Original Articles
Balloon catheter dilation for treatment of adults with partial nasolacrimal duct obstruction: a preliminary report1

This article was presented in part at the American Society of Ophthalmic Plastic and Reconstructive Surgery Annual Meeting, San Francisco, October 1997.
https://doi.org/10.1016/S0002-9394(98)00278-5Get rights and content

Abstract

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.

Section snippets

Methods

Between May 1996 and February 1997, balloon catheter dilation was performed prospectively on a series of 16 partially obstructed nasolacrimal systems in 14 adult patients with moderate to severe epiphora. One patient with unilateral obstruction died 5 months after the procedure from causes unrelated to lacrimal drainage obstruction or its treatment; this patient was eliminated from the study. Partial obstruction of the nasolacrimal system was defined as a negative Jones-1 test and canalicular

Results

Two weeks following balloon catheter dilation, with silicone intubation in place, 11 of 13 patients with obstructions experienced relief of symptoms. Silicone tubing was removed 2 months after the procedure. The results are given in the Table. Saline irrigation at the 2-month follow-up examination disclosed completely open nasolacrimal systems in 11 of 15 obstructions, for an objective success rate of 73%. Subjectively, eight of 16 obstructions had no tearing (grade 0), and five had grade 1

Discussion

In the majority of cases, acquired nasolacrimal duct obstruction in adults appears to be caused by age-related stenotic changes and low-grade infection of the lacrimal drainage system. Stenosis may predispose the sac and duct to stasis and infection, which causes thickening and folding of the mucosal wall, resulting in further narrowing of the lumen.24, 25 By mechanically restoring patency, balloon catheter dilation may break this cycle of stasis and inflammation, allowing the soft tissue to

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    The authors have no financial support and no proprietary interest in any of the products described in this study.

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