasolacrimal canal and the nasal floor in the pediatric patients (<10 years; p = 0.00), and pediatric patients had more acute angles than adult patients (>10 years old). Conclusions: In nasolacrimal probing of congenital nasolacrimal duct obstruction, the probe should be passed more to the posterior part of the nasal cavity. In other words, the distal part of the probe should form a more obtuse angle with the forehead in pediatric patients than in adults. This study may contribute to the establishment of a detailed anatomical and morphometric baseline of the bony nasolacrimal canal and provide useful information for the planning of interventions for nasolacrimal duct obstruction in adults and children.

Endoscopic dacryocystorhinostomy not using canalicular silicone intubation tube with and without mitomycin C: a comparative study

To determine the outcome and safety of endoscopic dacryocystorhinostomy (EN-DCR) with the use of adjunctive mitomycin C (MMC) in nasolacrimal duct obstruction in adults. In this retrospective, comparative case series, 54 consecutive adult patients underwent EN-DCR. We performed endonasal dacryocystorhinostomy with adjunctive MMC in 28 patients and endonasal dacryocystorhinostomy without MMC in 26 patients. All patients underwent a standardized procedure, with an endonasal approach to the lacrimal sac, surgical removal of nasal mucosa, lacrimal bone, and a fragment of the frontal process of the maxilla. The medial wall of the lacrimal sac was removed completely. In the study group (28 patients), a neurosurgical cottonoid soaked in MMC at 0.5 mg/mL was placed at the osteotomy site for 5 minutes (not using canalicular silicone intubation tube). In the other group (26 patients), standard endonasal dacryocystorhinostomy technique was used without MMC (not using canalicular silicone intubation tube). Main outcome measures were resolution of epiphora, absence of discharge, and patency of the ostium confirmed by irrigation at 6 months. The EN-DCR procedure with adjunctive MMC was successful in 24 (85.71%) cases. The mean follow-up was 14.3 months (8-24 months). No significant complications were encountered. In the control group, the EN-DCR was successful in 19 patients (73.07%). The mean follow-up was 13.2 months (6-24 months). Endoscopic dacryocystorhinostomy with MMC is a safe and successful procedure for the treatment of nasolacrimal duct obstruction in adults.

Symptom score questionnaire for nasolacrimal duct obstruction in adults--a novel tool to assess the outcome after endoscopic dacryocystorhinostomy

The incidence of nasolacrimal pathway obstruction increases with age, and dacryocystorhinostomy (DCR) is a commonly applied surgical technique to treat severe cases. However, no disease-specific tools to assess the symptoms and the subjective outcome after DCR have been established. We have developed a specific Nasolacrimal Duct Obstruction Symptom Score (NLDO-SS) questionnaire to evaluate the outcome, and tested it in a prospective clinical trial. Prospective clinical follow-up study. Sixty-eight consecutive primary endoscopic dacryocystorhinostomy (EN-DCR) procedures were performed in 64 patients during 2004-2008. Preoperatively and during the three follow-up visits (at 1 week, 2 and 6 months), the patients filled in the NLDO-SS, and at the second and third follow-up visits they also filled in the Glasgow Benefit Inventory (GBI) questionnaire. At one year after the operation, a GBI questionnaire was sent to the patients. The surgical success rate of EN-DCR was 93 %. EN-DCR resulted in a significant reduction in all of the eight symptoms scores of the NLDO-SS (p= 0.001). The GBI scores indicated a significant benefit at 2 months (+37 (SD; 28) and an even higher benefit at 6 months after surgery (+52 (SD; 29), p= 0.001), but no further improvement was found between 6 and 12 months (+52 vs +52, p= 1.0). The correlation between the total GBI and NLDO-SS was significant (p=0.001). EN-DCR significantly improves the quality of life as measured by the GBI. The NLDO-SS correlated with the GBI and gave more information about the benefits after EN-DCR than GBI alone. The NLDO-SS proved to be an effective tool to evaluate lacrimal obstructions and EN-DCR benefits. Further studies to validate NLDO-SS are needed.

Nonlaser Endoscopic Endonasal Dacryocystorhinostomy with Adjunctive Mitomycin C in Nasolacrimal Duct Obstruction in Adults

To determine the outcome and safety of nonlaser endonasal dacryocystorhinostomy (NLEN-DCR) with the use of adjunctive mitomycin C (MMC) in congenital, traumatic, and primary acquired nasolacrimal duct obstruction in adults. Retrospective, nonrandomized, noncomparative, case series. One hundred ninety-three consecutive adult patients underwent NLEN-DCR with the use of adjunctive MMC. Thirty-one patients had a simultaneous bilateral procedure performed. All patients underwent a standardized procedure, with an endonasal approach to the lacrimal sac, surgical removal of nasal mucosa, lacrimal bone, and a fragment of the frontal process of the maxilla. The medial wall of the lacrimal sac was removed completely, and a neurosurgical cottonoid soaked in MMC at 0.5 mg/ml was placed at the osteotomy site for 10 minutes. All patients underwent bicanalicular silicone intubation. Resolution of epiphora, absence of discharge, and patency of the ostium confirmed by irrigation at 6 months. The NLEN-DCR procedure with adjunctive MMC was successful in 212 (95%) cases. The mean follow-up was 18.2 months. Intubation of more than 3 months was associated with a higher rate of obstruction (P<0.00018, Fisher exact test), with 9 eyes of 8 patients losing patency. Age, diagnosis, side operated, or infection at the time of surgery had no influence on the final outcome. No significant complications were encountered. Results suggest that NLEN-DCR with MMC is a safe and successful procedure for the treatment of congenital, traumatic, and primary acquired nasolacrimal duct obstruction in adults. It has the advantage of leaving no scar and of preserving the medial canthal structures. It can be performed successfully as a simultaneous bilateral procedure.

Silicone Intubation With Intraoperative Mitomycin C for Nasolacrimal Duct Obstruction in Adults: A Prospective, Randomized, Double-masked Study

Silicone Intubation With Intraoperative Mitomycin C for Nasolacrimal Duct Obstruction in Adults: A Prospective, Randomized, Double-masked Study

Silicone Intubation With Intraoperative Mitomycin C for Nasolacrimal Duct Obstruction in Adults: A Prospective, Randomized, Double-masked Study

To assess the efficacy of intraoperative mitomycin C (MMC) during silicone intubation (SI) as a substitute for dacryocystorhinostomy (DCR) in nasolacrimal duct obstruction (NLDO). In this prospective, double-masked study, 88 patients with complete NLD obstruction who were candidates for DCR were randomized in 2 groups. All study patients underwent SI with application of MMC or placebo in a randomized, double-masked fashion, with the former receiving 0.2 mg/mL for 2 minutes before SI. After a mean follow-up interval of 8 months, 25 of the 43 eyes in the MMC group and 21 of the 44 eyes in the placebo group had a successful outcome and were free of tearing and discharge. No significant difference was noted between the 2 groups (p = 0.331). In patients with simple epiphora and less than 6 months of duration, SI alone was effective in 83% of patients; however, in the same group, MMC application during SI did not show beneficial effect over SI alone. But in patients with simple epiphora of 6-months duration or longer, the application of MMC during SI resulted in better efficacy compared with SI alone. The success rates in the patients that had chronic dacryocystitis was lower (23%) compared with patients that had only epiphora (63.7%). SI alone could effectively substitute for a more extensive procedure such as DCR in patients with simple epiphora, particularly those with newly developed symptoms. In cases with longer duration of symptoms of epiphora, application of MMC would increase the success rate significantly.

Transcanalicular Dacryocystorhinostomy With Diode Laser: Long-term Results

To evaluate the effectiveness of transcanalicular dacryocystorhinostomy with diode laser in treatment of epiphora in adults. A prospective, noncomparative, interventional case series of transcanalicular dacryocystorhinostomy in 25 patients presenting with epiphora due to nasolacrimal obstruction. Patient age ranged from 32 to 72 years. Patients were evaluated postoperatively at 12, 24, and 36 months. Patients were evaluated for symptom improvement through a visual analog scale, and patency of osteotomy by lacrimal system irrigation with fluorescein and direct visualization by nasal endoscopy. Success was defined as resolution of epiphora. Transcanalicular dacryocystorhinostomy was able to re-establish patency of the lacrimal system in 88% of cases after 36 months of surgery. No differences were found between patients older than 65 years and younger patients (chi-square, p > 0.05). Early (12 months) and late (36 months) results were similar (chi-square, p > 0.05). In this prospective series, transcanalicular dacryocystorhinostomy was effective in treatment of epiphora in adults with little morbidity.

Antegrade balloon dilatation of nasolacrimal duct obstruction in adults

AIMSTo determine the efficacy of antegrade balloon dilatation of postsaccal lacrimal stenosis in adults.METHODSBalloon dilatation was performed in a series of 30 patients with complete nasolacrimal duct obstructions and epiphora....

Treatment of nasolacrimal duct obstruction in adults with polyurethane stent

PURPOSE: To evaluate the efficacy of polyurethane nasolacrimal duct stents in the treatment of epiphora resulting from primary acquired nasolacrimal duct obstruction in adults. MATERIALS AND METHODS: In 25 patients (21 women and four men with mean age of 44 years, range 20 to 74 years) with nasolacrimal duct obstruction, 28 hollow polyurethane stents designed by Song and associates were placed under fluoroscopic guidance. The obstruction was complete in 20 lacrimal drainage systems and partial in eight. The lacrimal sac size was normal or large on dacryocystogram in all lacrimal drainage systems. A Ritleng probe was introduced through the upper punctum and advanced past the obstruction. A guide wire with a flexible tip was then introduced through the probe, over which the stent was advanced in retrograde fashion and placed into the lacrimal sac and nasolacrimal duct. Clinical success was defined by the demonstration of a completely patent lacrimal drainage pathway through saline irrigation and no or minimal complaint of epiphora. RESULTS: Stent placement was technically successful in 26 of 28 lacrimal drainage systems (93%). The mean time of fluoroscopy screening was 3.2 minutes (range, 1.4 to 5.8 minutes). The overall success rate was 82% (23 of 28 lacrimal drainage systems). Two stents were completely occluded. In one lacrimal drainage system with minimal epiphora, the stented drainage pathway was partially occluded. The patients were followed up from 4 to 22 months (mean, 7.2 months). CONCLUSIONS: Retrograde placement of a hollow polyurethane nasolacrimal duct stent is a technique that is simple and well tolerated by patients. This method achieves a high success rate and may be suggested as a nonsurgical procedure for adults with primary nasolacrimal duct obstruction and proper lacrimal sac size. The Ritleng probe facilitates the procedure.

Balloon catheter dilation for treatment of adults with partial nasolacrimal duct obstruction: a preliminary report

PURPOSE: The purpose of this study is to determine the efficacy and morbidity of balloon catheter dilation for treatment of partial acquired nasolacrimal duct obstruction in adults with epiphora. METHODS: We performed balloon dacryocystoplasty prospectively on a series of 15 partial nasolacrimal duct obstructions in 13 adults with epiphora. Partial obstruction was diagnosed by a negative Jones-1 test and canalicular irrigation revealing simultaneous reflux through the opposing punctum and drainage into the nose. Balloon dacryocystoplasty was performed under local anesthesia using an antegrade insertion technique. Silicone intubation of the nasolacrimal system was performed immediately after balloon catheter dilation, and the tubes were removed 2 months postoperatively. RESULTS: Success was measured objectively and subjectively at follow-up examinations 2 months and 6 months after the procedure. At 2 months, 11 (73%) of 15 obstructions were open on irrigation, with subjective success (Munk, grade 0 or grade 1) reported in 13 (87%) of 15 obstructions. At 6 months, 11 (73%) of 15 obstructions were open on irrigation, with subjective success (Munk, grade 0 or grade 1) reported in 9 (60%) of 15 obstructions. CONCLUSIONS: Balloon dacryocystoplasty may be a satisfactory primary treatment for adults with acquired partial nasolacrimal duct obstruction who exhibit no clinical signs of chronic infection. Additional long-term observations following balloon dacryocystoplasty are required.