Dacryoendoscopic surgery and tube insertion in patients with common canalicular obstruction and ductal stenosis as a frequent complication.

PURPOSE: To report the performance of a new technique and strategy for treating common canalicular obstruction (CCO). Since ductal stenosis is a frequent complication of CCO, access to the whole lacrimal passage is important for CCO treatment. METHODS: In a retrospective, nonrandomized clinical trial, 46 patients (57 CCO cases, 42-93 years old) were treated with either dacryoendoscopic canalicular incision (EI) dacryoendoscope-guided tube insertion (EGT), EI plus inferior meatal dacryocystorhinostomy (iDR)/EGT, EI plus endonasal dacryocystorhinostomy (enDCR), or external canaliculo-DCR depending on the degree of ductal stenosis. The dacryoendoscope was used for incisional positioning, examination and guidance. RESULTS: Ductal stenoses/obstructions were complicated in 14 of 57 CCO cases (24.5%). The success rate after 6-25 months of postoperative follow-up was 89.5% (51/57 cases). The success rates after EI/EGT alone, EI plus enDCR, and EI/EGT plus iDR were 90.4% (38/42 cases), 100% (4/4 cases), and 90% (9/10 cases), respectively. In one case, false passages through the submucosa of the canaliculi were identified, and the surgical approach was converted from EI/EGT to canaliculo-DCR. CONCLUSIONS: EI/EGT alone is an effective, minimally invasive method for treatment of simple CCO. Additional lacrimal surgery (iDR/ EGT, enDCR, and canaliculo-DCR) is effective for complicated CCO.